Obesity now a lifestyle choice in US, says author

As adult obesity balloons in the United States, being overweight has become less of a health hazard and more of a lifestyle choice, the author of a new book argues.

“Obesity is a natural extension of an advancing economy. As you become a First World economy and you get all these labour-saving devices and low-cost, easily accessible foods, people are going to eat more and exercise less,” health economist Eric Finkelstein says.

In The Fattening of America, published this month, Finkelstein says that adult obesity more than doubled in the US between 1960 and 2004, rising from 13% to about 33%.

Globally, only Saudi Arabia fares worse than the US in terms of the percentage of adults with a severe weight problem—35% of people in the oil-rich desert kingdom are classified as obese, the book says, citing data from the World Health Organisation and Organisation for Economic Cooperation and Development.

With the rising tide of obesity come health problems and an increased burden on the healthcare system and industry.

“But the nasty side-effects of obesity aren’t as nasty as they used to be,” Finkelstein says. “When you have a first-rate medical system that can cure the diseases that obesity promotes, you no longer need to worry so much about being obese.”

His book says: “With our ever-advancing modern medicine there helping to save the day (at least for many people), are government and the media blowing the magnitude of the ‘obesity crisis’ out of proportion?”

Life expectancy

A study in which Finkelstein and colleagues at the RTI International, an independent research institute in North Carolina that focuses on social and scientific problems, asked overweight, obese and normal weight people to predict their life expectancy came up with a total difference of four years.

Normal weight respondents predicted they would live to 78, the obese to 74 and the overweight 75,5.

Other studies that looked at death data back the conclusion that people who carry excess weight tend to die slightly earlier, the book says, and draws the conclusion that “many individuals are making a conscious decision to engage in a lifestyle that is obesity-promoting”.

“People make choices, and some people will choose a weight that the public health community might be unhappy about. Why should we try to make them thinner?” Finkelstein says.

Linda Gotthelf, a doctor who heads research at Health Management Resources, a private, nationwide firm that specialises in weight loss and management, agrees that Americans now live longer but stresses that quality of life declines with age.

“People are living longer but with more chronic diseases,” Gotthelf says. “That brings a diminished quality of life, especially for the obese who have more functional limitations as they age and tend to be on multiple medications.”

Not a choice

Obesity is not a choice for Alley English (28), a mother from Missouri who has struggled with a weight problem all her life. “If you knew that you could be what society considers normal, why would you not choose to do that?” English says.

“As we get older, life does get more rushed and we do tend to make the easier choices sometimes,” English, who currently weighs 178kg, says. “But you can’t say if you quit going to the drive-through, exercise more and eat more vegetables, you’ll lose weight. There are so many more factors involved.”

Gotthelf also disagrees that people choose to be obese. “There are studies in which people have said they would rather lose a limb or be blind than obese. Being obese is not a desire,” she says.

“For many, this is a problem they have struggled with for many years ... it gets discouraging after a while,” she adds. “I would not doubt that if you asked obese people if they could push a button and not be obese, close to 100% would say they would push the button.”

Finkelstein says he wrote The Fattening of America to “encourage discussion of what I understand is probably an uncomfortable position for a lot of people”.

Even if private industry and government take steps to protect society against the costs of obesity, many Americans “will likely continue to choose a diet and exercise regimen that leads to excess weight”, because losing weight requires too many lifestyle sacrifices, his book warns.

Meanwhile, frustrated by years of unsuccessful dieting and weight-loss programmes, English has opted to join a growing number of Americans who have gastric bypass surgery—hailed in Finkelstein’s book as “the best-known treatment for severe obesity”.

“I have a higher risk of developing diabetes or hypertension if I don’t have the surgery,” English says. “I don’t care if I end up with a body like whoever in the media thinks I should look like; I just want to be healthy and able to participate in my daughter’s life.”—AFP

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