Aging Capriciously

Everyone knows or has heard that there is an epidemic of obesity in the USA.  The statistics are staggering.  The health problems associated with obesity are well known and cited often enough that if Tchaikovsky were alive, he would have written Symphony No. 7 in B Minor: Op. 74 “Obesity”.  “Physiologically, adolescents with obesity have an increased risk of developing adverse health outcomes such as type 2 diabetes, hypertension, elevated serum cholesterol and triglyceride levels, respiratory disorders such as asthma, and joint problems.”  — “Obesity Stigma and Bias”

I was at a party in Prague over 25 years ago and I was approached by a younger woman who sat down next to me.  She promptly asked me, “Why are so many Americans overweight?”  I gave the usual uninformed answer and replied, “Because they are lazy and do not exercise enough.”  This was part of my belief system back then and is probably still shared by many Americans today.  Since that time, Karen and I have traveled to several other countries.  I think we are at about 43 now.  Over the past few travels, we have noticed that not only the USA, but many other countries are also suffering from the same “Epidemic of Obesity.”  If it is a psychological problem of motivation and willpower, than a whole bunch of countries are suffering from the same lack of motivation and willpower.

“Obesity is a complex physiologic condition influenced by genetics, hormones, sleep, environment, cultural norms, and economics.  The oversimplistic assumption that obesity is a choice and can be “fixed” by moving more and eating less is outdated and inaccurate in the current science of obesity.  Over the last 20 years, researchers have begun to shed light on the multifaceted complexity of obesity.”  — “Obesity Stigma and Bias”

I started thinking about this problem more recently after observing some of the children in my high school classes.  I am a substitute at three high schools in Casa Grande Arizona.  I noticed that many of the kids are overweight.  Back sixty years ago when I was in high school, there might have been one or two overweight children in the entire high school.  Today the statistics say that as of 2023, 1 in 5 children in the United States are obese, and this number is increasing yearly.  The rates of obesity are higher for Latino (43%) and Black (40%) youth. — Obesity or Oveweight Now Affect 1 In 3 Youth: How Experts Are Responding.

I wondered how these children deal with this problem.  Has obesity become acceptable?  We now have many stores with Plus Size clothes and there is an entire industry of “Plus Size Models.”  Do these children feel the weight stigma that is allegedly associated with obesity?  If they do feel it, how does it impact their socialization, personal image, and mental health?  Are they blamed for being overweight as much of the research suggests?

“As the rates of overweight and obesity rise, weight discrimination in America has increased by 66% over the past decade and is equivocal to racial discrimination.  Perceived provider weight discrimination often causes individuals with overweight and obesity to be reluctant to seek medical help, not only for weight reduction but also for any health-related problems…Bias against those with obesity appears to be socially acceptable and is reinforced by the media.  Mass media has stigmatized obese individuals.  A review of research over the past 15 years related to weight bias in media has reported that many media sources such as animated cartoons, movies, situational comedies, books, weight loss programming, news coverage, and YouTube videos have represented individuals who are overweight and obese in a stigmatizing manner.” —  Obesity Stigma and Bias

How Can We Help People with an Obesity Problem?

Someone once told me that we are either part of the solution or we are part of the problem.  I have noticed that I am part of the Obesity Problem.  I have looked many times at obese people and thought “They need to get out and exercise more.”  I have been less than empathetic to their problems and less than supportive of their physical and mental state.  I have not been helpful.

“Obesity stigma is characterized by prejudiced, stereotyped, and discriminatory views and actions towards people with obesity, often fueled by inaccurate ideas about the causes of obesity.  Despite decades of research supporting the dominant influence of genetic and environmental factors in the development of obesity, in the public consciousness, obesity continues to be viewed as a result of individual-level decision-making.” — Obesity Stigma: Causes, Consequences, and Potential Solutions

In my opinion, the health experts have not been very helpful nor have our politicians.  We allow many of the sources of the problem to continue to add fuel to the fire.  These include inappropriate media images, stereotypes of obese people, purveyors of low-quality high-fat junk foods, poverty conditions, lack of health education in poor and rural areas and overall a political system that almost totally ignores the “Epidemic of Poverty” but is more than happy to spend billions of dollars on any war against drugs.  Starting with the war on heroin, then the war on alcohol, the war on pot, the war on cocaine, the war on crack, the war on methamphetamine, the war on oxycodone and now the war on fentanyl, we spend billions of dollars on drug enforcement and drug incarceration for those convicted of selling the drugs.  How much do we spend on health education in our schools?

“This summer, the war turned 52 years old.  It was June 1971 when President Richard Nixon declared drug abuse to be “public enemy No. 1” that required a “new all-out offensive” and additional government funding.

Since then, the country has spent more than a trillion dollars fighting drug use, according to some estimates.  That includes more than $39 billion the federal government spent last year alone, according to the Government Accountability Office. 

And, of course, illegal drugs and drug abuse are still very much with us.  In 2021, a Gallup Poll found 64% of Americans said the nation’s drug problem was “extremely serious” or “very serious,” though the primary scourge changes.  In the 1980s, cocaine and crack cocaine were the dominant stories.  In 1989, President George H.W. Bush held up a bag of crack cocaine during his first White House address and announced the war on drugs would be a primary focus of his time in office.” — Costs in the war on drugs continue to soar, NBC News

This article does not say anything about the costs spent fighting heroin or pot or alcohol long before some of these other drugs became “epidemic.”  I wonder what “prohibition” would have cost in today’s dollars?  As for health education, who has ever heard of a “War on Obesity.”  The obesity problem kills more people than drugs, but it would not benefit our economy to wage such a war.  “According to the National Institutes of Health, the obesity epidemic is responsible for an estimated 300,000 deaths per year.  The World Health Organization (WHO) estimates that at least 2.8 million people die from being overweight or obese each year.”  As for the comparison figures for the “Fentanyl Epidemic” the overdose death rate topped 112,000 in a 12-month period ending in December 2023 according to the Centers for Disease Control and Prevention.

You may wonder where I am going.  From obesity to drugs and back to obesity.  Well, what if the two epidemics are related?  What if there is not really two epidemics but one huge epidemic?  What if one is correlated with the other or what if one even causes the other?  Could the stigma of obesity lead to more drug use or could more drug use lead to more obesity?  What if all the money we spend on arresting drug users adversely impacts the health of poorer communities where most drug abusers seem to come from?  Is there any possibility that the two epidemics are related?  Consider the following:

“Since the declaration of the U.S. drug war, billions of dollars each year have been spent on drug enforcement and punishment because it was made a local, state, and federal priority.  For the past half century, the war on drugs has subjected millions to criminalization, incarceration, and lifelong criminal records, disrupting or altogether eliminating access to adequate resources and supports to live healthy lives.

Drug offences remain the leading cause of arrest in the nation; over 1.1 million drug-related arrests were made in 2020, and the majority were for personal possession alone.  Black people – who are 13% of the U.S. population – made up 24% of all drug arrests in 2020.”  — How the war on drugs impacts social determinants of health beyond the criminal legal system, published online 2022 Jul 19.

Do you think it is a coincidence that Black people suffer the highest rates of obesity in the USA and are also targeted the most for drug related offences?  It is much sexier to arrest, try and convict a person for a drug related offence than to work to change a system that systematically poisons people with unhealthy foods.  Our drug enforcement system keeps lawyers, police, and judges employed.  Our nutrition system if you can call it that employs millions of people to sell junk foods in fast food restaurants and grocery stores.  Obese people are part of a system that promotes obesity and drug use.  Make no mistake at that.  As my mentor Dr. Deming used to say, “Put a good person in a bad system and the system will win every time.” 

We need more than a drug war and more than health education to fix the ONE large epidemic in America.  We need to have a war on a callous system that condemns millions of people to prison and death all in the name of selling things.  Our purveyors of unhealthy foods are just as guilty of being “Drug Pushers” as anyone selling fentanyl in a back alley.  The only difference is that “Fruit Loop” cereal is legal and legally spends millions of dollars on advertising each year while fentanyl is illegal and unadvertised.