Obesity: the elephant in the corner

Abstract

In 2055, everybody knew that obesity was a problem, but what did they do about it?The year is 2055. Socrates is discussing the history of the western obesity epidemic with Panacea, the goddess of healing.Socrates: Do you recall the days when people were still allowed to smoke? Panacea: Indeed, Socrates. It seems unthinkable now. Of course in those days smoking was the leading preventable cause of chronic disease. It is remarkable how times have changed.Socrates: In the past 50 years, obesity has come to account for more health problems than any other single factor. I can't help thinking, Panacea, that something could have been done to prevent this. What on earth was going on at the beginning of the 21st century?Panacea: Well, it was common knowledge that more and more people were becoming overweight. Obesity was well established as a risk factor for all kinds of diseases. There was even talk of epidemics and time bombs. Socrates: So why were people becoming obese? The rational prescriptionPanacea: Surely that's obvious. They were consuming more energy than they were expending.Socrates: It was that simple? Panacea: Absolutely. Socrates: I suppose this was a recent scientific discovery?Panacea: Oh no, Socrates. Even in the 20th century, the concept was well understood. Socrates: Is the human body not designed to regulate itself?Panacea: Indeed. It has sophisticated mechanisms for controlling hunger and appetite.Socrates: So why did some people not achieve a balance between their energy inputs and energy outputs?Panacea: Well, Socrates, it was all to do with their lifestyle choices. Socrates: Some followed a lifestyle of gluttony? Panacea: Or a lifestyle of sloth. Or both. Socrates: Your explanation implies a very neat, rational prescription, Panacea. If people consume more energy than they expend, they will gain weight, and if they are told to adjust their intake to suit their needs, they won't gain weight.Panacea: Indeed, Socrates.Socrates: Didn't your disciples take this message to the people? Panacea: Oh yes! They offered all manner of diets, drugs, operations, healthy living campaigns . . . One could hardly avoid being exposed to the information.Socrates: These measures helped people to lose weight?Panacea: Sort of. Well, some of them, anyway. Socrates: I see. So much for controlling energy intake. Can we also assume that people were expending too little energy? Panacea: Conceivably, Socrates. The television demanded many hours of attention each day. The more advanced citizens even managed to watch TV while simultaneously eating high energy snacks to support their cerebral activity. 6The rational prescription

The Epidemiology of Obesity and Gastrointestinal and Other Diseases: An Overview

“…Adiposity is promoted at an individual level, as a reevaluation of the Framingham Heart Study suggested that the risk of becoming obese increased if a person had a close friend or spouse that was obese [23]. Society also probably promotes obesity in more subtle ways by promoting unhealthy lifestyles and limiting the choice for day-to-day aerobic exercise [24,25]. A European study, for example, reported lower obesity rates in pleasant areas with lots of greenery and low levels of litter and graffiti [26].…”

The War on Obesity as a Moral Project: Weight Loss Drugs, Obesity Surgery and Negotiating Failure

“…This moralising language is grounded in the assumption that the management of body size is within the remit of the individual and that the work of disciplining the body and its size constitutes a moral obligation (see, for example, Ebbeling et al, 2002;Ogilvie & Hamlet, 2005;Burry, 1999). One consequence is that clinical interventions that appear to relieve individuals of that responsibility-for example, drugs and surgery-are easily designated by critical others, through the mobilisation of well-established discourses of individual responsibility, as 'cheating'.…”

Eating behaviour and obesity

“…This can only increase the urgency to identify effective treatments. Behavioural treatments that focus on helping people to control exposure to cues that trigger eating and to monitor and modify their behaviour have had consistent but modest success and are recognized to be most effective, apart from the drastic option of bariatric surgery (25). Drug treatments have not proved to be the promised panacea, but it is likely that treatments of the future are going to come from combining behavioural and pharmaceutical interventions, probably also taking into account genetic and behavioural differences.…”