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A prominent political reporter digs into the obesity epidemic

Political reporter Marc Ambinder of the Atlantic has a new must-read piece on the obesity epidemic. Ambinder comes at the issue from the perspective of a former obese person, though he himself notes that his "cure" of bariatic surgery is risky, expensive, and one that can't be considered a blanket solution for the general population.

He also raises the chilling but very real possibility that the current generation of the medically obese (i.e. those with a body-mass index reading of over 30) may never succeed in returning to a more normal weight. Scientists have learned how tenaciously the body guards its resources, even when body weight far exceeds what's needed for survival.

But Ambinder is not without hope. In fact, he also wrote an accompanying blog post summarizing his priority list for tackling the problem. And two of his elements refreshingly face the often overlooked issues of class and stigma head on:

  • 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 infrastructure, 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.
  • 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.

This issue of luck is crucial. The food industry and others who hate regulation want the debate to revolve around personal responsibility. But if just doing the "right thing" isn't enough, i.e. if obesity could happen to anyone, then it’s harder to argue against universal policies to address it. It's easy to get caught up in the science and forget these larger, more psychological factors. Indeed, anti-obesity stigma and the cult of personal responsibility interact in pernicious ways. It’s hard to have much desire to help those you stigmatize. Understanding the amplifying nature of these two trends is crucial.

Meanwhile, the article itself includes some of the first indications that Michelle Obama’s Let's Move anti-obesity initiative may turn out to be a velvet glove over an iron fist:

A few weeks after Obama announced her plan, I asked Susan Sher, her chief of staff, whether the first lady was trying to encourage cooperation, rather than attacking the industry for, say, advertising. “It is clear that this is just a first step, and for example, the totally voluntary commitment that the beverage industry made is a terrific first step,” Sher told me, referring to a recent agreement that would put calorie counts on the front of soda bottles and cans and on vending machines. “But the FDA may have more-stringent requirements in the future, so I think that everything that’s happened so far shouldn’t be viewed as the end of the game in any respect. We didn’t make demands, and I think that the first lady is very clear that that is not her role, that you have a lot of federal agencies involved in regulations — the FTC will probably have a say about this as well, in terms of advertising. So this was really a lot of industry deciding, at least at some level, ‘We want to be part of the solution, not just part of the problem.’” A few weeks later, the FDA—led by Margaret Hamburg, another New York City veteran with a strong nanny streak—warned 17 food manufacturers that their food labeling made misleading health claims that needed to be corrected. This was the most significant FDA enforcement action on such matters in more than a decade.

Perhaps the Obama administration's strategy for this policy will mirror the health care negotiations -- make the effort to cooperate, even coopt the other sides issues (like the need to show some amount of personal responsibility) and when that all proves insufficient, tax, regulate and otherwise act decisively. Ambinder ends with the same question we all have about obesity and the White house: Is Michelle Obama willing to take the gloves, velvet or not, off?

Editorial Notes: The connection between fossil fuels, cheap industrialized food and obesity is a striking example of how cutting back improves health and happiness. The Ambinder is available online at The Atlantic: Beating Obesity. -BA

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