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WASHINGTON -- 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 Seattle and Alabama are pushing to go one step further, waging campaigns to eliminate junk food advertising aimed at youngsters.
And in New York state, Democratic Assemblyman Felix Ortiz 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 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 Deidre 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 food companies. 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 Banzhaf.
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 160 million adults, or 64 percent of the population, are overweight, and an additional 69 million 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 30 percent of children are overweight and 15 percent are obese.
"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."
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