by Robyn Toomath
Johns Hopkins University Press, 2017
Review by Christian Perring on Jul 11th 2017
Toomath's point about the health problems caused by obesity is a simple one. Public education and focus on personal responsibility for weight control have very little effect. The only real way to control weight problems is for governments to change social conditions such as the availability of foods that cause weight problems. Her view is that the solution has to be political and requires direct and indirect interference with the agriculture and food businesses. In 2001 she formed a group called "Fight the Obesity Epidemic," and the group ended in 2016. In a 2015 article for the Guardian, she explains that civil uprising is the best hope for change.
The idea that there is a good chance of restricting the free market in the USA in order to reduce the problem of obesity may at first seem far-fetched, but of course American politics is full of surprises, and there is at least some sympathy for the idea that children should be a focus of public health concern and that corporations should not have free reign in maximizing their profits at the expense of young people. Other countries have taken measures such as imposing taxes on unhealthy prepared food and beverages and restricting the advertising of such products.
The book was previously published in New Zealand as Fat Science, and on the Amazon page for it one reader complains that the book was not useful in helping them learn how to lose weight. Of course, the basic message Toomath is giving is one of despair: there is no way to change one's body type when in a particular environment and social setting. For people of a certain genetic disposition living surrounded by fatty foods, their chances of permanently changing their weight is very slim unless they can afford surgery. She says that as a doctor, she has stopped encouraging her obese patients to lose weight, and now focuses on getting them to live more healthily with their obesity.
But Toomath's view is not completely negative. She does think that political change is possible. She wants a world where it is easy to get healthy food and much more difficult to get unhealthy food. If people become able to change their own environment, maybe by moving to a place where the food options are different, this could presumably make a difference to their weight, although it may require resources they do not have.
Toomath argues that the focus on personal responsibility for weight not only is ineffective, but also has negative consequences in highlighting the moral judgment that obese people lack self-control. She spends a good deal of her book pointing out how prejudice against obese people is a major social problem and has a major effect on their lives. This is one of her main arguments for why we should stop trying to get people to change their eating habits -- it is actually counterproductive. She makes a strong case that programs aimed at weight loss do more harm than good.
Nothing that Toomath says goes against that conditional that if you change your eating habits to non-processed healthy food then you can lose weight. What she is denying is that people can actually do this in the long run. Of course we can change our habits in the short term, refraining from fatty sugary food for a day, but we can't do it for a lasting period of time if the food is easily available to us and we have normal pressures facing us. She does not deny even that a small minority of people might be able to do this: her focus is on public health, and effective strategies for reducing obesity. So even if there are a few people who really can succeed, that's largely irrelevant to her point that the vast majority of people cannot.
We might worry that she is overly pessimistic. Maybe we just haven't found the right self-control strategy to teach people yet. But of course, people have been looking for ways to control their food and sexual appetites for thousands of years, with apparently very limited success, so we shouldn't hold our breath in the search for really successful approaches.
So The Obesity Epidemic is a thoughtful and provocative take on the problem of people being overweight, well argued in crisp language with some personal details that help to keep the reader's attention. It casts the food and agricultural industries in a very bad light, and seems overly optimistic about the chances of governments really changing their policies about food. But maybe it's a step in the process we need for that kind of political change.
© 2017 Christian Perring
Christian Perring has regularly taught Heath Care Ethics.