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Sunday, Mar. 19, 2006
The Politics of Fat
Experts say our expanding girth is killing us and costing the health-care system billions. [Right to tell others they are wrong--RSB.] But is this a problem government can solve? Or should? The debate grows as we do
By KAREN TUMULTY
These are fat times in politics. Literally. Nearly 400 obesity-related bills were introduced in state legislatures across the country last year--more than double the number in 2003. A quarter of them were passed into law, up from only 12% two years before. In Washington the word obesity appears in 56 bills introduced during the current Congress; this, the Wall Street Journal points out, is fast catching up with the number containing the word gun. Surgeon General Richard Carmona says obesity is a greater threat than terrorism. Some public-health advocates have begun urging the government to put a warning label on soft drinks; others are calling for a "fat tax" on fast food.
When voters and the possibility of big public spending are involved, you can be sure the politicians will discover a problem. The stats are depressingly familiar: more than 60% of us are overweight, and the percentage of us who are considered obese has nearly doubled since 1980. Health-care spending attributable to obesity reached $75 billion in 2003, by some estimates, with taxpayers shelling out more than half of that through Medicare and Medicaid programs. Last month Medicare increased its financial obligation to the problem by announcing it would cover bariatric surgery, a procedure aimed at weight loss that generally costs $25,000 for a simple case. Government researchers estimate that obesity is associated with anywhere from 100,000 to 300,000 deaths a year.
Most alarming of all, the rates of obesity among children and teens have tripled in the past 25 years. Health-care providers say they are seeing something of an epidemic of potentially lethal Type 2 diabetes, once known as the adult-onset version of the disease, among children as young as 10 and 11. "Without some intervention, this is the first generation of young Americans, being born today, who are expected to have a shorter life span than their parents or grandparents," says Arkansas Governor Mike Huckabee, a Republican, who wrote a book about his 110-lb. weight loss and made a healthy America his top priority as chairman of the National Governors Association. That prediction of diminishing life expectancy was published last year in the New England Journal of Medicine by a group of university researchers; other experts have disputed it as overly dire.
Huckabee, who is a possible 2008 presidential contender, has given state employees in Arkansas exercise breaks instead of smoking breaks. The state's public school children are screened for their body mass index, an indirect measure of body fat, and confidential reports are mailed to their parents. Huckabee wants to experiment with a system in which food stamps would be worth more if they were spent on healthy purchases like fruits and vegetables.
Nearly every state has taken some steps on obesity, mostly centered on children. In the past year, Arizona set nutritional standards for all food and beverages sold on school grounds. California banned the sale of junk food as snacks in schools starting next year. Kentucky requires students to engage in vigorous physical activity for 30 minutes a day or 150 minutes a week and next year will prohibit its schools from serving that staple of Southern cuisine, deep-fried foods. Maryland plans to put timing devices on school vending machines to limit access during school hours. Many states plan to make nutrition instruction part of their curriculums.
There are certain to be more new rules. For the Governors' winter meeting in Washington a few weeks ago, Huckabee, who opened the conference by leading some of his fellow Governors and their staffs on a 5K run, invited a former fat kid who is also a quadruple-bypass patient to speak. Bill Clinton related to the problem of weight in typical feel-your-pain fashion. The two Arkansas pols, longtime adversaries, have joined together to work toward halting the rise in childhood obesity by 2010 and reversing it by 2015. "Look at Huckabee," Clinton told the Governors. "You've got to consume less and burn more. There is no other alternative. And to do that, you've got to change the culture."
But how? Embarrass Americans into saying no to that second helping of cheesecake? Taxing calories? Hauling the corporate chiefs of Frito-Lay and Coca-Cola before a congressional committee, as happened in 1994 with the heads of seven tobacco companies, and suing them? There have been many instances in which government has either rallied a majority to rescue a group of suffering Americans, as in the War on Poverty, or tried to push Americans out of unhealthy and expensive bad habits, including smoking, littering, drunk driving and failing to wear seat belts. All involved some combination of education, cultural change, legal penalties and old-fashioned shame.
But obesity does not evoke deprivation, and it's more complicated than a bad habit: it involves food. The old messages won't work, says veteran Democratic operative Michael Berman, whose new memoir, Living Large, chronicles his struggles to come to terms with being fat. "This is different from second-hand smoke, where you can have a program of abstinence. You can give up smoking. You can't give up eating."
Berman warns that even the best anti-obesity programs won't produce the gratification that politicians like best: quick results. That's because our growing waistlines are a product of so much else that is happening in the U.S. Researchers say it's not a coincidence that the obesity epidemic has coincided with a growth in the number of working parents who have less time to prepare meals from fresh foods; technologies that make it possible to mass-produce packaged and fast foods in cheap, enormous portions; financially strapped schools getting rid of their physical-education programs and playgrounds even as they allow vending machines and food advertising in their buildings; and computer and television programs that ensnare kids who might otherwise be playing outside.
Even larger economic forces may play a role. "It seems to be inextricably bound up to ... stagnant wages in the global economy," Clinton told the Governors. "The price of everything has gone up except food. Food is still a good deal in America." Rates of childhood obesity are worst among the poor and are a particular challenge in immigrant communities--in part because there's no cheaper dose of assimilation than a trip to Burger King. The New York Times Magazine reported that a couple of years ago, after administrators trimmed fat and sugar from menus at schools in Rio Grande City, Texas, along the Mexican border, students staged lunchroom protests, hanging signs that read NO MORE DIET and WE WANT TO EAT COOL STUFF--PIZZA, NACHOS, BURRITOS.
Where government fits into finding a solution is a matter of no small dispute. After all, it's not like Americans don't have an inkling why they are getting fat. "People who are overweight know it," says Huckabee. "The denial is different from a lot of denials. We don't deny that it's there. We deny that it affects us."
That's why there are plenty who argue that the blame--and the answer--must lie squarely with fat people themselves. When Iowa Senator Tom Harkin, a Democrat, attacked junk food in schools two years ago, then Democratic Senator Zell Miller, whose home state of Georgia is the location of Coca-Cola headquarters, scoffed, "Our kids are not obese because of what they are eating in our lunchrooms at school. They are obese, frankly, because they sit around on their duffs watching MTV and playing video games, and to do something about that requires the role of the parents, not the role of the Federal Government." His Georgia colleague, Republican Saxby Chambliss, was equally dismissive of Harkin's plan to set federal nutrition guidelines for schools: "We would be a lot better off to spend that $6 million to educate children about what they ought to eat, both in school and out of school, and if we think that by cutting them off at school they are not going to go to the 7-Eleven as soon as school is out and pick up these items, then we are kidding ourselves." There was a none-too-subtle message in the title of Republican-sponsored legislation aimed at protecting the food industry from obesity-related lawsuits: the Personal Responsibility in Food Consumption Act of 2005. Nicknamed the Cheeseburger Bill, it passed last October, with yeas outnumbering nays 2 to 1.
Mindful of anything that may look like the heavy hand of a nanny state at work, George W. Bush's Administration has focused its anti-obesity efforts primarily on public education. Former Health and Human Services Secretary Tommy Thompson wore a pedometer to tout his department's Small Step initiative. But pressure for bigger strides is building. Says Harkin: "This is not just a personal problem. It's a public-health problem." He wants the Agriculture Department to regulate all food--not just meals--being served in schools. The rules now are set at the state and local levels, with widely varying standards, although the torrent of state legislation suggests that everyone is looking to go healthier. Harkin and others want to give the Federal Trade Commission more say over the $10 billion a year that the food industry spends advertising to children. Some in Congress are pushing to require nutritional labeling on restaurant menus, as was done for packaged foods. There are restaurants that print the information voluntarily, but the restaurant lobby opposes requiring it.
Meanwhile, food companies are trying to get out in front of the issue. McDonald's did away with supersizing. Coca-Cola no longer advertises on television programs aimed at viewers younger than age 12. In its ads on children's television, Kraft pitches white-meat chicken Lunchables rather than Oreos. Food packaging, from mac-and-cheese to soup and pancake mix, offers tips for more healthful preparation.
Big Food is eager not to repeat the mistakes of Big Tobacco, and it knows that self-regulation is one way to keep the government from stepping in. What worries the food industry most are the lawsuits that have begun to move through the courts, often going where politicians fear to tread. One key question is whether public-health advocates will succeed in sticking the food industry with one of the charges that damned the tobacco business: that its executives knowingly harmed the health of the public--especially children--with their marketing tactics. Of course, Big Tobacco had the additional problem that its products are clearly addictive.
Plaintiffs against food companies have had some initial setbacks--in courts of law and in the court of public opinion. People snickered when two New York teenagers--one whose regular diet consisted of two Big Mac or Chicken McNugget meals a day and another who usually ate a Happy Meal or a Big Mac three or four times a week--sued McDonald's, claiming it had made them morbidly fat. A federal judge tossed out their case in 2003. But last year an appeals court revived it and allowed discovery, an unsettling development for food companies because it could open up their marketing strategies to public scrutiny. Around the country, state attorneys general, encouraged by their success in wringing billions from the tobacco companies, have the food industry in their sights, says Rogan Kersh, a Syracuse University political-science professor who argues that the political forces arrayed against the two industries show striking similarities.
The food fight seems certain to get bitter, whether it is ultimately fought in the courts or the legislatures or on the floors of Congress. But there is one thing on which all sides can agree: nothing will work until Americans are persuaded to change the choices they are making for themselves and their children. While some will say the government shouldn't have to pick up the tab for what people are doing to themselves, Huckabee insists that everyone should recognize that it already is. "It's not just about coddling people," he says. "It's truly about making good business decisions. The return on investment is significant when you put the focus on health and wellness as opposed to putting the focus on treating disease."
Copyright © 2006 Time Inc.
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