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Let's Move (faster) on childhood obesity

Michelle Obama chose well and aimed high when she took on childhood obesity four years ago.
First lady Michelle Obama hosts local children on the South Lawn of the White House in Washington, Tuesday, Oct. 11, 2011, as they attempt to break the Guinness World Records title for the most people doing jumping jacks in a 24-hour period. (Photo by...
First lady Michelle Obama hosts local children on the South Lawn of the White House in Washington, Tuesday, Oct. 11, 2011, as they attempt to break the...

Michelle Obama chose well and aimed high when she took on childhood obesity four years ago. There is no clearer threat to America’s long-term health, and no question about the need for collective action. A third of the nation’s children are now overweight and 17% are obese—a threefold increase in just four decades. Kids haven’t changed fundamentally since the 1970s, but their world has. It’s now a carnival of cheap calories—brightly packaged, aggressively marketed, nutritionally bankrupt—that make healthful eating an unlikely act of resistance. “We need you all to step it up,” the first lady urged food manufacturers after launching her “Let’s Move” initiative in early 2010. “We need you not just to tweak around the edges but to entirely rethink the products that you’re offering, the information that you provide about these products and how you market those products to our children…What does it mean when so many parents are finding that their best efforts are undermined by an avalanche of advertisements?”

That bold spirit vanished at critical moments during President Obama’s first term. Despite some major advances in food policy—notably an overhaul of the federal school lunch program and a national rule requiring chain restaurants to post calorie counts on menus—the administration has dropped or delayed other nutritional measures to appease the food and beverage industries. And Let’s Move has become more a jumping-jacks campaign than reform movement. With guns, immigration and climate change crowding the president’s second-term agenda, health advocates fear that food and nutrition issues may be sidelined yet again. But with focus and resolve, this administration could still reverse the obesity pandemic. Here are three ideas that stalled during his first term, and some prospects for reviving them in the second.

1. Stop pushing junk food on children.

The first lady’s “avalanche” quip wasn't just hyperbole. The nation’s food and beverage makers spend nearly $2 billion a year targeting children and teens, and the impact has been extensively documented. “There is strong evidence that television advertising influences the food and beverage beliefs, preferences and requests of children ages 2–11 years,” the Institute of Medicine (IOM) declared in a 2006 report. Specifically, the IOM’s expert panel found that “television advertising influences children to prefer and request high-calorie and low-nutrient foods and beverages.”

Some countries regulate child-targeted ads, since kids lack the skills to assess them critically, but U.S. policymakers have generally stuck to voluntary measures. The 2006 IOM report urged industry to “work with government, scientific, public health, and consumer groups” to stop undermining children’s health—adding that if voluntary efforts failed to “[shift] the emphasis away from high-calorie and low-nutrient foods and beverages, Congress should enact legislation mandating the shift on both broadcast and cable television.” In the wake of the IOM report, Congress directed four federal agencies to establish voluntary standards to help the industry improve its record on child advertising. The agencies—CDC, FDA, USDA and the Federal Trade Commission—formed a working group, which reported back in 2011 with some proposals for public review.

The group’s report set out two simple ideas: first, that “foods marketed to children should provide a meaningful contribution to a healthful diet,” and, second, that food makers should minimize ingredients that “have a negative impact on health or weight.” Specifically, the agencies proposed that foods hocked to children include at least one healthful ingredient (such as a fruit, vegetable, nut, seed, or low-fat dairy product), and minimal amounts of salt, sugar and unhealthy fats. In an April 2011 press release soliciting public comments, the group stressed that “the proposed principles are voluntary and do not call for government regulation of food marketing.”

Even so, the food makers took the report as a declaration of war. Over the next few months, they mobilized congressional allies to condemn the proposals as an attack on free speech and a back-door scheme to ban products. Some 40% of all House members and 30% of senators wrote letters of condemnation, according to an analysis by the Sunlight Foundation, and industry executives descended on the White House. Meanwhile, 97% of public comments on the proposals were positive. But instead of defending the effort, the administration folded its hand. “This was a modest initiative,” says Margo Wootan of the Center for Science in the Public Interest (CSPI), “but the opposition was the fiercest I’ve seen in 20 years here. The industry came down hard and no one seemed to push back. The White House just went silent.”

A few months later, in December 2011, Congress effectively killed the initiative by demanding a companion study of the potential costs to business. No one expects that to happen—federal health agencies aren’t equipped to cost out food companies’ manufacturing options—but the administration could take other steps to keep the issue alive. Obama could work to seed new technologies that let parents block junk-food ads from their televisions—a prerogative that even libertarians might welcome. And though the administration has ceded oversight of marketing practices, the president could the industries accountable simply by speaking out as he has against the gun lobby.

The food makers have taken steps to police themselves since the IOM first sounded the alarm in 2006. Recent research by the Federal Trade Commission shows that the industry's Children’s Food and Beverage Advertising Initiative sparked some welcome improvements from 2006 to 2009. But the progress has been modest. In a 2009 analysis, CSPI found that most of products blessed by the industry failed to meet a single third-party benchmark for nutritional quality.

2. Turn the food stamp program into a nutrition program.

Five years ago, Congress renamed the nation’s 49-year-old food stamp program to reflect a basic fact of 21st century life. “The challenge for low-income families in today’s food environment is [no longer] obtaining enough food,” Dr. David Ludwig of Boston Children’s Hospital wrote recently, but to find “dependable access to high-quality food.” Hunger was still pervasive when Congress passed the National Food Stamp Act in 1964, but the mass production of low-quality food has changed the face of poverty. A low-income child is now seven times more likely to be obese than underweight. By re-branding the food stamp program as SNAP—the Supplemental Nutrition Assistance Program—Congress acknowledged that food stamps should actually nourish people. And with 47 million Americans now relying on food stamps, up from 27 million at the start of the recession, the stakes could hardly be higher. If SNAP promoted healthy food, it would change the nation’s diet. Unfortunately, it often does just the opposite.

SNAP is by far the biggest of the federal government’s three major food programs. During Obama’s first term, both the National School Lunch Program and WIC (which serves women, infants and children) were revamped to combat obesity and support good nutrition. But aside from its bans on tobacco, alcohol, vitamins and prepared food, SNAP still lacks nutritional standards. One result is that it bankrolls some 20 million servings of soda and other sugary drinks every day—at an annual cost of $4 billion. Besides lacking nutritional value, sugar-sweetened beverages are the biggest single source of excess calories in the American diet. As Yale University obesity expert Kelly Brownell observes, the soda subsidy promotes obesity and chronic disease among people who are at increased risk of both. Yet to date, the Obama administration blocked all efforts to redirect the money.

True, the politics are difficult. When New York City proposed a pilot study to see what would happen if it dropped sugary drinks from its SNAP program, anti-hunger groups protested as loudly as the beverage industry. The New York initiative would not have reduced anyone’s benefits, but the advocates saw the measure as paternalistic and discriminatory. With the soda industry taunting the city for trying to “tell people what they can and can’t drink” and hunger groups saying the exclusion would trample the rights of the poor, the USDA rejected it, citing easily resolved technical challenges, a lack of “clear evidence that small businesses would not be disproportionately affected,” and its own preference for incentives over restrictions.

The soda subsidy won’t end anytime soon. USDA has now rejected nine out of nine state efforts to discontinue it, and health advocates aren’t in a position to force the issue during the second term. But there are other ways to put some N into SNAP. In a recently published report, a coalition of leading nutrition experts offers 10 good suggestions. The first is simply to preserve the program’s funding—a critical priority when one American in seven lacks steady access to nutritious food. Others include rules to ensure that retailers carry fresh produce, expanded discounts for healthful foods, and a restoration of SNAP Ed, a nascent healthy-eating initiative that got slashed by a third during last year’s budget dramas. “It’s challenging to eat well if you can’t spend your day preparing food from scratch,” says Tracy Fox, a Washington-based food policy consultant. “SNAP Ed was just starting to help people deal with that issue when the rug got pulled.”

3. Devise a nutrition label that promotes healthy eating.

If you like to construct mental spread sheets, the nutrition labels on packaged food can come in really handy. Suppose you’re shopping for crackers. First you plot out the total amounts of fat, cholesterol, sodium, potassium, fiber, sugar and protein you’ll need over the course of the day. Then you decide how much of each nutrient you’d like to get from crackers, and add those percentages to the ones you’ll draw from other foods. Presto—you’ll see how this brand of cracker suits your lifestyle. To compare several brands, you simply repeat the process for each. If you stick to the same assumptions about the non-cracker portion of your diet, the calculations will show how each candidate cracker affects the bottom line.

Alas, few of us shop this carefully. By buying the most expertly marketed products, we end up over-consuming calories, sodium, sugar and unhealthy fats while scrimping on other nutrients—a tendency that has huge collective consequences. Health officials have long dreamed of a clear, simple rating system that would help consumers size up a product’s overall nutritional value at a glance. At the government’s behest, experts convened by the Institute of Medicine have now devised a system that could revolutionize food shopping by scoring packaged foods on three simple criteria. Under the proposed regimen, detailed breakdowns could still appear on the back of the pack, but every product would sport a simple, standardized rating—from zero to four points—right on the front of the package.

Manufacturers and interest groups have recently festooned packaged foods with their own front-of-pack seals of wholesomeness. If the FDA adopted this one, it would replace them all with one easy-to-read label listing calories and three “nutrients of concern”—salt, sugar and unhealthy added fats. And instead of detailing grams, milligrams and percentages of daily values, the label would simply indicate whether the three ingredients were held below reasonable thresholds. A product could earn up to three points, which would appear as instantly recognizable stars or checks or rhino heads. And if a product exceeded any single threshold egregiously enough, it would forfeit all its points. Soda, for example, would sweeten itself off the chart despite low levels of sodium and an absence of fat.

The manufacturers have dismissed the IOM’s three-point plan as unnecessary, claiming that their own “facts up front” labeling scheme better addresses consumers’ needs, but they’ve shown none of the vitriol that greeted the child-marketing proposals. Some experts predict the industry will be content to soften the front-of-pack standards rather than kill them. And any objective standard will give manufacturers a strong incentive to formulate healthier products. “It’s like a dance,” says Ellen Wartella, the Northwestern University psychologist who headed the IOM’s labeling panel. “Once the music starts, companies won’t want to be left out.” But that assumes the White House will let FDA press the initiative. The IOM submitted its proposal 15 months ago (in October 2011), and the FDA has yet to respond. The agency hasn’t signaled its plans (the labeling issue doesn’t appear on its 2013 legislative calendar), but it has begun some consumer research, and Wartella remains optimistic. “I don’t read the silence as rejection,” she says. “We suggested that they study this before putting anything out.”

A four-year term can slip away fast, and the new administration’s faces tough choices about where to invest its finite political resources. But the obesity pandemic warrants more than a well-intentioned awareness campaign. If recent trends continue, the number of obese American will rise by 65 million between now and 2030. Millions of today’s children will experience disability and early death from cancer, diabetes, heart disease and stroke, and the associated health care costs will approach $68 billion. The forces driving this scourge are now deeply ingrained our economy and our politics. Taming them will take intense focus and a stiff spine. But if the administration can reassert the spirit of Let’s Move’s heady debut, progress is still within reach.