The War on Obesity: Whose Battle is it?

By Jeffrey I. Mechanick, MD, FACP, FACE, FACN, ECNU


The war on obesity is not just about how many people are overweight or obese. It’s also about the biology, physiology, and complications related to obesity. Certain genes are involved. Obesity is not just a result of a person’s lack of willpower. The problem of weighing more than one should has many factors. These factors include biology, the environment, society, and even cultural issues.

What environmental factors promote overeating? Fast foods, foods high in calorie content, impulsive eating, increased food selection, and skipped meals all have an impact on overeating. Stress and mood changes can also cause a person to have abnormal eating habits. Even boredom, fatigue, and just habit can cause one to eat more than the body needs.

The costs of obesity in society are high. Obesity-related disorders include diabetes, heart disease, arthritis, depression, and certain cancers. These disorders increase the costs in our healthcare system. This is something on everyone’s mind nowadays.

So, with all of this information, why on Earth have we not made more progress in fighting the war against obesity? Why is it that more than one third of American adults (over 72 million people) and 17% of children aged 2 to 19 years are obese? Since 1990, obesity rates for adults have doubled and rates for children have tripled. No corner of our society is spared. Obesity affects all ages, genders, races, ethnicities, socioeconomic groups, education levels, and parts of the world.

The focus now on this war against obesity is on “implementation.” Implementation means how we as a society can use the above information to produce change for the better. Education about healthy lifestyle, scientific discoveries to create new anti-obesity drugs, and technologic innovations for procedures to change our physiology are needed. Also needed are economic rewards for healthy behavior and penalties for unhealthy behavior. Banning trans fats and posting calories on menu items is a great start. But the future will need to include bolder efforts.

Let’s consider a few ideas, and maybe you can even think of others:

  • Have street vendors for locally-grown fresh fruits and vegetables that are cheap to buy because they are partly paid for by the government. In turn, we should limit the number of street vendors with foods high in saturated fat.
  • Offer cheaper whole grain/high fiber breakfast cereals, and tax sugary cereals.
  • Include vending machines in schools, colleges, factories, malls, movie theaters, and amusement parks that contain healthy foods that people can afford. Also, limit the number of vending machines with junk food in these places.
  • Offer low-fat, higher-protein, less-sugary foods in school cafeterias. Food should be made from scratch (less prepackaged foods).
  • Promote healthy meals at social functions rather than the usual high-fat entrees and sweet desserts.
  • Provide free healthy foods, such as fresh fruits and vegetables, on planes, trains, and in their stations, which might even be good for business.

This approach of “behavioral economics” may hold the answer. As adults, we all have the ability to make choices. Sometimes our choices can be poor, such as eating junk food and having unhealthy lifestyles. However, maybe it wouldn’t be so hard to make better choices if our environment would promote a healthy lifestyle, be more affordable, and would be more available and certainly more interesting. It would also help if we could be well-informed about choices that go with this healthy lifestyle.

In the meantime, we need safer and more effective drugs. These drugs need to at least help someone stick with a healthy lifestyle and get “ahead of the curve” by losing weight and improving their metabolic profile. Many factors cause obesity. Biological processes in people with obesity are complex. These future safer, more effective drugs can target appetite, hormones, and/or fat cell function. Our government must support ongoing research to combat the epidemic of obesity. The new MyPlate campaign by the U.S. Department of Agriculture is a great start (www.ChooseMyPlate.gov).

Ultimately, doctors and scientists will need to work with the government and all aspects of our society so that each of us can live a longer, more high-quality life. At the same time, healthcare costs need to come down. The battle against obesity involves all of us!

Dr. Jeffrey I. Mechanick is Clinical Professor of Medicine and Director of Metabolic Support in the Division of Endocrinology, Diabetes and Bone Disease, Mount Sinai School of Medicine. He is Secretary and a member of the Board of Directors of the American Association of Clinical Endocrinologists and Chairs the AACE Publication Committee. Dr. Mechanick co-edited Nutritional Strategies for the Diabetic and Prediabetic Patient, The Complete Guide to Lifelong Nutrition, and Thyroid Cancer: From Emergent Biotechnology to Clinical Practice Guidelines to be published in 2011. Dr. Mechanick is in private practice in endocrinology and metabolic support in New York City.