The Situationist

The Power of Word Choice: “Lifestyle” Diseases

Posted by Adam Benforado on April 23, 2011

As readers will note, I’ve been blogging a lot about the situation of obesity recently and so I read Mark Bittman’s recent op-ed in the New York Times,  “How to Save a Trillion Dollars,” with special attention.

I agreed with a lot of what Bittman said about how changing our diets is one of the keys to reducing healthcare costs in the United States, including his ultimate conclusion:

The best way to combat diet-related diseases is to change what we eat. And if our thinking is along the lines of diet improved = deficit reduced, so much the better. If a better diet were to result only in a 10 percent decrease in heart disease (way lower than [Dr. David] Ludwig[, author of “Ending the Food Fight,] believes possible), that’s $100 billion project savings per year by 2030.

This isn’t just fiscal responsibility, but social responsibility as well. And the alternative is not only fiscal catastrophe but millions of premature deaths.

However, I thought that Bittman seriously undermined his message by referring to obesity-related afflictions, like diabetes and heart disease, as “lifestyle diseases.”

It seems like a minor point — and it’s true that the term has been adopted by certain individuals in the public health sphere — but I think we all need to be more careful about our word choices because the terms we use can have a powerful impact on our policy debates (e.g., are they “freedom fighters” or “terrorists”?  are they “taxes” or “dues”?).

The term “lifestyle disease” implies that obesity boils down to personal choice—people choose to be skinny, just as they choose to live by the beach or own dogs.

This has been the mantra of big food companies trying to avoid regulation and litigation for over a decade, but it is contradicted by a growing mountain of evidence that our obesity epidemic is the product of a toxic food environment.  If the incidence of Type 2 diabetes is characterized as the product of bad lifestyle choices then it is hard to advance the case for intervention at the societal level: people should just exercise personal responsibility and if they chose not to, they get what they deserve.

By way of comparison, imagine if Bittman had written an op-ed calling malaria and Guinea worm “lifestyle diseases.”  Technically, he would have been right: “they’re preventable, and you prevent them the same way you cause them: lifestyle.”  If you don’t want to get malaria, you should choose to live in an area of the world that doesn’t have malaria-carrying mosquitoes or you should choose to never venture out of your air conditioned home.  If you don’t want to get Guinea worm, you should only drink water that has been piped from fresh sources.   Change you lifestyle and you can greatly reduce your likelihood of getting these debilitating diseases.

But, of course, that frame is misleading and problematic.  Many of the people who suffer from malaria and Guinea worm have no meaningful control over their situations — they are trapped in communities where clean water and mosquito nets are in short supply.

Could the same be said for many obese people in the United States who suffer from heart disease and diabetes?

Don’t they, too, face significant situational constraints?  And if we actually want to reduce the incidence of obesity-related diseases shouldn’t we acknowledge that fact?

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One Response to “The Power of Word Choice: “Lifestyle” Diseases”

  1. dj said

    I believe you’re wrong on this one. This is where the situationist/ social psychological perspective goes completely off base. It’s not a good comparison to make – comparing bad food choices by low SES Americans to poor Africans who can’t avoid malaria or guinea worm. ( i realize I’m reading between the lines here – you haven’t actually mentioned SES by name, but I’m assuming that’s what you mean when you said, ‘… they are trapped in communities where clean water and mosquito nets are in short supply.Could the same be said for many obese people in the United States who suffer from heart disease and diabetes?” If you’re not referring to poor communities in the US, then please correct me.)

    As you mention, Mosquitos nets and clean drinking water are simply not available for many poor Africans, and they clearly can’t just pick up and move. I’m sure your heart is in the right place, but your argument does a real disservice to poor Africans, whose daily struggles far surpass what poor Americans experience.

    I live in an urban area and can walk one block to the deli and buy myself a cucumber for .79, an apple for .60 and some cottage cheese, low fat, for about 2.29. This is a pretty filling meal and comes in under $4. Or I could walk one block in the other direction and spend about the same amount of money at McDonalds. This same choice is available to most anyone in the city in which I live.
    By suggesting that personal choice isn’t the real problem, you’re failing to acknowledge all of those people, and many of them are poor, who are concerned with their health and don’t eat at McDonalds. How do they do it? How do they resist the lure of cheap, high fat junk food? They make a choice not to. I don’t know how much time you’ve spent with low SES folks, but they’re not all fat and they don’t all subsist exclusively on burgers and fries.

    Social psychological arguments display their political stripes very openly and unabashedly in arguments like yours. Blame the obesity epidemic on society and encourage government to regulate fast food out of existence, then we’ll finally see a return to healthy eating, yeah? How about rather than regulate fast food out of existence, we start by acknowledging that there are those who do make healthy choices, figure out why they’re able to do so, and others aren’t, and try to create incentives that would motivate people to make different decisions? I think that’s a more productive place to start.

    Personally, I detest fast food restaurants and everything they represent. And I’m in favor of pressuring them to provide healthier alternatives or list the nutritional content of their food items. But change isn’t going to come by regulating them out of existence. Their lobbying power is far too strong for that to work. We need to be focused on getting individuals to change their behavior, somehow incentivizing them to make better choices, rather than punishing those who choose wisely by blaming society.

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