Overcoming the Overweight We Keep Overlooking

We can overcome the prevailing threat of obesity, but first, do need to stop overlooking it under our own roofs. We can overcome oblivobesity if we understand the tendency at its origins. When all is said and done, generally more than enough has been said, and not nearly enough has been done.
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The New York Times has attributed the term "oblivobesity" to me, and rightly, so far as I know; I did, indeed, coin the expression. It refers to the overweight under our own roofs that we are prone to keep overlooking, most notably that in our own children. But frankly, I would much prefer to help fix this problem -- and problem it is, since where there is more obesity, there is more serious chronic disease- than come up with cute things to call it. This, then, is dedicated to that more meaningful enterprise.

There are generally two prerequisites to fixing any problem: acknowledging the problem, and understanding it. In this case, we really have two contingent problems with which to contend: obesity itself, and the oblivobesity compounding it. Fixing obesity likely depends partly on fixing oblivobesity, so let's start there.

I can think of four salient reasons for oblivobesity, all surmountable, and none cause for shame. Here they are, in no particular order.

1. For whom the bell curve tolls.

We tend to recognize any crisis as a departure from the norm; if it were normal, after all, it wouldn't qualify as a crisis. That makes slow crises both particularly insidious and particularly intractable, because they alter the norm as they creep along. Frogs, famously, will contentedly boil to death in a kettle provided the water temperature is turned up just one degree at a time. That tale is usefully precautionary even if apocryphal, and reverberates rather ominously through the accumulating changes to our climate. But the crisping of California followed by its submergence in the Pacific is another's day worry.

In the case of obesity, as average weights rise around the world, generally accompanied by a penchant for ever-looser fashions, we simply acclimate, and compare ourselves and our kids to the new normal. Heavy may be absolute in terms of health risks, but the perception of heavy is certainly relative. One reason we may overlook overweight in our kids is because everyone else's kids are at least that heavy. But let's recall those frogs, beware the danger that this way lies, and apply our parental eyes a bit more discerningly.

2. Our mothers' mothers.

Throughout most of human history, calories were relatively scarce and hard to get, and physical activity was unavoidable (it was called survival, rather than Zumba). We have devised a modern world in which physical activity is scarce and hard to get, and calories are unavoidable. Houston, we have a problem.

Fundamentally, we have no native, biological defenses against caloric excess or the lure of the couch, never having needed them before. But more hopefully, we have no cultural defenses either. That's more hopeful, because unlike genetics and biology, culture is a medium of our devising and can be changed -- any time we choose to wake up, smell the Slimfast, and snap out of it.

Our mothers' mothers encouraged plate cleaning, like their mothers before them, because the age-old threat to human children was starvation, not obesity. That ancient maternal lineage echoes in our heads to this day, and to this day, many parents encourage plate-cleaning by kids far more prone to type 2 diabetes than kwashiorkor. Old habits die hard, but if we acknowledge them --- we can consign them to the dustbin of obsolescence, along with yesterday's iPhone; and move on.

3. If it ain't broke...

One potential translation into the vernacular of medicine's prime directive- primum non nocere (first, do no harm)- is that we shouldn't fix what ain't broke. One reason for any of us to overlook overweight is that if we don't acknowledge it, there is nothing broken, and thus nothing to fix. That is a particularly, if subconsciously, tempting alternative when we don't feel we know how to fix it in the first place. There is something of a Catch 22 contributing to the global obesity pandemic in adults and children alike: we will never fix it if we don't acknowledge it, and we are disinclined to acknowledge it because we don't know how to fix it. Actually, we do- but we'll get back to that momentarily.

4. Enough about you.

Obesity tends to run in families, partly because of genes, but largely because the environmental and behavioral factors that matter most also run in families. Families that are very active and eat well tend to avoid obesity in parents and children alike. Families that do otherwise tend to have other outcomes.

What all this means is that the parents most prone to oblivobesity are also most prone to obesity themselves. Acknowledging the issue in one's child may therefore obligate acknowledging the issue in oneself (i.e., enough about you, let's talk about me...). Unless you are motivated to change your own diet and activity pattern, that may constitute the lid you prefer to leave on Pandora's box. Or, for those of my generation, it may remind of Fred Sanford's proclivity for putting unopened bills back in the mailbox. Either way, overweight parents may be disinclined to notice overweight in their children- because of shame, self-recrimination, a disinclination to change all that would have to be changed, intimidation, procrastination- or any variation on this theme.

These, then, are the salient reasons for oblivobesity. What to do about them?

First, once we acknowledge that obesity is hyperendemic, the default presumption is that our own family is affected, rather than unaffected. We should accept that, and also accept that we are all in this together.

Second, we need to differentiate strictly between blame for the problem, and responsibility for the solution. None of us is to blame for being born in a given era. Only in this era is obesity a prevalent threat. But we are all obligated to respond to the exigencies of our own time. We can all thus embrace some shared responsibility for overcoming the peril of obesity, without blaming ourselves or one another for the problem in the first place.

Third, we need to accept that fixing obesity can be hard without being complicated. There are rare cases of extreme weight loss resistance and such, but by and large, we can lose weight and find health by eating well and being active. Really. Being active is clear enough, and eating well- despite all the railing to the contrary- is also well established, and well understood.

Fourth, we can manage the third on our own, or together; and together is better. Armed with what I like to call skillpower, we can get to health in spite of it all. But why should we have to do so? Why should we have to struggle for portion control in a world where, as Michael Moss so incisively tells us, foods are literally engineered to maximize the calories it takes to feel full? Some of the best defenses of the human body reside with the body politic, and we would constructively navigate past competing ideologies and nanny-state concerns to acknowledge that. Personal and collective responsibility are not mutually exclusive. Why should parents have to struggle to feed children well, even as our culture peddles multi-colored marshmallows as part of their complete breakfast? At some point, it's essential to call profit-driven hypocrisy just what it is, and rectify it accordingly.

Fifth, this all needs to be about family, and love. The solution to a child's overweight is generally neither about weight, nor the child. It's about a family, looking out for one another. It's about people who share everything that matters most in life, sharing the behaviors that matter most to the length and quality of life. It's about unity and strength; love, not judgment; vitality, not pounds.

We can overcome the prevailing threat of obesity, but first, do need to stop overlooking it under our own roofs. We can overcome oblivobesity if we understand the tendency at its origins. When all is said and done, generally more than enough has been said, and not nearly enough has been done. In that spirit, I am much less interested in neologisms than in figuring out new ways to get there from here.


Director, Yale University Prevention Research Center; Griffin Hospital

Editor-in-Chief, Childhood Obesity

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