In 2003, I was a teaching assistant for a class at Yale called “Fat and Thin: A History of American Bodies.” We learned about everything that makes us obese: the history of fad diets and health food, the car culture and suburbs, nutrition science and vitamin pills. Immigration and food cultures, food policies and the obesity epidemic, gastric surgery, eating disorders and disordered eating.
I learned that tons of different things interact to shape and reshape our bodies. Food and exercise and emotions and social connections and culture and genes all contribute to the size and shape of our bodies. Where we live, work and play matters. What we choose to eat, drink and do matters too.
Obesity, more than any other American disease, is a biopsychosocial disease that demonstrates the intersection of the social and structural determinants of health. What can we do to tackle our national epidemic of obesity? Medically, we need an interprofessional approach with nutritionists, physical therapists, trainers, dietitians, clinicians, health educators, yoga teachers, social workers and mental health therapists to treat the physical, social and emotional sides of the disease. Policy wise, we need an intersectoral approach with departments of transportation (for bike lanes and networks of public transport), agriculture (for sane food subsidies), policing (for safe neighborhoods to exercise), parks and rec (for green space and soccer fields), education (for healthy messages in schools and healthy school lunches), housing (for safe community centers where people come together) and more. There are so many factors–our behaviors, determined by our environments, opportunities and culture–determining how we move, eat, and interact. Making us obese.
There may be a simple step to a cure.
Over the course of the class, I became convinced that sugary drinks were to obesity as tobacco was to lung cancer and heart disease– known to be direct causes of disease, with their use defended by industry lobbyists and advertising as personal choice, though they were addictive.
Our bodies need oxygen.
They don’t need oxygen plus addictive nicotine plus smoke and tar residue.
Our bodies need water.
They don’t need water plus addictive sugar plus additive caffeine.
Soda pop is like cigarettes, half a century later. The same arguments about personal choice and the same terrible effects on health remain. Cigarette use was curtailed by taxes, a surgeon general’s warning, limiting advertising to minors.
These same policies, adapted, may curb the dreadful health impact of sugar sweetened beverages today.
I am happy, for the sake of my obese patients and the American waist line, to see that legislators in Illinois have proposed a tax on sugar sweetened beverages.
Taxing sugar water is the first and in some ways simplest step to combating America’s obesity epidemic. The more the tax, the less people drink. And through the tax, those who do drink now will pay for their future health care costs.
To me, a tax on sugar sweetened beverages is a no brainer.
The American Beverage Association and its $8 million worth of lobbying efforts would disagree.