As obesity-related
health costs soar, policymakers nationwide are pursuing
legislative solutions modeled after the anti-smoking
campaigns of the 1990s to attack what many in the medical
community say is one of the gravest threats to the nation's
long-term health.
In the District of
Columbia and half a dozen states, lawmakers are debating
bills that would require fast food and chain restaurants to
post nutrition information such as caloric, fat and sugar
content on menus.
Twenty-five states,
following successful efforts in Arkansas and Texas, are
considering restrictions on the sale of soda and candy in
schools. Parent and advocacy groups in Alabama and Seattle
are pushing to go one step further, waging campaigns to
eliminate junk food advertising aimed at youngsters.
And in New York
state, Assemblyman Felix Ortiz (D) has proposed six
anti-obesity bills, including one that would tax not only
fatty foods, but also modern icons of sedentary living --
movie tickets, video games and DVD rentals -- and use the
resulting $50 million for nutrition and exercise programs.
"We have focused on
smoking; now it is about time we fight obesity," said Ortiz,
a Puerto Rican immigrant who watched his overweight mother
suffer through diabetes, a kidney transplant, vision
impairment and a heart attack.
Americans have been
getting heavier for three decades, and with the extra weight
has come serious medical consequences, such as diabetes,
heart disease, high blood pressure and kidney failure. Until
recently, weight remained the province of physicians, diet
gurus and women's magazines.
But now, fiscal
imperatives have thrust the issue onto the public policy
agenda, triggering a debate between those who view girth as
a matter of personal choice and those who argue that the
societal toll has made obesity a government problem.
"Obesity is the
fastest-growing disease in America," said Health and Human
Services Secretary Tommy G. Thompson. "If we're really
interested in holding down medical costs and improving the
health of citizens, we have to do something about obesity."
So far, state
lawmakers have filed more than 140 bills aimed at obesity,
nearly double the 72 filed last year, said Deirdre Byrne,
policy associate at the National Conference of State
Legislatures.
Many, such as a
bill enacted this year in Maine, appoint commissions to
study the problem; others impose physical education
standards in the schools.
"It's something of
a free-for-all," said Richard Berman, executive director of
the Center for Consumer Freedom, an advocacy group
underwritten largely by foodmakers. To counter the trend,
conservative leaders and the food industry have developed
bills that would insulate restaurants from lawsuits that
attempt to hold food purveyors responsible for the negative
health effects of obesity.
"It's an individual
responsibility issue," Berman said. "If I'm going to shorten
my own life by eating too much or being too sedentary, that
may not be much different than shortening my life by riding
a motorcycle without a helmet on."
Thompson and
others, however, say that the $117 billion spent each year
on the direct and indirect medical expenses of obesity make
it a cause for concern for families, corporations and
government.
"The non-obese are
forced to subsidize the obese" in the form of higher
insurance rates and government health programs such as
Medicare and Medicaid, said George Washington University law
professor John F. Banzhaf III.
Banzhaf and
Thompson are among a growing number of experts who advocate
linking health insurance premiums to obesity, just as auto
insurance rates are pegged to age, driving record and other
risk factors. Thompson has asked Bush administration lawyers
to craft an approach that would not run afoul of
anti-discrimination laws.
About 34 percent of
U.S. adults age 20 and older are overweight, and about 30
percent -- or 59 million people -- are obese, according to
the Centers for Disease Control and Prevention, which sets
measures based on an individual's body weight in relation to
height, known as body mass index. In two academic studies,
obesity is identified as the second-leading cause of
preventable deaths in the United States. And the bulge once
associated with middle age now afflicts an increasing number
of youngsters; the CDC found that 15 percent of children age
6 to 19 are overweight, about triple the proportion 20 years
ago.
"The word
'epidemic' doesn't even do this justice. It is one of the
most profound medical crises we've had in generations," said
Eric Topol, who as the chief of cardiology at the Cleveland
Clinic treats the most serious obesity-related heart cases.
"We are at the point now where it is so profound we have to
be creative, and we can't take decades to fix this because
it's happening so fast."
Maine state Rep.
Sean Faircloth (D) said state officials would be negligent
to ignore the problem.
"What other
situation would you have where there's an epidemic that
affects over 60 percent of the populace and public
policymakers don't do anything?" said Faircloth, who
persuaded colleagues to form an obesity commission with an
eye toward enacting several bills next spring.
Much of the early
attention has focused on children. Jim Metrock, president of
the child advocacy group Obligation, is helping parent
groups in several states fight the in-school television
station Channel One, in part because of the commercials it
airs for candy, soda and other sweets.
"Public health
departments are trying to avert this obesity crisis while
the other arm of government -- schools -- is showing
motivational films to eat junk food," he said.
Steven C. Anderson,
president of the National Restaurant Association, said the
efforts miss the point. "We have gotten away from proper
parenting," he said in reaction to the proposed school
restrictions.
The association
opposes mandatory nutrition information on menus, saying it
would be impossible to calculate accurate calorie data on
meals that customers often tweak to suit their own
preferences.
The most vocal
anti-fat activists praise Thompson for crusading about
obesity but say the federal government has not gone far
enough.
The CDC's ad
campaign promoting healthy lifestyles for young people began
with $125 million in 2001, was reduced to $51 million this
year and is slated to receive $5 million in President Bush's
2004 budget, said Margo Wootan, director of nutrition policy
at the Center for Science in the Public Interest. "The
administration gets an A-plus for talk but a D for action,"
she said.
"The most telling
moment in this administration with respect to obesity was
when Secretary Thompson told the Grocery Manufacturers [of
America] to go on the offense against critics like us," said
Gary Ruskin, executive director of Commercial Alert, a
consumer group with ties to Ralph Nader. That advice,
delivered last fall in a private session, was posted on the
food association's Web site.
Topol applauded the
Food and Drug Administration for adding trans-fat
information to food labels but said the Bush administration
could have followed Europe and banned the "horrible, toxic
stuff" outright. If he were a politician instead of a heart
doctor, Topol said, he would have every American weigh in at
the post office on tax filing day each year.
Slender taxpayers
would receive a credit, while "the people ruining our health
care economics would pay the standard tax," he said.
"People who are able to be disciplined and lose weight
should be rewarded."
