Inside the First Lady's Obesity Report

I've finally gotten through the 98 pages of the First Lady's Let's Move task force report on preventing childhood obesity. It's a substantive document. For those who are familiar with the problem and the research, it would be little more than a good introduction to the quandary were it not for its authors and their power to get things done.

First, note the significant focus on parents, babies and their environments: what doctors do and say, what parents are to be told about healthy eating during pregnancy, what government can do make sure nursing parents are eating correctly, making sure that parents without resources aren't penalized for making healthier choices, making healthy food available to parents and increasing the quality of pre-and-post natal health care. The narrative and bullet points are good, but figuring out how to get all of this done will be quite difficult. The new health reform legislation helps, but the obesity epidemic is redefining the term "early onset." Something about that very very early environment -- genes (can't control that!), where parents live, the stress in their lives, how kids are fed, when they're exposed to television, their access to health care, the access to healthy and non-stigmatic cultural norms about body weight, maybe even their exposure to chemicals and lack of sleep -- something, or perhaps everything seems to create the threshold for determining which kids grow up obese and which don't.

On food deserts -- those places where access to healthy food is limited -- the administration recommends "the establishment of regional, city, or county food policy councils to enhance comprehensive food system policy that improve health." This isn't as Orwellian as it sounds. Indeed, anti-obesity activists are realizing that full-scope community-based efforts can be effective: bring every stakeholder, from industry to local government to faith groups to local grocers to social service agencies to the parks departments, into one room, set specific goals based on the community's particular needs, and hold each one accountable for meeting those goals. (Making sure nursing parents have access to proper breastfeeding care? That's the responsibility of group "X," and it will be vetted by group "Y."  Increasing PE at schools? The PTA will hold the school system accountable. And so on.) As simple as this sounds, most cities and municipalities don't do this, or don't even think of doing this. Nor do they convene the kind of task forces that will take the action they should. The most they'll do is maybe order a report and move on to other business.

The First Lady's Let's Move task force's goal is to eliminate food deserts -- places where people must travel more than one mile in an urban area and ten miles in a rural area to a supermarket -- within seven years. This will take money -- more than the government is willing to spend -- to create tax incentives for supermarkets to relocate.

The section on food and beverage industry marketing contains an interesting recommendation. After several planks urging the industry to self-regulate, to limit the licensing of cartoon characters, to establish uniform marketing standards and more, the task force recommends that "[i]f voluntary efforts to limit the marketing of less healthy foods and beverages to children do not yield substantial results, the FCC could consider revisiting and modernizing rules on commercial time during children's programming." Translation: if you don't do it, government will.

Then there's Recommendation 4.9: "Analyze the effect of state and local sales taxes on less healthy, energy-dense foods." This is a way of incorporating ideas about salt and sugar taxes, which the administration officially opposes, although its outspoken CDC director, Thomas Freiden, does not.

"Consumers may, however, be fairly responsive to a price change in caloric-sweetened sodas, fruit drinks, and sports drinks. The extent of the response would certainly be affected by the size of the change in price. Recent research indicates that current state-level tax rates on soda purchases have had a relatively small impact on adolescent and adult weights. But a higher tax rate would likely have a greater impact on consumption, as evidenced by the effects of the substantial rise in tobacco taxes."

No one is going to be raising taxes significantly, so the administration prefers a subsidy-based approach, noting the linkage between corn subsidies and sugar consumption. Unfortunately, getting rid of corn subsidies is beyond the ken of Congress's intestinal fortitude. So what the report calls "additive subsidies" are what's on the menu: "A recent study on the effect of price subsidies on healthy food consumption among SNAP participants suggests that a 10% subsidy for vegetables and fruits would increase vegetable consumption from 1.26 cups to 1.33 cups per day, and fruit consumption from 0.89 cup to 0.97 cup."