Health is regulated by homeostasis, a property of all living things. Homeostasis maintains equilibrium at set-points using feedback loops for optimum functioning of the organism. Long-term disruptions of homeostasis or ‘dyshomeostasis’ arise through genetic, environmental and biopsychosocial mechanisms causing illness and loss of well-being including obesity, the addictions, and chronic conditions. These and many other phenomena of Psychological Homeostasis are explained in A General Theory of Behaviour.
Obesity dyshomeostasis is associated with a self-reinforcing activity of a vicious Circle of Discontent in which hedonic reward overrides weight homeostasis in an obesogenic and chronically stressful environment. Over-consumption of processed, high-caloric, low-nutrient foods, combined with stressful living and working conditions, have caused loss of equilibrium, overweight and obesity in more than two billion people.
The prevalence of obesity is higher in women and low-income groups who are more exposed to chronic stress and low purchasing power including some ethnic minority groups.
Research on different diets suggests that a plant-based diet containing low amounts of sugar, little or no red meat and the minimum of fats promotes weight-loss and prevents obesity, diabetes, metabolic syndrome, coronary heart disease, and cancer. A vegan diet with no meat, fish or dairy is especially anti-obesogenic.
The ‘thin ideal’ pervades popular culture with narratives and images of thinness which has an entirely negative effect on youth the world over. Legislation should be enacted to ban the use of artificially enhanced images of ultra-thin models in magazines and media.
Discrimination against people who are overweight or obese causes stress and socio-economic disadvantage. Approaches to the epidemic that invoke a narrative of ‘blame-and-shame’ exacerbate the problem. There are very few people who deliberately become obese through conscious effort or who would not like to avoid it if they possibly could.
Homeostatic imbalance in obesity includes a ‘Circle of Discontent’ (COD) a system of feedback loops linking weight gain, body dissatisfaction, negative affect and over-consumption. This homeostatic COD theory is consistent with a large evidence-base of cross-sectional and prospective studies.
A preliminary model suggests that obesity dyshomeostasis is mediated by the prefrontal cortex, amygdala and HPA axis with signalling by the peptide hormone ghrelin, which simultaneously controls feeding, affect and hedonic reward.
The totality of evidence within current knowledge suggests that obesity is a persistent, intractable condition. Prevention and treatment efforts targeting sources of dyshomeostasis provide ways of reducing adiposity, ameliorating addiction, and raising the quality of life in people suffering chronic stress.
Vigorous and uncompromising Governmental actions are required, independent of corporate interests, at all levels of society to reduce the prevalence of obesity and related conditions. A four-armed strategy to halt the obesity epidemic is necessary.
There is an immediate need to enact anti-discrimination legislation to protect people with obesity and improve their quality of life. Anti-discrimination laws are necessary to eliminate one of the primary causes of obesity which fuels the Circle of Discontent. PLWO need legal protection from discrimination which has been shown to be detrimental to the mental health of the victims of obesity.
Legislation to enforce a mandatory code of practice is needed to resist and devalorize the thin-ideal. Precedents have been set in Israel and France to ban models with extremely low BMI, examples which should be followed in all countries. The retouching of pictures in fashion magazines to make the human subjects appear slimmer or more attractive should be controlled. Consumers should be informed when images of people have been manipulated.
Generic legislation is necessary to curb the widespread consumption of energy-dense, low nutrient foods and drinks. Mexico, France, Finland and Hungary and, most recently, the UK have set charges for a levy on sugary drinks, a step in the right direction. More generic taxation is necessary to incentivize producers and retailers to reformulate products. An ‘Unhealthy Commodities Tax’ which would yield revenue and improve the diet of a large segment of the at-risk population.
Improving the access to plant-based diets is an effective strategy for producing weight loss. The example of the WIC in the US indicates that increasing access to fruit and vegetables has a positive effect on food consumption towards a healthier diet. Following the WIC model, legislation should be considered in every state and country to improve F/V intake. Proceeds from a UCT could be used to subsidise the organic production of F/V with payments to growers and sellers to enable lower retail prices of organic F/V. Interventions to increase access and affordability of F/V would help to slow the obesity epidemic.
Huge resources have been invested on the monitoring of the epidemic and on the treatment of PLWO. The major part of future investment should be re-directed towards containment and control by legislating strategies for obesity prevention as was previously the case in tobacco control. No more kowtowing to industry. Let’s cease the “shock-horror” narrative of obesity at all levels of society and replace it by concrete actions.
We know what is required. Can our national governments show the necessary leadership and do what is necessary? The survival of the planet and the human race requires nothing less.