THE COMPLEXITIES OF OBESITY: 

A broader system’s review in considering the layers and dimensions of the increasing prevalence of weight-related issues and our relationship with food

Mickey Skidmore, AMHSW, ACSW, MACSW

I remember my freshman year of high school (9th grade) meeting perhaps the most obese individual I had ever encountered that was my own age. Vince was barely 5’ 4” and easily more than 300 pounds. Before his sudden and quiet withdrawal from school, I would learn than he previously had his jaws surgically wired in order to limit his intake to liquids in hopes of reducing his weight. He waddled more so than walked and he had rashes on his inner thighs from chafing and rubbing. He also struggled with hygiene issues due to profuse perspiration (which also aggravated his rashes). And he spent considerable time in bed so as to avoid the physical exertion of walking. I recall my impressions of him being a highly sensitive individual with the soul of an artist and penmanship that looked like calligraphy. However, his mood was often dark, shameful and underscored with deep despair.

When I attended my 20 year high school reunion I discovered another classmate who had become hugely obese. My memory of Tony as a teenager was that his physical build was thick and stocky, but not especially overweight. Yet over the years he had morphed into a man somewhere between 300 and 400 pounds. During that weekend I noted that he would order two or three meal portions in order to satisfy his hunger and dietary demands. I recall my impressions of him being distant and avoidant — shunning any significant social interactions and being guardedly superficial with personal details about his life.

When we consider a meaningful conversation on a topic such as this, I begin with the view that it is probably not useful to attempt to label or address this in a singular or limited context. While the title of this editorial essay highlights the term “obesity”, it simply is an inadequate framework for this conversation. The two individuals I described above for lack of better terminology might be described as pathologically or morbidly obes — something transcending being over weight. Of course there is the general medical definition emphasising a ratio of fat within body mass. And then there are those we might consider “over weight” (which is a highly subjective label). Like many afflictions, I have come to appreciate that there is often a wide continuum or spectrum where variant degrees of concern or pathology rests.

For some time now, there has been recognition that the general populations in the US and other countries including Australia are increasingly (and alarmingly) over weight. Recently the medical establishment has made some controversial announcements in news releases updating protocols and recommendations for medical management of obesity in children and adults that now include bariatric surgery and off-label use of new medications initially developed for diabetes. Some of these doctors have gone on record as discrediting long-standing theories of genetic pre-disposition; while still others have been quoted as essentially stating “we simply do not know what causes obesity.” One does not have to be a rocket scientist to push back on such disingenuous gaslighting, where only from a single-minded medical model approach looking for a singular cause might this even possibly be considered as a reasonable statement.

Let’s begin with a few obvious variables. While it is far from an empirical statement, it is difficult to deny that our relationship with food is highly problematic — and far from being as healthy as we’d like to believe. (This is probably closer to a truism that most of us would like to admit). Too many (western) nations diets consists of increasingly toxic crap. While obesity is a valid concern, so is diabetes, strokes, cardiac-related conditions, kidney failure, diverticulitis, lactose intolerance, gastric reflux, stomach cancer and numerous other medical ailments. Regardless of the range of medical issues that may be associated with obesity, there is often a significant if not profound emotional and psychological impact from this condition as well. Where is the research to investigate the role that our unhealthy diet contributes to many of these health issues? We are blitzed with manipulative advertisements influencing our food choices everyday. Even in the grocery stores a high volume of our foods include excessive sugar; extreme levels of sodium; preservatives and chemicals; our meats are laced with antibiotics; and what other species in the animal kingdom other than humans regularly consumes milk from other animals? As a result we become addicted to sugar, fat, fast foods, and generally unhealthy foods. In the two countries where I’ve lived (America and Australia) the general population overwhelming eats far too much crap. Moreover, the portion size of fast food entrees (especially in the US seems to be a straight-forward contributor to obesity). And then they scratch their heads when the rates of obesity and weight-related medical conditions rise. Might this be at least part of a theory to explain obesity?

Over the holiday’s I ate at a Loving Hut restaurant. Beyond their adequate vegetarian cuisine, I noted that they strive to present a case that overall, plant based foods are generally a healthier dietary option for humans and more environmentally friendly. On the whole, I suspect there is some merit to this argument. And personally, I have nothing against the natural tastes of vegetables and tofu (or plant-based foods in general). Moreover, despite not apologising for being a carnivore, I suspect there are likely some useful heath benefits to eating less meat. However, it seems inconsistent (and perhaps even hypocritical) that they serve vegetarian dishes that taste like beef, pork chicken and various seafoods. To the best of my knowledge there is no natural plant-based food to accomplish this without turning to (unknown) chemicals and/or other artificial flavouring.

In affluent countries such as Australia, I firmly believe that the abundance of foods available to us is yet another factor contributing to the rise of obesity. Wouldn’t it be interesting to compare the obesity rates of affluent (western) societies with those less fortunate? Also intertwined with the variable of abundance is the variable and issue of convenience. While I am comfortable with my choice of being a carnivore, I have often said that if we didn’t have slaughter houses, butchers and grocery stores; and if I had to hunt and prepare my prey for consumption there is no doubt that I would be eating considerably less meat. (I also imagine I’d weigh less as well). Think of how easy it is to walk into any grocery store and purchase meat(s) essentially whenever we want.

Beyond sustenance, food also plays a role in a range of other cultural contexts. Numerous family systems the world over underscores the use of food for cultural identity and connection. Many cultures employ the use of food as a “love” language. Despite such intentions, there are plenty of examples of how this influence may not result in the most healthy outcomes (physically or mentally). Moreover, the withholding of food can also contribute to nefarious psychological damage as well. The use of alcohol for example comes to mind. Even in today’s age, there are cultural traditions that fall on gender lines where men in particular are socially pressured to drink until they are intoxicated with little regard for restraint.

Psychologists (some anyway) have historically emphasised character flaws as explanations for obesity (essentially a variation of blaming the client/victim). Despite the harshness of such a framework, the role of personal reflection and responsibility is a worthwhile consideration in my view. Is there any credible or reliable research confirming a verifiable reduction or lacking of self-disciple; self-restraint; perseverance; will-power or determination to manage the compulsion of eating unhealthy, toxic, fast food crap? And if so, do the findings point to the isolation of this occurring between the ears (within brain chemistry)? Or is it more likely that these behavioural patterns were learned, established and reinforced within family system’s and further entrenched at the intersection of relationships with other human beings; and influenced further by unrealistic societal norms and algorithms of social media platforms that are housed in prolific electronic devices? Might these be additional considerations to better understand and/or explain obesity?

Such observations in all likelihood is not an exhaustive list of considerations that contribute to this issue. There are likely additional variables (religion?; iatrogenic medications? the impact of poverty?) to name a few that may further reflect the profound layers, dimensions and complexities that contribute to this phenomenon. One does not need to look further than the endless number of diets and food programs that despite whatever testimonials they offer simply are largely unsuccessful for the vast majority of people looking for solutions. Too often these efforts target and profit from vulnerable individuals seeking a quick or simple cure for these issues. I’m not sure that prescribing the life-long use of Ozempic or Wegovy to over-weight children is likely to be the solution to this problem.

Even the tried and true adage that the only thing that really works as a credible weight-loss strategy is to exercise more and eat less, may no longer yield the desired outcome. My sense is that the recognition of the complexity of these dynamics must be fully considered and better understood before nations, cultures and peoples can attempt to establish a new and healthier relationship with food. However, as this is not a sexy proposition and is not something that can easily be monetised, it will be difficult for such a perspective to gain significant traction.

REFERENCES

1) Real Time with Bill Maher: Episode 27 Jan 2023, Paramount +