Over one-third of the world’s adult population – defined as those aged 18 and above – were overweight as of last year. And one-third of these overweight adults were considered to be obese.
According to the World Health Organization (WHO), 39% (1.9 billion) of the global adult population was estimated to be overweight in 2014, with 13% (over 600 million) in the obese category.
Back home, the latest National Health and Morbidity Survey (NHMS) published in 2011 reported that one-third of adult Malaysians (5.4 million) were overweight, with over a quarter – 27.2%, or 4.4 million – being obese.
Humanity’s waistline is expanding, and it bodes no good.
The problem of obesity was considered critical enough by the American Medical Association to be declared as a disease in its own right in June 2013.
It is also a risk factor for several common chronic medical conditions, including cardiovascular disease, diabetes, cancer, infertility, osteoarthritis and sleep apnoea; not to mention, low self-esteem and being bullied.
The solution to being overweight is, of course, to lose weight.
For the vast majority of people – the exception being the morbidly obese who require more drastic surgical intervention – the only way to do this is to eat less and exercise more.
A simple solution on the surface, but one that is often difficult to implement and maintain, especially in the long run.
This difficulty is often put down to a simple lack of willpower. After all, isn’t it just a matter of self-discipline to resist that piece of chocolate or get up a bit earlier to exercise?
But, as with many things, the answer may not be so easy or clear-cut.
Lack of awareness
Professor Dr Simon Griffin is a professor of general practice at the University of Cambridge, United Kingdom, and deputy director of the Centre for Diet and Physical Activity Research (Cedar) – a partnership between Cambridge, the University of East Anglia and Cambridge-based UK Medical Research Council units.
Initially focusing on managing diabetes, his research soon ventured into prevention.
He shares: “I found that most of my studies trying to change individuals’ behaviour by targeting their knowledge, attitudes and beliefs, which has been the traditional model, have been largely unsuccessful.
“And I think I’ve realised that the habitual behaviours are strongly environmentally cued; that we probably need to alter the environmental cue if we are going to have an important impact.”
He adds: “I don’t think there are many people in the UK who don’t know that they need to eat five (portions of) fruit and veg(etables) a day, and don’t know that they should do 30 minutes brisk-walking equivalent a day.
“And yet, not many people do that.”
In Malaysia, the 2011 NHMS reported that only 7.5% of the population eats five or more portions of fruit and vegetables a day.
According to Prof Griffin, if measured objectively, less than 10% of people in the UK achieve 30 minutes of moderate exercise a day.
But this number goes up to 30%, if people self-report, i.e they evaluate their own physical activity.
According to the 2011 NHMS, 64.8% of Malaysians were considered to be physically active. However, their levels of activity were self-reported through answering the International Physical Activity Questionnaire.
“That is one of the problems – a lack of awareness about what we are doing with these habitual behaviours.
“So, we don’t realise that we are sedentary all day, we don’t realise that we are sitting in front of the television consuming energy-dense, high-salt, high-sugar foods.”
He says that when people are confronted with how much they eat in a week, they are always incredibly surprised.
This, he thinks, is due to their lack of awareness about their own habitual behaviours,
More telling is that even when people are given feedback on their lack of physical activity, it still has no significant impact on their behaviour.
This, Prof Griffin believes, is why it is the environment around us that needs to be changed.
The obesogenic environment
In 1999, Kiwi endocrinologist Dr Boyd Swinburn – now Professor of Population Nutrition and Global Health at the University of Auckland, New Zealand, and Alfred Deakin Professor and director of the WHO Collaborating Centre for Obesity Prevention at Deakin University, Australia – coined the term “obesogenic environment”.
It is defined as the “sum of the influences that the surroundings, opportunities or conditions of life have on promoting obesity in individuals and populations”.
These influences may be overt, like poverty, but are more often subtle, like the ease of having food delivered to our doorstep, exerting their influence on our subconscious.
It can range from general infrastructure (e.g. the lack of sidewalks or bicycle lanes, which discourages walking or cycling) to architecture (e.g. giving lifts and escalators prominence, while hiding staircases away) and the type of food available (e.g. having a majority of takeaways and fast food outlets in the surrounding area).
Looking at most modern homes and workplaces, we can easily see how they are designed to make us sedentary – just think of how much time we spend sitting, whether it be at our desk in front of the computer or television, or in meetings or presentations.
“If the environment is very oppressive in its obesogenic influence, then I think individuals are going to struggle to make a difference,” says Prof Griffin.
Other influences are things that we are familiar with, but still work despite our awareness of them. This includes advertisements and product placement in supermarkets and other shops.
Prof Griffin notes that supermarkets have very big budgets to spend on how to manipulate our food choices – budgets that are usually much larger than any organisation or institution keen on promoting healthy diets.
While not discounting personal willpower, which will always remain a critical factor in trying to lose weight, it is equally important to take into account these other factors that may be sabotaging efforts by the overweight and obese to lose weight.
Tan Shiow Chin was a 2015 Khazanah-Wolfson Press Fellow at Wolfson College, University of Cambridge. This article is part of a series from her fellowship project on the subconscious cues that influence us to eat more and unhealthily. Her next article will be on the roles of diet and physical activity in losing weight.