CAUSES OF OBESITY: ESCAPING ENVIRONMENTAL INFLUENCE
Environmental pressures encouraging us to eat are very powerful. To avoid food altogether is impossible. It is easy to eat. It is comfortable, satisfying and relatively inexpensive. We are subject to very strong physiological signals that make us want to eat and very weak signals to stop. Hunger makes us feel unwell, sometimes irritable, and food is often available 24 hours a day. We eat when we are happy, we eat when we are sad and we have adopted social and celebratory habits that incorporate excessive eating and drinking. We associate an ability to eat well with health, affluence and social status.
Simultaneously, our society has worked hard over generations to make life easier and physical activity less necessary. To become more active is not easy. It requires effort and can be uncomfortable and time consuming. In past generations, large-scale workforces were paid for their physical activity but in today's society, where work is much more sedentary, we have to pay to be more active by joining gyms and playing formal sports. After a long day at the office or in the classroom, and with other tasks to be done at home, it requires a great deal of motivation to expend more energy and take ourselves out of the comfort zone.
There is no clear strategy for changing the environment. Some have suggested fat taxes on food or even tax rebates for physical activity. Some have suggested statutory changes to prevent the promotion of energy rich foods and fizzy drinks. For the vast majority of people, avoiding obesity, or achieving meaningful weight loss in those who are already obese, is extremely difficult. We ask patients to go against their physiological instincts to eat when food is available and to rest when physical activity is not required.
Changing the environment to one that encourages a more healthy lifestyle would require measures to not only educate but also to facilitate individuals to take steps to override their physiological drives. However, according to the National Weight Control Registry (NWCR) in the US, of those who are successful in losing weight, only 9% have been able to maintain their weight loss without regular physical activity and only rarely does an individual achieve long-term weight loss maintenance without significant amounts of physical activity.
It might be that the most significant impact that can be made on the obesogenic environment is on physical activity, and that increasing activity is what we should aspire to and where our initial efforts should be concentrated. For individuals who are obese, treatment strategies must include lifestyle advice and the use of appropriate medical therapies. On a preventive level, and taking a global approach to weight management and disease prevention, we must work towards changing the environment and developing an increased understanding of how to facilitate weight management within that environment.