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WHO IS RESPONSIBLE FOR OBESITY: THE INDIVIDUAL OR THE POPULATION?

Simon says, at home he eats what they give him. Enrique says, what he eats is his responsibility.

Simon suffers from that kind of mixture of bad habits and a body that is not able to cope, what many call metabolic syndrome. Enrique has that athletic build that he loves so much today, he has chosen to overcome his limitations.


What do you think, is Simon guilty of his condition or is Enrique an exceptional case? Think about it for a few seconds, or as long as you need.
Now, reformulate it.


Simon says, they live as they can in their house. Enrique says, there is work for whoever is looking for it. Simon suffers from that kind of mixture of laziness and lack of specific knowledge for the working world, what many call a long-term unemployed. Enrique has a good job thanks to his hard work in his studies and the scholarships he has obtained, he has chosen to overcome his limitations.


What do you think, is Simon guilty of his condition or is Enrique an exceptional case? Think about it for a few seconds, or as long as you need.
Now, compare your answers.


Have you answered the same to the two questions? Well great. Whatever your question is, you are consistent with your thoughts. If not, rethink it. Rethink why you think differently in two similar cases. Do you think they are not dichotomous questions? Very well, you have not fallen for my plot fallacy. Forgive me the dramatic appeal!
Is Simon to blame for being unable to resist the extra-large hook-and-win?
Have you ever driven drunk? Surely you’re tired of being told on television how dangerous it is to drive drunk, to be told that a drunk person is five times more likely to be involved in an accident, or what is to say, between a 30 and a 50% of accidents were related to alcohol. Despite this, it is likely that you have ever driven with a cup more than the account or have gone in a car whose driver would have tested positive in the blood alcohol test. And most likely, here you are, reading me without having suffered an accident (I hope!).


What happen? For the individual a 5 times greater probability is not so much. Some 6000 people have died or been hospitalized due to an accident on interurban roads ( source ) in Spain. We divide it by days of the year and people of our country and we have every day a 0.00004% chance of having a scare really with the car, 0.0002% if we go drunk. The numbers look much smaller like that, right? Being strict, the probability of suffering an accident is low in both cases, for the individual it does not seem so dangerous to drive a day having drunk. Now, if we calculate the probability of suffering an accident during 40 years of driving, either yourself or someone close to those 30 people that we would consider from our inner circle … The numbers become more real and coincide with the experience of that practically everyone knows someone who has had a traffic accident who has had to receive hospitalization or even death.


To me, as an individual, it is most likely that taking the car having drunk three glasses of wine will not take me to the hospital, the famous go, nothing will happen!”. But if we increase the sampling time and the number of people, we see figures that are very scary. That’s why we say “if you drink, do not drive”.


Statistics speak of collectives, not individuals . It’s that easy. Talking about obesity or the percentage of unemployment in Spain helps us explain whether or not there is a structural problem. The fact that there are countries with greater unemployment or obesity than others, indicates the institutional functioning when dealing with these problems. In the case of unemployment are the policies of stimulation of employment, investment and thousands of factors that I will not entertain to explain here. In the case of obesity are the lack of public health policies, the food industry and thousands of factors that I will not entertain to explain here.


Enrique is indeed an exceptional case. It is that person who, in spite of the structural problems, has been able to find his place or health. Simon really is not to blame for behaving like an individual above average. Or rather, about the collective we will see Enriques who will be the exceptional ones who have overcome adversity and many Simons who create the bulk of people. The problem that the average collective health is higher or lower on an imaginary scale is a structural issue. Neither people with obesity have a problem of will nor the unemployed a problem of lack of laziness.


When we talk about the collective and the obesogenic environment, which explains the public health problem, and we focus on specific individuals, things change. Moreover, it must change by pure statistical logic. Popular imagery and cinema are full of cases of people who have endured adverse situations and have overcome them against all odds, we have all seen some show of liberal moral fulfillment of the American dream , that Rocky enduring fifteen rounds of combat to Apollo Creed or that Mark Zukerberg creating Facebook during his college years.


We who disclose in health have to be careful in our words, because it is not the same to encourage everyone to fulfill their great dream than to accuse those who the circumstances do not allow them to fulfill it. Precisely, fulfilling dreams is not easy and it is likely that in general the Simons will experience more hunger or anxiety than the Enriques of this world.
That we can not all be Rocky, does not imply that we can not try, but that it exempts us from guilt for not reaching it.
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