In “Obesity: Chasing an Elusive Epidemic,” an article in the January-February 2013 Hastings Center Report (a center devoted to bioethics) Daniel Callahan calls for an “edgier” strategy to reduce obesity levels in the United States. He calls for a three-pronged attack:
- Strong and most likely somewhat coercive public health measures
- Childhood prevention programs
- Social pressure on the overweight
The last one, not surprisingly, has caused a lot of buzz on the web in the past few days.
I felt compelled to respond to Callahan’s article because the policies he is advocating are not in line with what I believe is his vision for a healthier and happier population.
In order to guide any action, we first need a clear vision: a place to start from that answers questions such as, “What are we doing this for?” and “What is really guiding us?” Because any action that runs counter to this deeply-held vision will cause suffering to ourselves and others, even if it appears to lead to our desired outcome.
We here at the Center for Contemplative Mind in Society believe that education should foster, create and sustain environments that support students, faculty and staff in inquiring into what is most deeply meaningful to them, so that this vision can guide their action in the world. This vision and meaning is primary–and just sacrificing it for any expediency is simply harmful. In other words, the ends don’t justify the means.
Setting the Stage
What I would like to do is provide some of the data on obesity that Callahan refers to and provide a critique of his suggestions with an emphasis on the educational component, because that is the focus of our work here at the Center.
I want to call for a new approach to this entire issue, and issues like it.
Obesity is identified according to body mass index (BMI), computed on one’s height and weight; obesity is defined as a BMI equal to or greater than 30. In 1985, the CDC collected the following data on rates of obesity in the US population; you’ll notice that many areas were not even tracking obesity data at this time.
In 2010, this is what the data showed; this dramatic increase is what Callahan is responding to as a major public health crisis.
You can see this increase in the obesity of US adults, from 1990 to 2010, which follows this progression. Areas of the country which reported obesity in 10-15% of the population in 1990 reported 25-30% or more by 2010; this progression is moving across the US and becoming greater and greater each year.
There are many possible reasons for this increase, but let’s look at some of the economic drivers of obesity.
On the demand side, we have better food engineering. That is to say, providing calories in a way that is really built for human beings. David A. Kessler, MD has a brilliant argument in The End of Overeating in which he argues that the engineering of food and the ability to produce for texture and a delivery of sugar, salt and fat has really increased over time. Restaurant chains have really thought about out how to deliver those three items to us in human-delectable ways.
A second factor is an increase in poverty over time. It is very clear that the propensity to become overweight is higher among the poor, and we will see why that is in a moment.
On the supply side, there’s also been a fall in the prices of fast food and soda, in particular. On this diagram you can see how prices of carbonated non-alcoholic drinks have gone very much downward. Fruits and vegetables are more expensive; organic fruits and vegetables, even more expensive. You can see much cheaper items, providing large amounts of calories, have increased the quantity demanded of these types of food. Access to the more nutritional foods requires greater income.
Implicit in Callahan’s analysis is that obesity is expensive to the rest of the US. The overall costs of obesity are rather unclear and quite complicated to calculate. So rather than give you figures, I will just say that it seems the health costs to society are somewhat significant. They are similar to those of stress, smoking, or other behaviors conducted by Americans that affect overall health, and can be estimated in the tens or even hundreds of billions of dollars, measured as lost productivity, overall health costs, etc.
A Critique of Callahan’s Response
What should be done about this? This is what Callahan is addressing: he’s talking to policy makers. But what should be the goal of such policies? What outcome would be the most beneficial?
Let’s return quickly to Callahan’s plan. He wants to advocate:
- Coercive public health measures
- Childhood prevention programs
- Social pressure on the overweight
The coercive public policies could, for example, tax high-sugar and fast foods–raising the cost of those goods to lower demand–and establish laws to prohibit the sale of certain goods. The burden of these policies would fall on the poor, while the costs of obesity are felt over society as a whole. If you are interested in punishing the poor, these are effective measures!
However, if you want to encourage healthy outcomes, why not subsidize more nutritious and expensive foods such as fruits and vegetables, especially those which are organically produced, reducing pollution caused by pesticide and fertilizers? Subsidies provide greater access for everyone, rather than increasing the cost on those who perhaps can bear it the least.
Again, it’s crucial to ask, what is the real vision here? What are we ultimately trying to achieve? Both taxing and subsidizing are likely to change behavior, but which is more consistent with the real vision of what we are trying to achieve? It seems to me that subsidizing the more nutritious foods is more in line with our vision of creating a healthier and happier population.
Next, let’s look at childhood education. That’s a fantastic thing, and we support it in the work we do at the Center for Contemplative Mind in Society. Certainly, improving education is a very powerful way to begin. We should support students in developing healthy views of themselves and others, including healthier visions of body image, because we’re interested in true health: mental health, emotional health, spiritual health, and physical health. But this education for true health needs to be provided along with access to more wholesome foods. Again, this may be achieved by subsidies, establishing farmers markets in neighborhoods that lack access, and so forth. This would be a public policy response to promote the consumption of goods that might yield lower costs on the rest of society, yet is also consistent with an overall vision of health.
Last is the social pressure issue: increasing stigmatization. First, let me say that I believe that Callahan is interested in true health. He believes that obesity may be “the most difficult and elusive public health problem this country has ever encountered,” and nothing seems to be working so far to reverse rising obesity rates. In desperation, Callahan is willing to advocate for policies that stretch beyond, or even break, health and happiness. But that is where, I believe, we need to return.
Shaming people about how they look will not do that–it might increase the costs of obesity and lower weight (maybe…), but it only increases stress and lowers self-image. It causes more suffering. Again, what is our overall vision here? To create environments that people can be healthier in? To reduce suffering? Or, it is to punish?
Vision in Action
Prior to acting, we need to establish a vision, and we need to support and sustain environments that deepen our inquiry into our vision. In this way, when we are acting–making policies, for example–we are acting in line with what is really meaningful to us. Only then are we set to act: our actions NOT determined blindly by outcomes, but by our vision.
So, if our vision is for people to be healthier and happier, let’s start with that, and think about how to create environments that support and sustain health and happiness. It’s not about simply getting rid of obesity or stress or this or that. Rather, it is about how to create environments that foster physical, mental and spiritual health, especially when we turn to childhood education.
Let’s support and stand for what we believe in, rather than do what seems easy and expedient.