Chapter 14. Health at Every Size

Thinking Beyond the Individual

When tools such as BMI are used, then can lead society and an individual to think that excess weight, body fat, and health risk are due to individual level factors alone, but what is often overlooked is the importance of factors beyond the individual level that can contribute to weight gain.

There is no doubt that BMI is a multifactorial disease, which is clearly highlighted in Figure 5.2 (page 89)  in the Tackling Obesities: Future Choices Project Report. 2007.

Therefore, it’s particularly important to think beyond obesity being related to personal choices and behaviours. This is highlighted in survey research on over 30 million of American children designed to determine risk factors of obesity. In this study they found the following risk factors and protective factors which span beyond the individual level:

  • Risk factors: Non-Hispanic Black (↑53%) and Hispanic identity (↑50%), children of single parents (↑30%), living in neighborhood with no amenities (↑27%)
  • Protective factors: Parental attainment of college education (↓48%), private health insurance (↓45%), language spoken in home other than Spanish (↓47%) [1]

There are numerous social/ community determinants of obesity. For example, access to recreational facilities and shops with modestly priced healthy foods was associated with less obesity [2]. But unsurprisingly the odds of obesity increase with greater concentrations of convenience and fast-food outlets [3], which is concerning as the fast food industry has been growing for decades, in Canada today, there are over 14,000 McDonald’s restaurants, while in 1967, there was one.

Food portions have been getting bigger since the 1960s, and in the 1990s, North American society experienced the “super-size” marketing boom, which still endures. Escalators, elevators, and horizontal walkways now dominate shopping malls and office buildings, factory work has become increasingly mechanized and robotized, the typical Canadian watches more than four hours of television daily, and in many workplaces, the only tools required to conduct work are a chair and a computer. The list of all the societal obesogenic factors goes on and on. They result from modernization, industrialization, and urbanization continuing without individuals, public health officials, or the government adequately addressing the concurrent rise in overweight and obesity.

To help. it is paramount that policies be implemented or reinforced at all levels of society, including education, agriculture, industry, urban planning, healthcare, and government. Reversing and stopping obesity are two different things. The former will require much more societal and individual change than the latter. The following are some ideas for constructing an environment in Canada that promotes health and confronts the obesity epidemic:

Individual Level

  1. Purchase less prepared foods and eat more whole foods.
  2. Decrease portion sizes when eating or serving food.
  3. Eat out less, and when you do eat out choose low-calorie options.
  4. Walk or bike to work. If this is not feasible, walk while you are at work.
  5. Take the stairs when you come upon them or better yet, seek them out.
  6. Walk in your neighbourhood and know your surroundings. This benefits both health and safety.
  7. Watch less television.

Community Level

  1. Request that your college/workplace provide more access to healthy low-cost foods.
  2. Support changes in school lunch programs.
  3. Participate in cleaning up local green spaces and enjoy them in your leisure time.
  4. Patronize local farms and fruit-and-vegetable stands.
  5. Talk to your grocer and ask for a decent price for better whole-food choices and seafood.
  6. Ask your frequently visited restaurants to serve more nutritious food and to accurately display the caloric content of menu items.
  7. Introduce a health and wellbeing principle as part of local government decision-making when considering land use planning and zoning permissions
  8. Implement regionally appropriate actions to support and empower priority populations
    1. These actions need to be designed, implemented and evaluated collaboratively with communities and their leadership to ensure they are culturally centered and meet community needs.

Government/National Level

  1. Support policies that increase the walkability of cities.
  2. Support national campaigns addressing obesity.
  3. Support policies that support local farmers and the increased access and affordability of healthy food.
  4. Create/ update regulations to restrict the marketing of unhealthy diets to children and young people
  5. Implement consistent healthy food and drink service policies which promote and enable healthy diets

  1. Yusuf et al.,Int J MCH AIDS . 2020;9(1):22-33. doi: 10.21106/ijma.337. Epub 2019 Dec 28.
  2. https://www.canada.ca/en/public-health/services/health-promotion/healthy-living/obesity-canada/factors.html
  3. Elinder and M. Jansson, "Obesogenic Environments – Aspects on Measurement and Indictors," Public Health Nutrition 12 (2008): pp. 307-315.

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Human Nutrition Copyright © 2022 by Luisa Giles and Komal Dhaliwal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

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