Walk into any American airport today and pause. Look around at the travelers waiting at the gate, the families queuing for fast food, the crowds rushing past. You are looking at a country that our grandparents would not recognize. In less than three generations, the very shape of the American body has shifted so dramatically that what would once have been regarded as rare or concerning is now routine. Airplane seats have been widened, retail clothing racks have been extended, mannequins have been reshaped, and soda cups have been enlarged. Entire industries have recalibrated to accommodate a physiology that is neither healthy nor sustainable.

Yet our cultural narrative increasingly insists that this shift is normal—sometimes even desirable. We are told that larger mannequins are a sign of “representation,” that rebranded fashion shows signify “inclusivity,” and that bigger chairs and bigger uniforms are gestures of compassion. But none of this changes biology. A mannequin does not get diabetes. A marketing campaign cannot erase hypertension. And no amount of “body positivity” cancels the cruel arithmetic of metabolic disease.

Obesity is not normal physiology. It is common, costly, and deadly. Pretending otherwise is not kindness—it is cultural anesthesia.

A Nation Grows Heavier

The data tell the story with unflinching clarity. In 1960, the average American man weighed 166 pounds, while the average woman weighed 140 pounds. By 2002, men averaged 191 pounds and women 164 pounds, representing gains of more than 20 pounds per person in a single generation [1-2]. Height increased by about an inch during the same period, which is nowhere near enough to explain the mass increase.

Obesity prevalence, once a marginal condition, ballooned in parallel. In the early 1960s, about 13 percent of adults met criteria for obesity. By 2010, the figure had reached 36 percent. Today, more than 40 percent of American adults live with obesity[3-5]. This is not a slight cultural drift. It is a wholesale population-level transformation, visible everywhere and confirmed by every credible dataset.

The costs are staggering. Annual medical expenditures attributable to obesity are estimated at $173 billion in the United States. Adults with obesity generate, on average, nearly $1,900 more in health costs per year than their normal-weight peers[6-7]. These figures capture only direct medical spending. They do not reflect lost productivity, shortened lifespans, military unfitness, or the millions of families silently managing the downstream complications: diabetes, heart disease, liver failure, sleep apnea, infertility, and cancer.

The Environment That Made Us Sick

What changed so radically between the early 1960s and the present? Not our genes. The human genome has not undergone significant mutation in half a century. What changed was our environment: the way we eat, the way we work, the way we live.

Per capita daily caloric availability in the United States increased by more than 20 percent between 1970 and 2010, a surge driven by the consumption of processed, shelf-stable, calorie-dense foods. [8] Portion sizes, which began to expand in the 1970s and continued to grow in the 1980s, exceeded what earlier generations would have considered a regular meal. Studies consistently demonstrate that larger portions lead to greater intake at a single sitting and cumulatively across days [9-10].

At the same time, the energy we burn at work fell sharply. As manufacturing and agriculture gave way to service industries and screen-bound labor, occupational energy expenditure dropped by more than 100 calories per day since 1960[11-12]. For an individual, that number might sound trivial. For a population of 330 million people, compounded across decades, it is catastrophic.

The composition of our food supply also changed. Today, more than half of all calories consumed by American adults come from ultra-processed foods: engineered products designed for bliss-point palatability and low cost. Among youth, the proportion is closer to two-thirds[13-14]. These foods are calorie-dense but nutritionally hollow, engineered to override satiety mechanisms and promote overconsumption. A growing body of cohort studies links ultra-processed food intake with obesity, diabetes, and cardiovascular disease, confirming what common sense already suspected.

The epidemic is not mysterious. We eat more, we move less, and the food itself is industrially reengineered to push appetite into overdrive.

Cultural Rebranding of Disease

Even as the physiology deteriorated, the culture adapted—by redefining what counts as “normal.” This is where mannequins and marketing come into play.

In 2019, Nike unveiled plus-size mannequins in a flagship London store and hailed the move as a gesture of inclusivity and representation. [15] Victoria’s Secret, once the cathedral of a single body type, abandoned its iconic runway show and rebranded with mannequins of different sizes and a new language about empowerment[16-17]. Other retailers quickly followed suit.

No one disputes that people deserve dignity and clothing that fits them well. But retail is not an altruistic enterprise. The introduction of larger mannequins was not a campaign for justice; it was a marketing strategy. Representation has its place. The problem is when representation blurs into normalization—when physiology that carries increased risk of disease is recast as simply another aesthetic option.

This is cultural anesthesia. It reassures without healing. It consoles while condemning. It teaches people to accept a physiology that will shorten their lives and bankrupt their health. That is not compassion. That is capitulation.

The Limits of “Health at Every Size”

It is both possible and necessary to treat every individual with respect while telling the truth about obesity. But slogans like “health at every size” cross a line from kindness into denial. Biology is not a social construct. Excess adipose tissue is not a role model.

Obesity is associated with increased risk for type 2 diabetes, hypertension, fatty liver disease, sleep apnea, osteoarthritis, infertility, and several cancers[6-7]. It shortens lives and drains public resources. To insist that these risks are merely inventions of stigma is to lie to patients under the guise of affirmation.

The clinical reality is not pleasant, but it is unavoidable. Physicians must treat disease with honesty, even when the culture demands euphemism. Compassion means helping patients reverse risk, not reassuring them that risk does not exist.

The 1950s Baseline

Invoking the 1950s risks nostalgia. That era had its own injustices and inequities. But metabolically, it provides a valuable baseline. Families ate smaller portions, prepared more meals at home, moved more in the course of daily life, and consumed fewer ultra-processed foods. Sugary sodas existed, but they were modestly sized and not consumed by default with every meal. “Large” meant a single cup, not a liter.

The lesson is not that the 1950s were a golden age. The lesson is that, within the same borders and with the same genetic pool, Americans were metabolically healthier before their environment was re-engineered. That proves the point: environment, not destiny, is the driver.

Incentives for Obesity

The obesity epidemic is not an accident. It is the product of incentives. Food companies profit when people eat more often and in larger quantities. “Value” is measured in calories per dollar, not nutrients per life. Pharmaceutical companies profit when chronic diseases linger; lifelong pharmacotherapy for obesity and its complications is now a growth market. Retailers profit when larger sizes are normalized and more units are sold. Politicians profit when difficult policy reforms—such as agricultural subsidies, zoning changes, and school meal standards—are replaced with slogans about inclusivity.

There is no conspiracy here. There is scaffolding. And people, especially children, grow into whatever scaffolding we build. These children will grow up with a variety of chronic diseases, and their lifespan will be limited.

A Different Kind of Compassion

The way forward requires disentangling people from pathology. Individuals must be respected and never humiliated. But the epidemic must be denormalized, not celebrated. That means telling the truth plainly: obesity is not neutral. It is a disease state.

It means recalibrating the environment. Portion sizes should return to sanity [9-10]. Schools should reintroduce daily physical activity, not token electives. Public institutions should reduce procurement of ultra-processed foods and increase access to minimally processed, nutrient-rich options. Zoning and city planning should make real food accessible and ensure safe movement.

It means aligning incentives with health. Subsidies should support sustainable food production, not cheap calories. Food labeling should reflect processing levels, not just calorie counts. Employers and insurers should reward healthy behaviors, rather than simply absorbing the costs of disease.

Clinically, it means utilizing every available tool: diet, exercise, sleep hygiene, stress management, pharmacotherapy when appropriate, and bariatric surgery when necessary. However, all of these must be anchored in environmental change, not a surrender to lifelong pharmacological management of a preventable condition.

And culturally, it means honesty. Larger mannequins may serve a retail function, but they must not be confused with a health message. We can sell bigger clothes without selling a bigger lie.

Closing the Loop

The America of 1960 was metabolically healthier than the America of 2025, not because our grandparents had better genes, but because they lived in an environment that did not constantly conspire against their physiology. Smaller portions, fewer processed foods, and more regular physical activity helped maintain lower baseline weights and reduced risks.

We cannot go back in time. But we can tell the truth. And the truth is that obesity is not normal, no matter how many mannequins we reshape or marketing campaigns we rename. Normalizing people is right. Normalizing disease is wrong.

If we want to love people, we must tell them the truth—and build a world where health is once again ordinary.

References

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2. Ogden CL, Fryar CD, Carroll MD, Flegal KM. Mean body weight, height, waist circumference, and BMI among adults: United States, 2003–2006. NCHS Data Brief. 2008.

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5. Centers for Disease Control and Prevention. Adult obesity facts, 2023.

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13. Martínez Steele E, Baraldi LG, Louzada ML, et al. Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ Open. 2016;6:e009892.

14. Juul F, Parekh N, Martinez-Steele E, Monteiro CA, Chang VW. Ultra-processed food consumption among US adults from 2001 to 2018. Am J Clin Nutr. 2022;115(1):211-221.

15. Ritschel C. Nike’s plus-size mannequin divides opinions. The Independent. June 2019.

16. Victoria’s Secret. Company rebrand announcement, 2021.

17. Chan M. Victoria’s Secret fashion show rebrand includes diverse mannequins. Time Magazine. 2021.