Obese people are often simply greedy and should not always be treated with pills, the head of the British Medical Association said last week.
Dr Hamish Meldrum believes an obsession with medical labels may be stopping overweight people addressing their own problems.
He said the obesity epidemic is being mistakenly targeted with medical treatments and doctors' appointments.
See more on this story here.
Is the above statement a discriminatory attack on people suffering from obesity? Are obesity problems better expalined by the absence of self-control, or even biological factors? Michael easily knows most about the research in this area, so he might have some comments.
In relation to the self-control perspective, a new IZA paper, Limited Self-Control, Obesity and the Loss of Happiness, proposes that "the economics of happiness" is an approach that can be used to study the phenomenon. The authors say that "based on proxy measures for experienced utility, it is possible to directly address whether certain observed behavior is suboptimal and therefore reduces a person's well-being. It is found that obesity decreases the well-being of individuals who report limited self-control, but not otherwise".
This approach, of using proxies for experienced utility, is similar to that undertaken by Jonathan Gruber and Sendhil Mullainathan (NBER, 2002): "Do Cigarette Taxes Make Smokers Happier?" In this paper, the authors match information on cigarette excise taxation to separate surveys from the U.S. and Canada that contain data on self-reported happiness. They "find consistent evidence in both countries that excise taxes make predicted smokers happier" with the explanation that... "smokers are made better off by taxes, as they provide a valuable self-control device".
The comparison of these two papers (IZA 07 and NBER 02) opens up a debate as to whether excise taxies can be used as a proxy for self-control. To be fully semantic, excise taxes should not necessarily enhance self-control, but should simply restrict individual freedom. The self-control problem could very well still be there except that it can't be acted upon due to financial constraints. Sometimes constrained self-control problems are acted upon e.g. thieving by addicts to feed narcotics habits.
Getting back to obesity and self-control, and focusing just on the diet perspective, the "Food Dudes" programme aims to instil healthy eating habits in children at a young age; could this be perceived as a preventitive measure against self-control problems (related to diet behaviour) that are driven by unhealthy eating habits at an early age? Is it the "habit" of eating unhealthily that makes self-control progressively harder to achieve?
According to an article in last week's New Scientist (see here), the Food Dudes programme attempts to convince children to try fruit and vegetables again and again until they actually begin to like the taste. "If you eat a food repeatedly for 10 to 15 times, you learn to like it," says Fergus Lowe (who co-developed the Food Dudes programme at the University of Wales, Bangor). "It educates and habituates the taste buds, but you need to repeatedly eat the food for this to happen."
The New Scientist article also mentions the pioneering evaluation of the Food Dudes programme carried out by the Geary Institute last year: "So could the Food Dudes be the answer? The government of the Republic of Ireland is already sold on the idea. It was so impressed by results from an ongoing pilot trial of the programme in 150 Irish primary schools that in February it decided to end the trial prematurely after two years and launch it nationwide to all children aged 4 to 11. The full roll-out will begin in September. Trials are also under way in the UK and Italy, while California and Canada are preparing for pilot trials too".
4 comments:
I look forward to reading the paper in detail. I like their conclusion that obesity is ok if you don't have a self-control problem but the problem is they didn't assess self-control.
What we have is a 4-item scale which assesses helplessness not self-control and a 'tick if you feel it applies to you' in relation to if the person feels lack of willpower gets in the way of having a healthy diet. This is clearly dependent on factors like- what is your standard for a healthy diet- do you aim to eat healthy- do you percieve the question as applying to you or someone pursueing a healthy diet.
How to phrase a question that doesn't tell you anything: "Many people- maybe you too- attach importance to a healthy diet. Do you see any obstacles for someone pursuing a healthy diet? Please tick the reasons that apply."
The obesity debate is littered with arguments for personal versus societal responsibility. It's not really helpful to use adjectives like greedy or gluttonous as such treatment of obesity is likely to reinforce avoidance behaviours such as those relating to not exercising due to fear of ridicule or avoiding negative internal experiences through comfort eating.
One thing any researcher in the area will agree with is that there are multifarious causative mechanisms when it comes to obesity. We have the FTO haplotype explaining a few kg's of obesity. We have time usage, availability of food, town planning, sedentary workplaces, time-perspectives and more complicated cultural conditions such as consumption as a hope or liberation from present conditions which is associated with a culture of promoting extrinsic rewards.
So everyone has to pick an angle and like the hippocratic oath it's best to work, for a start, in a way that doesn't do any harm which is clearly not what the head of the British Medical Association appears to be doing. However, he may be getting at a valid point which is that obesity can be reduced through lifestyle changes and empowering individuals to act in their own long-term self-interest (and in tandem the interests of society) rather than solely plying these people with drugs. The issue here is that pharmaceuticals companies are quick to exploit the well-being market through offering effortless solutions to problems that aren't that simple.
Another interesting contributor to expanding waistlines: Indulgence in motors, not Big Macs, is fuelling obesity crisis, report says
Is that conclusion, "that obesity is ok if you don't have a self-control problem", based on the idea that some people may have a preference for gluttony, that they make a rational trade-off between being healthy or indulging in fatty foods?
That could be in sync with Becker and Murphy's (1988) "Theory of Rational Addiction":
http://ideas.repec.org/a/ucp/jpolec/v96y1988i4p675-700.html
Another contender for multifarious causative mechanisms of obesity is overeating in pregnancy.
New research from from the Royal Veterinary College in London says that Pregnant mothers-to-be who "eat for two" by increasing their intake of fatty and sugary food could unwittingly be putting their children at risk of obesity.
The authors are neuro-scientists and they suggest that controlling appetite involves hormones which act on the brain to regulate energy balance, hunger and satiety - the sensation of "feeling full".
"However, feeding is not merely mechanical. It is partly governed by "reward centres" in the brain whose pleasure responses may override normal "feeling full" signals. Previous research has shown that junk foods rich in fat and sugar inhibit satiety while promoting hunger and stimulating the mind's reward centres".
"The Government is trying to encourage healthier eating habits in schools, but our research shows that healthy eating habits need to start during the foetal and suckling life of an individual," he said.
http://news.independent.co.uk/health/article2864210.ece
I think the logic is that people will have greater experienced utility if they don't believe that they have a self-control problem and that that's ok.. It's doubtful though if you would really maximise utility over time. That's interesting about the research emphasising food reward systems. There's a growing consensus that the plastic changes in the brain as a result of drug addiction mirror those associated with reward learning supporting the contention that addiction frameworks can be applied to obesity.
There's an obvious connection between memory and addiction in the cues which people associate with satiation and reward driving the motivation for consumption. There have been studies of a particular brain pathway from the amygdala to the lateral hypothalamus (a big reward centre) that show that disconnection of this pathway subtley alters the valuation of food which is based on learned sensory cues and also diminishes the formation of new food-reward learning in the brain (in rats of course). So the quickest solution to obesity seems to be to snip the amygdalo-lateral hypothalamic pathway and bobs your (slightly jaded) uncle!
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