Fat City

According to an Institute of Medicine (IOM) report revealed at this year's Weight of the Nation Conference, "Obesity fight must shift from personal blame." The study acknowledges that curbing our national sweet tooth is too big a job even for the schools (who already have their busy hands full with feeding, sex-counseling, and testing our young). Nothing less than an overhaul of society is needed, because if present trends continue, 42 percent of Americans will be obese by 2030 (up from today's 34 percent). That would be a disaster for public health, because fat people cost us an additional $190 billion per year now-another 8 percent would break the bank.

The report doesn't reference "fat people." It consistently uses the term "obesity," a cloudlike phenomenon that blankets the United States. Our problem is an "obesogenic" environment: too much soda, not enough sidewalks. "The average person cannot maintain a healthy weight in this obesity-promoting environment," said IOM panel member Shiriki Kumanyika of the University of Pennsylvania Medical School.

Did you catch that? The average person is helpless in this super-size society. Everywhere he goes, sugar is throwing itself at him, fat particles clog the air he breathes, a paucity of sidewalks force him to drive to work, vegetables scamper out of his reach. What's needed is a full-bore intervention by government, industry, and school to pull obese America back from the brink.

The IOM report is far from svelte: 478 pages of diagnosis and recommendations. The latter involves a five-pronged strategy involving state and local governments, childcare providers, employers, manufacturers, farmers, and, of course, schools: "Strengthening schools as the heart of health" occupies pride of place at the end.

It's hard to argue with some of these goals-I'd like to see breast-feeding encouraged and children getting out to play. There are two problems, though. For one, the policies are so wide-ranging they clash with other policies. For farms to grow more whole grains and vegetables they'll have to give up their corn subsidies. For schools to schedule the recommended one hour of physical activity per day they will have to sacrifice some of the time used to meet their testing requirements. The obesity crisis is head-butting the academic crisis. That's how it is out in culture-land: This policy obstructs that initiative, which circumvents the previous agency guidelines.

The other problem is the overlooked battleground: home. What used to be the "heart of health" is an empty shell, as far as the War on Fat is concerned. Parents are mentioned occasionally, but not as major players. For what are parents but average persons thwarted by our obesogenic environment? Like the rest of the bovine public, they must be poked and prodded into the health corral. Of course, the IOM can only address public policy, not dictate what's on the table at family meals. Yet if there is a fat epidemic it's partly because family meals are becoming scarce. America has left home. This really is a "culture": Figuratively speaking, America roams the streets at night and makes the rounds of agencies by day, collecting food stamps and WIC vouchers and qualifying for the free lunch, breakfast, and sometimes even dinner programs at the local school.

Is it too simple to say we all need to go home? Sure. Obesity is a problem, and as one who struggled with weight gain in the past, I sympathize. But it's an individual problem, not a national one, and the solutions will have to be individual, too.