Is Obesity Predominantly an
Individual Problem?
Joshua Taylor-Tulloch
s2942759
Griffith University
Introduction to Health Promotion
1977MED
Dr Bernadette Sebar
Is Obesity Predominantly an Individual Problem?
S2942759
Obesity is a severely expanding long-term overweight condition that is
traditionally seen by public health authorities as a culmination of poor individual
health choices (Drewnowski, 2009). However, the presence of social,
environmental, cultural and health service determinants of health substantially
affect the control of individual choices driving obesity-inducing lifestyle habits.
The social gradient of health can be used to explain the correlation between
obesity and how a social determinant, such as socioeconomic status, and the
proximal environment can pressure the choices made by the individual.
A 2001 study undertaken in Melbourne, Australia, investigated the
environmental “area-level” influences on unhealthy food choice that were
determined by socioeconomic status and found the prevalence of fast-food
outlets was significantly higher in poorer suburbs than socioeconomically higher
suburbs (Reidpath, Burns, Garrard, Mahoney, & Townsend, 2002).
By analysing the number of individuals per fast-food outlet in socioeconomically
defined suburbs, results show there were 5641 individuals per outlet in “SES 4”
suburbs (where median individual income ranged between $160-199/week) and
14256 individuals per outlet in “SES 1” suburbs ($400-899) (Reidpath, Burns,
Garrard, Mahoney, & Townsend, 2002). This determines that having lower
socioeconomic status provides a higher susceptibility to fast food, resulting in a
higher risk of unhealthy eating habits than wealthier people. Despite whether
demand or the susceptibility of less wealthy people to eat fast food caused higher
density of outlets, there is a direct trend that social status stimulates the
environmental determinants influencing individual action.
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Is Obesity Predominantly an Individual Problem?
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The existence of these “obesogenic” environments and the inequitable access to
healthy foods can be severely influenced by the cost and affordability of food
(Drewnowski, 2009, p. S38). There is an “economic hypothesis” where the link
between poverty and obesity is established from the affordability of energydense and low-nutrition foods that provide encouragement for the poor to have
worse eating habits than others who can afford more nutritional food
(Drewnowski, 2009, p. S38). In an attempt to satisfy caloric intake needs, these
low cost diets tend to be composed of an unhealthy dose of refined grains, added
sugars, and high fat contents. Through economic circumstance, the notion of
“individual choice” falls absent because only limited numbers of consumers can
afford to engage in healthy food choices, such as replacing fats, sugars and
refined grains with fresh produce, like fruits, lean meats, and fish.
Addressing the importance of these healthy foods and lifestyle choices from the
individual level is critical when seeking other external factors that influence how
people gauge healthy living importance. Despite increasing individual
awareness around food and activity healthiness, there is limited inclination to
apply this knowledge to daily life in primary school children and their parents
(Hesketh, Waters, Green, Salmon, & Williams, 2005, p. 22). Research shows that
putting this knowledge to practise is influenced by a combination of social
determinants such as food advertisement and packaging, environmental
determinants including increased home-to-school distances, unsafe cycling
routes, and unhealthy school canteen options and some cultural determinants,
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Is Obesity Predominantly an Individual Problem?
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involving local safety and child peer pressure on unhealthy foods and activities
(Hesketh, Waters, Green, Salmon, & Williams, 2005, p. 23). When these
determinants are incorporated to daily life, there is an increasing influence on
child lifestyle choices that often continue into adolescence and further
adulthood. Whilst needing to address lacking individual skills that make healthy
food choices and increase participation in physical activity, distal determinants
are significantly affecting children to make the unhealthy choice the most
appealing, especially when other children come from an unhealthy eating and
sedentary culture (Hesketh, Waters, Green, Salmon, & Williams, 2005, p. 23).
When parents buy food, nutritional labelling confusion, child focussed
advertisement and family budget considerations affect the individual’s product
choice from upstream, uncontrolled influences resulting in health inequality
among families from different social positions with unequal time and money to
determine the healthy choice.
As the prevalence of unhealthy choices promotes more obesity in the
industrialised world, there has been a cultural shift in the identification of what
determines a healthy weight. An Australian study looked at how differently
weight status perception compared to pre-measured BMI in children and
adolescents from age 5 to 17, and included the perception of parents for those
aged 5 to 12 (Abbott, Lee, Stubbs, & Davies, 2010). Weight “status” was used
rather than weight “level” so the study’s focus could distinguish the way weight
was identified, rather than measured. The “healthy” population had a high
degree of accuracy when self-identifying weight status, but a considerable
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Is Obesity Predominantly an Individual Problem?
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underestimation of weight status by overweight and obese people sheds light on
why management isn’t being taken. Parents identified younger children more
poorly than their elders, and again, healthy children were more accurately
identified than overweight children. This shows that a changing culture around
childhood weight concern and desensitised view of fatness are certain
determinants to be considered in how newer individual obesity cases would
continually have to be more extreme to be identified and managed.
Once obesity has set in, it often requires lifelong management, but there is a
negative trend in effective long-term treatment (Mauro, Taylor, Wharton, &
Sharma, 2007, p. 173). This comes from many barriers affecting obese and
overweight people from accessing and utilising the health services that they
need. A major concern for obesity treatment is a lack of recognition of obesity as
a chronic condition rather than a poor lifestyle choice from both health
institutions and medical schools. Factors like comorbidities often restrict the
ability of health service providers to utilise straightforward strategies and
implicate the necessity to address obesity from a highly holistic standpoint.
These comorbidities can range from mental health and chronic pain to
musculoskeletal and respiratory disorders that contribute to lacking individual
control over obesity management. Measures for obesity treatment generally
consist of motivation-dependent exercise routines and diet advice with no
established medical cure, however, there is the option for the extremely obese
(BMI>40) to have surgery and take medication, but it is restrictive and a shortterm solution that a majority of people cannot afford because they are
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unsubsidised procedures (Mauro, Taylor, Wharton, & Sharma, 2007, p. 175).
Therefore, individual action towards obesity management relies heavily on
unholistic and disconnected health services that often need personal payments
to address associated costs.
Despite individual choices around eating, exercise and weight management
contributing towards healthy lifestyle direction, certain distal factors act as
barriers from making the healthy choice the easiest choice. While the argument
remains that individual action and knowledge determines a person’s capacity to
prevent or promote obesity, the social, environmental, cultural and health
service determinants of health have a significant effect on how those individual
choices are made and must be considered equally or more importantly than the
individual determinants of obesity.
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Is Obesity Predominantly an Individual Problem?
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References:
Drewnowski, A. (2009). Obesity, diets and social inequalities. Nutrition
Reviews, 67 (supp 1), S36-S39. doi: 10.1111/j.1753-4887.2009.00157.x
Reidpath, D.D, Burns, C., Garrard, J., Mahoney, M., & Townsend, M. (2002).
An ecological study of the relationship between social and environmental
determinants of obesity. Health & Place, 8 (2), 141-145.
Retrieved from
http://www.sciencedirect.com/science/article/pii/S1353829201000284
Hesketh, K., Waters, E., Green., J., Salmon, L., & Williams, J. (2005). Healthy
eating, activity and obesity prevention: a qualitative study of parent and child
perceptions in Australia. Health Promotion International, 20 (1), 19-26.
doi:10.1093/heapro/dah503
Abbott, R. A., Lee, A. J., Stubbs, C. O., & Davies, P. S. W. (2010). Accuracy of
weight status perception in contemporary Australian children and adolescents.
Journal of Paediatrics and Child Health, 46, 343-348. doi:10.1111/j.1440754.2010.01710.x
Mauro, M., Taylor, V., Wharton, S., Sharma, A. M. (2007). Barriers to
obesity treatment. European Journal of Internal Medicine, 19 (3), 173-180.
Retrieved from https://www-clinicalkey-comau.libraryproxy.griffith.edu.au/#!/content/journal/1-s2.0-S0953620507002701
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