April 4, 2008

Are our Surroundings Making us Fat?

By Michele Warmerdam

Is our country facing an obesity epidemic because of an environment saturated with food advertising, convenience foods, and huge portion sizes? Or, is it our own personal responsibility for not having enough willpower, motivation, and/or education about nutrition? The reality is that body weight results from a number of factors including genes, metabolism, behavior, environment, culture, and socioeconomic status. In particular, behavior and environment are the factors that play the greatest role in the battle against the bulge. Consequently, these are the primary factors targeted for prevention and treatment actions.

There has been the assumption that, given the right amount of nutrition education and motivation, people will be able to maintain a healthy body weight. Indeed, recent efforts to fight obesity have focused on nutrition education but we have to ask ourselves, are they really working? Well, after 25 years of rapidly increasing obesity rates, since 2003-2004, they have finally and fortunately come to a halt. However, obesity levels still remain high – at 34% of adults according to recent data from the Centers for Disease Control and Prevention (CDC). Can we then assume that nutrition education efforts are working? It’s quite possible, but that question requires further research in order to confirm. What we do know is that it is not simply a matter of education.

Look at doctors, nurses, and dietitians who are overweight or obese for example. Deborah A. Cohen, MD, MPH, study author of a recent article published by the Centers for Disease Control and Prevention (CDC) entitled, “Eating as an Automatic Behavior” states that, “if it had anything to do with how much we know about nutrition or how much we’re motivated, we would never see people with such expertise be overweight or obese.”

Kelly Brownell, PhD, director of the Rudd Center for Food Policy and Obesity at Yale University, noted that there is a long history of failure for nutrition education programs, in part because they compete in an environment “that provides massive inducement to eat unhealthy foods”. For example, it is widely accepted that unhealthy foods tend to be cheaper and more heavily marketed than healthier foods.

A changing environment has definitely contributed to a change in eating habits for many Americans. Grocery stores stock their shelves with a huge selection of products. Pre-packaged foods, fast food restaurants, and soft drinks are also more accessible. While such foods are fast and convenient they also tend to be high in fat, sugar, and calories. And, because of growing portion sizes over the last 25 years, people may be eating more during a meal or snack.

Furthermore, despite all of the widely known benefits of physical activity, most Americans are not getting nearly enough. Advances in technology have contributed to an increasingly sedentary lifestyle. For example, people opt to use their cars to run short distance errands instead of walking or riding a bicycle, and kids sit on the couch and play video games instead of playing outside.

The theory that our environment is to blame for our rates of overweight and obesity is gaining support from health and nutrition experts. Researchers have described high levels of food marketing, convenience, and quantity as the “toxic environment” at the root of the obesity epidemic. In her article, Dr. Cohen presents the theory that eating is an “automatic behavior” over which the environment has more control than do individuals. She defines automatic behaviors as “those that occur without awareness, are initiated without intention, tend to continue without control, and operate efficiently or with little effort.” Essentially, we’re eating on autopilot. Based on this information, nutrition education alone will obviously not solve the obesity epidemic.

She suggests changing our approach to the crisis, focusing less on nutrition education, and more on shaping the food environment. “It’s easier to change the environment than it is to change people,” Cohen says. In her article, she states that people need protection from the “toxic environment” and calls on governments, communities, and organizations to solve the obesity problem. She advocates reducing portion sizes, limiting access to ready to eat foods, limiting the availability of snack foods in schools and workplaces, and reducing food advertising.

“The environment, I think, to a large extent explains the obesity epidemic,” says Dr. Robert H. Eckel, a professor of medicine at the University of Colorado and past president of the American Heart Association. “But should we change the environment to alter the obesity epidemic? And how much do we need to change it? Those are difficult questions. To blame it all on the environment is a mistake. There is individual responsibility.”

I agree with Dr. Cohen that there is definitely an automatic component to eating which is largely influenced by our environment, but as Dr. Eckel points out, to blame it exclusively on the environment is a mistake. The problem is attributed to a number of factors besides the environment, including individual responsibility and lack of reliable nutrition education.

There is a lot of conflicting information out there about diet and exercise, making it difficult to determine what really represents proper nutrition and healthy behaviors. Some foods are marketed as healthy, low-fat, or fat-free, but may contain more calories and unhealthy additives than the less healthy foods they are trying to replace. Even if we reduced portion sizes, limited access to ready to eat foods, and restricted food advertising, it is still crucial that individuals have access to accurate information in order to make informed decisions about their health.

What’s more, these efforts at environmental change will most likely take some time to be put into effect, so our best effort in the meantime is to arm individuals with appropriate nutrition knowledge to resist these harmful environmental influences. Ultimately, successful public health efforts will most likely require collaboration among food industries (to provide healthy foods), educators (to promote healthy choices), government (to enforce legislation and provide incentives), and researchers (to investigate the causes of obesity).

Michele Warmerdam is a Health Educator with UCSD Nutrition Link, an elementary school nutrition education program, as well as a Personal Trainer. Nutrition Link is funded by USDA’s Food Stamp Program through the California Department of Public Health. These institutions are equal opportunity providers and employers.

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