Preventing Childhood Obesity - Evidence Policy and Practice.pdf

CHAPTER 14
Evidence on the food environment and obesity
Deborah A. Cohen
The RAND Corporation, Santa Monica, CA, USA
Summary and recommendations
for practice
Although weight is a function of the balance between
what we eat and how much we exercise, a growing
consensus points to food intake as the primary cause
of the obesity epidemic. 1 – 3 The dominant thinking
about the obesity epidemic is that it could be solved
if people would exercise more self - control; thus, multiple
interventions have been designed to increase self -
efficacy, knowledge and skills with respect to nutrition
and dieting. 4 – 6 However, most people know that if
they eat too much and exercise too little, they will gain
weight, and they also know that if they would just
eat less and exercise more, they will lose weight.
Furthermore, most people know that certain foods
increase the odds of gaining weight, like chips, sodas,
donuts, ice cream, candies and big portions of foods
such as French fries and meat, yet these products continue
to be among the best - selling items in America
and other parts of the developed world. Knowledge
appears to be less a problem than willpower.
Yet lack of willpower appears to be an implausible
explanation as well. Given that people tend to gain
weight when they move to a society where more
people are overweight, 7,8 it would mean that an individual
’ s character changes just by emigrating. If loss
of willpower was the source of the problem, it would
suggest that there would be significant differences in
willpower by race, gender, ethnicity and age and, more
importantly, by country of residence or historical
Preventing Childhood Obesity. Edited by
E. Waters, B.A. Swinburn, J.C. Seidell and R. Uauy.
© 2010 Blackwell Publishing.
cohort. Is it conceivable that 30 years ago when fewer
were overweight and obese, people had more willpower
than they do now?
This paper is the result of searching the literature
for counterfactual evidence that would indicate that
the dominant conceptualization that people eat too
much because they lack self - control or have insufficient
knowledge is plain wrong. Rather, the problem
of obesity can be traced to the dramatic changes in our
food environments and their interaction with human
neurophysiology. This chapter describes how environments
affect people in manners that defy personal
insight or are below individual awareness. If people
are unaware of the environmental forces and cues that
are artificially making them feel hungry and leading
them to eat too much, they cannot possibly control
how much they eat.
Introduction
Eating is not a rational behavior. Eating is not like
studying for a test, memorizing facts, understanding
and manipulating sophisticated mathematical equations,
painting a portrait or writing a book. It is not
an advanced behavior, but a primitive one — one that
is instinctual, hard - wired and in many ways uncontrollable.
Humans are endowed with a metabolic
pathway that allows them to store extra energy as fat.
One might argue the existence of a pathway to create
and store energy means that people were actually
designed to eat too much. Given that more food is
available in today ’ s world compared to the past, individuals
are functioning normally and responding in
the manner in which they were designed. Nothing is
wrong with us. The problem is the environment in
which we now live.
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