Being fat — whether it's termed chunky, chubby, a bit overweight, very overweight, obese or morbidly obese — in most minds is probably a fairly simplistic problem with an equally simplistic solution: eat less, be more active.

At the very basic level, of course, that is the simple solution. But that paradigm of simple problem/simple solution has dramatically shifted in the Western world.

It has shifted because of the impact of technology, a point extensively supported in a recent book with the lengthy but perfectly descriptive title, The Escape from Hunger and Premature Death, 1700-2100: Europe, America, and the Third World, by Robert William Fogel, a Nobel Prize-winning economist.

In his book, Fogel provides extensive data demonstrating that through most of human history homo sapiens have been chronically undernourished and malnourished, as evidenced by their stunted body size, truncated life spans and susceptibility to disease.

Extending his thesis, Fogel documents the way in which technology — primarily over the last 300 years — has produced larger body mass, lengthened life span and created a variety of barriers to disease. The technologies he points to for these improvements are primarily enhancements to productivity and improved public health. The result of these, he argues, has been an increase in body size of about 50% and a doubling of life span in the countries where these enhancements are at work.

Fogel characterizes these changes as a type of evolution, an evolution, not genetic but largely social and technical. He calls this "technophysio evolution" and argues that these developments in health have produced a variety of other benefits — reductions in economic inequality, shorter work week hours and increased hours of leisure, and, importantly for readers of Biomedical Business & Technology, an increased demand for healthcare.

While Fogel focuses on the last 300 years, rather than the future, it is fairly easy to extrapolate from his work and see that technophysio evolution is currently in a phase of declining benefits in those countries where it has been, up until now, most actove.

Increased productivity in the food industry — combined with information technology that so effectively tracks our various weaknesses and addictions — has resulted in increasingly large quantities of food at lower prices, foods empty of nutrients and characterized by processing chemicals and systems with multiple unhappy effects on the body.

Meanwhile, computerization and the various forms of electronic media have served to balloon the combination of sedentary work and leisure hours. And human bodies that have increased in body mass are now becoming unhealthy with a doubling or even tripling or more of mass, creating another form of malnourishment.

And unfortunately the pestering voices calling for greater activity and fewer calories have little chance against the highly refined impact of technophysio evolution. Put another way, the will power of the average human has little chance against the combination of processed food production and media manipulation. (The exception can be seen in Paris, where you pay twice as much for half as much food, compared to America, counterbalancing the effects of technophysio evolution. An overweight person in Paris is a rarity, the exceptions probably most often being tourists.)

But what to do in the U.S. and — ultimately —around the world?

Quite simple. What we must do is find new technologies that counterbalance the impact of technophysio evolution while bringing technophysio technologies to those countries where malnourishment and undernourishment are still rampant.

This search is apparently underway. Perhaps, as a medical conference focusing on obesity must suggest, we are in the first stages of such technical development, in terms of new drugs and devices for fighting a syndrome of increasing weight in an increasing number of people. But how far this will go, and how effective it will be we can only guess.

Unfortunately, what is much easier to project —given such an overpowering and inexorable cultural trend — are the barriers to such technologies, those barriers built into healthcare itself. The main barrier is that modern Westernized healthcare probably wants to see the technophysio evolution to continue. It wants it continued because it is in healthcare's high-profit interest to see most people getting bigger and fatter … and sicker, earlier and more chronically.

The fact is that sickness is thought to provide good food to fuel the healthcare engine, a fact that Fogel points to with data indicating greatly increased demands for healthcare.

But looking to the future, it seems clear that we can't depend on new technopohysio developments to do this. The other half of technical change is its creeative human use and creative human endeavor. What is needed in this case is a new commitment in the healthcare commnity to balancing technology —not with lip-service, but with real emphasis on prevention as much as to cure.

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