When Harkin was chairman of the committee, he drafted the USDA’s budget for the federal school-lunch program. Last spring, Harkin introduced a bill that would regulate the snack machines outside cafeterias that are such a prodigious source of calories for kids. For years, he has championed efforts to standardize and make more visible the nutrition content on food labeling. (The evidence that this particular intervention works is scant; in general, people who are already healthy are the ones most likely to read food labels.) In 2004, Harkin asked the FTC to study the potential effects of an advertising ban; in 2008, in a follow-on study that Harkin also pushed for, the agency found that marketing to kids was pervasive and damaging, even as it stated, without irony, that most large companies were beginning to take their “self-regulatory obligations seriously.”
The mash-up of congressional health-care drafts, endorsed by President Obama this February, contains several worthy anti-obesity initiatives. Insurers would now be required to pay for obesity screening and counseling. Medicaid programs would be required to cover obesity counseling. The bill includes billions of dollars for community health centers, and it experiments with so-called Safeway grants for small employers to create employee-wellness programs. Safeway, the grocery giant, says it has reduced its health-care expenses by providing financial incentives that encourage employees to, among other things, shop around for medical care, give up smoking, lose weight, and lower their blood pressure and cholesterol. We don’t yet know whether employees are healthier over the long term, whether the program is fair to poorer employees, or whether, if implemented nationally, this approach would save as much as Safeway’s CEO suggests. Still, it’s an experiment worth funding.
States and cities have come up with some of the best structural initiatives. In Pennsylvania, for example, the state has partnered with nonprofits and supermarkets to open high-quality food stores in underserved areas. In Louisville, Kentucky, housing projects, including the one where Cassius Clay grew up, have been redesigned with a focus on health. In one, wide sidewalks ring the perimeter so families and kids can walk in groups with less fear of crime. Near the boxer’s childhood home, the local sanitation department has cleaned the soil of toxins for the creation of a community garden. And there is a farmers’ market at a school across the street every Saturday. With the strong leadership of the mayor, the blue-collar city of Somerville, Massachusetts, lowered the rate of obesity in its elementary schools by promoting exercise in schools, smaller portions in restaurants, health counseling, and biking and walking to school. (The Robert Wood Johnson Foundation supported all three of these initiatives.) Kenneth Warner, the dean of the University of Michigan’s School of Public Health, sees obvious parallels with the war on tobacco: “When you look at the most important development in tobacco control, aside from taxation, it’s the smoke-free laws for workplaces and public spaces: they started out in a few localities, many of them in California,” he told me. When I spoke with him last fall, he was skeptical that the federal government would be a leading force for change.
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.