Opinion | What’s the Right Way to Reverse the Obesity Epidemic?

Kevin Hall, a senior researcher at the National Institutes of Health, chalks this up to what he calls the “push hypothesis”: Larger crop yields and increased subsidies in the 1970s and 1980s to keep down food prices caused production of corn and soybeans to surge, driving the proliferation of cheap processed food and coinciding with a 250 to 300 calorie increase in the average American adult’s daily diet.

“To actually make a difference, we have to look at the broader environment,” Sara Bleich, professor of public health policy at Harvard, told The Harvard Gazette. Changing the default options in fast-food restaurants and school lunchrooms could shift the choice architecture, she said, but so could something like Philadelphia’s soda tax, an idea Kelly D. Brownell popularized in The Times back in 1994. Dr. Bleich said:

It’s one of these policies where not only is it targeting behavior we know is bad for you, but the money is being given back to low-income groups in the form of a free, universal pre-K program. … That is a great example of a policy win.

Government needs to play a more paternalistic role

Tinkering at the edges of consumer choices can help, but the state may need to play a larger role, Noah Smith has argued in The Atlantic. He points to Japan, which has managed to achieve the lowest obesity rate in the developed world (4.2 percent in 2016) — through a naturally healthier diet, in part, but also through government interventions that run counter to American individualism.

In 2008, for example, Japan passed legislation that mandates yearly waistline measurements and requires those who exceed the maximum to attend diet classes. It also fines employers and municipalities that don’t meet targets.

Cultural stigma against being overweight is strong in Japan, but it works in tandem with the government and the food environment to encourage thinness. That pressure may also be driving a rise in eating disorders, according to Toshio Ishikwa, president of the Japan Society for Eating Disorders, especially among women. Nonetheless, Mr. Smith wrote:

Government paternalism is in some sense a last resort, but it has worked wonders in the realm of public health in the past. Hand-washing regulations, sewage treatment regulations, cleanliness education and other such paternalistic initiatives brought us out of the cesspool of the Middle Ages into the clean, safe, mostly disease-free paradise in which we now reside.

Medical and cultural attitudes needs to change

The health care system has ignored evidence-based approaches to wage a cruel, counterproductive war on overweight people, wrote Michael Hobbes in HuffPost. Despite research proving the force with which some people’s bodies fight against long-term weight loss, many doctors, encouraged by the financial and administrative structures of the health care system, take a blanket “tough love” approach that can do more harm than good.

Indeed, research shows that obese people get worse medical care, because, as Gina Kolata wrote in The Times, doctors “don’t see past the fat.” Ms. Kolata detailed many ways doctors sometimes discriminate against obese people, from dismissing symptoms of life-threatening illnesses to denying a patient surgery.

The result can be harmful for patients in more ways than one. Sarai Walker, the author of the novel “Dietland,” told Ms. Kolata:

I have avoided going to a doctor at all. … That is very common with fat people. No matter what the problem is, the doctor will blame it on fat and will tell you to lose weight.

And others, such as the writer Ijeoma Oluo, take issue with the idea that overweight bodies are a problem to be solved in the first place. “Your body is your business and you deserve the right to exist in it in peace,” she tweeted in a thread: