Obesity plays a central role in metabolic syndrome— coexistence of insulin resistance (e.g., type 2 diabetes or non-insulin dependent diabetes mellitus), dyslipidemia (elevated blood triglycerides), and hypertension (high-blood pressure). Obesity is a risk factor for heart disease and a host of medical conditions. Obesity is even being linked to the COVID-19 (SARS-CoV-2) disease. Obesity is often referred to as a disease. I prefer to think of it as a symptom—not to a physical disease, per se, but to a host of societal problems.
While there is some genetic link to obesity, obesity of itself is a behavioral issue. Yes, for some, weight management is complicated by genetic predisposition, but this should not damn one to a life of morbid obesity and disease. Obesity is more a result of physical inactivity and poor nutritional habits than one having chosen his/her parents unwisely.
As it becomes increasingly clear that obesity is a symptom of poor health and that obesity is a comorbidity for a range of physical diseases, it is time to have a frank discussion about the environment that creates and encourages body fat. As we are now many weeks into quarantine and stay-at-home restrictions, it is important to look at prevention going forward.
There is a difference between fat-shaming and a genuine concern for one’s health. As “six-pack abs” is increasing promoted as the fitness standard (bullsh**, in my opinion), it is important to shift the focus to healthy body composition. I also stress that body composition is not body mass index (BMI; i.e., body weight in kilograms divided by the height in meters squared). BMI only considers body weight and not body composition. One can gain muscle and “worsen” the BMI, and one can, likewise, lose muscle to “improve” the BMI. It is the ratio of fat to total body weight (percent body fat) that is most important. I have seen numerous “lean” people who were actually “skinny fat”.
The obesity epidemic and subsequent drain on the health care system requires greater individual responsibility and community support. Schools should be promoting more rather than less activity. (Who was first to think it a bad thing for a kid to be “hyperactive”??) Physical education must be a priority on par with math and science. Teachers need to be mindful of the impact of their sugary rewards and treats for kids. School lunches need a significant overhaul. Kids need to walk a little farther to the bus stop. (In primary school, my daughter’s but literally stopped at both ends on the same block!!)
As parents, we need to model and support healthy behavior. No excuses. Exercise! Encourage kids to get off the couch and off the computer. Support youth sports. (It amazes me the extent to which club sports have taken away from school sports, particularly in middle school. This tend to limit, rather than promote activity.)
There needs to be a personal cost to obesity. Yes, some will perceive this as “fat shaming”, but it should be understood that there is a societal cost to obesity. This is, perhaps, shaped by my appreciation of “The Tragedy of the Commons” (Garrett Hardin), but we can’t allow the community (the commons) to bear the burden of others’ poor health choices. In reality, I am asking to reward healthy behavior rather than penalize unhealthy behavior, though I am sure that many will perceive that I am suggesting the opposite. It is just a matter of fact that obesity and inactivity (and smoking, for that matter) have a tremendous cost to society. The question is: who should pay?
As we eventually leave our homes as stay-at-home orders are lifted, we have a choice. We can go back to business as usual—and wait for the next health pandemic to arrive—or we can innovate and be more responsive to the underlying health issues that are weighing on our national health care. We can go back to not going to the gyms we are currently complaining are closed, or we can take our exercise habits seriously. We can keep eating crappy foods, or we can change our diets—not “diet”. We can insist our school increase, rather than cut, physical education. We can support the development and maintenance of outdoor activity spaces—e.g., parks, cycling lanes, running/hiking trails, playgrounds, tennis courts, etc. We can demand that food manufacturers stop corrupting food with chemicals and high-fructose corn syrup and other substances that increase our consumption and waist circumferences. (We can blame food manufacturers and fast food for our obesity, but they will only sell what we are willing to buy. We control the market with our dollars. So, buy less crap!)
It is easy for us who can afford to make these choices. There are segments of our population, however, who have limited choices. This should not be the case. All Americans should have access to healthy foods. I am not necessarily opposed to government having better control over this—when it is for the benefit of the people being served. There are far too many Americans who need nutritional support and education. I am personally bothered when I see well-meaning people providing “food” for needy families that is anything but healthy (e.g., cheap white bread, sugary treats, etc.). These families need quality foods—whole foods, vegetables/fruit, basic staples like rice, beans, flour, etc.—not foods donated from our pantries because we won’t eat them or that we offer because they are cheap.
Today, I rant. I know. Nevertheless, I hope we don’t return to “normalcy” as we move out of the restrictions associated with COVID-19. Instead, I hope we will step into a new normalcy of improved health and innovation. It is hard now, but going forward, let’s…
Be our best today; be better tomorrow.
Carpe momento!