The Ironic Politics of Obesity

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Science  07 Feb 2003:
Vol. 299, Issue 5608, pp. 781
DOI: 10.1126/science.299.5608.781

Here is a great irony of 21st-century global public health: While many hundreds of millions of people lack adequate food as a result of economic inequities, political corruption, or warfare, many hundreds of millions more are overweight to the point of increased risk for diet-related chronic diseases. Obesity is a worldwide phenomenon, affecting children as well as adults and forcing all but the poorest countries to divert scarce resources away from food security to take care of people with preventable heart disease and diabetes.

To reverse the obesity epidemic, we must address fundamental causes. Overweight comes from consuming more food energy than is expended in activity. The cause of this imbalance also is ironic: improved prosperity. People use extra income to eat more and be less active. Market economies encourage this. They turn people with expendable income into consumers of aggressively marketed foods that are high in energy but low in nutritional value, and of cars, television sets, and computers that promote sedentary behavior. Gaining weight is good for business. Food is particularly big business because everyone eats.

Moreover, food is so overproduced that many countries, especially the rich ones, have far more than they need—another irony. In the United States, to take an extreme example, most adults—of all ages, incomes, educational levels, and census categories—are overweight. The U.S. food supply provides 3800 kilocalories per person per day, nearly twice as much as required by many adults. Overabundant food forces companies to compete for sales through advertising, health claims, new products, larger portions, and campaigns directed toward children. Food marketing promotes weight gain. Indeed, it is difficult to think of any major industry that might benefit if people ate less food; certainly not the agriculture, food product, grocery, restaurant, diet, or drug industries. All flourish when people eat more, and all employ armies of lobbyists to discourage governments from doing anything to inhibit overeating.

Food companies are well aware of the economic implications of reversing the obesity epidemic, as are government agencies. Economists at the U.S. Department of Agriculture (USDA) calculate that “large adjustments” would occur in the agriculture and processed food industries if people ate more healthfully. That threat is one reason why food producers contribute generously to congressional campaigns, and why federal agencies have failed to take the obvious first step: a national obesity-prevention campaign in response to the Surgeon General's 2001 Call to Action. Such a campaign would have to address dietary aspects and include messages to eat less as well as the far less controversial “be more active.” No other federal health agency has stepped in to lead the nation on dietary issues, which explains why USDA is left in charge of national nutrition policy. USDA's primary mission is to promote U.S. agricultural products (“eat more”), but it also issues advice about diet and health (sometimes meaning “eat less”). This notorious conflict accounts for the ambiguity of federal dietary guidelines (“aim for a healthy weight,” “choose beverages and foods to moderate your intake of sugars”) and the confusing nature of USDA's food guide pyramid.

If campaigns to promote more healthful eating are not in the best interest of industry, and government agencies are caught in conflicts of interest, how can any society address its obesity epidemic? The leadership vacuum in the United States leaves much room for litigation against the obesity-promoting practices of food companies. Whatever their legal merits, the current lawsuits engage the food industry's rapt attention and encourage scrutiny of their current products and practices. The vacuum also creates an opportunity for scientists and public interest groups to advocate better policies. Existing food policies could be tweaked to improve the environment of food choice through small taxes on junk foods and soft drinks (to raise funds for anti-obesity campaigns); restrictions on food marketing to children, especially in schools and on television, calorie labels on fast foods; and changes in farm subsidies to promote the consumption of fruits and vegetables. The politics of obesity demand that we revisit campaign contribution laws and advocate for a government agency—independent of industry—with clear responsibility for matters pertaining to food, nutrition, and health.

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