I hope you're still thinking of that child I wrote about yesterday. In my article on obesity, I tried not to bias the writing by unveiling my own set of policy preferences. There was plenty of Marc Ambinder in that thing. But I do have some ideas, actually, that flow from the reporting I did. And I have reason to want to circulate the ideas. It's not particularly because they are novel or profound, but because I sincerely believe that the problem I outlined is fixable. That's good news. Here's some more good news: I think we can significantly reduce the incidences of childhood obesity without too much sacrifice. We can make a difference within even the narrow confines of American politics. We can make a difference even though social inequality is a fact of life and even though the nuclear family has dissolved for many of us and even though the concept of a dinner table, of a family meal, is an artifact of an earlier era.
There will be trade-offs, and some people will have to do more to help other people, but there is nothing profoundly redistributive about these interventions, nothing terribly inconvenient, nothing that will impinge upon the choices that adults make -- nothing that's going to prevent a kid from eating an occasional Twinkie. Indeed, the fact that we can solve this problem fairly easily means that if we dawdle and don't, we ought to be ashamed of ourselves. So here's what I'd like to see:
1. Universal access to quality pre-and-post-natal care for mothers in chronically stressed, underserved communities. The correlations between a mother's nutrition consumption and how a child is nourished for the first year of life and obesity are quite strong. Pregnant women, particularly younger pregnant women, don't experience their pregnancy with any significant degree of social or community support; they don't nurse their child with access to health care, or to a support system or feedback system that guides them.2. Congress should ask the Federal Trade Commission to begin a rule-making process to ban food companies from advertising unhealthy food to kids under 10 or 12. The industry will probably respond by establishing (another set of) voluntary guidelines, which will progressively tighten as the rule-making progresses. Make the implementation of the rule contingent of the industry coming up and complying with its own set of rules, and perhaps monitored by an independent panel appointed by the Institute of Medicine. If the industry resists, ban all food advertising aimed at kids, and aggressively enforce the ban. Drawing lines with be difficult, because one person's advertising "aimed" at kids could easily be claimed to be "aimed" at teenagers or adults. Come down on the side of the kids. Prevent ads from airing during "family" hours. Be creative. Let's have this debate again. Marketing practices need to be revised.
3. The government already highly regulates foodstuffs and the content of school lunches. The political will exists to streamline and clarify these regs, and to prevent food companies from finding loopholes. No new regulations are needed; regulations that comport with the 21st century reality of education are required. We can regulate less, if we want to, but regulate better, if we want to.
4. Significantly increase training for all primary care physicians, OBGYNs, NPs and GPs in obesity prevention. Pay particular attention to cross-cultural differences in the perception of obesity, and drill into the heads of these docs that the WAY they interact with their overweight or obese patients has TANGIBLE effects on the quality of their health care.
5. I'm skeptical about a tax-based (Pivgovian) approach to obesity control, but the truth is that no one really knows what will happen. So I wouldn't be opposed to an experiment -- to a state that wants to try a soda tax and see whether it works. More federal funding for experiments, more private funding for experiments, rigorous randomized, placebo-controlled double blind trials for behavioral interventions, if possible. Another idea: why not try to come up with economic incentives for parents to better monitor their kids' eating habits? Don't know how that would work, but it really hasn't been tried.
6. Stigma. So
long as our mind's default reaction to fat people is disgust, it will
be very difficult to get rid of fat stigma. The partial solution, if
there is one, is to recognize that we react in a certain way, and try
to consciously counter our reactions. One way to do this is to instill
in kids from an early age a sense that SOME marketers and food companies and
fast food places are trying to manipulate them into overeating -- into
becoming addicted, in a way, to their foodstuffs. Make distinctions between good companies and bad companies. This isn't broad demonization, per se -- it's simply a better way to rechannel the
negative feelings towards fat we feel organically. Let's also reduce
the stigma for gastric bypass surgery. I've done my part, here.
The procedure can help a lot of people today who are shy about even
researching it on Google. Learning about it will help everyone
understand why obesity is so challenging.
7. Unless we convert Congress to a unicameral legislature, we're not going to get rid of corn subsidies and sugar price supports anytime soon, and the market will remain distorted in a way that promotes obesity. So as long as we're going to be distorting this market, let's distort it in a way that promotes healthy eating: add subsidies for farmers' markets, fruits, vegetables, etc.
8. Teach kids how to cook. Jamie Oliver is on this one already. It's a great idea.
9. Increase funding for community-based experiments that focus broadly on lifestyle, including movement and urban planning and collective responsibility for the health of individuals. There's some evidence that this type of approach works, and it allows for flexibility and regional/culture difference. It avoids the heavy hand of government. Done properly, it reduces the environmental pressures and provides the foundation for parents to make better choices and be rewarded, socially and even financially, for those choices. Everyone gets involved, from schools to police departments to churches to garden clubs. For examples, look to successful experiments in France, Newark, Somerville, Massachusetts, Louisville, Kentucky and elsewhere. Where the government can play a role, it can do so through the creation of a Millennium Challenge type of organization that grants funds and serves as a repository for best practices. Get the president involved: have him travel to the communities that do the best job.
10. End food deserts: places where access to quality food is a mirage. (Visit an American Indian reservation and you'll see how devastating these deserts really are.) This requires government intervention in the form of money and pressure on the grocery industry. It may result in higher unemployment and some cultural disruption for owners of bodegas; we need to recognize this trade-off and see if we can incorporate the displaced people into the solution.
So those are ten ideas.
What are yours?