Legislating Away Obesity?

Today is the beginning of the 2nd National Obesity Summit hosted by the Canadian Obesity Network in partnership with the Canadian Association of Bariatric Physicians and Surgeons and the Coalition Poids here in Montreal.

Over the next five days, almost a 1000 researchers, clinicians, policy makers and other stakeholders from across Canada will be discussing the latest in obesity prevention and management.

Just in time for this meeting, the Canadian Medical Association Journal released an article by Mark Eisenberg and colleagues from Montreal’s McGill University on legislative approaches to tackling the obesity epidemic – a topic that will be broadly discussed and addressed at this Summit.

In their paper, the authors present a comprehensive look at the many legislative instruments that policy makers could potentially use to address the obesity problem at a population and individual level.

The paper looks at a wide range of legislative initiatives including taxation and bans of ‘obesogenic’ foods, changing the built environment to promote active transportation, introducing school and workplace programs, and addressing advertising to children – i.e. is the full complement of topics that are generally looked at in ‘policy’ discussions on this topic.

The authors also discuss how approaches to tackle smoking, sodium or transfats could serve as models for tackling the obesity epidemic.

While the article is both timely and balanced, my only criticism is that it brings nothing new to the discussion and fails to address any of the real underlying problems driving the obesity epidemic.

Thus, for example, the authors repeat the often heard argument that the recent rise in the prevalence of obesity, is unlikely due to metabolic or genetic changes, a statement that flies in the face of the increasing recognition that intrauterine and perinatal epigenetic modifcation can lead to a rapid genetic ‘reprogramming’ even within the time frame of a single generation, thereby vastly increasing the ‘genetic’ risk for obesity. This, incidentally, is the topic of a full day workshop, a plenary session and several original presentations at this Summit.

Furthermore, the authors (like most of the public health discussion on obesity) essentially fixate on the paradigm of “eat less – move more” as a solution, albeit using public health language, which still focusses on influencing eating and moving, be it through legislation.

What the article does not discuss are possible legislative measures to address the ‘real’ underlying root causes of why people are eating more and moving less. Thus, while the authors suggest reducing caloric intake by policing food, they do not suggest policies that would address likely drivers of overeating like lack of sleep, lack of time, or stress and depression,.

Who is to say that efforts focussing on teaching the population time management skills, finding work-life balance, getting more and better sleep, improving mood and self-esteem, or perhaps even ‘regulating’ the media and fashion industry to stop propagating unhealthy body-images that promote weight cycling and disordered eating, would not be as, if not more effective, than simply slapping a tax on fast food.

It is not that any of these measures have been shown to be effective, I am just noting that the authors appear to be focussed on legislating what I see as the consequences rather than the root causes of the obesity epidemic.

Thus, junk food and fast food can also be seen as the direct results of public policies that increase both the AVAILABILITY and NEED for cheap and convenient food. So the idea that we now need other policies to stop people from using these cheap and convenient foods without addressing why people turn to these foods in the first place is perhaps short sighted and overly simplistic.

Additional complexity is added to this discussion by the many critics of legislative solutions to obesity, who never fail to pose the question, regarding how far the nanny state should go and where individual responsibility begins?

Indeed, as I have said before, public health discussion on preventing obesity that focus on eating less and moving more may do little more than perpetuate the already widespread stereotype that people, who are obese, carry that excess weight simply because they eat too much and don’t exercise enough.

This is not a ‘healthy’ public discussion to have – as it calls on governments to intensify the ‘blame and shame’ game (adding a punitive touch when it comes to taxing and banning) rather than addressing the real underlying problems, which is that as a society we no longer have time to eat, have jobs that force us into sedentariness, make unhealthy food cheaper than healthy options, build cities that discourage active transportation, and create a latch-key generation of kids that cannot come home to a simple home-cooked meal eaten by the whole family seated at the table (with the television off).

Unless these topics are also part of the public health discussion we are willing to have, I would personally tend to perhaps lean towards the opinion expressed in a Globe and Mail Editorial that discusses this paper:

“Demonizing smoking is very different from demonizing obesity, which is a condition, not a behaviour. It is influenced by genetic factors. Shaming and blaming, taxing and banning, will not work. We need to promote greater movement, at all ages, and all weights, and keep in mind that the heavy hand of the state is not the answer to every ill.”

This is not to say, as regular readers of these pages will note, that denying people who have obesity related health problems and are seeking treatment is acceptable policy. This, perhaps is the first place, where I would see a need for legislation to step in and stop discriminating against people ‘suffering’ from obesity, who clearly need and want treatment.

Montreal, Quebec