Health May 2010

Beating Obesity

By 2015, four out of 10 Americans may be obese. Until last year, the author was one of them. The way he lost one-third of his weight isn’t for everyone. But unless America stops cheering The Biggest Loser and starts getting serious about preventing obesity, the country risks being overwhelmed by chronic disease and ballooning health costs. Will first lady Michelle Obama’s new plan to fight childhood obesity work, or is it just another false start in the country’s long and so far unsuccessful war against fat?

But that was before Michelle Obama went public on February 9 with her campaign against childhood obesity. Almost a year earlier, she had decided to make fighting obesity her principal cause: working largely in secret, over a period of about six months in 2009, the first lady’s staff and the White House Domestic Policy Council began to draft a truly comprehensive anti-obesity strategy. They enlisted Cabinet secretaries like Vilsack, who, according to several government officials I spoke with, is willing to confront the agriculture giants that the USDA regulates. Obama herself spent dozens of hours in private conversations with virtually all stakeholders. With health-care legislation stalled, the administration decided to unveil the initiative in early February. It is modest and audacious, all at once. The proposals that Raben and his group pondered have a place in the framework: state and local cooperation, nutrition-labeling standards, money to promote programs to bring healthy food to poor communities, and reforms to the school-lunch program. The goal is to end the epidemic of childhood obesity within a generation.

Like other trademark Obama-administration policies, it is cautious and reliant on consensus. Moreover, Obama’s effort is understandably constrained by the reality of the Great Recession: though it targets “food deserts”—places, rural and urban, where low-cost nutritious food is hard to find—it proposes only $400 million to begin to remedy the problem, a process estimated to cost billions.

And where are the ideas of the CDC’s Thomas Frieden, arguably the administration’s most outspoken anti-obesity advocate? In an article that appeared in Health Affairs shortly after the unveiling of the first lady’s strategy, he advocated, among other measures: instituting “a tax of a penny an ounce on sugar-sweetened beverages”; increasing subsidies for fruits and vegetables; using zoning restrictions to keep fast-food restaurants away from schools; “removing unhealthy foods from all schools, child-care and health-care facilities, and government institutions”; and “completely eliminating” children’s exposure to food advertising on television (which he says could reduce childhood obesity by 15 percent). In February, I asked Frieden about the discrepancy between his approach and the White House’s, particularly on the soda tax. He responded quickly: “Price, if we learned from tobacco, is the single most effective way of reducing consumption, and I think there’s strong evidence that a soda tax would be very effective. But a soda tax is also very controversial and very challenging, and, as with tobacco, a lot of the innovation happens at the state and local level. And I would anticipate that some state or other will likely go before any national level in terms of taxing soda.”

A few weeks after Obama announced her plan, I asked Susan Sher, her chief of staff, whether the first lady was trying to encourage cooperation, rather than attacking the industry for, say, advertising. “It is clear that this is just a first step, and for example, the totally voluntary commitment that the beverage industry made is a terrific first step,” Sher told me, referring to a recent agreement that would put calorie counts on the front of soda bottles and cans and on vending machines. “But the FDA may have more-stringent requirements in the future, so I think that everything that’s happened so far shouldn’t be viewed as the end of the game in any respect. We didn’t make demands, and I think that the first lady is very clear that that is not her role, that you have a lot of federal agencies involved in regulations—the FTC will probably have a say about this as well, in terms of advertising. So this was really a lot of industry deciding, at least at some level, ‘We want to be part of the solution, not just part of the problem.’” A few weeks later, the FDA—led by Margaret Hamburg, another New York City veteran with a strong nanny streak—warned 17 food manufacturers that their food labeling made misleading health claims that needed to be corrected. This was the most significant FDA enforcement action on such matters in more than a decade.

That same day, however, Sam Kass, an assistant White House chef who works with the first lady on food policy, told representatives from the National Restaurant Association in a conference call that the administration did not intend to “demonize” them or “demonize cheeseburgers and soft drinks,” according to a person who attended. (Through a spokesperson, Kass subsequently denied having said this.) Is there a subtle good-cop, bad-cop routine playing out? Yes, a senior administration official told me. “The goal is to use the threat of regulation to prevent us from having to make regulations, which would take more time anyway,” he said.

Even the ever-cautious FTC is poking its head out of its foxhole. At the request of Congress, the agency plans to submit a proposal (with the CDC and other agencies) for new “voluntary” advertising guidelines by July. What happens next will be up to Congress.

The food industry is anxious, in this new regulatory environment, to cooperate prophylactically. Food giants like PepsiCo, Kellogg, ConAgra, and more than two dozen others have created the Healthy Weight Commitment Foundation to promote better diets and more exercise in schools and the workplace, an effort that the Robert Wood Johnson Foundation, among others, has agreed to evaluate. (The way to promote healthy eating, said Kellogg President David Mackay at the launch event, is “to educate, not legislate.”) The American Beverage Association announced in March that its members have reduced the calories in the drinks they send to schools by 88 percent over six years. Major food-service companies have agreed to double the amount of fruits and vegetables they offer on school menus, a deal brokered by the National Restaurant Association. “There is a creative tension here, and the conversations can be difficult,” said the association’s president, Dawn Sweeney, of its negotiations with the administration. “Having said that, we have to have real things to offer, because if regulation is in the offing at some point down the road, we want to be out in front of it.”

Developments like these make the former FDA commissioner David Kessler, a kindly curmudgeon, optimistic. That’s a big change from how he felt a year ago, shortly after his book was released, when we first spoke about obesity. Then, he told me that he wanted to adopt a strategy similar to the demonization of the tobacco industry that culminated in the early 1990s: when consumers learned that the tobacco industry was spiking the levels of nicotine in cigarettes, they began to confront their own addictions with a clearer sense of purpose—and they had a foil. “Everybody knew [smoking] was bad,” Kessler told me. “But until you saw this industry was manipulating the product like it really was a drug, people didn’t do anything about it.”

Now, for the first time since he left government, he senses that the nation’s political leadership seems determined not only to take obesity seriously, but to do something meaningful. And food-industry firms, he believes, are starting to get nervous—a sure sign that they will offer concessions. Momentum, he told me, is finally building in the right direction. The Obama administration, he said, is “pitch-perfect. Everyone knows that this is the first lady’s priority. Everyone knows that it has the attention of the president’s senior staff. And she is the best spokesperson, and the best kind of spokesperson, to help change people’s minds.”

And minds need changing, not only about the causes of obesity, but about the obese themselves—who they are (and aren’t), and what they represent. That message has to come from the bulliest of pulpits: a hugely popular political figure who can help redirect the stigma that brutally accompanies obesity, away from those who don’t deserve it, and toward those who do—like food marketers who deploy psychological deception, or grocers who put sugary cereals where kids are most likely to see them. Those are the people who should feel ashamed. Cooperation and self-regulation are fine places to start, but the success of Michelle Obama’s campaign will ultimately rest on her willingness to name names.

I hope she’s got what it takes. As I write this, it’s one year to the day since I had my surgery. Walking by my office, a colleague calls me a ghost of my former self. So far, at least, that’s still true. But I was very privileged, and very lucky. I had the resources to conquer obesity and all its attendant miseries with major surgery—a choice that we, collectively, should ensure that the adults of tomorrow don’t have to make.

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Marc Ambinder is The Atlantic’s politics editor.

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