Obesity Interventions (Katherine Turner)

Katherine Turner at Dating God has posted a paper that takes an integral look at the obesity issue. It seems like a good thing to post here.

Here is the article link and the paper. If you like what you read, please stop by her blog and let her know. I am also interested in reading any comments anyone might have.

Obesity Interventions: The Politics of Fat

The Belmont Report states that when research is designed to evaluate the safety and efficacy of a therapy, if there is any element of research in the experimental activity, the activity should undergo review for the protection of human subjects. It also says that in the pursuit of science, we should practice beneficence, making efforts to always go beyond the boundary of obligation to secure well-being for all scientific participants (NCPHSBBR, 1979). The Public Health Code of Ethics asserts that “identifying and promoting the fundamental requirements for health in a community are a primary concern to public health” and “public health should advocate and work for the empowerment of disenfranchised community members, aiming to ensure that the basic resources and conditions necessary for health are accessible to all” (APHA, 2006). If these ethical principles are combined together when looking at issues of chronic disease, specifically obesity, what is revealed is that addressing the health issue head on, much less solving the problem of it altogether, is tricky
business in the current commercial climate of The U.S. in the early 21st century. It also begs the question, is obesity a health behavior or simply a symptom of health reactions?

According to the CDC, chronic disease is one of the top ten health topics in our current medical climate, with obesity as one of the top three chronic illnesses. Our current population levels of obesity, 30% for adults and 16% for children, are considered epidemic, and the numbers grow larger every year. One of the 2010 national health objectives is to reduce the prevalence of adult obesity to less than 15%, but current data indicate that obesity rates are increasing rather than declining (CDC, 2006). A key reason for our inability to even stabilize the disease it that we understand so little about it, perhaps other than the fact that obesity is only one aspect of a cluster of many other health problems like renal disease, chronic stress, CVD (cardiovascular disease), immune disorders, psychological illnesses, and many others.

What makes obesity so difficult to study are the seemingly countless variables that are associated with it. The peptide leptin, insulin resistance, and neurotransmitter levels are just a few genetic variables thought to possibly contribute to obesity. There are a variety of social issues involved including what our family will and won’t eat, eating alone or at social events, eating while on the run from home to work to errands. Culture, the one we are born into and the ones we adopt along the course of our lives, plays a tremendous role in the amount of fat, sugar, salt, and calories that we consume. The environment plays a role in what foods are available and where, how much they cost, how they are packaged and presented, whether they are vibrant and full of nutrition, or full of pesticides and preservatives. How active we are is determined by financial status, the amount of free time we have, the structure and form of our built environment. Obesity results from a combination of these things, though which ones and how much each one is weighted is anyone’s guess.

So how do we study the impact and importance of these variables? This is the big question, and also the place where the ethical dilemmas began to make themselves known. In terms of obesity and how to study it, it obviously isn’t ethical to experiment on humans in regards to feeding. You can’t take a cohort of normal weight children of differing sized parents, differing social, and physical environments, give different diets over the span of their lifetimes to see who becomes obese who doesn’t. So far, the most that we can do are animal experiments, such as the ones being conducted on mice in regards to leptin levels (the ethics of which we won’t even touch on in this paper), mildly controlled studies involving diet and exercise, or attempts to find the closest we can get to a controlled environment already occurring in an individual or group’s lives, and then study as closely as we can.

“People and their physical environment are interdependent. People depend upon the resources of their natural and constructed environments for life itself” (APHA, 2006).

One of the biggest issues with obesity and the low SES population is financially what they are able to afford to purchase for food, and the quality of food that is available to them. Lower income neighborhood stores tend to stock less fresh fruits and vegetables, and foods higher in refined carbohydrates, sugar, and fat. It would be easy to fault storeowners for stocking such unwholesome food, but in fact the more refined food has a longer shelf life, and is much easier to stock and manage than fresh food. And if refined foods high in sugar, fat, and calories are what is most available, and are also the least expensive, can we really blame the poor, or expect them in any way to change their eating habits based on recommendations put forth by departments of health, the results of scientific study?

There is also the built environment to contend with. We now live in a predominantly automobile accessible-only world, and in fact, most suburban roads no longer even have sidewalks, or safe pedestrian crossing at intersections. Low-density zoning in combination with single use zoning means that the links between residential areas and commercial areas are accessible only by car or at great inconvenience and compromised safety (Ewing, 2006). According to Ewing (2005), environmental factors such as economic influences (cost and access), neighborhood safety (perceived and objective), and transportation opportunities play as much of a role in BMI (body weight status) as do genetic, SES, social factors, and other individual characteristics. Ewing also speaks to how sprawl relates to BMI, and his 2005 study showed that there is a 6.3-pound difference between the least and most sprawling counties in the U.S. for the average adult. 6.3 pounds may not seem like a lot, but as this is the average, picture how this shows up when those of average or underweight are factored out.

There is also the marketing environment to factor into the obesity equation. Many studies have shown that advertising is a powerful psychological tool, and food is a fiercely marketed commodity in our country. All holidays and special occasions now have some sort of candy associated with it, including everything from Valentine’s Day, Easter, to Super Bowl Sunday. McDonald’s and breakfast cereals are marketed directly to children. Processed, nutritionally deficit foods such as “energy” drinks and bars are marketed to teens and on-the-go adults. All the while, commercials show healthy, vibrant, thin people consuming these foods. The public is hypnotized by these mixed messages, and while quite possibly mentally able to see that they are being manipulated, on the subconscious level, most seem incapable of quelling the urge to purchase the cookies, the fries, the convenience foods they see advertised on billboards, in magazines, in the middle of their television shows, everywhere their eyes might land for a few seconds during the course of their day. Can we blame them for their food addictions, the resulting health problems and obesity?

“Humans have a right to the resources necessary for health” (APHA, 2006).

As a possible way to both generate revenue, and make it more challenging to purchase, the idea of a ‘sin tax’ has been raised in regards to junk food, much like what is being done with tobacco and alcohol. Some say that a junk food tax could be used in part to subsidize fruits and vegetables, make them more affordable to those with lower SES. Junk food tax revenue could also be used to help lessen the spiraling health care cost burden, a burden that is directly effected by the low quality food that most of us consume on a daily basis that erodes our health.

Another added bonus to having a ‘sin tax’ attached to junk food is that is further breaks down the illusion that junk food is food, but rather acts as a drug in the human system, much like tobacco, alcohol, cocaine, etc. People tend to view a drug is a new, foreign agent introduced into the body, which then sets off a chain of reactions, some pleasurable, some damaging to the system. But the fact of drugs is that they are simply what the body generates for itself on a daily basis, just introduced into the body in such great quantities that the body’s delicate chemical balance is thrown off. Heroin, for example, operates on the opiate receptors of certain neurons, and the withdrawal that occurs in the wake of quitting heroine is in direct proportion to the time it takes for the body to begin producing it’s own endogenous opiates (Wagner, 2005).

Refined sugar acts on the body in a similar manner. The body requires sugars for fuel. Refined sugar is simply pure glucose, without any of the fiber or protein that usually accompanies it and slows down its release into the blood stream. Junk food is predominantly full of refined sugar, and a person who is eating a regular supply of it has become addicted to the rush of pure glucose entering their system, and the resulting insulin release causes the sugar levels in the blood to plummet, setting into motion withdrawal symptoms, and sugar cravings begin, a vicious cycle created that wreaks havoc on every system in the body.

Why shouldn’t junk food be treated as a drug, levied as a drug, regulated like a drug? In the human body, it acts like one, with the same devastating circumstances.

“Knowledge is important and powerful” (APHA, 2006).

The ethics of obesity interventions lay not so much with the interventions themselves, but with how we view obesity, the nature of what causes it, and the way that we insist people respond to the ‘treatments’ we’ve devised to help them. Would we expect a heroin addict to be likely to stay off heroin is it were present in every store, at every social gathering, whose goodness, pleasure and supposed health were
advertised in every aspect of media? Obesity shows up in the individual, but fat isn’t so much a personal problem as a social one, and if anything is to be done to halt this new epidemic, we have to change how we view it. Because ultimately, we all pay for the fallout of this disease, we all lose.

References

American Public Health Association. Public health code of ethics. Retrieved from: http://www.apha.org/codeofethics/ethics.htm

CDC. Overweight and Obesity. Retrieved from: http://www.cdc.gov/nccdphp/dnpa/obesity/

Ewing, Reid. (April, 2005). Can the physical environment determine physical activity levels?Exercise and Sport Sciences Reviews, 33 (2). 69-75.

Ewing, Reid. April 4, 2006. Obesity and the built environment: the evidence to date. Lecturefor National Public Health Week, SUNY Albany School of Public Health.

The National Commission for the Protection of Human Subjects of Biomedical and BehavioralResearch. (April 18, 1979). The Belmont Report: ethical principles and guidelines for the protection of human subjects of research.


Wagner, Christine. (Fall, O5). Substance Abuse and Addiction. Biopsychology APSY214.