The Politics of Fat

[Guest guest]

Sunday, Mar. 19, 2006

The Politics of Fat

Experts say our expanding girth is killing us and costing the health-

care system billions. But is this a problem government can solve? Or

should? The debate grows as we do

By KAREN TUMULTY

These are fat times in politics. Literally. Nearly 400 obesity-

related bills were introduced in state legislatures across the

country last year--more than double the number in 2003. A quarter of

them were passed into law, up from only 12% two years before. In

Washington the word obesity appears in 56 bills introduced during

the current Congress; this, the Wall Street Journal points out, is

fast catching up with the number containing the word gun. Surgeon

General Carmona says obesity is a greater threat than

terrorism. Some public-health advocates have begun urging the

government to put a warning label on soft drinks; others are calling

for a " fat tax " on fast food.

When voters and the possibility of big public spending are involved,

you can be sure the politicians will discover a problem. The stats

are depressingly familiar: more than 60% of us are overweight, and

the percentage of us who are considered obese has nearly doubled

since 1980. Health-care spending attributable to obesity reached $75

billion in 2003, by some estimates, with taxpayers shelling out more

than half of that through Medicare and Medicaid programs. Last month

Medicare increased its financial obligation to the problem by

announcing it would cover bariatric surgery, a procedure aimed at

weight loss that generally costs $25,000 for a simple case.

Government researchers estimate that obesity is associated with

anywhere from 100,000 to 300,000 deaths a year.

Most alarming of all, the rates of obesity among children and teens

have tripled in the past 25 years. Health-care providers say they

are seeing something of an epidemic of potentially lethal Type 2

diabetes, once known as the adult-onset version of the disease,

among children as young as 10 and 11. " Without some intervention,

this is the first generation of young Americans, being born today,

who are expected to have a shorter life span than their parents or

grandparents, " says Arkansas Governor Mike Huckabee, a Republican,

who wrote a book about his 110-lb. weight loss and made a healthy

America his top priority as chairman of the National Governors

Association. That prediction of diminishing life expectancy was

published last year in the New England Journal of Medicine by a

group of university researchers; other experts have disputed it as

overly dire.

Huckabee, who is a possible 2008 presidential contender, has given

state employees in Arkansas exercise breaks instead of smoking

breaks. The state's public school children are screened for their

body mass index, an indirect measure of body fat, and confidential

reports are mailed to their parents. Huckabee wants to experiment

with a system in which food stamps would be worth more if they were

spent on healthy purchases like fruits and vegetables.

Nearly every state has taken some steps on obesity, mostly centered

on children. In the past year, Arizona set nutritional standards for

all food and beverages sold on school grounds. California banned the

sale of junk food as snacks in schools starting next year. Kentucky

requires students to engage in vigorous physical activity for 30

minutes a day or 150 minutes a week and next year will prohibit its

schools from serving that staple of Southern cuisine, deep-fried

foods. land plans to put timing devices on school vending

machines to limit access during school hours. Many states plan to

make nutrition instruction part of their curriculums.

There are certain to be more new rules. For the Governors' winter

meeting in Washington a few weeks ago, Huckabee, who opened the

conference by leading some of his fellow Governors and their staffs

on a 5K run, invited a former fat kid who is also a quadruple-bypass

patient to speak. Bill Clinton related to the problem of weight in

typical feel-your-pain fashion. The two Arkansas pols, longtime

adversaries, have joined together to work toward halting the rise in

childhood obesity by 2010 and reversing it by 2015. " Look at

Huckabee, " Clinton told the Governors. " You've got to consume less

and burn more. There is no other alternative. And to do that, you've

got to change the culture. "

But how? Embarrass Americans into saying no to that second helping

of cheesecake? Taxing calories? Hauling the corporate chiefs of

Frito-Lay and Coca-Cola before a congressional committee, as

happened in 1994 with the heads of seven tobacco companies, and

suing them? There have been many instances in which government has

either rallied a majority to rescue a group of suffering Americans,

as in the War on Poverty, or tried to push Americans out of

unhealthy and expensive bad habits, including smoking, littering,

drunk driving and failing to wear seat belts. All involved some

combination of education, cultural change, legal penalties and old-

fashioned shame.

But obesity does not evoke deprivation, and it's more complicated

than a bad habit: it involves food. The old messages won't work,

says veteran Democratic operative Berman, whose new memoir,

Living Large, chronicles his struggles to come to terms with being

fat. " This is different from second-hand smoke, where you can have a

program of abstinence. You can give up smoking. You can't give up

eating. "

Berman warns that even the best anti-obesity programs won't produce

the gratification that politicians like best: quick results. That's

because our growing waistlines are a product of so much else that is

happening in the U.S. Researchers say it's not a coincidence that

the obesity epidemic has coincided with a growth in the number of

working parents who have less time to prepare meals from fresh

foods; technologies that make it possible to mass-produce packaged

and fast foods in cheap, enormous portions; financially strapped

schools getting rid of their physical-education programs and

playgrounds even as they allow vending machines and food advertising

in their buildings; and computer and television programs that

ensnare kids who might otherwise be playing outside.

Even larger economic forces may play a role. " It seems to be

inextricably bound up to ... stagnant wages in the global economy, "

Clinton told the Governors. " The price of everything has gone up

except food. Food is still a good deal in America. " Rates of

childhood obesity are worst among the poor and are a particular

challenge in immigrant communities--in part because there's no

cheaper dose of assimilation than a trip to Burger King. The New

York Times Magazine reported that a couple of years ago, after

administrators trimmed fat and sugar from menus at schools in Rio

Grande City, Texas, along the Mexican border, students staged

lunchroom protests, hanging signs that read NO MORE DIET and WE WANT

TO EAT COOL STUFF--PIZZA, NACHOS, BURRITOS.

Where government fits into finding a solution is a matter of no

small dispute. After all, it's not like Americans don't have an

inkling why they are getting fat. " People who are overweight know

it, " says Huckabee. " The denial is different from a lot of denials.

We don't deny that it's there. We deny that it affects us. "

That's why there are plenty who argue that the blame--and the answer-

-must lie squarely with fat people themselves. When Iowa Senator Tom

Harkin, a Democrat, attacked junk food in schools two years ago,

then Democratic Senator Zell , whose home state of Georgia is

the location of Coca-Cola headquarters, scoffed, " Our kids are not

obese because of what they are eating in our lunchrooms at school.

They are obese, frankly, because they sit around on their duffs

watching MTV and playing video games, and to do something about that

requires the role of the parents, not the role of the Federal

Government. " His Georgia colleague, Republican Saxby Chambliss, was

equally dismissive of Harkin's plan to set federal nutrition

guidelines for schools: " We would be a lot better off to spend that

$6 million to educate children about what they ought to eat, both in

school and out of school, and if we think that by cutting them off

at school they are not going to go to the 7-Eleven as soon as school

is out and pick up these items, then we are kidding ourselves. "

There was a none-too-subtle message in the title of Republican-

sponsored legislation aimed at protecting the food industry from

obesity-related lawsuits: the Personal Responsibility in Food

Consumption Act of 2005. Nicknamed the Cheeseburger Bill, it passed

last October, with yeas outnumbering nays 2 to 1.

Mindful of anything that may look like the heavy hand of a nanny

state at work, W. Bush's Administration has focused its anti-

obesity efforts primarily on public education. Former Health and

Human Services Secretary Tommy wore a pedometer to tout his

department's Small Step initiative. But pressure for bigger strides

is building. Says Harkin: " This is not just a personal problem. It's

a public-health problem. " He wants the Agriculture Department to

regulate all food--not just meals--being served in schools. The

rules now are set at the state and local levels, with widely varying

standards, although the torrent of state legislation suggests that

everyone is looking to go healthier. Harkin and others want to give

the Federal Trade Commission more say over the $10 billion a year

that the food industry spends advertising to children. Some in

Congress are pushing to require nutritional labeling on restaurant

menus, as was done for packaged foods. There are restaurants that

print the information voluntarily, but the restaurant lobby opposes

requiring it.

Meanwhile, food companies are trying to get out in front of the

issue. Mc's did away with supersizing. Coca-Cola no longer

advertises on television programs aimed at viewers younger than age

12. In its ads on children's television, Kraft pitches white-meat

chicken Lunchables rather than Oreos. Food packaging, from mac-and-

cheese to soup and pancake mix, offers tips for more healthful

preparation.

Big Food is eager not to repeat the mistakes of Big Tobacco, and it

knows that self-regulation is one way to keep the government from

stepping in. What worries the food industry most are the lawsuits

that have begun to move through the courts, often going where

politicians fear to tread. One key question is whether public-health

advocates will succeed in sticking the food industry with one of the

charges that damned the tobacco business: that its executives

knowingly harmed the health of the public--especially children--with

their marketing tactics. Of course, Big Tobacco had the additional

problem that its products are clearly addictive.

Plaintiffs against food companies have had some initial setbacks--in

courts of law and in the court of public opinion. People snickered

when two New York teenagers--one whose regular diet consisted of two

Big Mac or Chicken McNugget meals a day and another who usually ate

a Happy Meal or a Big Mac three or four times a week--sued

Mc's, claiming it had made them morbidly fat. A federal judge

tossed out their case in 2003. But last year an appeals court

revived it and allowed discovery, an unsettling development for food

companies because it could open up their marketing strategies to

public scrutiny. Around the country, state attorneys general,

encouraged by their success in wringing billions from the tobacco

companies, have the food industry in their sights, says Rogan Kersh,

a Syracuse University political-science professor who argues that

the political forces arrayed against the two industries show

striking similarities.

The food fight seems certain to get bitter, whether it is ultimately

fought in the courts or the legislatures or on the floors of

Congress. But there is one thing on which all sides can agree:

nothing will work until Americans are persuaded to change the

choices they are making for themselves and their children. While

some will say the government shouldn't have to pick up the tab for

what people are doing to themselves, Huckabee insists that everyone

should recognize that it already is. " It's not just about coddling

people, " he says. " It's truly about making good business decisions.

The return on investment is significant when you put the focus on

health and wellness as opposed to putting the focus on treating

disease. "