A Big Fat Crisis (30 page)

We don’t need a new law to fix this problem. What we do need is for businesses to voluntarily get rid of junk food near checkout lines. Many school districts are changing their policies about selling sugary sodas in schools. Now let’s start moving those Reeses Pieces to the backs of the stores.

—Don H. Gaede, MD

The more people complain about the conditions that undermine us, the more likely things will change.

Start a restaurant certification program that makes healthier meals available
. Ask your favorite food outlets to prepare healthier five-hundred- and seven-hundred-calorie meals and encourage your friends and coworkers to dine there and order these meals. Ask your workplace or health-care plan to partner together to provide free PR for all restaurants that offer these healthier meals. Figure out how to make it worthwhile for restaurants to meet the needs of consumers like you, such as holding school fundraisers at these locations.

Ask your supermarket to make candy-free cash register checkout lanes available
. Write to the CEO, talk to the store manager, and ask your friends to do the same. If there is more than one supermarket in town, let them know that you and your friends will only be shopping at the one that doesn’t undermine you or your family. Do the same with the hardware stores, bookstores, and everywhere you notice unwanted candy displays. And then start tackling the end aisle displays and floor displays.

Ask your workplace to adopt practices and policies that reduce snacking and increase physical activity
. Get your coworkers to sign a request to remove the soda and snack machines, or request they be moved to a less salient location, like a closet in the basement. Lead an “Instant Recess” during your ten-minute breaks.

Contact your elected officials
. Another option is to focus your efforts on elected officials and government employees who make and enforce the rules that govern the food environment in your town, city, or state. Ask them to:

       
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Hold forums with the health department, and start a public discussion on the kinds of factors that lead people to eat too much, from ubiquitous food marketing to the junk food in many retail outlets.

       
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Discuss instituting standardized portions.

       
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Discuss adding licensure requirements to mandate that any restaurant serving meals
must
offer options that won’t increase the risk of chronic diseases in order to get their operating permits.

       
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Plan on requiring licenses for all places that sell food—whether it is through vending machines or candy at the cash register.

       
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Then ask the health department to cap the number of licenses it issues for vending machines and for outlets that exclusively sell sodas and junk food.

Be creative
. Even if you cannot accomplish anything on the above list, if you can convince others that environmental barriers are the main forces that need to be addressed to control obesity, you will have moved us much closer to a solution. It is all about framing the problem and generating the political will to act. With more than 150 million Americans who are overweight or obese, how can people continue to doubt that at least some of us, if not most, are vulnerable to a food environment that is filled with temptations?

You Are Not Alone

Although what a single individual might be able to accomplish is limited, according to the well-known anthropologist Margaret Mead, “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.” Together, a group of similarly minded people could work to change the food landscape across our communities, cities, states, and the country.

Just twenty-two years ago, the Americans with Disabilities Act was signed into law after a relatively small group of committed activists persuaded Congress to pass it. In many ways, this legislation was more groundbreaking than the changes mandated by the Sanitary Revolution because of the way it reframed how we view people with disabilities. In his book
No Pity: People with Disabilities Forging a New Civil Rights Movement
, Joseph Shapiro summarized the forces that led to the ADA’s passage.
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He noted that disabled people did not want to be
pitied but wanted to be considered as equals to nondisabled citizens. Thus, the ADA squarely established that people with disabilities are “people” first—and, as such, are entitled to the same rights and benefits as people without disabilities.

Disability rights activist Mark Johnson said, “Black people fought for the right to ride in the front of the bus. We’re fighting for the right to get on the bus.” Until 1990, many wheelchair-bound individuals who were otherwise fully capable of working full-time could not work at all because they were unable to get to or into an office building. Having buses with wheelchair lifts and buildings with ramps were key demands of disability activists, who fought for the disabled to become fully functioning and employable members of society. They no longer wanted to be shut in, isolated, and dependent on subsidies or charity. Even with disabilities, most are able to work with appropriate support.

Judy Herman, a wheelchair-bound disability activist, said, “Disability only becomes a tragedy for me when society fails to provide the things we need to lead our lives—job opportunities or barrier-free buildings.”

One of the tenets of the disability rights movement was that people with disabilities, even the most severe disabilities, like quadriplegia, still have lives worth living. Even being disabled, they can contribute to society and enjoy life as much as able-bodied individuals.

Just as reframing our expectations was critical to helping the disabled become part of mainstream America, we must reframe our view of obesity. We can no longer consider obesity the consequence of an individual’s deliberate and thoughtful choices. Just as we think of infectious diseases as the result of exposure to bacteria, viruses, parasites, or fungi, and cancers the consequence of exposure to carcinogens, obesity is primarily the result of exposure to an obesogenic environment. If people were not exposed to an environment with too much readily available food, fewer would be overweight or obese.

Hand in hand with the view that obesity is largely caused by environmental conditions, we must also reevaluate the widely held view that most individuals have the capacity to transcend obesogenic environments and to maintain a normal weight. Yes, some people can do it, but they are the minority. Many who are thin remain so despite this
environment, and not because they have a superior ability to resist the temptations of too much food. Actually, I put myself in this category. I believe I am thin, not because I am able to count calories or resist sweets (which I can’t), but because I am not frequently exposed to an obesogenic environment. I seldom watch television, eat out, or have easy opportunities to snack. This is not a conscious choice, but an unintended consequence of the demands of my career and family and the physical limits of a twenty-four-hour day. But when I go on vacation and have to eat out every meal for more than one week, I often come home packing a few extra pounds around my waist.

Others who maintain a normal weight are protected by physiological conditions, like early satiety, malabsorption, or an active metabolism. Many are protected by habits—of having a structured life, of eating a routine diet that doesn’t have the novelties, variety, and other foods that can lead to obesity. Thirty to forty years ago, most people were able to maintain a normal weight just by going about their routine activities; they weren’t faced with too many choices, too many snacks, or extra-large portions. The extra burden of navigating through a plethora of options overwhelms those who are sensitive and pay attention to their surroundings—which is most of us.

We must finally accept the fact that most people cannot limit their intake without significant support, without controls on the environmental sources of food, and without constraints on the ubiquitous cues that make us feel hungry when we do not need to eat. Just as the physical environment constitutes a barrier for people with disabilities, the food environment is the primary barrier to achieving a normal weight for most Americans.

Another lesson from the disability rights movement is that the leaders were able to finesse the issue of cost to eliminate barriers. Initially, the cost of mandating curb cuts, building ramps, renovating bathrooms, and the like was estimated to be in the billions of dollars. Significant opposition to the ADA arose from both likely and unlikely quarters. Some religious groups opposed it because it would have required churches to make costly structural changes to ensure access for all. One church estimated it would have had to spend $6,500 for a ramp.
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Many in the business community were also against the passage of the ADA. They claimed that the costs of accommodation would make business services and products unaffordable and would spell financial ruin to small businesses in particular. Yet a 1982 Department of Labor study found that most accommodations for the disabled were simple and cheap. For example, the cost of putting blocks under a deck to raise it for a wheelchair user was negligible, and 30 percent of all accommodations cost between $100 and $500—a pittance to allow someone to work full-time. Other changes did cost more—all buildings with more than two stories needed an elevator. Stores would have to widen their aisles to make room for wheelchairs. Phone companies had to hire operators to relay messages from the deaf using new telecommunications devices. Bus companies had to install wheelchair lifts. But the law included a potential break or waiver for businesses if the expense of the accommodation was beyond reasonable.

Surely, when it comes to implementing policies and regulations for obesity control, we will hear the same objections—that change is too expensive and will harm more people than it helps. Yet it is absurd to think that it is too difficult or expensive for a restaurant to figure out the nutritional content of the food it serves. The complaint was accepted without question by our lawmakers when they exempted from menu-labeling laws food outlets that have fewer than twenty locations. After all, packaged foods are already labeled with the nutritional ingredients, and the nutritional ingredients of unprocessed food are listed in free databases published by the USDA.

Moreover, there is ample free software that allows anyone to figure out the nutritional content of any recipe. All it takes is some basic knowledge of arithmetic and algebra. If businesses in the food industry can figure out how to order their supplies, pay wages, fill out their taxes, and meet the demanding requirements of sanitary regulations, surely they can figure out what is in the food they are serving and how much is in each portion. Worse comes to worst, a restaurant can hire a registered dietician to help on a one-time basis.

Nobody would expect restaurants to make changes to their serving sizes overnight, but it should take no more than a day for a restaurant to teach its servers how to use measuring cups and kitchen scales, and
less than a year for all types of food outlets to implement standardized portion sizes. It should take no more than a few years to figure out how to redesign supermarkets to help people make better dietary choices—if we make it a national priority.

After all, bigger changes are being made all across the United States to integrate the more than fifty million Americans with disabilities. Cities and towns everywhere are changing the designs of sidewalks and intersections so people in wheelchairs can navigate the streets. All new stores and restaurants and buildings are now wheelchair-accessible, with ramps or elevators so people who cannot walk can patronize the premises. All the bathrooms in these facilities had to be designed to accommodate wheelchairs as well.

Despite many of the provisions of the ADA, it was popular with politicians and passed with few concessions. Why? Because every politician knew someone or had a close friend or family member who was disabled, or was himself suffering from some disability.
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Tony Coelho, the bill’s original House sponsor, had epilepsy. Senator Lowell Weicker, the original Senate sponsor, had a son with Down syndrome. When he lost reelection, Tom Harkin, who had a deaf brother, became the Senate sponsor. Other politicians had close experiences with disabilities. Edward Kennedy’s son, Teddy Jr., had lost his leg to cancer. Bob Dole had a paralyzed arm from a World War II injury. Orrin Hatch had a brother-in-law with polio who slept in an iron lung. President George H. W. Bush’s son Neil suffered from a learning disability. His son Marvin had much of his colon removed and had to wear an ostomy bag. And his favorite uncle was a quadriplegic.

At the time of the bill’s passage there were forty-three million American constituents who were disabled—most of them voters. It would have looked cold and somewhat cruel for a politician to vote against the disabled.

Now there are more than 150 million Americans who are overweight or obese. If everyone could agree that a food environment that encourages consumption of extra-large portions and impulse buys of junk food is as much of a barrier to weight control as a flight of stairs or a curb is to the disabled, we could create an atmosphere that would
be conducive to fixing the problem at a common and malleable leverage point.

The analogy with the ADA shouldn’t be taken too far. I am not at all suggesting that people who are overweight or obese are disabled. It’s just that we are all human—not machines, not automatons. We are a species that is wired to be inquisitive, adventurous, and to take advantage of opportunity. When too much food is available, our DNA has us wired to eat more than we need. Our natural proclivities must be taken into account as we build a society that prides itself on creating conditions that do not increase our risk of disease but do provide us the possibility of achieving our full potential.