First of all, thanks for the link from Alas!

>>I’m glad you’re not advocating a “cure” — but Michelle Obama is: “This isn’t like a disease where we’re still waiting for a cure to be discovered – we know the cure for this.”

I think the problem here is that there are two conversations that need to be had regarding obesity: one that is about the medical complications, and the other that is about social acceptance.

On the one hand, obesity — and more specifically, central adiposity — is well-established in the scientific community to be a risk factor for a host of debilitating illnesses that are occurring in younger and younger populations. It’s not like it’s still up for debate in the scientific community whether or not central adiposity (and consequent obesity) is a health problem — we KNOW that excessive adiposity leads to metabolic syndrome, which itself causes development of hypertension, cardiovascular disease, type II diabetes, and peripheral artery disease. So, there’s compelling medical reasons to try and improve nutrition and physical activity in high-risk populations for obesity — specifically those in lower socioeconomic classes.

But, on the other hand, what we DON’T want to do is start a witch-hunt against the obese by cultivating a perception that obese individuals are lazy or stupid, deserving of our scorn or derision. It’s inexcusable that fat individuals experience work-related discrimination and are depicted as the butt of reality television; in particular, children who are particularly sensitive to self-esteem issues may be aversely affected by this kind of treatment.

My point is that we need to (somehow) divorce the health aspects of the obesity crisis from the appearance/acceptance issue. I simply don’t believe that working towards addressing obesity (in children or adults) and ending fat phobia are mutually exclusive — can there not be a way to teach people that obesity is itself unhealthy without saying that obese people are worthy of derision?

There are (as far as I know) no empirical studies of any real-world anti-obesity programs, showing that those programs consistently lead to fewer kids being fat over the long run. Until some substantial empirical evidence of real-world long-term successes exists, my statement stands.

I suppose it depends on your definition of “real-world anti-obesity programs” — there are several clinical intervention studies that have been done that explore the relationship between what can be taught during the intervention and long-term results both in adults and in kids. While most of these studies aren’t “real-world programs” (there really aren’t any specific anti-obesity programs for kids currently in place) but are studies, they do demonstrate that certain kinds of interventions can lead to sustained weight loss. In this review, the authors show that some kinds of interventions that promote short-term weight loss by diet and exercise lead to long-term maintenance (and even additional) weight loss between 1 and 3 years after the initial study.

As for “real-world programs”, this review shows that popular diets can produce modest reductions in body weight up to 1 year after initially joining the program, as long as the dieters stick with the program.

Anecdotally, we also see creative approaches to try and improve physical activity in children. Some of my colleagues are trying to incentivize students to be more active using a Wii-based fitness regimen and are seeing some success, while another one of my colleagues is conducting a study aimed at getting female children to do some sustained jumping exercises to promote improved bone mineral density. One of the consequences of his study is (I think) that kids in the experimental group appear to enjoy the exercises (and motivate their friends who aren’t party of the study to do it with them) and are showing reduced adiposity. But, obviously that’s just anecdotal and unpublished.

In conclusion, you’re right — adherence to the intervention is a major problem, and weight regain is common in several interventions. Futher, there aren’t any data on the consistency of long-term impact of real-world anti-obesity programs — mainly because there aren’t many pre-existing real-world anti-obesity programs to emprically evaluate.

But, I think that there are studies out there that show, particularly in chronically ill patient populations, that diet and exercise regimens can consistently produce sustained weight loss, but that in the everyday population, the problem is motivating people to stick with the program. That’s why I disagree that just because we haven’t seen data on the effectiveness of anti-obesity programs, we shouldn’t pursue national anti-obesity programs. We know that many interventions aren’t effective, but we also know it’s because most regimens haven’t found the right way to make the diet and exercise motivating for patients, not because diet and exercise itself doesn’t work. The only way to address the question is to try different approaches to get people more physically active and more aware of nutrition, and see how people respond.

Re: physical activity and sedentary lifestyle

Well, as with the whole issue, it’s complicated. There are more commercial gyms out there now than there were twenty, or even ten years ago. There are gyms that specifically cater to “beginners” or “non-athletes” like Curves.

But, keep in mind that it takes money and education for people to join gyms. This study shows little change in overall activity level in Americans since 1990, but when you break it down by education, we see that Americans with the lowest education levels actually are becoming less active between 1990 and 2000. In addition, sedentary activities are much more prevalent now: fewer Americans walk, bike, or take public transportation, and television ownership (and watching) has increased. One caveat: the study only considers the period between 1990 – 2000, when America was experiencing an economic upswing with the Clinton years, and doesn’t take into account changes in activity associated with the current economic recession.

So, while gyms are more prevalent, it’s not clear that people who purchase gym memberships are actually being more active, and that these gyms are actually reflect increased physical activity in the highest-risk populations, those with the lowest SES.

>>But even if your diagnosis is correct, that doesn’t mean we know how to reverse those changes in a sustainable, effective way.

No, there is no magic bullet formula. But, again, we have ample data showing that *if* we can get people to be more active and to eat better, we can induce weight loss that can be sustained. It’s not that we don’t know that diet and exercise produces sustainable results, it’s that we don’t know how to get people to take the time to choose to exercise.

I don’t see any reason to think that Ms. Obama’s approach is going to be magically more successful than any of the other failed anti-obesity programs have been. And, like the many, many other initiatives it resembles, it’s going to be really fucking bad for some fat kids.

No, we have no idea if Mrs. Obama’s program will work. But, does that mean we should just throw up our hands and give up? I guess my problem is that, while we worry about stigmatizing obesity, we are also at risk at pretending that there isn’t an obesity problem in this country. Neither of these outcomes are good; so how do we find an approach that both admits the problems with obesity while protecting fat kids from social ostracization?

“improving kids health” would do the same thing — but it wouldn’t stigmatize fat kids.

It would, and I think the same is true about encouraging adults to get physically active. While shedding weight motivates a lot of folks, it’s not generally a sustainable motive for getting fit. But other motivations require education — the most direct risk factor for cardiovascular disease is hypertension and elevated heart rate (both of which occurs in obese individuals), but it takes educating the public to know that what we’re REALLY trying to do is reduce those things. So, I would favour a re-focusing of the program on cardiovascular health rather than the number on the scale — but my hope is that Mrs. Obama’s plan will set a precedent for kids to become more interested in their own health, and consequently will be taught about the merits of focusing on cardiovascular health that way.

Also, note that Mrs. Obama’s plan doesn’t just target fat kids; she is promoting healthy eating and active lifestyles in ALL kids through school lunch and exercise programs.

That being said, I disagree with the statement that there is no way to prevent people from being fat in a sustainable manner.

There are (as far as I know) no empirical studies of any real-world anti-obesity programs, showing that those programs consistently lead to fewer kids being fat over the long run. Until some substantial empirical evidence of real-world long-term successes exists, my statement stands.

I contend that the reason Americans are becoming more obese is that, while there is an accepted cultural fat phobia, we as a nation are also living a more sedentary, less nutritious lifestyle.

I’m skeptical. IIRC, I’m a bit older than you; when I was younger, gyms were relatively rare, and those that existed were catering to boxers and bodybuilders, not to the general public.

Now, gyms are commonplace and friendlier — not to mention the fitness centers in almost every large hotel, in newer apartment buildings, etc.. There even gym chains, like 24 Hour Fitness and Curves. So if Americans are exercising less than ever, why are there more gyms than ever?

But even if your diagnosis is correct, that doesn’t mean we know how to reverse those changes in a sustainable, effective way.

I don’t see any reason to think that Ms. Obama’s approach is going to be magically more successful than any of the other failed anti-obesity programs have been. And, like the many, many other initiatives it resembles, it’s going to be really fucking bad for some fat kids.

Finally, if the real point is to improve nutrition and exercise, then why frame it as an anti-obesity program at all? Framing it as “improving kids health” would do the same thing — but it wouldn’t stigmatize fat kids. A sincere commitment to opposing anti-fat bigotry isn’t compatible with support for programs that will have the effect of stigmatizing and harming fat people.

http://www.scidev.net/en/opinions/obesity-researchers-must-understand-how-capitalism.html

“What is really driving the obesity epidemic is not increased dietary intake, or decreased activity levels, but the web of economic strategies and commercial interests that cause individual people to change or maintain certain behaviours. The way industry understands and manipulates individuals’ behaviour is fundamental to the growth of the obesogenic niche.”

When we look at many of the social ills in today’s society, I think many people within the research community tend to overlook one of the obvious culprits.

Our culture isn’t even slightly apathetic towards obesity; fear of fat is one of the most publicized social panics there is, and bigotry against fat people is widely accepted and encouraged. Administration after public official after government panel after surgeon general after first lady have been talking about for years; corporations “encourage” fat employees to lose weight (sometimes with punitive measures); talking heads on the news pontificate about how fat Americans virtually every week.

And through it all, after a panic about fat that’s gone on longer than both of our lifetimes added together, Americans are still fat. Because the truth is, no one knows how to prevent people from being fat, in a sustainable and society-wide fashion. Getting kids to eat healthier and move around more is a good idea, because it will make the kids healthier; but it isn’t a cure for the existence of fat kids.

Fair enough. That sentence was not intended to blame obese people for being obesity — it was, however, to point out that obesity is one of the few national epidemics that can be greatly reduced with better politics.

Obesity occurs with a combination of insufficient education and insufficient access to proper nutrition and physical activity options. There are absolutely food deserts that occur far too readily throughout the nation, and for many families, a corner convenience store (that carries mostly junk food) is the primary source for groceries.

However, what I was trying to point out is that the food desert issue is not the SOLE problem; for many Americans, there’s rampant misconceptions or misunderstandings about nutrition. People know that McDonald’s has high calories, or that there is a difference between trans fats and non-trans fat — but they don’t know what all of it means. We don’t really teach it in schools, and we certainly don’t encourage parents to teach their children the benefit of physical activity. Furthermore (and perhaps most importantly), our politicians are not educated on the facts about fitness and nutrition that could help them make better policy decisions.

So, while you’re right that my sentence is a bit misleading, I don’t think we can disregard the education factor here. And pointing out that Americans — regardless of their BMI — are miseducated about health and fitness isn’t blaming the obese (or non-obese) individual; it is pointing out that, as a society, we don’t provide that education.

This is problematic; it suggests that the obese individual is completely responsible for her obesity, and ignores some extremely important socio-geographical factors — indeed, factors that underlie the correlation between obesity and poverty that you’ve pointed out here.

A key concept here is food desert. Poor communities, both urban and rural, often lack physically close and economically affordable grocery stores. If it takes you 20 minutes each way on public transit to get some fresh veggies that would kill your food budget for the day, it doesn’t matter how well educated you are; you’re still going to go around the corner to eat at McDonald’s or 7 Eleven for a couple bucks.