Book Review: A Big Fat Crisis: The Hidden Forces Behind the Obesity Epidemic – and How We Can End It

Nearly half of Americans are overweight or obese, and the numbers are only getting worse. Dr. Deborah Cohen is not the first author to point out this growing health problem, but she does offer a unique take on the subject, and one that is both comforting and disturbing. In “A Big Fat Crisis: The Hidden Forces Behind the Obesity Epidemic – and How We Can End It,” the noted epidemiologist, medical doctor and RAND Corporation researcher does not berate people for overeating. Instead, she offers them a sympathetic shoulder, and some relief from the guilt they are feeling or have been made to feel for being fat. 

Dr. Cohen presents what is basically a conspiracy theory about a plot by greedy companies to get rich by pushing products they know are bad for people. While she does coddle her readers, she does it with the best of intent. Dr. Cohen seeks to help people in their battle with obesity by letting them know that it is not their fault – or at least not their fault alone – that they are overweight. 

“It's not your fault” if you're overweight

While acknowledging that people are responsible for their own actions, Cohen offers her readers the comforting thought that when it comes to being fat, “it's not your fault.” That statement is not only the title of the first chapter, but also the theme of the first third of the book. Dr. Cohen argues that the deck is stacked against people these days, as not only is food more plentiful, more easily available and more affordable than ever before in history (at least in America and other parts of the industrialized world), but much of it is also less healthy. 

Companies make, market and push high-calorie foods that are addictive and fattening. Fast-food joints and snack food makers are not the only culprits, says Cohen. Even some of the best restaurants compete for customers by offering all-you-can-eat buffets and unhealthily oversized portions of foods that are high in fat and calories. The human brain, she says, is simply “overwhelmed” by such a cornucopia of food, and is so bombarded with advertising and choices that many people are pushed beyond “the limits of self-control.”

We live in a “food swamp”

In most of America at least, food is “abundant and cheap.” Unfortunately, a lot of that “abundant and cheap” food is not necessarily good, healthy food. Many nutrition experts lament that large parts of the country are “food deserts,” where although people may have access to food, they do not have places nearby in which to purchase fruits, vegetables and other healthy foods. Instead, they fill their shopping carts and tummies with foods that are poor in nutritional value. Dr. Cohen says this is not a “food desert,” but is instead a “food swamp.” By that she means that the “food environment” in which Americans live is tainted, even toxic, and for that she blames the companies that make the food, the companies that advertise it, the restaurants and stores that sell it – and the government for letting them all get away with it.

“We are all in this together” - and together we can make a change

Dr. Cohen's book presents the problem, points out who is to blame for causing it and making it worse, and then offers a proposed solution to what she calls this “big fat crisis.” As someone who has made her career in tracking and treating public health issues, Dr. Cohen tends to look at the big picture, and believes that the government can and must play a big role in fighting what she sees as an epidemic. 

In her book, she makes the case for more and better regulations, which she believes are needed to change how food is made, marketed and served. Dr. Cohen proposes that companies and restaurants should be required to provide better and more comprehensive information about the contents of their products, and even required to have warning labels similar to those on cigarette packs for those foods that present a health risk. Dr. Cohen also supports legal guidelines to control the portions of food which are served in restaurants, much like the limits already in place on the amounts of alcohol a restaurant or bar is allowed to serve. She also urges restrictions be placed on what she calls “impulse marketing” - such as limiting or banning the placement of candy bars and other high-calorie foods at checkout counters.

People make bad choices – and need help to make better ones 

Cohen's conspiracy theory aside, she admits that people make bad choices and need to make better ones. People are “hardwired” to overeat, she admits, and human nature leads people to eat more of what tastes good, even if it is not good for them. Government intervention will not change this, and when it comes to fighting this epidemic of obesity government action can not do it all, admits Cohen. People have to become better educated and more responsible, exercise more and learn to change the way they eat, but to do so, writes Cohen, they need help, because right now the deck is stacked against them.