The Moral Urgency of Obesity

The argument for government and collective action

"If you go with the flow in America today," says Thomas Freiden of the CDC, "you'll end up obese." He means that obesity is a side effect of progress. But not just progress: a particularly Western version of progress that we're exporting to the rest of the world. Enormous advances in food preparation and cultivation technology. Media culture and sedentary lifestyles that participate in it. A collective choice, perhaps embedded in our country's frontier roots, to keep expanding, to act as if nothing is too big to fail.But there have been consequences. Our bodies were programmed to convert sugar into fat and store it long before Euripides made fun of fat people; fat people have been around since humans have been walking the earth. But obesity is something different. It is an extreme manifestation of the condition of being fat, and it's been around for about 30 years. Yes, obesity becomes a "something" when scientists and policy-makers decide to call it a something, but reliable enough records exist to show that whatever this thing is, its nature changed dramatically as the age of Ronald Reagan began. (I'm not blaming Reagan, Mr. Norquist, so keep your gun in your holster.)

When you go back to that juncture in history, a lot of different things happened; a lot of choices were made; a lot of forces intersected. The chronic stress of people who live in the inner cities, in ghettos, or in desperately poor rural areas intersected with the availability of cheap, emotionally satisfying and physically pleasing food. A generation of children born into dysfunctional families themselves began to have children, and didn't -- couldn't -- raise them to eat properly. The ubiquity of advertising, Congress's deference to industry, enormously wasteful corn subsidies, the microwave and the VCR, social stratification, rising incomes and unequal access to material resources like good health care and doctors were all factors, too.

What's the moral case for justifying our attention?

Think, for the moment, of what images come to mind when you hear the word obesity. Most people, I am guessing, tend to think of a very fat adult or those television images of people's large torsos walking around (to illustrate obesity stories). When we think about adults and food, we think about choice and agency. But let me ask you, my reader, to reframe obesity in your mind's eye.

Think of a kid. A working class kid. Maybe he's black or Hispanic, or pale while. She or he is standing inside a very dark room, so you can't seem her or him. Then she walks out the door. Suddenly, cymbals start to crash and the child becomes afraid and experiences stress; an unending inner monologue begins urging the kid to "eat, eat, eat"; think of arrows sending pulses to the child's brain insisting that they consume more and more; think of a table of food in front of the kid, who has a few bucks to spend and can only buy the cheapest stuff; this new room is also a 360-degree high definition media experience, with television commercials tempting the kid by linking toys to the food on the table; think about the parents...where are the parents? They're at work; both of them; two incomes are needed to maintain a standard of living. Think of self-hatred and self-reinforcing stigma. The kid lives 24/7 outside the dark room, and grows up. Unless his or her genetic code has a lucky guanine where others have an adenine, there's a good chance -- soon to be a better than even chance -- that the kid will be fat or obese by the time he or she is in the second decade of life.

Obese people can live happy and fulfilling and even healthy lives. Many chronic illnesses that accompany obesity or result from it can be treated by modern medicine. But chances are, the person will experience much more misery than they otherwise would. Chances are that they will develop painful and debilitating illnesses. Chances are that their lives won't be very happy.

This is what obesity really is. This is the flow of American life. And while many of us can find ways to walk against the current, most of us who don't have an hour a day to exercise, or access to a nutritionist, or Pilates class, or who can't travel too far from our houses lest we become victims of a crime, or who didn't have parents who knew how to nurse us properly, or who partake in the school lunch program -- we just go with the flow. We're not making that choice. It's being made for us, thanks to -- well, so many different things, but deliberate policy decisions by our government being among them.

So the social inequity is apparent. So is the degree to which productivity, in a macroeconomic sense, is lost to obesity. So are rising medical costs.

If we can, from a governmental, parental, academic, cultural standpoint intervene in a way that can help kids before they become obese, we ought to do so, especially because the obesogenic environment that they grow up in is the result of collective choices we've already made. Fixing this problem does not involve radical changes to our politics or to our identity as a country. It will involve some money, but not all that much. And it will require concessions and compromise from everyone -- including industry. And it will require a will to resist the inevitable challenges to change, even small ones, like the line items I'm proposing below.

Later today, tomorrow, ten modest proposals to reduce the obesity epidemic.