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Eat less, move more is unhelpful
Energy balance
Gaining weight over time means taking in more energy than is spent. Calorie intake appears to have kept rising, with perhaps a recent plateau, while energy output has fallen as work changed over the last 30 to 40 years. Many states have dropped physical education, often over budget cuts. Together that looks sufficient to explain the obesity epidemic.
Complicating factors
People often add judgment to energy balance and conclude that someone who is obese is lazy. In practice, people are more complicated. One study of obese women found they were 50% more likely to have a history of sexual assault trauma. People in lower-income areas are more prone to obesity, and a study showed that people with higher ACE scores, a measure of traumatic childhood events, are more likely to be obese.
Personal responsibility
Personal responsibility plays a part. What helps more than the instruction itself is describing and implementing the habits and behaviors that make the imbalance fixable.
How much has physical activity at work fallen?
In a 2011 study in PLoS ONE, Timothy Church and colleagues at the Pennington Biomedical Research Center analyzed US labor data. They found that the share of private-industry jobs requiring moderate physical activity fell from about half in 1960 to less than a fifth by 2008. They estimated that the average workday energy expenditure had dropped by more than 100 calories.
What is the ACE study?
The Adverse Childhood Experiences study was run by Vincent Felitti at Kaiser Permanente and Robert Anda at the Centers for Disease Control and Prevention, with results published in 1998. More than 17,000 adults completed a questionnaire about abuse, neglect, and household dysfunction before age 18. People with higher ACE scores had higher rates of obesity, heart disease, and depression. The study began from observations in a Kaiser weight clinic.