Two new reports  from the Centers for Disease Control and Prevention (CDC), published in the Journal of the American Medical Association (JAMA), show that the rate of obesity in the United States has risen yet again. From 2013-2014, about 35% of men and 40% of women were obese. The obesity epidemic is now three decades old, and the Trust for America’s Health and the CDC both project rates over 42% by 2030. 
Reversing this epidemic has long been a “best-bet” approach to achieving health and well-being at the population level, since obesity is a leading cause of early, preventable death from diabetes, heart disease, and other chronic illnesses. And at first glance, obesity seems easy to tackle through diet and exercise.
Unfortunately, it has not been easy, and not for lack of trying. In an editorial accompanying the two JAMA reports, the journal’s editors write,
“Numerous foundations, industries, professional societies, and governmental agencies have provided hundreds of millions of dollars in funding to support basic science research in obesity, clinical trials and observational studies, development of new drugs and devices, and hospital and community programs to help stem the tide of the obesity epidemic.”
Our own organization has worked with communities across the country for 14 years on policy, systems, and environmental change strategies to increase safe opportunities for physical activity and affordable access to healthy food. Organizations nationwide have launched myriad programs and promotional campaigns. And all of us have been collectively educated to tedium about the importance of diet and exercise.
While there’s no way to know how much worse the epidemic would be without all our hard work, we can’t declare success. That’s clear.
A deeper dive into the CDC data reveals disparities across gender, race, age, and educational attainment. The starkest disparities fall along racial lines, and the people with the highest rates of obesity are also those who struggle most against concentrated poverty, low educational attainment rates, unsafe neighborhoods, institutionalized racism, and other disparities across all the social determinants of health. These disparities suggest that the forces at play are larger than individuals’ choices around diet and exercise, and that even providing improved environments for healthy eating and physical activity doesn’t go far enough. The growing movement around a culture of health acknowledges that obesity is symptomatic of much more complex problems within our society.
Medical treatments for obesity will not create large-scale, transformational change. The JAMA editorial calls for prevention—prevention efforts that encompass entire families. The authors note,
“… even motivated parents may have trouble feeding their families nutritious food. Low-income neighborhoods often lack grocery stores. Balancing work, family, and other obligations means few parents have time to prepare meals at home regularly.”
Most obesity-prevention efforts to date have neglected the basic, daily realities that people face. American culture—and increasingly, global culture—is pushing us beyond our natural, healthy limits. We face a stream of anxiety, insecurity, fear, anger, loss, guilt, shame, and confusion about what’s wrong with us and what to do about it. Too many isolated individuals and families, seeking a more stable physical, social, and economic foundation, are working harder, risking more (often by taking on unsupportable debt), or losing hope and giving up. At that point, being overweight can seem like the least of it: just another thing to deal with in a sea of things afflicting our spirits and their lives. One of the clearest critiques of our culture is that this is happening in the midst of more resources than we’ve ever had.
Where does that take us, and our work?
First, we know (and the CDC data further underscores) that there are gross inequities in who bears the burden of obesity in the U.S. This highlights the importance of equity as an essential practice in healthy communities work.
Second, we need to continue to find and disseminate what works by sharing stories of success and lessons learned. There are encouraging signs of progress as many communities are seeing declining rates of childhood obesity. There are bright spots across the country where place-based investments have created an entire cultural shift around health and wellbeing. The creative solutions we need will come from communities who know their own context, and who leveraged their strengths and assets. There will not be a one-size-fits-all or silver-bullet solution to the obesity epidemic. We need to continue to build capacity in all communities, helping them find context-appropriate solutions to this problem.
Finally, there are countless benefits to investing in healthy communities beyond changes in BMI—like improved mental and physical wellbeing from an active lifestyle and healthier eating, better school performance and learning among children, safer neighborhoods, economic benefits, and increased social cohesion and awareness, to name a few.
The solution to obesity will come when we turn toward the solution to virtually all our wicked problems: collaboration, connection, and community.