If obesity impacts all of us, the obvious question is: Should our government become more aggressively involved in fighting it?  The answer for First Lady Michelle Obama has been a resounding “Yes!” (8) But what additional steps could be taken in the public policy arena to reverse, or at least alter, the course of this dangerous, expensiv problem? And how can we take action without completely undermining an individual’s freedom to make his or her own choices about food?

A successful action plan would likely mirror other successful approaches to major public health disorders. Progress generally comes when a number of tried and true policy tactics are combined to attack a health problem from multiple angles. In the case of obesity, these angles include public disclosure, the courts, taxes, school policy, and public health screening regulations. Each of the five can be viewed as a tool that can be brought to bear on the obesity problem.

The first is public disclosure. We have already made progress on this front in the form of food labels. Not only have they become more precise and complete with the addition of trans fats, but they’re also more readable. As the consumer health movement continues and consumers learn more about what’s healthy and what’s not, disclosing nutritional content falls in line with America’s preference for more information rather than less. (9)

Second, the courts. In Pelman v. McDonald’s the court permitted plaintiffs’ claims of deceptive representation of nutritional benefits to proceed to trial – a sign of hope to public health advocates.(10)  And although nearly half the states limit such action through “commonsense consumption” laws that emphasize personal responsibility in food choice, major food manufacturers and providers of fast food are aware of the increasing risk to their value proposition once they become positioned in the “Obesity Camp”, with special referencing to targetting poor urban youth. (11)

Third, tax policy. Some public health advocates now favor a “fat tax.” (12)  Non-nutritional selections would carry a tax and be more expensive, as with cigarettes.  The resulting revenue would be directed toward public health and nutritional programming.

Fourth: school policy. This approach involves amending school policies on nutrition and exercise.  Such policies have been drawn up by obesity task forces in almost every state.  Legislative proposals have been written to restrict school vending machines, and school physical education is getting a careful re-examination as well. (13)

Fifth: public health screening. This approach involves aggressive chronic disease surveillance. In New York City, for example, diabetes is now monitored using many of the same approaches used to screen sexually transmitted diseases. Physicians must report lab findings that indicate diabetes in city residents, and the city provides recommendations for diabetes control.  Such an approach is not without controversy. (14)  Many believe this type of surveillance interferes with personal autonomy, privacy and clinical freedom. Others insist that the benefits to public health outweigh these concerns. (15)

These five approaches, attacking the obesity problem from different angles in order to secure a positive result, are available to us today, and reinforce the important leadership provided by Michelle Obama. As Lawrence Gostin said in 2009, “It is time to address obesity as a disease, like any other, and enact legal action items that will directly reduce the disease burden and prevent future crisis. The future of our country’s health depends on the
implementation of legal action items now.” (16)

For HealthCommentary, I’m Mike Magee.

References

1. Gostin LO. Law as a tool to facilitate healthier lifestyles and prevent obesity. JAMA. 2007;297:87-90.
2. Trust for America’s Health. “F as in Fat: How Obesity Policies are Failing in America, 2006.”
http://healthyamericans.org/reports/obesity2006/
3. Hedley AA, Ogden CL, Johnson CL, et al. Overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA. 2004;291:2847-2850.
4. Olshansky SJ, Passaro DJ, Hershow RC, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med. 2005;352:1138-1145.
5. CDC. Obesity Trends: 1985 to 2009. http://www.cdc.gov/obesity/data/trends.html
6. DukeHealth.org. “Childhood Obesity: A Growing Crisis.”  http://www.dukehealth.org/dr_clements/obesity.
7. Finkelstein EA, Feibelkorn IC, Wang G. State-level estimates of annual medical expenditures attributable to obesity. Obes Res. 2004;12:18-24.
8. The First Lady Takes On Childhood Obesity. http://1.usa.gov/i7j2Kw
9. FDA: Labelling and Nutrition. http://www.fda.gov/food/labelingnutrition/default.htm
10. Pelman v McDonald’s, 396 F3d 508 (2005).
11. Antler AB. The role of litigation in combating obesity among poor urban minority youth: a critical analysis of Pelman v. McDonald’s Corp.http://www.cardozolawandgender.com/uploads/2/7/7/6/2776881/15-2_antler.pdf
12.  Jacobson MF, Brownell KD. Small taxes on soft drinks and snack foods to promote health. Am J Public Health. 2000;90:854-857.
13. CDC: Nutrition School Health Guidelines. http://www.cdc.gov/healthyyouth/nutrition/guidelines/summary.htm
14. Epstein R. What (not) to do about obesity: a moderate Aristotelian answer. Georgetown Law J. 2005;93:1361-1386.
15. CDC. Federal Obesity Related Research. 2011. http://www2a.cdc.gov/phlp/Federal_obesity.asp
16. Pomeranz JL and Gostin L. Improving laws and legal authorities for obesity prevention and control. The J. of Law, Medicine and Ethics. 37:2, 2009. 62-75. http://www2.cdc.gov/phlp/docs/ObesityPrevention.pdf