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Obesity In America: How the Social Norm on Weight Has Shifted

The phenomenon raises an interesting question: When the majority of us are overweight, isoverweight?
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When overweight celebrities like Drew Carey, John Goodman and Jennifer Hudson make headlines by losing (collectively) nearly 300 pounds, you realize how the social norm on weight has shifted. Being overweight, even 100 pounds overweight, does not trigger public discussion, but bringing one's weight into the normal range does. Indeed, these celebrities' weight loss triggered multiple articles in national publications.

The phenomenon raises an interesting question: When the majority of us are overweight, is anyone overweight?

How "normal weight" has skewed upward:

  • 70 percent of obese people say they are merely overweight
  • 39 percent of morbidly obese people think they are overweight but not obese
  • 30 percent of people who are overweight think they are actually of "normal" size

One way to instantly reverse the epidemic of obesity would be to revise the height and weight chart that currently defines the categories of normal weight, overweight, obesity, morbid obesity and super-morbid obesity. With a permanent marker, we would bring the categories into alignment with our self-perception. And as an added bonus: we would instantly and significantly reduce the worldwide epidemic of obesity.

This clever trick would not, unfortunately, eliminate the side effects of surplus pounds. Experts estimate that as much as 80 percent of chronic disease (cancer, stroke, heart disease and diabetes) is linked to weight, and weight is linked to lifestyle choices, such as not eating healthy food, consuming too much sugar and soft drinks and so on.

So if we aren't going to change the chart, then we'll have to change our behavior. But can entire communities orchestrate a massive change in eating behavior, much as we orchestrated a shift in our attitude toward smoking?

The number of overweight Americans (66 percent) exceeds the number of smokers 40 years ago (40 percent). Even then, smokers wished they could kick the habit as much as overweight individuals today wish they could drop a few pounds, especially now that we know extra weight carries health risks as dangerous as those associated with cigarettes. And like those who smoke find it hard to quit smoking, overweight individuals find it difficult to kick the habit of eating too much of the wrong kind of food.

Yet, thanks to a massive campaign involving legislation, product labeling and social marketing, nearly half the smoking adults have quit since 1965. Of those who continue, four out of five are actively trying to quit smoking.

When it comes to surplus weight, can we engineer a similar shift in the social norm? Can we help entire populations go from fat to fit?

That's the topic of a report titled "Obesity and the Economics of Prevention: Fit Not Fat," authored by economists under the auspices of the Organisation for Economic Cooperation and Development (OECD). OECD is a Paris-based 33-member organization (including the United States) that gathers statistics and research on economic, social and environmental issues among its members. The three-year obesity study resulted in a 265-page report whose purpose was to compare policies, articulate solutions to common problems and identify best practices.

Franco Sassi was the lead author, and the exhaustive report benefits from the insights and special contributions of leading economists in member countries as well as analysis of research spanning member and nonmember countries.

Obesity Will Weigh Down the U.S. Economy
The economists predict that by 2015, three-quarters of Americans will be overweight or obese and that this condition will drag down our economy and eventually impoverish us; however, we won't be alone. Given the speed at which the epidemic is traveling, globesity will trigger similar downdrafts on economies worldwide.

In responding to this impending crisis, the economists point out three obstacles that must be confronted.

The first obstacle results from the gap between want and need. Most individuals know that they need to eat for health, but what they want to eat is another matter. For example, we may need to eat fruits and vegetables, but what we want is another piece of pizza.

The second obstacle is the time gap between behavior and consequences. For example, if I put my hand on a burning stove and suffer a painful burn, I quickly learn not to put my hand on the stove. But if I eat a hearty steak, a loaded baked potato and a rich dessert tonight and the consequences of this style of eating are delayed 20 or more years, I lack the information and incentive I need to change.

The absence of immediate consequences results in a phenomenon the economists refer to as hyperbolic discounting; this is our tendency to discount the risks of current behavior as we move into the future. A good analogy would be paddling toward a waterfall in a canoe. We may or may not have a general fear of the waterfall when we start out, but after hours of quiet paddling without incident, we lose our sense of danger. We discount the future danger of the waterfall until the churning water is in full view and we cannot change course. By then, our options are limited, and our life is in jeopardy.

The third obstacle involves the absence of clear stakeholders with the power to implement policies that promote healthful behavior. For example, our government cannot unilaterally, quickly or easily regulate food consumption, production or marketing. Nor are food producers or retailers likely to alter their products given consumer demand. Health care providers are, for the most part, compensated for treatment rather than prevention. And pharmaceutical companies are under pressure to create drugs to treat diseases that are the byproducts of surplus pounds.

The economists conclude that no easy solution or coalition of stakeholders seems obvious or likely. Still, after reading the OECD report, I am not discouraged. Indeed, the report provided me an invaluable perspective on my own work and triggered a sense of optimism.

A Different Perspective
Six years ago, during the eight-week Nevada County Meltdown, over a thousand neighbors and friends joined forces to lose weight -- four tons to be exact. More by accident than by design, we involved all the stakeholders in the community: radio stations, local and regional television stations, the local newspaper, school officials, fitness center owners, businesses, restaurants, churches, medical professionals, elected officials, hospital administrators, weight-loss groups (like Weight Watchers and TOPS Club), civic leaders, service organizations, supermarkets, employers and others.

Most importantly, we transformed the social norm from one of being out of shape and sedentary to one where everyone seemed to be seeking fitness and weight loss. If residents went to a restaurant, they found that the restaurant had a Meltdown menu. Churches published team results and encouraged participation in their weekly bulletins. Everywhere, you saw individuals outside walking with buttons reading "Ask Me about the Meltdown."

Since our local pioneering event, over 400 group weight-loss events have been staged across the country, and I continue to be actively engaged in developing and supporting these community programs.

Trickle Down or Bottom Up?
An unstated assumption in the OECD report is that the solution to globesity will emerge from top-down agendas; that is, from government, food producers and retailers, pharmaceutical companies, health care providers or some combination of stakeholders.

What if the opposite were true? What if grassroots programs, such as the Nevada County Meltdown, ultimately provide the means and solution to reverse the trend toward obesity, or at least have an impact as great as, or greater than, top-down programs?

In his book "The World Is Flat," Thomas Friedman argues that globalization has leveled the playing field for businesses, thereby creating a new world order. I would take his thesis one step further and argue that the flat world concept applies to social and political institutions as well. Given the exponential leap in social media, solutions to global problems are just as likely to float to the top as they are to trickle down. Let's hope I'm right and that the solution to globesity bubbles up before we are hopelessly weighed down.

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