What Role Should Government Play in Combating Obesity?

September 18, 2012
By BETSY MCKAY

Should the government tell you what size soda you can drink?
New York City Mayor Michael Bloomberg seems to think so. He has pushed through a ban on the sale of sugary drinks larger than 16 ounces?stirring controversy in the Big Apple and beyond.

Public-health advocates view the ban, set to take effect in March, as a national model for the fight on obesity. But many New Yorkers consider it an intrusion into personal choice. Even Mr. Bloomberg only went so far: The ban won?t apply in every venue, nor does it limit how many sodas a consumer can buy.

We asked a panel of experts in nutrition, consumer behavior, and health care to discuss, in an exchange of emails, what role government should, and should not, play in the quest to curb the nation?s obesity epidemic.

Our panelists:
? Marion Nestle , the Paulette Goddard professor in the Department of Nutrition, Food Studies and Public Health at New York University. She is also a professor of sociology at NYU and a visiting professor of nutritional sciences at Cornell University.

? Brian Wansink , the John S. Dyson professor of marketing at Cornell University, where he also directs the Food and Brand Lab. His research focuses on how the way foods are presented or served influences the amount a person consumes. Dr. Wansink was executive director of the U.S. Department of Agriculture?s Center for Nutrition Policy and Promotion from 2007 to 2009, helping develop the 2010 U.S. dietary guidelines.

? Michael D. Tanner , senior fellow at the Cato Institute, leads research on several domestic policies, including health-care and social-welfare policy, and Social Security.

Here are edited excerpts of the discussion.

Who?s Really Responsible?
WSJ: What role should government play in addressing the obesity epidemic?

MARION NESTLE: 'The point of public health is to make the healthier choice the easier choice.'

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DR. NESTLE: The government is up to its ears in policies that promote obesity. To name only a handful: supporting production of food commodities, but not of fruits and vegetables; permitting food and beverage companies to deduct marketing expenses from taxes; permitting SNAP benefits [food stamps] to be used on any food, thereby encouraging food companies to market directly to low-income groups.

Research on the prevalence of obesity shows that after decades of remaining at the same level, it began to increase sharply in the early 1980s. Our sense of personal responsibility did not change then. What did change was the food environment, transformed by food industry imperatives to increase sales, to one that increasingly urged people to ?eat more? by making it socially acceptable to eat anywhere, anytime, and in very large amounts. In this kind of food environment, all but the most mindful eaters overeat. Few of us are in that category.

The food, beverage and restaurant industries collectively spend roughly $16 billion a year to promote sales through advertising agencies, perhaps $2 billion of that targeted at children. Marketing to children is well established to encourage kids to want advertised products, pester their parents for them, and believe that those products are what they are supposed to be eating. The ?I am responsible? argument does not work for children (I?m not aware of evidence that it works well for adults either). Because regular consumption of junk foods and sugary drinks is linked to obesity in children, marketing these products to them is overtly unethical.

To expect food and beverage companies, whose sole purpose is to increase sales and report growth in sales every quarter, to voluntarily stop marketing to children makes no sense. On ethical grounds alone, government intervention is essential.

Given the personal and economic costs of obesity?currently estimated at $190 billion a year?governments have many reasons to promote the health of their populations. Just ask the military.

MICHAEL D. TANNER: 'Food bans or taxes are, in effect, anti-responsibility.'

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MR. TANNER: To argue that the government can control what I eat, and presumably other health-related activities, because it may have some future need for my military service is to assume that the state has some sort of pre-existing claim on me. But one of the foundational principles of a free society is self-ownership.

If the state is going to abrogate that self-ownership, the burden is on it to show both that its goals are necessary and that they cannot be achieved in any other way. To claim otherwise is to give the state all manner of control over our lives?indeed to reduce us to little more than functionaries of the state. For example, the state might have a proper claim to limit my behavior if that behavior directly harms someone else. But my drinking a Big Gulp or eating fried food harms no one but myself.

There should be no doubt that many government policies contribute to the obesity epidemic in this country. The federal government subsidizes sugar farmers to the tune of as much as $2 billion per year. By some measures, sugar is the most heavily subsidized of all U.S. crops. The government also subsidizes corn, much of which ends up as high-fructose corn syrup. That the federal government would actually use taxpayers? money to make unhealthy food cheaper and more plentiful is the height of absurdity.

But government subsidizing something is not the same, practically or morally, as failing to prohibit an activity.

Should the government ban sky diving or surfing? Home drowning accounts for 800 deaths every year. Why not a hefty new tax on home swimming pools?

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BRIAN WANSINK: 'When it comes to food, people don't behave like we expect.'

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DR. WANSINK: When it comes to food, people don?t behave like we expect. Will low-fat foods cause people to eat less? Our studies showed Chicagoans compensated by eating 28% more. Will soft-drink taxes cause people to buy less soft drinks? Our ?From Coke to Coors? study in Utica, N.Y., supermarkets showed that beer-drinking households responded to a six-month soft drink tax by buying more beer.

When my Cornell Food and Brand Lab runs an unsuccessful research study, we can change it in a week. When a food company launches an unsuccessful new product or campaign, they can change it in a quarter. When a government passes an unsuccessful law, it often sticks around until it has done more damage than we can stand. As any student of organized crime would tell us, Prohibition stuck around for 12 years.

The biggest disservice that public health has ever done to Americans is to make them believe that they and their kids were fat because the schools, the food companies, the fast-food restaurants and the government made them that way. It stripped people of their hope and empowerment, and it left them resigned to never try anything other than an occasional ?Lose 40 Pounds in a Week Turnip Diet.?

What government can do is to give people hope and to give them the tools to make it happen.

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A responsible government would show how parents could help preschoolers get over their food funks, how breast-feeding moms should eat, how a stressed-out parent of three can make a healthy meal after a 10-hour day. They wouldn?t obsess about taxing Pepsi and Coke and penalizing lower-income citizens; they would instead show parents how to get milk or tap water back on the dinner table instead.

WSJ: Obesity can lead to heart disease and diabetes?costly chronic conditions for which the American taxpayer often foots the bill. Doesn?t the fact that government is paying the cost of obesity give it a right to intervene?

MR. TANNER: My poor eating habits may indeed lead to health consequences such as diabetes or heart disease, even cancer. But those illnesses only increase insurance costs to the degree that we prohibit insurers from charging actuarially appropriate premiums.

Ghoulish as it sounds, government programs may actually benefit from the unhealthy. Social Security?s finances are certainly boosted if recipients die early. The situation with Medicare is murkier, but to the degree that unhealthy lifestyles do contribute to increased benefit costs, there are mechanisms to shift at least some of those costs back to the individual.

Nearly every choice I make in my life could be said to potentially impose costs on someone else. Who I choose to have sex with increases my possibility of sexually transmitted diseases, which could increase insurance costs. The career I choose could reduce the amount of taxes I will someday pay, leading others to pay higher taxes. Where I choose to live could influence housing prices or property taxes. To suggest that the mere existence of some societal cost grants government the power to regulate my decisions is to open the door to government intervention pretty wide.

Will It Succeed?
WSJ: Let?s talk about some specific initiatives. Will Mayor Bloomberg?s cap on soda sizes reduce soda consumption? What about the proposed municipal tax of a penny an ounce on sugary drinks in Richmond, Calif.?

DR. WANSINK: I?ve dedicated over 20 years of my research career to trying to help people eat better. I fear, however, that the soft-drink ban in New York will be a huge setback to fighting obesity for two reasons: 1) unless it succeeds, it will poison the water for better solutions, and 2) it won?t succeed.

First, consider the McLean Effect: McDonald?s launches the visible and controversial low-calorie hamburger; it fails, becoming a cautionary byword for restaurants for the next 15 years, when no one dared introduce low-calorie fast-food offerings because ?Look what happened to the McLean.?

Second, 150 years of research in food economics tells us that people get what they want. Someone who buys a 32-ounce soft drink wants a 32-ounce soft drink. He or she will go to a place that offers fountain refills, or buy two. If the people who want them don?t have much money, they might cut back on fruits or vegetables or a bit of their family meal budget. Who buys large soft drinks? Soft drinks are bought by one-third of the poorest two million New Yorkers, but only one-sixth of the richest one million.

My colleague David Just and I have a new study that shows that a person?s belief about various food issues is driven more by their preferences than their politics. For instance, the more fast food you eat, the more unfavorably disposed you are to soft-drink taxes, and the more favorably you view high-fructose corn syrup. You have the exact opposite views the more you cook at home. But personal preferences is no way to decide policy. People wouldn?t stand for a splinter group of vegetarians who campaigned for a ban on restaurant meat entrees over 8 ounces, nor would they stand for the two of us?as non-coffee drinkers?crusading for a ban on the 20-ounce Starbucks Caf? Mocha because it had 340 calories.

Soft-drink companies and restaurants make money by selling liquid?not sugar. By working with these companies, New York City could discover new ways to better promote lower-calorie options. For instance, perhaps there could be a meal discount if a person bought a diet drink. Or a perhaps a healthy-habit loyalty card would be given out and punched if a person opted for milk, juice, or water instead of a sugary drink.

DR. NESTLE: If only education and personal responsibility worked to improve eating behavior. Brian Wansink?s research clearly shows that his own students, diligently educated to understand the effect of large food portions on eating behavior, will still eat more when given more food?and, more seriously, they will underestimate the amount they have eaten.

Education must be backed up by a supportive environment. So why not create a food environment that makes it easier for people to eat less? Mayor Bloomberg?s idea of capping soda sizes at 16 ounces is an interesting approach to doing just that. A 16-ounce soda is not exactly abstemious. It is two standard servings, 50 grams of sugar and 200 calories.

To suggest that food laws will not change behavior makes little sense. For one thing, anti-obesity initiatives have scarcely been tried. For another, the history of anti-smoking interventions suggests quite the opposite. Attempts to get smokers to quit by invoking personal responsibility made little headway. Smokers quit when the government made smoking so inconvenient and expensive that it became easier to stop than to continue.

The intense response of soda companies to Mayor Bloomberg?s cap on soda size is testimony to the effectiveness of regulatory approaches. The companies would not be putting this kind of effort or spending millions to oppose an action they expected to fail.

MR. TANNER: Food bans or taxes are, in effect, anti-responsibility. Because they assume that the government will protect me against any adverse consequences from my lifestyle choices, they grant the government the right to make those choices for me. Effectively it treats us all as children who can neither be trusted to make our own choices or be held responsible for those choices.

Suppose I am in extremely good health, I exercise regularly and eat a healthy diet on most occasions. I am not obese and unlikely to develop diabetes or have an obesity-related heart attack. However, on occasion I feel like having a large soda or a greasy cheeseburger. What then is the justification for taxing me or prohibiting me from indulging my occasional unhealthy craving? There is no nexus between my decision and anyone paying higher premiums or the impending collapse of Medicare. Thus, food taxes or bans are a shotgun approach, imposing a penalty on everyone regardless of whether or not they actually increase societal costs.

DR. NESTLE: This view assumes that individuals have appropriate education and resources to protect themselves from public-health problems if they choose to do so. But the entire point of public health is to make the healthier choice the easier choice, particularly if those choices affect other people. If obesity were purely an individual matter, the personal responsibility argument might suffice. But it is not. Obesity incurs substantial costs to individuals and to society that must be paid by the population at large.

At its extreme, the personal-responsibility argument suggests that there is no role in society for public-health measures that infringe on personal choice. But if you choose not to have your child vaccinated, your child may spread disease to others. That is why governments impose clean water, vaccines against smallpox and other communicable diseases, and laws against drunken driving.

Public-health measures have successfully eliminated smallpox and polio, reduced accidents caused by drunken drivers and made it easier for addicted smokers to stop, thereby reducing hazards from secondhand smoke. Making people pay for the problems that they, as individuals, cause may make sense in theory, but in practice runs up against societal inequities. Not everyone can afford to pay for the consequences of individual behavior.

And what about the food companies? They use sophisticated psychological methods to induce people to desire their products, and cause children to crave foods and drinks that undermine health and burden society. Shouldn?t we, as a society, hold industry accountable for its actions? If we are asking government to let personal responsibility run public health, shouldn?t we also demand that government insist on corporate responsibility?

Like it or not, we live in an interdependent society. It?s a responsibility of government to ensure some semblance of fairness and equity in our society. In the case of obesity, this must mean to protect vulnerable citizens against the effects of food marketing and corporate imperatives to sell products that promote poor health.

Ms. McKay is the Atlanta bureau chief for The Wall Street Journal. She can be reached at betsy.mckay@wsj.com.

http://online.wsj.com/article/SB10000872396390444812704577609482961870876.html?mod=dist_smartbrief

Source: http://healthy-america.org/?p=1632

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