Quotes of the Day
Nutritionist Marion Nestle stares in wonder at the latest bit of marketing wizardry to hit American sweetshops: sour green tamarind-flavored Shrek candies. She pops off the Shrek-shaped cap on a Crazy Hair confection and, after some initial befuddlement (of a kind no one under 12 would suffer), turns a dial on the bottom of the plastic tube. Sticky strands of chartreuse goo extrude through a nozzle and "grow" upward in apparent defiance of gravity. "Wow!" says Nestle, who has a deep appreciation for such ingenuity. She plunges in with a taste test. "Yech! So sour!" she complains. "And it sticks to your hands." Popping on her reading glasses, Nestle, who chairs the department of nutrition, food studies and public health at New York University, casts a practiced eye on the label. "Nothing but sugar, corn syrup and a bunch of food additives," she says, sighing. "What kid can resist this?"
Some 70 miles up the East Coast in New Haven, Conn., psychologist Kelly Brownell pulls out a full-page advertisement he has torn from the Wall Street Journal and marvels over the message. The ad displays a new snack-food product from Frito-Lay called Munchies Kids Mix, packaged, once again, in that child-friendly chartreuse hue. It reads, "Mom and Dad, you'll feel great about offering it to your kids because Munchies Kids Mix is a good source of 8 essential vitamins and minerals, has 0 grams trans fat and meets nutritional guidelines established by [Texas fitness expert] Dr. Kenneth Cooper for sugar, fat and sodium." The snack is a mix of Cheetos, Doritos, Rold Gold pretzels, SmartFood popcorn, Cap'n Crunch cereal and M&M-like candy. "See what we're up against?" laments Brownell, who is director of the Yale Center for Eating and Weight Disorders. "This is being promoted as a healthy product? No wonder people are confused."
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For Nestle (rhymes with wrestle), Brownell and a handful of other researchers and clinicians, the fight to control America's obesity epidemic has become more than a scientific quest for new data and better ways to help individual patients battle the bulge. It has become a crusade to change the way Americans live. The nation's landscape, they argue, is littered with junk food masquerading as health food, candy and candylike cereals featuring kids' favorite cartoon characters and toylike packaging, schools that shamelessly hawk soft drinks and snack foods, and multimillion-dollar advertising campaigns to promote such unwholesome products. Schools, in particular, "have become nutritional disaster areas," says Dr. David Ludwig, a Harvard pediatrician who directs the obesity program at Children's Hospital Boston. Experts like Ludwig and Brownell are equally worried about what's missing from the landscape: sidewalks and bike paths; neighborhoods with safe, accessible parks and stores you can walk to; daily physical-education classes in public schools; and staircases in office buildings. "We've created environments that are hostile to physical activity," says psychologist James Sallis, director of the Active Living Research Program at San Diego State University.
Working in their individual fields — nutrition, psychology, pediatrics — each of these scientists has concluded that it is simply too difficult for Americans to stand up to the many forces that propel them to eat too much and move too little. For decades, they say, the country has seen obesity as a personal problem to be solved by each overweight individual waging a lonely war to trim pounds on the diet du jour. While it's true that we are each responsible for what we put in our own mouth, they note that the personal-responsibility approach has been a big, fat flop. In the past 30 years, the percentage of Americans who are overweight has ballooned from 48% to 65%. The percentage of children who are overweight has tripled, from 5% to 15%, and another 15% are considered borderline.
While biology and personal habits play an undeniable role, there's abundant evidence that environmental factors loom large in the obesity rate. Brownell likes to point to studies of immigrants from low-obesity countries such as India, Somalia and Japan. "When people move to countries where there is more obesity, they tend to gain weight," he notes. "Did they suddenly become less responsible when they moved?" More likely, they are responding to their new environment's cues to eat more calories and be less active. After years of trying to help obese patients lose weight in the land of the fat, says Brownell, "it became clear to me that there was this disastrous environment that almost guaranteed an obese population and something had to be done about it. That's when science became advocacy."
Call them the obesity warriors. Restaurant-and food-industry lobbyists have called them "nutrition nannies" and the "food police." But Brownell, Nestle, Ludwig, Sallis and a few other scientists have stepped out of the ivory tower of academe to challenge communities, industry and government to do more to fight obesity and especially to prevent it from afflicting more children. Taking cues from the battle against smoking, these scientists write books, they lecture at meetings — including food-industry gatherings — they dash off op-ed pieces and they spend generous amounts of time talking with reporters from major networks, newspapers and magazines like this one. What Brownell, author of Food Fight (Contemporary Books; 356 pages), and like-minded researchers advocate is change at every level of society — from local communities and schools to the Federal Government.
They are fully aware of how difficult it will be to engineer this kind of change. Nestle, who served in the Reagan Administration as senior nutritional-policy adviser and editor of the first — and only — Surgeon General's Report on Nutrition and Health, knows that health messages are politically dicey when they concern the mighty food industry. Her 2002 book, Food Politics (University of California Press; 469 pages), documents how those messages get distorted. Still, that doesn't stop her and her fellow warriors from campaigning for action.
A look at their ideas for cleaning up our fattening environment:
Start with the Schools
Nothing infuriates the obesity warriors more than dietary conditions in public schools. "We as a society have really abdicated responsibility for teaching kids how to eat right and how to have an active lifestyle," charges Ludwig, who wants to eliminate "junk food, fast food and soft drinks" from schools. "Students are a captive audience," he says. "Promoting their physical well-being should be part of the school's educational mission." The first step is getting rid of soft drinks, which "are basically candy," says Nestle. "Get 'em out of the schools." Tackling soft drinks alone could make a remarkable difference. Ludwig's research shows that for every additional daily serving of a soft drink, a child's risk of becoming obese rises 60%. The typical adolescent, he says, gets a whopping 10% to 15% of his or her daily calories from soft drinks. If those drinks were replaced by water, far fewer kids might become overweight.
Increasingly, school officials across the country are coming around to this point of view. Los Angeles, Philadelphia, San Francisco, Chicago, New York City and numerous smaller districts have taken steps to ban the sale of soft drinks during the school day (although New York has made the dubious decision to replace soda with sugary Snapple beverages). California and Texas have issued statewide bans on soft-drink sales in elementary and middle schools.
The next step, say Ludwig and Brownell, is to restrict the sale of potato chips, candy and other junk food in schools. Texas, Los Angeles and New York City are leading the way. After that, says Brownell, cafeteria menus should be revised to replace foods high in empty calories with more nutritious fare. Ludwig is eager to eliminate fast-food-type meals from school cafeterias, some of which sell food supplied by McDonald's, Pizza Hut, Burger King and other franchisers. On days when kids eat fast food, they consume an average of 187 more calories than on days without fast food, Ludwig and collaborators reported in a large study published in the January issue of Pediatrics. Since, on average, the American kid eats a fast-food meal 1 out of every 3 days, "this would account for an extra 6 pounds of weight gained a year," says Ludwig. "It's a poor return on investment to fund education by selling this kind of food to kids."
Besides reforms in the cafeteria, obesity experts would like to see changes in what kids learn about fitness and diet. Studies have shown that teaching kids to eat smarter, be more active and watch less TV can have lasting results. The largest school-based health-intervention study ever done was a mid-1990s trial, involving 5,000 children in four states, called CATCH (Child and Adolescent Trial for Cardiovascular Health). Aimed at preventing heart disease rather than obesity, it showed that improvements in the lunchroom, gym class and health instruction could change kids' eating habits and activity levels at school and at home. And the lessons stuck. A follow-up study three years later found that kids who had been through CATCH from third grade through fifth grade still had a healthier diet and were more physically active when they reached middle school than control-group kids.
Some of the most important anti-obesity lessons must be delivered in the gymnasium. Sallis and the others want the nation's schools to revive the tradition of daily physical-education classes and make sure those classes provide an adequate workout. Studies have shown that in a typical elementary-school gym class, each kid engages in moderate to vigorous activity for only about 3 minutes. Sallis' group has devised a program called SPARK (Sports, Play and Active Recreation for Kids) that ensures at least 15 minutes of activity for every child, which has achieved measurable improvements in fitness.
Some parents fear that more time in the gym means less achievement in class, but Sallis' SPARK research suggests otherwise. Academic performance can actually improve with more activity. There may be other benefits as well. Ludwig observes that during years in which phys ed has declined, the nation has seen big increases in attention-deficit disorder and childhood depression. "It shouldn't be so surprising that low physical-activity levels would have adverse effects on a child's emotional health," he says. "Exercise benefits overall well-being, not just body weight."
Community Action
Kids, of course, are not the only ones who can benefit from regular workouts. In a new TIME/ABC News poll, "lack of exercise" was seen as the No. 1 cause of the obesity epidemic, edging out even "poor eating habits." Fewer than one-quarter of the 1,202 adults polled said they exercised vigorously three times a week for at least 20 minutes, as many health experts recommend.
While most people blame themselves for their sloth, obesity experts say the environment plays a role here too. Research shows that people who live in communities where it's easy to walk to stores have lower rates of obesity than folks who must drive everywhere — but 70% of Americans live in what Sallis calls "non-walkable environments" (see "The Walking Cure," page 92). "If we want to stop obesity, we have to stop building the infrastructure for obesity," he says. "We need to re-engineer opportunities for activity back into our environment."
In many towns, this would mean changing local ordinances and zoning laws. And it would cost money. Sallis and other experts on obesity want more federal dollars used to build paths for bikers and pedestrians. How telling, he remarks, that the federal transportation bill now before Congress is called the highway bill. Sallis suggests making better use of one of the few recreational facilities that every community has: schools. "We have many more schools than parks around the country," he says. The challenge is to find funding to keep them open after hours as community centers.
A Role for Government
The most controversial ideas from the obesity warriors call for a greater role for the Federal Government. Ideally, they are looking for action on the order of the 1964 Surgeon General's report on tobacco, which kicked off a national effort to reduce smoking. Obesity, they point out, is on the verge of supplanting smoking as the nation's No. 1 preventable cause of disease and death. Many of their suggestions for federal action come directly from the antismoking playbook.
Idea No. 1 is to ban the broadcasting of junk-food commercials to young children, just as the Federal Government banned cigarette ads from television in 1971."The average child sees more than 10,000 food commercials a year, and most are for high-calorie foods," says Ludwig. The American Academy of Pediatrics has concluded that advertising to children under age 8 is inappropriate, Ludwig says. "It's inherently unfair to market directly to young children, who lack the intellectual maturity to distinguish commercials from the substance of a TV show." Nestle argues that it's unfair to parents too. "Why should you have to fight with your child every day about what goes into the lunch box?" she asks. The restaurant and food industry spends about $13 billion a year on ads that teach children to pester their parents for special foods, she contends. "Children are supposed to have their own foods and not eat boring adult foods. Kids are supposed to have things like Lunchables," she scoffs. "There's your personal responsibility for you. It's your personal responsibility to fight this level of marketing. It's you against them, and they have bigger resources."
Although there is popular support for a ban on food ads directed at children--56% of participants in the TIME/ABC poll said they favor this — it's difficult to imagine the land of free enterprise following the lead of Norway and Sweden, which have banned advertising aimed at children, or Australia, Italy and New Zealand, which have statutory guidelines that limit it. The next best thing, says Nestle, would be a federally mandated campaign of public-service ads that would promote healthy eating and help counteract the effects of junk-food ads. This sort of counterprogramming is exactly what the government required in the late 1960s, before smoking ads were banned from TV. Cigarette use dropped during all four years that the antismoking ads ran.
What sort of message should an anti-obesity campaign send, given that diet experts are still wrangling over such issues as whether low-fat or low-carb diets work better? "How about just eat less, move more and eat your fruits and vegetables?" suggests Nestle. Few people appreciate more fully than she just how difficult it would be for the Federal Government to approve such a message. "Move more" is not a problem. The Centers for Disease Control and Prevention (CDC) has budgeted $193 million for its Verb campaign, encouraging young Americans to be active. "Eat less" is another matter. In the past, federal efforts to tell Americans to eat less meat have been foiled by lobbying from the Cattlemen's Association. Attempts to tell people to eat fewer sweets have raised the hackles of the sugar and corn-refining industries. Ultimately, the government winds up putting out such bland advice as "Choose two to three servings of lean meats" and "Moderate your intake of sugars" rather than a clear "Eat less" message. "If you're dealing with obesity, people have to eat less," Nestle insists. "I'm all for activity, but if one of those 20-oz. soft drinks is 275 calories, that's 2 3/4 miles of walking to get rid of those calories right there. People can't easily do that. People have to eat less, and nobody wants to talk about that."
Nestle's experiences with the Department of Health and Human Services, which runs the CDC, and the Department of Agriculture, which controls the food pyramid, have convinced her that responsibility for messages on nutrition should be moved someplace less subject to political pressure. She is not alone in thinking so. In May, Senators Ted Kennedy and Peter Fitzgerald proposed a bill that would transfer authority to the Institute of Medicine, part of the National Academies of Science. "This legislation would give us a new general in the war on obesity," says Illinois Republican Fitzgerald.
How would the Federal Government fund a national campaign for healthier eating? Once again, the obesity warriors want to steal a leaf from the tobacco wars: if you want people to use less of something, put a tax on it. "Health economists have shown that the tax on cigarettes is the single most effective thing they've done to prevent smoking," says Brownell, so why not tax junk foods or soda? A big tax, like that on cigarettes, would not be palatable, but Brownell believes a small tax could go a long way toward funding anti-obesity campaigns on TV and in schools. Some 18 states, he notes, already place tiny taxes on soft drinks or junk food. Arkansas raises about $40 million a year from a soft-drink tax of about 2¢ a can. Nationally, he says, "we could raise $1.5 billion from a penny-a-can tax on soft drinks. With $1.5 billion, we could create a 'nutrition Superfund' to clean up the toxic environment. You could get Beyonce Knowles away from Pepsi and Shaquille O'Neal from Burger King and have them promote healthy eating instead."
A tax on junk foods? A ban on advertising to tots? A national nutrition campaign advising us all to eat less? Could any of this actually happen? In the days when the Marlboro Man was riding high on the airwaves, Brownell points out, no one thought you could ban cigarette ads. "I don't know at what point the country will be so desperate," says Nestle, but she thinks that point is approaching fast. "If you're a family that has kids with Type 2 diabetes, your life is not going to be pretty," she says. "Nobody has a clue how much this overweight business is going to cost us."
Health economist Kenneth Warner, director of the University of Michigan Tobacco Research Network, remembers when the world thought it was everyone's personal responsibility to cut down on smoking and when the government had little to say on the matter. In many ways, he says, where we are in fighting obesity today is similar to where we were with cigarettes in the early '60s: "We've identified a health-risk factor, but we're only now starting to get serious about conveying its importance and magnitude to the public."
- Claudia Wallis