XXL: Obesity and the Limits of Shame

By Neil Seeman and Patrick Luciani.

© 2011

Obese individuals are twice as likely to experience heart failure as non-obese people. More than eighty-five per cent of type 2 diabetes sufferers are overweight. And in the United States, obese and overweight individuals make up more than two-thirds of the adult population. Public health organizations and governments have traditionally tried to combat obesity through shame-inducing policies, which assure people that they can easily lose weight by eating right and exercising. This generic approach has failed, as it does little to address the personal, genetic, and cultural challenges faced by obese individuals.

XXL directly confronts the global public health sector by proposing an innovative, alternative policy - the 'healthy living voucher' - for decreasing high calorie consumption and its related health problems. Neil Seeman and Patrick Luciani argue that many public health campaigns have made the problem of obesity worse by minimizing how difficult it is for individuals to lose weight. XXL challenges governments to abandon top-down planning solutions in favour of bottom-up innovations to confront the obesity crisis.

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Product Details

  • Series: U of T Centre for Public Management Series on Public Policy & Administration
  • Division: Scholarly Publishing
  • World Rights
  • Page Count: 192 pages
  • Dimensions: 6.0in x 0.5in x 9.0in
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SKU# SP003198

  • PUBLISHED MAR 2011

    From: $15.57

    Regular Price: $23.95

    ISBN 9780772786272
  • PUBLISHED MAR 2011

    From: $17.96

    Regular Price: $23.95

Quick Overview

XXL challenges governments to abandon top-down planning solutions in favour of bottom-up innovations to confront the obesity crisis.

XXL: Obesity and the Limits of Shame

By Neil Seeman and Patrick Luciani.

© 2011

Obese individuals are twice as likely to experience heart failure as non-obese people. More than eighty-five per cent of type 2 diabetes sufferers are overweight. And in the United States, obese and overweight individuals make up more than two-thirds of the adult population. Public health organizations and governments have traditionally tried to combat obesity through shame-inducing policies, which assure people that they can easily lose weight by eating right and exercising. This generic approach has failed, as it does little to address the personal, genetic, and cultural challenges faced by obese individuals.

XXL directly confronts the global public health sector by proposing an innovative, alternative policy - the 'healthy living voucher' - for decreasing high calorie consumption and its related health problems. Neil Seeman and Patrick Luciani argue that many public health campaigns have made the problem of obesity worse by minimizing how difficult it is for individuals to lose weight. XXL challenges governments to abandon top-down planning solutions in favour of bottom-up innovations to confront the obesity crisis.

Continue Reading Read Less

Product Details

  • Series: U of T Centre for Public Management Series on Public Policy & Administration
  • Division: Scholarly Publishing
  • World Rights
  • Page Count: 192 pages
  • Dimensions: 6.0in x 0.5in x 9.0in
  • Reviews

    'This slim book is fat with data and ideas, and stands on the imaginative frontier of a very fast-moving public policy debate ... It's bound to cause controversy and thought as we face the public health challenge of trying to engineer weight control.'
    Michael Bliss, University Professor Emeritus, University of Toronto, and author of The Making of Modern Medicine and The Discovery of Insulin

    'Promising, thought-provoking and smart.'
    David Frum, best-selling author and adviser to former President George W. Bush

    'XXL critically examines the money and policies we're throwing at the obesity epidemic and proposes a new, thoughtful and sensitive approach—healthy living vouchers—that offers meaningful incentives to those who ever have, or ever will, struggle with the emotional and physical battle of weight gain.'
    Bertha K Madras, Professor of Psychobiology, Harvard Medical School

    'XXL offers both an authoritative yet readily accessible review of the relevant science and, even more important, an imaginative proposal for government action.'
    Frederick Lowy, OC, MD, CM, LLD, President and Vice-Chancellor Emeritus, Concordia University, former Dean, Faculty of Medicine, University of Toronto

    'This book takes a fresh, bold, and deep look at an important human error stemming from the illusions of control and the overestimation of knowledge of the human body and behavior. It shows the mistakes committed when governments, in a top-down and naïve manner, try to control our biology.'
    Nassim Nicholas Taleb, Distinguished Professor, New York University Polytechnic Institute and author of New York Times best-sellers The Black Swan and Fooled by Randomness

    'This book provides the one thing that's sorely lacking amidst the cacophony of claims about what will fix the obesity crisis: A recognition that this is a massively multi-factorial problem utterly resistant to universal, simple solutions, and that individuals require customized strategies for losing and keeping off weight. The idea that public policy can and must support individualized weight-loss plans is as close to a winner as we're likely to see.'
    David H. Freedman, best-selling author of Wrong: Why Experts Keep Failing Us – And How to Know When Not to Trust Them, and contributing editor of Inc. Magazine

    'Messrs. Seeman and Luciani's suggestions will annoy both the left and the right. Market forces are anathema to the top-down thinking of many on the left, and handing money to the "undeserving" is anathema to many on the right. But the very fact that their idea defies conventional wisdom suggests that it is a good one.'
    Matt Ridley, international bestselling author of The Rational Optimist and Genome
    The Wall Street Journal

    ‘The authors have provided us with a clear summary of our current obesity challenges alongside the range of possible avenues to take on this “wicked problem,” all smartly compiled in this readable book.’
    Terrence Sullivan
    CMAJ February 2013

    (This title received Outstanding rating by members of the 2012 University Press Books committee…. They are essential additions to most library collections)

    ‘Entertaining and insightful are not two words you would normally associate with a book about obesity, but this book certainly has both traits…. I would recommend this book for all large public libraries


    Christina Beaird
    University Press Books for Public & Secondary School Libraries, 2012
  • Author Information

    Neil Seeman is director of the Health Strategy Innovation Cell and a senior resident in health system innovation at Massey College, University of Toronto.



    Patrick Luciani is a senior resident at Massey College, University of Toronto.

  • Table of contents

    Introduction: The Genesis of Shame

    Part 1: The Paradoxical Costs of Fat

    Part 2: (Nearly) Everything Causes Obesity, and (Almost) Everyone is Different

    Part 3: One-Size-Fits-Nobody

    Part 4: Healthy Living Vouchers

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