Are diet and exercise really personal choices?
A human epidemic of obesity / near-obesity has correlated worldwide with the spread of manufactured food & beverage, and motorized transport. Diet & exercise though seem to be intensely personal choices. How can this dilemma be solved?
Preface: This is a discussion paper, not a researched academic document. The reading list at the end is a collection of contemporary links from the Internet and pretty accidental, not edited for quality. The author is a principal organizer for a Brisbane, Australia, discussion group whose members come from diverse backgrounds, and which deals with an eclectic collection of topics. Where a topic is of broad general interest I have adopted the practice of posting discussion starters like the present one on Academia.edu in the hope that others might also find them worth thinking about.
1. This discussion about diet and exercise is mostly grounded in Australia. The issues themselves do impact on every country and culture, although in different ways. For example 3rd World and developing countries tend to show quite different patterns of conscious physical activity from post-industrial societies, although the marketing of manufactured food is impacting on them in increasingly similar ways. Australia itself as a nation of immigration with over 200 sources of ethnic origin hosts a huge diversity of practices and attitudes. Nevertheless patterns are discernible, and not all of them are encouraging.
2. Younger people are traditionally expected to be more active than older people, yet as a group they appear to be becoming much less active and less fit, as well as subsisting on often dubious fast food diets. Extensive statistics are available from the United States of America, which is a lead to many Australian trends. American standards of military recruitment, for example, are in steep decline. From one report (Staff Metro 2014), 75% of American military applicants are too fat to be accepted, and 65% of the remainder cannot pass a simple fitness test. This is a halving of earlier fitness levels. From all 17 to 24 year olds in the United States, 27% are too fat for military service and 75% overall are ineligible for physical, educational or criminal reasons (Jaslow 2012). Concordant with America, I came across an account of probationary Australian police recruits rejected for failing to manage five push-ups (Dowling 2013). China is facing similar trends, with 19% of military applicants amongst college graduates obese or overweight (Zheng Xin 2013).
3. The idea of deliberate, scientifically researched, lifelong body management for a beneficial diet, fitness and health is becoming a central lifestyle choice for a particular segment of educated populations. I place myself within this demographic, but remain mindful that it is a minority of the population, and may always be a minority. Shifting others to this orientation sometimes seems an insurmountable challenge. Almost daily I encounter people for whom my own relative good fitness is read as an unspoken personal insult to their own relative lack of fitness. Apparently my experience is not an isolated one, as indicated by the recent report of a woman barred from a “Planet Fitness” gym after someone complained that her obvious fitness was intimidating to the other customers (The Telegraph, London, 2014). This hostility sometimes extends to the medical profession. I am by no means Mr Universe, yet one visibly unfit doctor brimming with aggression produced a medical report for me headed in bold type: “Fitness Fanatic”. Fanatic? Is efficient body management so exotic?
4. In Australia, as in America, obesity and it’s precursor, “being over-weight”, is affecting a major part of the population. A compact and rather frightening summary is available from the American President’s Council on Fitness, Sport and Nutrition (see the reading list). By 2030 half of Americans are on track to be obese, with major health consequences. Health itself is a complex phenomenon. [Note: the Wikipedia entry, “Health” gives quite a good summary of the public and private meanings of that concept. It is worth reading as preparation for any discussion on the issues raised in these notes].
One of the depressing characteristics of obesity is that fat mothers produce fat children, partly because of epigenetic settings which occur during pregnancy, and partly from the environmental influence of families after birth. I have heard informally that some researchers into obesity have even suggested that children like this should undergo gastric bypass surgery at a young age – a proposal obviously not viable both because of the surgical risks and the huge number of children involved.
5. The title of this paper asserts a dilemma: “Are diet and exercise really personal choices?” At first blush the dilemma might not be obvious to everyone. The implicit question is the extent to which governments or other agents should interfere in the lifestyle choices of individual citizens. There may be a visceral response to this question, but hopefully the following paragraphs will show that the problem is quite nuanced.
In Australian society the answer is likely to be “yes of course diet and exercise are personal choices. This is a free country.” Any threat of intervention by “big brother” in intimate daily activities will be fiercely resisted with good reason. Bureaucracies have a poor record of successful intervention in private lives. Yet there are more and more public interventions in the management private lives for a whole range of reasons.
Also, in practice, private commercial interests impact on supposedly free consumer choices much more than governments do, and often for quite amoral reasons (e.g. see Freudenberg 2014). We need to identify these interventions by public and private interests, decide whether they are justified, decide whether they are effective, and whether they are beneficial. On a much wider scale, the health and survival of whole human populations drills down to personal choices which are influenced by myriad external pressures. This is not an abstraction. Again, we need to identify what is going on and why.
6. How well do Australians help themselves to good health? 62.6% of Australian males and 72.5% of Australian females had been sedentary or only engaging in low levels of activity in the previous week of a survey in 2011-2012 (Australian Bureau of Statistics). In a 2007 ABS survey, 17.6% of males and 22.3% of females reported symptoms of mental disorder in the preceding 12 months (lifetime rates: 48.1% males and 43% females). In 2011-2012 75.6% of males and 77.7% of females were living with one or more long term health conditions. Interestingly, the statistics for medical staff are no better than for the general population. In spite of these issues, Australians had longer life expectancies than the citizens of all but a handful of other countries (and much better than USA). On the upside, the word “lifestyle” has acquired overtones of effective physical management, and found a niche in popular media. Are things changing in a positive way, and for whom? A factoid to chew on: in UK it is known that the least privileged part of the population lives 20 years less than the most privileged part of the population (Saul 2014).
7. Two vignettes: If you walk along the river cycle track from Southbank to the Story Bridge in Brisbane, Australia at 5pm, the number of wonderfully fit people you see is impressive (and the scene would have been unthinkable 40 years ago). If you walk around, say, Toombul Centro shopping centre in north Brisbane on any weekday, the bloated human wreckage shambling in and out looks like a national emergency, at least to my eye.
It is usually pointless or counterproductive to stigmatize people for their bodies, their health status or their lifestyles (Rebecca 2010). We don’t get to choose our bodies or our brains in a baby supermarket before birth. However, fatalism is also a dead end track. As one of the world’s uglier humans I adapted to that misfortune long ago with good grace, but also decided to maintain and develop what I did have to its optimum. It is a continuing learning process. Yet it seems that huge numbers of people, once past the breeding cycle, are resigned to disintegrating physically (and often mentally) over several decades, usually at a cost to all around them, and at a cost to the public health system. Why? Should, or can anything be done about that?
8. Although we are proud of our individual lifestyle choices, those choices overwhelmingly conform with cultural norms. This is as true of food choices as it is of clothing choices, personal grooming choices, educational choices, transport choices or exercise choices. Where laws are passed to influence such choices, the laws will be also interpreted within cultural norms. Even where health institutions and doctors are encouraged to advise patients to change diet or exercise patterns, the doctors, nurses etc will inevitably “translate” that advice according to their own cultural expectations and habits (and if you doubt that, check out the awful food served up to patients in Brisbane’s hospitals, as well as the rather poor physical/mental condition of many medical staff).
9. Cultural norms change via various mechanisms – by natural evolution, through generational revolt, from the influence of new community members (e.g. from immigration), from media influences (often international), from changing educational curriculums (slowly), from commercial manipulation (marketing), from institutional pressures (e.g. from employers, insurance companies), from government regulations or campaigns … and so on. These currents of pressure on cultural norms flow unevenly through communities, are often in opposition to each other, and yield outcomes which are essentially unpredictable except for narrowly targeted purposes on specific sub-groups (e.g. a liquor industry advertising campaign to hook young adults on ‘cool’ alcopops).
10. Attempts to change cultural norms of diet and exercise through official channels suffer major handicaps.
a) There is no question that worldwide public health has improved greatly over the last century, resulting in an explosive increase in human populations and sometimes a doubling of life expectancy. A good deal of this has been due to infrastructure investment by governments in clean water and sanitation, vaccination programs to reduce epidemics, and improved hygiene standards. However when it comes to government agencies influencing personal behaviours, the successes have come far more slowly and soon encountered resistance. Without any reliable scientific or even cultural consensus on standards of diet and health, arbitrary regulation seems unwise, and publicity campaigns invite scepticism. Past experience has given us all good reason to be cautious about political shape-changing, even in the name of public health.
b) When difficult problems of public behaviour are posed in casual conversation, it is common to hear a comment such as “A law should be passed to XYZ”. For example, I have heard a proposal for a “fat tax” whereby overweight individuals would be required to fund their future expected excessive use of public health resources. The law is an extremely blunt instrument, almost guaranteed to cause individual injustices in the hunt for a greater good, and absolutely guaranteed to come at great financial cost. That is, the formal regulation of private behaviour, while sometimes necessary at the extreme, should always be a last resort. Where regulation seems desirable, it is generally most effective to treat the supply side of the equation (e.g. the enforced regulation of food standards). Private behaviour is more effectively managed by peer influence and sometimes by public education.
c) There is no such thing as unanimous medical opinion about diet and exercise. Any systematic search for a consensus will throw up endless contradictions, violently opposed opinions, and huge inconsistencies over time; (I’m sure about this – I’ve been following the mess for years). In other words, your average passive citizen can be pushed in a dozen different directions, often perilously. Your friendly local general practitioner (doctor) is often a poor guide in this thicket of opinions.
d) A large number of the most creative brains on the planet are dedicated to undermining public health in the name of profit (e.g. see Freudenberg 2014, Malhotra 2014). The “food and drink industry” is huge, and embraces numerous professions from chemical research to manufacturing to marketing. This industry rivals the arms industry as a potential threat to us all, yet presents as an essential service. The political influence of the food and drink industry is relentless, and its advertising presence ubiquitous. However, the evidence of effects from an industrialized food industry is unequivocal as poor dietary choices become embedded in the culture.
The principal agents of the food & drink industry are typically amoral, but of course spin a soothing narrative for public consumption. The resources of the corporations these talented and highly paid people work for are almost bottomless, and effectively beyond the reach of national governments. (In less regulated jurisdictions like China the blatant contamination of food & drink is extreme, and a major political issue).
11. Conscious physical exercise is a phenomenon that has mostly emerged in advanced industrial or post-industrial societies. My parents were almost offended by the idea of adults “doing exercise”, complaining that the working day left them exhausted enough, thank you very much. The attitude is still widespread, and sophisticated knowledge about keeping in good, resilient physical condition throughout life remains relatively rare in the community (including amongst health workers). There is also a huge amount of misinformation out there.
People become angry if told they are lazy, yet will fight for a parking space in a shopping centre instead of walking a couple of hundred metres. Half-hearted attempts at beginning to keep fit are very common, but like learning a foreign language, they rarely last the distance. Those addicted to social support quit as soon as their friend gives up. “Going to the gym” is usually less about lifelong body management than about having a social need exploited in a carefully nurtured market niche (e.g. see The Telegraph, London, March 23, 2014). Above all, there is little patience or understanding about building physical capability gradually but persistently.
The widespread lack of determination to actively maintain physical resilience throughout our lifespans is a great pity. As a distance runner for 50 years, I am still learning and adapting. Exercise has also played a major part in maintaining my mental and emotional stability. For those who seek to know, research into physiology and kinesiology is constantly advancing. The average person sets themself a very low standard when it comes to effective body maintenance (investing in hair dressers etc doesn’t cut it for the meaning of a well maintained body!).
12. Enthusiasm for mass spectator sport achieves easy popularity, even in cultures where historically it was relatively unknown. This popularity occurs regardless of the personal physical fitness of spectators (or rather, lack of fitness). That is, people will talk the talk ever more loudly, but are reluctant to walk the walk. Even attendance at real sporting venues is substituted by vicarious electronic participation. This kind of “mental masturbation” is not confined to sports of course. To take an utterly digressive example, loud talk about religious morality is rarely matched by moral performance. Human tendencies of this kind are never going to be eliminated. It may be however that clever public policy can sometimes leverage the high repute and enthusiasm for vicarious sporting participation into some more concrete commitments to personal physical maintenance and improvement.
13. Learning on our feet seems to me to be one of the most promising options for improving the general physical fitness of whole populations. Even the unconscious physical adjustments for balance while standing make significant active use of muscles. Each day I average almost 15 kilometres on my feet, walking and running, without becoming weary. This is not dead time. It is always multitasked with MP3 recordings for language learning and podcasts. Humans are evolved to function on their feet, and think better while doing that. As a teacher and lecturer I spent years on my feet while students foolishly sat. Finally in a low-standard South Korean university with students who were resigned to failing at everything I rethought the paradigm and made them all stand in my language learning classes. The transformation was remarkable. The story of that experiment is recorded in the paper, “Standing Room Only - Posture, Space and the Learning Process in ESL Classes” (Thor May, 2005).
14. Personal experiment, caution about advice from agents of “authority”, intensive research, constant learning, and educated evaluation are probably the best survival stratagems for capable individuals trying to keep fit and in good health. At least, that has been my own hard won experience over 68 years. Almost by definition though, this is hardly a solution for the mass of the population.
Even intelligent people, when younger, will put aside preventative health care and wait for degeneration and significant disease to afflict them before seeking intervention. That “underprivileged demographic” which lives 20 years less than the “privileged demographic” remains almost unreachable, even when beneficial lifestyle changes become more or less fashionable. These years-minus-20 people have their own diversity, but by broad generalization are less educated, poorly employed or unemployed, more likely to have drug & alcohol problems, more prone to seek instant gratification in daily life, likely to be low in self-esteem, are often attached to a different set of values, and above all are easy prey for food & drink marketing vultures.
15. We know that different cultures and different countries show great diversity in diet and exercise. Equally there is a diversity in healthy living outcomes and age expectancy. Knowledge of such diversity is useful because it shows us that what we practice ourselves is not the only possibility. Diet and exercise regimes within Australia have changed dramatically in my own lifetime (I was born in 1945). The reasons are many, but the biggest influence has certainly been large scale immigration from an ever increasing number of countries. Interestingly the immigrants themselves tend to show little cultural adventurism in the first generation, but their children and those of us whose ancestors have been here for generations dabble happily with expanded food choices and develop ‘fusion cuisines’ which in the best cases are a great improvement on the original monocultural origins. However, the fierce competition working against dietary experiment and diversity is a soulless, industry driven monoculture of fast food and packaged convenience food.
16. Most people are intensely social creatures. When they can afford it they will eat out frequently, especially those who are unpartnered and/or without children. In Australia, as in many countries, restaurant culture is widespread. The Australian scene is fortunate for its wide diversity of cuisines. Indeed, one of the perpetually listed required skills on the Australian government’s favoured list for skilled immigration is “cook/chef” (I find this astonishing, given the unemployment rate). While restaurants may be socially attractive, any continuing diet based on commercially produced food is unlikely to be an improvement on even mediocre domestic preparation – and this is regardless of reputation or price. These places are in business for a profit, and staffed by usually underpaid kitchen hands who are not knowledgeably dedicated to your continuing good health. The bottom of this food chain, so-called fast food, is not even fast. It never takes me longer than 15 minutes each day to cook dinner – 120 grams of meat, fish or egg, spiced with cumin, turmeric and pepper, plus small helpings of all of the following: beans, broccoli, cabbage, capsicum, carrot, celery, cucumber, garlic, ginger, mushrooms, onion, peas, tomato. Half the vegetables are eaten raw, the others quickly steamed, and dashed over with a bit of mint sauce. The point is to give my body access to every fresh nutrient it needs for optimum maintenance. No restaurant is ever going to do that.
17. Broad cultural habits of diet and exercise will always encompass a percentage of individuals given to excess, and some others enamoured of moderation or even asceticism. That is, there is a continuum of attitude and practice which is unlikely to alter at the extremes, whether we are talking about body management, or risk taking, or any other human activity. Nevertheless there are cultures where moderation is held to be a worthwhile goal, a pattern favoured by the majority. There are other cultures where extreme behaviour, including dietary behaviour is overtly and/or covertly glorified. It is a basic tenet of consumer capitalism that maximum consumption for maximum monetary profit must be promoted in all things. Should we be surprised that an ideal of maximum consumption is reflected in the nation’s waistlines?
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The source of this document:
meetup group: Gentle Thinkers http://www.meetup.com/Gentle-Thinkers/
discussion topics blog (for the list of proposed topics): http://discussiontopics.thormay.net/
topics already discussed: http://thormay.net/unwiseideas/DiscussionTopics/DiscussionIndex.htm
comments: Thor May - firstname.lastname@example.org;
Professional bio: Thor May has a core professional interest in cognitive linguistics, at which he has rarely succeeded in making a living. He has also, perhaps fatally in a career sense, cultivated an interest in how things work – people, brains, systems, countries, machines, whatever… In the world of daily employment he has mostly taught English as a foreign language, a stimulating activity though rarely regarded as a profession by the world at large. His PhD dissertation, Language Tangle, dealt with language teaching productivity. Thor has been teaching English to non-native speakers, training teachers and lecturing linguistics, since 1976. This work has taken him to seven countries in Oceania and East Asia, mostly with tertiary students, but with a couple of detours to teach secondary students and young children. He has trained teachers in Australia, Fiji and South Korea. In an earlier life, prior to becoming a teacher, he had a decade of finding his way out of working class origins, through unskilled jobs in Australia, New Zealand and finally England (after backpacking across Asia in 1972).
Are Diet and Exercise Really Personal Choices? (c) Thor May 2014