Dr. Valerie Taylor doesn’t believe that most people with a weight problem would say, “This is not my fault,” or, “This is because of McDonald’s.”

“Absolutely, they take responsibility,” says Taylor, an assistant professor in psychiatry and behavioural neuroscience at McMaster University in Hamilton, and director of the Canadian Obesity Network mental health program. Many people feel guilty about their weight, she says, “and they struggle to accept treatments like surgery because they really feel they should be able to control this problem themselves.”

The truth, she says, is that certain people are vulnerable to overeating, “and we have created an environment in which high-fat food is abundant.”

But is the solution more self-control? More regulation of the food industry? More social pressure?

Some say what is required is nothing less than a fundamental shift in social norms and the way we view food.

Like smoking in the 1970s, Dr. David Kessler says, there are no social boundaries when it comes to eating. It has become culturally acceptable to eat almost anywhere, and anytime - in a business meeting, in a classroom. “We have children who are eating almost constantly throughout the day.”

Even three meals a day are no longer enough. “Some restaurants have been as audacious as to advertise the fourth meal,” says Kessler, a former U.S. Food and Drug Administration commissioner who led the crusade for tougher tobacco laws in the ‘90s. Taco Bell markets a late-night menu called the Fourthmeal, “the meal between dinner and breakfast.”

“What the food industry did was to take fat, sugar and salt, put it on every corner, make it available 24/7, make it socially acceptable to eat any time,” Kessler says. “We’ve added the emotional gloss of advertisement, we’ve made the food into entertainment, and we’re living the consequences.

“What did we think was going to happen?”

Today in Canada, 61% of adults - 13.2 million Canadians - and 26% of children aged six to 19 (1.4 million) are overweight or obese. “Kids are probably not going to live as long as their parents do, because of weight,” Taylor says. Doctors are reporting a rise in the “super-obese,” people with a body mass index in the 50s and 60s, something that was unheard of a generation ago. A BMI - a measure of body fat based on weight and height - of 30 or more is considered obese.

In the fight against obesity, some are pushing for public policies, such as higher taxes on soft drinks. Studies suggest sugar-sweetened beverages - the single greatest source of added sugar in our diets - may also be the single biggest driver of the obesity epidemic, especially among children.

“There seems to be something special about calories when they get delivered in liquids,” says Kelly Brownell, co-founder and director of the Rudd Center for Food Policy and Obesity at Yale University. “The body doesn’t recognize them well, and there’s less compensation when people consume too much. Third is, they’re so heavily promoted, it’s ridiculous. And fourth, you’ve got this possibility of the sugar, especially coupled with caffeine, being addictive enough to be a problem.”

In a report published last year by the New England Journal of Medicine, Brownell and half a dozen other experts in nutrition, public health and economics, called for a penny-per-ounce tax on soft drinks and other sugared beverages.

Brownell says his group’s research shows a penny-per-ounce tax on sugary drinks would raise $150-billion over 10 years in the U.S. “That’s how high the consumption is.” A penny-per-ounce tax - which would add, roughly, 34 cents to the cost of a one litre bottle of pop in Canada - would lead to about a 23% reduction in consumption of those beverages, Brownell says, “which, in the United States, would mean the average person would go from drinking 50 gallons [per year], to 38.5,” Brownell says. “It’s not as if you’re forbidding people from having them. They’re still drinking 38.5 gallons.”

Taylor and others want tougher controls on the commercial diet industry, too. “People are desperate,” she says, “and they’ll spend huge amounts of money on these quick fix diets that promise losing 40 pounds in eight weeks through very unhealthy ways.

“We know that when people do that, most will rebound, and probably gain back more weight than they had lost,” she says. “Even trying to lose weight is contributing to obesity. We have a generation of people that are dieting themselves into obesity.”

What’s more, we live in a thin-obsessed culture still steeped in the idea that if people just try hard enough, they’ll get the body they want, that fat people, somehow, “do it to themselves.”

Doctors aren’t immune to those attitudes. “Health-care professionals are human beings, and human beings, we have this aversion to the big fat slob. Do you know why? Because we’re afraid we may end up like that if we lose control,” says Dr. Nicolas Christou, a professor of surgery at McGill University and director of the bariatric surgery program at the McGill University Health Centre.

“Almost all of us are fighting, one way or another, unless we’re anorexic, to maintain a weight down to a level we’re comfortable with. These people, when you see them, remind us of that failure.”

Understanding how we lose control in the first place could help people control their eating, Kessler says. In his book, The End of Overeating, Kessler describes watching people in restaurants “attack food with a special kind of gusto,” lifting their forks before having even swallowed their last bite, watching “as they reach across the table to spear a companion’s french fries or the last morsel of someone else’s dessert.”

“The easiest solution is to go live somewhere we’re not constantly bombarded with food cues and food is not available every 20 feet,” Kessler says in an interview. “But that’s unrealistic. The problem we face is the reality that, for the global food companies, their objective is growth, and growth means increased revenue, which translates into selling more foods and increasing the caloric burden of society - whether or not we need that food.”

Ultimately, he says, “The power rests with us.”

“Does the food industry need to change? Absolutely. Does government have a role? Without doubt,” he says. But in the end, he says, we need to take steps to protect ourselves from having our brains bombarded and activated by cues everywhere telling us to eat.

Sharon Kirkey, Canwest News Service