A big fat crisis -- stopping the real causes of the obesity epidemic | Deborah Cohen | TEDxUCRSalon



we're in the midst of a big fat crisis an obesity epidemic and everyone knows that obesity is bad for our health it's an underlying cause of heart disease hypertension type 2 diabetes cancer and premature deaths it's costing our health care system in excess of a hundred fifty billion dollars every year and in America two out of three adults and one out of three children are overweight or obese so why is this happening and what can we do about it well the dominant conversation about obesity is is that it's a matter of personal responsibility we think that if people are overweight or obese it's the result of their own conscious choices and we also think that people should have the capacity to control their weight but think about it if people did have the capacity to control their weight why wouldn't they this is my mom and dad and you can see them my dad struggled with his weight for a very long time for almost all of his adult life and he knew what to do he was a dentist he knew he should eat less and exercise more but he never could keep the weight off and he only had success for just a few months at a time and you know the weight came back and he was a hardworking person he served in the Army in World War two and in the Korean War he worked six days a week he seldom took vacation he raised three children he sent us all to college and graduate school and he was a kind of person who that if he said he was going to do something or be somewhere you could always count on him I don't think anyone could seriously call him personally irresponsible and that's the way it is with most people who are overweight or obese they get to work on time they pay taxes they raise children they volunteer for their communities if controlling one's way was as straightforward as meeting one personal responsibilities there's no doubt that we would not be having an obesity epidemic and so what I want to suggest is that personal responsibility is neither the cause nor the solution to the obesity epidemic well I specialize in public health and so I would like to offer a public health perspective on this so what's public health it's about creating conditions in which people can be healthy and one of public's health greatest successes is clean water 150 years ago diseases like typhoid and cholera were among the top causes of death and now we don't have to worry about it because America because the water is pretty safe in America today in countries where they don't have clean water waterborne diseases are big problems and they're the top killers of children under five now just imagine that we relegated clean water to personal responsibility and we didn't require that all homes and buildings have piped in clean water we had to fetch it and boil it and filter it and store it we wouldn't have time for anything else so public health not only reduces our risk but it reduces the burden on individuals and so in order to appreciate how the conditions in which we live are we are really important for obesity I'd like to you to imagine that we can take food out of the equation and instead let's replace it with alcohol now just imagine that in America today we treated alcohol the way we treat food so imagine for just pennies more we supersize servings of alcohol and what if we had all-you-can-drink buffets for one price and what if alcohol were short sold in vending machines and they were in every office building on every floor and in every break room and what if alcohol was everywhere you went and if you went to the bookstore instead of candy at the cash register they had alcohol and what if there was alcohol in car washes when you went to pay and what if in the hardware store instead of candy chips and soda they had beer wine and whiskey and what if we had no restrictions on the sale of alcohol to children and it was only up to parents to control what their children did or drank all the time what would the consequences be being well just a guess but we would probably have a lot more people who were drunk all the time adults and children we would have a lot more alcohol-related traffic fatalities more violence more people dying from liver cirrhosis and more alcohol-related chronic diseases well you know what I don't even have to guess because we can look at our own history because 200 years ago we didn't have any regulations or restrictions on the sale of alcohol and America had a reputation as a nation of drunkards alcohol was ubiquitous it was the drink of choice it was served to children it was drunk all day on the job and employers often paid their workers with allotments of alcohol as part of their wages 200 years ago the consumption of alcohol was twice as much per capita as it is today so here's the graph of alcohol consumption and it goes from the end of the 18th century to the present day and you can see how 200 years ago we drank a lot and when we improved the technology to distill whiskey there was even more alcohol and it was really a problem because so many people were drunk all of the time and society realized we needed to do something and when they analyzed the situation they said well people are being set up to drink too much because alcohol was ubiquitous and so they developed regulation where they decided to limit its availability and accessibility so they prohibited the sale of alcohol to children they limited the days and the times when alcohol could be sold they had policies to prohibit drinking on the job and businessmen even subsidized alcohol free taverns so people could socialize without being pressured to drink and you can see that in the 10-year period that very dramatic changes a sharp decline in alcohol consumption and and in that short period it dropped to a third of what it had been while we continued with more regulations and of course than we had prohibition which in retrospect we can say well that went too far but even after it was repealed we retained a lot of regulations to control alcohol sales and so the policies that we have today to control alcohol that work standardized portions restricting accessibility and restricting impulse marketing that's where the conversation to control obesity should start now is it fair to compare alcohol to food I say absolutely because consuming a moderate amount of each is not a problem you know we all need to eat but when we consume too much of either one that's where people get into trouble now 200 years ago people drank too much because they were living in an alcohol swamp and today people eat too much because we've allowed our country to become a food swamp and food and in particular junk food and sugar sweetened beverages are ubiquitous cheap and marketed relentlessly so I want to do an experiment to have you understand why thing in a food swamp is problematic so you've got two inches here and I with a show of hands those of you who feel like you're looking more at the hat raise your hand okay how many of you are looking at the cake okay well that's because people are wired to pay more attention to food than they are to other things in fact just looking at food can make you feel hungry and having the ability to get hungry at the sight of food was an evolutionary asset when food was scarce but now that we are making twice as much food as people need in America today it's killing us and the food industry knows how vulnerable we are to food placement and availability and that's why they pay retailers to place the products they want to sell in prominent locations so we can't ignore it and when they put food in these places like the end aisle displays or in special displays the sales of those items increased by 50% to two or three fold and in fact the sales from these locations account for 30% of all sales in supermarkets so if so whatever they put in those locations influences what we eat if they put more junk food there we're going to eat more junk food so even if we know we should make a different choice or eat less or avoid certain things it's very difficult for most of us to follow through because there's so much food always available and part of it is because we have a limited cognitive capacity so I want to tell you about an experiment that shows you know why people have trouble making good decisions all the time so Shiban Federica n– got a bunch of participants they randomized them into two groups and they had one group memorize a two-digit number and the other group memorize a seven digit number then they had them select a snack either fruit salad or chocolate cake and so what happened was the group that had to memorize the seven digits they were 50% more likely to choose chocolate cake and that's because we have a limited mental capacity so if we're preoccupied tired or stressed even with something as simple as memorizing a phone number right seven digits we are more likely to impulsively choose the item that has more calories that's our evolutionary wiring kicking in leads us to be impulsive you know get as much energy as we can you know in thinking about the short-term so because of this I think we need regulations that protect us from the food swamp standards and regulations wouldn't be about telling people what to do they'd be about stopping businesses from putting us at risk and they're serious risks you know heart disease type 2 diabetes cancer so we need to begin by asking food outlets not to put us at risk so right now if you go out to eat most restaurants serve people more calories than they can burn and people really can't tell just by looking how much they're getting and that's why people who eat out frequently are more likely to be overweight or obese and so if we had standardized portions and restaurants only serve as a single portion it would reduce our risk for obesity and if people wanted more they could always order a second or third portion the same way we can always order a second or third alcoholic beverage if we want but standardizing portions would empower all of us to really control how much we're eating and another Public Health approach is to restrict impulse marketing I mean do we really want people to make impulsive choices or do we want them to be careful and deliberate about what they're selecting and do we want these kinds of foods within the reach of children well I'm a mom and I have four sons and when they were young they were very mischievous and so when I couldn't find a babysitter and I had to take them shopping with me you can imagine they were always grabbing food like this or getting sugar sweetened cereals and hiding them in the cart and hoping I wouldn't notice until we got to the before we got to the checkout stand but if we could have some standards and regulations that would move foods that are associated with chronic diseases and obesity away from these prominent positions away from the caste register the end aisle displays and put the melter in the store that would help a lot of people especially parents and children avoid these foods and it wouldn't prevent people who really wanted them to get those foods and it would make their choices deliberate so we will never end the obesity epidemic if we continue to treat it as a problem of individuals we need to steer the conversation away from personal responsibility towards creating a safer food environment science tells us that people are being set up to eat too much by the way food is promoted and marketed and stopping businesses from serving us too much food or shoving food in our faces every time we walk out the door won't prevent people from buying or eating as much as they want if that's really what they want if the alcohol example tells us one thing it's that dramatic improvement is possible and sustainable with moderate regulations millions of people were able to control how much they drank when they didn't have to face alcohol everywhere they went and so we need to really stop talking about this as a hundred million individual failures and instead recognize that the problem is the food swamp and if we don't we're going to have a bigger fatter crisis it's time to drain the food swamp thank you




Comments
  1. I like the idea about laws standardizing portions served by restaurants. I imagine restaurants having a calorie limit per menu item (including combo meals). A Taco Bell cravings box contains 75% of your recommended daily calories. I'd eat those in one sitting. She's right. We need a safer food environment.

  2. Very dangerous thinking allowing the government to control food. These are the same arguments they used for alcohol prohibition. All the nice words like regulation rules etc are just nice words for using force when we disagree with a product.
    I recommend focusing on yourself rather than focusing on others.

  3. This idea that all overweight people eat too much and sit around all the time is based on medical philosophy over a hundred years old. No two people are the same. Why doesn’t she explain how it is some people can eat the same things and amounts with no exercise and stay at a “normal” weight. After years of struggling with my weight and doctors blaming any ailments I suffered from on my weight being told I needed to eat healthier and exercise I finally went to an endocrinologist a friend knew. He with a blood test and further examinations determined my thyroid was below normal function (after previous tests indicated “normal” range. He also found that my testosterone was low (again previous tests indicated “normal” range) and the root of it all was my pituitary gland not functioning correctly. He started me on meds and testosterone therapy and did regular blood work. Within 6 months I had lost 90 pounds (no change in diet or exercise) and any issues I had previously were not bothering me anymore. I slept through the nights, plenty of energy, I truly felt 20 years younger. He gave me my life back. Unfortunately as he explained insurance companies pressure doctors not to pursue testing the way he does because of the expense involved. He is independent and operates as a private pay doctor. I pay out of pocket for my treatments. I spend anywhere from $5K-$8K a year on it. To me it is money well spent. To insurance companies it is cheaper to let people be unhealthy and die an early death. Sure some people are overweight from their own doing but there is a large number of people like myself who genetically have things wrong that no amount of diet and exercise will fix. It’s no accident that doctors and insurance companies blame every overweight person for their own weight issues. My suggestion is if you’re struggling find a private pay doctor that will find the real reason for your weight.

  4. No, it definitely is a matter of personal responsibility, the truth is that all people are irresponsible about some things at least sometimes and the same is true of food. Any top-down regulation to try and control food always means reduced personal freedom. Alcohol is a in fact an excellent metaphor of this danger; does anyone really want to live in a world where we aren't allowed to buy ourselves fast food until we reach age 21?

  5. Just eat fewer calories than you burn daily.
    You LITERALLY cannot break the second law of thermodynamics.

  6. Personal responsibility has a role to play. Denying that is counterproductive.

    But it's also a public health crisis that markets aren't correcting. And they were failing to do so even before ACA. I think a tax on refined sugar would go pretty far toward solving the problem. If coke was costly enough to subtract 20 oz from the American diet per capita, per day, we'd be 25 lbs lighter per capita per year. That's enough bang for the buck to justify the intervention in my view.

  7. Sorry, but this completely overlooks metabolic syndrome, insulin resistance, and other medical issues that can and do lead to weight problems. I'm also disturbed by the notion that more federal regulations can fix the problem. We also have an opioid epidemic, and I doubt anyone will claim that's it's due to insufficient federal regulations.

  8. Standard portions would be amazing. I'd love to go out to eat and not be served a giant, 1,000 calorie salad. I just wanted lunch

  9. There is worldwide collusion between big agriculture and big pharmacy, the effect of which is to increase obesity and its detrimental health effects in order to drive up corporate profits. Unless and until this situation is recognized and addressed, no amount of outcry or organizational response will be effective in combating obesity.

  10. Every aspect of our lives, including weight, are the collective result of conscious choices. Try veganism ❤

  11. I'm sorry, but I don't want to provide an excuse for all those people who are so huge. An excuse is just a ticket to more overeating. You simply have. to. eat. less.

  12. Things would be a lot better if the sugar lobby didn’t control the politicians, bureaucrats and their recommendations which is why we can NEVER let the government dictate our food choices.

  13. I think this is the first talk I've seen where regulation was recommended rather than education. Side note: If you put a picture of Dr. Cohen's legs beside the picture of the chocolate cake, I'll be staring at the legs. My apologies, Dr. Cohen.

  14. Yeah, right… Let's have the government tell us what we can and cannot eat, and how much. That will solve the problem. It seems to work well in prisons.

  15. Or instead of regulations which the industry will find ways around or lobby against just promote health education to avoid insulinogenic foods which are the true cause of obesity. Alcohol isn't banned and is freely available but I rarely drink because I am aware of the negative consequences not because I can't find any…

  16. Risk is not the same as opportunity. "we don't want to restrict people's choices, we want to restrict businesses" Oh I get it.. So you want to tell the businesses they have to restrict our choices. My mistake. Choices are choices whether it's right in front of you or down the isle.

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