fb-pixel Skip to main content

‘A Big Fat Crisis’ by Deborah A. Cohen

More than modest proposals for fighting our obesity crisis

Dr. Cohen sees the battle with obesity in terms of a public health campaign.DIANE BALDWIN

What could be better timing for the release of a book about overweight and obesity than in a season of eating? "A Big Fat Crisis,'' written by physician-scientist Deborah Cohen of the Rand Corp., where she has been studying the country's obesity epidemic for more than a decade, begins by detailing some of the many factors that have led two out of every three adult Americans to be either overweight or obese. These include: a natural inclination for poor self-control when it comes to eating; the pervasiveness of aggressively-marketed, high-calorie food; the sheer variety of food choices available to consumers; and low rates of exercise.

Cohen concludes that humans are hard-wired to eat when prompted and that the coupling of readily available food wherever one turns with ubiquitous advertising combines to overwhelm all but the most strong-willed of us. Her solution to the obesity epidemic, which she presents in the second half of the book, is wide-scale government regulation and oversight of the retail food industry in order to create "a more balanced environment in which individuals can automatically make healthy decisions about when, what, and how much to eat."


Cohen compares the battle with obesity to past public health campaigns, such as those to stop the dumping of animal carcasses in city streets, and to restrict the use of tobacco and alcohol. She sees this as similar to government oversight in other areas because "[w]e expect the government to assume responsibility for what individuals cannot do to protect and promote their own welfare. In general," she continues, "the populace has mostly welcomed these protections."

Cohen recognizes that there will almost certainly be pushback to her proposals. However, she expresses hope that once we recognize how weak we are in the face of the food-and-marketing onslaught that results in poor health outcomes, we will, as a society, be ready for such policies.


She has her work cut out for her. While some of her suggestions, such as clearly labeling the caloric content of food items, seem both relatively easy to implement and sensible, others, such as restricting the amount and choice of food items supermarkets would be allowed to sell to individual customers, seem like ideas that could remarkably unite in opposition both the usually contentious smaller-government supporters of the right and the Big Brother resisters of the left.

For example, Cohen proposes an experiment with food capitation that, if successful, would presumably be rolled out on a larger scale. "[F]or the cost of $50 per person per week, the supermarket would have to provide all the food a person needs to stay healthy but not more than that." But why would anyone want others to decide what he or she may or may not eat? And what would a person who really doesn't like broccoli do when that happened to be the cheapest vegetable available for six weeks straight?

Likewise, standardizing portion sizes across restaurants so that all hamburgers, for example, contain the exact number of calories regardless of where purchased seems intrusive. Does that mean that I'll be out of luck if I want double cheese on my burger? That, however, might turn out to be the least of my worries should Cohen's proposal to legally restrict the number of fast-food outlets in a given city or neighborhood be adopted.


The take-away message here is that between innate human nature and the environment we've created, it's a wonder that obesity and overweight rates in this country are as low as they are. And if Cohen is correct in her conclusion that the only way to overcome these is by means of draconian and frankly oppressive regulation, the problem is likely to only get worse.

I need a cookie.

Dennis Rosen is a pediatric pulmonologist who practices in Boston. His book "Vital Conversations: Improving Communication Between Doctors and Patients'' will be published by Columbia University Press in 2014.