That we’re feeling powerless to turn this public health crisis around, but the physical and emotional health of our country and the financial impact of obesity do not afford us much time.
We have effective interventions to prevent and treat obesity. More people need access to affordable versions of those interventions, and we need a strong partnership with the food industry.
Obesity can be a very stigmatizing condition. Unfortunately, our society blames and shames individuals with obesity.
The way we see and treat people with obesity is very personal for me. I watched my single, working-class mother deal with lifelong problems associated with obesity. Sadly, these contributed to her death just a few weeks ago.
Please let me help by sharing what we know and what can be done about obesity. Long-term success in preventing and treating obesity requires substantive changes that can be demanding and difficult. It is, however, much more comfortable to face these challenges together.
Decades of research tell us that people who are obese have elevated risks for significant health conditions, such as diabetes, hypertension, and heart disease. Obesity also increases the risk of stroke, certain cancers, osteoarthritis, asthma, obstructive sleep apnea, and orthopedic problems.
Also, obesity is related to systemic inflammation, which increases physical pain in our bodies. When one has these obesity-related diseases, like my mom, they are often taking a lot of medications and receiving a large amount of health care services. Obesity places an incredibly heavy burden on our health care system. The best estimate for medical costs associated with obesity for adults aged 18 and older in the U.S. was $342.2 billion.
While the physical health consequences of obesity are clear, the mental health effects are less well understood. Many of the mental health consequences depend on how an individual identifies him/herself. In other words, perceiving oneself as obese is what is associated with an increased risk of depression and even suicidality.
The person who sees themselves as obese is ingesting and internalizing society’s devaluing views. Obesity stigma is getting under the skin and into their psyche, weighing them down with self-doubt and shame.
Last summer, at the age of 72, my mom said, “I have no willpower.” She didn’t feel that she could stop herself from binging on large amounts of unhealthy food. A lot of people, and some health professionals, mistakenly assume that a lack of determination and the overconsumption of food are the sole causes of obesity.
I tried to explain to my mom that there are numerous contributing factors. Like many Americans, my mom had a very sedentary lifestyle, spending hours sitting and watching TV. She didn’t cook healthy meals for herself. Instead, she consumed hyper-caloric processed foods and drank a ton of sugary beverages.
My mom couldn’t tackle obesity on her own. No one can. Often the solutions my mom chose were too-good-to-be-true. Like most people, when she reached her short-term weight loss goals, she would quickly regain most of the weight. This cycle of little progress and quick fall back set her up for further failure and demoralization.
Similar to many Americans, my mom couldn’t afford meal plans or a gym membership. Despite my husband and me paying for a membership and a certified fitness trainer, my mom was unable to maintain her motivation to go.
I couldn’t convince my mom to work with a health partner to establish a personalized health action plan. If she had, she would have learned that there are often psychological reasons at the root of problematic eating. Much has to do with a person’s ability to manage their emotions.
When we feel depressed, angry, anxious, or bored, we frequently reach for food to soothe our emotional pain. For some, food is tied to comfort and connection. One might say these individuals are starving for soothing and affection and use food as a substitute.
If my mom had agreed to attend an evidence-based treatment program, she would have learned to identify the physical reasons for eating, and how to recognize what the sensations of hunger and satiety felt like. She would have learned to spot her emotional states before eating and find alternative ways to manage them.
This could have helped her reduce, and over time eliminate, her unhealthy eating behaviors. Of course, her plan would have also included changes in diet, exercise, and problem-solving on how to move more. But, these kinds of programs can be costly, and her insurance might not have covered it. Even then, it probably would not have been enough.
Dr. Robin Masheb, a professor and clinical psychologist at the Yale School of Medicine, has spent the past 25 years researching obesity and eating disorders. As the founder and Director of the Veterans Initiative for Eating and Weight (The View), she started the first and only national program dedicated to addressing the broad spectrum of eating and weight problems in the Veteran population. Over the years, Dr. Masheb has figured out what works to effect positive change.
She says, “The obesity crisis in our country is a problem that’s still growing. Solutions focused at the individual-level are just not enough. We live under environmental conditions that allow industry practices and systemic issues to override individual choices that prevent obesity. We need to prioritize legislation and regulatory practices that create healthier defaults in schools, supermarkets, and society at large.
In the previous U.S. presidential administration, there was a substantial public awareness effort targeting obesity prevention by improving the availability of healthy food and physical activity for our children. T
hese programs have shifted from the limelight as apathy toward obesity has set in. There figuratively is no one minding the candy store. We need to come together as a society and recognize that obesity can only be addressed if we engage in change at the systems level.”
I agree. As a society, we need to do something comprehensive about this crisis that goes beyond the individual. And, for the sake of our children, we need to do it now.
To optimize health and reduce the financial burden on our nation, in terms of higher health care costs and lost productivity, we need to recognize that obesity is a complex chronic condition that requires a team approach.
First, we need to invest more money upfront on these evidence-based programs to prevent obesity and manage it rather than driving up the cost of health-care utilization after the fact. Second, we need to address weight stigma and bias in this country, and at the same time, help people engage in positive change.
Finally, we need to address the systemic issues in our food landscape by increasing healthy food choices in our schools, supermarkets, and restaurants, and discouraging unhealthy decisions, such as sugary drinks and high-fat snack foods.
These changes won’t save my mom, but they may keep you and yours.
Joan Cook is a psychologist, and associate professor at Yale University who researches traumatic stress and clinically treats combat veterans, interpersonal violence survivors, and people who escaped the former World Trade Center towers on 9/11.