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HBO documentary points to an obesity era

The causes of America's big problem are complex and thoroughly intertwined with our cultural, economic, and physical environments. And it's preventable.

By Jonathan Purtle

Philadelphia's public health community descended on the Franklin Institute on Tuesday evening for a preview screening of The Weight of the Nation,  an HBO documentary series about obesity in America that will be shown May 14th and 15th at 8 p.m.

The message is that the country's obesity crisis is serious: 37 percent of adults are obese, as are 17 percent of kids. Its causes are complex and thoroughly intertwined with our cultural, economic, and physical environments. And, luckily, the whole situation is preventable.

Watching The Weight of the Nation will likely leave you feeling shocked and empowered. Shocked because the magnitude of the obesity crisis is probably larger than you thought, empowered because you'll have a better understanding of what you can do about it. Like many public health issues, the question of what to do about the obesity crisis pits notions of individual liberty against those of collective responsibility. The film will make for a good debate between people with opposing ideological perspectives.

The 30 minutes of footage shown at Tuesday's public health screening focused on the importance of access to fresh and healthy food, highlighting two major determinants of who gets it: where you live and how much money you have.

More often than not, the foods that are cheap are the foods that make you fat. The calculus is pretty simple: if you have $2 to your name and the option of buying A) two fast-food burgers that will give you a day's worth of calories, or B) two apples that will hardly fill you up, you'll go with the burgers.  As Mayor Nutter, whose presence underscored the importance of the occasion, astutely noted: "hunger and obesity go together, as disparate as they may seem." The poorer you are, the harder it is to eat healthy.

Thanks to unfettered market forces, this situation has led to many low-income neighborhoods becoming "food deserts"— geographic areas where fresh, healthy food is impossible to come by, regardless of how much money you have. There's no shortage of fast-food and Chinese takeout options, but broccoli is harder to find.  The film uses the Overbrook section of Philadelphia — which didn't have supermarket for over 25 years until the ShopRite opened at 52nd and Parkside — as one illustration of the food desert phenomenon.

Philadelphia is the poorest big city in America, and also one of the fattest:  In 2008, 64 percent of Philadelphia adults and 57 percent of its children ages 6 to 11 were overweight or obese.  This situation, however, may be getting better.

Obesity rates among children in Philadelphia are declining.  According to Donald F. Schwarz, the city's health commissioner and deputy mayor for health and opportunity, there was a 5 percent decrease in obesity among Philadelphia school children between 2006 and 2012, with even greater reductions among African American boys and Latina girls.

In 2010, city health officials won a competitive federal grant that brought in $25.4 million for prevention and wellness.  This funding allowed the city to launch  — an innovative initiative that has taken major strides toward improving access to healthy foods, limiting junk food marketing, promoting physical activity, and making school environments healthier. The Healthy Corner Store Initiative, developed by The Food Trust, a local nonprofit, has become a national model for improving food access in low-income communities.

America is often said to be in the midst of an "obesity epidemic."  While this appropriately conveys the severity of the problem and the urgency with which we need to act, the HBO film left me thinking that we're actually in the midst of an "obesity era."  The way we've designed our neighborhoods, the cultural norms we've embraced, and the policies we've enacted have all made it challenging to not be overweight.  As a sound bite from the movie states, if you "go with the flow" in America, and don't actively seek a healthy lifestyle, there is a decent chance you'll become overweight.

We can, however, change this situation.  "Obesity is as much a community problem as it is an individual problem," said Shiriki Kumanyika, an epidemiologist at the University of Pennsylvania, in a panel discussion following Tuesday's screening. By collectively letting political officials and business owners know that we want healthy to be easy, our environments, and our waistlines, are likely to change for the better.

Read more about The Public's Health.