Obesity: The Pyramid Is Not Enough

Obesity is weighing on the minds of millions of Americans these days. From the latest diet fad to a popular reality television program where contestants competed to be The Biggest Loser our waistlines seem a national obsession. Despite the attention, however, our national strategies for combating obesity remain fragmented and inadequate.

Obesity exacts a tremendous toll on society, by elevating disease rates and skyrocketing health care costs — at a tremendous burden to taxpayers. The rising rates of obesity among virtually every segment of the U.S. population threaten to make our youngest generation the first in American history to live shorter lives than their parents.

Shelley Hearne is the executive director of the Trust for American Health and a Visiting Scholar at the Johns Hopkins University Bloomberg School of Public Health.

In less than two decades, there has been a 45 percent increase in overweight children. Type 2 diabetes in childhood has risen at an alarming rate. Yet, we still have not prioritized reducing obesity in meaningful ways. In addition to food and nutrition guidelines and educational campaigns imparting the importance of exercise, federal and state governments can and should be doing more to address the contributing factors of this health crisis.

In January 2005, the U.S. Department of Agriculture (USDA) unveiled an updated set of dietary guidelines for Americans. The new recommendations are easy to follow and offer clear and concise strategies for maintaining a healthy lifestyle. However, promoting food groups and switching to whole grains should not be our government's only strategy for fighting obesity.

Maintaining a healthy weight is unquestionably the result of individual behavior. However, the default "eat less and exercise more" mantra has been recycled and reiterated for decades with disappointing outcomes. Clearly, this message aimed at individuals has not worked in isolation. We need to investigate and encourage supplemental policies to address the larger context of how we live, not just what we eat. From sidewalks to school lunches, there is a lot more our government should be doing.

Every level of government, from Capitol Hill to county councils, must promote and enact policies that create an environment conducive to personal success. Yet state policies and programs are often nonexistent or uncoordinated. Federal policy lacks designated leadership and relies on a bureaucratic tangle of involved agencies and departments.

Among the problems are some glaring structural weaknesses in our nation's approach. In October 2004, a report from the non-profit, non-partisan health advocacy group Trust for America's Health (TFAH) examined the government role in fighting obesity. The TFAH report concluded that the current maze of government agencies involved in obesity hinders effective leadership to manage the health crisis.

Instead of the existing federal organizational structure in the fight against obesity, which is unnecessarily horizontal and unwieldy, the Centers for Disease Control and Prevention (CDC) should be designated as the "command and control center" to manage the obesity epidemic. CDC should have the tools and ability to monitor and evaluate state and federal programs and the authority to withhold funds from states not complying with guidelines.

Additionally, TFAH found some seemingly contradictory roles that complicated the structural weaknesses. For example, the USDA, the agency responsible for protecting the market viability of our nation's farmers and ranchers, is also responsible for determining national nutritional recommendations and providing the food content of school lunches. A 2003 U.S. Government Accountability Office (GAO) report on the School Lunch Program indicated that calories from fat accounted for 34 percent of lunches served under the program — above the target ceiling of 30 percent.

The presence of "competitive foods," items like doughnuts or sugar-laced sodas sold on school grounds that compete with government-regulated food and drink products, further complicates nutrition promotion in schools. Oftentimes, competitive foods are typical vending machine fare — high in fat and calories with minimal nutritional value. Healthier choices tend to lose out in competition with these unhealthy and higher-fat options. Yet, the TFAH report found that only 17 states limit access to competitive foods in schools.

Government's role need not be intrusive or limited to the education system. Proactive and creative policies, such as creating tax incentives for employer-provided wellness programs and encouraging public/private partnerships to convert "brownfields," unused or abandoned buildings, into activity-oriented facilities, are among the concepts that deserve further attention. Commonsense measures, such as USDA's plans to simplify and improve food labeling, should also include methods of tying labels to the nutritional guidelines.

While so-called fat actresses and weight-loss shows appear omnipresent on gossip pages and television programs, obesity has not been high on the government radar screen. Without a substantive series of policy initiatives, all the weight-losing reality shows won't make a dent because our nation's taxpayers will surely be the real biggest losers.

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