Easy Ripe and Luscious with Physicians and Fat

A team of earnest researchers offer a perspective on the obesity epidemic in JAMA. At the risk of oversimplifying this bright and nuanced perspective, the article suggests that two main factors may be causal: the individual or the environment. Which is it?

This concern prompted the recent Institute of Medicine (IOM) report, “Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation.” The groundbreaking report and accompanying HBO documentary, “The Weight of the Nation,” present a forceful case that the obesity epidemic has been driven by structural changes in our environment, rather than embrace the reductionist view that the cause is poor decision making by individuals. The report articulates a bold vision of accelerating change through a multifaceted systems approach and “shared responsibility across sectors and levels.”

Yet, the writers note a problem with the scientifically proven causes of obesity. Just folks don’t believe it.

For example, the report details accumulating evidence that the obesity epidemic has been driven by a complex interaction of changing factors in several critical environments — our schools, workplaces, communities, media, and food and beverage systems — rather than by individual choices. However, public opinion studies consistently find that this view is not widely embraced. Only 18% of Americans identify external factors (exposure to junk food, lack of safe places for children to play, and limited availability of healthy foods in some neighborhoods) as the biggest causes of childhood obesity, whereas 64% identify personal factors (overeating, lack of exercise, and watching too much television) as the biggest causes.

Put a bullseye on this writing team and all those commenters and probably most of the readers of JAMA. The simplest and most obvious explanation for obesity – eating too much and burning too little – is rejected in favor of a wildly more complex explanation. We need to change laws and regulations affecting farms and businesses and schools and workplaces and you know they will resist that so you’ve got a solution that will never get properly implemented and thus will not solve the problem you describe, but this work will never end so you’ll always have a job!

Assume just for a moment that all the science is pretty much right: obesity is a deadly, massive, and avoidable threat to mortality, it is caused primarily by external forces like marketing, subsidized agricultural interests, bad school lunch programs, a bad built environment that encourages driving rather than running and on and on. In other words, believe what this perspective says without reading the evidence for yourself, especially the methods and results sections. Furthermore, you now know why people are obese. Little or nothing they do causes it, but rather external forces cause it.

Given the structure of this argument you have no choice as a persuasion guy other than to change everyone who has anything to do with food except for the people who consume the food. Thus, the TACT falls gracefully from the perspective. Don’t target the Fat Other Guys, target Anyone Who Does Food.

Do you see the complexity?

There’s no way a persuasion campaign can possibly change people given this perspective since the problem is beyond human volition and action. Yet, the problem is presented as if persuasion is a solution, that somehow communication can Change the Other Guys.

However, if you do not let that analysis get in your way, realize all your persuasion possibilities. Just chase down people who cite this work or think like this work and provide your persuasion services. It’s selling sand and ice!

Colleen L. Barry, Ph.D., M.P.P., Sarah E. Gollust, Ph.D., and Jeff Niederdeppe, Ph.D. (2012). Are Americans Ready to Solve the Weight of the Nation? N Engl J Med, 367:389-391, August 2, 2012