By Jennifer LaRue Huget
Tuesday, August 11, 2009
The solution to America's ballooning obesity epidemic lies not in weight-loss counseling or programs to make people more physically active, Kelly Brownell has come to believe. To effect real change, he argues, we need to shift the economic balance between healthful and unhealthful foods, to curtail the all-pervasive marketing of junk food -- and to tax soda.
Brownell, a professor of psychology and director of the Rudd Center for Food Policy and Obesity at Yale University, has been pondering obesity for decades, trying to tease out its causes and figure out how to counter them. Along the way, he has become a flashpoint figure in the obesity debate and a go-to guy when the media want to chew the fat about fat.
Co-author of the 2004 book "Food Fight: The Inside Story of the Food Industry, America's Obesity Crisis, and What We Can Do About It," Brownell made a splash again in April when his argument in favor of taxing soft drinks sweetened with sugar and high-fructose corn syrup was published in the New England Journal of Medicine. It's an idea he first proposed some 15 years ago; he believes its time may now have come. In addition to the advent of a new federal administration, one he sees as more open to such measures, "what's made it feasible now is the convergence of the bad economy -- states need the revenue -- and the awareness that the obesity problem has stampeded out of control," Brownell says.
The idea is simple: Slap an 18 percent tax on soda, and people will drink less of it. Since increased soda consumption is, Brownell says, one of the main contributors to our rising obesity rate, cutting back should lead to nationwide weight loss. Brownell sees such taxes starting with the states and eventually taking hold at the federal level, much the way tobacco taxes evolved.
Revenue from a soda tax might be used to fund obesity-prevention programs, particularly those aimed at helping kids maintain healthy lifestyles. Better yet: Use soda tax revenue to subsidize farming of healthful fruits and vegetables, just as government subsidies currently support corn that's turned into high-fructose corn syrup, which many blame for soda's insidious effect on our weight. While Brownell says that pledging to use revenue in those ways might make the new tax more palatable to the public, he concedes it would be impossible to ensure the funds would be used for healthful purposes unless such a requirement were written into law.
With or without a soda tax, public health officials and experts have signaled that combating obesity is a top priority. Late last month the Centers for Disease Control and Prevention held a three-day "Weight of the Nation" conference in Washington, bringing together academics, scientists, physicians and public health officials from all over the world.
Research presented at the meeting estimated the 2008 cost of treating obesity-related ailments in the United States at $147 billion, highlighting what a weighty matter obesity has become for the nation.
And the problem is, er, widespread. In late June, the Trust for America's Health and the Robert Wood Johnson Foundation issued a report showing that in 31 states, more than a quarter of adults are obese; in only one state, Colorado, are fewer than one in five adults obese, and in no state had the obesity rate decreased since last year.
Obesity-busting tactics embraced at the CDC conference included encouraging communities to build schools within walking distance of students' homes and making it easier for people to get access to healthful foods. These are in keeping with Brownell's stance that the public-health approach to fighting obesity must shift from treatment of those who are already fat to preventing others -- especially kids -- from getting that way.
But while Brownell is supportive of those community-based efforts, he believes their effects will be severely limited unless big changes are made in the way food is marketed and in the basic economics of food. Until healthful foods routinely cost less than unhealthful ones, getting people -- especially low-income people -- to eat them will remain a challenge, he says.
And unless limits are placed on the marketing of unhealthful foods, the whole anti-obesity effort hardly stands a chance, Brownell believes. "Community programs won't work by themselves" in an environment where industry-funded temptations to eat poorly are constant and pervasive, Brownell says. "How can community programs contend with all that marketing?"
To some critics -- and, I'll confess, to me -- Brownell's approach smacks of paternalism and over-reliance on government intervention. Shouldn't diet and weight be a matter of personal responsibility, not the government's concern? Brownell counters that the ubiquity and marketing of fattening food stack the deck against individual willpower, and their allure is more than many people can resist on their own, no matter how responsible they are.
"If you take lab rats and throw them a bunch of food you got at 7-Eleven, some of those rats will triple their body weight," Brownell says research has shown. "Are those rats irresponsible? When people move to the U.S., they gain weight. Have they become less responsible? We have more obesity this year than last. Are we all less responsible?"
I'll concede that if we individuals are supposed to take charge of our own weight, too many of us are shirking that duty. And obesity's impact on health-care costs makes it everyone's problem, like it or not.
So, if obesity is one of the top public-health issues facing the nation (and the new administration in Washington), what to make of the nomination of Regina Benjamin, a highly accomplished and well-regarded physician who happens to be overweight, to the post of surgeon general? What message does President Obama's choice of her to lead America's public-health agenda send?
"She seems a very kind person who has persevered through very challenging circumstances," says Brownell, who, it bears noting, is not exactly thin himself. "What more do you need to know about a person?"
Benjamin, Brownell continues, "is an excellent role model because she does struggle with her weight. Her nomination underscores that there are better ways to judge a person than by how much she weighs."
Point well taken, Professor Brownell.
Check out Tuesday's Checkup blog post, in which Jennifer invites further debate on the soda tax. Subscribe to the Lean & Fit newsletter by going to http://www.washingtonpost.com and searching for "newsletters."