The New Health Dialogue

via http://unrealitymag.com/

Two weeks ago, American Beverage Association President Susan Neely took issue with Mark Bittman’s New York Times Magazine article, in which he advocated taxes on soda and other unhealthy foods. Bittman’s justification was that raising the prices of those unhealthy foods relative to more nutritious foods would encourage people to eat more healthfully, and so help combat the national obesity epidemic. Neely said in her response, “Obesity isn’t about “good” and “bad” foods. It’s about an imbalance between calories consumed — from all foods and beverages — and those burned through physical activity.”

She’s right, of course: many factors contribute to obesity, but the problem isn’t as simple as “eating bad foods makes you obese.” The thing is, that’s not what Bittman was saying, either. The ultimate goal of his tax proposal is to change the food environment in which we live.

Public health advocates believe that Americans live in an obesogenic environment: not one where anyone is forced to eat unhealthily and become obese, but an environment with forces that encourage overconsumption of calorie-dense, low-nutrition foods.

Some of those factors are deeply ingrained in our physiology and brain function: we are predisposed to eat fatty and sugary foods when they’re available, because they represented a scarce and valuable source of calories earlier in our evolutionary history. Similarly, we don’t think of beverages as having calories, and don’t feel full after drinking them, because historically that was a reasonable assumption. Now, though, sugar-sweetened beverages and calorie-dense foods are stacked nigh unto the heavens, and we have to overcome the reflex to eat them all the time. What was once an adaptation that allowed us to survive as hunter-gatherers, now makes us vulnerable to the charms of Little Debbie.

For some groups, there are additional pressures that make them even more susceptible to the threats of an obesogenic environment. The poor are obviously more income-constrained in their food choices, and so are more affected by the low price of foods with lots of saturated fat and added sugar. The additional time required to prepare a meal at home instead of buying fast food is also particularly important for the poor: A recent Health Services Research study underlined the importance of time-costs in determining Medicaid beneficiaries’ medical choices.

Finally, the issue of “food deserts” has come to the fore in recent years. The term refers to areas where a significant part population simply doesn’t have access to quality foods like fresh fruits and vegetables, because there are no grocery stores available within walking distance and access to cars is limited. While the issue of food deserts is clearly secondary to making healthy food choices more financially viable for the poor, it only further compounds the challenge of changing actual eating habits.

In addition to the poor, children get the fat end of the obsogenic stick in our modern food environment. Kids are surrounded by advertisements for low-nutritional-value foods, and the unhealthy habits they develop can haunt kids throughout their lives. Medical science has yet to determine the health effects of long-term obesity, but based on what we’ve seen with obesity later in life -- higher rates of diabetes, congestive heart failure, various cancers, high blood pressure, and a host of other chronic health problems -- the outlook for obese children is not bright.

None of the conditions I just named absolves individuals of their responsibility to make healthy choices or bear the consequences. But we can’t deny that our environment affects our food, our health, and our medical spending. Looking for ways to limit the negative effects of the food environment, as Mark Bittman was, is the only way to take responsibility for everything that affects our health.

Pass the (untaxed) broccoli.