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Jun 23

Let’s change the environment to solve America’s obesity problem – Alton Telegraph

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Market manager Kelsey Abad organizes local hydroponic-grown tomatoes at the Wild Ramp food store in Huntington, W.Va., in 2019. The city undertook slow, incremental changes to reduce its obesity rate.

Market manager Kelsey Abad organizes local hydroponic-grown tomatoes at the Wild Ramp food store in Huntington, W.Va., in 2019. The city undertook slow, incremental changes to reduce its obesity rate.

Photo: Washington Post Photo By Michael S. Williamson

Market manager Kelsey Abad organizes local hydroponic-grown tomatoes at the Wild Ramp food store in Huntington, W.Va., in 2019. The city undertook slow, incremental changes to reduce its obesity rate.

Market manager Kelsey Abad organizes local hydroponic-grown tomatoes at the Wild Ramp food store in Huntington, W.Va., in 2019. The city undertook slow, incremental changes to reduce its obesity rate.

Let's change the environment to solve America's obesity problem

It's weird that we're still fighting about the root of obesity. In two decades of journalism, I've talked with a wide swath of the public health community, and one obesity-related issue - and possibly only one - unites them. When you peel back the objections to fat, or carbs, or processed foods, you get to the real problem: The food environment changed.

Just this month,in a paper about obesity as a risk factor for severe novel coronavirus infection published in the BMJ, the authors say: "The obesity pandemic is the result of living in food environments where it is difficult not to overconsume calories." Full stop. It is not controversial.

Carbs, fat, additives, sugar: They're the building blocks of foods engineered - successfully, as it turns out - to be irresistible. With an assist from social mores that turn every meeting, class, sporting event, even gas station stop into a snacking opportunity, we did exactly what a species optimized for scarcity does when faced with overwhelming abundance: We ate.

The culprit wasn't any of those building blocks. The culprit was the old normal. Cheap, convenient food everywhere, and society's blessing to eat anywhere. Before that, in the really old normal, people cooked plants and animals at home, ate something like three times a day, and obesity was rare and nobody fought about carbohydrate metabolism.

But another part of the old normal made it worse: Doctors, scientists and the public health community told us weight loss was possible - easy, even - if only we ate in this one particular way. Nobody agrees on the particular way, but let's not quibble. For the most part, we know what not to eat, but just how are we supposed to do that when that very stuff is in our face 24/7?

It's not a knowing problem, it's a doing problem. It's not a diet problem, it's an environment problem. And an environment-busting pandemic is a remarkable opportunity to reshape what's normal.

Most suggestions for food environment changes are top-down, with the government and large food companies in a leading role. While I'm certainly in favor of aligning public dollars with public health (we could revamp SNAP, restructure farm subsidies, tax sugar), and it's crystal clear that Big Food has played a major role in obesity in the United States, there's a problem with the top-down approach: It takes time.

It has taken a lot of time already. Calls for changes to subsidies, taxes and food companies' portfolios have been going on for as long as I've been covering the space, with precious little to show for it. By all means, let's keep fighting the good fight, but maybe it's time for a little bottom-up.

Besides, normal is what we, the people, decide it is. If we want a better normal, now is the perfect time to take back the food environment.

Taking something back usually means taking it back from something pretty bad. When the women's movement started "take back the night," it was from rapists and abusers. But "take back the food environment" is from things we do want, which was what got us into this mess. Take it back from Doritos, from ramen, from hot dogs, from doughnuts.

Wait, you got doughnuts?

That's why this is hard. The problem isn't doughnuts; it's ubiquity. We need to safeguard the joy of a raised glazed, but we shouldn't have to face down that temptation everywhere we go. We have to give up on the idea that people who want to lose weight can succeed in the food system we've created. Sure, a few can, but most simply can't. If we, as a society, want to make weight loss possible, we have to make wholesale change.

Changing the food environment, like so much else, begins at home. Now that more of us are eating in, it's our big chance. Become a better cook. And maybe the easiest thing you can do is re-normalize your idea of a portion. Out-of-control portion sizes have made overeating seem like just plain eating; break out the scale and get a sense of just what two ounces of pasta, or five ounces of fish, looks like.

And get the stuff that calls to you out of the house. If it's there, you have to resist it every minute of every day. It takes seven seconds to skip it at the grocery store. Make your pantry and your fridge reflect the diet you would like to have. You're in control. Make it work for you.

Out in the world, a few communities have made changes like that on a larger scale, using an it-takes-a-village approach. Schools, markets, restaurants, city councils, YMCAs: All work together to tackle obesity by changing the food environment and the social mores around eating and exercise. And that seems to work.

Take Huntington, W.Va. In 2008, it had America's highest obesity rate, over 45 percent. Then British chef Jamie Oliver swanned in to fix it, and that started a conversation. The mayor took up the challenge; he started walking and encouraged others to join him. The school district revamped lunches and nutrition education. A new market, featuring local produce, became a touchstone. The community bought in and, 10 years later, the rate had dropped to 32.6 percent, a jaw-dropping improvement.

Two other researcher-led community-wide programs based on the same idea, one in Somerville, Mass., and one in France, have also shown long-term success by involving school and community, kids and parents, food and physical activity, education and action.

Esther Dyson, after a career in technology, founded Wellville, a decidedly low-tech, community-scale initiative to improve health and well-being. She and a group of advisers are working with five communities across the country to link nodes that already exist - health-care providers, community centers, gyms, schools - to make changes that support physical and mental health.

It's too early to say how well it's working (they have a 10-year horizon), but Dyson has watched the dynamic play out firsthand. "There's a positive change, and people want to be associated with it," she told me. "It's the fabric, not the nodes."

We are the fabric. We are the community. We can all play a part. Employers, have you asked your workforce what they would like, food-wise? A 2019 U.K. study found that 95 percent of people don't want office cake more than once a week. Likewise, Little League, maybe talk to parents about snacking, or not, after games. Retailers, do you really want parents with kids to have to run the candy gauntlet at checkout? Restaurateurs, would you consider half-portions of entrees?

While we wait for food manufacturers to step up, what if food scientists just said "no, thank you," to the job of formulating the next Count Chocula spinoff? Investors, maybe look at the public health impact of your choices. Make sugary cereals matter as much as share buybacks.

Hey, doctors and scientists, it seems pretty clear that telling people what not to eat, rather than how not to eat it, is futile. It just sets people up for failure and frustration.

Journalists - me! - are part of the problem. For years, I wrote about diets and weight loss in a way that was undoubtedly useless and probably counterproductive. The problem is that weight-loss stories that people will click and weight-loss stories that are true are all but mutually exclusive. But trumpeting every study as though it teaches something new, and every diet as though this time we have the key, leaves people confused and disempowered.

Nearly three-quarters of American adults are overweight or obese, and I know I'm a broken record about this, but when the vast majority of humans can't navigate the food system successfully, the problem is the system, not the humans. But we're all part of that system, and we can make it work better for us and the people around us. Many people are perfectly happy at higher weights, and the world needs to be a kind and accepting place for them and stop telling them they have to be thin. But I've talked to a whole lot of people who struggle with their weight (I'm one of them), and people who want to lose weight need support.

With this virus, we seem to have missed a chance to make common cause, but reopening gives us another one. When it's safe to venture back in the world, we'll get to decide what kind of world we want it to be. Normal is what we make it, so let's make it better.

- - -

Haspel writes about food and science and farms oysters on Cape Cod.

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Let's change the environment to solve America's obesity problem - Alton Telegraph

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