Are Americans ready to solve the weight of the nation?

n engl j med 367;5 nejm.org august 2, 2012 389 of adults and nearly one third of children in the United States are overweight or obese, and many public health experts are worried that we are not solving the prob­ lem quickly enough. This concern prompted the re­ cent Institute of Medicine (IOM) report, “Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation.” The groundbreaking report and ac­ companying HBO documentary, “The Weight of the Nation,” pre­ sent a forceful case that the obe­ sity epidemic has been driven by structural changes in our environ­ ment, rather than embrace the reductionist view that the cause is poor decision making by indi­ viduals. The report articulates a bold vision of accelerating change through a multifaceted systems approach and “shared responsibil­ ity across sectors and levels.” How do the IOM’s expansive recommendations square with the American public’s current views? Here, opinion data can be infor­ mative both for quantifying the gap between public attitudes about obesity and the IOM’s pre­ scription for change and for de­ veloping strategies to bridge that gap. For example, the report de­ tails accumulating evidence that the obesity epidemic has been driven by a complex interaction of changing factors in several critical environments — our schools, workplaces, communities, media, and food and beverage systems — rather than by indi­ vidual choices. However, public opinion studies consistently find that this view is not widely em­ braced. Only 18% of Americans identify external factors (exposure to junk food, lack of safe places for children to play, and limited availability of healthy foods in some neighborhoods) as the big­ gest causes of childhood obesity, whereas 64% identify personal factors (overeating, lack of exer­ cise, and watching too much tele­ vision) as the biggest causes.1 Public perceptions about how to solve the problem of obesity reveal a similar individual­oriented locus of responsibility, posing further obstacles to collective ac­ tion. Data from a 2011 national poll suggest how widely American opinions vary on the subject of multisector responsibility. On a 7­point scale, where 1 is “not at all responsible” and 7 is “com­ pletely responsible,” the idea that addressing the weight problems of obese children is “a joint re­ sponsibility for all of us in soci­ ety” averaged 4.33 (see graph). These views varied according to respondents’ political ideology, Are Americans Ready to Solve the Weight of the Nation?