Beating Obesity: An Update

A few months before she left office, Secretary of State Condoleezza Rice held an unusual meeting at the State Department. Her guests included the secretary of defense, Robert Gates, food company executives, and anti-obesity activists. The subject was the supply and production of food worldwide. The subtext, as Gates himself put it at the meeting, was that "food is a security issue."

One of the food company executives reminded Gates that President Franklin D. Roosevelt felt the same way on the eve of World War II, only that the balance of calories was inverted at the time. Too many would-be soldiers were malnourished and had iron deficiencies. The government partnered with industry to create the National Nutrition Committee on Defense to, essentially, stoutify the Greatest Generation.

The military faces a similar problem today, only it goes beyond the inverse of Roosevelt's dilemma -- teenagers are out of shape -- and extends well beyond the U.S. borders. The global food supply chain and the incentives that shape it are indeed a security issue. China's rising consumption of breads and grains has a direct impact on the ability of African countries to manage famines. Global climate change means that the rest of the world will come to depend more on the breadbasket countries of the Northern Hemisphere, the U.S. being one of them. And then there's obesity, a complex manifestation of 30 years' worth of domestic and global policy choices, technological developments, and cultural habits.

The First Lady, Michelle Obama, intends to significantly reduce the incidences of childhood obesity. Most of her public appearances are dedicated to the problem. As a direct result of her leadership, the United States is, for perhaps the first time ever, taking a leadership role in defining the boundary conditions for fighting a chronic condition. Obama plans several high-profile international addresses in the coming months, including one at the United States in September.

Her activism comes at a moment when the growth rate of obesity is slowing, almost everywhere -- even in Greece, where it had been notoriously hard to retard. The best data available, from a well-regarded national survey of the French, shows considerable progress from that country's integrated school lunch and activity program, which began about 10 years ago.

Simply talking about the problem will help; there is a correlation between public awareness and personal action on chronic health, something anti-tobacco researchers noticed. Talking will not solve the problem, however. And neither will government regulation, which is in the works. The Federal Trade Commission, the Food and Drug Administration, and even the recalcitrant United States Department of Agriculture are circulating various proposed rules to crack down on advertising to kids. Government regulation will help, certainly: school lunches provided to kids will be healthier. So will voluntary programs from industry, like an initiative from the American Beverage Association that has already reduced the number of calories that kids consume from their drinks.

But what's lacking in the current conversation, even from the administration, is a long-term plan that recognizes the interrelated nature of obesity and global food sourcing. Let's assume, for a moment, that, in 30 years, Americans eat as the food pyramid suggests they should. Great! We're healthy. But consumer behavior changes aren't simply going to happen. The American farmer is going to have to produce a lot more fruits and vegetables -- and, by consequence, less corn. But with corn much cheaper to produce than fruits and vegetables, thanks in part to subsidies, farmers have no incentive to change their crops. There IS pressure from industry, which is figuring out how to make money off this eventual transition, but policy changes are going to be necessary -- changes that the current Congress seems unwilling to even address. No one's talking about significantly curtailing corn subsidies and replacing them with fruit and vegetable subsidies; even the USDA has not gamed out precisely how such scenarios would affect the average farmer.

The obesity activism movement needs guidance, too. At a recent obesity conference in Sweden, there were four times as many papers presented on anti-obesity drugs than there were on basic food research. By volume, food companies don't have the same resources to put into that research that pharmaceutical companies do, and in the short term, anti-fat drugs would be much more profitable. Most of them don't work, however, and those that do have effects equal to that of a solid Weight Watchers program. (The shining star of obesity research continues to be the longitudinal studies about bariatric surgery, an extreme intervention that produces extreme(ly good) results.)

The First Lady's Healthy Living initiative partners with major multinational food conglomerates that represent about 20 percent of the food that's consumed in the country. It is a bit behind on engaging the producers who make the other 80 percent. These producers are local suppliers, smaller companies, farmers. They have less room to make concessions and are more worried about their near-term future, as they have the right to be. But they're the ones who are going to source our food in the future. So if we really want a country where fruits and vegetables are cheaper, they're going to have to fully engage in the project.

Talk of any national food policy smacks of socialism. It doesn't have to. What's needed -- and, actually, what works best, in terms of efficacy and financial efficiency -- are incremental policy changes like subsidy adjustments and different research priorities that are planned for in advance, kick in over time, and involve the input of people who actually make the food. This time-focus model, where the public engages along with policy makers every five or six years to renew programs or reform them, helps to make sure that the long-term goal is always in the public consciousness, and that stakeholders have plenty of opportunities to adjust policies that aren't working.

Try to regulate the food industry overnight and you'll fail. Try to cut ethanol subsidies and corn subsidies and sugar price supports overnight and you'll be thrown out of office. Demonize one sector or another and you'll alienate the people whose behavior needs to change. Realign incentives on a national level, over the space of several decades, and you might just solve the obesity epidemic.