Obesity is not a ‘public health’ issue

Flu epidemics, SARS outbreaks, multi-drug resistant infections, etc – these are public health issues. Obesity is not. Flu is contagious and can easily pass from person to person, leading to serious injury or death in susceptible patients (i.e. elderly). It mutates, and can thus transform into a more dangerous strain and have the potential to kill quickly on a large scale if not controlled. Obesity is not contagious – you can argue that environment plays a role (hence the recent NEJM article about how obesity is “spread” through social circles), but ultimately most obesity can be prevented through actions of the individual. Eating in moderation along with physical activity does the trick for most, although of course there are hormonal imbalances and other health issues that may make it more difficult for a certain percentage. The term ‘public health’ has been led along a twisted path for so many years that it has lost its meaning, and is used to scare people and make hasty (and poorly constructed) policy decisions.

Why am I drawing attention to this distinction? Because a panel recently compiled a report called “F as in Fat: How Obesity Policies are Failing in America,” and has called for the government to formulate a national strategy for controlling obesity, essentially comparing it to a flu epidemic (side rant – “epidemic” implies the rapid spread of something infectious, thus obesity fails to qualify as an epidemic). Short of physically holding people’s hands to drag them to grocery store and pick out healthy food, or poking them with a cattle-prod to get them to exercise, I’m not sure what will a national strategy will accomplish. People know the food pyramid – this stuff is drilled into our heads in elementary school. They know they should exercise, and they don’t. The author mentions environmental problems that inhibit our ability to take action, such as suburban neighborhoods without sidewalks. I call BS on that. Almost every suburban neighborhood I’ve ever lived in had no sidewalks, and I still exercised. They are paved, after all, providing a suitable surface for walking, running, or even riding a bike. Most homes aren’t built on a busy highway, so traffic is not much of an issue. You don’t need a fancy gym membership to exercise (although those are nice if you can afford them).

The author also mentioned dangerous urban environments. I don’t think most urban areas are dangerous. I don’t have a statistic to back up this claim, but I live in the heart of a city right now and feel safe walking and running by myself in most areas during the day. Still, I acknowledge that there are neighborhoods in urban areas that are indeed very dangerous, and may make it difficult for people to feel safe walking around. I have a different solution for that, namely a change in our policy towards illicit drugs. The drug war has not worked to end, let alone diminish, drug usage in this country. Most urban violent crime seems to be associated with gang activity (and thus related to drug activity), so a change in strategy here would probably eliminate that problem, and create a safe neighborhood where citizens may freely roam. A committee debating obesity from a government office will have little impact in this regard.

The report also states that the “strategy of focusing on personal responsibility is failing.” Personal responsibility would not fail if people have sufficient incentives to take action. For me, as a medical student, learning about every possible disease (even though I know many are rare) is enough to make me paranoid about staying healthy. For someone else it might be looking good in a swimsuit, or feeling confident, or being able to walk a mile with their child without getting out of breath. But my guess is that those incentives don’t work for most people. Money, however, usually does. I knew of an insurance company at my last university that offered significant premium discounts (10-15%) for customers who agreed to live a healthier lifestyle. This included moderate exercise, no smoking, and weekly or biweekly phone calls from a nurse to check in and keep them on track. It is my opinion that we should be focusing on those kinds of incentives (or coming up with new ones), rather than continuing to publish government-approved guidelines or develop yet another “task-force” to evaluate the scope of the problem. New ideas are good and should be implemented first on a small scale to test their success – a bloated government program is a fail-proof way to ensure the status quo for a long period of time, and usually inhibits any real change.

Via CNN – “Report: National strategy needed to fight fat

To read the entire report, click here (fair warning, it’s 120 pages long, and misuses “epidemic” 37 times)

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2 Comments

  1. Kent Burtner said,

    August 29, 2007 at 1:25 pm

    Obesity IS a public health problem! I generally concur with your point of view, but there is one point that needs a clear distinction. While “epidemic” may not be the best word to use due to it’s common reference to “infectious,” a public health problem is not limited to infectious diseases. As you continue your medical studies, I encourage you to look more deeply in the area of public health. Public health is by-and-large the single most significant contributor to the increase in longevity experience by Americans over the last hundred years.

    Thanks for your reflections on incentives.

    Kent Burtner
    Communications Officer
    Washington County (OR) Health and Human Services
    [read and responded to on my personal break time]

  2. Lily said,

    August 29, 2007 at 1:44 pm

    I appreciate the comments, Kent, but I still disagree. Obesity is a real problem (which we can both agree upon), but is a personal rather than public problem. I do not think it fair to charge taxpayers to fund a program aimed at something that is preventable by the actions of the individual and that does not affect the health of other people. Just because something affects a large portion of the population does not make it a ‘public’ problem. I would similarly say that smoking is a problem, but not a public health problem (unless you are discussing second hand smoke in public places).

    By the way, I also agree that public health is the most significant contributor to longevity increases – it’s amazing what clean water and sanitary conditions can do for a population (and it’s a shame impoverished third world countries still suffer from such things).


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