MY STORY, WITH DR. NANCY SNYDERMAN, KATE WHITE,
DR. DAVID KATZ, REBECCA PUHL, DR. EZEKIEL EMANUEL,
REAR ADMIRAL JAMIE BARNETT (RETIRED), MAYOR MICK
CORNETT, DR. ROBERT LUSTIG, DONNY DEUTSCH,
SENATOR CLAIRE MCCASKILL, SENATOR KIRSTEN GILLIBRAND,
JOHN BANZHAF, CHEF LORENA GARCIA
The conversation that Diane and I have been having, and the ideas that experts have shared here about how you think, eat, and move, mirror the conversations I think we need to have as a nation.
Overweight people are in the majority in this country. We need to fix that, but we can’t do it unless we are prepared to have an open, honest, and caring discussion—not one that stereotypes, blames, or disdains overweight people. The problem belongs to all of us, and so does the responsibility to find solutions. We need to face this head-on.
Morning Joe is all about conversation. By talking with people on all sides of an issue, we often find a meeting place somewhere in the middle, someplace we can settle, agree, and move forward. I don’t think we are there yet on obesity, but there is a lot of constructive and public talk going on around the country. Many concerned people are trying to find ways to get us on the right track. I hope that hearing about their attitudes and policies can help us change.
If you’ll pardon the pun, what follows is some food for thought. As I said at the beginning of this book, you won’t agree with me on everything, and you may not agree with some of these folks either, but let’s consider what they have to say. Some of their prescriptions just might work.
A good place to launch a broader conversation about the national obesity crisis is to talk about the ideas we have about a healthy body. That begins with an honest look in the mirror. Although Hollywood stars may seem to be wasting away, most of us are not. “As the population becomes fatter, study after study shows that instead of feeling bad about ourselves, we have entered a collective state of denial about how big we’re actually getting,” writes health writer and blogger Tara Parker-Pope. “While researchers admit that some denial may have to do with personal embarrassment, the consistency of the findings suggests that neural processing and psychology probably both play a role.”1
NBC’s Nancy Snyderman thinks we need to get the word fat back into our vocabulary, and I agree with her. I know that Diane was very hurt when I first told her she was fat, but she now uses the term herself, and it is helping her face her own situation. We should talk about being fat, not to be pejorative, but because we have to tell the truth. By trying to be politically correct and socially sensitive, we end up skirting the whole issue instead.
Clothing manufacturers also help us do that, by allowing women to brag about wearing a size 0 or a size 2, according to Kate White, former Cosmo editor and author of I Shouldn’t Be Telling You This: Success Secrets Every Gutsy Girl Should Know. “There’s been all this downsizing in clothes. I ordered a pair of pants from a catalogue. I put them on and I was swimming in them. And I realized, what used to be my size has now been increased; it’s still the same size but they’ve really blown out the waistline.”
David Katz says that the tendency to tell ourselves little white lies is normal human behavior. “We tend to think we’re an inch taller than we are, and we tend to think we weigh a bit less than we do,” he observed. “We tend to think we eat fewer calories and we all tend to think we exercise a bit more than we do.” When each of us admits the truth about our own body weight, we begin to understand that we have a shared problem.
At the same time, a lot of us struggle to respond in a healthy way to all of the media images suggesting that women who are beautiful must be thin. The average woman in America weighs almost 163 pounds and wears a size 14. So when Ralph Lauren hires a gorgeous six-foot-two model who is a size 12 as the face of his “plus size” line of women’s clothing, he sends a message to every woman about what the fashion industry thinks.
“We have billion-dollar diet industries, billion-dollar fashion industries that communicate the message that women must try to conform to very unrealistic ideals of physical attractiveness,” complains Yale’s Rebecca Puhl. “Thinness has come to symbolize core values in our culture.”
We have billion-dollar diet industries, billion-dollar fashion industries that communicate the message that women must try to conform to very unrealistic ideals of physical attractiveness.
—Rebecca Puhl
What’s happening is that as American women are getting heavier, models and actresses are getting skinnier. Kate White recounts looking at older photographs of Christie Brinkley and Cindy Crawford and realizing that those models “were not skinny, skinny girls. They were very healthy looking, very feminine, and lush almost. When actresses became more of a fashion influence in Hollywood, they got skinnier, too. You look at Jennifer Aniston compared to how she was when she first started in Friends; there’s a big difference.”
Kate says that when she was at Cosmo, “I encouraged our team to use models that aren’t super skinny. I reject super-skinny models. I think it’s important for us in the media to show women who are natural looking, who are curvy, who are more like the Christie Brinkleys who have luscious, healthy bodies.”
I reject super-skinny models. I think it’s important for us in the media to show women who are natural looking, who are curvy . . . who have luscious, healthy bodies.—Kate White
For Kate, it was a matter of showcasing good health—she didn’t want to highlight a super-skinny body, but she was not keen on showing more plus-size models in Cosmo either. “I feel that we’ve run amok in this country with nutrition and food. And the way you deal with it isn’t to say, ‘Okay, well, we’ll start showing people who are putting themselves in health danger,’ just as I wouldn’t show people smoking.”
So how do we start championing bodies that are a healthy thin? For one thing, let’s act on the latest science and start early. Dr. Zeke Emanuel tells me we should get kids on the right path even before they are born.
“We might think of in utero effects,” he explains. “We know that a woman can have a big impact on the size of her baby and the amount of fat on the baby. We may need to think about pregnant women and the diversity and the nutritional content of what they’re eating. We do have some good evidence that once you create fat cells, you can’t really get rid of them, and therefore later in life it gets very hard—not impossible—but very hard to lose weight.”
We might think of in utero effects. We know that a woman can have a big impact on the size of her baby and the amount of fat on the baby.
—Dr. Ezekiel Emanuel
If the tendency to be overweight starts in the womb, so might the craving for certain foods. But people can change their desires, according to Yale Prevention Research Center’s David Katz.
“Taste buds are very malleable little fellers,” he says. “When they can’t be with a food they love, they very quickly learn to love a food they’re with. They like what they’re used to.”
Taste buds are very malleable little fellers. When they can’t be with a food they love, they very quickly learn to love a food they’re with.
—David Katz
So here’s the really good news: research shows that taste buds can be retrained to like better foods in as little as one or two weeks!
“Imagine if all that stands between us and one of the more massive opportunities in the modern history of public health is a hill only two weeks high?” asks Katz hopefully. “How do we help the public understand that they need a week or two to get used to it, and then they’ll spend the rest of their lives being perfectly satisfied with a food that’s much better for them?”
It’s probably not quite that simple, as my own experience with eating mostly healthy foods and occasionally going on a binge suggests. But educating people at every opportunity can certainly help. The messages about food, weight, and health should be coming from lots of different places so that we hear them over and over again.
People who have learned how to eat well, enjoy their food, and maintain a healthy weight can share some of their secrets with people who still struggle. Supermarkets can help by installing interactive screens and other technology so that people know what’s in the food they are buying. Some of the nation’s leading grocery stores are already doing this, and others can follow. One innovation to adopt is the NuVal System, created by David Katz and his team, which scores food from 1 to 100 based on how nutritious it is. NuVal scores are placed right next to the price tags on store shelves, making comparisons easy.
Doctors also need to take more responsibility to educate their patients. Unfortunately, many of them don’t even know where to begin, since only 30 percent of US medical schools require a nutrition course. Most graduating medical students say their nutrition education was inadequate, which tells us we need to do a much better job incorporating it into the medical school curriculum.2
Talking to parents about their kid’s weight makes many doctors particularly uncomfortable, either because they don’t know how, or because they realize it’s going to anger some parents. “I can’t tell you the number of parents who hate the doctor for initiating the conversation, like it’s the doctor’s problem,” Dr. Snyderman says. “But it’s the doctor’s responsibility to be a child’s advocate and call it as you see it. That means getting a kid help.”
If an obese child or adult has a checkup, it should be the first topic the doctor raises. Instead, we have fat people walking into the doctor’s office all the time and it never even gets mentioned. How is that possible? You don’t walk in there with cancer and not have a doctor mention it. They take your blood pressure, check your temperature, check everything else, and weigh you. Then they should sit down and have a talk and explain how you can lose some dangerous weight.
That’s more likely to happen when the businesses that pay for health insurance start insisting on it. A lot of companies are already experimenting with payment plans that reward doctors for preventing illness, instead of paying them for every health service they provide. Some are negotiating insurance contracts that encourage medical practices to improve the way they treat complex chronic illnesses. I’d like to see doctors make more money if they successfully manage interrelated health problems, such as overweight, high blood pressure, and diabetes, as a single package. I’m also in favor of reimbursing employees for seeking out nutritional counseling, and providing discounts on insurance premiums when a worker reaches certain health targets.
All of these are great ways to get people committed to improving their own health, while reducing the cost to employers. Put the right incentives together, and we can create a win-win.
Obviously schools, where our children get 40 to 50 percent of their daily calories, have a big role to play in educating the next generation about food, health, and weight, and in making smart choices available.
It may surprise you, but the military is taking a lead role in pushing for better food in the schools, and I applaud that. “When we have somebody show up at our doorstep who wants to get into the armed forces and they’re overweight, we have to overcome eighteen years or more of lifestyle habits,” says Rear Admiral Jamie Barnett (retired) of Mission: Readiness, the organization of retired military officers that promotes investments in youth. “It’s pretty difficult. We really need to be able to start in early childhood with the right nutrition, the right fitness, and the right development in order to ensure that they have the best shot not only in the military but in the workforce in general.”
When we have somebody show up at our doorstep who wants to get into the armed forces and they’re overweight, we have to overcome eighteen years or more of lifestyle habits.
—Rear Admiral Jamie Barnett (retired)
It’s not the first time military officers have stepped forward with their concerns for our young people. Barnett points out that after World War II, the military helped convince Congress to pass the National School Lunch Act. Back then, too many Americans were unable to serve in the military because they were underweight and malnourished. Now, too many young people can’t serve because they are too fat, so the military is trying to get junk food out of the schools and exercise back in.
“This is a longitudinal problem with a longitudinal solution,” Barnett says. “What we really need to do is start with the kids who are in preschool, kindergarten, and elementary school.”
Retired top brass from all branches of the military are visiting schools across the country, and they tell me they are shocked by what they have seen. One school district in Kentucky didn’t even have an oven in the cafeteria. “All they had were deep-fat fryers. Guess what they were fixing for their kids?” asks Barnett.
That’s pretty basic. I could not have imagined a school district without a stove and other tools to make healthy food.
Along with equipping our schools properly, we also need to make sure that school nutritionists have proper training and authority. I’m not entirely sure what they are doing right now, but I think nutritionists should be holding seminars with students, cafeteria workers, teachers, principals, and school boards to talk about how to make the right food available.
I’m particularly enthusiastic about the kind of work that Venezuelan-born chef, restaurateur, author and television host Lorena Garcia is doing. Lorena goes into the schools to train the staff that actually prepares the food, encouraging them to be creative in making the small changes that can put a lot more nutrients into meals. “We’re really giving them a reason, and motivating them to start cooking a little more with ingredients that they already have, just stepping away from processed foods,” she says.
Everybody should have nutrition, weight, and health in mind when they make food-related decisions for their cafeterias. To me, allowing schools to sell soda, candy, and high-fat snacks in vending machines, or à la carte on the lunch line, defeats other efforts to serve healthier meals in schools. I’d like to see all of that prohibited.
And we have got to put exercise back into the curriculum. So many schools have cut way back on gym classes and recess, and some aren’t offering them at all. “We take normally rambunctious children, send them to school, bolt them to chairs all day long so they can grow up to become adults we can’t get off couches without crowbars, and we medicate them in the bargain,” complains David Katz.
With all the emphasis on test scores, it’s not always easy to sell schools on the need to make time for kids to exercise. But what if kids actually perform better when they have a chance to get some physical exercise during the school day? We should fund research to find out more about that. “Kids need to get up periodically and run around, period, end of story,” says Katz, who is the father of five children.
Katz has developed a novel approach, called ABC for Fitness, which gets kids moving in class. “We developed a program where classroom teachers could dole out activity bursts right there in the classroom for three minutes at a time, five minutes at a time, eight minutes at a time, at their discretion, throughout the day, whenever the kids needed it,” he explained. “We matched the activity bursts to grade level and subject matter, and pointed out to teachers how they could teach during the activity burst.”
To see whether ABC for Fitness made a difference, researchers conducted a study of over a thousand schoolchildren, and sure enough, the ones offered activity bursts improved their fitness, were less disruptive in the classroom, and needed less medication for asthma and attention deficit disorder.3 The program, which is free, is distributed in schools throughout the United States and can be used at home, too.
I love this idea. Kids need to move. They need to sweat. We should be insisting that our schools make that happen.
I’m also really interested in some of the ideas being discussed in urban-planning circles about designing communities for health. We should be thinking more about getting sidewalks throughout our towns and cities, providing safe parks that are easy to get to, and locating schools and businesses within an easy bike ride from residential neighborhoods.
Oklahoma City mayor Mick Cornett emphasized those kinds of strategies at the same time he put his entire city on a diet.
Cornett began his effort in 2005, truly the best of times and the worst of times for his city. Back then, Oklahoma City was getting some attention and respect, showing up on lists like “Best Places to Get a Job” and “Best Places to Start a Business.” But that same year, Men’s Fitness magazine published a list of America’s fattest cities, and Oklahoma City was right near the top.
“It embarrassed me,” recalls Cornett. He was even more embarrassed when he went to a health information website, typed in his height and weight, and discovered that he qualified as obese. “It took that website to point out that I was a part of the problem,” he admits.
The mayor’s first step toward solving it was to put himself on a diet. Then he persuaded a private donor to fund a health initiative, beginning with a website, thiscityisgoingonadiet.com, which offered everything from diet tips and shared journals to corporate challenges and exercise opportunities. Cornett called a news conference at the zoo, stood in front of the elephants and declared to residents, “We’re going to lose a million pounds.”
We’re going to lose a million pounds.
—Oklahoma City mayor Mick Cornett
Forty-seven thousand people signed up, and five years later the city had reached its goal of one million pounds. It was a remarkable accomplishment. What made it work?
For starters, Cornett took a leading role in the conversation and talked about his own story first. If he was going to put his city on a diet, he knew he would have to be honest about himself in the process. “I had to become comfortable talking about weight loss, how personal it is, how sensitive it is, how difficult it is, and my own lifelong struggles to keep my weight off.”
Once Cornett went public with his story, it was as if a light had been flicked on across Oklahoma City. Suddenly, obesity was “okay to talk about at the dinner table and okay to talk about over the backyard fence and at the water cooler at work and at church,” he says. “Seemingly overnight, people were willing to talk about obesity for the very first time in this community.”
The mayor did a lot more than talk. Cornett realized that like much of America, his city was ruled by the automobile. So he gathered city planners and asked them to reinvent the city; instead of catering to cars, he wanted to focus on people. As a result, he says, “We’re putting brand-new gymnasiums in all forty-five of the inner-city grade schools; we’re building health and wellness centers throughout the community for seniors; we’re completing our bicycle trail master plan; we’re putting in new sidewalks throughout the community; we’re putting in a downtown streetcar system to get a head start on mass transit. We are designing a city that revolves around people and pedestrians.”
The restaurant industry has embraced the cause, too. Chefs began offering low-fat options on their menus, and the fast-food industry now advertises its healthier meals and tells consumers how to make better choices.
Even with such a comprehensive approach, the mayor estimates it will take ten years to completely change the city’s culture from one that fosters obesity to one that fosters health and wellness. But the payoff has already started. Oklahoma City is now on the Men’s Fitness list of fittest cities in America, and the mayor says the changes in the environment have attracted an influx of highly educated twenty-somethings. Jobs have followed. A recent study named Oklahoma City the most entrepreneurial city in the country, with the most start-ups per capita, the lowest unemployment in the United States, and what Cornett calls “a boom economy.”4
I totally agree with the advice Cornett offers other government leaders who want to emulate his success. “Most elected officials don’t want to preach the message of what you eat and how much you eat because it seems invasive. Many government initiatives on obesity fail because they end up becoming just exercise programs. That shouldn’t just be a message for overweight people; that ought to be a message for everybody. I think it’s wrong to suggest that obese people can just exercise their way out of obesity. It’s about what you eat and how much you eat, and we have not run from that message.”
New York City’s Mayor Michael Bloomberg is another public figure who thinks that government has a really important role to play in turning back the tide of obesity. He’s my hero because he has gotten out there, ignited a conversation, and has even been sued as he pushes to make this issue a priority.
Under his watch, New York City began requiring chain restaurants with more than fifteen locations to post the calorie counts of their food. At least twenty other cities have followed his example since the law went into effect in 2008. New York also banned trans fat, a solid fat that is a leading cause of heart disease. Other municipalities picked up on that idea, too, and after the ball got rolling McDonald’s and some of the other fast-food chains decided to eliminate trans fat from all their outlets nationwide.
Bloomberg also called on the New York State legislature to impose a tax on soda. That failed to pass, but public health officials and researchers say it would have a meaningful effect on how much soda we drink, and I’d like to see other elected officials take up the issue.
The mayor’s latest accomplishment was to ban sales of soda and other sugary drinks in containers larger than sixteen ounces in restaurants, movie theaters, sports stadiums, and other entertainment venues. The soft-drink industry, joined by other business groups, sued to halt that regulation in October 2012.
I really admire the example Mayor Bloomberg is setting because politicians just have to make this a priority. Some people accuse me of calling for a “Nanny State” by welcoming the government into our supermarkets and restaurants and now, with my support for the large-size soda ban, even movie theaters. But I contend that the government already plays a real big role in how we eat, especially through the massive subsidies it provides to big agriculture. So it is not a new idea to involve government, it’s just a matter of changing the way we involve it.
“The fact is, we already have the nanny state, because we’ve already been told what to eat by the food industry,” points out Dr. Robert Lustig, the pediatric endocrinologist who has called sugar a toxic ingredient. “If you ask me, we’d be better off with a nanny state that has public health, not private profit, as its motive.”
We already have the nanny state, because we’ve already been told what to eat by the food industry . . . we’d be better off with a nanny state that has public health, not private profit, as its motive.
—Robert Lustig
I think the federal government can do a lot more to join the conversation, and to demonstrate the leadership and political will to change some of the policies that promote obesity. We should all be pushing our elected officials to act.
Ed Rendell, the former Pennsylvania governor, and Donny Deutsch were on Morning Joe one day, and as we were chatting afterward, Donny said, “Can you imagine if we could eradicate obesity? Everything else would follow. Our health care costs would go down, and our health in general would be better. Everything would change in this country.”
Can you imagine if we could eradicate obesity? . . . Our health care costs would go down, and our health in general would be better. Everything would change in this country.—Donny Deutsch
He’s right, which is why obesity needs to be at the top of the agenda in Washington. I challenge our politicians to explain why it isn’t. Someday soon, instead of saying “economy, economy, economy” we need to start saying “obesity, obesity, obesity.” We’ve got to. Because, as Senator Claire McCaskill points out, the two issues are so closely tied together. “It would be a relatively painless way for our country to soar with a completely sound fiscal footing if we could put a dent in this increasing epidemic of us eating cheap food in portions that could strangle a horse,” she says. “Making that food primary in our diets is going to break our country if we’re not careful.”
One thing our public officials can do is use the bully pulpit, just as First Lady Michelle Obama has with her “Let’s Move” campaign, which is dedicated to ending childhood obesity. Her initiative includes commonsense strategies to educate parents, provide healthier food in schools, help children become more active, and make sure all families have access to healthy, affordable food.
I believe we also urgently need to change the nation’s farm policy, especially the agricultural supports that make processed food much less expensive than most fresh foods. Robert Lustig maintains that our current approach to crop subsidies makes sweeteners so inexpensive that “80 percent of the food items that are available in the US food supply are currently laced with sugar.”
With a lot of research indicating that sugar can make us sick, Lustig says the government winds up paying twice.
“The government paying for food subsidies is, number one, breaking the bank. We don’t need these subsidies. We don’t have the Dust Bowl. We don’t have farmers who are in trouble. We don’t have a hungry population that needs dried, storable food. Number two, all the disease that comes of it, the government ends up paying for in the form of Medicare and Medicaid. So no wonder Medicare is going broke.”
Meanwhile, average Americans find it harder to afford a healthy diet of fresh fruits and vegetables, and schools struggle to find the funds to comply with new federal nutritional standards. That tells me we should think more about how government can help make good food less costly than bad food. As Dr. Zeke Emanuel says, “We’re not going to be able to raise the cost of school lunches that much, given budget realities, and so we’ve got to think about how we can bring the price of the healthier food components down.”
A lot of people tell me we can do that by overhauling the Farm Bill, which is the key federal legislation guiding agricultural policies in this country. Instead of rewarding huge mega-farms, we should be giving more support to smaller farms, especially organic ones that supply local food networks with fruits and vegetables. If we want families to eat better food, that’s where we should be spending public dollars.
I’m very encouraged to have Senator Kirsten Gillibrand sitting on the Agriculture Committee, the first representative from New York in forty years. She takes a vastly different approach toward food issues than senators who hail from states that produce commodity crops, especially corn, soybeans, and rice. I am with her all the way.
Gillibrand says she wants to “create a framework that’s focused on having safety nets or insurance for farmers when they go through a storm or a bad weather condition that takes a toll on crops. What we’re also hoping to do is enhance programs that are ‘farm to fork,’ getting whole foods directly into our public schools.”
As a mom and a policy maker, Senator Gillibrand is also backing the federal Healthy Foods Financing Initiative. I think that initiative is one of the most important tools for nourishing the 25 million people in America who live in areas known as “food deserts”; that is, inner-city neighborhoods, rural areas, and other communities where good-quality markets don’t exist and people don’t have easy access to fresh, healthy foods. This legislation would provide grants to help existing grocery stores, farmers’ markets, and food co-ops sell fruits and vegetables at affordable prices, and draw new food businesses into areas where they don’t currently exist.
I also agree with the experts who say the government should require better labels on our food and more transparency in the industry so that people have a fuller understanding about what they are eating, and what it does to them. The US Food and Drug Administration is talking about revising the current label and requiring calorie counts to be posted more prominently. I also hope we will see more specific information about sugar content so we know just how much sugar is added to each serving of food. New York Times columnist Mark Bittman has another suggestion I like: put a traffic light logo on the label. A green light would be for food you can eat all the time, a cautionary yellow light would describe foods you should eat only once in a while, and a red light would warn about food that should be avoided altogether.
We also need to push our political leaders to get involved in refocusing the food industry. “We can’t all go back to hunting or trapping or growing our own food,” acknowledges Robert Lustig. Instead, “we need a new food system, one that works for the populace, one that doesn’t overfeed them, one that doesn’t cause significant chronic disease, and one that actually protects the environment. How is that going to happen when the only thing the food industry is interested in is making money?”
The answer is that government has to pressure food businesses, and for that to happen, Americans need to pressure their government. It’s not a matter of what’s in the government’s best interest, it’s what’s in the best interest of the people.
I think that legal action against the food industry is one of the ways we can bring about broader changes. As more conversation about the causes of obesity and disease takes place, and Americans become more educated about the food system, this is beginning to happen. Some of the same lawyers who went after the tobacco industry decades ago are now going after Big Food.
“Fat and food have become the new tobacco,” says John Banzhaf, one of the first attorneys to take legal action against smoking in the mid-1960s. Banzhaf is a public interest law professor at George Washington University and founder of Action on Smoking and Health. “Those legal actions against smoking had a lot to do with changing the mind of the public. In the fifties, sixties, seventies, eighties, even early nineties, most people blamed smoking solely on the smoker. It was his fault, it was his bad choice, it was his lack of responsibility.”
Fat and food have become the new tobacco.
—John Banzhaf
To me, that sounds very much like the way we have looked at obesity.
Initially, nobody thought to lay blame for smoking on the tobacco industry. That began to shift, Banzhaf said, “as the revelations came out about how they promoted addiction, about how they lied, how they were underhanded. I think people began seeing that while personal responsibility plays a role, and people shouldn’t smoke, at least part of the responsibility lay with those who were promoting it.”
Again, I see a parallel with obesity and the aggressive marketing of fast foods. Still another similarity is that anti-smoking measures began to take hold when we discovered how adversely nonsmokers were affected by secondhand smoke. Likewise, as we recognize how the costs of too much weight affect us all, in higher taxes and inflated health insurance premiums, for example—we also recognize that everyone has a stake in dealing with the problem.
By mid-2012, twenty-five lawsuits had been filed against companies like ConAgra Foods, General Mills, and PepsiCo contending that they are mislabeling their products and thus misleading consumers.5 These high-profile cases have forced companies to change, especially companies that value their public image.
“They are much more worried that this is going to hurt them than tobacco companies ever were,” Banzhaf says. “Tobacco companies already wear a very, very black hat. The food companies are reacting to the fact that we are beginning to place a black hat on them.”
While the tobacco industry couldn’t make a less hazardous cigarette, the food industry has a wider range of possible responses. “When you sue the fast food companies they can do things. They are doing things,” Banzhaf says. “They are lowering the calorie count in some of their foods. They have introduced more nutritious entrees. They have provided increased disclosure of fats.”
Walmart is one of the leaders here, reducing the salt and fat in some of the food they sell. “They’re the big gorilla, the single biggest grocery seller in the world,” said Zeke Emanuel. “Their decision will first and foremost shape their private label, but after that it will also affect a lot of the other products they sell. And a lot of manufacturers are going to take the products that they’re selling at Walmart and distribute them more widely. So I’m strongly anticipating a very big effect throughout the manufactured-food industry.”
Still, I wouldn’t expect the food industry to voluntarily make all the changes we need. The lawyers are still likely to have a role. And legal action will eventually lead to new statutes and regulations. “We will litigate until they legislate,” says Banzhaf. “In our country there have been quite a number of movements, including the civil rights movement, which started with litigation, because there was very little public support for significant change. The only way to begin the change, to kick down the door, to arouse public attention, and then get legislative attention was through lawsuits.”
Here it might be helpful to identify some of the new statutes and regulations which have already been sparked by the fat law suits. For example, New York City and then California required the disclosure of calories in foods at many chain restaurants, including fast food ones, and this requirement will apply nationwide in 2014 as a result of the Obamacare statute. More than two dozen jurisdictions now have a tax on or aimed at sugary soft drinks. Many states followed the example triggered by litigation in New York City and are restricting what foods can be sold and/or even brought into schools. Some jurisdictions are prohibiting establishing fast food outlets within x number of yards of schools. And, of course, New York City has banned trans fats in foods and limited the sale of sugary soft drinks in movies and many other venues to only sixteen ounces.
I say it’s time to declare war on obesity. I know it is not going to be easy to win, as Nancy Snyderman explains. “Never before has the human race been threatened by a profound overabundance of food,” she says. “Cheap, affordable, toxic food that coincides with a loss of American sidewalks, the raping of public schools and taking away gym classes, and a technological environment that invites people to do more by doing less. It’s the perfect storm of societal issues that I think will doom the next generation if we allow it.”
Never before has the human race been threatened by a profound overabundance of food.
—Nancy Snyderman
We can’t allow it. The problem threatens our health, our wealth, and our national security, and I’m convinced that together we can make the commitment to solve it. It will take education, government regulations, legal action, and commitment at every level of society, but tobacco showed us how much is possible. At one time, half of all American adults smoked; now fewer than 18 percent of them do. Turning that around took a combination of things.
“It wasn’t just doctors talking to patients, it wasn’t just getting rid of the advertising, it wasn’t just raising the prices, and it wasn’t just changing social attitudes and driving smokers off campuses,” says Zeke Emanuel. It was all of that and more.
So it has to be with food, he says. “We have to get smaller plates, we have to get better labeling, we have to get the price differential reduced so that the healthy thing is not the more expensive thing. All of these things are going to be important in getting our arms around the obesity epidemic.”
• Start talking honestly about what needs to change. Hold constructive and public conversations about weight, body image, and how we produce, distribute, market, and eat food in America. Put the word fat back into our vocabulary and start using other blunt and forceful language. It’s not enough to say “eat more fruits and vegetables.” We also need to say “here are the foods that are killing us.”
• Publicize the costs of obesity. The idea is not to stigmatize plus-size Americans, but to allow government officials and employers to break out their calculators and see whether programs to prevent or reverse obesity are worth the investment.
• Insist that our leaders lead. People with influence and authority at every level—in federal, state, and local government, in the workplace, in the health care system, and in the schools—should help promote the broad changes that will get us on a healthier path.
• Establish a federal obesity commission. I’d like to see smart recommendations, based on science, coming from the top about how to build healthier communities, incorporate incentives for weight loss into our health care system, make healthier foods more affordable, promote behavior change, and much more.
• Fund more scientific research. Losing and regaining weight involves complicated biology, and we need to learn more about that. We also need to understand whether food really can become addictive and what messages will get people to act.
• Overhaul the food climate in this country. There are a million public policy opportunities to make a difference. For starters, we should change the crops we subsidize, eliminate food deserts, revise the food label, and levy taxes on soda and other unhealthy food.
• Educate the public at every opportunity. Our health care professionals should talk about weight with their patients, our markets should install touch screens to provide more information about what’s in the food they sell, and people who have succeeded should share their secrets with those who have not.
• Make our kids the first priority. There is lots more we can do to improve the quality of school lunches, teach kids more about food, and get them moving. Teachers should talk to parents about their kids’ weight. And there is no excuse for selling sugary drinks and snacks in school vending machines.
• Forge a healthful vision in small towns and big cities. Let’s make communities that work—with sidewalks, bike paths, easy-to-access and safe recreational activities, farmers’ markets, and stores that have an incentive to sell fresh and healthy food.
• Celebrate a healthy thin in the media. Enough with the ultraskinny models. Let’s show photographs of what real and healthy bodies look like.