Several considerations must govern determination of who is at fault for the rise in incidence of obesity. In as much as the rise is a public health phenomenon, the obesity is the fault of the public health agencies, the medical practitioners, and medical science researchers. They should know what is going on. They should have an objective understanding of the phenomenon without bias from any industry associated with the public health issues (e.g., food, restaurant, pharmaceutical, medical industries). They have the responsibility for originating and shaping public health policy.
Public health agencies cannot solely be to blame, however. Individuals are responsible for the rise in obesity in two respects. First, they are politically responsible. Public health policy exists completely within a political arena. Political choices by elected representatives and ultimately by voters determine the framework of authority and responsibility for public health. Voters cannot shirk their responsibility for these political decisions.
Individuals are also responsible, in a second respect. Every person owns their own body and mind, their health and their illnesses. I recognize that ownership is not uncomplicated. We do not create our health out of thin air. Genetic inheritance from our parents and ancestors determine much of our health and susceptibility to disease. How each person is nurtured and raised by their parents lays the foundations of adult health. Parental decisions about whether to breast feed, what diet to give to the child, what exercise routine to follow, what friends to have, and what lifestyle choices to make are largely outside the child's capability to affect, yet will have an enormous impact on adult health. When the child finally becomes an adult and can take on responsibility for personal health, probably eighty percent of all factors affecting health are already in place, with little opportunity for modification.
Nonetheless, within that twenty-percent scope lies the opportunity to shape a great deal of our health. The old saying is appropriate here: Diet and exercise are three-fifths of health. This saying is epecially helpful in dealing with the obesity phenomenon. We can see our opportunity better if we place it in the context of history of weight gain.
To review, there are at least five kinds of weight gain.{1}
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Normal, cyclical weight gain and loss;
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Illness induced weight gain and weight gain accompanying recovery from illness;
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Medicine induced weight gain;
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Metabolic syndrome weight gain;
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Obesity
Normal cyclical weight change. Every person goes through cycles of weight gain and loss. Simple water retention and loss due to physiological cycles (such as menstruation) will add five pounds in a week. A modest illness, such as the flu, will shed three to five pounds in a few days, and the weight will be regained in the month after the illness has passed. Pregnancy will add twenty pounds to the expectant mother, who will lose the weight normally in the year after giving birth. Men will gain ten or twenty pounds in the months after they cease vigorous exercise in a sport, such as playing basketball or soccer in college. They will lose that weight naturally as their appetite diminishes when their caloric requirement diminishes.
Medicine induced weight gain. As I discussed previously, many pharmaceutical medicines cause weight gain. As long as the patient remains on the medicine, the weight gain stays. The remedy is to go off the medicine. Obviously, this is dangerous to do for many medical conditions. Nonetheless, alternative medicine by naturopathic doctors and other practitioners provide remedies that are effective for many diseases and do not have the side-effects of pharmaceutical drugs. Any patient experiencing medicine weight gain should investigate alternative medicine.
Illness weight gain. Everyone experiences weight loss and gain with common diseases, such as influenzas, as well as serious diseases. These are normal side-effects of the body's ongoing combat with infectious disease.
Metabolic syndrome weight gain. Metabolic syndrome weight gain is the result of an underlying sub-clinical medical condition. I have adapted the term from the etiology of diabetes II. The syndrome typically brings a weight gain of twenty to thirty pounds, along with medical indicators of an incipient disease condition, such as rising cholesterol, rising blood pressure, and (in the case of pre-diabetes) rising blood sugar.
The metabolic syndrome is a definite medical condition, but one that has not yet become a crisis. In the pathway to obesity, inflammation has become chronic, but it is still remediable. In metabolic syndrome, the underlying medical condition can be cured and normal health recovered by radical changes in diet and exercise, sometimes involving lifestyle change (in the same sense that ending smoking is a lifestyle change).
The US military, concerned about the excessive weight of recruits to the armed services, are considering weight-conditioning camp before boot camp to help recruits bring their weight down. Such weight loss seems to me entirely possible for most young men and women, whose excessive weight gain is almost certainly still within the metabolic syndrome stage.
It is, ultimately, the individual's responsibility to seize the moment of opportunity provided by the metabolic syndrome. The syndrome is a warning period with lots of warning flags. It provides an opportunity to heal ourselves and recover our health. We should want our medical community and public health agencies to provide information to help us; but ultimately it is our responsibility.
The symptoms of the metabolic syndrome are obvious. The rapid gaining of weight, the increasing blood pressure, and increasing fatigue are felt daily. But lethargy has not yet set in; we remain capable of self-motivated care. As we become aware of the symptoms, of course we should seek medical help; but we can do most of the work in healing ourselves by ourselves. Two thirds of recovery of normal health will come from radical transformation of diet and daily vigorous exercise.
Obese weight gain. At some point, the underlying disease condition of the metabolic syndrome kicks over to a crisis; at that point, we are on our way to obesity. For reasons I have previously discussed, we lose the opportunity willfully to halt the weight gain and recover our health. Lethargy sets in, depriving us of the motivation to exercise. Weight gain becomes inexorable.
I don't know what remedies medical science or public health can produce to halt and reverse the rising incidence of obesity. On the societal level, we would need to reverse the terrible developments in processing of food, diet, and medicine after 1945 which are the ultimate cause of the rising incidence of the disease, as I discussed in "The Perfect Storm". I believe that it is out of the realm of possibility for ordinary, obese individuals to heal themselves and reverse their obesity. Perhaps heroic efforts might make extreme weight loss--a hundred or two hundred pounds--possible; but heroism of this scale is not widely distributed throughout the population.
On the other hand, I am an existential optimist. I believe that medical science has nearly everything to learn about the etiologies of obesity, the different kinds of obesities, and bio-chemistry and pathways of obesity diseases; and that medical science will eventually learn. For research science, knowing nearly nothing at this point is probably good, because it will be easier for new knowledge to knock out prejudice and error about obesities. I also believe that no obese person can know whether they are capable of heroic weight loss and transformation of their life until they try. So we should try. As individuals succeed, they will light the path to greater understanding of how to recover health from the grasp of obesity and, thereby, help us all.
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{1} My typology of weight gain is purely phenomenological. I have no expertise to devise an obesity classification on the basis of medical symptoms, or diseases, or bio-chemical principles.
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Revised. April 29, 2009, October 16, 2011.
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The Causes of Obesity
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