For too long our society - including the medical community - has treated obesity as a life-style problem. The general feeling is that obesity is simply a lack of will-power which allows the fat person to take in much more food than a normal person would. It has also been a general perception that obese people are lazy, and therefore, do not exercise enough to burn off those extra calories.

The truth is that most people struggling with obesity are intelligent, motivated, contributing members of society. It is obvious that as our society gets more complex and faster paced that somehow a larger percentage of the population has become imbalanced with regard to calorie intake versus the amount burned off. Is it possible that our advanced society has created conditions that are putting an increasing number of its members at risk for becoming imbalanced? How else can we explain the massive shift in BMI that has occurred over the last few decades?

We have unfavorable eating habits (remember “finish your plate and then you can have dessert”). Probably as a biologic survival imperative – possibly coupled with reminders about the experience of starvation, such as the Great Depression – our society encourages eating everything available to eat. To further augment our gorging instinct we are enticed with advertisements, at a very early age, for foods that are loaded with sugar and fat. Coupled to this increased drive to eat is the ever increasing availability of food. Although the fast food industry is not completely to blame, they certainly must be implicated as part of the problem. The industry provides complete meals, in a matter of minutes, at relatively little cost, often to people who have limited time and multiple responsibilities, such as a job and children. To ensure repeat customers – especially the children – the food is extremely dense in fat calories, which makes it taste better. Of course, to maintain their market share of the food economy, traditional restaurants have offered larger and larger portions, presumably to provide more “value” with their product. From supermarkets to convenience stores everything is now offered in bulk, “jumbo” or “economy sized.” Call it the hyper-calorie equivalent of the Wal-Mart Effect where large volumes at a lower unit cost lead to super-sized consumption.

The flip side of the coin is that the average person in society is exercising less than his or her counterpart did, even 10 to 20 years ago. We have gone from an agricultural and manufacturing based economy to a service based economy. We have literally outsourced much of our daily exercise. Although occupations centered in the cubicle may be challenging, emotionally demanding and time consuming, they most assuredly are not physically demanding. Working at a computer terminal is no match for tending the fields when it comes to burning calories. Add to this the fact that most modern work environments are stocked with food that can be consumed all day long it is no wonder that the modern office worker is much heavier than those with other types of occupations. Beyond our jobs we have also become a society that prizes convenience as one of its greatest goals. From cell-phones, to valet service, to drive-thru, to remote controls we have tried to avoid effort at all cost. Our society is now almost solely based on the automobile. Parking lots have replaced walkways, as our cities are designed to be more and more spread out. We drive everywhere in air-conditioned comfort, our only worry being how close to the entrance can we park. Finally, even our pastimes have become less physically demanding. We want to be completely entranced in passive entertainment on our couches as we watch other people exercise via DVD. This is now especially true for the children who spend hours exercising their thumbs playing games from gaming consoles while the sport fields stay empty and the bicycles unused.

Frequently, it is said that the problem of obesity is genetic, or that a particular obese person is a victim of a slow metabolism. Although this can occasionally be partially responsible for obesity it is not the cause of our current morbid obesity epidemic. The human genome changes much too slowly to explain the log rhythmic rise in morbid obesity over the last few decades. A more reasonable idea is that some people are more genetically vulnerable to obesity and as the environmental factors become less favorable the risk of the imbalance goes up. Thus, if ones parent is obese there is a high likelihood, given the same or worse environment, that the offspring will also be obese. Overall, genetics is thought to contribute 20-30% of the problem.

In summary, the source of our society’s sudden problem with obesity is not well understood. It seems reasonable to assume that a combination of environmental factors have coincided to bring it about. Just as it appears our society has defeated many of the old causes of morbidity and mortality, such as infectious diseases, and is making great strides against others (e.g. cancer), its changes have led to new problems which are just as deadly. Obesity may soon become the leading cause of preventable death for our age.