Handbook of Eating Disorders: Physiology, Psychology, and Treatment of Obesity, Anorexia, and Bulimia

By Kelly D. Brownell; John P. Foreyt | Go to book overview

11
The Control of Obesity:
Social and Community
Perspectives

Albert J. Stunkard

Social and community perspectives are of value in understanding any disorder. But when clinical measures are limited, as with obesity, such perspectives can be particularly useful. The precedents are many and of long-standing. In 1854, for example, when cholera was overwhelming the clinical efforts of London's physicians, John Snow traced its origins to the social group at risk—users of the Broad Street pump. When he removed the pump handle, he did more than stop an epidemic, he established a model of public health practice.23 Since then the details have changed but not the principles.

Changes in public health practice since the days of John Snow reflect the changes in the burden of illness. The conquest of cholera and the other infectious diseases has left as our greatest burden the chronic and degenerative diseases, with their very different demands. In the era of infectious disease, the major public health efforts were exerted by the experts and little was demanded of the population other than its passive participation—in allowing swamps to be drained and sewers to be built. At most, it required visiting the doctor's office for immunizations. By contrast, public health measures for the control of obesity may require an extraordinary degree of participation on the part of the citizenry.

Such active participation is needed because obesity is so largely a result of the way we live, of our life styles and personal habits. Controlling obesity may well require major changes in those life styles and personal habits. Such an undertaking is clearly an ambitious endeavor. It would

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