Is it just me, or does the following quote horrify you?
“The unapologetically unhealthy restaurant . . . serves . . . 9,982-calorie ‘quadruple bypass burgers.’ (Patrons who are able to finish them are escorted to their cars in wheelchairs.) Customers who weigh over 350 pounds eat free.”
Surely You Jest
That quote comes from a recent Yahoo! News article announcing the death of a second unofficial spokesperson and regular patron of the Heart Attack Grill restaurant, a restaurant which literally lives up to its name (Heart Attack Grill Spokesman Dies of Apparent Heart Attack). Other patrons over the years have enjoyed various ‘medical emergencies while dining at the grill,’ including a man who suffered a heart attack “while eating a ‘triple bypass burger’.”
What, you mean I don’t have to pay extra for that?
Before I took this year to play in the writing world, a research path in pediatric obesity beckoned me, beginning with my public health degree’s capstone project. (Click here for abstract if curious.)
So indulge me in a bit of public health foreplay. I promise I’ll be gentle.
Whose Fault Is It?
When it comes to obesity, it’s easy to blame the individual.
If she ate less and exercised more, she wouldn’t be overweight.
Whoa. Not so fast. It’s not quite as simple as that.
The influences of any chronic condition, including obesity, nest within one another. In public health we refer to this as the Social Ecological Model.
- At the core of the model is the individual; let’s call him Joe.
- A social network of family, friends, and coworkers wrap their loving arms around Joe.
- Further snuggling this motley crew is the outside community, complete with its environmental evils (restaurants called the Heart Attack Grill) and environmental angels (parks, sidewalks, accessible gyms).
- Next up comes the institutional tier, where healthcare systems and organizations help influence Joe’s health outcomes at all three of the previous levels.
- And finally, formal policies help keep Joe in check, whether at the local, state, or federal level.
Think of the arrangement as a lovely set of nesting dolls. Or an ugly set, like this one my husband picked up in St. Petersburg, Russia.
In other words, it takes two to tango. Or in this case, five.
Come On, Carrie, That’s a Bunch of BS
Before you accuse me of making excuses for a person’s obesity, please know that I do understand it ultimately comes down to individual behavior. But arguing about that gets us nowhere. The fact is, many people choose not to or are unable to change their behaviors, and it’s easier to understand why when one considers this nesting doll model:
Bubba: “Hey Joe, come out to eat with us tonight.”
Joe: “Well, I should really make a healthy meal at home.”
Bubba: “Oh, come on, it’s 5-dollar off night at that Heart Attack place. What are you, a wuss?”
Joe: “Hey, who’re you calling a wuss? I’m in. But maybe we should walk there to get a little exercise.”
Bubba: “No can do. You know there aren’t any sidewalks on the busy road leading to the burger joint. The cars will smack us down like bowling pins.”
Joe: “Okay, I’ll drive then. But I have to get home early. I haven’t been feeling so good. My insurance sucks, so I’ve missed my check-ups. And they don’t cover my blood pressure meds, so I’ve only been taking half a pill.”
Bubba: “That stinks. There should be a law saying they have to cover those things.”
Dotty Dee, who’s been silent thus far: “They should make a law banning restaurants that serve 10,000-calorie burgers…”
I hope you get my point. Yes, as individuals we need to make good choices. But no, ‘society’ should not get off scot-free. Only when change happens at every layer of Mr. Rubin’s ugly little nesting dolls can positive outcomes occur.
Agree? Disagree? Scary restaurants you’ve visited? Just want to say ‘hi’?
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Carrie Rubin is a physician with a master’s degree in public health. She is the author of The Seneca Scourge, a medical thriller.