With Michelle Obama making childhood obesity her pet cause, one in three Americans now weighing in as obese, and our country having the dubious distinction of ranking first in fatness, you’d think it’d be time to issue something equivalent to an orange alert for the invasion of triglycerides. Public-health officials refer to obesity as an “epidemic”—which strikes this rather skinny person (a condition achieved not by virtue, but by having a metabolism that functions well on red wine and peanuts) as odd. Don’t epidemics generally refer to infectious diseases? Wouldn’t it be more proper to state that American obesity has achieved “epidemic proportions”? I suppose the officials mean simply that even if obesity isn’t an infectious disease, like chickenpox, it sure spreads like one.
But for all the obesity chatter—which seems to get louder whenever summer approaches, and more flesh is about to be exposed in public—it’s hard to see how we’ll ever crawl our way, as a nation, to a reasonable BMI (body mass index). First, we’re caught in a web of conflicting scientific accounts of what causes obesity. Studies blame it on sedentary lifestyles, or the workplace, or poor diets, or depression, or parents, or corporations, or the special ingredients intended to increase cravings that are routinely added to junk food. Add to the scientific controversy our deeply conflicted values about how individuals fit in society: On the one hand, Americans believe individuals are responsible for their own fate. On the other, we acknowledge that society and social forces can be beyond any one individual’s control. Top this off with the problem of stigmatization, and our insistence that the rights of individuals must include the right to be free from discrimination based on something external to the ability to perform the job at hand.
It’s helpful to make sense of this rather messy picture by considering the following three items, written without any reference to one another, plucked from The New York Times over the course of this past week:
1) Arizona, squeezed to find money to finance its Medicaid program, has proposed a $50 fee on childless adults on Medicaid who are either obese or smoke. (For the plan to go into effect, the federal government must first approve it.) The proposed fee puts front and center the struggle over the rights of particular individuals measured against the whole of the state.
2) Recent research studying the changes in the labor force since 1960 indicates that declining physical activity during the workday itself accounts for a big part of the national weight gain.
3) In an essay written by an avowedly obese woman, the argument is made that despite our public assertion of tolerating differences, “Public attitudes about fat have never been more judgmental; stigmatizing fat people has become not just acceptable but, in some circles, de rigueur. I’ve sat in meetings with colleagues who wouldn’t dream of disparaging anyone’s color, sex, economic status or general attractiveness, yet feel free to comment witheringly on a person’s weight.”
Adding fees for Medicaid services heaps humiliation on top of poverty and health problems, and besides, it’s extremely questionable if it will work. Waiting for private employers to insert physical activity into the workplace is akin to waiting for Godot to show up. As for the problem of stigmatizing obese people, if it’s true that one in three Americans is obese, it follows that the other two-thirds ought to climb off their high horses and deal with it. That’s an awful lot of fellow Americans not to hire, or not to be friends with, or to have contempt for.
You don’t have to be a public-health official to see that obesity, while a problem for individuals, is also a public-health problem. In this case, government—that means laws regarding what’s served in schools, what’s subsidized in farming, what’s permissible as additives in our foods, and what public health officials should be promulgating regarding diet and exercise—is the solution.