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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.

AMS
Montreal, Quebec

10 Comments

  1. “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…”

    Good luck with that. At the population level, no strategy that calls on people to exercise personal responsibility will be affective.

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  2. Dear Doctor Sharma: The only legislation that would have any kind of impact would be making restaurants have Canada food guide size serving available for the consumers to chose from. Any thing other than having proper portion sizes available would interfer to much with consumers free will. After all, the individual consumer is the one who needs to decide if weight management is best for them. The freedom to chose is one thing that makes weight management easier to do and stick with; not everyone is ready to banish or prohibit fast or junk foods. Prohibition is one of the tactics a government might chose to limit access–then when prohibition is lifted there is an all out frenzy of the product that has been banned. And no one needs a food frenzy to work with–or more aptly against weight obesity. Thanks

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  3. Thank you so much for this, and I wish you could get it widely published and disseminated in both Canada and the US. It’s a desperately needed voice and message.

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  4. That’s the best that McGill can come up with?! Sheesh. What a waste of an expensive university education. I’d like to see public policy solutions for weight bias. That’s one area where government’s can help. There’s been great progress made by governments in addressing discrimination of other marginalized groups over the past several decades. Other social scientists have done research on this problem already that the eggheads at McGill could use, if they can’t come up with any ideas on their own.

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  5. I am writng to Canadians who have taken great bullying and demoralizing over weight issues that the Government wants to mandate Obesity in the same category as smoking. There the same only if your comparing addictions but that only goes so far. Obesity is a disability according to Supreme court of Canada vs Boisbriand. That changed when the Supreme Court of Canada ruled in Québec v. Boisbriand (2000) that a handicap is more than a biomedical condition, and can exist outside of functional limitations. It was a comment made in passing in a case that considered claims by two individuals under the Quebec Charter of Human Rights and Freedoms, but it set the stage for change. “Boisbriand offered the view that you can’t decide what disability is virtuous and what isn’t,” says Hugh O’Reilly, a lawyer who heads the pensions and benefits practice group of Cavalluzzo Hayes Shilton McIntyre & Cornish in Toronto. the issue is to find the best way to slow down this increase in obesity it is just not a Canadian issue but a global problem in industrialized countries.
    Alan Moffat

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  6. While you may disagree that legislation designed to decrease availability of unhealthy food is a valid plan I don’t believe these regulations “demonize” obesity. Rather, if you want to use the word demonize, it could be said they demonize unhealthy food choices including sugar sweetened beverages and high fat/high salt fast food.

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  7. “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.”

    I was very disappointed when I heard about this article released by the Canadian Medical Association. Punishing people with taxes is not the answer. If the underlying causes of obesity are not addressed the disease will continue to escalate.

    Some things that could help are:

    The COACH initiative:
    http://www.obesitynetwork.ca/coach

    Education: All Canadians need to be educated on what healthy eating is…ie. portion sizes, fat content, trans fats, fiber content, sugar content. For example, the Weightwise modules, offered in Edmonton, include a session that teaches how to read the nutrition labels on food products. I thought I understood them but soon found out I had a lot to learn. These sessions should be offered across Canada. Maybe even online?

    Restaurants should be required to have nutrition type labels for all their menu items.

    Incentives are needed for Canadians to buy healthy food and cook at home. Or to have healthier fast food outlets for our busy lifestyles.

    Tax breaks for Canadians at all ages for home exercise equipment, bicycles, swim passes, etc to get the country moving.

    I could go on but you get the point. Instead of punishment, a pro-active approach is needed.

    Thanks for listening,
    Rosemary in Edmonton

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  8. You are right that ELMM policy leads to more shame and blame. No one is “choosing” to be fat by adopting some “fat lifestyle” that legislators can simply criminalize or “educate” away.

    In my humble opinion, the most productive thing you could ask from government now, (that is not premature and based in hysteria, stereotyping, etc.) is $upport for empirical research. More than anything, we need to know what obesogens are triggering the “rapid genetic reprogramming” that you reference above. Is it simply the mother’s macronutrient intake, or something more insidious? Hormones in our drinking water (remnants of birth control that women flush away)? Livestock growth hormones in our meat and milk? Particular preservatives, colorants or other food additives or exposure to pesticides, plastics or other environmental toxins? We are a changed people, indeed, and it is showing in the bell curve that plots our average weight and the one that plots the average age onset for puberty.

    I am heartened to see that you have a whole day devoted to epigenetic changes. Now, connect the dots to public policy. Throw your effort there, and with urgency.

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  9. I am wondering if anyone at the summit will look into maternal health programs that have proved to be effective in France, and their reduction of epigenetic “problems”

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  10. As a single mom of three children who works a full time job, and makes $32000 per annum my choices are bore from necessity. Explain why a cooked chicken costs more than a raw one, and why the price of kale went through the roof ever since it was classified as a ‘super food’. Learning how to read a food label is not the issue, affording healthy choices is.

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