Obesity and Responsibility in the Health Care Debate

Who is responsible for overweight people?

Posted Aug 12, 2009

Here's a headline from MSNBC.com the other day: "Health reform idea: Put down the doughnut." Largely missing from the health care debate, says the author, is a discussion of the role of personal choice in creating health problems such as obesity. Some people wonder why their tax dollars should be used to care for people who are ruining their own health by eating too much.

In contrast, a few days earlier Ellen Goodman had written an op-ed piece in the Boston Globe arguing that the nation's obesity problem has something to do with the way food is marketed. The food industry has invested billions in advertising and food processing techniques in order to make food irresistible, and Goodman opined that this just might have something to do with why so many people eat too much. A lot of Goodman's readers seemed to incline more toward the "personal responsibility" explanation; several of them combined this view with the opinion that Goodman was a sicko commie witch for even suggesting that the food industry bears some responsibility in this issue.

From my perspective, this debate is never going to get past the shouting stage until we recognize that some of our ethical concepts-in particular the way we think about intentional behavior and responsibility-have not kept up with the research on why people act the way they do. Morally, we are stuck in the Middle Ages, with assumptions like "except for reflexes, people's actions are intentional and voluntary." In this view, almost everything sane people do is the result of conscious decisions to act.

There is by now overwhelming evidence, from fields such as social psychology and cognitive neuroscience, demonstrating that this is flat wrong. In fact, most of what we do is orchestrated by mental processes that never reach full consciousness: deeply ingrained habits, unconscious cognitive schemata and stereotypes, and so on. My own work in this area has been especially concerned with the role of imitation: human beings are imitation machines. To take a single example, a person will closely imitate the facial expressions of a conversational partner, without any intention or even awareness that he or she is doing so.

That point has enormous implications for understanding the efficacy of advertising. Social psychologist John Bargh and his colleagues have done a number of relevant studies here; a recent paper shows that watching people eat increases eating behavior in viewers. As I argue in my book Caught in Play, imitation is also central for understanding the effects of our participation in entertainment more broadly. Entertainment is another domain in which automatic mental processes shape our values and behavior.

So, what's the point? Simply this: I have no argument with those who urge consumers to be responsible. People who eat too much need to take responsibility for that. But we now know that eating behavior-to stick with this example-can be powerfully encouraged by mental processes that occur outside of conscious awareness. Who is responsible for that? Isn't it the people who intentionally design advertising and food processing to generate over-consumption? If you demand that consumers be responsible, why not be consistent and demand that the industries promoting consumption be responsible as well?

Peter G. Stromberg is the author of Caught in Play:  How Entertainment Works on You.  Photo by Bandita.