The question in the title to this blog would, at first blush, seem to yield an obvious answer. Think of the fast food industry and its tactics, increasing portion sizes, and of inactive bodies with eyes glued to television and computer screens. Too much food (especially of dubious nutritional value) and too little exercise: too many calories in and too few calories out. The question underscores how individuals of "nondeviant weight" can be pretty quick to judge -- negatively -- those struggling with obesity.
A focus on calories in/calories out is clearly relevant. Encouraging everyone to eat better and to be more physically active is a sound strategy. Such prompting can be especially important for kids so that, from the get go, good health and weight go hand in hand. There's lot that governments can do -- always focused on effectiveness, not just wishful thinking -- to promote better eating/more exercise: from regulating advertising, especially to children, to encouraging physical activity, again, especially of children, for example, incentives built into the tax system such as the Children's Fitness Tax Credit, and community health challenges, such as the campaign recently launched by the Ontario government. There is some recent evidence, in the United States, that obesity rates among young children are falling.
All that said the reasons why people become obese remain complex in many instances. Here are a few examples. A front page story in the latest New York Times Sunday Review (March 9) explores the impact of antibiotics in the food chain and elsewhere on weight gain. More specifically, there is evidence that children given antibiotics within the first six months of life have a significantly increased chance of being overweight by age 3. Studies suggest that a child born by cesarian section is about twenty two percent more likely to be obese than one delivered vaginally. Maternal age at time of delivery may also increase the chance that a child will be obese. Children with Prader-Willi syndrome, a rare genetic disorder, frequently suffer from incessant hunger that often leads to obesity.
Then there are the fears around endocrine disrupting chemicals (EDCs). These substances may promote obesity in a number of ways, including increasing the number of fat cells, altering the amount of calories utilized while an individual is at rest, and modifying the body's mechanisms for appetite and satiety. In 2010 the White House Task Force on Childhood Obesity warned of the potentially dire consequences of these substances and how easily exposure to them can occur: for example, baby bottles and plastic containers should not be micro waved unless explicitly labeled as safe for that purpose.
With obesity the die is usually cast early. The results of a major study in the US have established that a third of children overweight in kindergarten are obese by the eighth grade. Almost every child who was very obese stayed that way as they grew older. An individual should not be easily blamed for conditions that result from their childhood when they have little control over their well-being.
What are we to make of these complicated causes of obesity and its frequent onset at an early age? There are several implications. A crucial one is to surrender assumptions that all people who are fat are slovenly and indulgent and can and should diet themselves into thinness and caloric redemption. Once a person is obese it is very difficult for them to lose weight and to sustain that loss: 95 per cent of fat people who can shed pounds regain them (and sometimes additional weight) within five years. People who become obese, including those who do so at a young age, are likely to remain that way whatever their efforts to change.
So to all those of "nondeviant weight": the next time you encounter an obese person please don't just think "lazy", "excessive" and goodness knows what all. Maybe think something like "complex" and "once a child with things that happened that were not of their choosing". Let's not let size drive judgment.
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