HBO’s Weight of the Nation: Society, not individual, to blame

By Deborah Kotz, Globe Staff

Obesity, once seen as a failure of personal responsibility and lack of willpower, has been repackaged in a four-part HBO documentary airing tonight through Thursday as a complicated phenomenon that’s largely resulting from societal pressures that make it far easier for us to commute by car rather than by bike and to eat McDonald’s rather than steamed vegetables with tofu.

We’re told that 60 to 70 percent of the risk for becoming obese lies in genes inherited from our parents but that these genes don’t act in a vacuum; how they’re expressed depends on environmental factors like exercise and our daily diet.

“There’s no nature versus nurture,” said Dr. David Altshuler, director of the Broad Institute’s Program in Medical and Population Genetics in the first part of the documentary. “There’s nature and nurture.”

It almost seems like HBO is trying to let us off the hook for becoming overweight, by implying that we should blame our government, schools, food manufacturers, and farmers for setting us up for failure. That might partially be the case, but an underlying message that could be interpreted from this documentary is that if overweight individuals are absolved of responsibility, then they have to wait for someone else to do something about it.

Weight of the Nation does, though, sound a powerful call to action -- especially when warning about the future of overweight children.

“The evidence is incontrovertible that children who are obese are at greater risk for diabetes, later hypertension and heart disease, and a variety of other health problems,” said Dr. Jack Shonkoff, director of Harvard’s Center on the Developing Child, in a part of the documentary devoted to childhood obesity.

And National Institutes of Health director Dr. Francis Collins tells parents that they need to pay attention when a pediatrician deems their child to be at increased obesity risk in the same manner that they would treat an impending cancer diagnosis.

But we see firsthand just how frustrating it can be to try to turn the tides once a child becomes overweight. Families who participated in the documentary -- including one from Dorchester -- allowed cameras to track them through visits to pediatric weight clinics, exercise programs, family meals, and endless conversations with doctors about how to fix the problem.

In heart-breaking moments, children spoke about being teased and bullied by their slimmer peers. “These girls, they call me fat, they call me ugly,” said 8-year-old Tiarra Francis from Dorchester. “That’s rude and sad to me.”

In certain Boston communities like Roxbury, Dorchester, and Mattapan, more than half of children are overweight or obese, which is much higher than the national average. Dr. Elsie Taveras, a pediatrician and obesity researcher who treated Francis at her Children’s Hospital Boston clinic, told me that the advice she doles out to her patients can be very difficult for them to follow after they head back home.

“Families go back to a setting that doesn’t support exercise and good nutrition,” said Taveras. “Playgrounds are in chaotic shape; parents and kids are bombarded with advertising that tells them what I’m saying is wrong. This powerful environment becomes the default.”

She firmly believes these factors are driving the obesity crisis. After all, parents in previous generations never made a concerted effort to get their kids to exercise or eat fresh fruit, yet only a small percentage of kids was overweight.

“If this was just a parenting responsibility,” said Taveras, “we would not be where we are today.”

Still, she searches for solutions that are within families’ control, advising Tiarra’s parents in documentary footage to remove the TV from her bedroom. As Taveras explained, TV isn’t just a sedentary activity, it exposes children “to pretty toxic advertising -- sugary beverages, high sugar cereals -- and it’s really through content of this advertising that TV might be associated with weight gain in children.”

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.