Perspectives in Health Magazine
The Magazine of the Pan American Health Organization
Volume 7, Number 3, 2002

Beyond the soft touch

While prevention programs such as those in El Paso hold promise, they may not be enough to counter the fast-growing worldwide epidemic of obesity. Rigby, of the International Obesity Task Force, says the "soft approach of more education about food at school and encouraging exercise" is no longer enough. "We need to tackle the root causes with ambitious initiatives to counteract the huge changes we’ve seen in recent years."

A key target of this newer get-tough approach is the multibillion-dollar global food industry. Critics argue that the industry’s advertising, marketing and pricing practices actively promote excessive consumption of high-calorie, low-quality foods. To counter the trends, Rigby and others are urging such measures as requiring nutritional information on restaurant and fast-food menus. They also favor restrictions on advertising, particularly ads aimed at children, and using public pressure to make the food industry "part of the solution."

"In Europe, McDonald’s stopped using transfatty acids years ago because Europeans wouldn’t stand for it," says PAHO’s Jacoby. "Now, in the U.S. they’ve promised to do the same."

Others have called for placing so-called "fat" or "Twinkie" taxes on unhealthy foods and using the revenues for counter-advertising or subsidies on healthier foods. Supporters cite studies showing that people will opt for healthier foods over unhealthy ones when the price differential is significant.

Advocates are pursuing these issues at both the national and global levels, working to incorporate them, for example, into international trade talks under the auspices of the World Trade Organization. The parallels with anti-tobacco efforts are clear, but many hope the multinational food industry will be more cooperative toward such efforts than the tobacco industry has been.

"Unlike tobacco, food itself is not a poison," notes Jacoby. "It’s just a question of quality and the amount that’s consumed. So there is real potential for cooperation with industry."

Rigby agrees: "The idea of public health collaboration with the food industry isn’t really new. We’ve had iodine-enriched salt, for example, and some sectors of the food industry have espoused the idea of sending out public health messages as part of their product marketing….But a large part of the processed foods we eat today are still part of the problem and not yet part of the solution. So we are challenging the food industry to deliver truly healthy options—not just to niche markets, but to all consumers."

At least as difficult a challenge is finding ways to address the other side of the obesity equation: energy expenditure through physical activity.

"There are already too many megacities and urban environments where the car is king and it is impossible for people to get around easily on foot or bicycle," says Rigby. "We need to create physical town environments that sustain and support good health." This means incorporating the "healthy cities" approach into urban planning, promoting parks, bike paths and pedestrian malls; restraining suburban sprawl; increasing funding for public transportation; and making car use less attractive and less necessary.

Getting countries around the world to sign onto such an ambitious agenda may require a rethinking of what constitutes a higher standard of living, akin to the increasing acceptance of the idea that economic development must be socially and environmentally sustainable. "It is tempting for developing countries to believe that much of the environmental change that produces the huge public health burden of obesity is inevitable," says Rigby. "It is our job to persuade them that they can act now to steer a different course."

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