New York Times: Understanding Obesity

In a recent New York Times Well Blog post, Jane Brody added an insightful chapter to the ever-growing dialogue about what caused America’s obesity epidemic and what we can do to fix it.

Ms. Brody—a veteran health and wellness reporter—urged readers to take a look at obesity from a historic perspective and understand that multiple factors contributed to its meteoric rise.

We have a tendency to want to blame one factor (like sugar) for weight gain, but it’s much more complicated than that, says Ms. Brody: “a closer look at what and how Americans eat suggests that simply focusing on sugar will do little to quell the rising epidemic of obesity. This is a multifaceted problem with deep historical roots, and we are doing too little about many of its causes.”

Today obesity affects more than a third of American adults and nearly one in five children, according to the Centers for Disease Control and Prevention—it’s no longer considered an isolated problem, but a very serious public health crisis. Unlike many diseases, this one is entirely preventable and treatable but “[e]ffective measures to achieve a turnaround require a clearer understanding of the forces that created the problem and continue to perpetuate it.”

First, explains Ms. Brody, we’re eating more—of everything.

The increase in obesity began nearly half a century ago with a rise in calories consumed daily and a decline in meals prepared and eaten at home.

According to the Department of Agriculture, in 1970 the food supply provided 2,086 calories per person per day, on average. By 2010, this amount had risen to 2,534 calories, an increase of more than 20 percent. Consuming an extra 448 calories each day could add nearly 50 pounds to the average adult in a year.

“Sugar, it turns out, is a minor player in the rise,” Ms. Brody continues. “More than half of the added calories — 242 a day — have come from fats and oils, and another 167 calories from flour and cereal. Sugar accounts for only 35 of the added daily calories.”
Adding to the confusion about what role sugar plays in our increased caloric consumption, is the fact that “sugar” is often used to describe all caloric sweeteners, including honey, agave and high fructose corn syrup (HFCS), as well as table sugar. While Ms. Brody is right to point out that the contribution of these caloric sweeteners to added calories is minor compared to other foods, readers might also be interested to know that the consumption of table sugar has actually gone down since 1970—by almost 40 percent.

Ms. Brody also notes societal changes led to fewer home-cooked meals, making it more difficult to know exactly what we’re eating:

As more women entered the work force, family meals and especially home-cooked meals became less frequent… Eating just one meal a week away from home can translate into two extra pounds a year for the average person, the [USDA] calculated. Although the recent economic downturn forced more people to dine at home, the average adult now eats out nearly five times a week.

And the less we prepared our own food, the less we understood the importance of things like portion control:

Portions have grown along with waistlines… Although some weight-conscious diners will share an entree or take home half a meal for another day, most people tend to eat what they are served.

When we look at obesity from a historical perspective, it’s easy to see how we lost sight of what caused obesity. It can’t be traced back to a single development, but a gradual series of changes—some of which were seemingly unrelated to food.
Ms. Brody acknowledges that, despite what many articles written on the topic may suggest, reversing the effects of obesity is not a simple matter of cutting sugar out of the diet. Like her explanation of what caused the rise in obesity, the solution is much more complex:

Researchers now know that people who struggle with weight are battling evolution itself, which has programmed us to store calories when food is plentiful and, when food is scarce, to reduce calories we expend.

When an overweight person cuts down significantly on what he eats, the body defends itself by using fewer calories. The effect can be long-lasting: If a person’s weight drops to 150 pounds from 250, significantly fewer calories must be consumed daily to stay at that weight than would be necessary if the person had never been overweight.

Even if a 170-pound person loses 20 pounds, he needs 15 percent fewer calories to maintain the new weight than someone who always weighed 150. Short of bariatric surgery, very gradual weight loss — say, no more than 20 pounds a year — may be the only way around this metabolic slowdown. This strategy gives the body and appetite a chance to adjust.

The answer to fighting obesity is not a prescription—it’s a process. And with work, family, friends and countless other responsibilities demanding our time, it’s easy for food to end up on the back burner. But gaining a better understanding of what causes obesity and what we can do to fix it might help to make food a higher priority. Ms. Brody sums it up well: “No Time? People always have time for what they consider important, and what is more important than your health?”

Read the entire post, Many Fronts in Fighting Obesity, here.