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Fighting Obesity Like Cigarettes

| May 6, 2012

Would you like some arteries with that?

Since first lady Michelle Obama made childhood obesity her signature project almost two years ago, the issue has had the kind of highly visible national leadership that it previously lacked.

But that isn’t enough, say public health leaders frustrated with the slow progress in stemming America’s obesity epidemic.

Something more ambitious is needed, they argue — something more like the anti-tobacco movement.

The similarities between the two public health challenges are compelling. Tobacco use is the nation’s No. 1 cause of preventable deaths in the U.S., killing 467,000 people in 2005, according to a landmark study by Harvard University researchers. Being obese or overweight caused an estimated 216,000 deaths from heart disease, diabetes and other conditions, researchers estimated, while another 191,000 deaths resulted from being physically inactive – another key contributor to expanding waistlines.

In terms of health care costs, obesity is now the larger concern, accounting for $147 billion to $190 billion in yearly expenditures, compared to $96 billion for tobacco.

After decades of lawsuits, damning reports about industry practices, and stop-smoking campaigns, smoking rates have plummeted, from a high of 42 percent of adults in 1965 — a year after the first Surgeon General’s report on smoking and health — to just over 19 percent today. Meanwhile, obesity has been soaring since the 1980s and only last year reached a plateau, which experts say may be only temporary. Currently, 45 million American adults are smokers, while 78 million adults and almost 13 million youngsters are counted as obese.

Some public health advocates see other parallels.

“When I look at what’s going on with obesity, it reminds me of what was going on with tobacco in the 50s, 60s, and 70s, when there was a lot of emphasis on personal responsibility, voluntary self-regulation, and trying to make safe cigarettes,” said Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco.

That approach didn’t work, and efforts to reduce smoking didn’t really have much success until advocates shifted their emphasis from changing individual behavior to community-based activism and holding cigarette manufacturers accountable for harmful products, Glantz said.

A similar shift is needed today in the fight against America’s expanding waistlines, many experts believe. Instead of approaching obesity as a personal issue, it needs to be redefined as a community challenge that calls for collective action and wide-ranging policy changes such as more informative food labels, limits on marketing to children, and taxes on unhealthy products, they argue.

But there are many hurdles. The scope of the obesity problem is much larger than tobacco ever was: it touches on the food we eat, the beverages we drink, the amount of television we watch, how much we exercise, the way our cities are designed, and more. While the variety of policy changes proposed are therefore broader, the political will to enact them has not materialized, in part because “people don’t yet perceive a significant personal threat,” said Dr. William Dietz, director of the division of nutrition, physical activity and obesity at the U.S. Centers for Disease Control and Prevention.

The issue will take center stage in the nation’s capitol this coming week, as the Institute of Medicine releases a new report on strategies to combat the obesity epidemic, the U.S. Centers for Disease Control and Prevention hosts a major conference highlighting efforts to control obesity, and HBO prepares to air a four-part documentary on the obesity crisis.

As public health experts committed to stemming obesity study the history of the anti-tobacco movement and look to it for guidance, it is helpful to consider some key similarities and differences between these issues.

Children are central. The vast majority of people who use tobacco take up the habit as teenagers, and one-third of kids who smoke daily will eventually die prematurely of tobacco-related illnesses, according to the Campaign for Tobacco Free Kids.

The health impact of obesity is similar: seriously overweight children are at greater risk of developing a multitude of health problems that can continue through adulthood, including diabetes, liver disease, heart disease, joint problems and asthma, and are more likely to become obese adults, a wide body of research has demonstrated.

Preventing harm to young people is a central goal of both anti-tobacco and anti-obesity campaigns.

“First, let’s protect our children,” said Dr. David Ludwig, a child obesity expert at Harvard Medical School, noting that the calorie-laden foods and drinks that kids consume in abundance “are not just neutral — they actively undermine our health by overwhelming fundamental biological pathways that regulate appetite and body weight and by manipulating dietary preferences that may be difficult to change over a lifetime.”

Changing social norms is the goal. Dr. Jeffrey Koplan, former head of the CDC and vice president for global health at Emory University in Atlanta, remembers smoking a pipe while writing up patient notes at a prestigious New York hospital in the 1970s. (He gave up the habit more than 30 years ago.)

Today, that would be inconceivable: Smoking rates have been cut by more than half, intolerance of smoking in public places is widespread and anti-smoking policies are in place at hospitals, workplaces, and venues across the country.

Koplan is convinced the same shift in social norms is called for — and achievable — when it comes to childhood obesity.  “Our (eating and physical activity) tastes, our preferences and our behaviors are learned and can be changed,” he said. It isn’t going to be easy and it isn’t going to be fast, but “we’re dealing with a population that would like to be thinner and that works in our favor,” he said.

We can’t just say no to food. “Tobacco we can get rid of entirely. We don’t need it. It has no intrinsic value. But we have to eat to live and make terms with food as the enemy,” said Dr. David Katz, director of Yale University’s Prevention Research Center.

That makes curbing childhood obesity a much more complicated issue than tobacco use, Katz and other experts agree. The message to kids and their families can’t be “stop, don’t do this,” which is clear and easy to understand. Instead it has to be “make good choices, do this in moderation, set boundaries,” a message that is considerably more difficult to convey.

Our biology works against us. Throughout most of history, humans lived in an environment where food was scarce and hard to get. As a result, we’re primed, biologically, to eat food when it’s available and “we’re very good at storing calories and defending calories once we’ve got them,” said Dr. Stephen Daniels, chair of the department of pediatrics at the University of Colorado School of Medicine.  “In some ways, you could say that our biology is our own worst enemy when it comes to being overweight or obese.”

While smoking is highly addictive, the biological responses attached to eating food are even more deeply rooted in human evolution, Katz and other experts said.

A sense of shame and denial is greater. People’s self-image is intimately associated with their body weight in a way that isn’t true of smoking.

“When you talk to kids who are excessively heavy and break through their protective shells, what you find is that they feel terrible about their weight — they feel in many ways that they’ve failed,” Daniels said.

“Obesity is seen as a pejorative term that people don’t connect with. They think ‘I’m just 30 or 40 pounds overweight, but I’m not obese,’” said Dietz of the CDC. That suggests the entire way of talking about the issue may need be reframed before personal and social change becomes possible, he suggested.

The variety of products is larger. Tobacco is a single substance, with a limited set of companies that produce cigarettes and related products.

By contrast, the food and beverage industry is enormous and makes a huge array of goods that extend into every home, restaurant, convenience store, and grocery store in America. “That makes the [struggle against childhood obesity] much more difficult than the fight against tobacco,” Dietz said.

There is no second-hand smoke equivalent. The American public was alarmed when it learned that the cigarette smoke non-smokers breathed in airplanes, bars and restaurants was dangerous, and that no amount of second-hand smoke was safe.

“The notion that my behavior as a smoker can have an effect on you and can make you sick was critically important in accelerating people’s intolerance of smoking and their willingness to see the government take action,” said Michael Eriksen, director of the Institute of Public Health at Georgia State University.

There is no equivalent in the fight against obesity.  “Your being obese does not affect me in the same direct way,” Eriksen said.

The best argument might be that obesity consumes enormous health care resources, driving up the cost of medical care for everyone, suggested Dr. Robert Lustig, a professor of pediatrics and director of the Weight Assessment for Teen and Child Health Program at the University of California, San Francisco. But others think that is too abstract and will never yield the same sense of personal outrage that the second-hand smoke issue created.

The role of industry is less clear. In the anti-tobacco fight, tobacco companies were painted as an enemy willing to lie and manipulate the American public for the sake of profits. In turn, the demonization of Big Tobacco — made possible by bitterly fought lawsuits and the release of thousands of company documents — cultivated a common sense of threat.

By contrast, public health advocates aren’t willing to turn food and beverage into enemies in the fight against obesity.

“With obesity (as compared to tobacco), there’s a much more nuanced relationship with industry,” said Dr. James S. Marks, director of the health group at the Robert Wood Johnson Foundation. Food and beverage manufacturers, restaurants, and grocery stores all have a vital role to play in making healthier food more widely available, he noted.

“We can’t regulate our way out of this,” said Jeff Levi, executive director of the Trust for America’s Health.  “We need to work with industry cooperatively to help change consumers’ tastes and habits.”

Others are much less certain that the food and beverage industry can be trusted to be helpful partners.

“Some companies are making huge profits off obesity,” said Stan Dorn, a senior fellow at the Urban Institute, a public policy research center in Washington, D.C., “and I worry that people who are focused on anti-obesity strategies aren’t being tough enough on them.”

–Judith Graham, Kaiser Health News

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11 Responses for “Fighting Obesity Like Cigarettes”

  1. B. Claire says:

    ummm ummmmm….what is that…grilled chicken & coleslaw?
    …dear god, must have one right now.

    [ not helping FlaglerLive... :) ]

  2. GoodFella says:

    Its really hard to find good places to eat that are healthy. All the burger joints are out of the question as well as the all you can eat buffets. They market themselves as being “Golden” but all they are doing is adding to the problem. We need to have better importing with other countries to bring in more fresh veggies. This country only uses 1/8 of the global variety of fruit and vegetables. How many obese people do you see in other countries? No where near what this country has, but it is our own fault!!! Ever since the 1950′s and 60′s when convenience food was introduced the problem has been “growing”, no pun intended. We should all boycott burger joints and buffets until they either close down or offer healthier choices with more variety.

  3. tulip says:

    Good eating habits begin with the parents. Too many children are allowed all the sugars, soft drinks, fats,salts, etc. that they want . Then all the same junk food has been allowed in the schools for decades, and no one did anything about it.

    Todays kids don’t play outside and run around, ride bikes—most of them are couch potatoes along with a lot of adults who should know better, so they sit on the thousands of calories they just dumped into their stomachs.

    I feel terrible for today’s young child who is overweight because of their parents. A child has no control of what he/she eats, it’s decided by parents and once the child becomes used to the junk food and extra large portions and soft drinks, they don’t want to revise their eating habits at all, and the cycle continues.

  4. palmcoaster says:

    I can attest about how bad cigarette smoking and fat laden diets do, given just my own family history.
    I am the oldest of a buch of siblings. My youngest brother was born the same day of my fifteen Bday!
    Back then I guest my Dad and Mon didn’t go much to the movies and the catholic church teachings had great influences on my Mom.
    Anyway being the oldest I saw most of my loved brothers and sisters fall into the bad habits of cigarette smoking and/or fat laden over eating. The smokers stayed slim, except some that also overate.
    I am on my 70′s now and saddly I already lost my second sister to heart ailment, diabetes due to smoking and bad diet, my baby brother born in my 15th Bday had 3 heart attacks, no longer smokes, too little too late. The others all have heart ailments, diabetes or high blood pressure. I have none of those ailments why could be? I attribute it to our different lifestyle and outdoors sports and gym.
    I never smoked, thought thru peer pressure tempted often and I have a regime of in as much as possible, healthy diet with home cooking. Going out to eat just occasionally and almost never fast food. Lots of vegies fresh and steamed or broiled in few drops of “olive oil” Red meats maybe once a week or less and in small portions. Fish plenty. Avoid cold cuts, ice cream use yogurt instead .Plenty of salads fancied with Kalamata olives, asparagus, pecans, fruit chunks, avocados and/or beans..Candies almost never as they are replaced by fruit or home made desserts with low fat/ low sugar ingredients. Low fat milk with our morning coffee. No softdrinks just fruit juices, carbonated waters or green tea. Maybe our time may come tomorrow, meanwhile we are still here and… we take no med’s.

  5. Alijane says:

    They should start with Monsanto and their GMO food, then get the corn syrup out of food. Back to basics. The growth hormons used to fatten up cattle and chickens is fattening us up too. They started using it in the 80′s, small wonder we have an obesity problem now – we have been fattened up for the drug companies and medical community to slaughter with taxes and bans.

    Think about it, do your own research, there is a reason for the obesity epidemic. Do not vote to tax any foods manufacturer, the government and drug companies are guilty of this problem too. Taxing only feeds grant tramps like Dr. Glantz who has made a lifetime living sucking free money extracted from other.

  6. devrie says:

    Some studies suggest that there is a correlation between poverty and obesity. Some studies suggest that there is a correlation between stress and obesity.

    What I find intriguing is that at the same time high fructose corn syrup entered our economy and changed agricultural practices, not only did our consumption of fructose-laden sugars increase (in the late 1970′s), but our income to productivity levels changed as well. Obesity skyrocketed in the early 1980′s, and I think in some ways, it has a lot to do with economic and social changes that happened during those times…just when the sugar content of our food increased.

    To suggest that being overweight is simply a matter of will power is to overlook signs that other nations with much lower obesity rates have similar will-powers when their citizens enter western places then gain an average of 30 lbs. Will power is part of it, but we are humans. We are motivated to consume at a very deep level. Some of us are more motivated than others, and our environment only exacerbates that. Add the stress of longer, harder job hours, and convenience foods become primary dietary staples.

    People don’t have to eat Twinkies and potato chips to start gaining weight. A diet of no breakfast, Ramen noodle lunches punctuated by a coke or two and dinners of Hungry Man Microwaveable slop and a glass of cheap wine is enough to push an average sized woman into near-obesity. After a year, she’s more hungry because she’s gained 10-15 lbs. Isn’t anyone else out there noticing the bigness of people who graduated college 10 years ago concerned? Most people who graduated college 10 years ago have gained about 20-40 lbs! That’ so not normal. We accept it as normal, but it’s not. You’re not the norm these days if you’ve maintained a healthy weight, especially if you are a gen-x’er.

    People think Gen x’er’s are lazy because they want to decrease their productivity…but we just want what our grandparents had. We don’t want our school loans paid, nor do we want to eat pizza all day and sit out the couch, yet be magically thin. We want normal food choices, normal work hours, honest (not magnificent…unless we deserve it) wages, and a little time for the family or our personal lives.

    Overworked in America: http://www.motherjones.com/politics/2011/06/speedup-americans-working-harder-charts

    Productivity and the Real Median Family Income Growth 1947-2009: http://stateofworkingamerica.org/charts/productivity-and-real-median-family-income-growth-1947-2009/

    Obesity and Poverty correlation: http://frac.org/initiatives/hunger-and-obesity/are-low-income-people-at-greater-risk-for-overweight-or-obesity/

    Stress and obesity correlation: http://www.webmd.com/diet/news/20070702/stress-unlocks-fat-cells-ups-obesity

  7. History Buff says:

    How about an article telling everyone how the Robert Wood Johnson Foundation has FREE FELLOWS sitting in Mrs O’s office. Then you can explain how Johnson and Johnson which owns at 250 pharmaceutical companies pays them while they make their no-smoke products, Splenda and other products ‘to fit THEIR sales agenda’, along with how they fund their research / grants to universities and marketing to sell their products ……. How about it? When can we see some of what is behind the press releases they do? Even further, how about some knowledge of how much money those noted above have received?

  8. David says:

    How can parents allow their child to to be obese ? Isn’t this child abuse ? With all these parks, beaches, bike paths, and nature walks their no excuse to get out and enjoy the great days in our Sunshine State. Florida has the best climate. Parents it’s time to unplug the video games, turn off the TV’s. take the cell phone ad spent some quality time with your child and do something about this.

  9. markw says:

    And remember, quitting smoking can lead to obesity…….
    Johnson & Johnson Company manufactures anti-smoking drugs (patches, gums, etc) and anti-obesity products like Splenda and Realize brand laparoscopic brand anti-obesity products……which explains why their private foundation the Robert Wood Johnson Foundation (RWJF) provides hundreds of millions of dollars to lobby for anti-smoking and anti-obesity laws….it’s all about corporate profits not concern for health.

    http://cleanairquality.blogspot.com/2011/04/question-of-day-do-smoking-bans-and.html

    http://cleanairquality.blogspot.com/2009/10/covert-smoking-ban-promoter-rwjf.html

  10. Initialjoe says:

    SO, it is really all about eating healthy, eating better, and not eating so many preservatives. It just takes the drive to want to change your habits.

  11. Anonymous says:

    There is no second-hand smoke equivalent. The American public was alarmed when it learned that the cigarette smoke non-smokers breathed in airplanes, bars and restaurants was dangerous, and that no amount of second-hand smoke was safe.

    Err he means we cant find a comparable PROPAGANDA piece to match the JUNK SCIENCE they used against smokers……………..

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