On Tuesday I talked a bit about the analysis in the medical journal The Lancet about the “increasingly polarized” debate on what is causing more people to have a body mass index (BMI) in the obese range. The journal’s second series on obesity, published last month, consisted of one editorial and five articles. In this post, I’ll focus on the parts that are likely to be the most useful and/or interesting to you, my readers.

In the first article, “Patchy progress on obesity prevention,” the authors note that in the 2011 Lancet series, the globalization of food systems that promote overconsumption of high-calorie, low-nutrient foods and beverages was identified as the major driver of increasing obesity rates around the world. Since then, strategies to address obesity have mostly focused on trying to change people’s behavior rather than changing the food and physical activity environments.

Note: I should make it clear that weight does not determine health. While this article is focused on what contributes to obese BMIs, a food environment that makes it harder to be active or nourish ourself with food that helps us be healthy and feel our best affects everyone, whether or not they have a tendency to gain weight.

The article points out one of the dichotomies I mentioned Tuesday: one faction places the responsibility (blame?) on individual people and their choices [I would argue with this position, because plenty of people of higher body weights eat great and move often, while plenty of people in smaller bodies don’t], while the other faction places the responsibility on environmental and social factors [more likely, and I would throw in genetic factors]. The authors assert that both positions have merit because:

  • People have some responsibility for their health.
  • Environmental factors can affect the ability of people to exercise personal responsibility.
  • The food environment delivers large amount of unhealthy foods to people.
  • This, in turn, affects food preferences and sustains or even increases the demand for unhealthy food.

Going further, the modern food environment exploits our individual biological, psychological and social/economic vulnerabilities in ways that undermines out ability to act in our long-term self-interest (i.e., eat in a way that promotes good health and lets out bodies settle at their natural weight).

Biological vulnerabilities

  • Low-nutrient, high-calorie foods are highly appetizing and are processed in ways that make it hard for our bodies to regulate how much we eat and how much we weigh.
  • Many foods are high in salt, sugar, fat, flavor enhancers and caffeine, which increases their “reward value,” while being low in fiber and protein, which would normally help us feel satisfied and slow absorption of sugar into our bloodstreams.
  • When we try to lose weight, we experience changes in brain chemistry, metabolism and hunger/fullness hormones. This can make weight loss difficult!
  • Then, when we regain the weight (then lose, then gain, then lose, then gain) we feel like a failure because we failed to lose weight and keep it off.
  • These feelings of failure make us more susceptible to promises of quick weight loss results, including the claims from weight loss products that have little-to-no regulation.

Psychological vulnerabilities

  • The food industry designs their “food-choice architecture” to promote consumption of foods of low nutritional quality, which have the highest profit margin. This includes the serving size of containers, where items are placed in the supermarket, product pricing and promotional strategies.
  • We have a strong tendency to stick with “default options.” This is why the default option in many restaurants is large portions with side orders included, all of which promotes overeating.
  • Despite wanting smaller portions, most people rarely deviate from the status quo by asking for less food!

Social/economic vulnerabilities

  • High-calorie, low-nutrient foods tend to be inexpensive, and many people are on a budget.
  • Quick and convenient (but less healthy) ready-to-eat foods are appealing to household where women work all day.
  • The modern food environment exploits these vulnerabilities (the need for quick and/or cheap food).

This post is running long, so I’m going to wrap it up with Part 3 next Tuesday, in which I will talk more about the food environment (including the oh-so-important home food environment, which affects many of my patients and clients).

But first, I am humbly requesting that you watch this video from Center for Science in the Public Interest (CSPI), on “Anatomy of a Supermarket Purchase.” It’s almost 11 minutes long, which, yes, I know is long for a video, given our decreasing attention spans, but I managed to watch the whole thing and was glad that I did (it really does have nice animations throughout: you won’t be watching a “talking head”). If you think you are in full control when you walk into the supermarket, think again. Knowledge is power!