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Big Food Has Become a Big Problem

Politicians and health officials must address pandemic obesity.

November 28, 2002|Ellen Ruppel Shell | Ellen Ruppel Shell, author of "The Hungry Gene: The Science of Fat and the Future of Thin" (Atlantic Month Press, 2002), is co-director of the Knight Center for Science and Medical Journalism at Boston University.

Al Roker, the amiable "Today" show weatherman, and Rep. Jerrold Nadler, a Manhattan Democrat, recently revealed that they had undergone stomach-reduction surgery for their morbid obesity. They had struggled with obesity all their lives and had tried many remedies without success. So they each took extreme surgical measures because, like an increasing number of Americans, they saw no alternative.

Each year, obesity claims about 300,000 American lives and soaks up about $120 billion in health-care costs. Yet, as a nation, we have done almost nothing to combat it.

That Nadler's twin brother is also obese is not surprising. Scientists have known for decades that obesity has an important genetic component, a fact made irrefutable by the discovery of the obese gene at Rockefeller University in 1994. Subsequent research points to the increasing role of genetic factors.

Yet with more than 30% of Americans obese and fully two-thirds overweight, we continue to consider obesity a lifestyle choice rather than the public health disaster it has so clearly become.

Gastric bypass surgery is increasingly being performed on children, a practice whose potentially dangerous consequences are unknown. What we do know is that American children are becoming overweight and obese at an alarming rate, with fully 15% in the danger zone. As a consequence, obesity-linked disorders are increasingly common in the young, among them Type II diabetes, a devastating and costly disorder that until just a couple of decades ago was almost unheard of in children.

In "Illness as Metaphor," Susan Sontag wrote: "Any important disease whose causality is murky, and for which treatment is ineffectual, tends to be awash in significance." Obesity fits the bill. Mythology shrouding the disorder has muffled sensible discourse and, until the past decade, stymied research.

But in recent years, obesity science has exploded, offering startling new insights into the genetic, prenatal and environmental factors underlying body weight regulation. We now know that obesity is the consequence of environment acting on genetic inclination, and that genetic predisposition combined with an increasingly "obesegenic" environment underlies the current pandemic.

Some of us are more vulnerable to the environmental effects than others, but none of us is immune.

Anemic public service messages such as eat "five a day" (referring to servings of vegetables and fruits) do little to counter the temptations launched -- and aggressively marketed -- by a rabidly competitive processed-food industry.

Big Food is a cunning manipulator of public opinion, characterizing its critics as a conspiracy of "food cops, vegetarian activists and meddling bureaucrats" intent on using "junk science" to build a "nanny state."

But eating decisions, like all decisions, are molded by available information. Advertising is by far the most potent source of information when it comes to food. It's time to counter industry influence with a vigorous public information campaign based on the new science of appetite regulation.

Big Food argues that Americans are free to make healthy food choices, knowing full well that its incessant and cleverly designed messages are dissuading a growing number of us from doing so.

In the last decade, the restaurant and processed-food industries have increased substantially the sugar and fat load of their offerings. Cheap fat and sweeteners bulk up portion sizes, giving the perception of value at very low cost to producers. The marketing of these products, especially to children, has grown from vigorous to relentless.

Scientists now believe that eating large quantities of fat and sweeteners may -- for at least some -- muffle biochemical signals that tell the brain when we have eaten enough and that this effect is magnified by a sedentary lifestyle. This effect is probably genetically mediated, and some of us will feel the brunt of it more than others.

But as the food supply becomes increasingly rich, and our lives increasingly sedentary, more and more of us will have difficulty regulating our appetites and controlling our weight.

By regulating food advertising to children and subsidizing the production of fruits, vegetables and other unprocessed foods, government could go far toward reversing this vicious cycle; studies make clear that all of us make food choices based partially on cost.

Obesity is not just an individual problem but a tragedy of the commons. Getting a grip on this costly pandemic will require making tough personal choices, certainly, but also tough public ones. Aggressive public health efforts must become the first line of defense. It is time for public servants such as Rep. Nadler to make the personal political.

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