Tuesday, April 13, 2010

Battling the Bulge

When you have a moment, go check out Marc Ambinder's thought-provoking piece, "Beating Obesity," in The Atlantic this month.

Ambinder makes an interesting argument that "[m]uch of the solid advice society imparts to people who want to lose weight is best suited, intentionally or not, for well-off Americans." After all, celebrity trainers and diet gurus enjoy "the freedom [their] status and position in life give [them] to follow a diet." According to the author, simply telling (or, in some cases, shaming) people to diet and exercise isn't enough -- especially when their economic circumstances, shady agribusiness lobbyists, food marketers and the prevalence of cheap-but-toxic ingestables conspire to make it almost impossible to do so.

Pointing to "The Biggest Loser" as an example, Ambinder writes: "contestants are plucked out of their environment and social circle, sent to a weight-loss boot camp, and forced to radically change their calorie intake and output for several months. That’s one way to lose weight. But who, besides the very rich, or the very idle, can replicate the show’s setup?"

Of course, Ambinder recognizes that obesity is a killer, and acknowledges that "[w]e should care about what we put into our bodies, and we shouldn’t neglect exercise." However,
we need to recognize the limits of individual agency, especially in the new, “obesogenic” environment that’s been created over the past 30 years, and especially for those in the bottom third of the socioeconomic pyramid. Putting individual solutions and free will up against the increase in portion sizes, massive technological and societal changes, food-company taste-engineering, and the ubiquity of effective television advertisements is like asking Ecuador to conquer China. And yet, that is what public-health campaigns suggest we do.

The government can’t ask someone to pursue a healthier lifestyle—to attain a “normal” BMI, to become a non-stigmatized being—if it isn’t prepared to provide that person with the foundation for health granted to some of us purely by the accident of birth. “Increasing awareness” about healthy lifestyles is not simply gentle paternalism; in the absence of real support, it’s immoral. In that context, stigmatizing young children for being fat is unconscionable; stigmatizing poor adults is only marginally less so; and stigmatizing Mexican American boys and black women and American Indian children of both genders for their weight is both immoral and racist.
The problem of fat stigma is a real one, and I agree that it's often patronizing, cruel and in bad taste. I, for one, side with those who have concluded that shame and humiliation turns people off of exercise rather than the other way around, and that the best way to get people off the couch is through encouragement and support.

I also agree with Ambinder that "[t]he people most vulnerable to obesity ... do not have access to healthy food, to role models, to solid health-care and community infrastructures, to accurate information, to effective treatments, and even to the time necessary to change their relationship with food." People on the lowest socioeconomic rung on the ladder don't have easy access to fresh produce, let alone organic fruits and vegetables; instead, they're stuck with the corner convenience store, stocked with heavily-processed non-perishables -- junk food. For the poorest in our society, there is no access to preventative medicine or health education. The urban and rural poor have little to no resources with which to battle obesity.
I disagree, however, with Ambinder's generalization that only the rich and idle can afford to diet and exercise. For the vast middle class, getting healthy doesn't have to be expensive. It's true, of course, that gym memberships aren't free. As a general matter, organic, whole (non-super-processed) foods are more expensive. And yes, time is a precious commodity when you're hustling like crazy just to put food -- any food -- on the table.

But consider the following:

You don't have to pay for a gym membership. Snag free passesMake your own fitness equipment on the cheap and work out at home. Don't have time/skills to build your own weights? Do bodyweight resistance exercises and equipment-free cardio routines. Or go on a run. You don't even need shoes.

If you can afford to eat organically, you should -- but you don't need to eat organic to lose weight. If you're cash-strapped but want pesticide-free, sustainably-grown food, try Wal-Mart, where cheap(er) organic food can now be found. But nutrient-wise, food is food. And contrary to conventional wisdom, "real" food isn't more expensive than processed or fast food. Admittedly, it takes more effort to cook than to hit Burger King, and you have to have access to a kitchen, but come on:
[C]ooking cheaply can be done, and in much healthier fashion than buying chili dogs and donuts at the local convenience store. Assuming a kitchen, a stove, running water, etc., cooking is not that time-consuming -- it can be done while performing other household chores, or for that matter by using a slow cooker, which takes almost no time at all, since it’s almost entirely unattended. No. it’s not automatic. It’s not a true no-brainer. But it’s been done by the most varied assortment of the world’s citizens imaginable, since humans stood upright.
You can find time to diet and exercise. You're busy, but if you can find time to watch other people work out on "The Biggest Loser," you have time to work out. (Americans watch an average of over five hours of television per day.) It's a matter of setting priorities. As Ambinder puts it, "[t]he obese are more likely to be depressed, to miss school or work, to feel suicidal, to earn less, and to find it difficult to marry. And their health care costs a lot. Obese Americans spend about 42 percent more than healthy-weight people on medical care each year. Improper weight and diet strongly correlate with chronic diseases, which account for three-fourths of all health-care spending." So I daresay that working on your health is more important than catching the two-hour American Idol results show tomorrow night.

Of course, there are other options. Ambinder himself recently lost 85 pounds through bariatric surgery. "There is a way to beat obesity," he writes. It's "radical and expensive," but "no other diet or weight-loss approach is remotely as effective as bariatric surgery."

This makes me sad.