The best anti-obesity policies

Today, professors Brownell and Campos discuss the best practices in stemming the expansion of the national waistline. Yesterday, they pondered the government’s rationale for intervening on the issue, and Monday, they attempted to define the parameters of the problem. Later in the week they’ll debate cultural issues and common misconceptions.

More labeling, and selective restrictions
By Kelly D. Brownell

Paul,

The easiest path is to start with a positive approach. People like support and encouragement more than restriction and limitation; politicians would rather give than take away.

Many positive approaches have been suggested. Awaiting Gov. Arnold Schwarzenegger’s signature is a menu labeling bill requiring restaurants to provide nutrition information. This is done in the spirit of helping inform consumers. Adding physical education back into the school curriculum, boosting food stamp funds for fruit and vegetable purchase, and subsidizing healthy foods to make them more affordable have all been proposed. A fine example of a positive approach is legislation championed by Sen. Tom Harkin (D-Iowa) that offers free fruits and vegetables in schools as snacks.

Holding back progress is the fact that most approaches have not been evaluated, leaving officials with only intuition when choosing among the possibilities. In an ideal world, policy would follow the science; we would know in advance how things work. But this often is not possible. Consider the case of cigarette taxes. When taxes were proposed as a means of reducing smoking, economists could only guess how cigarette sales would be affected. Only until courageous legislators enacted such taxes could scientists test the impact. They found that taxes have been the single most effective action taken to reduce smoking.

No single approach will solve the nation’s problems with poor diet, physical inactivity and obesity. The social, economic and political factors contributing to these problems are stampeding forces that will thwart single, easily concocted solutions, so in all likelihood programs to cut back on negative influences will be needed. Logical places to start would be the sale of unhealthy foods in schools, the marketing of unhealthy foods to children and the discouraging of economic practices that favor calorie-dense foods over healthier alternatives. Movements to ban trans fats in restaurants fall into this category as well.

There is a trap we must avoid, one often set by the food industry -- the belief that education is the answer to nutrition problems. The ostensible rationale is that people do not understand nutrition, that educating them will drive up demand for healthier foods, and that the industry will be happy to meet that demand. The hidden rationale is that such programs will have little impact, allowing industry to do business as usual. I can see industry executives jump with glee each time government officials point to education as the answer, because: a) education has weak effects, if any; b) it will drain resources; c) it makes industry seem on the side of consumers; and d) it bolsters industry’s hope that government will allow it to self-regulate while government agencies sit on the sidelines. It is the perfect script.

Americans are ready for change. Polls show that more than 90% believe that childhood obesity is a serious problem. More than 70% favor restricting food marketing directed at children. More than 80% support menu labeling and banning soft drinks and snack foods in schools. These are now winning issues for politicians. We should see much progress on the horizon.

Kelly D. Brownell PhD is a professor of psychology, epidemiology and public health at Yale University, where he serves as director of the Rudd Center for Food Policy and Obesity.

We don’t know how to make people thinner
By Paul F. Campos

Kelly,

Before anything else, we need to ask this question: What are we trying to accomplish? Are we trying to improve public health or to make people thinner?

If the answer is, we want to do both things, or rather we want to accomplish the former by means of the latter, then I would answer that it isn’t necessary to make people thinner to improve their health -- which is a very good thing, given that we don’t know how to make people thinner.

We should focus on a goal that is to some extent achievable -- getting people to be less sedentary and to eat a nutritious array of foods that they enjoy, rather than on trying to make people thinner or trying to keep them from getting “overweight” (sic) in the first place. We know that getting sedentary people to become more active improves health. By contrast, we don’t know if making people thinner improves their health. As you’re well aware, there isn’t a single study in the entire medical literature demonstrating the health benefits of significant long-term weight loss.

And the reason for this couldn’t be simpler: There is no known method for turning “obese” people into “normal weight” people, so the hypothesis that doing so would on balance be beneficial to their health isn’t even testable. Every discussion of this subject should start with an acknowledgment that we don’t know how to turn fat people into thin people. Nothing better demonstrates the depth of our cultural neurosis on these issues than the fact that we’re talking about how to best employ scarce public health resources to achieve something that no one knows how to achieve and that we don’t know would be beneficial even if we could achieve it.

I’m all for making it easier for poor people to buy fruits and vegetables. I strongly support giving people accurate information at a reasonable cost so they can make informed decisions about their own health. I very much want to encourage people, and especially children, to learn about the pleasure of being physically active.

But what I don’t want to do is to pursue any of these worthy goals by telling people with a BMI of 25 or higher (146 pounds and 177 pounds for average-height women and men respectively) that they have something wrong with them that needs to be “cured.”

We already have quite a bit of data about what happens when intensive interventions attempt to improve activity levels and nutrition for the purposes of producing weight loss. Activity levels and nutrition improve; meanwhile, weight is not lost. This is because we don’t know how to make people thinner. If you’re going to indulge in the fiction that saying we should do something somehow makes it possible to do it, I’m going to indulge in the fiction that pointing out a fact over and over again to people who don’t want to acknowledge it will somehow cause them to eventually acknowledge it.

Paul Campos is a professor of law at the University of Colorado and syndicated columnist for Scripps Howard. His most recent book is “The Obesity Myth.”