Beating Obesity: First Principles

Jumping off this article in the May issue of The Atlantic, I want to sketch out a few principles for what I think would be an enlightened, realistic approach to beating obesity. Here's where I'm coming from: I think the obesity crisis is real AND reversible; no one solution -- not banning high-fructose corn syrup, not soda taxes, not universal health care -- will be the panacea. Instead, a broad-based, metric-monitored national public health campaign, led by a strong political leader who has the authority and legitimacy to knock heads, can identify what works, what doesn't, and to persuade states, Congress, companies, and the culture at large to follow suit. I'm about additive solutions, not broad demonization, because additive solutions tend to work, and because selective demonization works much better.

What I worry about is that a generation of poor white, black, brown, and Native American kids will grow up obese, through no fault of their own, simply because they drew the short straw when it came to being born into families and settings that are able to resist the obesogenic environment. Obese people can be healthy, happy, and live long lives. But they tend not to -- at least not in comparison to the rest of us. In fact, they tend to suffer -- a lot more. So we must:
1. Recognize that what separates skinny people from fat people is luck, and not willpower. Either your genes or your unchosen social environment, will provide a shield against the pressures of the default obesogenic environment. If you're part of a chronically stressed population, have little or no access to quality public infastructure, find yourself growing up in a dysfunctional family, and have limited social mobility, the chances that you'll be able to summon some magical reserve of willpower is slim to none. If you're white, upper middle class, tend to be hopeful about improving your lot in life, and have the time and resources to diet and exercise, you might be able to find a weight loss regimen that works for you. Either way, don't give yourself credit, and don't blame other people who aren't as lucky.

2. End "food deserts" immediately. D.C.'s Anacostia neighborhood did not land its first real supermarket until just a few years ago; that alone constituted a public health advance, because it gave parents, for the first time, a regular and reliable source of cheaper healthier foods. Borrowing from pilot programs in Pennsylvania, states should provide incentives for grocery chains to situate themselves in food-impoverished neighborhoods and areas.

3. Deal with stigma on its own terms: so long as there are fat people, there will be fat stigma. Fat stigma is a dangerous health problem in an of itself. Since we collectively perpetuate it, we ought to collectively be more aware of how harmful it is, and channel that energy into stigmatizing those specific institutions and entities that actually make us fat and profit from doing so.

4. Accept that regulation is a necessary evil. The core dilemma involves young children who aren't mature enough to make decisions about food on their own, or who come from families or social environments that reinforce bad choices. Accepting incremental regulation that makes it easier for people without resources to make better choices is an acceptable trade-off, particularly when the health and happiness of millions of kids is at stake. I'm personally more in favor of advertising restrictions than higher taxes -- behavioral economic models are ill-suited to the obesity epidemic because incentive-tinkering will produce an unequal distribution of positive effects. It's easier to respond to incentives when you are making choices already. But the people I'm most concerned about -- young kids -- aren't just making choices. They're trying to grow up.

5. Give Michelle Obama everything she asks for. She is in many ways the perfect political leader for this cause. She embodies hope and optimism. This is so important, because one of the main reasons why obesity tends to strike members of American minority groups living in chronically stressed environments is that they tend to be pessimistic about the possibility of weight loss and about the effects that weight loss will have on their well-being, happiness, and status. Obama is a role model.