GRSJ224/ObesityASociallyComplexDisease

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Obesity as it is currently defined affects a large amount of people worldwide (13% of adults in 2016)[1]. And yet for something seemingly so clearly defined, it intertwines in complex and unique ways between and within different cultures, industries, and facets of society. Rather than being a static concept, it is one that has changed throughout time, place, and context, and is still not yet best understood in how to treat or handle it.

The History of Obesity - A Social Construction

For the most part, a disease is looked at as something negative, undesirable, to be feared, and measures are taken to get rid of it or prevent it at all costs. However, unlike almost all other diseases, obesity was not always regarded as something negative. This not only had to do with a lack of knowledge of how being obese affected our health until it was officially studied in the 17th century[2][3][4] (other than the obvious inhibitions it causes to physical activity), but also its relations to its causes and evolutionary history. While it may be necessary to be fit and strong in order to survive as a hunter gatherer, evolutionarily it was seen to be an advantage to be able to store fat, as it is a high source of energy, and food was never a given.[2][5] Additionally, weight was linked to good fertility.[2][6][7] In ancient and medieval times, being fat was a marker of status.

Venus of Willendorf - ancient figurine depicting women, 30,000 BCE

One of the main causes of obesity is overconsumption of food. Yet throughout the vast majority of the history of the human species, food was scarce. If one was able to eat enough food to become fat, that meant they were quite well off. Being fat therefore used to be desirable and even attractive. This primarily was due to the notion that if you were fat then you had good access to lots of food, which many did not. However, in medieval times being large also carried connotations of good character. Traits such as kind, lovable, and happy were associated with fat people, as depicted in both art and literature of the time.[2][6][7] Across cultures, views were not always predominantly positive towards obesity. In fact, the ancient Greeks, Romans, and some Asian cultures recognized the negative health effects of being overweight.[4] Biblical writings also produced negative attitudes towards obesity.[6] However, it was not until the 18th century that negative connotations towards obesity started to arise, and these views were not popularized until the early 20th century.[2][7]

Throughout time, there have been many different connotations surrounding obesity, from a sign of good fertility, to good character and attractiveness, and now towards a disease and being predominately negative. Additionally, there have been many different connotations about being overweight across cultures. The idea of obesity is therefore a social construct, meaning it is not objectively true everywhere, but is rather constructed differently through contexts of knowledge and culture. Analyzing obesity as a social construct is important, as the idea of obesity as a disease or illness is tied to and reinforced by multiple industries in different ways.[8]

Obesity and the Medical Industry

Typical definitions for obesity use the Body Mass Index (BMI). The World Health Organization defines obesity as “abnormal or excessive fat accumulation that presents a risk to health… A person with a BMI of 30 or more is generally considered obese. A person with a BMI equal to or more than 25 is considered overweight.”[9] The Centre for Disease Control and Prevention (CDC) also uses the BMI to categorize obesity, and places it in 3 classes.[10] While BMI is widely used to determine obesity, it is not a direct measure of fat content in the body, and is even described as a “crude” definition by the WHO, and noted that it is only moderately correlated with direct measures of body fat.[9][10]

How Body Mass Index is determined

While obesity has only recently had the possibility to become an issue due to increased food security and availability (as compared to most of human history)[2][5], the disease is described by the medical industry as an epidemic.[1][11][12] This industry is rooted in science, and therefore it treats obesity with a very scientific lens. It focuses on the direct causes such as diets high in simple carbohydrates and fats and low levels of physical activity, and effects such as increased rates of heart disease, diabetes, musculoskeletal disorders, cancers, among other things.[4][13][14][15][16] Goals of the medical industry are to reduce obesity due to its negative health effects on individuals and its economic costs to society.[8][12]  Not only is the commonly used definition for obesity not exactly accurate at assessing the epidemic, but medical practitioners are not seen as adequately able to deal with it. Additionally, some practitioners treat obese patients with prejudice.[3][6][17][18]

The medical industry largely attempts to deal with this epidemic by putting the onus on individuals to deal with their problem, suggesting they eat healthier and exercise more, having patients strive for a BMI at or below 20.[6][8][19] The way the medical industry frames obesity has thus led to inadequacies in dealing with obesity both in terms of how the industry itself views it as an epidemic, and how others view it as well (such as those who do not believe that BMI is the best indicator and that labelling obesity as a disease is productive in dealing with it).[8]

Obesity and the Food Industry

Being a disease for which one of the main causes is poor diet, obesity is intricately linked to the food industry. There are both overt and covert ways in which the food industry contributes to the narrative of obesity. In direct opposition to how the medical industry frames the problem of obesity, organizations such as the Center for Consumer Freedom[20] lobbies for the fast food and meat industries, among other unhealthy industries.  Under the popular notion of free choice, this organization dismisses scientific studies related to obesity, understates the causal role of unhealthy eating for obesity, discredits BMI as a standard for measuring obesity, fights against governmental policy aimed to limit unhealthy foods, and challenges the notion that being overweight is always unhealthy.[8] With such a powerful industry directly contradicting the medical industry, it may be difficult for individuals to get a grasp on how they should think of obesity. 

File:WarheadsJuniorsExtremeSour.jpg
Example of vibrant packaging used for candy.

The food industry also opposes the medical industry in more veiled ways. The food industry has lots of control over what food is available to be purchased.[21][22] Studies have shown that a vast majority of packaged food items in grocery stores contain added sugar in North America.[23][24] It is widely known that these added sugars are a contributor to obesity,[25] and are what medical professionals tell their clients to try and avoid. Additionally, these added sugars are difficult to identify due to poor labelling practices,[23][26] and the industry actively resists governmental policy aimed at improving the transparency of food labels.[8] While added sugars are actively being hidden from food packages, consumers are heavily incentivized to buy junk food through advertisements,[27] and through packaging design.[28]  Junk food packages often use bright colours, lovable cartoon characters, big lettering, and emphasize any healthy nutritional fact.

Another major factor in junk food consumption is pricing. While obesity as defined by the medical industry started off as a predominantly high socio-economic status problem, it is now largely affecting people of low socio-economic status around the world.[12]  This is due to relatively cheap prices for junk food and fast foods.[29][30] The food industry has therefore acted as a catalyst for a shift in the demographics of obesity in recent decades.

Obesity, the Media, and Popular Culture

Advertising in the media is linked directly to constructions of obesity through food and fashion. Children are mostly affected, with food advertisements directed at them.[27][31][32] Advertisement time for children’s television is dominated by unhealthy foods.[27] These advertisements have merged with popular culture by involving many celebrities, including popular musicians and actors.[33][34][35] Arguably equally as explicitly, popular culture has fashioned being extremely skinny as the norm for women and muscular as the norm for men.[36] Popular culture body ideals have subsequently become reinforced through anti-obesity advertisements, with one ad stating “It’s hard to be a little girl if you're not.”[37] This implies that it is the norm and expectation to be small and skinny as a female. 

On the one hand, the media helps encourage and reinforce the food industry’s mantra of consumer freedom and unhealthy eating being acceptable, and on the other hand popular culture sets a high standard for body image. These conflicting constructions in the media help reinforce prejudice, stereotyping, and fat-shaming.[17]

Looking Forward

It becomes difficult to solve a problem when there are competing views as to whether the problem exists, how to define the problem, who gets to define it, and how to solve it. Obesity as a disease has been constructed and deconstructed in complex ways through different industries and has had several different results. It is important to recognize that all of these industries have constructed notions of obesity, and therefore it cannot be necessarily proven that one is righter than the other. It is argued that the only way forward is for these different industries to start working together, whether they can agree on specific definitions or not.[6][38][39]

References

  1. ↑ 1.0 1.1 WHO. “Obesity and overweight” Accessed at: http://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight Accessed on November 28th, 2018.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Eknoyan, G. “A History of Obesity, or How What Was Good Became Ugly and Then Bad”. Advances in Chronic Kidney Disease, Vol.14(4), pp. 421-427. 2006. 
  3. ↑ 3.0 3.1 “The social history of obesity”. Nutrition Research Newsletter, p. 72. 1995.
  4. ↑ 4.0 4.1 4.2 Bray, G.A. “History of Obesity” in Obesity: Science to Practice, pp. 3-18. 2009.
  5. ↑ 5.0 5.1 Haslam, D. “Obesity: a medical history”. Obesity Review, Vol.8(1), pp. 31-36. 2006.
  6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 Buchwald, H. “A Brief History of Obesity: Truths and Illusions”. Clinical Oncology News. July 2018. Accessed at: https://www.clinicaloncology.com/Current-Practice/Article/07-18/A-Brief-History-of-Obesity-Truths-and-Illusions/51221 Accessed on November 28th, 2018.
  7. ↑ 7.0 7.1 7.2 Woodhouse, R. “Obesity in Art – A Brief Overview” in Obesity and Metabolism, Vol.36, pp. 271-286. 2008.
  8. ↑ 8.0 8.1 8.2 8.3 8.4 8.5 Kwan, S. “Framing the Fat Body: Contested Meanings Between Government, Activists, and Industry”. Sociology Inquiry, Vol.79(1), pp. 25-50. 2009. 
  9. ↑ 9.0 9.1 WHO. “Health topics – Obesity”. Accessed at: https://www.who.int/topics/obesity/en/ Accessed on November 28th, 2018.
  10. ↑ 10.0 10.1 Centre for Disease Control and Prevention. “Defining Adult Overweight and Obesity” CDC. Accessed at: https://www.cdc.gov/obesity/adult/defining.htmlAccessed on November 28th, 2018.
  11. ↑ Friedrich, M.J. “Global Obesity Epidemic Worsening”. JAMA, Vol.318(7). 2017.
  12. ↑ 12.0 12.1 12.2 Caballero, B. “The Global Epidemic of Obesity: An Overview”. Epidemiological Reviews, Vol.29(1). 2007. 
  13. ↑ Chen, M. and R. Andrews. “Obesity and Other Diseases” in Obesity: Science to Practice, pp. 323-339. 2009.
  14. ↑ Iacobellis, C. and A.M. Sharma. “Cardiovascular Disease and Obesity” in Obesity: Science to Practice, pp. 287-311. 2009. 
  15. ↑ Ma, R.C.W., G.T.C. Ko, and J.C.N. Chan. “Health Hazards of Obesity: An Overview” in Obesity: Science to Practice, pp. 187-208. 2009.
  16. ↑ Van Gaal, L. and I. Mertens. “Assessment and Investigation of Obesity” in Obesity: Science to Practice, pp. 367-385. 2009.
  17. ↑ 17.0 17.1 Hill, A.J. “Social and Psychological Factors in Obesity” in Obesity: Science to Practice, pp. 344-363. 2009.
  18. ↑ Lee, B.Y. “Doctors need more training to address obesity”. The Baltimore Sun, December 2015.
  19. ↑ Lee, B.Y. “How Our Health-Care System is Feeding the Obesity Epidemic”. Time, September 2016. Accessed at: http://time.com/4485435/health-care-obesity-epidemic/Accessed on November 18th, 2018.
  20. ↑ Center for Consumer Freedom. https://www.consumerfreedom.com/about/
  21. ↑ Howard, P.H. Concentratio  and Power in the Food System: Who Controls What We Eat? Bloomsbury, 2016    
  22. ↑ Mercola, J. “The Concentration of Power in the Food Industry: What We Eat is Dependent Upon Who’s in Control”. July 2017. Accessed at: https://www.sott.net/article/357990-The-Concentration-of-Power-in-the-Food-Industry-What-We-Eat-is-Dependent-Upon-Whos-in-Control Accessed on November 26th, 2018.
  23. ↑ 23.0 23.1 Acton, R.B., L. Vanderlee, E.P. Hobin, and D. Hammond. “Added sugar in the packaged foods and beverages available at a major Canadian retailer in 2015: a descriptive analysis”. CMAJ Open, Vol.5(1). 2017. 
  24. ↑ Ng, S.W., M.M. Slining and B.M. Popkin. “Use of caloric and noncaloric sweeteners in US consumer packaged foods, 2005-2009”. Journal of the Academy of Nutrition and Dietetics, Vol.112(11), pp. 1828-1834. 2012.  
  25. ↑ Wang, H., L.M. Steffen, X. Zhou, L. Harnack and R.V. Luepker. “Consistency between increasing trends in added-sugar intake and body mass index among adults: the Minesota Heart Survey, 1980-1982 to 2007-2009”. Am J Public Health, Vol.103(3), pp. 501-507. 2012. 
  26. ↑ Vanderlee, L., C.M. White, I. Bordes, E.P. Hobin and D. Hammond. “The efficacy of sugar labelling formats: Implications for labelling policy”. Obesity (Silver Spring), Vol.23(12), pp. 2406-2413. 2015. 
  27. ↑ 27.0 27.1 27.2 American Psychological Association. “The impact of food advertising on children”. American Psychological Association. Accessed at: https://www.apa.org/topics/kids-media/food.aspxAccessed on November 26th, 2018.
  28. ↑ Reimann, M., J. Zaichkowsky, C. Neuhaus, T. Bender and B. Weber. “Aesthetic package design: A behavioral neural, and psychological investigation”. Journal of Consumer Psychology, Vol.20, pp. 431-441. 2010. 
  29. ↑ Finkelstein, E.A., K.L. Strombotne, C. Zhen and L.H. Epstein. “Food Prices and Obesity: A Review”. Advances in Nutrition, Vol.5(6), pp. 818-821. 2014. 
  30. ↑ Powell, L.M and F.J. Chaloupka. “Food Prices and Obesity: Evidence and Policy Implications for Taxes and Subsidies”. The Milbank Quarterly, Vol.87(1), pp. 229-257. 2009.
  31. ↑ Jolly, R. “Marketing obesity? Junk food, advertising, and kids”. Parliament of Australia. 2011.  
  32. ↑ Story, M. and S. French. “Food Advertising and Marketing Directed at Children and Adolescents in the US”. International Journal of Behavioral Nutrition and Physical Activity, Vol.1(3). 2004.
  33. ↑ Bragg, M.A., A.N. Miller, J. Elizee, S. Dighee and B.D. Elbel. “Popular Music Celebrity Endorsements in Food and Nonalcoholic Beverage Marketing”. Pediatrics, Vol.138(1). 2016. 
  34. ↑ McClure, A.C., S.E. Tanski, D. Gilbert-Diamond, A.M. Adachi-Mejia, Z. Li and J.D. Sargent. “Receptivity to television fast-food restaurant marketing and obesity among U.S. youth”. Am J Prev Med, Vol.45-5, pp. 560-568. 2013.
  35. ↑ Potters, J. "Meghan Markle, Taylor Swift, and Other Celebrities You Never Knew Promoted Fast Food". marie claire, 2018. Accessed at: https://www.marieclaire.com/celebrity/g22746554/celebrities-fast-food-advertisements/ Accessed on: November 30th, 2018.
  36. ↑ Robinson, L., I. Prichard, A. Nikolaidis, C. Drummond, M. Drummond and M. Tiggemann. “Idealised media images: The effect of fitspiration imagery on body satisfaction and behavior”. Body Image, Vol.22, pp. 65-71. 2017.    
  37. ↑ Lohr, K. “Controvery Swirls Around Harsh Anti-Obesity Ads”. Wyoming Public Radio. January 2012. Accessed at: http://www.wyomingpublicmedia.org/post/controversy-swirls-around-harsh-anti-obesity-ads#stream/0 Accessed on November 30th, 2018.
  38. ↑ Binks, M. “The Role of the Food Industry in Obesity Prevention”. Curr Obes Rep., Vol.5(2), pp. 201-207. 2016.    
  39. ↑ Verduin, P., S. Agarwal, S. Waltman. “Solutions to obesity: perspectives from the food industry”. The American Journal of Clinical Nutrition, Vol. 82(1), pp. 259-261. 2005.
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