By Matthew Flinders
One of the critical skills of any student of politics — professors, journalists, public servants, writers, politicians and interested members of the public included — is to somehow look beyond or beneath the bigger headlines and instead focus on those peripheral stories that may in fact tell us far more about the changing nature of society. It was in exactly this sense that I was drawn recently not to the ‘War in Whitehall’ or Cameron’s speech on the UK’s future relationship with the European Union but to a story about the launch of a ‘smart fork’. The ‘smart’ feature being the existence of a shrill alarm which would inform its user if they were eating too quickly. This, I have quickly realized, is just the latest in a long stream of innovations that seek to nudge individuals towards making better choices about the way they lead their lives (eat less, save more, drive more slowly, etc.). And so it turns out that the ‘smart fork’ is just one of a great series of new innovations that seeks to deliver a form of liberal-paternalism by somehow reconciling individual freedom and choice with an emphasis on collective responsibility and well-being. My favorite amongst these innovations was the ‘smart trolley’: a supermarket trolley with sensors that beeped (and flashed) at the errant shopper who succumbed to the temptation to place a high-fat product in their trolley.
There was something about the idea of a smart fork, however, that I found particularly disturbing (or should I say ‘hard to swallow’, ‘stuck in my gullet’, ‘left a bad taste in my mouth’, etc.?). My mind jumped back to Michael Sandel’s argument that ‘the problem with our politics is not too much moral argument but too little…Our politics is over-heated because it is mostly vacant’. My concern with the launch of the ‘smart fork’ is that it arguably reflects an unwillingness to deal with the moral arguments that underlie the obesity endemic in large parts of the developed world. If Sandel’s concern about the imposition of market values is that it could ‘crowd out of virtue’ then my own concern is that behavioral economics revolution risks ‘crowding out thought’ in the sense that new technologies may provide little more than an excuse or displacement activity for not accepting responsibility for one’s actions. In the twenty-first century do we really need a computerized fork or shopping trolley in order to tell us to eat less food more slowly, or to buy less high-fat food and exercise more?
The smart fork therefore forms little more than a metaphor for a society that appears to have lost a sense of self-control and personal responsibility. This, in turn, pushes us back to broader arguments concerning the emptiness of modern political debate and to the relative value of the public and private sectors. As Alain de Botton argued in Citizen Ethics in a Time of Crisis, we could ask whether individual freedom has really served us so well as the leitmotif of modern life. ‘In the chaos of the liberal free market we tend to lack not so much freedom [but] the chance to use it well’ de Botton writes; ‘We lack guidance, self-understanding, self-control….being left alone to ruin our lives as we please is not a liberty worth revering’. Slavoj Žižek paints a similar argument across a broader canvas in his provocative work Living in the End Times . ‘The people wanted to have their cake and eat it’, Žižek argues; ‘they wanted capitalist democratic freedom and material abundance but without paying the full price’. He uses an advert on American TV for a chocolate laxative—‘Do you have constipation? Eat more of this chocolate’—to mock the modern public’s constant demand for results without ever having to suffer unpleasant side effects.
Although hidden far beneath the front-page headlines, the story of the launch of the smart fork (in Las Vegas — need I say more) highlights the existence of an underlying problem in the sense that most politicians appear either unwilling or unable (possibly both) to tackle the issue head-on. Between 1980 and 2000 obesity rates doubled in the United States to the extent that one in three adults (around sixty million people) are now clinically obese, with levels growing particularly amongst children and adolescents. In this context it may well be that individuals require — even want — not a nudge but a shove or a push towards a healthier lifestyle? If this is true, it is possible that we need to revisit certain baseline assumptions about the market and the state and not simply define the role of the latter as an inherently illegitimate, intrusive, and undesirable one. To make this point is not to trump the heavy hand of the state or to seek to promote some modern version of the enlightened dictator, but it is to inject a little balance into the debate about the individual and society. Is it possible that we ‘hate’ politics simply because, unlike those unfeasibly self-contained, sane, and reasonable grown-ups that we are assumed to be by liberal politicians, most of us still behave like disturbed children (or political infants) who simply don’t want to take responsibility for our actions or how they impact on the world around us? Or — to put the same point slightly differently — if the best response we have to the obesity crisis is an electric fork then in the long term we’re all forked.
Matthew Flinders is Professor of Parliamentary Government & Governance at the University of Sheffield. He was awarded the Political Communicator of the Year Award in 2012. Author of Defending Politics (2012), he is also co-editor of The Oxford Handbook of British Politics and author of Multi-Level Governance and Democratic Drift. Read more of Matthew Flinders’s blog posts and find him on Twitter @PoliticalSpike.
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By Mark S. Gold, MD
Public health officials and academics identified cigarette smoking and related disease as the nation’s number one killer and foremost driver of health costs in the 1980s. At that time overeating and obesity were not major problems, yet they may soon cause more disease, deaths, and health care costs than cigarettes. Food addiction, which may explain part of the epidemic, is slowly and finally “catching on”. It’s been controversial, with some scientists dismissing it out of hand, so like any hypothesis, it needs additional tests.
If overeating is due to food acquiring drug-like or tobacco-like brain reinforcement properties, then the current globesity and overeating-related health crisis might have lessons to learn from tobacco. For example, taxes on tobacco products have been the single most important prevention tool in reducing smoking. Based on food addiction hypothesis, higher prices might also reduce soda consumption. A review suggested that for every 10% increase in price, consumption decreases by 7.8%. An industry trade publication reported even larger reductions; as prices of carbonated soft drinks increased by 6.8%, sales dropped by 7.8%, and as Coca-Cola prices increased by 12%, sales dropped by 14.6%. It follows that a tax on sweetened beverages might help consumers switch to water or more healthful beverages. Such a switch would lead to reduced caloric intake, and less weight gain.
Changing the attitudes and behaviors of the public combined to reduce smoking and smoking-related health care costs and suffering. Changing access to cigarettes by elimination of cigarette vending machines, raising the price per pack to decrease numbers of cigarettes or packs/day smoked, crafting PSAs to reduce smoking initiation, and training medical professionals to intervene and not look the other way, all helped reduce smoking.
Age of onset and exposure can change genes, and make use and addiction more likely. We know that early exposure to tobacco via second-hand-smoke, either in utero or in early life greatly increases the risk of life-long tobacco use and addiction. In the 1990s, children’s intake of sweetened beverages surpassed that of milk. In the past decade, per capita intake of calories from sugar/HFCS-sweetened beverages has increased by nearly 30%. Beverages now account for 10–15% of the calories consumed by children and adolescents. It is likely that food addiction models can be used to explain early exposure and changes in preference becoming fixed and persistent for life. An extra can or glass of sugar or HFCS sweetened beverage consumed per day increases the likelihood of a child’s becoming obese increases by 60%.
Our efforts to manage and treat overeating and obesity might benefit from addiction methods and experience. We could develop realistic food addiction models and test new treatments. Would animals self-administer food or food constituents, avidly, with bingeing and loss of control? Yes. Our work (and Bart Hoebel’ s before) clearly demonstrates that sucrose and fructose corn syrup are self-administered as if they were drugs and that an opiate-like abstinence syndrome could be produced by detoxification or antagonist administration. Sugar stimulates its own taking causes craving, wanting, withdrawal, and can motivate and change our behavior.. If the food addiction hypothesis were relevant to the human condition, these animal models could be used to test new medications. New treatments developed for overeating and obesity were previously shown to be effective in addiction medicine.
These new treatments approved by the FDA include phentermine plus topiramate and bupropion plus naltrexone. Topiramate has been used with success in alcohol dependence, bupropion in nicotine dependence, and naltrexone in opiate and also alcohol dependence. While early, these treatments are important tests of the addiction hypothesis and harbingers of more progress in the future. With addiction medicine and food addiction model systems, we may develop treatments which change food preference and not just appetite.
Food addiction may explain some, but certainly not all obesity. The Yale Food Addiction Scale may be used to screen patients for addiction-like pharmacological and psychological interventions. Medically-assisted smoking cessation efforts were enhanced once treatment advanced from simple nicotine replacement or detoxification, to the brain and the neurobehavioral attachment to cigarettes. With an addiction hypothesis that included dopamine, we discovered the efficacy of bupropion and then Chantix. Thus, rather than a successful short term treatment rate of less than 20%, we routinely helped 30% of smokers. Still, addiction-inspired public health measures rather than medically-assisted treatment were responsible for most of the successful cessation efforts, early intervention, and prevention.
Smoking-related disease caused 400,000 deaths per year in the USA plus an additional 40,000 deaths due to second-hand smoke. Until recently little effort was directed at preventing smoking or treating smokers, although we treated the lung cancers, stroke, erectile dysfunction and other diseases caused by smoking. With all this progress, all of the health savings related to smoking cessation will soon be replaced by obesity-related costs. Are these two events related? As smoking and addiction is associated with decreases in eating and weight, a nation detoxifying from smoking addiction should be expected to become overweight. Until recently, with the scientific support provided by food and addiction models, we have not applied the same lessons learned from tobacco to overeating and obesity.
Proposals for food taxes have been made and calculations formulated of revenue-benefits based on our experiences with tobacco taxation. Even when these fail, the public and health experts have to think through the idea that fruits and vegetables are more costly than fatty, sweet, fast foods. Using taxes on ingredients such as added sugar and fructose corn syrup would decrease exposure according to addiction models. This might make Coca-Cola and other sodas return to sucrose as in Mexican or Kosher Coke. Reducing portion size, while supported by cigarette experience with numbers of cigarettes per pack and purchase limits, is a weaker intervention than other approaches. Now we see food labels and calorie postings. This educates everyone as they consider is it worth the calories and do they have the time and energy to exercise away the calories ingested. Exercise is important, and promotes health, but is not a stand-alone obesity treatment or management strategy. Stigmatizing the overweight with added health premiums and workplace incentives has not worked well in the past. Blaming the patient, creating shame and guilt, doesn’t do much to inspire treatment efficacy.
Obesity has changed the width of the seats in airplanes, dress, and trouser sizes. It has also made high cholesterol, high blood pressure, high blood sugars, knee and joint pain, and other obesity-related problems routine in medical practice and treatment. Over the past three decades, rates of obesity have increased in the United States and elsewhere, so that now more people are obese and in need of treatment than ever. New approaches, evidence-based approaches, like those that have been used successfully to develop novel public health and treatment approaches for tobacco, alcohol, and other addictions are needed.
Mark S. Gold, MD is the co-editor of Food and Addiction: A Comprehensive Handbook with Kelly D. Brownell. He is the Donald Dizney Eminent Scholar, Distinguished Professor and Chair of Psychiatry at the University of Florida. Dr Gold is a teacher of the year, researcher and inventor who has focused for much of his career on the development of models for understanding the effects of tobacco, cocaine, opiates, other drugs, and also food, on the brain and behavior. He began his work on the relationship between food and drug addictions while at Yale working with addicts in withdrawal. He has worked for 30+ years trying to understand how to change food preferences, make eating and drugs of abuse less interesting or reinforcing at the brain’s dopamine and other reinforcement sites. Kelly D. Brownell, PhD is professor of psychology, epidemiology, and public health at Yale University and is director of Yale’s Rudd Center for Food Policy & Obesity. Dr. Brownell does work at the intersection of science and public policy. The Rudd Center assesses, critiques and strives to improve practices and policies related to nutrition and obesity so as to inform the public and to maximize the impact on public health.
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Image credits: (1) Young mother and her baby, sleeping in bed. Photo by SvetlanaFedoseeva, iStockphoto. (2) Shrimp cocktail elegantly served in a martini glass accompanied by a glass of white wine. Photo by sbossert, iStockphoto.
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For the past few years, the topic of establishing healthy habits at an early age has garnered much news, investigation, and governmental action across the nation. As centers for community life and lifelong education, libraries are uniquely positioned to contribute to the formation of these healthy habits in young people. Indeed, given the special role of social responsibility many libraries assume in their charters and mission statements, supporting healthy habit formation may be viewed as a necessity in your library.
The Indiana State Department of Health summarizes the need for and suggests a direction to library involvement in this issue: “Ideally, population-based, sustainable approaches for changing the weight status, diet, and physical activity of people should include creating environments, policies, and practices that support increases in physical activity and improvements in diet, especially among those disproportionately affected by poor health. Interventions should go beyond people acquiring new knowledge and allow people to build the skills and practice the behaviors leading to a healthy weight. Supportive environments are necessary to sustain healthy behaviors.” [emphasis mine] (Indiana State Department of Health 2011)
What follows is a list of activities young adult librarians can put into practice to stimulate interest in and action towards healthy habit formation with their teen patrons.
- Book displays on healthy habits. (A classic library tactic, and it never hurts to cover the classics.)
- Create QR codes linking to healthy habits websites.
- Distribute dream journals with blurbs on healthy sleep habits printed on the pages.
- Administer an online cooking challenge where teens upload a picture of a healthy meal they cooked.
- Amend the food and drink policy to allow water in the library.
- Serve healthy snacks at TAB events, such as popcorn and juice rather than chocolate and soda pop.
- Display samples of healthy and unhealthy organs (such as lungs, livers, brains, and bones), as supplied by a nearby medical school.
- Start a co-cooking program with teens. (This has been the most popular teen program at my library for two years. We have cooked smoothies, shish kabobs, hummus, baked apples, and more.)
- Host tournaments for Wii Fit and Xbox Kinect. (For lower-tech options, try ping-pong, Twister, and other active games. The teens at my library lit up when I told them we would play Twister with face paint dolloped on the dots.)
- Arrange for your local car insurance company to bring their impaired driving program to the library parking lot.
- Host local experts in demonstrations with audience participation, such as yoga lead by fitness instructors or cooking by local restaurateurs.
- Add library programming with a physical element: a college football boot camp, circus performer experience, etc.
- Arrange a Glee with the Stars program where teens learn a routine performed by your local theatre or high school group. (Granted, this will take a great number of volunteers, a large space, and some very enthusiastic teenagers.)
- Consider adding “healthy eating during pregnancy” and “breastfeeding and childhood obesity” to to your outreach efforts to pregnant teen patrons.
- Work with your local school librarians and physical education and health teachers to limit the junk food and soda pop available to students at school. Perhaps you can even collaborate with these educators to recruit and support a chef for the
By Mark Hanson
We are failing to deal with one of the most important issues of our time – in every country we are getting fatter. Although being fat is not automatically linked to illness, it does increase dramatically the risk of cardiovascular disease, diabetes, and other so-called non-communicable diseases. We are starting to see very high rates of these diseases in some places, sometimes affecting 50% of the population. Even in some of the poorest parts of the developing world, where such disease itself is not yet common, we nonetheless see warning signs of its arrival. There is great concern that it may soon outweigh the burden of communicable disease such as HIV/AIDS. The humanitarian and financial cost of this non-communicable disease in such parts of the world will be unbearable, and made even worse because the risk is passed across generations, so children born today and tomorrow will have a bleak future.
It seems that we don’t know how to tackle this problem, because current attempts are obviously failing and obesity continues to increase. Governments, doctors, and even NGOs seem to have adopted the same strategy – to focus on our sins of “gluttony and sloth” and to transfer the responsibility for slimming down to each of us as individuals. Of course it’s true that we can’t get overweight unless we eat more than we need to, and the wrong types of foods, and get too little physical exercise. Our biology did not evolve to protect us from obesity and its consequences in today’s sedentary world with such easy access to food. But why is it that we find it so hard to lose weight and, if we do shed the kilos, it seems very hard not to put them back on again?
What we are missing is a focus on our early development. We’re just not adopting the right approach to the problem. And it seems that the generals who are leading us in this global war on obesity and disease have adopted the wrong strategy, and they stick resolutely to it as if they were wearing blinkers. They blame us for the failure to win the war, for our greed and laziness; they blame parents for letting their children get fat; they blame the food industry for peddling unhealthy food, and so on. As if we choose to be fat. It’s important to realise just how limited this way of attacking the problem is on a global scale. Does the little girl force-fed before marriage in Mauritania have any choice in her life? Does the 12-year-old child bride in rural India have any choice when she becomes pregnant and drops out of school? Does the little toddler in Detroit have any choice when his mother feeds him French fries? Does the little boy from Tonga whose mother had diabetes in pregnancy have any choice about developing obesity? Does the little girl in Beijing have any choice in being an only child? And yet every one of these scenarios, and many more, sets that little child up to be at greater risk of becoming obese and to have non-communicable disease.
But new research is uncovering many things that will give us new tactics and strategies for the war against obesity and non-communicable disease, and so we’re hopeful. We now know that we will have to give much greater focus to the mother and unborn child. We may well have to give emphasis to the lifestyle of the father as well. And most importantly of all, we’re starting to realise that behaviours such as propensity to exercise, or appetite and taste for certain foods, which we previously thought to be based on individual choice, have a large constitutional component – in part based on inherited genes, in part on epigenetic changes to gene function in response to the developmental environment, and
By Michael Otto
Dear First Lady Obama:
I am writing this letter in support of your Let’s Move campaign against obesity. As you well know, traditional recommendations for physical activity and good nutrition have met with failure in the United States. According to the Center for Disease Control, rates of adults who engage in no leisure time physical activity have been in the range of 20-30% for over 20 years. Moreover, over 75% of individuals do not
Today’s post comes to us from Camilla Nord, who found some striking statistics about kids’ fast food eating habits in the wake of some recent self-imposed health-focused changes by food marketers. Despite changes for the better, kids... Read the rest of this post
By Bianca Haase
Cats are among the most common household pets and they share the same environment with humans and thus many of the risk factors. Obesity is a growing problem for feline health for the same reasons as it is in humans and has become a serious veterinary problem. Multiple diseases, such as type II diabetes mellitus and dermatosis, are associated with excess body weight and obesity in cats and may result in a lowered quality of life and potentially lead to an early death. Appleton et al. demonstrated that about 44% of cats developed impaired
By Lauren Pecorino
The statement "cancer is personal" can have several meanings. The fact that cancer affects one in three people over their lifetimes means that it is a disease that will hit close to home for everyone. Everyone will have family or friends that will be affected and loved ones will become cancer patients. Cancer is personal. Luckily, we are living in a new age when cancer patients are more likely than ever to be cancer survivors. There are 28 million cancer survivors in the world today. Out of approximately 12 million cancer survivors in the United States, 4.7 million received their diagnosis at least ten years ago. The good news that everyone should know is that there is progress in cancer management.
In this, the 10th Oxford Comment, Lauren and Michelle investigate what makes a classic beauty icon, learn about appearance-based discrimination, talk body politics, and discover the threads that tie fashion to beauty.
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Featured in this episode:
Historian, archaeologist, and classical scholar, Duane W. Roller is emeritus professor at Ohio State University and the author of eight books, the most recent of which is Cleopatra: A Biography. Read his OUPblog posts here.
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Deborah L. Rhode is the Ernest W. McFarland Professor of Law and Director of the Center on the Legal Profession at Stanford University. She is the author or editor of over twenty books, including The Beauty Bias: The Injustice of Appearance in Life and Law.
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Margitte Leah Kristjansson is a PhD student in communication at UCSD whose work is situated within the emerging field of fat studies. She is interested in all things fat, and blogs about her interests at margitteleah.com and riotsnotdiets.tumblr.com. Margitte recently completed a documentary on fat female bodies and visibility available for viewing here.
Jessica Jarchow is a body acceptance activist in San Diego, CA. When she’s not blogging at
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