Government can play important role in obesity epidemic, expert argues

Thomas A. Farley, M.D., M.P.H., Commissioner of the New York City Department of Health and Mental Hygiene, presented the article at a JAMA media briefing.

"Americans consume many more calories than needed, and the excess is leading to diabetes, cardiovascular disease, and premature mortality. Since the 1970s, caloric intake has increased by some 200 to 600 calories per person per day. Although it is unclear how important changes in physical activity are to the surge in obesity prevalence, it is quite clear that this increase in calorie consumption is the major cause of the obesity epidemic—an epidemic that each year is responsible for the deaths of more than 100,000 Americans and accounts for nearly $150 billion in health care costs," writes Dr. Farley.

Many foods contribute to excess calorie intake, Dr. Farley adds, but sugary drinks have drawn particular blame because of the near-tripling of consumption since the 1970s and their association in epidemiologic studies with obesity, weight gain, diabetes, and markers of cardiovascular disease. Also, the size of sugary drinks sold has increased substantially from a standard 6.5- or 8-ounce size in the 1960s to 20, 32, and even 64 ounces today. "The increase in portion sizes of these beverages is important because studies consistently show that when people are offered larger portions they simply consume more without recognizing it and without compensating for the increased consumption by decreasing intake later."

Dr. Farley writes that the food industry is effective at marketing foods with a high-profit margin. "How should government address the health problems caused by this successful marketing of food? To do nothing is to invite even higher rates of obesity, diabetes, and related mortality."

He suggests one option is to encourage food companies to voluntarily alter their products or marketing to reduce health risks. "Food companies understand how customers respond to their products and marketing better than anyone and could make many changes that would promote health. Food companies have indeed been responding to the obesity crisis by marketing products that have lower calorie contents by substitution (as with 'diet' beverages) and more recently by offering smaller portions. However, as publicly traded companies responsive to the interests of their shareholders, food companies cannot make decisions that will lower profits, and larger portion sizes are more profitable because most costs of delivering food items to consumers are fixed."

"The balanced and most effective approach is for governments to regulate food products that harm the most people, simultaneously encourage food companies to voluntarily produce and market healthful products, and then provide information to consumers in ways that facilitate their choosing healthful products."

Dr. Farley cites a number of initiatives taken by New York City to improve public health, including requiring restaurants to eliminate artificial trans fat, working with food companies to voluntarily lower sodium levels in packaged/processed foods, and providing information to consumers by requiring that chain restaurants post calorie counts on their menus and menu boards. These actions followed similar steps to address smoking, which have led to a 35 percent reduction in smoking rates in the city in the past 10 years.

Dr. Farley describes steps taken by the city to address what many believe is the greatest single contributor to the obesity epidemic—sugary drinks. Among the initiatives, New York City supported a 1-cent-per-ounce excise tax on sugary drinks; the city also supported a change in policy on the Supplemental Nutrition Assistance Program that would have prohibited the use of program benefits to purchase sugary drinks; and the city's Health Department proposed a cap on the portion size of sugary drinks served at restaurants. "… the portion-size studies strongly suggest that, with a smaller default portion size, most consumers will consume fewer calories. This change will not by itself reverse the obesity epidemic, but it can have a substantial effect on it."

"Although the idea of government action to prevent obesity by regulating portion size is new, this action is easily justifiable, is manageable by the dynamic food industry, and will be effective in preventing needless deaths," Dr. Farley concludes.

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(JAMA. 2012;308[11]:1093-1094. Available pre-embargo to the media at http://media.jamanetwork.com)

Editor's Note: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.