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Barred from indulging in public spaces // taxed on their habit // targeted by public health campaigns // shunned socially?

The Future of Obesity?

By Charles Slack and Deborah Kelly // Summer 2009
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obesity as a public health issue

Andreanna Seymore/Photonica/Getty Images

You can still see it on YouTube. In 1968 a heavily medicated William Talman, known to almost everyone as Hamilton Burger, Perry Mason’s foil on the long-running television drama of the same name, spoke in a public service announcement as photos and home movies of his family appeared on the TV screen. He didn’t really mind coming up short in those fictional courtroom battles, Talman said, but now he was in a fight he didn’t want to lose. “I’ve got lung cancer,” he explained. “So take some advice about smoking and losing from someone who has been doing both for years. If you don’t smoke, don’t start. If you do smoke, quit. Don’t be a loser.”

Six weeks later, Talman was dead. But he won his case. The war on tobacco and smoking he helped kick off has been extraordinarily successful. In 1971 the U.S. government prohibited cigarette advertising on television, and the decades since have seen a steady, concerted campaign by public and private health organizations and local, state and federal lawmakers. They have sought to make cigarettes more expensive and inconvenient (through higher taxes and greater restrictions on where smoking is permitted) and to drive home the health risks and hygiene consequences. Once considered the quintessence of cool, lighting up has become a social faux pas, discouraged by withering glances and thank you for not smoking signs. Ashtrays, once a fixture even in nonsmoking households, have all but disappeared. Manufacturers have been subjected to increased, and ever more successful, investigations and lawsuits—with huge monetary awards often used to fund further antismoking efforts.

Smoking, of course, remains a major public health issue, with an estimated one in five American deaths caused by such smoking-related illnesses as lung cancer, obstructive pulmonary disease and coronary heart disease, according to the American Lung Association. Yet per capita consumption of cigarettes dropped from 4,345 in 1963 to 1,691 in 2006. And the percentage of U.S. adults who smoke has fallen by more than half since 1965, to a level of around 20%.

Could a similarly concerted effort by government and health organizations make progress against another kind of epidemic? More than a third of American adults and more than one in six children are obese, according to the Centers for Disease Control and Prevention. They have a body mass index of 30 or higher. (A man six feet tall, weighing 222 pounds, has a BMI of 30; so does a five-foot-five woman weighing 181 pounds.) And their obesity puts them at high risk for an array of serious health problems, from heart disease and diabetes to hypertension, liver disease and many types of cancer.

In some places, the antiobesity effort has already begun. This fall parents of public school children in Massachusetts won’t just learn how their son or daughter is doing in math and social studies; they’ll also find out the child’s BMI. In New York City, restaurant chains have been required since 2008 to post calorie counts for every item they serve. And scores of municipalities have banned junk food from school cafeterias.

Even as such initiatives gain momentum, there are questions about the parallels between smoking and obesity and about whether a campaign against our collective girth makes sense. Whereas tobacco is an addictive but physiologically unnecessary substance, food is, of course, essential to life. You can’t go cold turkey on protein, fats and carbohydrates. And while smoking represents a single substance (tobacco) delivered primarily through one product (cigarettes), food comes in almost infinite varieties, each with its own nutritional values and risks.

Moreover, tobacco presents a component—secondhand smoke—that makes it ripe for legislation. Many of the most aggressive initiatives have been justified because smoking represents a public health hazard to innocent bystanders, including children. Although research by scientists, including Nicholas Christakis of Harvard and James H. Fowler of the University of California, San Diego, suggests that people influence the obesity levels of those in their “social networks,” that’s not as compelling as the notion that kids in smoke-filled public spaces greatly increase their risk of lung cancer.

Could a combination of public health messages, food industry regulation and healthy lifestyle promotion help stem the tide of obesity-related illnesses? Should we even try, or would the effort infringe on personal freedoms? Can we at least find a way to help children and the poor—two demographic groups that are particularly susceptible to the messages of a fast-food culture? Should we make it less socially acceptable to be overweight, just as smokers have been made personae non gratae, or do we need to be more forgiving, to counter the stigma and the discrimination increasingly connected to obesity? Or should we, to paraphrase a recent political catchphrase, sue, baby, sue?

Those are some of the issues addressed by eight experts who are vitally interested in the obesity question.

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1. The End of Overeating: Taking Control of the Insatiable American Appetite, by David Kessler [Rodale Books, April 2009]. Kessler, a pediatrician and FDA commissioner under Presidents George H. W. Bush and Bill Clinton, explains the science behind appetite and food cravings, noting that highly palatable foods containing sugar, fat and salt activate the brain’s reward center and trigger overeating. He argues that changing one’s behavior is the key to reversing the obesity epidemic.

2. F as in Fat: How Obesity Policies Are Failing in America, by S. Vinter et al. [Trust for America’s Health, August 2008]. This fifth annual report documents the fact that the rate of obesity has increased in 37 states and recommends that federal policymakers join with state and local governments, businesses and schools to craft a national strategy aimed at combating the trend.

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