Social, environmental, cultural factors play role in obesity

I believe there are more significant issues related to obesity than whether it is a classified disease:

1) Obesity is a health disparity. That is, obesity is disproportionately represented in subsets of the population (persons of color, people who live with less socioeconomic advantages and rural Americans) than the population as a whole.

Among the major sex-age groups, the prevalence of obesity is lower among whites than among blacks and Mexican-Americans. An inverse association exists between family income and obesity prevalence among white females and white males, but the association is weak among other groups. A higher percentage of WIC-enrolled 2-year-olds in rural Montgomery County are obese compared to the urban 2-year-old WIC enrollees of Roanoke city.

2) Obesity is an epidemic that accounts for 10 percent of all U.S. medical spending, nearly $150 billion a year.

3) Whether a person is obese or not is influenced more by social, cultural, environmental and policy factors than by individual behavior choices. Some people of privilege can access resources to attain healthy weight whereas some cannot. How we’ve built our communities does not support safe walks to school, secure playgrounds in every neighborhood, active transportation for daily activities or breastfeeding, and many people do not have access to affordable fruits and vegetables within a one-mile radius of home. Fast foods are cheapest. Processed foods with high fructose corn syrup have long shelf lives. Cities like New York and Anchorage have dramatically reversed childhood obesity rates through policies in day care, schools and community that support breastfeeding, physical activity, fresh fruits and vegetable access and limited screen time and sugar-sweetened beverages.

The doctor-patient relationship is a powerful context to address obesity, but all of us need to exert personal responsibility for ourselves and institutional and community decisions that promote healthy living.

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