It’s not the diet, it’s the environment
Posted on February 26th, 2009 – 10:31 AMBy Josephine Marcotty
The take home message in the diet study published today in the New England Journal of Medicine is that diets don’t work.
Real news flash, huh? It’s the calories that count no matter where they come from –fat, protein or carbohydrates. Eat more than you burn, you get fat.
I thought the editorial in the NEJM, written by Martijn Katan, Phd., from the Institute of Health Sciences at VU University in Amesterdam, clearly outlined the only solution to the obesity epidemic. And it’s not weight-loss surgery for all.
The inability of the volunteers to maintain their diets must give us pause. The study was led by seasoned investigators who were experienced in the performance of diet and drug trials. The participants were highly educated, enthusiastic, and carefully selected. They were offered 59 group and 13 individual training sessions over the course of 2 years. Nonetheless, their body-mass index (the weight in kilograms divided by the square of the height in meters) after 2 years averaged 31 to 32 and was moving up again. Thus, even these highly motivated, intelligent participants who were coached by expert professionals could not achieve the weight losses needed to reverse the obesity epidemic. The results would probably have been worse among poor, uneducated subjects. Evidently, individual treatment is powerless against an environment that offers so many high-calorie foods and labor-saving devices. (My emphasis)
In other words, it’s the environment stupid. Obesity experts have been pounding this drum for a long time. Overeating and obesity is not a matter of self control — we can’t defeat our biology. We are programmed to over eat. The only way to halt the obesity epidemic is to change our environment. Katan offers a case in point. She describes a little noticed study in France. Starting in 2002 two small towns in France built a community-wide effort to prevent overweight schoolchildren.
Everyone from the mayor to shop owners, schoolteachers, doctors, pharmacists, caterers, restaurant owners, sports associations, the media, scientists, and various branches of town government joined in an effort to encourage children to eat better and move around more. The towns built sporting facilities and playgrounds, mapped out walking itineraries, and hired sports instructors. Families were offered cooking workshops, and families at risk were offered individual counseling.
The results were remarkable. By 2005 the rate of overweight in children had fallen to 8.8%, while in neighboring towns it rose to 17.8%, in line with the national trend. That community approach is now being extended to 200 towns in Europe, under the name EPODE (Ensemble, prévenons l’obésité des enfants [Together, let’s prevent obesity in children]).
Could we do that here? What would it take? Banning food advertisements on TV? Is it worth the investment up front to give kids healthier lives and to prevent higher costs later on?
12 Responses to "It’s not the diet, it’s the environment"
Ban fast food or junk food OR their advertisements and the food industry will find another way. Teach Americans to cook real, healthy foods instead of relying on fast-food and the 21st century equiv. of TV dinners — maybe that will help, maybe not. I dont’ think that’s any more realistic. Neither is a ban on video games and the TV networks. You might get somewhere but only if you can find a way to get the kiddies to “go out and play” instead of staring passively at the screens…and don’t just pick on the kids. It’s the same with adults. We need to make activity more attractive than passivity at every possible level. Maybe you’re right, we can’t fight the human urge to feed. Can we ramp up the activity levels to return to the point where we burn those calories? Not while phys ed programs get cut, open areas get paved for mall parking, TV and computer games take over the hours that used to be spent playing outdoors with the neighbors & their kids, neighborhoods are planned around cars istead of walking, etc etc. The list of hurdles is tall and long. We need to get OUR selves and OUR OWN families into the game, not wait for some magic solution — activities program, diet or medical proceedure.
Nutritional education and financial education should be mandatory in our schools today with emphasis on the outcome if you don’t follow what you are taught. Can you imagine what a healthy person with a healthy checkbook looks like today? Not too many around!!!!
The thing about education? We all know what we “should” do. We all know we shouldn’t buy that new outfit on credit, and we “know” fast food isn’t good for you, but hey, it’s right around the corner and I’m busy and it won’t hurt just this once. I agree in principle with environment changes, but I also don’t want to let the tobacco police go after fast food like they did after the smoking ban. Don’t you think all of this health legislation is going to backfire?
I have coached little league and girls softball. It has driven me nuts for years that the parents show up after the game with a bunch of treats like ice cream, pop etc. Its like kids can’t exercise for an hour unless we fill them with crap afterwards. A couple of years I tried banning it from my teams, but the parents thought I was being too strict. “All the other teams kids get treats. Why can’t ours.” Because its not good for them. That’s why.
I’m pretty sure it’s the environment, too. More and more people live in neighborhoods where you can’t walk anywhere. Parents get paranoid about abductions and won’t let their kids play outside. Busy families buy takeout food instead of cooking, and as a result, don’t pass cooking skills on to their children. As I look back at my elementary school pictures from the 1950s, I see ONE fat kid out of 30. That’s because we walked back and forth to school four times a day: in the morning, home for lunch, back to school an hour later, and home at the end of the day. Plus we had recess twice a day and phy. ed. three times a week. When it was too cold to go outside, we did folk dancing or square dancing in the cafeteria. Our diet wasn’t particularly healthy, but we wore off what we ate.
I lost over 120 pounds with no help from anyone. The method was simple: use more energy than I eat. The key difference for me was I actually cut down on the food I ate.
*** Why should things be banned because you people are all too irresponsible to control your food intake? You want to force restaurants to close down and force everyone to live their lives to suit your weaknesses.
*** Do I get an exemption? How do you propose to compensate me for all the freedoms and choices I’ll lose? And why? Because you fail to exercise the free will that comes with your basic humanity?
My doctor got on my case a year ago Februaray. He said I was obese and neeed to do something about it.
I actually agreed with himt that enough is enough its time to change.
I had successfully created a quit smoking plan that worked flawlessly so it was time to create a lose weight plan.
1, My first tenet in thinking this out was ‘diets don’t work. Only a combination of eating the right or less amount of food and exercise really work and one has to commit to a life style change.
2, I’ve lost 38 pounds since last Feb and was just in Mexico and did ten laps in the pool and wasn’t breathing hard, I’m 63.
Looks like the medical profession discovered what I did last year on my own.
Moderate Diet and Exercse works everytime it is tried. Don’t be stuck on stupid…like more govt
People want the government to inact these laws (ban fast food, etc) so then they are not responsible anymore for their own well being. They can blame the gov’t for their obesity just like they do for everything else.
Moderation, which seems so sensible, is one of the hardest things to achieve on a consistent basis. It’s easier to adhere to a strict diet with clear do’s and don’ts, or to go off the wagon completely and eat everything that isn’t nailed down, than it is to follow a middle course. But I agree, such moderation is the only answer.
The focus should be on life style rather than weight per se—not everyone can achieve “thin” without starving themselves, which won’t work in the long run. Exercise and moderate amounts of healthy food are the key.
I’m a little skeptical that kids in the 1950’s wore off all the food they ate. It takes an amazing amount of activity to burn a small number of calories. I think portions were smaller, kids generally did not eat between meals, and food wasn’t available 24/7.
It appears from this article that the only way to control over-eating is to create an environment where it isn’t an option. Outside of solitary confinement, where meals are delivered on tin trays three times a day, I don’t think there is such an environment in the real world. People are going to have to struggle against the biological imperative to over-eat, unless famine solves the problem for us.
I walk fast 4 or 5 times a week on the streets in my neighborhood, for 50 minutes each time. I’m 58 and still weigh just 150 (5′ 11″). It doesn’t take any government intervention. It just takes a decision to do some regular moderate exercise and not be a pig when you’re eating. Jeez, nobody wants to take any self-responsibility anymore. We’ve become a nation of whiners and wimps who the government to solve our personal problems. Let health insurance companies charge more for those who are overweight. That would give people some incentive. Oh, that’s right, the messiah is now going to give all of us free government healthcare. Well that will soon lead to rationing, so maybe then they will ration it to fat people, creating an incentive.
I walk fast 4 or 5 times a week on the streets in my neighborhood, for 50 minutes each time. I’m 58 and still weigh just 150 (5′ 11″). It doesn’t take any government intervention. It just takes a decision to do some regular moderate exercise and not be a pig when you’re eating. Jeez, nobody wants to take any self-responsibility anymore. We’ve become a nation of whiners and wimps who expect the government to solve our personal problems. Let health insurance companies charge more for those who are overweight. That would give people some incentive. Oh, that’s right, the messiah is now going to give all of us free government healthcare. Well that will soon lead to rationing, so maybe then they will ration it to fat people, creating an incentive.
