...talk about chain fast food and drive through lines is like nothing I've ever seen in other middle aged colleagues and acquaintances around the world.
we eat a lot more processed foods and a lot more sugar. i think that is def a contributing factor to the obesity rate being much higher. not *the* factor but it contributes.
to the built environment thing, maybe yes, maybe no. America has always been substantially less population dense than Europe (for example you can go back and look at automobile adoption rates from 1900-1930 and they are much higher in rural America than Europe or urban America), but the obesity rates really diverged only in the 1980s. i think there's something to the built environment argument, but it's not the only thing.
it's mutli-causal but i think the biggest contributor is food quality and portion sizes. yes, Europeans eat big meals too, but not as consistently as Americans. And they walk more, smoke more, have better healthcare. It's a lot of things.
it's what we do with the calories we take in. They do significantly more walking (to work, school, and errands) than we do.
That said, the 15-20% increase in obesity doesn't account for a 3x increase in maternal mortality.