Let’s face it, so many of us battle an addiction to junk food. As a kid, I loved Hostess chocolate cupcakes. In college, Cap’n Crunch fueled many a group study session. As an adult, I mostly eat healthy foods – except for chocolate chip cookies. And an occasional ice cream. And . . .
For many Americans, junk food – foods high in calories, sugar and fat but low in nutritional value – is the staple of every day’s diet. And it shows.
There is no denying that we face an obesity epidemic in our country. Nor is there any denying that pervasive obesity is having an belt-busting impact on health care. Health care costs attributable to diabetes alone – according to the American Diabetes Association – account for 1 in every 10 health care dollars annually. That doesn’t even count lost time from work, reduced productivity and other economic consequences of the disease.
So, what is wrong with the idea of regulating junk food as a means to better health? When New York City Mayor Bloomberg recently proposed outlawing jumbo-sized sugary soda drinks, he ignited a firestorm. The proposal had nothing to do with outright banning Coke or Mountain Dew, but libertarians barked anyway at the idea of any government encroachment into personal choices.
What about my personal choices? Dietary decisions are a significant cause of obesity, which leads to higher rates of chronic disease, which leads to greater demand for health care, which leads to super-sized health care costs. Widespread obesity in our country, in short, affects us all.
One can understand why the makers of sugary cereals and king-sized candy bars and fast-food burgers would balk at any suggestion that these foods be regulated. But why isn’t there greater attention to how reasonable regulations would control junk food? After all, less junk food means more people would lose weight, the incidence of debilitating cardiovascular diseases would drop and the health cost savings would be immense.
The fact is we do not have a completely free market when it comes to certain potentially harmful consumer goods. We accept, perhaps grudgingly, sometimes extensive and intrusive regulations on certain products, notably cigarettes and alcohol. Even though they are legal, we limit who can buy these products, where they can be consumed, how much can be purchased at one time, who can have access to them, and how these products can be advertised. There is no doubt that these regulations have reduced consumption and the varied costs associated with excessive drinking and smoking.
So why not with junk food? Deborah Cohen, who has a masters in public health, and Lila Rabinovich, of the RAND Corporation, have written an article for the Centers for Disease Control and Prevention’s publication, Preventing Chronic Disease, in which they imagine how junk food could be regulated in ways similar to the ways alcohol is regulated. (Here is a link to the article: http://dx.doi.org/10.5888/pcd9.110274)
There are obvious distinctions to draw between food and tobacco and alcohol, the authors acknowledge up front. First, tobacco use, we now widely accept, is adverse to good health, even in small quantities. Alcohol use provides perhaps a better analogy to food because moderate use of alcohol is less likely to produce adverse health effects. It is the overuse of alcohol, as with low nutrient foods, that leads to health problems with all of the attendant social consequences and costs.
The authors question whether well-meaning policies and programs to reduce rampant obesity in our country can be effective without some rethinking of the role of regulation. Most programs assume that with greater education and awareness, people will make more conscious and rational decisions about their food choices. In other words, if people only knew better what they were eating, they would make more health-conscious choices. The authors note that there is little convincing evidence that community-wide programs, for example, to increase access to fruits and vegetables and to provide for menu labeling, have been effective.
Counteracting programs like Michele Obama’s anti-obesity initiative for kids, are powerful market forces that necessarily are more interested in selling more pizza doodles and chocolate snack cakes and 99-cent tacos than the public’s health. The fast-food industry alone, according to a recent analysis by Yale University’s Rudd Center for Food Policy and Obesity, each year spends $4.2 billion – that’s billion – on marketing.
“Given the magnitude and cost of the growing obesity epidemic,” Cohen and Rabinovich declare, “society must go beyond current thinking in addressing the problem.”
The authors examine five different kinds of regulations that currently apply to alcohol and imagine how these could be implemented with food. Density regulations, for one, limit the number of licenses for the sale of liquor. Studies show that areas with higher density of alcohol outlets also have higher rates of violence, drunk driving and other alcohol-related injuries. So why not regulate junk food by limiting the number of junk-food outlets in a particular geographic area?
Which comes first, a person’s hunger-driven desire for a Big Mac or the ubiquitous presence of junk-food and fast-food outlets? The authors posit that limiting “the density of food outlets, in particular outlets that primarily sell food items high in calories and low in nutritional value, could help reduce consumption of such foods.” Requiring a license to sell certain kinds of food, would also effectively limit the types of places where junk food was available, such as gas station mini marts.
Another type of regulation widely applied to the sale of alcohol is portion control. This is the sort of initiative Mayor Bloomberg has proposed for New York. Alcoholic products are classified by the percentage of alcohol and a standard alcoholic drink is defined by federal regulation as containing 0.6 ounces of alcohol. This leads to standardization of drink sizes for beer, wine and even hard liquor. This, in turn, bears on how drinks are priced and sold, which, in turn, has a direct effect on consumption.
Portion control regulations could fairly easily be implemented with food, the authors explain. Studies clearly show that portion sizes have dramatically increased over the years, leading to changing perceptions of what a single portion is and, therefore, what a normal meal should look like. By defining portions of certain foods y content of sugar or calories, could reduce the amount of junk food consumed. One would still be free to consume more portions, but there would more clearly be a price associated with that additional consumption.
The authors also explore other sorts of regulations commonly applied to alcohol that could work as well in reducing consumption of junk food, including pricing measures, warning labels, and restrictions on displays of junk food in retail stores. Would such measures work? This is, of course, difficult to say. When it comes to alcohol use, the authors note, “Alcohol-use control policies have not eliminated problems related to alcohol use but have kept the problems under control in localities where the policies are strictly implemented and enforced.”
We have to do something. We are the fattest country on the planet and the obesity epidemic is spreading like a plague. Judging by the eruption of complaints from some quarters in New York to the Bloomberg soda proposal, one would expect resistance to broader restrictions to be intense.
The greatest opposition, of course, would come from the same companies that have billions to spend on advertising. No one spends that kind of money on marketing, unless the expected profits justify that investment. The food companies and other junk food retailers would not quietly accept such limitations on their bottom lines.
What are the alternatives? If we continue to allow complete freedom to consume unlimited quantities of unhealthful food, will we slim down on our own initiative? If we don’t find ways to restrict access to food that literally is killing millions of Americans each year, will we be able to stomach the enormous cost this imposes on all of us?
Whose freedom is really at stake? The recommendations in Cohen’s and Rabinovich’s article warrant serious consideration.