Charles Reyman is vice president of Communications for the Colorado Health Foundation.
Editor's note: This posting originally appeared in Health Affairs' GrantWatch Blog.
Statistically speaking, there's not much controversy as to whether obesity is a serious problem in the United States. Data from the National Health and Nutrition Examination Survey shows that more than one-third of adults and 17 percent of youth were classified as obese in 2009 and 2010. In addition, the medical community is sounding the alarm over the dramatic increase in type 2 adult-onset diabetes in obese children.
Nor are there many arguments about whether obesity is costly (a recent article from the Obesity Journal estimates the nation's cost of obesity may be as high as $147 billion annually—approximately 9 percent of all U.S. medical spending). Another article forecasts that if obesity levels were to plateau at 2010 levels, the combined savings in medical expenses over the next two decades would be $549.5 billion.
What is subject to controversy, however, is whether federal, state, and local governments should take a more active role or retreat to the sidelines in regulating fat- and sugar-laden foods.
We are beginning to see some of that debate play out in the public square. In 2007, New York City issued a first-ever law restricting artificial trans fats in restaurants. Since then, other cities have followed suit. Last year, New York City Mayor Michael Bloomberg proposed an outright ban on large servings of sodas. Elsewhere, municipalities such as El Monte, California, have weighed imposing a "soda tax" as a disincentive for consumers to indulge in sugary beverages (this also gives cities a much-needed revenue stream from those who continue to imbibe these "liquid candies").
Depending on your perspective, the government's role in determining what we eat is either a necessary intervention or a blatant intrusion on American free will. With the controversy percolating in town hall meetings, the airwaves, and the blogosphere, the Colorado Health Foundation decided to host a food policy debate as part of its 2012 Colorado Health Symposium.
With a tip of the hat to the movie "National Lampoon's Animal House," we titled this year's debate "Food Fight! Who Gets to Decide What Our Kids Get to Eat?" and turned our panelists loose on the following resolution: "Resolved: Healthy eating is a function of personal choice and should not involve government regulation."
Hank Cardello, a former food-industry executive who now works for the Hudson Institute and favors a market-based approach to combat the obesity epidemic, joined Lisa Katic, an expert in regulatory programs related to nutrition and obesity, in supporting the resolution. Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest, teamed up with James O. Hill, founding executive director of the Colorado Center for Health and Wellness, in opposing the resolution.
As in past years, observers were given a hand-held device, enabling them to agree or disagree with the resolution and to identify the panelist who made the most persuasive points. Unlike previous years, when the resolution clearly polarized the pro and con factions on health care issues, our "Food Fight" engendered nuanced disagreement. All of the panelists supported personal responsibility and a government role on food policy. But they didn't concur on the balance.
A former food marketer, Cardello said he views personal responsibility versus regulation through a different lens than the other panelists. He said, "From a marketer's perspective, your boss is the consumer. . . . You tell us what products you like and what you don't like, what you want and what you don't want. And if we don't listen to you, we get into trouble." Cardello said consumers are doing "a pretty good job" telling the industry what they should (and shouldn't) be selling. He noted that over the past decade, consumers have reduced their consumption of soda calories by 25 percent. "[Consumers] are still taking in the same amount of liquid, but the amount of calories they're taking [in] is significantly lower."
While some might say the beverage industry isn't moving fast enough on lowering calories, Cardello maintains it's heading in the right direction. "Diet Coke didn't even exist in 1982; now it's the No. 2 (soft drink) product." He also mentioned that sales of "better-for-you" products sold in fast-food and quick-serve restaurants grew by 400 percent while traditional products declined by 300 percent. Historically, Cardello said, regulation doesn't achieve the goal of reversing obesity rates. Since the government imposed nutritional labeling requirements on packaged foods in the 1990s, Cardello noted that obesity rates have doubled. Overall, he concluded that regulations aren't getting the job done and that any governmental intervention should only come in the form of incentives for the food and beverage industry, not punitive measures. Meanwhile, consumers are "stepping up" demands for healthier food—which the industry is delivering.
"We tried personal responsibility, and obesity grows and grows," said Hill of the Anschutz Health and Wellness Center. "No doubt, if we leave it to personal responsibility alone, obesity rates are going to continue to go up and up." The fundamental problem, Hill said, is that most of what is convenient and relatively inexpensive is high in sugar and fat and offered in large-portion sizes. "What [that has] done is to create an environment with high rates of obesity," he said. "But guess what? Most people like this environment. . . . They'd like to weigh less, but they aren't really ready to do what it takes."
Hill maintained that he aligned himself with the "disagree" of the resolution ("Resolved: Healthy eating is a function of personal choice and should not involve government regulation."), but his position actually falls somewhere in the middle. "I don't think companies should be regulated strongly, but they're not going to [regulate] themselves. It's just too difficult for them to change." Countering Cardello's free-market position, Hill said that simply making better products available isn't enough. Since the government's ability to regulate food is limited, Hill suggested that governments can lead by example by regulating themselves beginning with banning unhealthy food in government offices, the military, and schools. The government also can encourage food companies to innovate, limit portion sizes, and reduce the energy density of packaged foods by adding more water. "If the industry as a whole did this, we could make a tremendous impact. But somebody [the government] needs to be the referee and make sure we do it fairly." Hill concluded that success in reducing obesity rates is a matter of supply and demand. "It isn't going to work if we don't have healthy foods, and people aren't going to eat healthy foods unless you give them a reason to choose those."
In presenting her position, Katic said she believes in personal choice, but she doesn't think that consumers should be left "on their own without any tools or resources to make better or healthier choices." Instead, Katic favors "empowering" consumers to "make the choices we want them to make." The government can help by raising awareness and providing education. She cited Michelle Obama's Let's Move! campaign as a "perfect example" of this dynamic at work. In confronting the obesity epidemic, the First Lady brought "all the right players to the table," Katic said.
"The food industry alone certainly can't solve this issue. We all know that obesity is a multifaceted issue and there are a lot of contributors involved," Katic said, listing urban sprawl, transportation, and sedentary work hours among them. "We know, for example, that less than 4 percent of the adults are getting the recommended thirty minutes of physical activity—or more—a day."
Instead of government regulation, Katic encouraged observers to consider effective programs that work with industry to improve nutritional standards. For example, the Alliance for a Healthier Generation brought together different stakeholders to set higher standards on food sold in schools. While the food industry wasn't initially on board with the effort, it became engaged through discussion, negotiation, and debate. As a result of the alliance's groundwork, soft drinks have been removed from 98 percent of the schools in the country—thereby decreasing the available calories in schools by 88 percent. Other advances in schools include reducing sugar and sodium levels while increasing the availability of whole grains, fruits, and vegetables. While it's too soon to tell whether these efforts are working, Katic said they represent a step in the right direction.
Among the debaters, Wootan made the most impassioned case for government intervention in the obesity epidemic. "We know an overwhelming majority of Americans are obese or overweight. It's a tremendous burden on people as individuals," Wootan said. "One of the roles of government is to protect citizens from threats—both foreign and domestic. And obesity threatens the health and well-being of Americans." She pointed out that the U.S. Department of Defense is concerned about obesity because a growing number of young people are not fit enough to serve in the military. In business, companies consider the health of the local workforce in determining whether to branch out to new communities.
"Government also has a keen interest in obesity because of its cost," Wootan said. "Obesity costs upwards of $150 billion a year. More than half of that is paid by governments through Medicaid, Medicare and [federal] employee health insurance claims. So, government is already in the business of addressing obesity—they're just mostly in it on the tail end. We leave people to get sick, and then we clean up the mess in a very expensive way."
At the Center for Science in the Public Interest, Wootan said she works to implement policies designed to keep people from getting sick in the first place. Those policies include coordinating efforts to label trans-fat foods, improve school food, reduce junk food marketing aimed at children, and require calorie labeling at fast-food restaurants. "Our food environment has changed dramatically over the last thirty years in a way that makes healthy eating seem like swimming upstream. . . . We are not saying that personal responsibility is not the most important thing, but there is more to it than that. Obesity is a societal problem, and we all have a role to play in addressing it: parents, individuals, health professionals, organizations, food companies, manufacturers of sporting goods, and, of course, government."
Despite nuanced differences of opinion, the nays won with 73 percent of the audience of nearly 200 people voting against the resolution (compared with 56 percent who disagreed with the resolution prior to the start of the debate). The evening's big winners, however, were balance and proportion. Unlike much of the polarized debate occurring in the nation's capital and across the country, where ideological zero-sum gamesmanship rules the day, the Colorado Health Symposium's 2012 "Food Fight" debate demonstrated something different: the value of balance and proportion drawn from the strength of divergent positions.
Watch the video of the Food Fight debate at the Colorado Health Symposium.
Copyright © 2012 Health Affairs by Project HOPE—The People-to-People Health Foundation