For decades the gun lobby has told us that guns don’t kill people. If only people would stop pointing them at themselves and each other, guns would be completely harmless. It’s not the availability of guns that’s the problem, they say it’s the individual’s decision to pull the trigger.
In a recent post Paul Frijters makes the same claim about food and obesity. He dismisses the idea that changes in the availability of attractive, energy-dense foods have contributed to the increase in obesity. Instead he suggests that somehow cultural change has reduced self-restraint.
Frijters major complaint is that "there is a large constituency of voters and pundits out there who want to believe their obesity is not of their own choosing." He wants them to admit that they are not victims of outside forces but are making themselves obese. He wants them to take responsibility for their choices. While this might make Frijters less grumpy, it’s not clear it would do much to reduce the rate of obesity or lessen its impact on health.
Environment or individual?
Research suggests that a change in food availability is one of the most likely causes of the recent increase in obesity. It’s the environment that’s changed rather than the psychology of individuals.
According to a 2003 paper by economists Cutler, Glaeser and Shapiro, the increase in obesity in the US is primarily the result of people consuming more kilojoules. And the increase in food consumption is "the result of technological innovations which made it possible for food to be mass prepared far from the point of consumption, and consumed with lower time costs of preparation and cleaning."
Foods like french fries and biscuits have long been available, but in the past they were much more time consuming to prepare. People consume more of them now, not because they have less self-control than in the past, but because the food processing industry has made them easier to obtain.
From a public policy perspective, focusing on self-control encourages anti-obesity campaigns that stigmatise people who are overweight and obese.
If the problem is deficient self control, then it might seem reasonable that the first step is to get those of us who are obese to accept responsibility for their own food choices. Then, to bolster weak self control, we should make bad food habits socially unacceptable. The aim is to make the shame of irresponsible food choices and the stigma of being obese outweigh the pleasure of eating.
But as Lenny Vartanian & Joshua Smyth explain, the evidence suggests that shame and stigma are more likely to make the problem worse. Shaming people who are obese does not seem to motivate better food choices.
At a population level, interventions that change the environment in which people make decision seem more promising. And that’s why many in the policy community are looking at policies that make cheap, palatable high calorie foods less easily available, reduce serving sizes and restrict advertising.
The downside of such policies is that they impose costs on people who are not at risk of obesity and they limit freedom. While few people are upset that nanny-staters won’t let them cover their front lawn with land mines, many balk at the idea that some expert in Washington or Canberra can stop them having a cheap pizza. So even if they were effective at reducing the obesity rate, there’s still a debate to be had about whether these policies are a good idea.
Frijters is wrong to rule out changes in food availability
Frijters is annoyed about the "large constituency of voters and pundits out there who want to believe their obesity is not of their own choosing." And he’s right to dismiss the claim that there are hundreds of millions of people who are eating a healthy diet and getting plenty of exercise but are nevertheless becoming obese. But where Frijters goes wrong is rejecting the idea that changes in the availability of food could be contributing to the increase in obesity rate.
According to Frijters, people in developed western societies have long had access to palatable high calorie foods:
… did rich 1950s Americans and Europeans not already have access to as much processed trans-fats and sugars as they needed to become obese? Of course they had. But they chose not to eat them in the same quantities. And was 19th century Victorian England not already awash with recipes for very fatty pies, sugary tarts, and protein-rich roasts? Of course it was. Again, the sub-populations who could afford to eat as much as they wanted (the rich) chose not to.
In their 2003 paper, economists David Cutler, Edward Glaeser and Jesse Shapiro agree that attractive fattening foods have long been available. But whether they are merely available misses the point:
People could always make almost any form of food that is currently available, if they were willing to spend the time to do so. Cream-filled cakes could be made by ambitious cooks, for example, but it took time. Technological innovations since 1970 mean that preparation can now be done in restaurants and factories, exploiting technology and returns to scale. Cream cakes are now available widely for less than a dollar.
As Cutler, Glaeser and Shapiro observe, there are many people who will eat a biscuit from a vending machine a few metres away from their desk at work who would not bother to eat one if they had to walk 10 minutes to a shop or make them themselves at home. Whether people eat a high kilojoule snack or not, often hinges on how cheap and easy it is to buy one.
Frijters’ preferred theory seems to be that people have less self-restraint than in the past. In a blog comment he writes:
I find the issue of self-restraint an interesting avenue and one that clearly is not constant throughout time or cultures at all. Self-restraint is something taught. It is indeed an interesting question why that would have changed in recent times and places and not other times or places. Anglo-Saxon societies now probably see more self-restraint on sexual and criminal matters than at almost any other point in time, but clearly the same is not true for the temptations of food. And its not just Anglo-Saxon countries. A decidedly non-Anglo Saxon country like Mexico has the same obesity issue. Its a genuine puzzle.
However there is no evidence of a population level change in self-restraint when it comes to food. As Cutler, Glaeser and Shapiro show, it’s possible to explain the increase in obesity in the US and differences in obesity rates between countries without invoking any change in self-restraint.
But even if Cutler, Glaeser and Shapiro are right, their theory still doesn’t explain why some people respond to changes in food availability by overeating while others do not. The most common folk psychological explanation is that some people have more ‘self-control’ or ‘willpower’ than others.
Ultimately our behaviour is the result of their environment and physical processes in their brain and body. And despite more than a century of research into the brain, these processes are still poorly understood. But chances are, the better we get at explaining behaviour towards food, the less we’ll rely on folk psychological notions of personal choice.
Magical theories of personal choice
In a paper titled ‘Time to abandon the notion of personal choice in dietary counseling for obesity?‘, medical researchers Bradley Appelhans, Matthew Whited and Sherry Pagoto write :
The term “personal choice” implies that human behavior derives from conscious, volitional decisions, and connotes that humans have “free will” to decide between alternative courses of action – independent of biological and environmental forces.
Unless you believe in magic (which Frijters says he doesn’t), no human behaviour is independent of biological and environmental processes. So any discussion about choice and self-control needs to fit with what we know about these processes. It’s not useful to tell someone that a free buffet filled with their favourite food will only influence their behaviour if they choose to allow it to. For many people, it’s better to avoid situations where there’s a risk they’ll behave in ways they later regret than to rely on ‘willpower’.
Appelhans, Whited and Pagoto argue that people who treat obese patients need to focus the processes that influence eating behaviour rather than simply urging their patients to make better personal choices. People need to understand that their behaviour doesn’t come out of nowhere and that if they can change the situations they put themselves in and manage things like their stress levels and sleeping patterns, they can often change their eating behaviour.
The aim of their approach is to help people understand how the environment, genetic makeup and brain processes influence behaviour:
Though it may seem counter-intuitive, shifting the focus away from “personal choice” and towards the environmental and neurobehavioral processes involved in eating can encourage patients to take an active stance in their approach to weight management. We recommend that dietitians simultaneously convey two messages about weight control to their patients: 1) obesity is heavily influenced by genetic and environmental factors, and an epidemic of obesity is precisely what would be expected given the genetic heritage of our species and the omnipresence of palatable food in the environment; and 2) successful weight management can be achieved by taking active steps … to minimize the impact of the environment on eating behavior.
Choice isn’t some magical process independent of what happens in the environment and in people’s brains. But Frijters seems to dismiss the most promising environmental explanations for an increase in the obesity rate and provides little or no explanation of why some individuals and groups are more prone to obesity than others.
There’s no reason to think that lecturing people about personal responsibility is an effective way to treat obesity. In fact if you are obese being stigmatised and shamed for your food habits is likely to be worse than useless because of the damaging effect it can have on your mental health. Managing your overall health may mean learning to accept your body as it is while focusing on becoming healthier rather than just slimmer.
Instead of getting annoyed that people are refusing to take responsibility for their food choices, we need to find better ways to help each other lead healthy lives. And given the damaging effects of social stigma, that means changes in the behaviour of those of us who are not obese as well as those who are.