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Like Eating, Moderation is key

Posted - Jan. 21, 2004 at 2:20 p.m.



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WASHINGTON, Jan 21, 2004 (United Press International via COMTEX) -- (This is part two of a two-part series on the social and government response to America's obesity problem.)

WASHINGTON, Jan. 20 (UPI) -- Obesity is a growing epidemic in the United States with increasing evidence that the problem has significant health and economic costs for both those affected and society as a whole.

Because of this, there is a growing effort to address the problem through both public policy and legal means, but experts warn about the dangers of overreaching on the part of health advocates and policymakers, pointing to the lessons learned from past attacks on social and health evils like alcohol and illicit drugs.

Rogan Kersh, a professor of political science at the Maxwell School at Syracuse University, told United Press International that all the action surrounding the issue of obesity in the United States points to a changes in public perceptions on the issue and eventual political action, likely of a drastic nature.

He pointed out that historically other consumed substances that were once purely thought of as a matter of personal choice, came to be overseen by government or social regulation, including alcohol, drugs and even sex.

"Historically you have issues like these framed as a matter of personal choice," said Kersh. "The government should not touch the food we eat, you hear that time and time again. (But) there is a kind of ethic in American history whereby various kinds of substances that were once considered matters of private choices, sometimes very swiftly, become matters of public regulation (both socially and by the government)."

For instance, prior to the Civil War, the abortion rate in the United States was relatively high, but following the end of the conflict family planning came into vogue in the United States lower rates of the procedure.

In addition, taverns and drinking before the turn of the 19th century were considered acceptable meeting places, a fact that changed relatively quickly in the early part of the 20th century.

Obesity and related weight issues are a major contributing factor to problems like heart disease, cancer, diabetes, muscular-skeletal disorders and there is evidence the rise has lead to increases in disability.

Public health advocates say the time has come to address the issue head-on with proactive programs aimed at stopping the tide of seemingly ever-growing Americans with the accompanying social and economic costs.

Some argue for a traditional legislative-based public policy approach, while other advocates are taking cues from the legal attack on Big Tobacco by bringing lawsuits against fast-food chains and other purveyors of junk food.

Currently around 30 cases are pending against fast-food companies and food manufacturers in the United States.

Leif Wellington Haase, a healthcare fellow, at the liberal Century Foundation, told UPI that obesity and the impacts of fast food is at the same level that tobacco and nicotine were at in the 1970s, when the health effects of cigarettes began to take hold of the public consciousness.

The stigma that ultimately became associated with smoking has begun to be seen with obesity and the over-consumption foods lacking in nutritional substance, he added.

Kelly D. Brownell, chair of the psychology department at Yale University and an expert on eating issues, argues in the book "Eating Disorders and Obesity: A Comprehensive Handbook," that the focus should be placed on a broad public health approach through strong public policy measures, instead of the patient-by- patient model of medical treatment more traditionally used to address obesity.

Specifically, Brownell calls for several steps to address the problem including greater public funding of opportunities for physical activity to help offset the decline in physical activity in the United States.

This is considered a key contributor to increasing obesity.

In addition, Brownell calls for the regulation of food advertising aimed at children and for the prohibition of fast food and soft drinks from schools. He writes that the average child in the United States views 10,000 advertisements for food each year, 95 percent of them for fast foods, sugared cereals, soft drink and candy.

Brownell also calls for the restructuring of school lunch programs to emphasize healthier foods, subsidizing of the sale of healthy foods, (which tend to be more expensive than their junk-food counterparts), and taxing the sale of food with poor nutritional value.

But these and other solutions tend to not take into account the myriad of unanswered questions about the striking rise in obesity in the United States and other developed nations.

One is whether this is the result of the fact that people in these nations are facing a different environment in which they eat more and exercise less or whether is it simply a matter of individuals not making very good decisions.

Conventional wisdom holds that it is most likely a combination of the two along with other factors.

Other questions center on what policy and market decisions impact the situation.

For instance, some economists suggest that a proper response from a health insurance standpoint would be to charge more for insurance for the obese whose problem can not be traced to a genetic predisposition.

This would have the effect of transferring some of the costs associated from the population as a whole to those most responsible.

There are those that also question the ability of public policy to even properly address the issue.

"I don't know that it is so clear that it is a public policy problem," said Darius Lakdawalla, an economist at the RAND Corporation who studies healthcare issues. "The question is are people doing what they think is best for them. If they are, it is a public policy situation. If they are not, then what is causing them to do it (increase weight)?"

Lakdawalla told UPI that previous research he has done demonstrates that increasing obesity can be, in some part, attributed to the decreases in the price of food over the last 20 years.

In addition, some theories hold that the decline in strenuous work in western society could be a contributing factor.

But these issues are the result of social and cultural advancements that few, if anyone, would want to turn back.

Legislative efforts at the federal level have tended to focus on more traditional public health models.

For instance, The Senate Health Committee approved a bill in October aimed at reducing obesity and improving the way people eat through traditional public health means.

The measure would provide training for health professionals and health sciences students on how to identify those at risk for obesity, provide treatment, and on preventive measures.

Funding would also be provided for community, school-level, and local public health office promotion of good nutrition and physical activity.

According to Haase, properly addressing the issue should come much more at the local level, such as in schools where he believe soft drinks should no longer be offered for sale.

"Obesity clearly should be emphasized and a lot more funding should go to education and dissemination of information (about the problem)," said Haase." But as far as policies, local level policies are going to be more effective."

However, according to recent reports, in some school districts that have outlawed the sale of soft drinks, vending machines are now being stocked with sport and fruit drinks that offer little more in the way of healthiness than their soda counterparts. In some cases, these products actually have more sugar.

This fact highlights the limits of market-based solutions that typically catch the eye of the public, such as the low-carbohydrate Atkins diet.

Similar problems can be found in sales of manufactured low fat foods that increase sugar to improve taste, considering that the body turns sugar into fat.

"An awful lot of things done in the name of stopping obesity are just clearly the shifting of the source of weight gain from one type of carbohydrate or sugar to another," said Haase.

When the Senate measure was approved by the committee, Majority Leader Bill Frist, R-Tenn., hailed the bill, a move that Democratic and Republican Congressional aides said demonstrated that the safe bet was on only such traditional measures gaining approval on Capitol Hill.

But Kersh says that a movement is growing that signals obesity making the change over from a personal issue to a public-domain one.

He believes this could result in drastic policy responses as the historical response has tended to be an overreaction to the problem as was the case with alcohol prohibition or with the war on drugs.

Kersh defines seven triggers that move such issues from the private to public sectors, ones that he says the Unites States seems to be traversing pretty rapidly when it comes to obesity.

"Whatever short-term political constraints will be, longer term patterns seem to indicate that food and obesity are making this change," he said. "The action can be swift and extraordinarily powerful, outstripping the power of any political grouping."

The triggers include social disapproval for the substance or behavior, medicalization of the related problem, a growing surge of self-help surrounding the problem, demonization of the industry that produces the good or service, demonization of users or those with the perceived problem, a social movement aiming to act on the problem, and development of interest groups along with judicial action.

All of these developments can be seen in the case of obesity.

Kersh added that policymakers should be looking now for middle-ground solutions to head off drastic action from the judicial and legislative branches.

"This is by no means a positive story, it is more of a way to describe what can often be an excessive and crucial movement." he said. "The same rule that applies to excess with food applies to policymaking. As in eating, it is moderation that is probably the best approach in terms of regulating obesity."

Copyright 2004 by United Press International.

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