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Michael Kirkpatrick


OPINION

Obesity: Is personal responsibility the answer?

By James F. Sallis
April 9, 2004 (B-7) Obesity is becoming a defining issue in the United
States. So many children are now overweight that "adult" diabetes is an epidemic
that foretells long-term suffering of individuals and enormous medical costs for
the nation. Two-thirds of adults are now overweight, and the rate continues to
increase. It has taken the federal government a couple of decades to decide
obesity is a problem, but the government's strategy is now becoming apparent.
The House of Representatives recently passed the "Personal Responsibility in
Food Consumption Act." The law would prohibit lawsuits holding restaurants
liable for their customers' obesity. Last month, a Department of Health and
Human Services representative objected to the World Health Organization global
strategy to combat obesity by stating that the administration insisted on
emphasizing personal responsibility instead of policy changes. On the day of the
announcement that obesity and inactivity are now rivaling tobacco as the No. 1
cause of death, the Department of Health and Human Services began a public
service ad campaign to encourage people to move more and eat less. One clever TV
spot encouraged people to take the stairs to help them lose their "love
handles."
These three apparently separate government actions define an approach to what is
quickly becoming the most deadly and most costly health problem in the country.
It is clear that the main strategy _ perhaps the only one _ is to promote
personal responsibility for eating and exercise choices. Much can be said in
favor of this approach.
Paraphrasing a recent statement from the president of the National Restaurant
Association, it is obvious that everyone can freely choose whether, what, when,
where and how much to eat. We also decide every day whether and how much to
exercise.
Encouraging more healthful choices does not restrict any freedoms. As a health
psychologist, for years I have studied programs to teach people behavior change
techniques that help them make more healthful choices.
There are many programs that significantly help people improve their lifestyles.
Over the years people have reduced their fat intake, and there have been small
increases in exercise levels and fruit and vegetable intake, proving the
population can change.
It sounds like everyone agrees that helping people make more healthful choices
is the way to go, so the government's strategy should be endorsed.
But there is another side of the argument. Although teaching behaviorial change
skills can be effective, many of us who develop and study these programs for a
living have realized a number of limitations.
First, although many well-designed programs have significant effects, even the
most motivated participants do not change, and changes generally are modest.
Second, most people do not want to participate in programs offered by work
sites, health care organizations, schools and the Internet. Behavior change
takes effort, and people prefer to use machines that promise "exercise without
effort," pills that make unsubstantiated claims and fad diets.
Third, the biggest problem is that most changes don't last. About 50 percent of
exercisers drop out after a year. Diets go back to normal after programs end.
Success rates five years after behavioral obesity treatments are usually in the
single digits.
Even though we have been promoting physical activity since the 1970s, only about
12 percent of adults claim to do regular vigorous exercise, and about 30 percent
admit they do no structured activity. A consensus is developing among health
scientists that the obesity problem is so widespread that programs promoting
only personal responsibility will never be sufficient to control the epidemic.
Why does the personal responsibility approach not work better? To begin with,
food choices are not entirely free. From birth, humans have biologically based
preferences for sweet and fat foods, and these both drive consumer demand and
constrain choice. The food industry is built around these preferences.
Not only are sweet and fatty foods vastly cheaper than nutrient-rich fruits and
vegetables, but they are almost the only foods that are advertised. Take a look
at the food ads on children's TV sometime and try to find an ad for something
that is not sweet or fatty.
It is clear to most of us that children are not able to make rational choices
about foods, so foods ads can be considered exploitation. In an area of soaring
childhood obesity, this is no longer acceptable.
Although individuals do need to take responsibility for what they put in their
mouths, what about the responsibility of food companies? Is it responsible to
heavily promote foods of low nutritional value to children and adults? Doesn't
this make it more difficult for people to make healthful choices?
But people have free choice when it comes to physical activity, right? No one is
chaining us to easy chairs, but a wide variety of companies spend a great deal
of money to make it easy for us to be sedentary and difficult to be active. The
billions of dollars spent on ads for TV shows, movies, DVDs, computer games,
professional sports, cars and computers tell us how great it is to sit.
How many ads are there encouraging us to take responsibility to be active? Very
few. When some people want to go out and take a walk, they find tree-lined
sidewalks, well-lit trails and attractive parks. But when too many Americans go
out their doors, there are no sidewalks or trails, the streets are filled with
fast traffic, there are few safe street crossings and the parks are run-down.
Numerous studies show that people walk less in suburbs built on the assumption
that people would drive everywhere. We have invested trillions of dollars to
maximize the convenience of auto travel, with very little consideration given to
making our streets safe and attractive for pedestrians. When we design for
pedestrians, we find people walk more.
We know eating and physical activity are not driven only by personal
responsibility. We have created environments that make it difficult to make
healthful choices. A national strategy that addresses only part of the problem
is likely to fail, and the stakes for failing to control obesity are too high.
We need to motivate and help people make healthful choices, but we also need to
create environments that make the healthful choice the easy choice.
We have a long way to go on both of these goals. The nation cannot afford to
politicize the debate over personal versus societal responsibility for eating
and physical activity. Individuals, families, community and faith-based
organizations, corporations, and governments all must take responsibility for
contributing to the solution of this national problem.

Sallis is professor of psychology at San Diego State University. He is studying
approaches for improving physical activity and eating habits and is co-author of
"Physical Activity and Behavioral Medicine" (Sage, 1999).





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