Obesity: Why is the prevalence so high?

It has been reported today that approximately half of men and forty per-cent of women in the UK could be obese by 2030. This is undesirable not only for the individuals concerned, who will be at increased risk of obesity-related morbidity and mortality, but also for society, which must cover the cost of medical care for these people. If this situation is to be avoided, and if the current prevalence of obesity is to be reduced, action and interventions must address the range of factors that contribute to obesity.

'Obesogenic' environment
Becoming obese or overweight isn't simply a matter of a failure to exercise personal responsibility or restraint. Of course, these things are very important but they do not tell the whole story. The truth is that we live in what has been called an 'obesogenic' environment, in which it is highly likely that people will consume a diet that promotes weight gain unless they are armed with adequate knowledge of nutrition and healthy eating. The supermarket, now the main source of food for most people, is an excellent example of this. Somewhere in supermarkets, amongst the crisps, chocolates, sweets, biscuits, fizzy drinks, processed meats, frozen pizzas, pies, ready meals, cakes, alcoholic drinks, and other unhealthy products, there are in fact some healthy options. But for those who have no real understanding of what is healthy and what isn't, it's quite easy to leave with trolley loads of food and drink that will make them and their families fat and unhealthy.

In addition to supermarkets, there is a multitude of outlets selling food and drink at all hours of the day and night for those feeling hungry while on the move. There are junk food chains, fried chicken shops, chip shops, sandwich, coffee, and cake shops, pubs and bars, and so on. You might even be 'lucky' enough to have vending machines in your workplace or someone from the local sandwich shop coming in to sell you fat sandwiches and cakes. There are some healthy options in these kinds of places, but they are almost always outweighed massively by high-calorie options that are full of sugar and/or fat. Unless someone has the nutritional knowledge to identify the healthy options, the chances are that they'll choose something else.

To illustrate how someone could easily consume way over their recommended caloric intake, consider the following hypothetical example of an office worker in London. They wake up late and skip breakfast. Feeling hungry at the train station, they grab a chocolate bar from the kiosk. By mid-morning at work they are feeling more hungry, so they nip across to Starbuck's for a blueberry muffin and a Caffe Mocha. At lunch, they go with their team to the local Wetherspoon's for a pub lunch - they order the scampi and chips. After a long afternoon at work and having worked late, they grab a Big Mac, medium fries, and medium banana milkshake from McDonald's on their way home. Laid out on a table, that wouldn't look like a lot of food. Nevertheless, it contains 3,300 calories. For a man, that's 800 over the recommended daily caloric intake. Similar examples could be given with foods from other outlets or foods from supermarkets.

In addition to the wide availability of cheap, readily available foods that are high in calories, fat, and sugar, there are other aspects of the modern environment and lifestyle that promote weight gain. Most people have highly sedentary jobs, for which stapling two pieces of paper together or picking up a phone would be among the most physically demanding aspects. People no longer walk significant distances these days either - in the time-pressured lifestyle people are forced to adopt today, they are driving everywhere or getting public transport. The huge amounts of money that companies spend on advertising junk foods can also not be ignored. The reason that these companies spend so much on advertising is because advertising works.

Poor knowledge of nutrition and physical exercise
In addition to existing in the previously described environment, most people simply have no knowledge of nutrition or how to exercise for health and fitness. They do not possess this knowledge because they've never been taught it and have either been too lazy to learn it of their own volition or have tried but been fooled or deterred by the huge amount of myth and contradictory information/disinformation that exists on these subjects on the internet and in the media.

Kids leave school with detailed knowledge of many topics irrelevant to their lives. They can calculate angles within a triangle or talk about people or events from hundreds of years ago, but they don't have the knowledge required to ensure that their own eating behaviour is good for their health. And while they've learned the rules of games like basketball and cricket in PE, they have no awareness of how to actually plan an effective and healthy workout or routine.

Given this mixture of 'obesogenic' environment and widespread ignorance of how to avoid its pernicious effects, it is not surprising that so many people are overweight or obese.

Other issues
Of course, the blame doesn't just lie with the companies promoting and selling unhealthy food, or the educational system that doesn't teach people how to maintain a healthy body and lifestyle. People who are overweight or obese must take some responsibility too. Most people have a general awareness of what food is "good" (or healthy) and what food is "bad" (or unhealthy). They know, for example, that oatmeal for breakfast is better for them than a Mars Bar, even if they can't explain why. They also know that big slabs of chocolate or boxes of cakes are bad for them, even if they are 'buy one get one free' at the supermarket.

Many people also see food as a source of pleasure rather than a source of nutrients for the body. Everything they eat has to taste great and eating must always be a pleasurable experience. If it doesn't taste great, they're not interested in eating it. These people are just like the little boy who wont eat his vegetables because they are 'disgusting'. It is within their power to not behave like spoiled children.

There is also a mentality that values quantity over quality. Many people will choose to buy greater quantities of cheap, poor quality foods than smaller quantities of more expensive, higher quality foods. While more economical in the sense that they get more for their money, it is a practice which is likely to encourage weight gain.

The role of biological abnormalities and deep-seated psychological problems in the most extreme cases of obesity should also not be ignored.

Solutions
Because of the broad range of factors contributing to the increasing prevalence of obesity, no single type of action or intervention is going to solve the problem. Simplistic health promotion messages merely telling people to eat more healthily will be met with extremely limited success. Research in health psychology has shown that these kinds of interventions are not particularly successful. The reason for this is probably that instrumental information (e.g. vegetables are good for my health) are not always the most important predictor of behavioural intentions and that behavioural intentions are often not a strong predictor of actual behaviour.

More comprehensive and detailed health education in schools would be more likely to be effective. The wide availability of cheap and readily available junk foods would still be a serious problem, however. Like it or not, health protective measures have to be taken which would either reduce the availability and advertisement of these products, or make it more difficult for people to afford them. That we live in a society in which McDonald's can sponsor youth football or sporting events such as the Olympics indicates that something is deeply wrong and that action is needed to limit the effects of such organisations on population health.