LAS VEGAS - Much of the controversy over appropriate public-policy approaches to combatting the increasing incidence of obesity in industrialized countries involves the question, "Is the food industry part of the problem, or part of the solution?"
It's both, said Sylvia Rowe, president of the International Food Information Council, who keynoted the National Automatic Merchandising Association Spring Expo here. IFIC and the IFIC Foundation were established to communicate science-based information on food safety and nutrition to health professionals, journalists, educators and government officials. Its partners range from the American Academy of Pediatrics and the U.S. Department of Agriculture to the Institute of Food Technologists and the Food Marketing Institute, and it is primarily supported by the broad-based food, beverage and agricultural industries.
Obesity is a complex phenomenon, and understanding it requires careful study and well-planned counteraction. "Obesity is a public health issue, but it's driven by politics. It's really resonating with the public," the speaker noted. "We have to bring consumers in, and give them reasons to want to follow the guidance of the premier health organizations."
The problem is real. Rowe recalled that the term "obesity epidemic" was coined in 1998, and public health experts in government and outside of it began to issue calls to action. "It's been out there, and people are more and more aware of it," the speaker observed. In July of 2002, two lawsuits were filed against McDonald's; neither succeeded, but in the second, the court provided guidelines for the grounds on which future suits might be brought.
"The Centers for Disease Control sees obesity as the 'health problem of the century'," the IFIC president reported. "There's talk of the 'tobacco analogy'; this is serious! And it's a worldwide problem. The incidence is just going up most rapidly here," Rowe continued. Ironically, even in developing countries, obesity is beginning to contend with malnutrition as a major health challenge.
CDC statistics that depict the increasing incidence of obesity in the United States are based on "body mass index," and they clearly show an alarming trend, the speaker said. Using projected "risk factor maps" depicting CDC studies of overweight and obesity state by state, Rowe explained that, in 1991, four states , Louisiana, Michigan, Mississippi, and West Virginia , reported that more than 15% of their populations were obese. By 1995, the majority of states were reporting that.
"In 2002, most states found more than 20% of their population obese, and a new category emerged: over 25%," the IFIC president continued. This cannot be accounted for by some sudden mutation; "Nothing has happened to human evolution to explain this," she emphasized. "Our genes don't change that fast."
And it's a real public health challenge, the speaker warned. "If you graph the rise in the indigence of obesity and the incidence of diabetes, the two are parallel," she pointed out. "Type 2 diabetes used to be called 'adult onset' diabetes. Now we're seeing it in children as young as five to ten years old. And it's skyrocketing."
More than 120 million adults are overweight or obese, the IFIC president added; 64% of adults are overweight. There are 400,000 obesity-related deaths a year.
"The government's old, conservative estimate of the economic impact of obesity was $117 billion," Rowe observed; it's closer to $238 billion, according to more recent data, and it will continue to go up, she predicted.
"We can say that adults are responsible for their own behavior, and that's great," the speaker said. "But children aren't; they're seen as victims. Where there are victims, there must be villains. And about one-third of American kids are overweight; childhood obesity has increased 35% since 1991. This has become the principal children's health problem." The Surgeon General has warned that, for this reason, today's children may be the first to have generally poorer health and a shorter average life expectancy than their parents, she added.
Thus the search for villains. "People will look for policy initiatives because of the perception that someone has to pay," Rowe observed.
"Who's concerned about this? Health, science, government, and consumer advocates , who are having a field day; they're the ones who are talking about 'good' and 'bad' foods, and claiming the vending machines sell the bad kind.
"And the food and beverage industries are very aware," Rowe continued. "So, of course, are consumers, and the media. They are listening, both here and abroad."
The media-consumer interaction is particularly worthy of attention. The journalistic community usually tires of a topic after a while, "but this problem is so complex that the media can't wear it out," the speaker emphasized. "I'm a former journalist, and I have to point out that this also is a very 'visual' issue! That's not true, say, of genetic engineering." The public wants to hear about it, and the news media naturally respond.
Many consumers have been interested in weight loss for much of this century, and the currently fashionable low-carbohydrate diets have become intertwined with the obesity issue, again with ample media coverage, the IFIC president said. That interaction has been especially fertile over the past two quarters.
Because the problem is international in scope, the World Health Organization has become concerned. It is planning to publish a "technical report" in final form this spring, and this report examines possible public policy solutions. "It does deal with vending, and it does discuss initiatives like 'fat taxes'," Rowe reported.
A number of federal agencies also have weighed in with their own task forces, the speaker continued. At present, though, there is no coordination among them.
And, responding to public concern, legislatures have proposed measures aimed at solving the problem. In the U.S. Congress, the number of bills introduced to address the obesity issue has risen from none, three years ago, to more than 30 this year. State legislatures, collectively, have introduced more than 180.
Some of these are entirely positive, the IFIC president explained, e.g. calling for once again making physical education a required class in schools. Others are negative, for example those seeking to restrict food and beverage advertising. "There's a lot of 'noise' in all of this," she pointed out.
The Department of Health and Human Services announced the Surgeon General's "Healthier US" initiative in December 2001, and the President's Council on Physical Fitness and Sports (whose origins date back to the Eisenhower administration, and which has been actively supported by every subsequent President) has expanded its communications efforts. HHS recently has teamed up with The Ad Council to create public service advertisements. Examples of these can be viewed online by visiting smallstep.gov.
The Food & Drug Administration has aired a "proposed action plan," which includes requiring calories-per-serving information on food labels, and encouraging restaurants to include this information on their menus. FDA also has launched a consumer education program, "Calories Count." Rowe pointed out that, at least in the United States, government to date has wanted to work cooperatively with industry.
Other groups are interested, too. These include trial lawyers, who have organized conferences (for example, on the recommendations made by the judge in the second McDonald's trial, who suggested that a court might consider arguments that advertising and marketing may induce harmful behavior; that processing can change food for the worse, and that certain foods may be "addictive"). Wall Street securities analysts have ranked companies according to their perceived vulnerability to product liability litigation. Major healthcare providers, such as Kaiser Permanente and the Robert Wood Johnson Foundation, also have organized conferences. Insurance companies are becoming concerned.
Rowe observed that one may assume that many of these entities are well-intentioned, while remarking that they tend to start with the erroneous belief that marketers create, or drive, consumer demand. "In fact, marketers respond to demand," she pointed out.
Allegations that marketing causes unhealthy behavior, or that food can be addictive ("no good science says it is," Rowe noted, "but none says it isn't, either") are part of an ongoing, often diffuse sense that the food and beverage industries are doing something wrong. The resulting attacks have tended to zero in on soft drinks first, but fast food also has drawn a good deal of fire, as have cookies, chips and candy.
Critics have decried increasing portion sizes, and marketing products high in calories and low in nutrients, and those with high "energy density" (like sugar). A former chair of the Committee on Sports Medicine of the American Academy of Pediatrics has charged that 60% of advertisements directed at youngsters on Saturday mornings are for food, and that "this is a national conspiracy against children."
In the United Kingdom, Rowe reported, consideration is being given to curbs on advertising, and on the use of taxation to change food and beverage purchasing behavior.
All of this, the speaker suggested, is part of a modern transition from blaming individuals to blaming society. "We've succeeded in raising awareness about the obesity epidemic," the speaker noted. "But we don't have proven strategies for solving the problem." The perceived need for action is so great that public health efforts will be initiated, even without supporting research, she warned. "Everyone is saying, 'Let's do something right now; it may not help, but it can't hurt.' Thus, proposals to restrict food or restaurant advertising, or to prohibit vending machines in schools."
Most of the solutions proposed so far have been food-based, and inclined to impose "disincentives" to consumption. On an objective view, of course, reduced physical activity would be targeted, not just increased caloric intake. And this might lead to studying the role of television, computers and video games. But these things can be made part of the solution, Rowe pointed out.
"We have to place as much emphasis on 'energy out' as on 'energy in,'" she insisted. "So encouraging increased physical activity is necessary, but it's not enough. We need solutions that are comprehensive and science-based, with a communications plan, and industry action with new products and information. The plan also must be multi-level, involving individuals, families and communities, and it must be sustainable."
In search of such solutions, IFIC conducted a study with 9-12 year olds and their parents and teachers, the speaker reported.
"Teachers said the focus has to be on the home," Rowe said. Thus, IFIC teamed up with the American Dietetic Association, the American Academy of Family Physicians, the American College of Sports Medicine, the International Life Sciences Institute Center for Health Promotion, and the National Recreation & Park Association in a cooperative program, ACTIVATE, to promote healthy lifestyles through nutrition and exercise. The initiative is being funded by food and beverage companies.
IFIC research found that kids relate their weight to their performance and appearance, but not to health and well being. "They associate 'weight' with food, but not with physical inactivity," the IFIC president explained. Parents, too, often do not regard obesity or physical inactivity as health issues. They also are inclined to believe that obese children will outgrow the problem.
To correct this skewed perspective, ACTIVATE launched a professionally designed website, "Kidnetic," intended to attract youngsters and to inform parents. It's online at www.kidnetic.com, and it delivers health information to kids where they are: in front of a computer. It features facts on food, fun, fitness, feelings and family dynamics.
This program also provides a benefit to the industry, Rowe said. It takes the offensive against the problem, with third-party credibility. ACTIVATE is one piece of the puzzle, she suggested, and it demonstrates the benefits of positive industry involvement.
Adult obesity appears to be related to a different perceptual defect, the IFIC president continued. Research with adults reveals that lifestyle demands and time management are key difficulties. Adults are not lacking information and knowledge about nutrition, and physical activity; but they often feel overwhelmed by tasks and duties.
"Why should we care?" Rowe asked. "Because this is the number one health problem , and the number one kids' health problem; and it will get worse before it gets better." If those reasons aren't enough, she warned, the accelerating uninformed reaction presents a clear threat to today's marketing practices.
IFIC offers a chance for the food and beverage industry to step up to the plate and say "we care," Rowe summed up. Information may be had at ific.org, or by calling IFIC at (202) 296-6540. The Kidnetic website also offers a good deal of information for parents and other adults.