The right food fight

Financial Mirror (Cyprus) - - FRONT PAGE -

To what ex­tent should gov­ern­ments reg­u­late or tax ad­dic­tive be­hav­iour? This ques­tion has long framed public de­bate about al­co­hol, to­bacco, gam­bling, and other goods and ser­vices in many coun­tries world­wide. And now, in the United States – ar­guably the mother of global con­sumer cul­ture – the de­bate has turned to­ward the fight against the epi­demic of child­hood obe­sity.

It is ironic that in a world where child­hood malnutrition plagues many de­vel­op­ing coun­tries, child­hood obe­sity has be­come one of the lead­ing health scourges in ad­vanced economies. The World Bank es­ti­mates that over a third of all chil­dren in In­done­sia, for ex­am­ple, suf­fer from stunted growth, con­fronting them with the risk of life­time ef­fects on fit­ness and cog­ni­tive de­vel­op­ment. Yet, the plight of mal­nour­ished chil­dren in the de­vel­op­ing world does not make obe­sity in the ad­vanced coun­tries any less of a prob­lem.

In­deed, though per­haps not on a par with global warm­ing and loom­ing wa­ter short­ages, obe­sity – and es­pe­cially child­hood obe­sity – nonethe­less is on the short list of ma­jor public-health chal­lenges fac­ing ad­vanced coun­tries in the twenty-first cen­tury, and it is rapidly af­fect­ing many emerg­ing-mar­ket economies as well. Yet solv­ing it poses much more dif­fi­cult chal­lenges than the kind of suc­cess­ful public-health in­ter­ven­tions of the last cen­tury, in­clud­ing near-uni­ver­sal vac­ci­na­tion, flu­o­ri­da­tion of drink­ing wa­ter, and mo­tor-ve­hi­cle safety rules.

The ques­tion is whether it is re­al­is­tic to hope for suc­cess un­less the gov­ern­ment re­sorts to far more blunt in­stru­ments than it cur­rently seems pre­pared to wield. Given the huge im­pact of obe­sity on health-care costs, life ex­pectancy, and qual­ity of life, it is a topic that mer­its ur­gent at­ten­tion.

The US leads the world in obe­sity, and is at the cut­ting edge of the de­bate. Al­most ev­ery­one agrees that the first line of de­fense ought to be bet­ter con­sumer ed­u­ca­tion. First Lady Michelle Obama’s “Let’s Move” ed­u­ca­tional cam­paign as­pires to elim­i­nate child­hood obe­sity in a gen­er­a­tion, though its im­pact so far re­mains un­clear. Other ef­forts in­clude ap­peals by celebri­ties like the chef Jamie Oliver and at­tempts to use peer-based learn­ing, such as the Sesame Street-inspired plat­form Kickin’ Nutri­tion (full dis­clo­sure: the cre­ator is my wife).

Yet, although ed­u­ca­tion is es­sen­tial to fight obe­sity, it is far from clear whether it will be enough in a food en­vi­ron­ment dom­i­nated by large cor­po­ra­tions with deep pock­ets and ev­ery in­cen­tive to cul­ti­vate ex­ces­sive con­sump­tion. Com­mer­cial tele­vi­sion pro­grammes aimed at chil­dren are re­plete with advertising for pro­cessed foods of du­bi­ous value to hu­man health. And, for ev­ery celebrity who do­nates time to fight­ing obe­sity, there are a dozen who ac­cept large pay­ments to hawk prod­ucts, such as ul­tra­sug­ary drinks, that are ar­guably the to­bacco of our gen­er­a­tion. It is hard for non-prof­its to com­pete with the pro­duc­tion val­ues em­bod­ied in Bey­oncé’s Pepsi com­mer­cial or Tay­lor Swift’s Diet Coke com­mer­cial.

The causes of obe­sity are com­plex, and the science of un­der­stand­ing hu­man be­hav­iour is em­bry­onic; but it is not hy­per­bole to call the prob­lem an epi­demic. Ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Preven­tion, roughly 18% of chil­dren aged 6-11 in the US are not just over­weight, but obese.

The risks posed by this epi­demic are man­i­fold, but the main one is that child­hood obe­sity begets adult obe­sity, with sig­nif­i­cantly in­creased risks of di­a­betes and heart dis­ease. In­deed, ex­perts es­ti­mate that more than 18% of all adults in the ad­vanced economies are obese. Even more stun­ning are es­ti­mates that roughly 9% of Amer­i­cans – and a sim­i­lar per­cent­age adults world­wide – have di­a­betes.

Yet politi­cians push back on Big Food at their peril. When the pop­u­lar for­mer mayor of New York City, Michael Bloomberg, at­tempted to ban large sug­ary drinks, public opin­ion – not to men­tion the New York State Court of Ap­peals – re­jected the ef­fort, de­spite sup­port from med­i­cal ex­perts. Many com­men­ta­tors, even those sym­pa­thetic to Bloomberg’s goal, ar­gued that it was wrong to try to leg­is­late con­sumer be­hav­iour so bluntly. Yet, when one con­sid­ers other suc­cess­ful ef­forts to im­prove public health over the last five decades – for ex­am­ple, smok­ing bans, seat-belt laws, and speed lim­its – one finds that leg­is­la­tion typ­i­cally sup­ple­mented ed­u­ca­tion.

A less in­tru­sive ap­proach to in­flu­enc­ing food choices might be to in­sti­tute a re­tail tax on all pro­cessed foods – not just sug­ary drinks – and an off­set­ting sub­sidy on non­pro­cessed foods. In the long run, low-in­come fam­i­lies (which suf­fer the most from obe­sity) would be the great­est ben­e­fi­cia­ries. And, in the short term, any in­come ef­fects could be off­set by in­creased trans­fers. To­gether with the med­i­cal re­searchers David Lud­wig and Dar­iush Mozaf­far­ian, I have pro­posed an out­line of such an ap­proach.

The right place to start to ad­dress it is by cre­at­ing a bet­ter bal­ance be­tween ed­u­ca­tion and com­mer­cial dis­in­for­ma­tion. But food is so ad­dic­tive, and the en­vi­ron­ment so skewed to­ward un­healthy out­comes, that it is time to think about broader gov­ern­ment in­ter­ven­tion. That should cer­tainly in­clude vastly en­hanced ex­pen­di­tures on public ed­u­ca­tion; but I sus­pect that a long-term so­lu­tion will have to in­volve more di­rect reg­u­la­tion, and it is not too soon to start dis­cussing the modal­i­ties. all of

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