By Merrill Eisenberg
University of Arizona
It’s not news that Americans are growing fatter. Obesity rates have been rising steadily since the early 1980’s, when the adult obesity rate was about 15%. Today, 33.8% of American adults are obese and another third is overweight. Like many other measures of wellness, (or lack thereof) obesity disproportionately impacts poor and minority communities. Recent BRFSS data for 2006—2008 show that non-Hispanic blacks had 51% greater prevalence of obesity, and Hispanics had 21% greater prevalence, when compared with non-Hispanic whites. Most alarming is that child obesity has also been on the rise – in 1971-74, 5% of children age 2-19 were obese. Today it is 16.9%. Children who are obese are likely to become obese adults.
Obesity is related to many health issues, including diabetes, cardiovascular diseases, liver and gall bladder problems, sleep apnea and respiratory problems to name a few. Forty-four percent of Americans have a chronic disease related to obesity, which makes it a societal problem. Health care costs related to obesity account for 9.1% of all health care spending – $500 per year for every man, woman and child in the US, according to the CDC. Obesity negatively impacts worker absenteeism and productivity, and is a growing concern with regard to military readiness, as 27% of potential recruits are deemed “too fat to fight” and the military discharges 1,200 enlistees annual because of weight problems.
The most usual immediate cause of obesity is an energy imbalance – we eat more calories than we burn. The usual interventions for obesity have been related to nutrition and physical education. These interventions are focused on the individual and are premised on the idea that once people know how to maintain a healthy body weight, it is up to them to follow through with the recommended food and physical activity behaviors. These types of interventions are important, of course, but they do not get at the systemic issues that drive people to make unhealthy choices and the disparities that impact the choices individuals are able to make. They ignore the physical, economic, and social constraints that play a role in the decision-making process.
For example, how can a family on a tight budget afford to purchase healthy foods when research shows that low-calorie, high-nutrient foods are far more expensive than high-calorie, low-nutrient foods? In addition, many minority neighborhoods are located in “food deserts” – places with no supermarkets or other access to fresh fruits and vegetables. But that doesn’t mean there is no access to food. The density of fast food restaurants, with their high-calorie/high-fat “dollar menus,” is highest in low-income areas. In Tucson, AZ for example, there are large swathes of the community in which you will pass 8-12 fast food restaurants before you come to a supermarket.
Food marketing is another systemic issue that drives us to make unhealthy choices. The food industry spends $89 per year for every man, woman and child in the US and 23.5% of high schools offered fast food from national chains in their cafeterias in 2006. Practices such as “super-sizing” and unlimited free refills on sweetened beverages steer us to obesity, especially in these times when our hectic lifestyle (fueled by an economy that does not favor stay-at-home parents who can regularly prepare healthy meals) has resulted in Americans now eating on average, 4 meals per week in restaurants.
The physical activity side of the energy balance equation is also problematic. Since the early 20th century, community design has been literally driven by the automobile. Using the construct of “Euclidean Zoning,” residential, commercial, and industrial land uses have been separated, resulting in having to travel great distances to conduct daily life. Decisions made decades ago to scrap existing electric street car lines in favor of roads for combustion engine-powered vehicles, have left us with sprawl, air pollution, traffic jams, and hours spent commuting by car rather than by what planners refer to as “active transport” – getting around by foot, bicycle, or public transport. In 1969, 40.9% of children rode their bikes to school each day; today that number is only 12.9%. The decline is attributed to the increase in distance to schools as a result of bussing, and community design that places schools outside of neighborhoods. In schools, physical education classes have been a casualty of declining education budgets and the increasing focus on high stakes academic testing, resulting in little opportunity for children to burn many of the high fat calories they ate at lunch.
With the decline of opportunities for active transport, physical activity is no longer part of our everyday life. We have to set aside time specifically for exercise, and given the chaotic nature of our 21st century lives, many people simply do not have the time or energy to engage in regular physical activity. Lack of parks and recreational areas, sidewalks, and lighting, and safety and crime concerns, which impact poor and minority groups the most, all create additional barriers to getting the exercise we need in our “spare time.”
Many of the barriers to healthy eating and active living are built into our communities through local policies and systems and are far more amenable to local community input than are federal level policies such as a Farm Bill. Local decisions determine things like where supermarkets are located, the density of fast food restaurants, the degree to which roads accommodate all types of transport, the siting of destinations in walkable/bikeable distance to residential areas, the presence of sidewalks, traffic calming, and lighting on community streets, restrictions on local food production and distribution, the content of foods that are available in schools, and many other community decisions that currently favor obesity over health.
Our fellow applied social scientists in the field of planning have recognized many of the issues mentioned above and have developed alternative policy solutions to remedy the situation. Concepts such as high-density mixed-use zoning, New Urbanism, Smart Growth, and Complete Streets have been well developed and are being promoted as an alternative to Euclidean zoning in communities across the country. The CDC is promoting the adoption of these types of community-based interventions through grant programs. Some communities are also adopting local ordinances that restrict the density of fast food restaurants or that ban the use of artificial trans-fats or require restaurant menus to include calorie, fat, and other nutritional information.
These policy responses to the obesity epidemic are very promising. However, the necessary changes to land use plans, zoning and other local ordinances, and school policies must be made in the political process. Schools won’t change their menus unless parents pressure them to do so; builders and developers will dominate the community design decision-making process unless citizens speak up. Local elected officials won’t be open to changes in the Food Code without prodding from grassroots interests that want to increase the production and distribution of local fruits and vegetables. But citizens won’t speak up if they don’t understand the role of policy in creating an obesogenic environment.
Recent media attention to the obesity epidemic, spurred by Michelle Obama’s “Let’s Move” initiative, coupled with the CDC’s “Communities Putting Prevention to Work” grants, have raised the salience of obesity as a public policy issue. This creates an opportunity for applied anthropologists, especially those working at the grassroots level on health issues that are related to obesity, to participate in creating meaningful policy change. By partnering with other “like minded” groups and organizations, we can contribute to the policy changes that create the environmental changes that promote health rather than disease.
Here in Pima County, Arizona we have been fortunate to have received a Communities Putting Prevention to Work grant and are busy working with residents of high-risk neighborhoods to identify and design environment improvements and policy changes that can increase access to fresh fruits and vegetables and increase opportunities for physical activity at the local level. We are also linking these neighborhood level groups with a variety of “like-minded” groups to influence planning, zoning, transportation planning, and ordinance development that will result in a re-design of our current environment and ensure that future development does not favor the behaviors that lead to obesity. Our allies are broad-based in this endeavor, including health-oriented groups that focus on obesity-related diseases, “green” organizations that are interested in local food production and environmental issues, organizations representing sports and physical activity interests, farmers and food cooperatives, planners and landscape architects, bike and pedestrian enthusiasts, parent organizations, and many others. Our overall goal is not to tell people how to live, but to make it easier for people to make health lifestyle choices. Our plan is to engage and empower local communities to participate in local policy processes such as the development of land use plans, zoning regulations, and city/county ordinances and programs that create the environment in which we live.
The role of the environment in creating culture has been well recognized by anthropologists for many decades. As applied anthropologists who are interested in using the concepts of our field to improve the human condition, the current national focus on obesity opens a door to creating real and positive culture change. Many of the systemic determinants of obesity are local level issues. The key to influencing the policies and systems that make it difficult for people to choose healthy lifestyle behaviors is to re-frame the locus of responsibility for the obesity epidemic in the public’s mind and to create broad coalitions at the community level that can advocate for community design and systems change that promotes health.