HBO’s documentary series The Weight of the Nation made me sad. I was left with the feeling that the wealth my parents have provided and all prior generations’ good intentions to make it easier for us to gather food and survive, and the technologies they developed to make our lives easier now are destroying us. My generation is short-circuiting. When looking to satisfy our needs, we meet no obstacles, no resistance. Everything is readily available to us, and we are fast-forwarding towards the negative consequences of constant access. And the food industry makes a profit off our misfortune.
The Weight of the Nation campaign consists of four main films, a dozen of extra short films and an accompanying book and website. It was launched in May by HBO and the Institute of Medicine in association with the Centers for Disease Control and Prevention, the National Institutes of Health, Michael & Susan Dell Foundation and Kaiser Permanente.
The campaign abandons the idea that obesity is an individual shortcoming or to results from a lack of self-control. Instead the campaign holds society responsible for today’s weight problems. Come to think of it, this is not unreasonable as humans have the same mental capabilities as former generations that were not obese. What has changed is our behavior and surroundings. Physical activity has been engineered out of our daily routine, while unhealthy tempting food has become cheaper and more accessible. Let’s not pretend that our grandparents had higher moral standards by avoiding sugar and fat and took the stairs instead of the elevator. They surely would have made the same choices as us if they had the chance. Given that nobody intends to become overweight or obese, we have designed a society where it is just too hard for most of us to maintain a healthy weight.
Consequences and Choices, the two first films of The Weight of the Nation series, examine the physiology and pathology of weight gain and obesity.
Connecting laboratory findings and test results to actual human emotions and behavioral patterns is not an easy task, especially on screen. We don’t easily connect our choices or feelings around food and exercise to brain responsiveness to fat storage and hormones. Biochemistry is a lot easier to grasp on paper than emotionally. The experts in the documentary talk a lot about biochemistry but I felt the interviews could have focused more on aspects such as our perception of time, ability to evaluate consequences and even self-awareness of weight gain. The documentary did not expand on the opportunity offered by some of the obese people interviewed to discuss these psychological issues.
In the documentary, Thomas Frieden, director of The Center for Disease Control and Prevention declares “if you go with the flow in America today, you will end up overweight or obese, as two thirds of us do.” Obesity rates are at an all-time high in the US with two thirds of the population being overweight now, with a predicted increase to 75% in the next eight years.
The documentary paid attention to helping obese people loose weight or stay healthy (secondary prevention), but this is really hard. Previously obese people have to eat less than their thinner peers for the rest of their lives to avoid regaining weight, a fact which undercuts all short-term diets. To sustain weight loss you can never go back to previous meal sizes or eating habits, which makes fad diets seem like a more manageable solution – the path of least resistance.
Diet purveyors have no real interest in solving the problem. Helping people maintain a healthy weight puts them out of business. My cynical view is that marketing and selling a lot of (unhealthy) food generates a lot of obese buyers for weight loss products. These industries have made a lot of money at the expense of consumers’ health. Health care payers end up picking up the bill. And of course individuals face a health issues and shorter life expectancy.
A positive correlation between economic growth and the increase in obesity rates has been found in both rich and developing countries. If our economy and the market play a significant role in our common weight gain and subsequent diseases, we have to include them in the conversation on how we should tackle the epidemic.
The Weight of the Nation scrapes the surface of this subject. It showed a congressional hearing where the food industry’s battled regulations on food advertisement towards children. Children we are told, develop brand loyalty very quickly. Good for industry but devastating for children, who grow up with high cholesterol levels and BMI as a result of that brand loyalty. I find it sad that children have to know their cholesterol levels instead of knowing how far they can run or how high they can jump.
The documentary showed farmers sighing over the fact that processed, unhealthy foods generate higher margins than fruits and vegetables. But there are reasons why society is like this. Walking will be slower that driving, and buying unprocessed food will require a higher degree of meal planning which means less flexibility. The risk of diabetes or weight gain some time in the future has no chance of outweighing higher profit or convenience. “To win, we have to lose”, which is the campaign’s slogan, might have a deeper meaning than presumed.
The Weight of the Nation left me with the impression that urgent action is needed. Even though when I’m a doctor I’ll make money from treating sick people, the goal is to keep people healthy. Recent research suggests that cells live longer on calorie restriction. At a time when the next generation may have a shorter life span than their parents, it’s time to put our cells into survival mode.
Coaching, behavioral changes and education to fight obesity are all targeting the individual, but my generation needs the environment to be on our side as well. That means changing subsidies from supporting sugar, corn and soy to fruit and vegetables. It means that school cafeterias have to stop selling candy to the children they are supposed to nurture. Food labels need to be standardized and made more comprehensible. And food containing lots of sugar has to become a more expensive, rather than cheaper, alternative.
When it comes to food, continuing the “more for less” strategy is not an option anymore – it causes too much harm. We need a new environment and that means new taxes and regulation.