Deborah A. Cohen

Medical doctor and Master of Public Health holder, Deborah Cohen would like the U.S. to reframe their view of obesity from a matter of personal control and decision-making to a public health matter that needs to be addressed through changes in laws and regulation. She cites a plethora of studies to make her case, and I found her research to be fascinating.

She begins by explaining that the obesity epidemic is caused by a confluence of environmental factors and human nature which makes it quite difficult for most people to consistently control how much and what they eat. Biologically, humans tend to have limited self-control when we are fatigued, rely on noncognitive systems when deciding which foods to buy, and eating is an automatic process that does not require full attention or awareness. Environmentally, food is an almost constant presence in our lives. Commercials, displays at counters, end displays in supermarkets, and more marketing techniques create an atmosphere of food exposure causing us to be manipulated into constantly thinking about food, particularly junk food.

In the final section, Cohen describes her alternate vision that she hopes would bring the U.S. out of the obesity epidemic. She uses the move from illegal to controlled alcohol as a model of how we can move toward a safer food environment. Due to the limitations of our biology to easily control how much we eat and what foods we are attracted to, society needs to change the way food is sold and marketed. Standardized portion sizes, special certification or ratings for healthy restaurants, better nutrition labeling and staff education at restaurants, ending food sales at sales counters, and changing the layout of supermarkets to highlight nutritious food and send junk food to low shelves would eventually help to decrease obesity. Just as with alcohol, tobacco use, and helmet and seat belt use, the public health benefits (less chronic diseases over time) of regulating food will outweigh any costs of implementation.

She makes no assumptions that she has all of the answers, but she does state that these methods should be experimented with. The food environment will need to change if the U.S. can have any expectation of decreasing obesity. Typically, the only way to change corporate and public behavior is through incentives/sanctions and regulations. Obesity should not be thought of as a human frailty and should instead be recognized as a public health crisis that is affecting two-thirds of the U.S. Regulations would make it easier for people to make informed rather than automatic or impulsive decisions.

I admit that at first I was skeptical of Cohen’s ideas and the American public and governments’ abilities to change the food environment. While I still have my doubts, her research and enthusiasm makes a compelling case. I wholeheartedly agree with her, but I am still wary that the changes she calls for will be widely backed.… (més)