Paying for the pounds

By Nanci Hellmich
USA Today

What if you lived in a world where your boss handed you a bonus if you lost 20 pounds, or gave you extra time off if you took daily walking breaks? What if every time you bought cupcakes or a soda you had to pay an extra tax, and the money paid for public awareness campaigns on better nutrition? What if your company offered free fruits and vegetables in the cafeteria and charged extra for chips, fries and other fatty foods?

Top weight-loss researchers and consumer advocates are calling for a war on obesity similar to the war on smoking. They say the nation's weight problem needs to be attacked on numerous fronts, as smoking has been for the past few decades.

The potential cost is billions of dollars, and opposition to many measures will be stiff, but the changes could save hundreds of thousands of lives, experts say.

Both tobacco and obesity are deadly. In the United States, cigarette smoking causes an estimated 440,000 deaths a year; an estimated 300,000 deaths a year are associated with extra weight and obesity. About 65 percent of Americans weigh too much, which puts them at greater risk of heart disease, diabetes, arthritis and most types of cancer.

"At first glance, all these changes seem daunting, but 30 years ago no one could have imagined that smoking would be banned in most public places, that there would be very high taxes on cigarettes and that states would have successfully sued tobacco companies," says Kelly Brownell, director of the Yale University Center for Eating and Weight Disorders.

"Things changed with tobacco, and things are beginning to change with food and activity," says Brownell, co-author of "Food Fight: The Inside Story of the Food Industry, America's Obesity Crisis & What We Can Do About It." The book is coming in September.

Changing the environment to fight obesity will be addressed this week at a national food-policy meeting in Washington, D.C., sponsored by the Consumer Federation of America.

The topic also was discussed at a recent meeting of the nonprofit Partnership to Promote Healthy Eating and Active Living.

This country needs to make major changes involving all aspects of society — businesses, schools, institutions, the public and the government, some experts say.

Everybody needs to work together, says John Peters, head of Procter & Gamble's Nutrition Science Institute. "We're not going to solve the obesity problem if we're playing in different sandboxes."

Michael Thun with the American Cancer Society says: "We have to stop blaming the individual. Obesity is a result of the combination of the individual choices we make and the setting we live in. The measures that produce the greatest benefit are the ones that change the environment."

In 1955, 57 percent of men and 28 percent of women smoked cigarettes, he says. But after decades of education campaigns, higher taxes on cigarettes, limitations on where people are allowed to smoke and a shift in the social attitude about smoking, those numbers decreased dramatically. As of 2001, 25.5 percent of men and 21.5 percent of women smoked cigarettes, Thun says.

Encourage more walking

Much can be learned from the anti-smoking campaign, but that effort involved changing only one behavior. Controlling weight is a complex issue with lots of different behaviors.

People need to make specific changes, and then they need the right environment to make those changes, says James Hill, director of the Center for Human Nutrition at the University of Colorado Health Sciences Center in Denver.

Hill and others launched the "Colorado on the Move" program last fall to get people to walk an additional 2,000 steps, or about one more mile, each day. They would like folks to do even more, eventually. Residents of Colorado and several other states and cities are wearing electronic step counters to keep track of how much they move.

On average, people in the United States are gaining one to two pounds a year, and that could be stopped if they walked those extra 2,000 steps, which burn roughly 100 calories, Hill says. "It would be a tremendous victory if we could get people to stop the weight gain."

Businesses, schools and other institutions could help. Hill is pushing for companies to provide places for people to walk and to encourage employees to take walking breaks. Companies also could offer incentives, such as extra days off or bonuses to people who meet their weight-loss, walking or healthy-eating goals, he says.

Teach portions

This country needs to launch a massive public education campaign around the "eat less" message, says Marion Nestle, chairwoman of the Department of Nutrition and Food Studies at New York University. "There is no reason we can't have one, but we never have."

A vital aspect of that campaign would be to teach people about proper portion sizes. "It's something nobody understands," says Nestle, author of "Food Politics: How the Food Industry Influences Nutrition and Health." People need roughly 2,200 to 2,500 calories a day, and they may eat 1,500 calories at lunch.

Many people say they don't have a fighting chance to control their weight in a society that serves cookies the size of saucers and muffins as big as softballs.

Servings are big because that's what people want, says Peters of P&G. "Here's the problem as I see it: Our American view of value right now is stuck in the 'more for less' domain."

The food industry has an important role in reshaping the way Americans think about portions, he says. Peters says companies could help people rethink the value question, possibly putting more emphasis on the experience of eating instead of on convenience and quantity. Restaurants and fast-food chains need to create places where the environment is delightful so people are willing to pay more money for smaller portions.

Start a junk-food tax

One idea that has been hotly debated for several years is called the Twinkie tax, junk-food tax or simply the food tax.

Michael Jacobson, executive director of the Center for Science in the Public Interest, a Washington, D.C.-based consumer group, Kelly Brownell of Yale and others have suggested adding a small tax on high-calorie foods such as sugary soft drinks, candy and some snack foods. Money from the tax ideally would be used to finance programs to improve diet and activity, possibly even for an education campaign on eating less and reducing portion sizes. The taxes wouldn't be high enough to discourage consumption of those products.

"Some states already collect $1 billion annually from such extra taxes on soft drinks and/or candy, but the money isn't earmarked for improving nutrition or activity," Jacobson says. "The money simply goes to roads, schools and other state projects."

But some take issue with this tax. Jim McCarthy of the Snack Food Association says it's difficult to determine which foods would be taxed, and it would be unfair to those that are. He says any tax would create the most financial hardship for the poor.

Sean McBride of the National Soft Drink Association agrees. "We're opposed to these taxes because it's unfair to single out our products."

Jacobson says an easier idea to implement might be to have cafeterias at government offices, businesses, hospitals and other places lower the price of salads, fruits and vegetables or even give them away — and make up the lost revenue by charging more for hot dogs, fries, burgers and other such foods."

Other ideas being discussed include banning junk-food ads during kids' TV programs, offering healthier snacks and drinks in vending machines in schools, building more sidewalks and walking trails, giving insurance breaks to people who maintain a healthy weight, giving government vouchers to lower-income people so they can buy treadmills and other exercise equipment, and letting food stamps be worth more when they are used to buy fruits and vegetables.

No one believes any of these changes will be easy to make.

"In the '80s, the public health community mustered the courage to say 'Tobacco is the enemy, and we're going to do something,' " says Jacobson of the Center for Science in the Public Interest.

With food, politicians in every corner of the country are involved, Jacobson says. For that reason, he says, it may be easier to encourage physical activity than to try to discourage people from eating unhealthy foods.

Taking sides

Brownell of Yale University says that food companies and lobbying groups representing industries such as snacks, soft drinks and sugar may resist many proposals. "On one side of the fence are public health crusaders, and on the other side of the fence are the food companies," he says. "And the question is, where does the government fit in? I think the government is more on the side of the food companies."

In the middle are people whose taste preferences and activity habits are deeply ingrained, he says.

"We're not on opposite sides," says Gene Grabowski of the Grocery Manufacturers of America, the trade group that represents brand-name food companies. "We want the same things. We want long-term solutions to the obesity problem. But we don't think banning foods or taxing them out of existence will really work. We believe the solution lies in providing good information to parents and their kids so they can make smart choices among the variety of foods that are available."