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Why Should Government Enforce Public Policy on Obesity?
By Rick Voakes, MD
Many people have expressed concerns to me that the "Obesity Police" will come and snatch that cheeseburger out of their hands! Does government have a role to play in the combating of obesity? We certainly don't want a police state where our personal choices are limited!
Dr Leona Cuttler (AAP Section of Endocrinology) suggests that we draw a parallel to the government regulation of child carseats. Children are not mature enough to make a rational decision about whether or not to buckle up in the car. Likewise, they cannot be expected to make informed choices of healthy foods while at school. Thus it is reasonable to mandate healthy foods be served in schools. But the problem is making laws that utilize evidence-based knowledge of nutrition. There has been a big push to get soft drinks out of schools, only to replace them with fruit juices, even higher in fructose load than the worst high-sugar sodas.
Nevertheless, the best effect that government mandates can have on childhood obesity will be through the schools. States can mandate healthy foods to be served, and require daily physical activity. States can also require a minimum of a certain level of health and nutrition education in the curriculum. This is a tough objective to achieve, since teachers and school officials generally strongly oppose government regulation of any aspect of school requirements, and particularly anything that increases the time demands on teachers, such as physical activity or adding curriculum items. This has been a major obstacle to obesity legislation here in Kentucky. Dr Walter Subczyk, writing in the Kentucky Medical Association Journal, has recommended that schools make health outcomes as important as academic outcomes. In other words, make your health report card as important as your academic report card.
Pilot projects in Warren County (Kentucky) have shown great success with including a health report card. However, school administrations are reluctant to add this to their report cards. Our own Natcher Elementary School has received many national awards for innovative nutrition and health programs, yet they dropped the health report card program as soon as the pilot study was over. Apparently it was worth the effort to get the award, but not worth the effort to maintain the children's health. This is an area where state regulations could provide a standard for all schools to include a health report card for each child. This would mainly give guidance to children and their parents who may not understand the value of certain aspects of health, such as BMI, dental health, lack of a medical home, need for exercise, need for sleep, etc. When they are actually given a grade for these health factors, it let's them know the serious nature of these factors.
Another area of proposed regulation is food advertising. Dr Cuttler suggests another parallel here, tobacco advertising. Like tobacco, many unhealthy foods are addicting, and habits are acquired at an early age. Advertising that is aimed at children gets them hooked on these foods. However, unlike tobacco, there is not a clear cut line of demarcation. Who is to determine where to draw the line as to what foods will be banned from advertising on TV, for example? Should it be foods that contain more than 50% fat? 45%? 44%? Or should we be looking more at sugar? Fructose is a major culprit in getting kids hooked on junk food. But what is the cut off? 1.5 gm of fructose per serving? 1.2 gm? Any fructose? As far as I can see, the only tobacco-like food product (unsafe at any level) is high fructose corn syrup. I could rationalize a total ban on advertising foods that contain this "poison". But that would take much more research to provide the needed compelling evidence.
Food labeling may be another important area for government regulation. Requiring labeling to reveal the nutritional content of foods gives the public a tool to make healthy choices, without taking away their right to have a choice in the first place. The trick is to get the government to require the right information. As medical science learns more about what makes food healthy or not, there will be a disconnect between that knowledge and what legislators were finally convinced to enact into law about ten or more years ago (resulting in the current labeling practices). There will need to be continuing efforts by medical groups and advocacy coalitions to lobby for changes needed to close these gaps.
The COAN (Childhood Obesity Action Network) has just released a report from the Second National Obesity Congress (Feb 2008) on ways that government might intervene in the obesity crisis. Here is a printable version of that policy: [Childhood Obesity: the Role of Health Policy]
