Obesity: Lifestyle Choice or Lifestyle Chance?

Readers of these pages should by now recognize that obesity is an extraordinarily heterogeneous and complex condition.

While energy balance is simply a matter of energy in and energy out, the determinants of energy in and energy out are anything but simple.

Indeed, the sociopsychobiology of ingestive behaviour is perhaps the most complex of all human behaviours (not surprising given its importance for survival of the species) and the physiological, neuroendocrine and biochemical pathways that determine energy metabolism and activity thermogenesis are clearly no simpler.

It is perhaps, therefore, not all that unexpected when study after study (let alone your own experience) shows that the simplistic formula: “eat less – move more” is so disappointingly ineffective in either preventing or treating excess weight.

Yet, health professionals, decision makers and the general public continue to believe that obesity is simply a matter of “choice”, or in other words, people struggling with excess weight are simply making the wrong choices. Were they only to smarten up and chose differently, their fat would simply melt away – hopefully forever.

The fact that this “simple” formula for maintaining a healthy weight is about as realistic and effective as the “simple” formula for getting rich on the stock market by simply buying low and selling high, apparently does not deter the “healthy living missionaries” from preaching to the uninitiated, who are simply too stupid to understand that weight management is really just a matter of choosing to do the right thing!

Let us for a minute assume that “lifestyle” truly is a major determinant of weight gain (and let us simply ignore the vast body of research on genetics, imprinting, fetal programming, environmental toxins, gut bugs, adipogenic adenoviruses, activated hypothalamic-pituitary adrenal axes, mood and anxiety disorders, addictions, attention deficit, abuse, emotional neglect, poor body image, obesogenic medications and the many other well-documented causes of obesity), then the question remains how much of lifestyle is truly simply a matter of “choice”.

How many of us simply chose sedentary jobs that keep us in front of a computer all day, simply chose to live in neighbourhoods with no sidewalks, simply chose to work in jobs where we earn so little that the only food we can afford to feed our family is crap, simply chose to live so far from work that we face daily hour-long commutes that leave little time for recreational activity (let alone enough sleep), chose to work rather than stay home so we can be around to fix a healthy meal from scratch in time for when the kids come home from school, simply chose to drive a car rather than spend our money on the 5-9 daily servings of fruits and vegetables for everyone in our family, simply chose to have a TV in the house that streams endless hours of advertising to our children, simply chose to drive our kids to school rather than let them cross those five busy intersections, simply chose to live in a country where the government subsidizes corn and meat producers rather than fruit and vegetables growers, etc, etc, etc? Are all of these “lifestyle” factors simply a matter of choice? If yes, then, I am sure we can all simply chose differently and obesity will simply vanish!

But what if obesity is not simply the result of lifestyle “choice” but rather the result of lifestyle “chance”. Do we all truly have a chance to always feed our families healthy foods, have the chance to live in neighbourhoods where it is safe for our kids to walk to school and play outside, have the chance to enroll them in daily sport programs, have the chance to prevent them from ever seeing ads for unhealthy foods, have the chance to ensure that they (and we) get 8 to 9 hours of sound sleep every night, have a chance to convince our politicians to make the right food and environmental policies?

If we don’t, but rather chose to continue living in this obesogenic environment, then do we truly have a chance of not gaining weight? Remember also, that the same environment does not treat everyone fairly – some people (the mutants?) can eat all the junk food they want and stay as thin as a rake, others, despite eating as healthy as possible and despite regular exercise, just keep packing on the pounds.

When it comes to lifestyle’s impact on obesity – is it not far more often a question of CHANCE than of CHOICE?

Let us do our best to first give everyone a fair lifestyle chance and then see if we can perhaps beat the obesity epidemic after all.

Edmonton, Alberta