Obesity is a product of capitalism

Obesity is a major health crisis. The World Health Organization estimates that one in eight people globally are obese (defined as abnormal or excessive fat accumulation that presents a risk to health, indicated by a body mass index above 30). In Australia, one in three adults do. Among children, the prevalence of obesity worldwide has grown from less than 1 percent in 1975 to around 7 percent in 2016. Obesity increases the risk of multiple health conditions, including arthritis, hypertension and type 2 diabetes (which in turn increases the risk of heart attacks, strokes, blindness, amputation and organ failure).

People with overweight and obesity, along with those who naturally have larger bodies, also suffer from a horrible stigma. This affects many aspects of people’s lives, from the quality of medical care someone receives to their likelihood of getting a job. Women particularly are subject to this stigma, which can lead to eating disorders, mental health conditions, substance abuse and a range of metabolic complications from the associated stress.

The stigma of obesity prevails in part because the long-standing and widespread explanation for obesity is that it is a disease of choice—people who develop obesity are weak willed, lazy, have no self-control and so on—so it’s okay to shame them for it. A person’s weight, according to this view, is the direct result of individual choices which are in turn the product of their underlying character, with little regard for the context in which these choices are made.

But that explanation is illogical. The worldwide prevalence of obesity didn’t double in the last three decades, and there wasn’t an explosion in obesity from the 1960s and 1970s across most industrialised countries, because an extra billion people suddenly became weak-willed, lazy and lacking in self-control. This explanation also can’t account for why the prevalence of overweight and obesity is highly dependent on occupation, income or geographical location. Any coherent explanation of the prevalence of obesity must be able to account for these facts.

What is needed to address this public health crisis meaningfully is an understanding of obesity that takes into account the social conditions in which people exist and their role in shaping the health and weight of the population and in curtailing the choices available to individuals. Specifically, an understanding of how capitalism and the market puts profit ahead of human health and wellbeing.

It is telling that overweight and obesity are rare in the few remaining pockets of human society that are relatively untouched by capitalism. For example, a study in the medical journal Obesity of the Tsimane’ of Bolivia—a population that predominantly lives a pre-industrial gatherer-hunter lifestyle but is increasingly coming into contact with industrial society—showed that the prevalence of obesity was only 2 percent among women in 2002, but that steadily increased to 9 percent in 2010 with the increasing consumption of market-based foods.

Disparities in who develops obesity within high-income capitalist countries also tell us something about the factors underpinning body size and health. This is helped by an increasing focus by researchers on the social conditions that shape health—not just in relation to the more “obvious” occupational examples like silicosis in stonemasons, mesothelioma in construction workers and carpal tunnel among office workers—but also in causing what are usually thought of as lifestyle diseases like obesity, diabetes and cardiovascular disease.

These social conditions are usually referred to as social determinants of health. They include not only directly health-related aspects like access to affordable health care, but also virtually every other aspect of people’s lives: their work (or lack thereof); their income or wealth; the environment in which they were raised; whether they experience oppression; the amenity of their neighbourhood; and others.

These social determinants of health have been shown to be associated with “lifestyle” diseases, including obesity.

And all of them have a socially patterned gradient—that is, they’re almost all worse for poor and oppressed people or worse in poorer areas in high income countries. It’s not surprising, then, that obesity (and health in general) shows a socioeconomic gradient: poorer people experience greater levels of obesity than wealthier people (along with diabetes, cardiovascular disease, shortened life expectancy).

The disparity is stark. According to the Australian Institute of Health and Welfare, the percentage of adults living with obesity in 2022 in Australia was 38 percent in the most disadvantaged areas, compared to 25 percent in the least disadvantaged areas. It’s worse for children, with the percentage of obesity in children three times higher in the most disadvantaged areas (15 percent) than the least disadvantaged areas (5 percent).

For decades, the fact that poorer people had higher rates of obesity was, like obesity in general, just chalked up to the idea that poorer people had less self-control and so they ate more junk food and exercised less. Again, the official explanation on offer was basically that it was their fault they were overweight.

No thought was really given as to whether it was plausible that self-control and the desire to exercise neatly sorted itself along class lines. So it has been a step forward in logical thinking that there is now an acknowledgement among some of the academy of the much more credible explanation for the correlation between disadvantage and obesity—that social conditions are to blame.

Of course, correlation and causation are two different things. But there’s strong evidence for causality in the relationship between social factors and obesity.

For example, a randomised clinical trial (a type of study design that can determine causality) published in the New England Journal of Medicine in 2011 showed that when people in the US were randomised to either remain in a high-poverty neighbourhood or given a voucher to move to a low-poverty neighbourhood, those that were randomised to the low-poverty neighbourhood had a lower prevalence of obesity (and diabetes) at the end of the study.

This study essentially proved that living in poor areas causes obesity, and that something as simple as offering people a housing voucher to move out of their poor area can cure it. Because people were assigned to poor or rich areas completely at random, and not on the basis of their income or wealth as they usually are, it shows that it was the social conditions they lived in that were causing their weight gain. This debunks the idea that poor people have less self-control or “deserve” their obesity, as well as the “weak will” argument for obesity in general.

So, what is it about the social conditions that people live in that causes obesity? Is it an increase in energy in or a decrease in energy out?

Decreases in exercise are unlikely to be a major driver, for a few reasons. First, exercise in high income countries over the past two decades has actually increased while the prevalence of obesity continues to rise. Second, the mechanisation of production (and consequent decrease in more active, hard labour) in high income countries, like the US, preceded the explosion in obesity by decades. Third, a broad range of countries with massively different levels of sedentary labour and exercise levels underwent the same explosion in obesity starting in the 1960s and 1970s.

So while exercise obviously can lead to weight loss and does explain some of the variability between individuals in their propensity towards obesity, on its own it can’t explain the obesity epidemic.

That leaves food. Under capitalism, we have a market-based food system—the food people consume is the food that they purchase in a competitive marketplace, meaning the choice of food consumption for an individual is determined by factors of the foods like taste and nutritional content, but also extra-food factors like affordability, food marketing, accessibility and preparation time.

The food companies compete with each other to sell as much food as possible to make as much profit as possible. This creates an incentive for food companies to create, market and sell foods that are as cheap as possible to manufacture while also being highly palatable and easy to prepare and consume. That means foods high in calories, salt, sugar and fat – a proliferation of typical convenience and junk foods, like premade freezer meals, cereal, chips, lollies, ice cream and so on.

These foods have a long shelf life, are easy to prepare and are usually cheap, making them attractive options for busy, working-class people. They’re also more aggressively marketed than healthier foods, further distorting people’s food choices.

But it’s not just junk food that has changed. The competitive drive to increase food sales through improved palatability and extended shelf lives also leads to a perversion of foods typically considered “healthy”. For example, most yoghurts have tonnes of added sugar, a bowl of corn flakes has a similar amount of sodium as a small chips from McDonald’s, and Subway’s bread has so much sugar in it that Ireland’s Supreme Court ruled that it could not be legally defined as bread.

While improving taste, extending shelf life and/or lowering production costs (and thus, increasing profits), changes of this type make foods far less healthy and satiating, leading to overconsumption and obesity.

Arguably the most important study on the obesogenic effect of highly processed foods was published in 2021 in the journal Cell Metabolism. This study was a randomised controlled trial conducted in a metabolic ward – a place where all food consumption is tightly controlled and measured. The study randomised participants to either a diet consisting of highly processed foods or a diet consisting of unprocessed foods for 2 weeks, with both diets matched for total calories, energy density and macronutrients. Participants could eat as much or as little as they wanted on each diet.

The results were that energy intake was 500 calories greater per person per day on the processed diet compared to the unprocessed diet, with the same levels of reported fullness and satisfaction as the unprocessed diet, and with the excess calories all derived from carbohydrates and fats. This led the participants to gain 1kg during the 2 weeks on the ultra-processed food diet, while on the unprocessed food diet the subjects lost 1kg.

It’s also worth noting that the unprocessed food diet in this study was about 50 percent more expensive, and the authors acknowledged that preparing the unprocessed meals takes extra “time, skill, expense, and effort ... resources that are often in short supply for those who are not members of the upper socioeconomic classes”.

So processed foods have clearly been engineered (consciously or not) to subvert the body’s natural fullness signals and drive higher food intake (which in turn, causes more sales and more profits). It’s no wonder then, that major food companies manufacture and market them aggressively, including to children.

Indeed, increasing consumption of highly processed foods is the most plausible explanation for the obesity epidemic: consumption of highly processed carbohydrates and fats took off from the early 1970s, paralleling the rise in obesity, and people in more disadvantaged areas eat more processed foods.

Highly processed foods now dominate the food supplies in high-income countries, and their consumption is rapidly increasing in other countries as multinational food corporations penetrate their food systems.

What can we do about this?

The fact that highly engineered, palatable, cheap and marketed foods are the main driver of the obesity epidemic is becoming increasingly recognised among leading researchers in the field. However, the solutions they offer are inadequate because they don’t address the root cause of obesity, which is the organisation of food production to make profit—in other words, capitalism.

The first solution on offer for obesity is weight-loss drugs, like semaglutide (ozempic). These work (and they do work) by injecting molecules that mimic the “fullness” hormones the body naturally produces.

Besides the fact that these drugs are expensive and not distributed equitably, using medications to fix obesity would just be a band-aid solution; it doesn’t address the underlying problem: a food system that harms people.

The other solution on offer is regulation, which is what many leading academics see as the answer.

For example, a review by Boyd Swinburn and colleagues, published in the Lancet with the aim of changing policy via the UN, states: “The obvious possible drivers of the [obesity] epidemic are in the food system: the increased supply of cheap, palatable, energy-dense foods ... and more persuasive and pervasive food marketing”. The authors also recognise that obesity and the obesogenic environment arise because of the economic situation, arguing for example: “obesity is the result of people responding normally to the obesogenic environments they find themselves in” and “obesogenic environments arise because businesses and governments are responding normally to the broader economic and political environments that they find themselves in”. They conclude: “The technological changes that are creating cheaper and more available food calories and the strong economic forces driving consumption will inevitably lead to overconsumption and obesity”.

So, without using the words, they recognise that competition and the profit motive inherent to capitalism inevitably lead to obesity. They go on to acknowledge the difficulty of changing this: “The pressure for market liberalisation means that regulatory approaches, although feasible, are difficult to achieve”. Nevertheless, the authors then recommend policy-based solutions to the obesity epidemic, implying that if all the policy makers just listened to reason, they could take on the major food companies and fix the obesity epidemic.

A similar approach, but one more directed at capital, is adopted in another influential review, by Moodie and colleagues, also published in the Lancet, who at least recognise that “the purpose of corporations is to maximise profits” and “[ultra-processed food and drink] products are more profitable than less-energy-dense, nutrient-rich foods”.

They argue against self-regulation by the food industry as a corrective, pointing out that “even if some progressive [sic] food and alcohol companies use healthier approaches, the gap in the market would be filled by others”. Nevertheless, while they state that “unhealthy commodity industries should have no role in the formation of national or international policy”, the authors end up arguing that “regulation, or the threat of government regulation, is the only way to change transnational corporations”, again looking to government regulation of the food system as the solution to the obesity epidemic.

This appeal to government policy to regulate the obesity epidemic is representative of the approach of many of the academics in the field, who pretty much uniformly refuse to move beyond a capitalist framework when considering how to address the epidemic.

These proponents of regulation point to two major public health successes—the near-elimination of trans fats in foods in some countries, and the massive decline in smoking prevalence—as evidence that regulation can fix public health crises.

However, neither of these are applicable to the food system in general. Trans fats could be virtually eliminated because the foods that they were incorporated into can be easily made without them, so heavily regulating their use only marginally affects the profits of the food industry and doesn’t involve major changes in eating habits. And smoking is not essential for life like food, so it can in theory be taxed out of existence (even if those taxes are regressive and exacerbate poverty).

To apply either of these strategies to processed food would be impossible under capitalism. The scale of change needed to food production and consumption is so massive and would involve such an enormous blow to the practices and profits of the food industry that it is very unlikely any sort of regulation could achieve it even in theory, let alone be successfully implemented. And regulation alone wouldn’t be enough anyway—meaningful change would require a massive mobilisation of resources to produce healthy alternatives to ultra-processed food regardless of whether it was profitable, which is contrary to the logic of capitalism. Such a change would involve expropriation of the necessary resources from the capitalist class and therefore a challenge to their power, a process that would go well beyond regulation.

Of course, more regulation is necessary and desirable—the tax on sugar-sweetened beverages in Mexico that was implemented in 2014 is a good example—but policies like these have only a marginal effect on overall calorie intake so long as the rest of the food industry continues to operate as usual.

Food system-wide regulation would definitely be better, but the food industry will resist at every step of the way. Even with the more piecemeal regulations that have so far been considered, the industry is pushing back, using the same playbook that big tobacco did to delay the decline of smoking. This has included emphasising that obesity is about personal responsibility; funding major lobby groups (that are organised, politically powerful, and considered the main barrier to nutrition policy) to stifle regulation; funding sympathetic scientists to publish studies that deflect the blame for obesity away from their products; and using the same public relations firms as the tobacco companies did to run their public lobbying campaigns.

And because food itself can’t be outlawed, in addition to finding ways to subvert (or overturn) any regulations put in place, the food industry will create new foods that meet any technical criteria required by regulation while remaining addictive and toxic.

Even smoking (addiction to nicotine), the poster child public health success story, is not really something that regulation has defeated. It is true and good that smoking rates have declined, but the prevalence of vaping, which could end up being as bad as or worse than smoking according to a 2021 review in the medical journal Lung Cancer, has increased dramatically and could be set to take smoking’s place. The Australian National Drug Strategy Household Survey found that active users of e-cigarettes (vapes) almost tripled from 2.5 percent to 7 percent between 2019 and 2023 in Australia, with daily use rising to 9 percent among people aged 18-24 years, up from 2 percent in 2019. Ironically, many of the major investors in the largest vape companies are “big tobacco” who were supposedly defeated by regulation according to the regulation proponents.

The experience of major tobacco and food companies (not to mention the pharmaceutical industry, which knowingly created the opioid crisis) shows that if there is demand, capitalists will develop, market and sell products to meet that demand, regardless of how damaging to public health those products are. They will then fight any regulation with their massive army of lawyers, lobbyists and scientists. There is no ethical boundary they will not cross in pursuit of profits, and the capitalist class will use humanity’s ever increasing understanding of biology to become more and more effective at their abuse of our basic biological drives.

While the profit motive is left in place, regulation will fail. If solutions to the obesity epidemic don’t address the underlying problem—that the competitive accumulation of profits drives everything in society, which is a defining feature of capitalism—then the solutions will be just partial or temporary. Competition and the profit motive will always drive food companies to do whatever they can to sell more food.

Capitalism has succeeded in both creating an environment that causes obesity and directing the blame away from the system and onto individuals (just as with an individual carbon footprint). Regulation won’t be able to address this. The only way we can ever hope to tackle the obesity epidemic would be to rationally and democratically fix the food supply so that it meets people’s nutritional needs without driving them to consume more than they need. That would require a radically different society that isn’t centred on competition and profits.