PART 2 of 3:
SHEREEN ANN ALI looks at what experts say from science, psychology and the economics of the food industry on why we pack on the pounds.
The devil has put a penalty on all things we enjoy in life. Either we suffer in health or we suffer in soul or we get fat – Scientist Albert Einstein
Confusion often reigns for many people with weight problems. What really causes one to put on excess weight? Is it their own fault, or are there other reasons and circumstances that aid and abet a tendency towards fatness?
Fatness is no longer a personal issue – it’s a national and global health problem and is having direct effects on the increasing numbers of patients with fat-related diseases admitted to hospitals. And the trend starts from young: a February 2019 meeting of TT’s Joint Select Committee on Social Services and Public Administration revealed that at least half of TT’s primary and secondary schoolchildren are overweight and are at risk of becoming diabetics. This should be a wake-up call for people to start organising their daily lives differently. But before they can take action, it helps to truly understand the problem.
A key truth is that there is no single overriding reason people get fat. Many factors together affect human health and weight. The good news is that most of those factors are environmental, not genetic – which means people can do something about it: their food and activity choices (both individually and at national policy level) can profoundly affect our health.
Genetics: ‘…but I was born big’
It is true that there are very rare single-gene forms of obesity. It is also true that some people are naturally bigger and carry more body fat than others depending on their genetic family history and ethnic biology.
However, a group of Harvard scientists emphasise that your genes are not your destiny. Even people predisposed to be fatter for a complex variety of genetic factors do not necessarily become so if they are active and eat sensibly.
In the article Genes Are Not Destiny (published online by Harvard TH Chan School of Public Health), a team of scientists write:
“Overall, the contribution of genes to obesity risk is small, while the contribution of our toxic food and activity environment is huge.”
Culture and imbalanced eating habits
In the Caribbean, there is often a profound connection between the food people eat, family and cultural traditions of togetherness, the circumstances of history in which their ancestors survived, and their health. Many West Indians have a heritage of poor nutrition because of the colonial deprivations of ex-slave or ex-indentured labouring societies. Their ancestors received the scraps and had to make the best of them, relying on free or very cheap or home-grown food sources, often with nutritional deficiencies.
In some cases, foods grown in home gardens provided a healthy addition to diet including peas, beans, vegetables and backyard chickens. In other cases, foods their grandparents or great-grandparents used to eat no longer serve their current lifestyles and are, in fact, unhealthy today, even though they may still love this way of eating.
Dr Nilash Ramnarine makes precisely this point in a recent interview with
Newsday. Ramnarine is a doctor and holistic health practitioner who works at the Chaguanas-based Ishtara Centre.
He says: “A patient might say: ‘But doctor, we’re accustomed to eating roti and fried aloo in the morning for breakfast for generations in our family.’
"But your grandfather who was eating that way used to go out and cut cane. Do you go out and cut cane ? ‘No.’
"And what do you do?
"‘Oh, I drive to work, I sit down in an office for eight hours for the day, then I sit in my car and drive back home.’
“So roti and fried aloo should not be the diet for you.
"That is a labourer’s diet: it’s high in calories which a worker will sweat and burn out. But you still have people that are eating culturally even though they’re not working in ways which that diet used to serve.”
Comfort eating tied to culture, family, and food rituals of survival are still big in TT, regardless of how unhealthy the meals may be.
Many people eat too many products made from flour – rotis, breads, and pastas – and for the carnivores, many of us eat too much fatty meats, so it’s not surprising there is a fat epidemic in Trinidad.
Trinidadian professor Dilip Dan is unequivocal about this: “We eat badly, with fast food and carbohydrates (especially sugar) being the preferred source.
"We eat late, and eat heavily late. Social gatherings and family events centre around food as opposed to activity.
"There is a very simple equation for weight – when calories eaten are greater than calories expended.
"There are also medical and genetic reasons for weight gain, and these must be investigated, but this is generally in the minority.”
Economics of the global food industry
The globalisation of poor-quality, cheap food options combined with poverty make it tempting to buy cheap, nutritionally poor foods that become toxic to the body over time. This is another huge reason people get fat and become disease-prone. It means that a person can be malnourished and fat at the same time because they are eating too much of the wrong types of foods.
The 2009 book Globesity: A Planet Out of Control by Francis Delpeuch, Michelle Holdsworth, Bernard Maire and Emmanuel Monnier says the causes of obesity are primarily socio-economic and the result of a distorted agricultural and food production and supply system. Fast-food giants may be partly to blame, but so are farmers, consumers, supermarkets, town planners and the media.
Governments are also at fault: the book notes subsidies on grain and livestock products in so-called First World countries, for instance, have created enormous overproduction in the developed world. That glut must go somewhere, so boosting public consumption of cheap foods is a must for these agroindustrial food systems, the book says.
So to address “globesity” meaningfully, individual societies must rethink and reconstruct the ways they produce and make available healthier, preferably local, food choices.
However, vibrant local agricultural systems producing more healthy, affordable, easily available whole food sources is often not meaningfully encouraged or facilitated by national policies in TT. A 2019 Forbes report by Daphne Ewing-Chow acknowledges the “marginalization of locally grown foods and the proliferation of unhealthy— high-sodium, high fat, highly processed — diets” in the Caribbean, leading to many public health problems.
Bad Science: A tale of toxic sugars,
trans fats & engineered food addictions
"We live in a toxic environment," says Kelly Brownell, director of the Yale Center for Eating and Weight Disorders, quoted in an August 2004 National Geographic article by Cathy Newman. "Bad food is cheap, heavily promoted, and engineered to taste good. Healthy food is hard to get, not promoted, and expensive. If you came down from Mars and saw all this, what else would you predict except an obesity epidemic?"
Many food corporations spend a lot of money on the chemistry of food and taste research to re-engineer a range of processed sweet and fatty foods to appeal to consumers and hook their tastebuds. Often this involves manipulating fat, sugar and salt levels in ways that are unhealthy, as writer Elizabeth Kolbert noted ten years ago in her July 20, 2009 New Yorker article XXXL: Why are we so fat?
Kolbert referred in her article to the book The End of Overeating by David A Kessler, a former commissioner of the US Food and Drug Administration. Kessler coins the term “conditioned hypereating” to describe how people respond to these laboratory-designed foods as if they were drugs. He says people may become so addicted to fake foods and overly sweet, fatty and salty treats that they may actually need a food rehabilitation programme to get them back on track to nutritious, wholesome eating. The American tendency to “supersize” portions also conditions peple to overeat.
Trans-fats in particular are very bad for people. “Denmark was among the first countries to ban the sale of products containing trans fats in 2003. Since that time the European Union has taken a stance to reduce trans-fats in the food supply and, at the same time, the US Food and Drug Administration ruled in 2015 that partially hydrogenated oils are no longer generally recognised as safe and should be removed from the food supply” says the 2017 article A Healthy Approach to Dietary Fats by Liu et al, in the Nutrition Journal.
Sugars are very, very bad indeed, even worse than fats.
So how much sugar is safe? The World Health Organization (WHO) currently recommends
no more than five or ten teaspoons of free sugar (sugar added to foods or drinks) a day for adults. That includes glucose and dextrose, fructose, household sugar (sucrose), as well as malt sugar (maltose) and sugars that are found in honey, syrups, fruit juices and fruit juice concentrates.
Sugars are added to 80 per cent of processed foods bought in groceries, including sauces like ketchup, as well as to soft drinks and foods from caterers and restaurants. A single 12-oz can of regular cola contains about nine teaspoons (or 39 grams) of sugar. Having two or more cans a day is way above safe sugar consumption – and that’s just from the soft drinks, not from anything else someone may eat for the day.
Trinidad doctor Dr Nilash Ramnarine notes that many food industry businesses have reduced or removed fats from their products to make them seem healthier, but at the same time, they’ve added sugars in ways people often do not realise. “Labels may say zero per cent fat, or fat-free, or zero cholesterol, as marketing gimmicks to make people feel that the food is healthier, when actually sugar content has been increased as fats have been decreased.”
British anti-sugar activist Dr Malhotra believes the WHO should adjust its recommendations for safe sugar consumption to no more than
three per cent of an adult’s daily calories, which is about
three teaspoons a day– not the current five to ten.
In his 2016 Treat Sugar Like Tobacco article, Malhotra writes: “The recent calls by the WHO to tax sugary drinks are very welcome news for health campaigners. The public health messaging, however, has to be clearer. There is nothing wrong with the occasional treat, but sugar has no place as part of a healthy balanced diet. Similar to smoking, any further regulatory measures to reduce sugar consumption, such as banning of sugary drink advertising and dissociating sugary drinks with sporting events, will have a further impact on improving population health within a short time.”
How inactive people are is a massive reason they are getting fat. And it’s not just a case of laziness or sloth.
Social and technological advances have changed the way people work and play. No one walks so much anymore; instead they drive (or are transported) to school, work or play. Many people work in seated office jobs instead of more active jobs requiring physical effort. To entertain themselves, people tend to sit and watch TV or streamed video content on computers or electronic devices instead of doing active things outside the house.
As they passively watch, many indulge in “mindless eating” of junk food, even as TV bombards them with ads for unhealthy foods.
And in what an increasing number of experts are seeing as an unethical practice, many food companies deliberately target young children with colourful ads for unhealthy, sugary foods and drinks, creating appetites for toxic foods that will make children fat and sick.
Many children play video games or watch YouTube instead of playing sports or outdoor games. And in TT, historically many schools have never taken very seriously the importance of physical education for lifelong personal health, although many schools may run token PE classes.
Some statistics from the US demonstrate some of the sweeping lifestyle trends that are global. This data is from a wide-ranging, very in-depth report on obesity prevention by the Harvard TH Chan School of Public Health (HCSPH). It says that in the US, in 1950, 30 per cent of Americans worked in high-activity occupations; by 2000, that proportion had dropped to only 22 per cent.
Meanwhile, the percentage of people working in low-activity occupations rose from about 23 per cent to 41 per cent. Driving cars increased from 67 per cent of all trips to work in 1960 to 88 per cent in 2000, while walking and taking public transit to work decreased. About 40 per cent of US schoolchildren walked or rode their bikes to school in 1969; by 2001, only 13 per cent did so.
These inactivity trends, combined with an explosion of bad eating habits, meant that Americans gained a lot of weight from the 1980s to now.
Today, fully a third of all US people are obese, a rate projected to rise to 50 per cent by 2030, says one HCSPH page of statistics. And it’s not just the US.
The HCSPH reports that worldwide, the rate of obesity has doubled since 1980, with just over 200 million adult men and just under 300 million adult women obese.
Other reasons people get fat
Inactivity and poor food choices are two of the biggest reasons people get fat.
But there are others. Trinidad paediatrician Dr David Bratt has long sounded the alarm for the bad effects of poor maternal nutrition for babies developing in the womb: he has said pregnant mothers who gorge themselves and put on too much weight have fat babies.
In a July 8, 2012 newspaper column, Dr Bratt also pointed to the bad impacts of baby formula feeds on infant health: formula is associated with fatness in babies, while breastfeeding is far healthier, he said. He cited studies by the US Centers for Disease Control and Prevention (CDC):
“Experts at the CDC in Atlanta estimate that 15-20 per cent of obesity could be prevented through breastfeeding. The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months and continued breastfeeding with the addition of appropriate foods up to at least one year of age. WHO goes even farther and recommends breastfeeding for up to at least two years.”
In the same article, Bratt also strongly criticised high-calorie commercial baby foods and feeding fast foods to young children.
Apart from bad child nutrition practices, other reasons people get fat include simple ignorance of good eating habits, healthy nutrition, and healthy food preparation and cooking techniques. These are not seriously taught or promoted widely in schools, communities or via public health campaigns. And in some cases, people may have difficulty accessing a wide range of healthier whole foods that are also affordable.
Next – Part 3: Fat: How to lose it and be healthier