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Dr. Pamela Peeke

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Can You Tax Away Obesity?

Posted: 02/16/10 02:16 PM ET

All year long, newscasts have been filled with stories on healthcare reform and obesity in America. There's no doubt that our current medical care delivery system is in need of some repair and refinement. And, most agree that we have an obesity epidemic on our hands. We need funds to implement critical changes, but from where? Taxes, of course.

It was so much easier when tobacco was the bad guy. The health consequences of inhaling smoke into your lungs day after day were clear and indisputable. Therefore, it took no leap of faith to recommend that cigarettes should be taxed, and that money should be used to fund smoking cessation programs and support healthy lifestyle behaviors.

Let's look at obesity. Does the cigarette analogy hold here? Can we find one food or beverage that's an easy target for taxing and funding our way out of this obesity crisis? Experts agree that there are multiple factors that increase the risk for obesity, including genetics, environment, over consumption of calories, sedentary behavior as well as socio-cultural elements. So, who's to blame? It was easy to demonize tobacco. You don't need it. Smoking makes you sick and it'll kill you. What about food products? Where's the bad guy? Chips, cookies, candies, cakes, or colas? Pasta, potatoes, paninis, or peanut butter? How can you prove any one item is more responsible for obesity than another?

Some politicians have narrowed their focus to taxing sodas. This idea has picked up some steam in a few states struggling to balance tight budgets in a recession. Can a beverage tax really solve America's battle with the bulge? Of course not, and worse still, such taxes may have the opposite effect.

Last September, the New England Journal of Medicine published a policy report by a group of distinguished experts that called for taxing sodas and other sugary drinks to fight obesity. The news media gave a lot of attention to the report. But last month, the press did not give much attention to a group of letters from prominent doctors published in NEJM noting that the report failed to cite any scientific evidence showing a tax would reduce the cumulative weight of Americans.

"Before assigning blame for the obesity epidemic, we should have clinical evidence that an intervention to reduce the consumption of sugar-sweetened beverages is effective in achieving this goal, is either more effective or additive to the effect of other proven dietary therapies, and will reduce the long-term propensity for obesity," wrote Dr. Michael G. Kaplan of Maimonides Medical Center in Brooklyn. He noted that all four of the long-term, randomized, case-control trials - the kinds of studies considered the gold standard in medical research - that were cited in the NEJM article failed to produce the hoped-for results in support of a tax.

For example, a British study of 644 kids between the ages of 7 and 11 found that the children who drank fewer carbonated beverages had lower BMIs after one year compared with kids who didn't. But the difference in BMI wasn't statistically significant. That means the difference could easily be explained by random chance. This study did find that kids who drank fewer sodas were slightly less likely to become obese.

Meanwhile, a paper in the January 2010 Contemporary Economic Policy Journal, authored by public health experts and economists from Yale, Bates and Emory, found that even a relatively large increase in taxes - like the 18% proposed by New York State - would likely "not have a substantial impact on population weight" or BMI. That's because other studies have shown that people who knew they were saving calories on soda wiped out the small savings by taking extra helpings of food or feeling less need to exercise.

If Americans want to solve the obesity epidemic, we don't need to pass new taxes, we need to plug in our brains. We need to think about how much food is going in and how many calories are being burned. One food or beverage never resulted in global obesity. We gain weight a few extra calories at a time - just a handful of chocolates, a glazed donut instead of the egg white omelet for breakfast, a little extra gravy at lunch or three sugar-sweetened drinks gulped at one sitting. Mindless eating is easy to do with the kind of busy, on-the-go lifestyles we all lead. But to drop excess weight we must connect our brains to our bellies and take responsibility for how and what we eat.

As I detail in my books, I've created a simple MMM template, Mind Mouth and Muscle, to help people remove excess body fat, become more fit and live a healthy lifestyle. It requires that you have a motivational focus that drives your determination to achieve and sustain health and wellness: mind. People need to be mindful of every mouthful, paying attention to quality, quantity and frequency of eating: mouth. And, everyone needs to stay physically active throughout their life: muscle.

In the January NEJM, the letter from Dr. Michael J. Rinaldi of the Sanger Heart and Vascular Institute questioned the fairness of singling out soda for punitive taxes. "If soda is taxed, should this tax also be applied to all "fast food," confections, or portion size? Why limit it to food? Should we not tax all behaviors linked to health care expenditures? Why not deter gun and motorcycle ownership or sedentary lifestyle through taxation?"

I agree with Rinaldi and other experts who believe that taxing food and beverages is not the strategy to combat obesity. Instead, let's invest in comprehensive preventive campaigns that address the mental, nutritional, physical, financial and environmental factors that influence the risk of obesity in America's families.