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Social Determinants of Health

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From:
Diana Liw <[log in to unmask]>
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Social Determinants of Health <[log in to unmask]>
Date:
Thu, 26 Jul 2007 07:45:52 -0700
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I don't get what all the fuss is about.  Isn't this the age long issue of "peer pressure"?

>>> Dennis Raphael <[log in to unmask]> 07/26/07 6:51 AM >>>
Are your friends making you fat? 
ANDRE PICARD 

From Thursday's Globe and Mail


July 26, 2007 at 8:43 AM EDT

When, a few years back, scientists and public health officials began using 
the expression "obesity epidemic," it was controversial.

The term epidemic was traditionally used to describe the rapid spread of 
infectious diseases such as influenza or polio. But the argument was made 
that the term could be used in a non-biological sense to refer to 
widespread and growing social problems.

Now comes word that obesity actually is contagious. Fat is not caused by a 
virus, bacterium or other pathogen. Rather, it spreads to the waists, 
thighs and other jiggly regions of the body through social networks.

In a fascinating article in today's New England Journal of Medicine, 
researchers at Harvard University and the University of California, San 
Diego, show that if a close friend becomes obese, your likelihood of 
becoming obese soars by 171 per cent. If it's a casual friend or 
acquaintance, the risk is still a notable 57 per cent, and your friend's 
friends have a similarly increased risk of obesity.


Enlarge Image 
Are your friends making you fat? This is a social network map of 2,200 
people who took part in a major study on obesity. Click on the link below 
to see an animated and narrated version of this graphic. 

Internet Links
Animated Graphic: Social network map 
 By comparison, having an obese sibling increases your risk 40 per cent, 
and an obese spouse ups your risk 37 per cent. All these risk calculations 
are done over a long period, 32 years.

The catchy, headline-grabbing interpretation of this study is: Your 
friends make you fat.

But there is a less sensational and more important point that should be 
retained.

"These findings reinforce the idea that obesity is not just an individual 
problem, but a collective problem," Nicholas Christakis, a professor of 
medical sociology at Harvard Medical School in Boston, told a media 
teleconference.

It's not that people who are overweight or obese seek each other out, but 
rather that friends are growing fatter together.

"What appears to be happening is that a person becoming obese most likely 
causes a change of norms about what counts as an appropriate body size. 
People come to think that it is okay to be bigger, since those around them 
are bigger, and this sensibility spreads," Dr. Christakis said.

The results of this type of thinking are visible in the streets and 
striking in the statistics.

In the United States, 66 per cent of adults are now overweight, including 
33 per cent who are obese (meaning more than 30 per cent of their body 
weight consists of fat.) 

Americans aren't the only ones losing the battle of the bulge. In Canada, 
59 per cent of adults are overweight, including 23 per cent who are obese.

In other words, normal weight is not normal any more.

And what the new study tells us is that, no matter how unhealthy being 
obese can be (excess weight is a risk factor for diabetes, heart disease, 
stroke and some forms of cancer), we are able to rationalize excess 
poundage because it is the norm in our social circle.

Physiologically, gaining weight is easy to explain: If you ingest more 
calories than you burn, you gain weight. Do so routinely over a period of 
years and, like the majority of Canadians, you find yourself overweight.

But understanding why and what people eat - quantity and quality - and how 
active they are is far more complex.

Genetics come into play, but our genes alone do not explain why we need 
ever-larger jeans.

Far too often in dealing with health issues, particularly public health 
issues, we ignore or fail to recognize the importance of social factors.

This new study looked at the influence of friendship and the social 
environments we create for ourselves.

From a public health perspective, the information is valuable: It holds 
the promise that, if you get one person to deal with their weight, it will 
have a ripple effect on their social network of friends and family.

Of course, we know this intuitively. Anyone who has ever tried to 
undertake a diet or exercise regime knows that, without the support of 
friends and family, it is impossible to maintain the lifestyle change. But 
the research demonstrates just how powerful these influences can be.

Bear in mind, however, that the new study is derived from the famed 
Framingham Heart Study, a research project that has been tracking the 
health of residents of a Massachusetts town since 1948.

The study has provided a gold mine of information, but its one weakness is 
the lack of racial and socio-economic diversity of its participants.

Friendship no doubt has an important influence on a person's weight, but 
it probably pales in comparison to matters over which individuals have far 
less control: income, housing, education, job security, food security and 
a sense of belonging.

It is no coincidence that rates of overweight and obesity are 
significantly higher among the poor and disenfranchised.

Socio-economic factors - not social networking - are fuelling a large part 
of the obesity epidemic.

You can't just blame the company people keep. You have to look at the 
society they live in.

That truly is a collective, not an individual, problem.

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