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Against Claims of Paternalism and Industry Pressure, Public Health Community Fights to Regulate Unhealthy Foods

By Dr. Ram Krishnamoorthi
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Several months ago, I stumbled onto an AM radio talk show when the topic of public health and obesity was being discussed. The talk show host was lambasting state and local legislatures for proposing laws that regulate the public’s choices with regard to unhealthy foods. From what I could gather, the story of the day recalled New York state’s proposal to tax sugar-sweetened beverages. Such laws were un-American, said the host, not only for cutting into individuals’ freedom to eat and drink what they wanted, but also for the paternalism of big government running people’s lives and excusing them from personal responsibility. A public health official had explained that a soda tax could significantly reduce obesity and cardiovascular disease outcomes because one sugary soda per day added nearly 10 pounds to the average New Yorker over the course of the year. But this calculation was bogus science, said the talk show host; another example of the lies that elitist intellectuals will craft to impose their agenda on the free public.


The American obesity epidemic should by now be a household phrase. Unfortunately, the childhood obesity epidemic is becoming one, too, as detailed by the Consortium to Lower Obesity in Chicago Children. Plenty of evidence exists about the negative role of easily available cheap, unhealthy foods for obesity and diabetes in lower income communities, not to mention that of the expensiveness of healthy foods and scarcity of grocery stores in food deserts. For the U.S. overall, the increase in soft drink consumption by 60% in adults and by double in children from mid-70s to the mid-90s is directly related to the rise in obesity and diabetes rates in both groups.

Over the past several years, several states and municipalities have launched initiatives to tax soda or junk food or ban certain killer additives. Along with the failed proposal to tax sugar-sweetened beverages (SSBs), New York has led the charge with banning “trans fat” in NYC, requiring restaurants to post nutrition details for their menus, and proposing to bar SSBs and other junk food purchases from the food stamp program. Washington state, New Mexico, Philadelphia, D.C., Mississippi, and others have also soda tax proposals.

A diverse group of health advocacy groups, from the Robert Wood Johnson Foundation to the American Heart Association to the Surgeon General, supports taxes on SSBs or a strong consideration for them. Yale University’s Rudd Center for Food Policy and Obesity provides a nice listing of these groups. Even the Bipartisan Policy Center, a think tank of fiscal conservatives like as Pete Domenici, the former Republican Senator, and Alice Rivlin, the former Clinton budget director, supports a tax to reduce obesity-related health care costs that are suffocating the federal budget.

However, most of these measures have failed under pressure from lobbying from the beverage industry and from conservative opposition. Arguments range from claims of regressively taxing the poor to intruding on Americans’ freedom of choice as mentioned before.

Indeed, who doesn’t like junk food? And the freedom to buy its convenience and deliciousness? For me, Hostess Twinkies ® and Ho-ho’s® were oh-so good. They were cheap for my parents to buy for me to snack on when I got home from school. Today, it’s easy to slip my dollar bill in the vending machine just 50 feet from my office and one floor down (I take the stairs, I swear), or to stop at Taco Bell on the way home, fulfilling the fat and carb addiction. “No worries, I’ll work out tomorrow,” I say, only to start the rat-race again, cowering to easy sugar boosts from food in a crinkly bag and over-the-counter.

And as Carol Duh wrote yesterday, it’s hard to eat healthy. It takes time, it takes money, and it takes creativity. The first two many low income people just don’t have, and the constraints of the food deserts of their neighborhoods make creativity difficult to execute.

So we get it. And so does the human body.  As Michael Pollan explained in Omnivore’s Dilemma: “it makes good economic sense that people with limited money to spend on food would spend it on the cheapest calories they can find, especially when the cheapest—fats and sugars—are precisely the ones offering the biggest neurobiological rewards.”

Philosophical conservatives may think it is terribly cynical to believe that we cannot impact our obesity epidemic without imposing paternalistic restrictions on our freedom. Since I hate cynicism, I agree, we can change our culture, at the level of empowering individuals and educating the public.

And the private sector may be starting to prove that it’s listening to the public. Walmart, which happens to be the nation’s biggest grocer, just announced a plan to decrease the amount of sugar and sodium in its packaged foods and to make its fresh produce cheaper and to urge its processed foods manufacturers to also follow suit. The price decreases are modest and so will be the health effects, at least until the company can see the benefits in their bottom line. But the discount retailer’s efforts should surely be praised.

The impetus for this, though, came from discussions with First Lady Michelle Obama, who is campaigning to fight childhood obesity. And the arguments for the free market to make similar shifts must come from an informed public, empowered to make different choices based on good information and economic freedom.

But is the information provided to the public fair and balanced? Are the influences of the public health community balanced with those of the food industry? The tobacco industry successfully duped the American public for decades, hiding its manipulations of nicotine and targeting youth. Pharmaceutical companies and device manufacturers have billions of dollars to market directly to consumers, but public health and prevention advocacy groups have much fewer resources to promote healthy eating and exercise. In Washington state, Coca-cola, Pepsi, and other beverage makers spent $16.5 million to lobby to repeal a soda tax that had just been passed, outspending supporters of the tax by 40 to 1. Alarmingly, it is suspected that Coke and Pepsi have even been able to influence Save the Children, the international advocacy group which had previously supported SSB tax proposals in several states, to drop their support of the proposals in exchange for the companies’ financial backing for other international charity efforts.

Claims of paternalism may carry some principle behind their argument, but in reality, this fight is less about principle and more about money. In the face of big money from the food and beverage industry, there is no level playing field for the public health sector to play. But what hamstrings the public health community the most is that the biggest culprit in promoting unhealthy foods may be none other than the U.S. government. For decades, we have subsidized the sugar and corn industries, resisting the calls of public health experts to recommend stricter guidelines on sugar or to increase financial support of healthier foods. The FDA has equivocated or has been reined in when regulations for unhealthy food additives, such as trans fat, have been proposed.

In February, Progress Notes will focus on disparities in health among different groups in America. The problem of cheap, processed, salty and sugary foods as a public health scourge becomes even clearer when considered in the context of low income and predominantly minority communities.

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  1. David Brown

    In my opinion, the government's Dietary Guidelines for Americans is largely to blame for the obesity epidemic and the high incidence of chronic inflammatory diseases. The release date for the 2010 version is January 31.

    Normally it takes about a year to select a committee, hold meetings, issue a report, and publish the new version. This time it has taken more than two and one half years to complete the process. Why? Perhaps it's becoming increasingly difficult to maintain the illusion that the Guidelines are based on sound scientific analysis. For example, when the Dietary Guidelines Advisory Committee released its report on June 15, 2010, it elicited harsh criticism from biochemists and clinicians. At a July 8 hearing Dr. John Salerno, a practicing physician in New York City said, “In my 20 year practice of medicine in New York City, I have treated many patients whose health had been severely compromised by excluding these necessary nutrients in their daily diet. It is my experience, backed up by scientific studies, that low fat diets have caused many of today’s lifestyle ailments including obesity, diabetes, heart disease and stroke. Basic biochemistry shows that the human body has a high requirement for saturated fats in the cell membranes, brain and other organs. If we do not eat saturated fats, the body makes fat from refined carbohydrates, leading to rapid weight gain and chronic illness.”

    Dr. Pramod Khosla, Ph.D, Associate professor, Department of Nutrition and Food Science, Wayne State University in Detroit, Michigan, accused the DGAC of “sidestepping the science” in continuing to ask the public to avoid saturated fat. He cited a highly publicized meta-analysis showing that there is no significant evidence that dietary saturated fat increases risk of cardiovascular or heart disease. He went on to say that what replaces the saturated fat is of greater concern.[1]

    Three months later Dr. Khosla hosted an International Saturated Fat Symposium at Wayne State University.[2]


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