In June, Ideas in Action, the weekly program I moderate on public television stations, focused on "The Cost of Obesity in America." It was a good discussion among three experts, but I was left unsatisfied -- just as I have been underwhelmed with much of the talk about this subject among politicians and bureaucrats lately. The tough question is how public policy can deal with a health problem of this kind.
My conclusion is that coercion won't work. A private-sector solution -- with critical government advocacy, encouragement, and redirected, rather than new, spending -- is the answer. Companies like Dole and McDonald's are already showing the way, but they need help.
Before I get to the specifics of what should be done, let's stipulate that too many Americans are fat. The Centers for Disease Control calls obesity "a national health threat and a major public health challenge... Obese adults are at increased risk for many serious health conditions, including coronary heart disease, hypertension, stroke, type 2 diabetes, certain types of cancer, and premature death."
The CDC conducts a huge annual called the Behavioral Risk Factor Surveillance System, or BRFSS. In 1990, the BRFSS found that, in not a single state, were more than 15 percent of adults obese and in at least 10 states, including California, fewer than 10 percent were obese. But the latest survey results show the polar opposite: In every state but one (Colorado) more than 20 percent of adults are obese, and in California the figure has jumped to 26 percent.
Overall, the 2009 BRFSS study, released on Aug. 3, found that 73 million adults, or 27 percent of the total, were obese -- up from just 16 percent in 1995. In other words, the proportion of obese Americans has jumped by two-thirds in 14 years.
Obesity is defined as a Body Mass Index of 30 or more. It's a bit complicated to calculate, but the National Heart, Lung, and Blood Institute of the National Institutes of Health has a handy calculator. The definitions seem awfully generous. If you are five feet-four inches, for instance, you are considered obese if you weigh 175 pounds.
Everyone talks about the dangers of obesity, but no one has a good idea of what to do. Lately, most action -- often taken under political coercion -- has centered on measures to make foods a bit more difficult to acquire or to modify their content. For instance, PepsiCo has pledged to stop selling full-sugar soft drinks in schools by 2012. Kraft Foods, the maker of Oreo cookies and Oscar Mayer lunch meats, announced it would further reduce the sodium content of its products.
I doubt these steps will have much effect on obesity. Weight gain is no mystery. It's the result of taking in more than you work off. A typical teenager can consume about 2000 calories a day without becoming obese. A can of Pepsi contains 150 calories. The objective shouldn't be to avoid soft drinks altogether, but to consume them in moderation -- or to drink sugarless ones. It's hard to believe that taking soft drink machines out of schools will change things much. School kids will simply drink Pepsi at home or pick one up at 7-11 or the local deli.
One obvious answer is to get children to exercise more, but, because of costs and risks of lawsuits, schools are dropping physical education programs.
Would taxes on calorie-rich foods help? Certainly if they were high enough, but there is no way -- short of a national Fattie I.D. Card -- to avoid taxing the three-quarters of Americans who aren't obese. In addition, why should government get into the business enforcing personal dietary standards? That's a dangerous path. Next might be daily exercise requirements to avoid fines. What we eat has to be our own choice.
Government can, however, play a role in encouraging Americans to eat well, and a positive approach would work better than a negative one. Rather than trying to slap our hands and tell us not to drink sugared soft drinks or cheeseburgers, government -- as well as businesses that bear the much of the costs for obesity -- should advocate eating the right things. A further requirement for such a program would be to keep it simple.
Also, I'm impressed with something called the Good Food Movement, which, in the words of Parke Wilde, a nutrition professor at Tufts, tries to make "eating healthy more tasty, fun, and inspiring." In a study in the Journal of the American Medical Association, Alice Lichtenstein and Robert Russell, who are, respectively, a leading nutrition scientist and the former director of the Jean Meyer Human Nutrition Research Center at Tufts, reflect the thrust of the movement when they advise that "the relative presence of some foods and the absence of other foods are more important than the level of individual nutrients consumed."
So, my proposal is that we focus on the "relative presence" of fruits and vegetables in our diets. There's persuasive research that shows that eating five servings (of about a cup each) of fruits and vegetables a day has a major positive effect on health. As the result of a recent study, the World Health Organization "recommends the intake of a minimum of 400g [about 14 ounces] of fruit and vegetables per day... for the prevention of chronic diseases such as heart disease, cancer, diabetes and obesity."
The latest BRFSS found that only 23.4 percent of Americans ate five or more servings of fruits and vegetables a day in 2009 -- a slight decline since 1996, when the question first appeared on the survey. So we have a long way to go. But we can get there -- and there's already some progress, without need of political coercion.
For example, Dole Foods, the world's largest producer and marketer of fresh fruits and vegetables, is, on its own dime, contributing 15 salad bars to schools around the country, including in California, Washington, DC, and North Carolina. Dole's effort is part of a "Salad Bar in Every School" campaign by United Fresh Produce, a trade association. Meanwhile, McDonald's is having huge success with its new McCafe Real Fruit Smoothies. The 12-ounce banana-strawberry version has 210 calories.
Rather than taking soft-drink machines out, schools ought to be putting fruits and vegetables in. And I would be stressing the fruits. It's not hard to get your five cups a day without eating broccoli or cauliflower. Each of the following constitutes a cup: a banana, an apple, 16 grapes, a pear, six baby carrots, an orange, a potato, an ear of corn, a small slice of watermelon, a snack container of applesauce, a small box of raisins.
The federal government's role should not be coercer but informer and encourager. A serious campaign that focused on one objective -- getting at least half of Americans to eat five fruits and vegetables a day within the next three years would be relatively easy to achieve.
Meanwhile, state and local governments should focus on how they can achieve the goal through schools. Salad bars and fruit, fruit, fruit are the obvious approaches.
What I am suggesting is hardly radical. There is already a National Fruit & Vegetable Program, with participants such as the CDC, the Department of Agriculture, and the American Heart Association. But it hasn't produced results, and it's been swallowed up in a mass of other efforts to encourage Americans to eat healthier. Let's drop the bureaucracy and the politics and Nanny Statism. Keep it simple, keep it positive, keep it fruitful.
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