According to a recent report, "F as in Fat" by the Trust for America's Health and the Robert Wood Johnson Foundation, "The number of obese adults...are on course to increase dramatically in every state in the country over the next 20 years." According to their analysis of government data, "If obesity rates continue on their current trajectories, by 2030, 13 states could have adult obesity rates above 60 percent, 39 states could have rates above 50 percent, and all 50 states could have rates above 44 percent."
This sobering news has doctors, health care providers and politicians asking the same questions: how do we prevent this scenario from happening, and how do we help people take control of their health?
America has a long history of solving complex problems. And while obesity is a complex problem about which not everything is understood, it is not beyond the grasp of better understanding and prevention. Over the last several decades, many factors have converged: a reduction in the amount of exercise we get (especially children) fueled by sedentary jobs and the elimination or reduction of P.E. in schools; the explosion of entertainment options that keep us indoors; growing safety issues for children that keep them from being outdoors; and a change in our diets that includes an increase in the number of dietary calories; as well as cultural changes that have led to more dining outside the home.
Despite these environmental changes, one thing remains constant: Weight loss and gain is about energy balance - calories in, and calories out. Recently this point was reinforced on NOVA's website by two obesity experts, Marion Nestle and Malden Nesheim, who wrote, "The easiest way to prevent weight gain is to eat less by choosing smaller portions, fewer snacks, and healthier meals in general. It also helps to be physically active and to monitor weight status with regular weighing." They went on to write - and this is important - "Until research convinces us otherwise, we believe a calorie is a calorie."
These two statements are critical and must factor into the current national policy debate about how we help people understand calories and whether or not government has a role in restricting consumer access to certain calories.
Unfortunately, the hyperbole expressed about why obesity is increasing drowns out reasonable voices in search of workable solutions. One of the loudest and most quoted voices is Dr. Robert Lustig from the University of California San Francisco, who recently said about sugar, "We're being poisoned to death."
He calls sugar "toxic," comparing it to tobacco and alcohol and blames it for the rise in obesity. His number one culprit is soda. (Robert H. Lustig, Laura A. Schmidt & Claire D. Brindis (02 February 2012) Public health: The toxic truth about sugar, Nature, doi:10.1038/482027a)
Variously, despite no actual evidence of causation, soda and even diet soda are claimed to be responsible for heart attacks, stroke, asthma, COPD and even death. Another vocal opponent of soda, Kelly Brownell from Yale University wrote, "To me, there is no difference between Ronald McDonald and Joe Camel. Are we going to have legislation tomorrow? No. But we have to start thinking about this in a more militant way." (Baltimore Sun, Nov. 17, 1998)
Toxic, poison, militant. I reject this rhetoric in the discussion about obesity and encourage you to do the same. Drs. Lustig and Brownell should know better than to make such comparisons. The Rudd Center for Food Policy and Obesity at Yale University was founded with an initial donation of $7.5 million from the Rudd Foundation - created through the passion of Leslie Rudd with funding in large part from his very successful wineries. Wine contains ethyl alcohol, an addictive substance.
The Centers for Disease Control and Prevention recently released a study that finds Americans get almost as many calories from alcohol - approximately 100 per day - as from soft drinks. Does that warrant referring to the vineyards of Napa as toxic? (NCHS Data Brief, No. 110, November 2012, Calories Consumed From Alcoholic Beverages by U.S. Adults, 2007-2010)
The risk of singling out certain foods as unique contributors to obesity and then demonizing those foods and advocating punitive (or "militant") government intervention is that people will tune out the obesity debate at a time when we most need them to listen.
Likewise, regulations that ban soft drinks containing more than 16 ounces lack public support and will do nothing to reduce obesity. New Yorkers immediately saw through what amounts to a gimmick. Americans like choice and the freedom to choose what's right for them. If they don't want the medicine being prescribed, don't believe it will work and don't trust the doctor prescribing it, progress stalls.
On The New York Times Opinionator blog earlier this year, Ronda Storm, a Florida state legislator, was quoted as saying, "It's just bad public policy to allow unfettered access to all kinds of food." And in the same article in The Times, food columnist Mark Bittman wrote, "All of this is part of the bigger question: How do we regulate the consumption of dangerous foods?" Consuming paint thinner is "dangerous." Let's keep things in perspective, shall we?
Denmark's Parliament was hit over the head recently with a big dose of perspective. The country that imposed the world's first-ever "fat tax" only a year ago was forced to repeal it earlier this month because Danes were driving across the border into Germany to purchase their butter and cheese. Or, they purchased cheaper versions. Attempts to restrict "unfettered access" to high fat foods resulted in food inflation and lost jobs, according to the Danish Ministry of Taxation, but not thinner Danes. Having learned their lesson, Parliament also abandoned a "sugar tax" proposal. Unfortunately, these same failed ideas also permeate America's national debate.
Whether it's soda, butter, cheese, wine or beer, no one food is the cause of obesity. For more than a decade, consumption of full-calorie soda has declined 12. 5 percent (Beverage Digest), yet obesity rates have climbed. A study published in the American Journal of Clinical Nutrition in 2011 finds that added sugar calories from soda are down 35 percent since 2000. (Welsh JA, Sharma AJ, Vos MB (2011) Consumption of added sugars is decreasing in the United States, American Journal of Clinical Nutrition, doi: 1-.3945/ajcn.111.018366)
Do the math. It doesn't add up that soda causes obesity. According to a peer-reviewed data analysis in the American Journal of Public Health, total beverage calories in schools are down 90 percent between 2004 and the end of the 2009-2010 school year.
So why is soda the target? It's an easy, well-known target that most Americans enjoy in some amount. But that is not a legitimate reason to try and use it as the lever in the debate over how to reduce our obesity rate.
The answer to the question of how we should reduce our obesity rate is summed up well by Dr. David Katz, another noted obesity expert from Yale who is not an advocate for sugar-sweetened beverages yet wrote in The Huffington Post, "As dietary guidance, the vilification of one nutrient at a time has proven as flighty as hummingbirds, propelling us from one version of humbug to another. My advice is to grasp firmly your common sense, and stay grounded."
Image: Fast food, BKQuadStacker: Mychal Stanley, Wikimedia