Since 1980, the obesity rate has doubled. But it’s not how much we’re eating—it’s what we’re eating.

Since 1980, the obesity rate has doubled in 73 countries and increased in 113 others. And in all that time, no nation has reduced its obesity rate. Not one.

The problem is that in America, like everywhere else, our institutions of public health have become so obsessed with body weight that they have overlooked what is really killing us: our food supply. Diet is the leading cause of death in the United States, responsible for more than five times the fatalities of gun violence and car accidents combined. But it’s not how much we’re eating—Americans actually consume fewer calories now than we did in 2003. It’s what we’re eating.

For more than a decade now, researchers have found that the quality of our food affects disease risk independently of its effect on weight. Fructose, for example, appears to damage insulin sensitivity and liver function more than other sweeteners with the same number of calories. People who eat nuts four times a week have 12 percent lower diabetes incidence and a 13 percent lower mortality rate regardless of their weight. All of our biological systems for regulating energy, hunger and satiety get thrown off by eating foods that are high in sugar, low in fiber and injected with additives. And which now, shockingly, make up 60 percent of the calories we eat.

Draining this poison from our trillion-dollar food system is not going to happen quickly or easily. Every link in the chain, from factory farms to school lunches, is dominated by a Mars or a Monsanto or a McDonald’s, each working tirelessly to lower its costs and raise its profits. But that’s still no reason to despair. There’s a lot we can do right now to improve fat people’s lives—to shift our focus for the first time from weight to health and from shame to support.

The place to start is at the doctor’s office. The central failure of the medical system when it comes to obesity is that it treats every patient exactly the same: If you’re fat, lose some weight. If you’re skinny, keep up the good work. Stephanie Sogg, a psychologist at the Mass General Weight Center, tells me she has clients who start eating compulsively after a sexual assault, others who starve themselves all day before bingeing on the commute home and others who eat 1,000 calories a day, work out five times a week and still insist that they’re fat because they “have no willpower.”

Acknowledging the infinite complexity of each person’s relationship to food, exercise and body image is at the center of her treatment, not a footnote to it. “Eighty percent of my patients cry in the first appointment,” Sogg says. “For something as emotional as weight, you have to listen for a long time before you give any advice. Telling someone, ‘Lay off the cheeseburgers’ is never going to work if you don’t know what those cheeseburgers are doing for them.”

The medical benefits of this approach—being nicer to her patients than they are to themselves, is how Sogg describes it—are unimpeachable. In 2017, the U.S. Preventive Services Task Force, the expert panel that decides which treatments should be offered for free under Obamacare, found that the decisive factor in obesity care was not the diet patients went on, but how much attention and support they received while they were on it. Participants who got more than 12 sessions with a dietician saw significant reductions in their rates of prediabetes and cardiovascular risk. Those who got less personalized care showed almost no improvement at all.

Still, despite the Task Force’s explicit recommendation of “intensive, multicomponent behavioral counseling” for higher-weight patients, the vast majority of insurance companies and state health care programs define this term to mean just a session or two—exactly the superficial approach that years of research says won’t work. “Health plans refuse to treat this as anything other than a personal problem,” says Chris Gallagher, a policy consultant at the Obesity Action Coalition.

The same scurvy-ish negligence shows up at every level of government. From marketing rules to antitrust regulations to international trade agreements, U.S. policy has created a food system that excels at producing flour, sugar, and oil but struggles to deliver nutrients at anywhere near the same scale. The United States spends $1.5 billion on nutrition research every year compared to around $60 billion on drug research. Just 4 percent of agricultural subsidies go to fruits and vegetables. No wonder that the healthiest foods can cost up to eight times more, calorie for calorie, than the unhealthiest—or that the gap gets wider every year.

It’s the same with exercise. The cardiovascular risks of sedentary lifestyles, suburban sprawl, and long commutes are well-documented. But rather than help mitigate these risks—and their disproportionate impact on the poor—our institutions have exacerbated them. Only 13 percent of American children walk or bike to school; once they arrive, less than a third of them will take part in a daily gym class. Among adults, the number of workers commuting more than 90 minutes each way grew by more than 15 percent from 2005 to 2016, a predictable outgrowth of America’s underinvestment in public transportation and over-investment in freeways, parking, and strip malls. For 40 years, as politicians have told us to eat more vegetables and take the stairs instead of the elevator, they have presided over a country where daily exercise has become a luxury and eating well has become extortionate.

The good news is that the best ideas for reversing these trends have already been tested. Many “failed” obesity interventions are, in fact, successful eat-healthier-and-exercise-more interventions. A review of 44 international studies found that school-based activity programs didn’t affect kids’ weight, but improved their athletic ability, tripled the amount of time they spent exercising and reduced their daily TV consumption by up to an hour. Another survey showed that two years of getting kids to exercise and eat better didn’t noticeably affect their size but did improve their math scores—an effect that was greater for black kids than white kids.

You see this in so much of the research: The most effective health interventions aren’t actually health interventions—they are policies that ease the hardship of poverty and free up time for movement and play and parenting. Developing countries with higher wages for women have lower obesity rates, and lives are transformed when healthy food is made cheaper. A pilot program in Massachusetts that gave food stamp recipients an extra 30 cents for every $1 they spent on healthy food increased fruit and vegetable consumption by 26 percent. Policies like this are unlikely to affect our weight. They are almost certain, however, to significantly improve our health.

Which brings us to the most hard-wired problem of all: Our shitty attitudes toward fat people. According to Patrick Corrigan, the editor of the journal Stigma and Health, even the most well-intentioned efforts to reduce stigma break down in the face of reality. In one study, researchers told 10- to 12-year-olds all the genetic and medical factors that contribute to obesity. Afterward, the kids could recite back the message they received—fat kids didn’t get that way by choice—but they still had the same negative attitudes about the bigger kids sitting next to them. A similar approach with fifth- and sixth-graders actually increased their intention of bullying their fat classmates. Celebrity representation, meanwhile, can result in what Corrigan calls the “Thurgood Marshall effect”: Instead of updating our stereotypes (maybe fat people aren’t so bad), we just see prominent minorities as isolated exceptions to them (well, he’s not like those other fat people).

What does work, Corrigan says, is for fat people to make it clear to everyone they interact with that their size is nothing to apologize for. “When you pity someone, you think they’re less effective, less competent, more hurt,” he says. “You don’t see them as capable. The only way to get rid of stigma is from power.”

This has always been the great hope of the fat-acceptance movement. (“We’re here, we’re spheres, get used to it” was one of the slogans in the 1990s.) But this radical message has long since been co-opted by clothing brands, diet companies, and soap corporations. Weight Watchers has rebranded as a “lifestyle program,” but still promises that its members can shrink their way to happiness. Mainstream apparel companies market themselves as “body positive” but refuse to make clothes that fit the plus-size models on their own billboards. Social media, too, has provided a platform for positive representations of fat people and formed communities that make it easier to find each other. But it has also contributed to an anodyne, narrow, Dr. Phil-approved form of progress that celebrates the female entrepreneur who sells “fatkinis” on Instagram while ignoring the woman who (true story) gets fired from her management position after reportedly gaining 100 pounds over three years.

“Fat activism isn’t about making people feel better about themselves,” Pausé says. “It’s about not being denied your civil rights and not dying because a doctor misdiagnoses you.”

And so, in a world that refuses to change, it is still up to every fat person, alone, to decide how to endure. Emily, the counselor in Eastern Washington, says she made a choice about three years ago to assert herself. The first time she asked for a table instead of a booth at a restaurant, she says, she was sweating, flushed, her chest heaving. It felt like saying the words—“I can’t fit”—would dry up in her mouth as she said them.

But now, she says, “It’s just something I do.” Last month, she was at a conference and asked one of the other participants if he would trade chairs because he didn’t have arms. Like most of these requests, it was no big deal. “A tall person wouldn’t feel weird asking that, so why should I?” she says. Her skinny friends have started to inquire about the seating at restaurants before Emily even gets the chance.

Hearing about Emily’s progress reminds me of a conversation I had with Ginette Lenham, the diet counselor. Her patients, she says, often live in the past or the future with their weight. They tell her they are waiting until they are smaller to go back to school or apply for a new job. They beg her to return them to their high school or wedding or first triathlon weight, the one that will bring back their former life.

And then Lenham must explain that these dreams are a trap. Because there is no magical cure. There is no time machine. There is only the revolutionary act of being fat and happy in a world that tells you that’s impossible.

“We all have to do our best with the body that we have,” she says. “And leave everyone else’s alone.

Excerpted from the Huffington Post

Stephen Carter King, once a scorched earth turnaround artist; often a pushy, sassy writer. He is Brand, Visibility and Search Leader, and CEO, at Kings Crossing where he helps people take control of their online presence, their data. He writes, consults and speaks on the disruptive internet and its impact on business, and tracks technology and related trends.

Instructing on digital marketing, brand innovation, evolving business models, rapidly changing customer experiences and ways of shopping and purchasing, he’s known for his “visual map of the data landscape.” Mostly, he dreams in Technicolor.

 His fave topic is the whispers and secrets that lie along the southern coast. A provocative futurist, he’s shamelessly enamored with all things in the Florida Keys.

Growing up in Cincinnati, playing ‘knothole’ baseball starting at four years old. He played this game into his early-twenties, even professionally. It was his very own “wonder years”.