In A Big Fat Crisis: The Hidden Forces Behind the Obesity Epidemic—and How We Can End It, scientist Deborah Cohen advocates for a “paradigm shift” in addressing obesity.
You argue for “an entirely new way to think about and frame” this epidemic. What’s at the heart of this new approach?
My idea for this book is to change the focus from blaming people to looking at how the environment controls behavior. It’s almost impossible for people to control how much they eat if there’s too much in front of them. It’s up to society to protect people from risk factors in their environment that undermine health goals.
Why is over-eating a “public health crisis”?
People tend to eat automatically. And being shown pictures of food, being exposed to the smell of food will make people feel hungry, get their digestive juices flowing, their mouth watering. We’re being exposed all the time to food cues [by advertisers] when we don’t need to eat.
So our “modern food environment” is leading to the high rates of obesity?
Right now, supermarkets and big-box stores are designed to encourage impulse buying. You put all the junk food on the end aisles, candy at the cash register. Supermarkets are controlling the American diet, because most people still eat most meals at home.
You suggest interventions to modify the supply of food, from redesigning supermarkets to standardizing restaurant portions that make food providers more responsible for offering better choices. What about free will?
It’s too much of a burden [to expect] everyone to be a diet expert. It’s up to the purveyors of food to make sure we don’t put people at risk. Obesity and chronic diseases have a huge price tag. My idea is a basic one: the easy choice is the healthy choice. If the commercial industry is only offering foods that don’t put us at risk, then, if we want to make a bad choice, we have to work at it. I’m not suggesting that people can’t choose what they want; what I want to do is change the convenience.
You also propose some government regulation and enforcement of food standards.
We have a precedent for that: the history of alcohol control. We had a terrible problem with drunkenness in the 19th century. Now we have certain restrictions; we’ve had reductions in mortality. We now have to think about [this] in respect to food. There’s ample precedent for society regulating the sale, marketing, and promotion of substances that are associated with poor health outcomes. We need standards and controls for food.