America is overlooking the real cause of its ever-expanding waistline, said Kelly Brownell, PhD, at APA's 2001 Annual Convention. The problem isn't so much people's lack of self-control, he said. It's a "toxic food environment"--the strips of fast-food restaurants along America's roadways, the barrage of burger advertising on television and the rows of candies at the checkout counter of any given convenience store.
"Whoever thought you could go eat at a gas station?" said Brownell, a Yale University psychology professor, adding that, with a new concept being test-marketed, "While you're pumping your gas you punch in the Fritos, the Twinkies and the Coke, and somebody brings it to your car. So the physical activity required to go in and get it is eliminated."
To be sure, Brownell acknowledged, genes and self-control play a role in obesity and the diabetes and other health problems that result. But, in his view, both face a losing battle against the ubiquity of bad food. The problem with medical and psychological interventions for individuals, he said, is that the costs of treatment outweigh the benefits, and weight-gain relapse rates remain high.
What's needed instead, he said, are broader-scale policy fixes that promote healthier foods and behaviors across American society.
"It's important for us to look at this from a public health point-of-view, where we're not so concerned with how overweight an individual is, but how overweight the population is," said Brownell. "Genetics is what permits the problem to occur, but environment is what drives it."
Of particular concern to Brownell is America's passive acceptance of unhealthy food. Americans fail to recognize, for example, the possible damage done by such fast-food icons as Ronald McDonald. "We take Joe Camel off the billboard because it is marketing bad products to our children, but Ronald McDonald is considered cute," said Brownell. "How different are they in their impact, in what they're trying to get kids to do?"
Certain "toxic signs" alarm Brownell:
Unnutritious foods reign. High-fat, high-sugar foods are widely available, taste good and cost less than healthier foods. Vending machines are ubiquitous, Kentucky Fried Chicken delivers and most fast-food outlets now serve breakfast. "Could there be a better fat-delivery vehicle than a bacon-egg-and-cheese muffin?" said Brownell.
Serving sizes keep increasing. Buffets abound and food outlets offer "value meals," providing more food for less cost. 7-Eleven's Double Gulp serves up 64 ounces of soda, and "McDonald's has made 'super-size it' a verb."
The food industry has run amok. Advertisements for prepackaged and fast foods saturate the airwaves, newspapers and magazines. Colorfully packaged single-person servings make processed foods appealing.
Physical activity has declined. Most Americans get less exercise than ever--walking less and driving more.
As further evidence that environment is to blame, Brownell noted that obesity has risen notably in other countries, including China, and that migrants to Western countries have much higher obesity rates than their relatives back home.
Particularly vulnerable to the problem are American children, said Brownell. Soda companies and fast-food outlets increasingly ink contracts with schools and gear advertising to kids. "The most intrepid parents can't win this fight," he said.
That is, they can't win it alone. But, said Brownell, they might stand a chance through the following proposed policy changes:
Make activity more accessible, by, for example, building communities to allow more walking or biking.
Regulate TV food ads aimed at children and mandate equal time for pro-nutrition messages.
Ban fast foods and soft drinks from schools, instead forging school contracts with sports-related companies.
Restructure school lunch programs to include more healthy foods.
Subsidize healthy foods and drive down prices of fruits and vegetables by 70 percent.
Discourage consumption of poor foods through a "fat tax," earmarking the funds for nutrition and recreation.
Brownell believes such measures would take the blame off people with obesity and are the only "real path to doing something constructive about this problem."