Indulge This: What The Anti-Obesity Movement Can Learn From The Defeat Of Big Tobacco

Rep. Henry Waxman has been working to curb the effects of tobacco on American consumers for three decades, so it goes without saying that today's passage of the bill to regulate tobacco -- today's overwhelming passage -- is a personal victory for the long-time legislator from California. Waxman details his struggle to regulate the industry in a new book, The Waxman Report, that he co-wrote with my Atlantic colleague Joshua Green. Lest you think I'm shamelessly inviting you to sample the wares of a colleague, you're absolutely right. But the book's chapter on tobacco is relevant to many of the topics I regularly write about.

When Waxman came to Congress, tobacco was ordinary. That nicotine was addictive, and that smoking cigarettes led to numerous health programs -- well, everyone kind of knew that. The American Public Health Association had been crusading against the industry since the 1950s. But the political environment that greeted Waxman -- and tobacco's cultural role -- made it next to impossible to make headway on an issue that Waxman saw as an urgent public health crisis. He points out that the tobacco industry had extremely powerful and well-funded lobbyists in Washington, D.C., whereas the public health community couldn't catch up. He noted that the tobacco industry routinely encouraged members of tobacco-producing states to join the energy and commerce committee, which oversaw tobacco regulation, in order to water down anything that might come down the pike. Many members of Congress smoked. Addiction was considered a personal matter -- failure of willpower for those who smoked too much. Little attention was paid to the socialization effects of tobacco advertising and the aggregate costs to our nation's health care.

The tobacco industry consciously cultivated the idea that regulation amounted to a reduction of choice. And they partnered with entertainment vehicles to produce iconic figures like Joe Camel and the Marlboro man "that were designed to be cultural signifiers of cool." [Note: J. Green had to have written that sentence, right?] They were ubiquitous in Washington, so much so that Waxman had a relapse. He found himself addicted to smoking, once again.  

Waxman writes of a few victories during the 1980s, mostly involving warning labels on cigarettes and Dick Durbin's successful ban on airplane smoking. In the 1990s, the "balance of power began to shift" for three reasons. One: the media started to investigate claims that the industry routinely misled consumers and the government. Two: Bill Clinton appointed a crusading FDA commissioner who proposed to regulate tobacco like a drug. And Three, the Environmental Protection Agency classified secondhand smoke as a "Class A" carcinogen. The floodgates opened, as whistleblowers began to out themselves and tobacco industry scientists began to speak to the media.  

State attorneys general wanted in on the act and began their own investigations; state governments got it in their heads that they could reap the benefits of prophylactic efforts by tobacco companies to forestall tougher regulation by settling expensive lawsuits. When Republicans took control of Congress in the mid 1990s, the push for federal legislation slowed, but states, much to the ire of Waxman, brokered the now infamous $368 billion deal with the industry. Federal reformers and anti-smoking crusaders believed that Big Tobacco had gotten off easy. In response, President Clinton's FDA tried to regulate tobacco unilaterally; the Supreme Court ruled that an act of Congress was needed. In 2009, with an activist Democratic Congress and a pro-regulation president, the day -- today, in fact -- is finally here.

Smoking became a social illness and was therefore subject to culture and social pressures. The model of blame moved from personal to communal; lobbying efforts against regulation were gradually overwhelmed by the weight accorded to the scientific community; the mainstream media played a significant role in disseminating information to the public. The industry gradually lost power, but it would not lose this fight until the American people elected a Congress and a President who favored an activist government.  

Apply that lesson to the debate over obesity. The same cognitive frames apply; lawmakers, supported by the food and agribusiness industries, see obesity as a personal issue, one where willpower and individual choices matter. Science sees obesity as a complex epiphenomenon. Our health care system has few incentives to fight obesity; health insurance have few incentives, right now, at least, to proactively cover preventative interventions, like paying for personal trainers and nutritionists for the slightly overweight. The food industry lobby is huge and powerful; the anti-obesity lobby is correspondingly weak and not terribly sophisticated.  Many health economists and scientists believe that action is needed now, but if the tobacco model repeats itself, it may be a while before something -- whatever that something is, because there is no consensus -- gets done.