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?
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This is an initial starter list for discussing the "Diet & Exercise " topic. The list makes no special claim to quality, and additions are welcome.
Notes by Thor
1. Some time ago I wrote an article about my personal approach to diet and exercise: Choose When to Live and When to Die - Some Notes on Diet and Exercise (You may well disagree with the pitch, but that is good for debate ^_^ )
2. The Wikipedia entry, “Health” gives quite a good summary of the public and private meanings of that concept. It is worth reading before participating on a discussion about the topic.
3. Before thinking about it, many people may be puzzled by the title of the topic, “Are diet and exercise really personal choices?” In our society the answer is likely to be “yes of course they are personal choices. This is a free country.” Any threat of intervention by “big brother” 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. We need to identify these reasons, decide whether they are justified, and decide whether they are effective. On a much wider scale, the health and survival of whole human populations drills down to personal choices which are influenced by public pressure. This is not an abstraction. Again, we need to identify what is going on and why.
4. 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 acquired 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.
5. Two vignettes: If you walk along the river from Southbank to the Story Bridge in Brisbane 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. 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?
6. 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 poor physical/mental condition of many medical staff).
7. 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).
8. Attempts to change cultural norms of diet and exercise through official channels suffer major handicaps.
a) The general public generally takes a dim view of ‘big brother’ interventions in their private lives. Past experience has given us all good reason to be cautious about political shape-changing, even in the name of public health.
b) 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 GP is often a poor guide in this thicket of opinions.
c) A large number of the most creative brains on the planet are dedicated to undermining public health in the name of profit. 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 this 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 a-moral, but of course spin a soothing narrative for public consumption. The resources of the corporations these clever 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).
9. 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 is still relatively rare in the community (including amongst health workers). There is also a huge amount of misinformation out there. People are offended to be 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. Above all, there is little patience or understanding about building physical capability gradually but persistently. This is all a great pity. As a distance runner for 50 years, I am still learning and adapting. It 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!)
10. Personal experiment, caution about advice from whatever “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 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.
11. 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 who 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 competition to dietary experiment and diversity is a soulless, industry driven monoculture of fast food and packaged convenience food.
12. 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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Are diet and exercise really personal choices? (c) Thor May 2014