Last month, I attempted to be a medical advocate for my friend. I failed at this task due to my shock when her doctor poked her larger belly and asked abruptly, “What are you going to do about this?” She was not there to discuss weight and this behavior was so hostile, I froze.
This reminder of the discrimination fat people face every day inspired me to share some of the science that contributes to fatness beyond personal behaviors. Last month, I discussed how discrimination in healthcare settings repels minorities, including larger people. I also discussed how obesity has been induced in animals when the digestive bacteria is changed. I will continue the dialogue by discussing how pollution plays a role in obesity, as well as how the infrastructure of our cities influences our body size.
Environmental pollution can turn on genes that promote obesity, and for good reason. Left unchecked, toxins can float around our blood and interact with tissues, causing serious damage. Our bodies cope with this by sticking the toxins into our fat cells, where they can most safely be stored. Well, it turns out that when someone is exposed to more environmental pollution, their body adapts by turning on genes that create more fat storage sites. Some chemicals are even called obesogens due to their ability to promote obesity. And unfortunately, it isn’t just what you are directly exposed to. In animal models, these genes can be turned on for several generations. The bodies of our ancestors were trying to protect future generations by storing our toxins safely. And which members of our society are the most impacted by environmental pollution? Minorities and low-income families, many of whom can only afford housing in areas with more industrial pollution.
Our lowest-income communities face not only pollution, but they also face infrastructure environments that make healthy lifestyle choices much more challenging. Many lower-income neighborhoods have been dubbed “food deserts” for their lack of grocery stores and access to fruits and vegetables. Even if someone can find fruits and vegetables in their neighborhood, these items are too expensive for many low-income families. The most affordable food is often processed food due to government subsidies of the crops that get made into refined foods. Statistically, people who eat more subsidized foods are more likely to be obese.
Around 50 million Americans are estimated to be food-insecure, and blaming them for choosing affordable processed foods instead of fruits and vegetables is myopic. The structure of lower-income neighborhoods also contributes to obesity. Many lower-income areas have fewer bike paths and pedestrian routes. Many of the longest work commutes fall to lower-income families that can only afford housing far from their place of employment. These structural issues happen at a societal level and require public health thinking to address.
Like I mentioned last month, I am not trying to say that personal behaviors play no role in our body size. However, there are so many factors that are missing from the conversation around fatness. And something that deserves a reminder: being fat is not a behavior. In fact, when people change behaviors exclusively with the goal of changing their fatness, they often struggle to maintain those behaviors, because fatness may or may not change. When I work with patients on these topics, I ask them to stop weighing themselves. I invite them to explore concrete rewards they notice when they engage in health-promoting activities. My patients frequently report less fatigue, more energy, better sleep, better mood, better digestion, less stress and less chronic pain when they add more exercise or unprocessed foods to their routine. Making the connection between these intrinsic rewards and the behavior modification often results in long-term change. Again, the weight on the scale may or may not change as these behaviors become habits. But the health benefits have merit onto themselves, and once someone really integrates this body wisdom, they become unstoppable!
I hope this article inspires some new thoughts for you. I promise you, if fatness was something that could easily be “fixed,” most larger sized people would race to get access to the cure. It is a persistent struggle to be a discriminated group within society. Perhaps, recognizing some of the lesser discussed factors opens up compassion for the larger sized people in your life.
Dr. Lauren Gresham is a naturopathic physician currently practicing telemedicine in Seattle. You can learn more about her by visiting www.totallylovablenaturopathic.com.