How Social Norms and Societal Changes Can Reverse the Obesity Epidemic

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• Social Norms and Obesity Prevention
• Portion Sizes and Food Environment
• Work Life and Eating Habits
• Quality of Food and Nutrition
• Complexity of Obesity Factors
• Socioeconomic Solutions to BMI Disparities
• Long-Term Societal Approach

Social Norms and Obesity Prevention

Social norms play an extraordinarily important role in shaping health behaviors and combating obesity, according to Dr. George Kaplan, MD. Changing these norms is difficult but possible, as demonstrated by the successful transformation of smoking from acceptable to unacceptable behavior in many communities. Dr. George Kaplan, MD, notes that while tobacco may be highly addictive, the challenge of weight loss requires addressing deeply ingrained social and environmental factors.

Portion Sizes and Food Environment

Dr. George Kaplan, MD, identifies portion size as a critical social norm that directly impacts obesity rates. Research shows people consume a certain percentage of what is placed in front of them, whether on large or small plates. The interview with Dr. Anton Titov, MD highlighted how American portion sizes are significantly larger than European standards, contributing to excessive calorie consumption. Restaurant servings designed for multiple people encourage overeating through environmental cues rather than hunger signals.

Work Life and Eating Habits

Modern work-life balance and family dynamics significantly influence eating patterns and obesity risk. Dr. George Kaplan, MD, explains that time constraints lead many people to eat alone or rely on fast food because they lack time for meal preparation. The convenience and low cost of processed foods create social norms that prioritize speed over nutrition. These behavioral patterns become ingrained through daily repetition and social acceptance of fast food culture.

Quality of Food and Nutrition

Shifting social norms toward higher quality nutrition represents another strategy for obesity prevention. Dr. George Kaplan, MD, suggests substituting locally produced, nutritious foods for frozen or prepackaged options could significantly impact public health. The conversation with Dr. Anton Titov, MD emphasized that food quality interventions must address both availability and social acceptance of healthier alternatives within communities.

Complexity of Obesity Factors

Obesity is an enormously complex condition with hundreds of contributing factors, as documented by the Foresight Group in the United Kingdom. Their mapping exercise revealed influences ranging from psychological to biological factors and food production systems. Dr. Kaplan stresses that no single intervention—whether eliminating high fructose corn syrup or targeting specific macronutrients—will solve the obesity epidemic alone. This complexity requires comprehensive, multi-faceted approaches.

Socioeconomic Solutions to BMI Disparities

Simulation models show dramatic potential for reducing racial disparities in body mass index through socioeconomic interventions. Dr. George Kaplan, MD, reports that BMI differences between black and white populations could be dramatically lessened or even eliminated within 20 years—approximately one generation. Key interventions include improving neighborhood walkability, increasing availability of healthy food options, and enhancing educational quality. These findings underscore that societal factors outweigh individual diet approaches for population-level impact.

Long-Term Societal Approach

The obesity epidemic developed over decades and will require sustained, long-term societal changes rather than quick fixes. Dr. George Kaplan, MD, emphasizes that the most significant impact will come from addressing fundamental socioeconomic factors rather than searching for magic pills or miracle diets. As Dr. Anton Titov, MD discussed with Dr. George Kaplan, MD, this approach recognizes that environmental and social restructuring creates the foundation for lasting health behavior change across populations.

Full Transcript

Dr. Anton Titov, MD: What do you think is the role of social pressures to affect changes in health habits in general and obesity in particular? And what's the effective way to use social pressure factors in changing public behavior?

Dr. George Kaplan, MD: Social norms are extraordinarily important, but they're also difficult to change. We saw that with smoking—it took a lot to make smoking unacceptable behavior. In the area where I live in Northern California, there are still areas where it is the norm.

People have argued that tobacco is more addictive than heroin. That may be the case; I don't know if it is or not, but certainly it's enormously addictive. And losing weight is extremely difficult.

The social norms and pressures we have to work on are those that have to do with portion size. Going into a restaurant and being served food for two people—the evidence shows that people tend to consume a certain percentage of what's put in front of them, whether it's a large plate or a small plate. If they put a big plate in, they eat more.

Portions in the United States are so much larger than in Europe. That's right. We also have to think about how work life and family life lead to eating alone or eating fast food because you don't have time to prepare food, or because it's cheap—how that contributes to obesity.

We have to think about norms that have to do with the quality of food, substituting perhaps locally produced, nutritious food for frozen or prepackaged food. There's a whole variety of things; obesity is enormously complex.

The Foresight Group in the United Kingdom did a map of all the factors that contribute to obesity, ranging from the psychological to the food production side, the biological side. There are hundreds of factors that contribute.

There's not going to be any magic thing. We're not going to be able to eliminate obesity, in my opinion, by eliminating high fructose corn syrup or by somehow intervening on carbohydrates or this or that. I don't think any single thing is going to do it.

These problems developed over a long period; they'll take a long time to reduce. We did show in a simulation model that we have that the body mass index difference between blacks and whites could be dramatically lessened, perhaps even eliminated in less than 20 years—one generation.

By intervening on the walkability of the neighborhoods in which people live, by the availability of good food, and by increasing the quality of education, in that simulation model—which is a model, not an intervention—we were able to eliminate BMI differences between blacks and whites in 20 years.

So that's another underscoring of the importance of socioeconomic factors rather than trying to look for a magic pill or a major diet on an individual level. It is the societal factors that will make the most impact on such enormous problems.

Dr. Anton Titov, MD: Absolutely. Thank you very much for this conversation.

Dr. George Kaplan, MD: Thank you.