“How far will society go to regulate ‘healthy behavior’?” So asked physician Faith T. Fitzgerald in an editorial, “The Tyranny of Health,” in The New England Journal of Medicine almost twenty years ago. Fitzgerald wrote that people tend to see “failures of self-care,” including obesity, as “crimes against society,” and evidence that others have “misbehaved.” As a result, they blame these others for their own illnesses, particularly because society bears so much of the burden in health care costs when people get ill. In the past twenty years, obesity rates have continued to skyrocket in the U.S. and most of the rest of the world. Those who study obesity use words like “pandemic” and “epidemic” to describe the situation and continue, rightly so, to warn of the dire consequences of increased incidences of type II diabetes, hypertension, abnormal blood lipid levels, and fat in all the wrong places, i.e., dangerously around our internal organs. Ironically, there are three phases to a classic epidemic, writes Dr. Katherine Flegal, who has conducted epidemiological studies on obesity and its prevalence: initially there is a reluctance to appreciate what is happening; the second phase consists of finding some framework to explain the events and may include blaming the victim; the third phase consists of creating pressure and a sense of urgency for the community to respond. We may be hovering between the second and third phases.
Fitzgerald’s question came to my mind during the recent controversy raised by New York Mayor Michael Bloomberg, who recommended, in an attempt to curb the burgeoning rates of obesity, that society regulates the sale of sugared soft drinks. Instead of thinking of obesity as a “crime against society,” though, many were quick to deride our “nanny” Mayor for his police tactics and think of themselves as the victims. The press has had a field day. Frank Bruni, while supporting Bloomberg’s recommendation in his recent editorial in The New York Times, pointed out the “random and absurb” nature of the ban on sodas greater than 16 ounces. After all, someone could still buy a 20-ounce milkshake with far more calories and considerably more fat. Bruni so aptly added, “Man cannot balloon on Mountain Dew alone.” Jon Stewart, meanwhile, debated the potential existential conundrum when he mused on melted frozen hot chocolate and the physicality of the Slurpee. Is it a liquid? a solid? Stewart pondered. When a comparison to cigarette smoking was made (and how our attitudes toward smoking have changed over the years), Stewart retorted, “Yes, but there is no such thing as second-hand carbonation.”
Obesity is a complex disorder that results from a combination of genetic, psychological, neuro-endocrinological, and environmental factors. Our genetics, though, have not changed in the past twenty years. Bruni rightly noted that what is most likely driving the obesity epidemic is the overproduction of inexpensive and increasingly available highly caloric (often processed) food rich in salt, sugar, and fat. This fact has been emphasized by Kelly Brownell, Ph.D., Director of the Rudd Center for Food Policy and Obesity at Yale University, and a major advocate for changes in food regulations and policy.
As a result, we actually do need some policing, since we cannot seem to police ourselves. Several psychological factors are involved: First, humans have what’s been called a “completion compulsion,” that is, we tend to eat in units. This was first noted in the 1950s by psychologist Paul Siegel when he found that people don’t leave a fraction of a cookie. Many people understand that mentality when they cannot seem to stop eating until they reach the divider of a package (or even, if so inclined, to finish the entire package.) The recent development of 100-calorie snack packs is a step in the right direction.
Further, we lose sight of what are called “consumption norms,” according to Dr. Brian Wansink, Director of Cornell University’s the Food and Brand Lab. In other words, we begin to think whatever we are being served is reasonable and appropriate, no matter what the size. We develop what Wansink calls, “portion distortion.”
How did supersizing begin? Greg Critser, in his book, Fat Land, explains that those in the food industry realized that people did not want to buy two boxes of popcorn when they were in a movie theater--because they didn’t want to be seen eating two boxes. Eating two boxes just seemed too gluttonous--somehow one jumbo-sized box of popcorn seemed less “piggish.” For just a little more money, retailers could sell much more—and with it, supersized Coca-Cola. Alex Bogusky, who came from an advertising background, says this is “value marketing”—increase the size of a product and increase its desirability for the customer. Bogusky’s book, ‘The 9-Inch’ Diet, tells how Americans have become so used to supersizing that some people thought they were buying “normal” drinking glasses when they were buying flower vases from Ikea!
Not only are we fat, but if you want the proverbial second opinion, we are generally lazy too. Wansink’s research has demonstrated that we are more apt to eat candy that has its wrapper removed or even placed just next to us. Want to inhibit eating? Just keep the wrapper on and move the candy several feet away, preferably to a locked cabinet. Cognitive behavioral therapists have known of these techniques for years.
So, of course, we can go back and order that second soda—but most of us won’t—nor will most want to be seen as gluttonous and take two sodas simultaneously. If we cannot do it for ourselves, let’s welcome the soda police, at least as a start. That’s no longer the tyranny of health.