An op-ed piece in The New York Times by Ezekiel Emanuel and Andrew Steinmetz ("Finally, some optimism about obesity," 4 May 2014) suggests that we should be optimistic about our efforts in controlling obesity. They lay out the game plan for how the smoking rates in the US were reduced (advertising restrictions, prohibitions on where people could smoke, and taxation), and go on to say that the response to the obesity epidemic has been even faster than it was for tobacco use. They note that 'within a decade' of the first reports of an increase in childhood and adolescent obesity, salt and saturated fat were limited in the school lunch program (full disclosure: I was involved in the development, implementation and evaluation of that effort, aka Team Nutrition). Later, a few voluntary actions by industry, a "Call to Action" (not annual reports as with smoking) by the Surgeon General, the "Let's Move" campaign, requirements for restaurant menu labeling, and some types of local and state sales taxes on sodas round out what they call this 'nimble response.'
Perhaps these responses to data about a new public health threat are happening more quickly than in past decades, but they pall in comparison to the restrictions placed on tobacco advertising (within 6 years of the first Surgeon General's report on smoking), the smoking ban on domestic airline flights and in government buildings (and many other places), and large increases in tobacco excise taxes in most states and many local jurisdictions (taxes applied to the companies, as opposed to sales taxes applied to consumers).
The response to the puzzle of the increase in obesity across most age groups may be nimble, but hardly effective. The authors embody the problem with their proposed solutions: more calorie counting, more explicit nutrition labeling, and banning advertising of junk foods to children. These education ideas may be well intended, but off the mark. What if all that had been done for tobacco control was to ban tobacco advertising to children, require prominent labeling of nicotine and tar levels on packs of cigarettes, and also have ingredients posted for each cigarette brand in places where people smoke? Would we be applauding the declines in smoking rates and lung cancer deaths? I don't think so.
A better set of solutions would start with where tobacco control became so effective - by demarketing tobacco use. Yes, you read that correctly, using marketing not to sell more cigarettes or food, but to reduce demand. How might that look for managing and reducing levels of obesity?
It may be difficult to ban food advertising, but what if all food advertising were regulated so that no images could be used in the ads or on packaging - just text and colors (not just for so-called 'kids' foods, but all foods)? What if vending/self-service machines were removed from all worksites and schools, thus reducing accessibility to foods and impulse decisions? What if food companies began to pay excise taxes on foods that in standard portion sizes (used as intended) exceeded daily standards for calories and sugars (think about the fast food offerings that this would include)? And what if we had a commitment to long-term, multi-faceted obesity control programs that went beyond information and education efforts run by lawyers and focused on increasing the price of doing business in the obesity creation marketplace? That helped communities and states reduce the ubiquity of food choices and access? And worked with organizations and industries, and not just those involved in health care, to increase incentives and opportunities for physical activity that could fit into people's lives and into organizational practices? We might have more than a nimble response, we could actually start bending the obesity curve.