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Obesity EpidemicCan Americans change their self-destructive habits?

The percentage of overweight American

children and teens has more than doubled in

the past decade. Moreover, two-thirds of the

adults are either overweight or obese, and at

least 300,000 Americans die each year from obesity-related

diseases. The reasons aren’t hard to fathom. The U.S. food

industry aggressively markets high-fat, high-sugar, super-sized

foods. Modern communities encourage driving rather than

walking. Physical education is being dropped by schools even

as fattening snack foods are welcomed onto campus. And

children are spending more time playing computer games

than sports. The question for policymakers is whether the

weight gain is just a matter of individual responsibility, or

whether a society that makes it so easy to get fat should be

retooled. At stake is not only the health of millions of Ameri-

cans but also $117 billion in annual health-treatment costs.

WINNER: SOCIETY OF PROFESSIONAL JOURNALISTS

AWARD FOR EXCELLENCE ◆ AMERICAN BAR

ASSOCIATION SILVER GAVEL AWARD

CQResearcher

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THE ISSUES..........................75

BACKGROUND ....................84

CHRONOLOGY ....................85

CURRENT SITUATION ............92

AT ISSUE ............................94

OUTLOOK ..........................97

BIBLIOGRAPHY ....................99

THE NEXT STEP ................100

THIS ISSUE

SPECIAL

EXPANDED ISSUE

32 PAGES!

Jan. 31, 2003 • Volume 13, No. 4 • Pages 73-104

www.cqpress.com

74 CQ Researcher

THE ISSUES

75 • Should schools bansodas and fast food?• Can fast food be blamedfor the obesity epidemic?• Does fat make you fat?

BACKGROUND

84 Early Health FadsRigid dietary fads werepopular in the early 1900s.

86 Scientific RootsA gene makes some people store more fat.

88 ‘Toxic’ Food EnvironmentU.S. culture encouragesovereating.

89 ‘Soft and Flabby’Experts warned about in-activity in the 1950s.

CURRENT SITUATION

92 Federal ActionLawmakers plan to discussanti-obesity options.

93 In the StatesSome school districts arebanning soda machines.

OUTLOOK

97 Rx: Common SenseWeight loss begins withnutrition and exercise.

SIDEBARS AND GRAPHICS

76 Dramatic Rise in Over-weight AmericansNearly two-thirds of Amer-icans are overweight orobese.

77 Diet, Inactivity Cause Most Premature DeathsDeath toll is about 1,200Americans every day.

78 Diet Program TargetsAfrican-American WomenHoward University physicianadvocates life-style changes.

79 Minorities Are Most OverweightMinority women and Mexi-can-American men are mostoverweight.

80 Obesity Skyrockets in Most StatesSouthern states hit hardest.

85 ChronologyKey events since 1916.

86 A Nation of Couch PotatoesNearly three-quarters of adultsdon’t exercise regularly.

91 Does U.S. Need HomelandObesity Department?Obesity jurisdiction is scatteredamong agencies.

94 At Issue• Should restaurants be liablefor customers’ weight gains?• Should chain restaurantsbe required to put nutritionlabels on menus?

FOR FURTHER RESEARCH

98 For More InformationOrganizations to contact.

99 BibliographySelected sources used.

100 The Next StepAdditional articles from currentperiodicals.

103 Citing The CQ ResearcherSample bibliography formats.

OBESITY EPIDEMIC

Cover: Twelve-year-old Cody Maples of Chicago takes his morning run at New Image WeightLoss Camp in Pennsylvania’s Pocono Mountains, where campers learn to lose weight throughproper exercise and good nutrition. (Getty Images/ William Thomas Cain)

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Jan. 31, 2003 75CQ on the Web: www.cqpress.com

Obesity Epidemic

THE ISSUESF or 30 years, Philadel-

phia nurse BarbaraPentz tried dozens of

weight-loss plans, includinglow-fat diets, high-fat dietsand a medically supervisedliquid diet. She could easilyshed up to 40 pounds fromher 5’4” 280-pound frame.But she would quickly putthe weight back on.

The daughter of a Philadel-phia baker, Pentz (not her realname) craved starchy treatsand would find any excuseto eat. “I was eating when Igot stressed, I was eatingwhen I got depressed, I waseating when I got bored,”Pentz says, reciting the mantraof many a defeated dieter.

However, as a nurse, sheknew that her weight put herat risk for diabetes and a va-riety of other obesity-relateddiseases. “If I didn’t do some-thing to keep the weight off,it was only a matter of timebefore it affected my health,”she says. Finally, she read anarticle about bariatric surgery— more commonly known asgastric bypass, or stomach sta-pling — and decided to try it.

While the procedure isrisky, patients lose about 100 poundsand keep the weight off for 14 to 17years, according to Judith Stern, a nu-trition expert at the University of Cal-ifornia, Davis. About 75,000 people un-derwent the surgery in 2002, includingRep. Jerrold Nadler, D-N.Y., and NBC“Today” show weatherman Al Roker.In fact, there’s a long waiting list forthe surgery, according to the AmericanSociety for Bariatric Surgery.

After undergoing the surgery morethan a year ago, Pentz is thrilled with

the results. Her stomach, once the sizeof a football, was surgically shrunk tothe size of an egg, allowing her to eatonly a small amount of food at a time.She has lost 130 pounds, but, equal-ly important, she is also exercising reg-ularly, swimming laps in her pool andeven taking belly-dancing lessons.

Pentz is not alone in her struggleto lose weight. Nearly two out of threeAmericans are overweight or obese,and the number of overweight ado-lescents has tripled over the last 20

years. (See graphs, pp. 76 and80.)

Obesity is the “fastest-growing cause of illness anddeath in the United States,”U.S. Surgeon General RichardCarmona said early thismonth. 1 It is associated withat least 300,000 deaths a year,causing more than 30 obesi-ty-related diseases, rangingfrom heart disease and stroketo arthritis and breathing prob-lems. (See box, p. 89.)

Treating obesity-relatedhealth problems costs Amer-icans $117 billion annually —an average of $420 per per-son, Carmona said. Consumersalso shell out $34 billion ondiet products each year.

But when it comes to thereasons why so many are over-weight, the blame gets spreadfar and wide. The human bodywas genetically designed tostore fat so it could weatherfamine and other once-com-mon deprivations. Given thatbiological propensity, manyquestion whether contempo-rary American culture andlifestyles — the result of acombination of individual, so-cietal, commercial and politi-cal decisions — have madeit too easy for people to gainweight.

For instance, some blame the epi-demic — at least in part — on thefood industry’s penchant for “super-sizing” portions and schools’ decisionsto eliminate recess and physical edu-cation while filling their halls with fast-food and soft-drink vending machines,and — in some cases — forcing stu-dents to watch fast-food advertisementson commercially provided education-al television programs. Still otherspoint to the government’s longstand-ing “cheap-food” policies.

BY ALAN GREENBLATT

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Experts blame America’s obesity epidemic on manyfactors, including the proliferation of fattening fastfoods — even in schools — “super-sized” portions inrestaurants, the elimination of physical education in

many schools and Americans’ lack of exercise. Obesity isthe “fastest-growing cause of illness and death in the

United States,” says U.S. Surgeon General RichardCarmona. It is associated with at least 300,000 deaths

a year and $117 billion in health-care expenses.

76 CQ Researcher

In 2001, then-Surgeon General DavidSatcher issued a “call to action” aboutAmerica’s obesity epidemic, notingthat so many young people now con-tract Type 2 diabetes — caused byobesity — that it could no longer becalled by its old moniker of “adult-onset” diabetes. 2

Diseases caused by diet and inac-tivity already rival tobacco as the lead-ing cause of preventable death inAmerica, a statistic that may stir a pub-lic outcry similar to what happenedwith tobacco. When the cost to soci-ety of treating smoking-related illness-es got too high, the public began de-manding that tobacco companies payfor the damages they cause to users’health. There is a growing sense thatindividual weight gain, multiplied mil-lions of times over, constitutes a pub-lic-health problem for the nation as awhole. Some patrons have sued fast-food restaurants, blaming their healthproblems on the restaurants (see p. 82).

More than 44 million Americans arenow considered medically obese, re-flecting an increase of 74 percent since1991, according to a recent study bythe Centers for Disease Control andPrevention (CDC). The rates are high-est among the poor and the less-edu-cated. “These increases are disturbingand are likely even underestimated,”said Director Julie L. Gerberding. “Moreimportant, we’re seeing a number ofserious health effects resulting fromoverweight and obesity. If we contin-ue on this path, the results will be dev-astating to both the health of the na-tion and to our health-care system.” 3

After a small plane crashed in NorthCarolina earlier this month killing all21 people on board, federal aviationofficials recommended on Jan. 27 thatsmall-plane passengers be weighed be-fore takeoff. Flawed weight estimates,developed before obesity became anepidemic, could have contributed tothe tragedy, officials said.

Even the U.S. military is concernedthat the levels of obesity and inactivi-

OBESITY EPIDEMIC

Dramatic Rise in Overweight Americans

The percentage of overweight or obese* American adults (top graph) rose to more than 64 percent — nearly two out of three adults — over the past quarter-century. At the same time, the percentage of overweight American teenagers (bottom) nearly tripled.

* Obesity is defined as a BMI of 30.0 or more; overweight is a BMI of 25.0 to 29.9. BMI (body mass index) uses a mathematical formula that takes into account both a person’s height and weight. BMI equals the weight in kilograms divided by height in meters squared.

Source: Centers for Disease Control and Prevention, National Center for Health Sta-tistics, “National Health Examination Survey” and “National Health and Nutrition Examination Survey,” 2002

Overweight and Obesity Among Adults(ages 20-74)

Overweight Children and Teens(ages 6-19)

Ages 6-11

Ages 12-19

Percentage of U.S. adults

0

10

20

30

40

50

60

70%

Percentage of U.S. children or teens

Overweight

Obese

32%

34%

1976-1980 1999-2000

15%

30.5%

47%

64.5%

0

10

20

30

40%

7%

14%

1976-1980 1999

5%13%

12%

27%

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ty among America’s youth threaten thenational security. “The military needshealthy recruits,” Carmona warned inhis speech in January. Secretary ofHealth and Human Services (HHS)Tommy G. Thompson has suggestedthat all overweight Americans shouldlose 10 pounds as a “patriotic act.”

But the United States is not theonly country with an obesity problem.Overweight and obesity are spreadingacross many nations, taking in half theadult populations of countries as di-verse as Brazil, England, Russia andSaudi Arabia, to name only a few.

“People are becoming obese be-cause they eat too much and food isso cheap,” says Adam Drewenowski,director of the University of Washing-ton’s Center for Public Health Nutri-tion. But, he says, “It’s not that peo-ple who gain too much weight arestupid, but they don’t have too manyoptions. We are beginning to realizethat obesity is not only a biomedicalproblem, it’s also a community andenvironmental problem.”

“We need to lead a cultural trans-formation,” Carmona told more than1,000 educators, doctors and publichealth officials at a conference on child-hood obesity. 4

American food — thanks in part tothe government’s generous agricultur-al subsidies — is not only the cheap-est in the world but probably the mostplentiful, available at 24-hour conve-nience stores, gas stations and evenround-the-clock supermarkets. Ameri-cans also eat out twice as often asthey did in 1970. Fast-food restaurantshave increased their sales by 200 per-cent during the last 20 years; otherrestaurants posted 150 percent gains.Americans now snack everywhere —even during church services. Sales ofsugary sodas rose from 40 gallons perperson in 1985 to 53 gallons per per-son in 2000. 5

Many of those sodas are sold inthe same schools that have droppedregular physical-education courses or

recess, giving kids less time to burnoff calories. Adults also engage in lessphysical activity at work: Fewer than2 percent of Americans today live onfarms, compared to more than half atthe dawn of the 20th century. More-over, fewer Americans work in man-ufacturing, and service-sector anddesk jobs just don’t provide the samecalorie burn as manual labor.

Nearly every family owns at leastone car, and suburban developmentsare plotted on the self-perpetuating as-sumption that people don’t want towalk more than a few hundred feet atany given time. Writer Bill Bryson oncequipped in The New Yorker that “thepurpose of the modern American sub-

urb is to make sure that no citizen isever more than 500 yards from a foodproduct featuring melted cheese.” 6

Meanwhile, little money is beingspent to educate consumers abouthealthy-eating choices. Restaurantsspend more than $10 billion on di-rect advertising each year, while theNational Cancer Institute is lucky toscrape together $2 million to promotethe government’s “five-a-day” fruits andgrains diet recommendations.

“Basically, we live in a culture that’sengineered to promote obesity,” saysMargo Wootan, director of nutritionpolicy at the Center for Science in thePublic Interest, a Washington, D.C.-based advocacy group.

Diet, Inactivity Cause Most Premature Deaths

At least 310,000 Americans die prematurely each year from diseases related to unhealthy eating and inactivity. That’s five times more than the number killed by guns, HIV/AIDS and drug use combined.

Source: National Alliance for Nutrition and Activity, “Obesity and Other Diet- and Inactivity-Related Diseases: National Impact, Costs and Solutions,” 2001

Leading Contributors to Premature Death

Diet/Physical Inactivity 310,000-580,000

Tobacco 260,000-460,000

Alcohol 70,000-110,000

Microbial Agents 90,000

Toxic Agents 60,000-110,000

Firearms 30,000

Sexual Behavior 30,000

Motor Vehicles 25,000

Drug Use 20,000

78 CQ Researcher

OBESITY EPIDEMIC

Others, however, scoff at the idea thatanyone but the individual eater is toblame for their obesity. Even Pentz feelsthe stigma. She still hasn’t told her fam-ily about her operation and admits thata part of her believes her obesity washer own fault. “Maybe I feel I shouldhave been able to do it the old-fash-ioned way,” Pentz says. “In every otherpart of my life, I’m able to be disci-plined, motivated and in control. Onlywith eating, I didn’t have any control.”

As the nation debates whether obe-sity is a matter of individual or corpo-rate and governmental responsibility, hereare some of the questions being asked:

Should sodas and fast food bebanned from schools?

In 1998, Michael Cameron, a stu-dent at Greenbrier High School inEvans, Ga., was suspended for a day.His offense was wearing a tee-shirtspelling out “Pepsi” on a day the school

had set aside to study and celebrateCoke. 7 Like thousands of other schoolsacross the country, Greenbrier reliedon a particular soft-drink supplier foran important source of revenue.

Sodas are now on sale at 60 per-cent of middle and high schools na-tionwide, according to the National SoftDrink Association. Some school districtsoffer companies exclusive “pouringrights,” for which soft-drink companiespay so-called signing bonuses worth up

G rowing up on a farm in Texas, Otelio Randall un-derstood the basic principles involved in preparinglivestock for butchering. You put an animal in a small

pen to keep it from moving about and stuff it with food tofatten it up. For Randall, now a cardiologist in Washington,D.C., these memories are all too analogous to the behavior hesees in many of his patients. “What these people are doing issitting themselves in a pen, watching TV and eating,” he says.“It’s no mystery why peo-ple are getting fatter.”

Randall has set up a su-pervised diet and exerciseprogram at Howard Uni-versity Hospital, targetedmainly at African-Americanwomen who, he says, are“the most obese populationin the United States.” Thenumbers bear him out. Onerecent study even showedthat a staggering 78 percentof black women are over-weight, 50 percent are obeseand 15 percent weigh 100pounds or more in excessof a healthy weight. 1 Otherminority groups, includingAfrican-American men, Lati-nos and Pacific Islanders,suffer from greater weightproblems than society as a whole.

For that reason, many researchers initially assumed there weregenetic differences to blame for the high obesity rates withinthese groups, says Shiriki Kumanyika, associate dean for healthpromotion and disease prevention at the University of Pennsyl-vania medical school. But with the rest of the population catch-ing up in weight gain, it appears that those groups were just

hit by the obesity epidemic harder and earlier. “If you make alist of the kind of environmental factors that are obesity pro-moting,” Kumanyika says, “many of them are more prevalent inareas where minorities live, especially African-Americans.” Amongthe factors in inner-city neighborhoods that contribute to obesi-ty are fewer opportunities for exercise, due to lack of openspace and safety concerns, plus a dearth of full-service groceriesor other food stores that might offer fruits and vegetables.

“Safety in the neighborhoodis a concern,” says Marie Pri-mas-Bradshaw, a retired school-teacher who lives in a black-dominated southeastern sectionof Washington. Primas-Bradshawhas long had poor eating habits.She loves Pepsi and potato chipsand says, “I baked cakes andate half of them.” As a result,even though she had been pe-tite as a young woman, sheeventually carried 190 poundson her 4’11” frame.

Having reached her late 50s— the same age her father waswhen he suffered the first in aseries of strokes — Primas-Brad-shaw grew sufficiently concernedabout the effect her weight washaving on her health to enterRandall’s expensive program at

Howard. Participants in the program spend at least 45 minutesthree times a week exercising on treadmills and eat meals thatRandall, with the help of his wife Donna, provides. The mealsare low in salt and fat — particularly saturated fat — withenough choices so that no dish is repeated within a two-weektimeframe. “We figured these meals had to look good, taste goodand have some variety,” he says. They offer instruction on both

Diet Program Targets African-American Women

Dianna Wright checks Jacqueline Starr at a weigh stationduring the “Fun, Fit and Free Festival” in Philadelphia on

July 3, 2001. A recent study showed that 78 percent of black women are overweight.

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Jan. 31, 2003 79CQ on the Web: www.cqpress.com

to $100,000 and offer discounted syrupfor schools to use selling soft drinks atfootball games and other events. About20 percent of the schools have alsoopened their doors to name-brand pur-veyors of high-fat foods, such as TacoBell and Domino’s.

“Teaching kids in a health classabout making healthy choices andthen turning them into a corridor linedwith soft drinks and poor-nutritionsnacks is sending a very mixed sig-

nal,” says Barry Sackin, director ofgovernmental affairs for the AmericanSchool Food Service Association.

Schools have invited soft-drink andfast-food vendors onto campus for asimple reason: money. In schools with“open-lunch” policies — in which stu-dents are free to leave campus duringlunch period — administrators mustcompete with nearby fast-food restau-rants for students’ lunchtime purchas-es. And the soda contracts help pay for

bands, athletic events, books and themore nutritious lunches prepared inschools’ own kitchens. Pragmatic prin-cipals must seek scarce dollars wher-ever they can find them.

Ejecting the fast-food vendors canbe costly: The mammoth Los AngelesUnified School District, which will bansoda sales on campus next year, facesan estimated $40 million revenue short-fall over the next 10 years as a result.“This is absolutely the right thing to

shopping and cooking,so that participantscan re-create the mealsthat helped them shedthe weight.

For Primas-Brad-shaw, the programworked. She lost 40pounds, and, althoughshe admits she recentlyregained seven of themover the holidays, shesays she’s eating rightand keeping up hertime on her hometreadmill. Other suc-cess stories from theprogram have beenwritten up in People,Ebony and The NewYork Times. Many pa-tients have not onlylost weight, but havebeen able to cut backon their diabetes andcholesterol medica-tions. The Randallshave written MenuFor Life, a book describing their diet and exercise program thatwill be published in March.

For Dr. Randall, the challenge is not helping his relativelylimited universe of patients to lose weight. That, he says, is nota problem. His larger hope is that African-Americans and thegreater population at large will make the lifestyle changes need-ed to beat obesity. He’s encouraged by some anecdotal signsof change. Black churches, which traditionally have fed theirparishioners perhaps too well at functions, have become major

partners in blood-pressure screening,and many of them nowoffer gym classes andfull fitness regimens. 2

“People are goingto be there anyway,it’s convenient,” saysJeanne Charleston, di-rector of a Universityof Maryland programthat sends trainers anddieticians to about 20black churches a year.In addition, fitnesschains, such as BallyTotal Fitness and 24Hour Fitness, which ispartnering with formerbasketball great MagicJohnson, have discov-ered the urban core asa ready market. 3

“People say youcan’t change behavior,but I believe you can,”Dr. Randall says. “I don’tthink there’s anyone

who doubts the benefits of this — they just don’t do it.”

1 See K.M. Flegal, et al., “Prevalence and Trends in Obesity Among U.S.Adults, 1999-2000,” Journal of the American Medical Association, Oct. 9,2002, p. 1723.2 See Steven Gray, “In Northeast, Moved By a Fitness Revelation; ChurchFinds New Calling in Fighting Obesity and Tending to Its Flock’s PhysicalNeeds,” The Washington Post, July 9, 2002, p. F1.3 For background, Jeannine Stein, “Fitness Chains Step Outside Familiar Ter-ritory,” Los Angeles Times, Nov. 25, 2002, p. 1A.

Minority Women Are Most Overweight

Black women are more overweight or obese than other minorities and whites. Among men, Mexican-Americans have a higher prevalence of overweight and obesity than both whites and blacks.

Source: Centers for Disease Control and Prevention,“National Health and Nutrition Examination Survey,” 2002

0

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20

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40

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60

70

80%

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Black(Non-Hispanic)

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78.0% 74.4% 71.8%

Percentage(with BMI > 25)

Overweight and Obesity, 1999-2000

80 CQ Researcher

do,” said Caprice Young, president ofthe district’s board, “but I wish wecould have chosen an implementationplan that would have made it lesspainful for the schools.” 8

The soft-drink industry and nutri-tionists disagree over the effect sodashave on weight. The National Soft DrinkAssociation, noting that carbonated sodasbarely outsell water, juice and sportsdrinks in schools, cites studies show-ing no correlation between averagesoda consumption and obesity.

“A thorough review of the data on12-to-16-year-olds shows no relationshipbetween the consumption of regular car-bonated soft drinks and BMI [body massindex],” a measurement for obesity, saidMaureen Storey, associate director of theGeorgetown University Center for Foodand Nutrition Policy and leader of theresearch team that performed the analy-ses. “Soft-drink consumption is notlinked to adolescent obesity, challeng-ing many misconceptions.” 9 The cen-ter’s research was supported by a grantfrom the soft-drink association.

“It’s the opinion of our industry thatwe should let parents decide whattheir children are eating and drinking

OBESITY EPIDEMIC

1991

Obesity Skyrocketed in Most States

Only four states had obesity rates of 15 percent or higher in 1991, and none had rates above 20 percent.* Ten years later, Colorado was the only state with an obesity rate below 15 percent, and 29 states had rates above 20 percent. More than 44 million Americans are obese — a 74 percent increase since 1991. Most live in the South.

* Obesity is defined as having a BMI (body mass index) of 30.0 or more.

Sources: Centers for Disease Control and Prevention, and A.H. Mokdad, et al., “Prevalence of Obesity, Diabetes, and Obesity-Related Health Risk Factors, 2001,” Journal of the American Medical Association, Jan. 1, 2003. The survey was based on self-reported data from the Behavioral Risk Factor Surveillance System, a state-based telephone survey that collects information from adults.

N.Y.

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Wash.

Idaho

Mont.

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Ariz. N.M.

Wyo.

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Alaska

Okla. Ark.

La.

Ill.

Miss.

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Ga.

Conn.

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MaineVt.

W.Va.N.J.

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Wis.

Mich.

Ind. Pa.

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Hawaii

2001

N.Y.

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Texas

Va.

Minn.

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Mo.

Calif.

Nev.

Ore.

Colo.

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Idaho

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N.D.

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Obesity Among Adults

No Data<10%

10-14%15-19%20-24%

+25%

Top 10 States with the Highest Obesity Rates

State Percentage ofpopulation that

is obese

Mississippi 25.9%

West Virginia 24.6

Michigan 24.4

Kentucky 24.2

Indiana 24.0

Texas 23.8

Alabama 23.4

Louisiana 23.3

Tennessee 22.6

Missouri 22.5

Jan. 31, 2003 81CQ on the Web: www.cqpress.com

at school,” says Sean McBride, an as-sociation spokesman. “It’s that simple.I don’t think any state or local gov-ernment is better at making decisionsfor children than parents are.”

Critics of soda sales cite other data,notably a recent report in the Britishmedical journal Lancet, which foundthat each extra soft drink a child con-sumes per day leaves him or her 60percent more likely to become obese.10 Even one of the studies McBrideprovides to the media notes that over-weight children drink, on average, twomore ounces daily of soft drinks thannon-overweight children.

Children now drink twice as muchsoda as milk, according to the Centerfor Science in the Public Interest. Twodecades ago, the opposite was true. 11

Several states last year considered ban-ning sodas or junk food from schoolsor limiting the hours when soda can besold on campus. At least 18 states con-sidered imposing taxes on sodas andother snacks, according to the NationalConference of State Legislatures. A billintroduced in Congress last session andlikely to be reintroduced this year wouldgive the U.S. Department of Agriculture(USDA) authority to regulate school sodasales. When the USDA tried to assertsuch authority a couple of decades ago,it was beaten back in court.

Some educators — who are some-times bigger cheerleaders for pouringcontracts than the soft-drink makersthemselves — say policymakers are toblame for the problem, not only forunderfunding schools but also forplacing heavy emphasis on academicachievement at the expense of phys-ical and nutrition education.

“I doubt that the outcome we de-sire as a nation is to have excellentreaders and outstanding math teachers— who are obese or undernourishedand who are not physically fit,” saysGerald N. Tirozzi, executive director ofthe National Association of SecondarySchool Principals. Noting that the ed-ucation law passed last year — the No

Child Left Behind Act — will holdschools and teachers accountable fortheir students’ performance by requir-ing new achievement tests, Tirozzi adds,“If teachers and principals are going tobe rewarded for test scores, that’s whatthey’re going to concentrate on.”

Most agree that increasing physicalactivity in schools would help solvethe obesity problem. “If we can findways to educate children that all of usneed to turn off the television, log offthe computer, get up off the couchand get moving, that would go a longway to get us away from obesity,”McBride says.

Many nutrition advocates agree withMcBride when he says that banning orrestricting access to carbonated bever-ages in school won’t solve the obesi-ty problem, but they argue that softdrinks are an important contributingfactor. Pepsi Co., in a video distributedto school food-service managers lastsummer, said, “Overindulgence in anyof our products is not something weencourage or recommend.” 12

“There is something wrong withour priorities if we cannot fund ourschools without selling junk food tochildren,” says Wootan of the Centerfor Science in the Public Interest.

U.S. Eating Less Meat, More Cheese

Americans are eating less meat, whole milk, eggs and butter than in the past — probably in response to warnings about saturated fat. To the dismay of nutritionists, however, they are eating fewer vegetables and 500 percent as much cheese, which is high in saturated fat.

Source: “Nutrient Content of the U.S. Food Supply, 1909-19 to 1990-99,” U.S. Department of Agriculture

Changes in U.S. Food Use(1909-19 to 1990-99)

Percent change

Meat -4.2

Poultry 415.9

Fish 33.3

Whole milk -63.2

Lowfat milk 131.1

Cheese 534.0

Eggs -15.8

Legumes, nuts and soy 27.3

Grain -30.7

Citrus fruits 290.0

Vegetables -26.0

Butter -73.2

Margarine 410.0

Salad, cooking oil 130.0

Sugars, sweeteners 64.0

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Can fast food be blamed for theobesity epidemic?

McDonald’s is having financial in-digestion. Not only did it post its first-ever quarterly loss on Jan. 23, but itwas sued in a New York court lastyear by two obese teens from theBronx who blamed the chain’s prod-ucts for their weight and health prob-lems. The lawsuit, which was dismissedon Jan. 22, had been greeted with dis-dain both by the restaurant industry,which called it frivolous, and by muchincredulous media coverage.

Still, the coverage was intense andwidespread, and the lawsuit was seenas emblematic of rising concerns aboutthe high-calorie, high-fat meals servedat the more than 30,000 McDonald’soutlets in 121 countries around theworld and thousands of other fast-food-eries. At least one similar suit has beenfiled, and more are certain to come.

“There are more industries and sec-tors to blame than fast food, but thatseems to be a pretty easy target,” saysMitchell Speiser, a restaurant analystwith Lehman Brothers, a New York-based investment bank.

In 1970, Americans spent about aquarter of their food dollar eating inrestaurants. Today, that figure tops 40percent. Moreover, one American outof four eats at a fast-food restaurantevery day.

Meanwhile, McDonald’s and otherrestaurants have “super-sized” their por-tion sizes. According to McDonald’sown Web site, a meal made up of aBig Mac and super-sized servings ofCoke and French fries adds up to1,600 calories — two-thirds of the totalrecommended for adults per day andabout double the amount of caloriesthe body can absorb at one sitting.(The rest is stored as fat.)

“It’s very interesting that the larger-portion business started at exactly thesame time that obesity rates started togo up,” said Marion Nestle, head ofnutrition and food studies at New YorkUniversity. 13

Studies have indicated that peoplewill eat larger portions that are put infront of them, out of all proportion totheir initial hunger. 14 “It’s a pleasure-seeking activity that’s prone to abuse,just like cigarettes, or cocaine,” saysGeorge Blackburn, an associate pro-fessor of surgery and nutrition at Har-vard University. “It gets right to thebasic reward centers of the brain.”

Yet another study, conducted by re-searchers at Penn State University’s Col-lege of Health and Human Develop-ment, had similar findings. “Everyoneresponded to the increased portion sizeby eating more,” including both menand women, dieters and non-dieters,fat people and slim, and those whohabitually clean their plates as well asthose who don’t, said lead researcherBarbara Rolls. 15

In fact, a study published Jan. 22 inJAMA, the Journal of the AmericanMedical Association, found that Amer-icans are “super-sizing” their food por-tions at home to match the portionsthey are being served in restaurants.“Portion sizes have increased over time,and it’s not just outside the home,” saidstudy co-director Samara Joy Nielsenof the University of North Carolina,Chapel Hill. The data revealed that overthe past 20 years, hamburgers have ex-panded by 23 percent, a plate of Mex-ican food by 27 percent; soft drinkservings by 52 percent; and salty snacksby 60 percent. 16

Although previous studies had con-firmed the trend toward bigger por-tions in restaurants, packaged foodsand in recipes, the new study is thefirst to look at how much people eatat their own dinner tables.

The fast-food industry denies theconnection between its products andincreased obesity. McDonald’s says itis no more responsible for weight gainthan the foods found in an obese per-son’s refrigerator. “For people to blamethe restaurant industry solely for thisissue is really a simplistic notion,” saysSteven C. Anderson, president of the

National Restaurant Association.“We’re not promoting a single prod-uct that the health community criti-cizes as unhealthful.”

But even McDonald’s has notedthat not all of its products are healthy.“We don’t sell nutrition, and peopledon’t come to McDonald’s for nutri-tion,” reads an internal company memofrom 1986. 17 McDonald’s French sub-sidiary advertised in 2002 that parentsshouldn’t bring their children to therestaurants more often than once aweek, for health reasons.

“The understanding and composi-tion of what hamburgers and Frenchfries do has been with us a long, longtime,” McDonald’s lawyer Brad Ler-man said in response to the class ac-tion filed against the company.

The fact that fast-food chains arebeing forced to defend their productsin court has some investors worried.After all, a lawsuit doesn’t have to suc-ceed to be a threat. “For someone notto know that a Big Mac is unhealthyis ignorance, and ignorance is not theresponsibility of the fast-food industry,”says Speiser, of Lehman Brothers.

Still, Speiser suggests that fast-foodchains should offer healthier choicesand more nutritional information “be-fore changes are forced upon them.”In a report issued in November, in-vestment bank UBS Warburg conclud-ed, “There is a clear long-term risk . .. that anti-obesity measures will curb[fast-food chains’] ability to grow rev-enues in the future.” 18

Already, McDonald’s announced lastSeptember that it was reformulating thefrying oil it uses to cut down on so-called trans fats, which are created whenoils are turned into more unhealthfulsolid fats like margarine and shorten-ing. Potato chip maker Frito-Lay madea similar announcement the same month.

Some consumer groups, like theCenter for Science in the Public In-terest, have lobbied the federal gov-ernment to require nutrition labelingon the menus at fast-food and chain

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restaurants, so the public will be ableto make more informed food choic-es. (See “At Issue,” p. 95.)

But the government does not ap-pear inclined to regulate fast-food fare.Instead, Surgeon General Carmona andHHS Secretary Thompson have metwith leaders of major fast-food com-panies and food manufacturers andencouraged them to voluntarily pro-vide healthier menu options.

McDonald’s and four other chainshave made nutritional information abouttheir products avail-able on request since1986, in response tolegal action takenby about a dozenstates. But somehealth advocateswant the informationto be displayed moreprominently in allchain restaurants.They believe thatconsumers, oncearmed with more in-formation about thefat and calorie con-tent of fast food, willmake hea l th i e rchoices.

But that may notbe so. McDonald’sand other chains sellsalads, for instance, but they accountfor only a negligible portion of theirbusiness. And the McLean Deluxe, Mc-Donald’s lean hamburger of the early1990s, flopped, even though the meathad performed well in blind taste tests.Marketed as something healthy, it did-n’t sell. “As if things weren’t goodenough, consumers also dropped allpretense of wanting healthy food,” anexecutive reportedly crowed at a 1999fast-food convention. 19

Growing pressure on fast-food restau-rants to offer healthier choices mayonly end up proving what the chainshave been saying all along — that theircustomers vote with their appetites.

The National Restaurant Association con-ducted a poll in November showingthat 95 percent of Americans feel qual-ified to order as they like when din-ing out and that two-thirds of them aretired of hearing what foods are goodor bad for them. 20 Only 12 percentof adults, after all, and 2 percent ofchildren, currently meet suggested fed-eral dietary guidelines. 21

Of course, it could be that peopleare eating unhealthy foods at chainsbecause they are in a hurry, and fat-

tening foods are about all that’s avail-able quickly. Taco Bell dropped itslow-fat Borders Light product line in1998 when stockholders worried saleswere slipping because customers per-ceived the entire menu had becomehealthy. The Subway sandwich chainhas been running ads for three yearsfeaturing Jared Fogle, a young manfrom Indiana, and others who havelost 100 pounds or more eating itssandwiches without oil, mayonnaiseor cheese. But the chain’s advertisingand marketing departments don’t pushthe weight-loss angle too hard, ac-cording to corporate spokeswomanMichele Klotzer, because people eat-

ing double-meat sandwiches and largesodas are “still our core customers.”

Does fat make you fat?Back in the 1860s, an Englishman

named William Banting was so fat thathe didn’t dare walk face-first downflights of stairs for fear he’d toppleover. His doctor recommended a diethigh in meat and alcohol and low infruits. Within months, Banting had lost35 pounds. Delighted, he wrote apamphlet about his diet that became

a bestseller and madehis name, for a time,synonymous with losingweight. 22

Since then, there havebeen any number ofpopular high-fat, low-car-bohydrate diets, most no-tably the diet espousedby cardiologist RobertAtkins. More than 10 mil-lion copies of his bookshave sold over the last30 years. His contentionthat carbohydrates — notfats — make people fatremains a hot topic of de-bate in both the mediaand the scientific world.

The Atkins diet allowspeople to eat foods highin fat and protein, such

as cheese, eggs and meats, limits theintake of certain fruits and vegetablesand severely restricts the consumptionof certain types of carbohydrates likebreads, rice and pasta. Denied carbo-hydrates, the body is forced to burnfat. A study presented at an AmericanHeart Association conference in No-vember suggested that over a six-monthperiod, people on the Atkins diet lostmore weight than a group on a high-carbohydrate diet.

But the Atkins diet remains contro-versial, in part because it’s so coun-terintuitive. How can people scarfingdown bacon cheeseburgers be on ahealthy diet, even if they discard the

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The Million Pound March in Santa Monica, Calif., attracted about 200people willing to speak out against the taunting and discrimination

that plague obese people. The National Association to Advance Fat Acceptance sponsored the 1998 event.

84 CQ Researcher

bun, while cutting down on fruits andvegetables? “We know it works,” saysRobert H. Eckel, professor of medicineat the University of Colorado and chair-man of the American Heart Associa-tion’s nutrition committee. “But we don’tknow whether it works long term, orwhether there are any adverse effects.One of the problems isn’t just beingoverweight, but being healthy.”

A controversial New York Times Mag-azine cover story last July defendedAtkins and blamed the obesity epi-demic on the federal government’sfood pyramid, which promotes multi-ple daily servings of bread and grains,and emphasizes consumption of low-fat foods. 23 (See diagrams, p. 90.)

“Over the last three decades, wehave been so brainwashed about thenegative parts of fat, and we’ve be-come so fat-phobic, that everybodyhas backed away from any type of fatand has concluded that carbohydratesare good and healthy and have be-come excessive carbohydrate eaters,”says Abby Bloch of New York Uni-versity, a consultant to the Atkins Cen-ter for Complementary Medicine.

The Times article generated a firestormof debate, including an unusual, long,point-by-point refutation from a re-porter at its competitor, The Washing-ton Post. 24 The Center for Science inthe Public Interest then chimed in withits own article taking the Times’ author,science writer Gary Taubes, to task. 25

Many scientists complained Taubes hadquoted them out of context and playeddown the dangers of saturated fat. Theyalso feared that, by blaming obesity onstarchy carbohydrates, he seemed tosuggest that even low-fat diets high infiber, fruits and vegetables — which arealso carbohydrates — were more like-ly to make people fat than a diet ofsausages and eggs.

“The truth is that the skinniest peo-ple on the planet — Asians and veg-etarians — eat plenty of rice and othercarbs,” says Neal Barnard, president ofthe Physicians Committee for Respon-

sible Medicine. “What makes Ameri-cans fat is not their occasional servingsof rice or potatoes, but rather their pen-chant for cheese, meat and fried foods.”

Jumping into the fray, the Nation-al Academy of Sciences last Septem-ber recommended a minimum dailyintake of carbohydrates that was aboutsix times higher than the number ofgrams of carbohydrates allowed dur-ing the weight-loss phase of the Atkinsplan. 26

Amid the brouhaha, everyone agreedon one thing, says Bloch: “The worstpossible combination is high carbo-hydrates and high fat.”

Many nutritionists say that the realculprit isn’t fat or carbohydrates but toomany calories. Americans consume onaverage nearly 10 percent more calo-ries per day than they did in the 1960s,according to the USDA. 27 Many thinkthat too many Americans misinterpret-ed the government’s anti-fat messagesto mean they could eat as much low-fat food as they wanted.

“We as a scientific community haveover-criticized [the Atkins diet] with-out data, and the authors have over-promoted it without data,” says GaryFoster, clinical director of the Weightand Eating Disorders Program at theUniversity of Pennsylvania. He is set-ting out to correct the situation. Inwhat will be the most complete studyof the Atkins diet so far, Foster is act-ing as co-leader of a five-year NationalInstitutes of Health study that will trackpatients in Missouri, Colorado andPennsylvania on both the Atkins dietand on low-fat regimes. It will com-pare their weight loss as well as theeffects of the diets on the heart, kid-ney and other organs.

“Some people have questionedwhether taxpayers’ money should beused to study a diet that’s so blatant-ly commercial,” Foster says. “My pointis that we shouldn’t study every dietfad, but we should study one that 10million people or more are on. Thisis a public-health issue.”

BACKGROUNDEarly Health Fads

A mericans have always been heartyeaters. The earliest settlers feast-

ed on turkey, bear and venison andlearned from Native Americans howto grow potatoes, pumpkins, beansand corn. The typical daily menu wasprobably the equivalent of several oftoday’s fast-food meals. But most earlyAmericans weren’t overweight or obesebecause they spent their days burn-ing off thousands of calories performingmanual labor. 28

But later Americans suffered gastricdistress from meals heavy on pork andother meats and low in fiber. In the1840s, health fanatic Sylvester Grahambelieved people should eat onlybread, vegetables and water. The lega-cy of his thought lives on in the formof graham crackers.

Similarly, John Harvey Kellogg, whosepuritanical dietary beliefs were vicious-ly but hilariously mocked by T. Cor-aghessan Boyle in his 1993 novel, TheRoad to Wellville, is now rememberedmostly for the corn flakes he invented.

By 1913, scientists had identified andnamed cholesterol as the source of fattydeposits on arteries. Three years later,the U.S. government began publishingfood guides. In 1958, the governmentidentified its “Basic Four” groups offoods — meats, fruits and vegetables,dairy and grains — recommending thata healthy diet consisted of moderateamounts from each group.

But it was only in subsequent yearsthat research indicated direct connec-tions between excessive consumptionof fats, cholesterol and sodium andthe risk of heart disease, high bloodpressure and other chronic conditions.The “Surgeon General’s 1988 Report

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Chronology1900s-1940sThe effect of calories and faton weight becomes known,while technology makes morefood choices available.

1916The nation’s first nutritional guide isdeveloped by the Department ofAgriculture.

1924American biologist Clarence Birdseyeperfects a process for quick-freezingfoods, making Americans less de-pendent on seasonal harvests.

1935Cornell University researcher ClydeMcCay demonstrates that rats onnutritionally dense diets live twiceas long as rats that eat freely.

1940American electrical engineer PercySpencer adapts microwave technolo-gy to create a new kind of oven,enabling consumers to preparemeals in minutes.

1948Esther Manz of Milwaukee startsthe first diet club: Take OffPounds Sensibly (TOPS).

•

1950s-1960sThe growing weight-loss move-ment raises concerns aboutsome diet programs.

1950Slenderella salons use vibrating tablesand diets. The fad lasts five years.

1960Metrecal, the first liquid diet prod-uct, is introduced. . . . Over-eatersAnonymous is established.

1963Jean Nidetch, an overweightBrooklyn, N.Y., housewife, startsWeight Watchers.

1966University of Michigan geneticistJames Neel discovers a set of genet-ic factors known as the “thriftygenotype.”

1968Life magazine helps expose thedangers of amphetamine-baseddiet pills.

•

1970s-1990sNew discoveries in food tech-nology change the ways Ameri-cans eat.

1971Food scientists in Japan producehigh-fructose corn syrup, a cheapsweetener six times as sweet ascane sugar.

December 1994Researchers at Rockefeller Univer-sity identify leptin, a hormone thatfat cells use to signal to the brainthat they are full. Although leptin’sabsence causes insatiable appetite,increasing levels of leptin doesnot suppress hunger.

1996The Food and Drug Administration(FDA) approves the synthetic fatolestra, which becomes a popularsnack food additive because it isnot absorbed in the intestines.

1997The FDA issues a public-healthadvisory after evidence surfacesthat the popular diet drugs fenflu-ramine and dexfenfluramine causeheart-valve damage.

1998New National Institutes of Healthguidelines for obesity indicate that97 million American adults areoverweight or obese.

•

2000-PresentConcern about obesity leads tolegislative and legal action.

Dec. 15, 2000Physical Education for Progress Actawards grants directly to schooldistricts to initiate or improve phys-ical education courses.

December 2001U.S. Surgeon General reports 61percent of American adults areoverweight.

August 2002Three New York teenagers sueMcDonald’s, claiming the fast-foodcompany made them fat by notdisclosing the health effects of itsproducts.

September 2002McDonald’s and chipmaker Frito-Lay announce they will changetheir cooking oils to removeharmful trans fatty acids.

Jan. 23, 2003U.S. District Judge Robert Sweetdismisses suit against McDonald’s,noting, “If consumers know (orreasonably should know) the po-tential ill health effects of eating atMcDonald’s, they cannot blameMcDonald’s if they, nonetheless,choose to satiate their appetitewith a surfeit of super-sized Mc-Donald’s products.”

2005Department of Agriculture is expect-ed to revise its food pyramid guide.

86 CQ Researcher

on Nutrition and Health” was the gov-ernment’s first formal recognition ofthe links of diet to certain chronic dis-eases.

In 1992, the USDA unveiled itsFood Pyramid, which ranked the typesof food by the amount of recom-mended daily servings. For instance,it recommends several servings offruits, vegetables and grains, whileadvising that sugars and fats shouldbe used only “sparingly.” Subject tomuch criticism, the Food Pyramid islikely to be revised over the nextcouple of years.

Scientific Roots

S everal recent scientific break-throughs point to possible mole-

cular explanations of why some peo-ple get fat while others, in similarenvironments, stay thin. In 1966, nu-tritionists identified the “thrifty gene,”which gives some people a geneticpropensity to store fat during feasttimes in order to better survive sub-sequent periods of deprivation.

Now that food is abundantly avail-able, the thrifty gene has made a lot

of people too heavy for their owngood. “Obesity is a tremendous ad-vantage for people who don’t haveenough food,” says Eckel, of theheart association. “They can live lit-erally months longer than others.But, what was once a tremendoussurvival advantage now has great costseconomically and in terms of mor-bidity.”

In 1988, James Neel, the Universi-ty of Michigan geneticist who identi-fied the thrifty genotype, updated histheory to suggest a series of geneticfactors — which he called a “syndromeof failed genetic homeostasis.” He ex-

OBESITY EPIDEMIC

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J eremy Korzenik works long hours trying legal cases, buthe still makes every effort to go out to hear live music.He gets irked when his friends and co-workers beg off

from joining him, complaining that they’re tired from work.“All they do is lift pieces ofpaper,” says the Washington,D.C., lawyer. “It’s not like they’relumberjacks.”

Korzenik is joking, sort of,but he raises an important point.Hardly anyone works on a farmor in a factory any more. Thetype of physical exertion oncecommonplace in the work forcehas been replaced by long,sedentary hours spent on thetelephone or in front of a com-puter. And people have not in-creased their leisure-time ac-tivity to make up for the lossof manual labor.

“Very few people performadequate physical activity thesedays — very few,” said LarryTucker, a professor of physicaleducation at Brigham YoungUniversity, in Provo, Utah. TheU.S. Department of Health andHuman Services issued a reportlast April showing that 70 per-cent of American adults are notregularly active. 1 Tucker notesthat physical activity, which helps

stave off weight gain and cardiac disease, is also abysmally lowamong children. “It’s a vicious cycle that probably starts at avery early age,” he says. “There’s more passive recreation avail-able to children with television, computers and Nintendo.”

The Centers for Disease Controland Prevention recommends thatindividuals get at least 30 minutesof mild exercise, such as brisk walk-ing, five times a week, or pursuemore vigorous activity for at least20 minutes three times a week. Datafrom the “National Health InterviewSurvey” indicates that 40 percent ofAmericans engage in no physicalactivity at all in a given two-weekperiod. 2

Tucker conducted a study show-ing that leaner kids tended to usethe late daylight hours right afterschools to skateboard, play basket-ball or otherwise get their bodiesmoving. Fatter kids, he said, tend-ed to spend their after-school timein front of the TV or in other seden-tary pursuits.

One reason children are so in-active during the day is that schoolsprovide few outlets for kids to runaround. Title IX, a federal provisionthat mandates equal athletic ex-penditures for boys and girls, hasmade physical education more ex-pensive. Today, Illinois is the only

A Nation of Couch Potatoes

Heavier kids tend to spend their after-school time infront of the television while leaner kids play

outside, according to a recent study.

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plained that thrifty genes had less todo with metabolic rate than an indi-vidual’s ability to regulate his or herown food consumption in times ofplenty. 29 In other words, the thriftygene might better be known as thegreedy gene.

In 1994, researchers at RockefellerUniversity announced that they hadpinpointed a molecule called leptin,which fat cells send to the brain tosignal that they are satiated. In theabsence of leptin, laboratory mice(and, in extremely rare cases, hu-mans) never feel full and eat theirway into extreme obesity. Early

hopes that leptin injections couldcure obesity were quickly dashed,however, when it was learned thatfat people tend to have plenty of lep-tin, but are resistant to it. If the bodyis missing a satiety signal, it makesup for it by eating.

But, if the body gets messages tostop eating, those can sometimes beoverruled by other genetic signals thatencourage appetite. That’s why dietpills tend to lose their effectivenessover the long term. “Mother naturewants her children to eat,” writes EllenRuppel Shell in her 2002 book TheHungry Gene. 30

There is still hope that leptin re-ceptors in the brain will prove a morepromising avenue for research thanthe leptin gene itself. Both molecularbiology and obesity science have beengrowing and well funded in recentyears, attracting top scientists hopingto find a lucrative chemical solutionto the obesity epidemic.

Nevertheless, said JoAnn E. Man-son, chief of preventive medicine atBoston’s Brigham and Women’s Hos-pital, “Physical activity is as close aswe’ve come to a magic bullet for goodhealth. It’s more difficult than poppinga pill, but it’s worth it.” 31

state that still requires daily physical ed-ucation for all students in grades K-12.Fewer than 40 percent of kids are stillphysically active by the time they reachhigh school, according to the AmericanCouncil on Exercise, and fewer than athird of high-schoolers take physical ed-ucation courses. Schools have been cut-ting back on recess as well. Atlanta,which has a no-recess policy, nowbuilds its schools without playgrounds.“Children are shuffled from car or busto school door, then proceed throughthe motions of a supervised day thatmore closely resembles house arrestthan childhood,” complained ChristineWoodside in a Washington Post opin-ion column. 3

Most proponents of physical activityblame the heavy emphasis on standard-ized achievement tests for hogging all theschool hours and leaving no time for kick-ball or free play. “We may leave quite afew children behind if we don’t makesure that they stay healthy and well andlearn how to take care of themselves,”says Judy Young, executive director of the National Associationfor Sports and Physical Education, referring to the new No ChildLeft Behind education law, which requires testing. “I do thinkthere’s a great concern in the public-health arena and even thegeneral public about the health risks of lack of physical activity.”

Young cites data suggesting that over the past decade, whileconsumption of calories has increased by seven or eight per-

cent, physical activity has dropped byabout 15 percent. The wide disparitybetween calorie consumption and ex-penditure of energy is bound to lead toweight problems. “There is no diet thatis going to keep people healthy if theyget no physical activity, which is thecase for most Americans,” says JamesO. Hill, director of the Clinical NutritionResearch Center at the University of Col-orado, in Denver.

As for Korzenik, he tries to be care-ful with his diet, always offering to sharehis salad or turkey sandwich withfriends who do manage to make it toclubs with him. “Have some vegetablematter,” he cajoles. He also makes aconscious effort to keep fit, alternatingruns with weightlifting in the gym lo-cated two floors below his office. Henotes that, at age 50, he weighs 30pounds less than he did attending ju-nior high school in New York City. “Icertainly feel better, more awake,” hesays. “Exercise is a form of relaxation.A lot of people don’t get that.”

1 U. S. Department of Health and Human Services. “Leisure-Time PhysicalActivity Among Adults: United States, 1997-98,” Centers for Disease Controland Prevention, National Center for Health Statistics, April 7, 2002.2 Department of Health and Human Services, “Physical Activity FundamentalTo Preventing Disease,” June 20, 2002.3 Christine Woodside, “Bring Back Recess,” The Washington Post, Dec. 8,2002, p. B7.

Daily P.E. Low in High School

Less than one-third of U.S. high-school students took daily phys-ical-education classes in 1999.

Source: National Alliance for Nutrition and Activity; 1999 is the latest date for which data are available.

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‘Toxic’ Food Environment

S ome biologists have theorizedabout a “set point,” a weight

below which the body simply does-n’t want to go. As people lose weight,their metabolisms slow down as theynear their individual “set point.” Theirweight loss plateaus, and they find itdifficult to burn off more calories. Thetheory is just one of the biological ex-planations for tendencies toward obe-sity that have begun to erode the long-prevailing view that weight gain wasa failure of individual willpower. Nu-trition professors, who once dismissedas hyperbole the idea of a 100 per-

cent overweight America by 2030,now say they’re not so sure.

The number of overweight Ameri-can children has doubled in the last 20years, causing an explosion in the num-ber of cases of childhood diabetes. By1999, up to 45 percent of juvenile dia-betes cases in some areas were Type2 diabetes — once so rare among youngpeople it was called “adult-onset” dia-betes. In 1992, Type 2 accounted foronly 2 to 4 percent of new cases. 32

Diabetes rates have also shot up in adultpopulations: During the 1990s, the rateof Type 2 diabetes among Americansin their 30s jumped 76 percent.

Our genes, thrifty or not, have notchanged so radically over the last

decade or two to explain such a rad-ical difference. So what has changed?

Everyone, it seems, has a favoritevillain in the obesity drama. The Na-tional Soft Drink Association and theGrocery Manufacturers of America, tiredof their products being blamed forweight gain, have been ardently pro-moting more physical activity as a so-lution. Anderson of the National Restau-rant Association, which is seeing someof its members sued by overweightcustomers, says, “I’m waiting for some-body to sue the makers of remote-control clickers. They’re as much toblame for obesity as we are.” Indeed,a recent study found that only 8 per-cent of children who watch one hour

OBESITY EPIDEMIC

Lean and Mean

Talk show host Oprah Winfrey has fought a much-publicized battle to lose weight and says regular exercisehas helped. Once-rotund weatherman Al Roker of NBC’s “Today” show slimmed down after undergoing gastricbypass surgery, or stomach stapling.

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or less of television a day are obese,while 18 percent who watch four hoursor more are obese. 33

No doubt all of these factors, andmany more, are contributing to the cre-ation of what Kelly Brownell, a notedexpert on eating disorders and direc-tor of graduate studies at Yale Univer-sity, calls a “toxic food environment.”People are eating bigger and fattiermeals, drinking more sodas and exer-cising less. There are fewer opportu-nities for children to play or for adultsto strain themselves physically at work.People sit in cars rather than walkingand tend to snack pretty heavily whenthey’re sedentary, whether they’re watch-ing TV, working at a computer, or try-ing to kill as many space aliens as theirXbox will allow.

‘Soft and Flabby’

N one of these complaints, ofcourse, is anything new. Back in

1957, U.S. News & World Report pub-lished an extended section warningabout the decline in fitness amongAmerican youth: “Parents are beingwarned that their children — taken toschool in buses, chauffeured to activ-ities, freed from muscle-building choresand entertained in TV sets — are get-ting soft and flabby.” 34

In response to such concerns, Pres-ident Dwight D. Eisenhower estab-lished the President’s Council on Phys-ical Fitness and Sports in 1956. Hissuccessor, President John F. Kennedybroadened the council’s scope: It de-veloped testing standards and begana series of physical-fitness clinics forteachers, administrators and recreationpersonnel. Marked improvements inphysical fitness appeared between 1958and 1965. 35

Since then, despite jogging fads andsoccer leagues — for girls as well asboys — the amount of exercise Amer-icans get has declined measurably. Over

the past quarter-century, foot and bi-cycle travel have dropped by 40 per-cent. Many schools no longer requirephysical education (PE) courses or evenlet kids out for recess. And those schoolsthat still require PE demand less phys-ical activity. Around the time of theU.S. News fitness warning, the average15-year-old boy could run 600 yardsin 2 minutes and 19 seconds and do45 sit-ups. Today, the military com-plains that volunteer troops aren’t in

good enough shape or coordinatedenough to complete basic training.

At the same time that students aregetting less exercise in schools, theyare being bombarded with ever-in-creasing numbers of soda and snack-food choices at school, plus advertis-ing messages both on campus and athome. One widely cited estimate is thatthe average American child sees 10,000ads a year for food products — andnot many of those are for fruits and

Health Consequences of Obesity

Overweight and obese* individuals are at increased risk for a wide range of serious and often fatal diseases and conditions, according to the National Institutes of Health, including:

* Obesity is defined as a BMI of 30.0 or more; overweight is a BMI of 25.0 to 29.9.

Source: National Institutes of Health, “Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults,” 1998

• High blood pressure (hypertension)• High blood cholesterol (dyslipidemia)• Type 2 (non-insulin dependent) diabetes• Insulin resistance (glucose intolerance)• Hyperinsulinemia• Coronary heart disease• Angina pectoris• Congestive heart failure• Stroke• Gallstones• Cholescystitis and cholelithiasis• Gout• Osteoarthritis• Obstructive sleep apnea and respiratory problems• Some types of cancer (such as endometrial, breast, prostate

and colon)• Complications of pregnancy• Poor female reproductive health (such as menstrual

irregularities, infertility, irregular ovulation)• Bladder-control problems (such as stress incontinence)• Uric acid nephrolithiasis• Psychological disorders (such as depression, eating

disorders, distorted body image and low self-esteem).

90 CQ Researcher

vegetables. As many as 80 percent ofthe commercials aired during children’sprogramming pitch calorie-densefoods. Saturday-morning cartoons ontelevision — “once a time for childrento get a few laughs on a non-schoolday, [have] become a time to indoctri-nate them on the benefits of grease,salt and ever-increasing amounts ofsugar,” writes Greg Critser, author ofthe new best-seller, Fat Land: HowAmericans Became the Fattest People inthe World. 36

Not only has the food industry in-undated American children with adsfor unhealthy snacks, it has packedits processed foods with cheaper —but more potent — sugars. High-fruc-tose corn syrup, developed in theearly 1970s, offers several commer-

cial advantages over cane sugar: It issix times as sweet and a lot cheap-er. By the 1980s, both Coke and Pepsihad switched their formulas from asugar/corn-syrup mix to pure high-fructose corn syrup, saving them 20percent on sweetener costs. 37

But the switch had health effectsas well. Fructose, also used in processedsnacks and many other products, isdigested differently from traditional sug-ars. It does not trigger the same sig-nals in the brain as regular sugar in-dicating that calories have entered thebody. Some studies indicate that fruc-tose causes the liver to produce moreof an enzyme that, in turn, causes thebody to store rather than to burn fat.

Fructose now accounts for 9 per-cent of the calories in the average adult’s

diet and 20 percent of the calories inthe average child’s diet. Nutrition re-searchers, who have spent a genera-tion blaming fat for obesity problems,were slow to pick up on fructose’sprevalence and possible responsibilityfor widespread weight gain.

But they weren’t so far wrong inconcentrating on fat. The anti-fat mes-sage has gotten garbled. Too manypeople believe that carbohydrates areharmless, thinking that if they eat nofat they’ll continue to eat lean. Fat hasslipped as a share of the American dietin recent years — but only becausewe’re eating so much more other food,not because fat consumption is down.Over the last 20 years, for instance,consumption of cooking and spread-ing oils has gone up by an average of

OBESITY EPIDEMIC

Food Pyramids Attract Controversy

The Agriculture Department plans to update its traditional Food Guide Pyramid by 2005 to respond to widespread criticism that it recommends multiple servings each day of processed carbohydrates like bread, rice and pasta and doesn’t differentiate between types of fats or meats. Meanwhile, researchers at the Harvard School of Public Health have developed the alternative Healthy Eating Pyramid, based on recent research. It also is controversial because of its heavy emphasis on calorie-rich vegetable oils and its recommendation that potatoes and white rice be severely limited. But many experts say its health effects have been evaluated and affirmed.

Sources: U.S. Department of Agriculture, Harvard School of Public Health

Harvard’s Healthy Eating PyramidAgriculture Department’s Food Guide Pyramid

Fats, Oils & Sweets

USE SPARINGLY

Milk, Yogurt & Cheese Group

2-3 SERVINGS

Vegetable Group

3-5 SERV-INGS

Meat, Poultry, Fish, Dry Beans, Eggs & Nuts Group

2-3 SERVINGS

Fruit Group

2-4 SERVINGS

Bread, Cereal,Rice & Pasta

Group

6-11 SERV-INGS

KEY

Fat (naturally occurring and added)Sugars (added)

These symbols show fats and added sugars in foods.

Jan. 31, 2003 91CQ on the Web: www.cqpress.com

13 pounds per person per year. Muchof that increase was attributable to par-tially hydrogenated vegetable oil, a com-mon but unhealthy form of fat.

Scientific theories that overexpo-sure to fructose and fat interferes withthe body’s ability to register satiety arestill controversial. But few people in

the scientific community doubt thatfats and sugar contribute to obesity.The prevalence of both in our culture,coupled with the dearth of exercise,

A dam Drewenowski, a nutrition professor at the Uni-versity of Washington, has a solution for the country’sweight problems that is right in keeping with the times:

establish a federal Department of Homeland Obesity.He may sound like he’s kidding, but some of the same ar-

guments used to create the Homeland Security Department arerelevant to how the government deals with the obesity epi-demic. For instance, responsibility for different aspects of theobesity problem is scattered across numerous federal agencies.The National Institutes of Health (NIH) takes care of research,the Centers for Disease Control and Prevention (CDC) handlesprevention and the Department of Agriculture is in charge ofnutrition education.

“It’s arguably our No. 1 public-health problem,” says JamesO. Hill of the University of Colorado Health Sciences Center,“and we don’t have a single national health program to dealwith it.”

Even within the various agencies, responsibility for differ-ent parts of the obesity puzzle is scattered among offices thatmay not coordinate effectively. At NIH, for example, cardiacresearch is conducted at one institute, while an entirely differ-ent institute studies outcomes of diabetes treatments. And manyare concerned that while research on particular diseases is beingprovided, the underlying pathology of obesity — a contribut-ing factor to a host of diseases — isn’t getting enough study.

Eva Obarzanek, a research nutritionist at the National Heart,Lung and Blood Institute, concedes, “There’s a gray area whereit’s hit or miss for funds.”

The American Obesity Association has been lobbying forcreation of a National Institute of Obesity. “That we wouldhave an institute on everything that’s serious to Americans andnot one on obesity or nutrition is criminal,” says George Black-burn, chairman of nutrition medicine at Harvard MedicalSchool.

The funding for research and education is also out ofwhack with the impact of obesity on both the nation’s healthand its pocketbooks. NIH spends about $250 million a yearon obesity research — less than a quarter of what it spendson AIDS research. Meanwhile, the CDC’s Division of Nutri-tion and Physical Activity receives $27.6 million a year to pro-duce educational programs to prevent obesity, while it re-ceives $100 million to reduce tobacco use — even thoughunhealthy eating and inactivity kill about as many Americansannually as tobacco use. 1

Just as important as creating a one-stop agency for obesityresearch, nutrition advocates say, is the need for a single gov-

ernment leader who can speak with authority on the issue —both when Congress is formulating new policies and to helpclear up confusion amid the welter of often-contradictory mediareports about weight and health problems.

“Within government, there’s not really an obesity leaderwho’s at a high enough level to work with Congress on craft-ing better proposals to deal with it,” says Morgan Downey, ex-ecutive director of the American Obesity Association.

Bill Pierce, a spokesman for Health and Human Services Sec-retary Tommy G. Thompson, says obesity “has been a top pri-ority for the secretary as part of his disease-prevention and health-promotion agenda” and that Thompson has made use of the“good, old-fashioned bully pulpit” to address the problem. Hehas also been working with Agriculture Secretary Ann M. Vene-man to promote more consumption of fruits and vegetables.

As Thompson himself notes, overweight and obesity costAmericans $117 billion a year, making it too big a problem forgovernment to ignore, especially as the baby-boom generationages, causing the cost of treating obesity-related illnesses to riseeven faster. “What’s gotten Thompson’s attention are health-care costs,” says Steven C. Anderson, president of the Nation-al Restaurant Association.

Those costs would drop significantly if the governmentwould increase the CDC’s anti-obesity education funding, ar-gues the National Alliance for Nutrition and Activity (NANA),a coalition of more than 200 health and fitness organizations.“A federal investment now in population-based primary pre-vention of expensive chronic diseases would pay for itself infuture reductions in Medicare and Medicaid costs for medicaltreatments, prescription drugs and hospitalizations, which willonly grow larger as the baby-boom generation ages,” Moham-mad Akhter, executive director of the American Public HealthAssociation (APHA), told the House Appropriations Subcom-mittee on Labor, Health and Human Services, Education andRelated Agencies last April 30. NANA, of which the APHA isa member, is also asking Congress to restore funding for theYouth Media Campaign, which funds physical-activity programsin middle schools, to its previous $125 million level.

The $125 million would be “significantly less than the $890million spent to promote Coca-Cola soft drinks or the $1.2 bil-lion spent annually for advertising and promotions by Mc-Donald’s,” Akhter said.

1 Center for Science in the Public Interest, letter to Congress seeking higherallocations for anti-obesity education efforts, http://actionnetwork.org/CSPI/alert-description.tcl?alert_id=2002636.

Does U.S. Need Department of Homeland Obesity?

92 CQ Researcher

leads University of Colorado physiol-ogist Hill to conclude that obesity “isa normal response to the Americanenvironment.” 38

CURRENTSITUATION

Federal Action

L ast year, a nutritionist called for a“Million Pound March” on Wash-

ington to secure increased funding fornutrition education, physical activityand obesity-research programs. Evenin the absence of such pressure, Con-gress this year will reauthorize theChild Nutrition Act, which establishedthe school breakfast program back in1966. This year’s debate is expectedto be highly contentious, as lawmak-ers discuss a variety of suggestions onhow the federal government mightcombat obesity.

Under the act, lunches served inschool cafeterias have to meet certainminimum nutritional guidelines. But,for the most part, food served else-where — in soda vending machinesor at counters run by fast-food chains— is exempt from either nutritionalrequirements or USDA oversight. TheUSDA has asked Congress for au-thority to regulate snacks in schools,and there will be a general push tomake sure all food served on campusis nutritious, but it’s not at all clearthat either policy will go through. Therelevant committees have not yet start-ed work on the bill, but already theyare being heavily lobbied on a po-tential guidelines conflict between ad-vocates for fruits and vegetables andthe dairy industry. 39

Members of Congress will use thelegislation to push their pet ideas.

New York Democratic Sen. CharlesE. Schumer, for example, has float-ed the idea of installing milk vend-ing machines in schools. Iowa Sen.Tom Harkin, also a Democrat, maywant to expand a program he in-serted into the 2002 farm bill, whichprovides free fruits and vegetables tostudents attending 25 schools in fourdifferent states. School cafeteriagroups will push for more moneyfor the nutritional efforts that theyhave under way.

The elevation of Tennessee Re-publican Bill Frist — a heart surgeon— to Senate majority leader breathesnew life into a bill he first introducedlast year and will probably bring upagain this year. It would provide $125million for a CDC nutrition-educationcampaign aimed mostly at youngpeople.

His bill would also give the statesand local governments $80 million topromote healthy eating and physicalactivity, and it would help schools de-velop courses on nutrition and weight-loss programs designed to serve mi-nority populations.

In 2000, Senate Appropriations Chair-man Ted Stevens, R-Alaska, sponsoredthe Physical Education for Progress Act,which awards grants directly to schooldistricts to initiate or improve physi-cal education courses. The five-yearprogram has struggled for funding eachyear, though, and its supporters say itfaces rough sledding in the currentbudget environment.

The interest of top Republican lead-ers like Frist and Stevens shows thatthe obesity issue has the firm atten-tion of Congress. Their approaches tothe problem, however, point out amajor political divide on this issue.Their programs are designed to pro-mote physical activity — not curb con-sumption of food. Many Republicanswould prefer a voluntary approach toa problem that they regard as mainlythe province of individual consumerchoices, not the fault of the food in-

dustry. As Frist wrote of his bill, “Itwouldn’t impose a ‘fat tax’ or imposeonerous new regulations on the foodindustry. In fact, the restaurant indus-tries have already demonstrated sig-nificant leadership by increasing thenumber of advertisements for fast-foodrestaurants promoting healthier op-tions.” 40

Democrats, by contrast, are morelikely to call for increased governmentregulations. For example, Sen. PatrickLeahy, D-Vt.,who tried last year to winauthority for the USDA to regulatemore of the food choices available inpublic schools, hopes to attach sucha provision to this year’s Child Nutri-tion Act reauthorization, said hisspokesman.

But Republicans and the adminis-tration — while not inclined to addto the regulatory burden on the foodindustry — are nonetheless concernedabout rising health costs associatedwith obesity. They are stepping upgovernment efforts to educate thepublic about the dangers of overweight.HHS Secretary Thompson announcedJan. 22 that his department is seekinga $100 million increase — or a totalof $125 million — in fiscal 2004 fora CDC program called “Steps to aHealthier U.S.” It would provide grantsto some states and about a dozencities to promote responsible healthchoices, and would fund health- andinsurance-company programs that em-phasize prevention and identify riskfactors for obesity, asthma and dia-betes.

The funding represents an ex-pansion of the Bush administration’sHealthy Communities initiative. TheCDC’s Division of Nutrition andPhysical Activity has an annual bud-get of $27.6 million, compared to the$100 million the agency spends onprograms to reduce the use of to-bacco.

Nutrition advocates welcome the ex-pansion of grant programs, but theynote that the federal government’s

OBESITY EPIDEMIC

Jan. 31, 2003 93CQ on the Web: www.cqpress.com

anti-obesity campaigns are dwarfed byprivate company advertising for candy,soft drinks and fast food. The NationalCancer Institute spends $2 million ayear to publicize its “5-a-day” programurging people to eat five fruits andvegetables daily. 41 Meanwhile, Marsspends $68 million — almost 35 timesthat amount — to promote its M&Mscandies, and McDonald’s spends 500times that amount on its advertisingand promotions. 42

Nutrition advocates, such as theCenter for Science in the Public Inter-est, have joined in an alliance of 235health-related organizations — the Na-tional Alliance for Nutrition and Activ-ity — to lobby for, among other things,more federal spending on nutrition ed-ucation and activity promotion. 43

New Pyramids

I n fact, the federal government’s nu-trition-education budget has been so

lean in recent years that much of thepublicity for the government’s food pyra-mid has come from private advertising— bakers and raisin growers and oth-ers using the pyramid to promote theirproducts as healthy choices.

In the process, complain USDA of-ficials, the pyramid has become anicon by itself, and is too often pre-sented without the pages of explana-tory text meant to accompany it.

The USDA is expected to revisethe pyramid by 2005, because manyfeel it is not sufficiently informative.The pyramid recommends, for instance,six to 11 servings of breads, grains,pasta or rice per day. But its conceptof what constitutes a serving doesn’talways gibe with the public’s view ofa typical serving. A single bagel today,for instance, is equivalent to four USDAservings. The pyramid also doesn’tdifferentiate between types of fats ormeats and doesn’t offer different guide-lines for children and adults.

First introduced in 1992, the pyra-mid has spawned many imitators.The Oldways Preservation and Ex-change Trust, a food-issues think tank,has introduced pyramids based onMediterranean, Asian, vegetarian andLatin-American diets and has anAfrican-American diet pyramid in theworks. 44

One of the best-known and per-haps best respected private pyra-mids, the Healthy Eating Pyramid,was put out by the Harvard Schoolof Public Health. Designed less as aweight-loss guide than a lifelong

healthy-eating plan, the Harvard pyra-mid puts more emphasis on the prosand cons of individual foods. Whilethe USDA pyramid was simplified tosuggest that most fats are bad andmost carbohydrates are good, the Har-vard plan suggests that carbohydrateslike potatoes and white rice shouldbe avoided, while fatty vegetable oilsare fine. 45

Because the USDA pyramid is soinfluential and has been used so heav-ily, any changes will be the source ofheavy lobbying from various food and

Continued on p. 96

Did You Know . . .

• 61 percent of American adults were overweight or obese in 1999.

• 13 percent of U.S. children were overweight in 1999.

• 14 percent of adolescents were overweight in 1999 — near-ly triple the rate 20 years earlier.

• Increases in overweight and obesity cut across all ages, racial and ethnic groups, and both genders — but are more prevalent among lower-income and less-educated groups.

• At least 310,000 Americans die each year due to causes associated with obesity.

• Treating obesity and its related diseases costs $117 billion a year.

• Less than a third of adults engage in the recommended amounts of physical activity (30-60 minutes per day), and 40 percent of Americans do not participate in any leisure-time physical activity.

• Between 1991 and 1999, the percent of high-school students attending daily physical education classes dropped from 42 percent to 29 percent.

• The federal government spends three times more on its anti-tobacco programs than it spends promoting nutrition and physical activity — even though unhealthy eating and inactiv-ity kill about the same number of Americans as tobacco use.

Sources: Centers for Disease Control and Prevention and Department of Health and Human Services, Office of the Surgeon General.

yes noSAMUEL HIRSCHPLAINTIFFS’ ATTORNEY

FROM A BRIEF FILED IN NEW YORK STATE SUPREME COURT, PELMAN V. MCDONALD’S, AUG. 21, 2002

mcDonald’s Corp. engages in the distribution, sale andmarketing of food products that are high in fat, salt,sugar and cholesterol content, which numerous stud-

ies have shown cause obesity, diabetes, coronary heart disease,high blood pressure, strokes, elevated cholesterol intake, relatedcancers, and other detrimental and adverse health effects. McDon-ald’s failed to warn the users and consumers of their food prod-ucts of the nature of these ingredients or adequately label pack-ages and containers. As a result, children under 18 have becomeobese and developed associated diseases.

The United States is experiencing substantial increases inoverweight and obesity that cut across all ages, racial and eth-nic groups, and both genders. Obesity has been increasing inevery state and has reached epidemic proportions. In 1999, anestimated 61 percent of U.S. adults were overweight or obese,and 13 percent of children and adolescents were overweight.Today, there are nearly twice as many overweight childrenand almost three times as many overweight adolescents asthere were in 1980. Approximately 300,000 deaths a year inthe United States are currently associated with overweight andobesity.

The most recent data estimate that 13 percent of childrenages 6 to 11 years and 14 percent of adolescents ages 12 to19 years are overweight. During the past two decades, the per-centage of children who are overweight has almost doubled(from 7 to 13 percent), and the percentage of adolescents whoare overweight has almost tripled (from 5 to 14 percent).

The question of law is whether McDonald’s engaged in, oremployed deceptive practices in the advertisement, sale orpromotion of its food products, in violation of New York gen-eral business laws; and whether McDonald’s knew or shouldhave known that the consumption of its products and foodswas harmful.

McDonald’s engaged in marketing practices which enticedchildren to consume their respective products in larger por-tions through the use of “value meal” and meal-combo adver-tisements without disclosing their detrimental health effects.McDonald’s directly marketed its food products to childrenand parents and enticed the children to consume its foodthrough the use of promotional incentives and marketing,aimed directly at children.

McDonald’s marketed its food as nutritious and engaged inunfair and deceptive acts and practices, in violation of theconsumer-fraud statutes and provisions of the New York Con-sumer Protection Act.

STEVEN C. ANDERSONPRESIDENT AND CHIEF EXECUTIVE OFFICER, NATIONAL RESTAURANT ASSOCIATION

WRITTEN FOR THE CQ RESEARCHER JANUARY 2003

recent lawsuits dealing with the complex issue of obesityand overweight among some Americans give the termfrivolous lawsuit a bad name. However, a recent land-

mark decision by U.S. District Judge Robert Sweet in New Yorkconfirmed that common sense and personal responsibility prevail.

On Jan. 22, Judge Sweet dismissed a suit against a quick-service restaurant chain underscoring the association’s positionthat restaurants — and food — should not be blamed or heldliable for the multifaceted issue of obesity. We are hopefulthis ruling will deter others from filing abusive, frivolous law-suits that further encumber our judicial system.

The trial bar and certain special-interest groups continue toswallow a simplistic notion by ignoring the complex reasons forobesity such as overall dietary choices, level of exercise, familyhistory, genetic susceptibility and other medical conditions. It isunconscionable that some will sit in their ivory towers to findways to enrich the trial bar at the expense of the hard-working11.7 million Americans who comprise the restaurant industry.

While America continues to rely upon high-quality, smart-valued meals prepared by restaurants, 76 percent of all mealsare eaten by individuals at home. When consumers do dine inone of the nation’s 870,000 restaurants, they find a variety ofmenu items to accommodate the dietary needs of any con-sumer. Experts agree that all foods can be part of a healthylifestyle, and that the real key to attaining and maintaining ahealthy lifestyle is through balancing energy in and energy out.

And, therein lies the problem. Our society has becomemuch more sedentary over the last 30 years, as evidenced bythe noticeable couch-potato culture, particularly among chil-dren. According to researchers at The Johns Hopkins Universi-ty School of Medicine and the Centers for Disease Control,the average child spends 15,000 to 18,000 hours watchingtelevision by age 17. Other important factors contributing tothis sedentary lifestyle include the virtually non-existent dailyphysical-education programs, as well as nutrition education, inAmerica’s schools. Only one state requires daily physical edu-cation programs in its schools — Illinois.

The restaurant industry is an industry of choice, and cus-tomers want options and flexibility in the foods they eat.American consumers know they are responsible for their owndietary choices, and recent association research shows that anoverwhelming 95 percent feel they are qualified to make theirown decisions of what to order when dining out. And theydon’t want government or anyone else sitting at the tabletelling them what to eat.

94 CQ Researcher

At Issue:Should restaurants be liable for customers’ weight gains?

noyes

Jan. 31, 2003 95CQ on the Web: www.cqpress.com

At Issue:Should chain restaurants be required to publish nutrition labelson their menus?

yesDR. MARGO WOOTANDIRECTOR OF NUTRITION POLICY, CENTER FORSCIENCE IN THE PUBLIC INTEREST

WRITTEN FOR THE CQ RESEARCHER, JANUARY 2003

which has more calories: a McDonald’s Quarter-Pounder or a nine-piece Chicken McNuggets? Whathas more heart-damaging fat: a roast beef sandwich

or a tuna salad sandwich?Don’t feel bad if you don’t know; the answers are not al-

ways obvious. (For the record, a Quarter-Pounder and theChicken McNuggets have the same calories; a tuna sandwichcan have twice as much saturated fat as a roast beef sand-wich with mustard.)

Fast-food and other chain restaurants must do a better jobof disclosing nutrition information. Americans eat out twice asoften as they did in 1970, now getting about a third of theircalories outside the home. Children eat almost twice as manycalories — 765 — when they eat at a restaurant compared tothe 425 calories they get when eating at home.

Overweight and obesity are the most pressing health issuesfacing the country. Over the last two decades, obesity rateshave doubled in adults and children and tripled in teens, andobesity-related health problems cost the nation about $117 bil-lion each year.

No one is suggesting that restaurants are entirely to blame,only that they need to do their part.

Consumers have a right to know what they are eating. Insupermarkets, most packaged foods must provide nutrition in-formation, but restaurants are exempt from that law. Somefast-food restaurants provide nutrition information in tiny printon hard-to-find posters or inconvenient Web sites. It would bemore helpful to see on menu boards that, for instance, thecost of a Cinnabon is $2.49 and 670 calories.

We’re talking big chains like T.G.I. Friday’s and Pizza Hut,not family-owned neighborhood restaurants. The model legisla-tion we’ve drafted would only require restaurants with 10 ormore units to disclose calories, saturated fat and sodium con-tent on their menus.

Mandatory nutrition labeling not only would make manyconsumers think twice about super-sizing already ample por-tions but also would let them know that the sirloin steak hashalf the calories of the porterhouse. And who knows? Restau-rants might start competing with each other on the basis ofnutrition, instead of just price.

Given the large role restaurants play in Americans’ diets andthe skyrocketing rates of obesity, Congress, state legislatures orlocal governments should require calorie and other nutrition la-beling on menus and menu boards at chain restaurants.

RICHARD BERMANEXECUTIVE DIRECTOR, CENTER FOR CONSUMERFREEDOM

WRITTEN FOR THE CQ RESEARCHER, JANUARY 2003

current litigation designed to force restaurants to providenutrition labeling on the food they serve is a smoke-screen for a much grander agenda to fatten attorney

wallets. Their strategy is to set up the industry for failure andfurther litigation, because food production and portion size arenot an exact science.

You never get the exact same number of fries when youorder them any more than your mom’s meatloaf will have thesame fat content each time she makes it. These lawyers sali-vate over the idea of forcing restaurants to label exact calorie,fat and sodium content, because they know it is a game thatrestaurants cannot win.

Fortunately, this strategy was recently dealt a setback. U.S.District Judge Robert Sweet dismissed a class-action lawsuitagainst McDonald’s.

“If a person knows or should know that eating copious or-ders of super-sized McDonald’s products is unhealthy and mayresult in weight gain,” Sweet ruled, “it is not the place of thelaw to protect them from their own excesses.”

This was a second blow to the same entrepreneurial attor-neys. Their earlier suit was filed on behalf of Caesar Barber,an obese adult who suffered from a lifetime of poor diet andlack of exercise. Mr. Barber and his crafty lawyers sued fourleading restaurant chains because he didn’t realize that over-consumption of their food was fattening him. This case waslaughed out of the court of public opinion, and rightly so.

Additional food labeling will not help Americans slimdown, but common sense will. If you need a warning label, amirror might do just as well. If Mr. Barber failed to follow re-peated advice from his doctor to change his diet and to exer-cise and if two heart attacks did not serve as a wake-up call,why would any judge or jury believe that a label on acheeseburger wrapper served by a teenage employee wouldmake him change his mind?

Obesity is a lifestyle problem that results from any combi-nation of poor diet, lack of physical activity, genetics, andage. Even John Banzhaf, the top adviser and cheerleader forthe fast-food lawsuits, realizes that customers have commonsense when he recently admitted to MSNBC: “Everybodyknows that, if you want to lose weight, you eat less, haveless calorie input, and get more exercise. You don’t have tolearn that.” We couldn’t have said it better ourselves.

The center is a coalition supported by restaurant operators, food and bever-age companies, and concerned individuals working “to promote personal re-sponsibility and protect consumer choices.”

96 CQ Researcher

OBESITY EPIDEMIC

nutrition groups. Aswith most federal foodguidelines, amendingthe pyramid is an oc-casion for food fightsamong all the affectedindustries — corn grow-ers, beef ranchers andjust about every otherfood producer — andnutrition advocates, in-cluding the medicallobby.

In earlier fights, thefood industry has spo-ken with perhaps thelouder voice. Becauseprocessed foods aremuch more profitablethan fresh vegetables,getting government sealsof approval on them in-directly through thecrafting of the food pyra-mid has become bigbusiness.

Whether concernsraised by the surgeongeneral and othersabout the health andeconomic costs of obe-sity will outweigh thecommercial concerns re-mains to be seen.

In the States

C urrently, 18 states regulate school-nutrition policy more strictly than

the USDA. Eleven state legislatures lastyear considered either banning softdrinks and junk foods from schools orincreasing sales taxes on them. Thebills largely went nowhere, but thatwon’t stop legislators in many statesfrom trying again. Advocates of thelaws believe they will discourage con-sumption and will help raise moneyfor health education or other purpos-

es. Their opponents argue that thereare plenty of other products that con-tribute to obesity, so sodas shouldn’tbe singled out in the tax code.

Some major school districts, such asthose in Madison, Wis., Oakland, Calif.,Philadelphia and Los Angeles, have de-cided to ban soft drinks from schools.Some districts have even gone so far asto send letters home warning parentsthat their kids are too fat. But most ofthe battle over school policy is takingplace in legislatures, where there is talknot only of banning sodas and otherfoods with “minimal nutritional value,”but also of restoring daily physical ed-

ucation to the required cur-riculum. About eight to 10states are also thinking ofemulating a program calledColorado on the Move,which seeks to get residentsof that state to walk an extra2,000 steps a day. The planis modest, but Colorado isthe only state in the unionwhere most adults aren’toverweight. “We’re the lean-est state in the Centers forDisease Control self-report-ed data,” says physiologistHill, a Colorado on theMove organizer. “We’re thebest of a bad lot.”

In the courts, much at-tention has been focusedon the lawsuits filed againstfast-food chains. The restau-rant industry is confident itcan bat back such legal chal-lenges. But John Banzhaf,a George Washington Uni-versity law professor whoadvocates the anti-fast foodsuits, notes that there wereseveral hundred lawsuitsfiled against tobacco com-panies before any of themmade it to trial.

Banzhaf says court actionis “a last resort,” he adds.Legislation would be much

preferable, but what’s happened in thisarea is “exactly what happened in to-bacco — legislators refused to legislate.”

Many nutrition advocates and oth-ers compare the legal fights against to-bacco companies with the burgeoningcomplaints — and skyrocketing health-care costs — related to obesity. LikeBanzhaf, they believe that, just as smok-ing was once viewed as strictly an in-dividual choice but eventually came tobe seen as a burden on society, oneday society will decide that it cannotafford to pay for health costs associ-ated with overeating and lack of ex-ercise. However, given the recent dis-

Continued from p. 93

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as C

ain

Potato chips featuring rapper Lil’ Romeo and other hip-hop stars nowtarget minorities, who have the nation’s highest obesity levels. Some

chip makers are reformulating the frying oil they use to cut down onso-called trans fats, which are created when oils are turned into

more unhealthful solid fats like margarine and shortening.

Jan. 31, 2003 97CQ on the Web: www.cqpress.com

missal of the lawsuit against McDon-ald’s and without tobacco-type evi-dence that food companies are lyingabout the health effects of their prod-ucts, it’s not clear that lawsuits willenjoy the same success as the anti-to-bacco crusade. And given the currentstate budget crunch, cash-strapped statesare not expected to take up expen-sive class-action lawsuits against cor-porate giants without smoking-gunproof that the food companies delib-erately misled the public.

OUTLOOKRx: Common Sense

B ecause the number of overweightand obese Americans has become

so staggering — about 135 million in-dividuals in all — the issue has becomea major focus of media attention. It’salso attracted the interest of top policy-makers, especially federal health officials.

Rather than imposing new nutritionlabeling or other rules on the restau-rant industry, the administration prefersto focus on funding local efforts to en-courage more exercise. Besides pro-viding federal funds for more walkingand bike paths, the administration’s“Healthy People 2010” campaign isaimed at reducing the prevalence ofobesity among adults to less than 15percent by 2010. It is one of the 15national priorities outlined in the sur-geon general’s 2001 Call to Action,which urged individuals, families, com-munities, schools, worksites, health-careorganizations, media, industry and thegovernment to work to prevent anddecrease overweight and obesity.

But because there are no easy fixesto a problem that is so widespread,things are likely to get worse beforethey start to get better.

Common sense and the best med-ical evidence suggest that regardless ofan individual’s propensity for weightgain, he or she would be well-advisedto eat fewer calories and get more ex-ercise. Imposing such discipline on amass scale, however, is going to takesome doing. Especially when practi-cally every message in the advertisingculture encourages more indulgence —whether for a caloric Frappucino or azippy car ride along the California shore.Eighty-five percent of all trips taken byAmericans now occur in a car, whichdoesn’t help anyone lose weight.

Individuals, on average, are gainingweight, and particular individuals are tend-ing to get heavier. That means incidenceof diabetes, renal failure and heart dis-ease will continue to escalate. “This isan issue that’s going to take generationsto deal with,” says Hill, of the Universi-ty of Colorado. “It’s going to take a longtime even if we start today.”

Nutrition advocates like Hill agree thatpeople should eat less fast food, walkmore, work out more and avoid soda.But most people don’t agree. It’s notjust a question of interested corporationscomplaining about such changes. MostAmericans like the lifestyle that nutri-tionists blame for obesity. And that lifestyleis spreading worldwide, causing obesi-ty problems everywhere it goes.

Getting people to change such in-grained collective habits is going totake a lot of self-will. But people —especially children — are probablygoing to need help. They will suc-cumb to temptation a lot less often iffoods high in sugar, salt and fatweren’t so readily available.

“I think with the amount of ener-

gy that’s being put into it now, it’spossible we might be able to stabilizethe prevalence. Maybe we can keepit from jumping another 10 percentpoints by 2010,” says Shiriki Kumanyika,associate dean for health promotionand disease prevention at the Univer-sity of Pennsylvania medical school.

But, she adds, “If people think mak-ing people more aware and that ex-ercise and self-restraint are going todo it alone, we’ll have an even big-ger increase in obesity over the next10 years.”

Notes

1 Quoted in Kim Severson, “Obesity ‘a threat’to U.S. security,” San Francisco Chronicle,Jan. 7, 2003, p. A1.2 For background, see U.S. Department ofHealth and Human Services, “The SurgeonGeneral’s Call to Action to Prevent and De-crease Overweight and Obesity,” 2001.3 CDC press release, Dec. 31, 2002. See AliH. Mokdad, et al., “Prevalence of Obesity,Diabetes, and Obesity-Related Health RiskFactors, 2001,” Journal of the American Med-ical Association, Jan. 1, 2003, pp. 76-79.4 Severson, op. cit.5 Beverage Digest 2001 Fact Book6 Bill Bryson, “The Baseball Writer,” The NewYorker, April 9, 2001, p. 46.7 See Carole Monaghan, “Attention — student— shoppers; Advertisers want kids’ biz —and they’re pitching to schools to capture it,”Chicago Tribune, Jan. 14, 2002, p. 10.8 Quoted in Erika Hayasaki, “Schools to EndSoda Sales,” Los Angeles Times, Aug. 28, 2002,p. B1.9 Quoted in press release issued by the cen-ter, April 3, 2001, at www.nsda/org/Soft-Drinks/CSDHealth/Nutrition/NutritionPR/Con-sumption43.html.

About the AuthorAlan Greenblatt is a staff writer at Governing magazine. He previously cov-ered elections, agriculture and military spending for CQ Weekly, where hewon the National Press Club’s Sandy Hume Memorial Award for politicaljournalism. He graduated from San Francisco State in 1986 and received amaster’s degree in English literature from the University of Virginia in 1988.

98 CQ Researcher

OBESITY EPIDEMIC

10 D.S. Ludwig, et al., “Relationship BetweenConsumption of Sugar-Sweetened Drinks andChildhood Obesity: A Prospective, ObservationalAnalysis,” Lancet, pp. 505-508, Feb. 17, 2001.11 Michael F. Jacobson, “Liquid Candy: HowSoft Drinks Are Harming Americans’ Health,”Center for Science in the Public Interest,http://www.cspinet.org/sodapop/liquid_candy.htm, Oct. 21, 1998.12 Quoted in “Absolute Risk of Obesity: Foodand Drink Companies Not So Defensive?”UBS Warburg Q-Series, Nov. 27, 2002, p. 18.13 Quoted in Mary Duenwald, “A Conversa-tion With: Marion Nestle; An ‘Eat More’ Mes-sage for a Fattened America,” The New YorkTimes, Feb. 19, 2002, p. F6.14 See, for instance, Erin Lynn Morris et al., “Por-tion Size of Food Influences Energy Intake inAdults,” FASEB Journal, March 8, 2001, p. A890.15 Quoted in John McKenzie, “Super-SizedNation,” ABC News.com, Jan. 21, 2003.16 Ibid.17 Quoted in Ellen Ruppel Shell, The Hun-gry Gene: The Science of Fat and the Futureof Thin (2002), p. 198.18 “Absolute Risk of Obesity,” op. cit., p. 1.19 Quoted in Eric Schlosser, Fast Food Na-tion (2001), p. 237.20 See the National Restaurant AssociationWeb site, http://www.restaurant.org/press-room/pressrelease.cfm?ID=52321 According to the USDA’s Food and Nu-trition Service.22 For background, see Shell, op. cit., p. 31.23 Gary Taubes, “What If It’s All Been a BigFat Lie?” The New York Times Magazine, July7, 2002, p. 22.24 Sally Squires, “Last Month, a Provocative Ar-ticle Argued That a Low-Fat Diet May Be Re-sponsible for America’s Obesity Epidemic — andThat High-Fat May Be Healthier. The Problem:A Lot of Good Science Suggests Otherwise,” TheWashington Post, Aug. 27, 2002, p. F1.25 Bonnie Liebman, “Big Fat Lies: The TruthAbout the Atkins Diet,” Nutrition ActionNewsletter, November 2002, p. 3.26 Sally Squires, “New Nutritional GuidelinesTie Exercise, Calories; Report Urges Ameri-cans to Consume More Fiber and Less Sugar,and Sets Carbohydrate Goals,” The Wash-ington Post, Sept. 6, 2002, p. A2.27 Agricultural Research Service, U.S. De-partment of Agriculture, “Food and NutrientIntakes by Individual in the United States,by Sex and Age, 1994-96,” Nationwide FoodSurveys Report No. 96-2, December 1998.28 For background, see Adriel Bettelheim,

“Obesity and Health,” The CQ Researcher,Jan. 15, 1999, pp. 25-48.29 Quoted in Shell, op. cit., p. 165.30 Ibid., p. 148.31 Quoted in Gina Kolata, “Five Decades ofWarning Fail to Get Americans Moving,” TheNew York Times, Sept. 10, 2002, p. F5.32 Greg Critser, Fat Land: How AmericansBecame the Fattest People in the World (2003),p. 133.33 C.J. Crespo et al., “Television Watching, En-ergy Intake, and Obesity in U.S. Children: Re-sults From the Third National Health and Nu-trition Examination Survey, 1988-1994,” Archivesof Pediatrics and Adolescent Medicine, March2001, p. 360.34 Kolata, op. cit.35 Richard L. Worsnop, “Youth Fitness,” TheCQ Researcher, Sept. 26, 1997, pp. 841-864.36 Critser, op. cit., p. 114.37 Ibid., p. 18.38 Ibid., p. 3.

39 For background, see Ted Monoson, “Dairyand Produce Industries Square Off over WICProgram Guidelines,” CQ Weekly, Dec. 14,2002, p. 3266.40 Bill Frist, “Childhood Obesity Can Have Life-long Effects,” The Hill, Sept. 18, 2002, p. 34.41 “Fruits and Vegetables, Enhanced FederalEfforts to Increase Consumption Could YieldHealth Benefits for Americans,” U.S. Gener-al Accounting Office, 2002.42 “100 Leading National Advertisers: 43rdAnnual Report,” Advertising Age, Sept. 28,1998, pp. s1-s50.43 See http://actionnetwork.org/CSPI/alert-de-scription.tcl?alert_id=2002636 and http://www.cspinet.org/nutritionpolicy/nana.html.44 Sheila Anne Feeney, “Dueling Pyramids:Which of the Many Triangle-Shaped FoodGuides Is Right for You?” New York DailyNews, April 2, 2001, p. 45.45 Geoffrey Cowley, “A Better Way to Eat,”Newsweek, Jan. 20, 2003, p. 46.

FOR MORE INFORMATIONAmerican Obesity Association, 1250 24th St., NW, Suite 300, Washington, DC20037; (202) 776-7711; www.obesity.org. A group sponsored by drug companiesand weight-loss companies that pushes for more coverage of anti-obesity drugs inprivate and government insurance plans.

Center for Nutrition Policy and Promotion, U.S. Department of Agriculture,3101 Park Center Dr., Rm. 1034, Alexandria, VA 22302; (703) 305-7600; www.usda.gov/cnpp/. Develops and coordinates nutrition policy.

Center for Science in the Public Interest, 1875 Connecticut Ave., NW, Suite300, Washington, DC 20009; (202) 332-9110; www.cspinet.org. Conducts researchon food and nutrition and lobbies for nutrition and food safety.

National Alliance for Nutrition and Activity, http://www.cspinet.org/nutrition-policy/nana.html. Represents more than 235 organizations in promoting a betterunderstanding of the impact on the nation’s health and health-care costs ofhealthy eating, physical activity and obesity control.

National Center for Chronic Disease Prevention, Centers for Disease Controland Prevention, 4770 Buford Highway NE, MS/K-24, Atlanta GA 30341-3717; (770)488-5820; www.cdc.gov. Government agency that tracks obesity and promotes betternutrition and increased physical activity.

National Restaurant Association, 1200 17th St., NW, Washington, DC 20036;(202) 331-5900; www.restaurant.org.

National Soft Drink Association, 1101 16th St., NW, Washington, DC 20036;(202) 463-6732; www.nsda.org.

North American Association for the Study of Obesity, 8630 Fenton St., Suite918, Silver Spring, MD 20910; (301) 563-6526; www.naaso.org. Scientific societydedicated to the study of obesity.

FOR MORE INFORMATION

Jan. 31, 2003 99CQ on the Web: www.cqpress.com

Books

Atkins, Robert C., Dr. Atkins’ New Diet Revolution, Harp-er Collins, 2002.The latest version of Atkins’ best-selling diet plan argues

eating proteins and fats is less likely to lead to weight gainthan diets rich in carbohydrates.

Critser, Greg, Fat Land: How Americans Became the Fat-test People in the World, Houghton Mifflin, 2003.A Los Angeles writer for Harper’s and other publications

offers a breezy summary of scientific data on obesity andexercise and original reporting on corporate and governmentdecisions that have made weight-promoting foods more wide-ly available.

Schlosser, Eric, Fast Food Nation, Houghton Mifflin, 2001.An investigative journalist argues in this best-selling book

that the fast-food industry has fundamentally altered the na-tional landscape and agricultural production as well as theAmerican diet.

Shell, Ellen Ruppel, The Hungry Gene: The Science ofFat and the Future of Thin, Atlantic Monthly Press, 2002.A science writer offers a summary of attitudes toward glut-

tony and obesity through the ages and standard critiques ofsodas, fast food and poor exercise habits. But the heart ofthe book is her accounts of recent breakthroughs in mole-cular biology.

Articles

Davis, Kevin, “It’s a Serious Step, But They Saw GastricBypass As Their Best Hope,” Chicago Tribune, Jan. 20,2002, p. C1.The number of stomach-staple operations has tripled in the

last decade, as grossly overweight people see surgical in-tervention as their last hope.

Gladwell, Malcolm, “The Trouble With Fries,” The NewYorker, March 5, 2001, p. 52.French fries are getting more caloric and are cooked in

dangerous fats, but getting people to stop eating them isgoing to take a marketing genius.

Kolata, Gina, “Five Decades of Warning Fail to Get Amer-icans Moving,” The New York Times, Sept. 10, 2002, p. F5.Kolata summarizes recent studies indicating that most Ameri-

cans are sluggish at best, and also briefly recounts the historyof post-World War II attempts to encourage exercise.

Mokdad, A.H., et al., “The Spread of the Obesity Epi-demic in the United States, 1991-1998,” Journal of the

American Medical Association, Oct. 27, 1999, p. 1519.Obesity increased by nearly 50 percent during the 1990s,

with increases noted in all states, both sexes and variousage and racial groups.

Squires, Sally, “Soft Drinks, Hard Facts,” The Washing-ton Post, Feb. 27, 2001, p. T10.Soft drinks are more widely sold than ever, but claims that

they are responsible for obesity, tooth decay, calcium lossand other health problems remain under dispute.

Squires, Sally, “Last Month, a Provocative Article ArguedThat a Low-Fat Diet May Be Responsible for America’s Obe-sity Epidemic,” The Washington Post, Aug. 27, 2002, p. F1.Experts offer a point-by-point refutation of Gary Taubes’

article (see below) in The New York Times surveying scien-tific studies and conclude that his article downplays the dan-gers of saturated fat.

Taubes, Gary, “What If It’s All Been a Big Fat Lie?” TheNew York Times Magazine, July 7, 2002, p. 22.A controversial but influential article contends that nutri-

tionists’ concern about high-fat diets has misled the publicand that the pro-carbohydrate message was based on un-scientific fantasy.

Tyre, Peg, et al., “Getting Physical,” Newsweek, Feb. 3,2003, p. 46.Nearly 15 percent of American children ages 12 to 19 are

overweight, and health experts are blaming their sedentarylifestyles.

Reports and Studies

“Absolute Risk of Obesity: Food and Drink CompaniesNot So Defensive?” UBS Warburg Q-Series, Nov. 27, 2002.In this survey of recent obesity data, the investment bank

reports that concerns about obesity may drive down salesof high-fat, high-sugar products.

Purcell, Amanda, “Prevalence and Specifics of District-wide Beverage Contracts in California’s Largest SchoolDistricts: Findings and Recommendations,” PublicHealth Institute, April 2002.This foundation-sponsored report looks at five districts’ soda

contracts and the ramifications for student health.

U.S. Department of Health and Human Services, “TheSurgeon General’s Call to Action to Prevent and DecreaseOverweight and Obesity,” 2001.The report notes that 61 percent of U.S. adults and 13-14

percent of adolescents are overweight and recommends morephysical activity.

Selected Sources

Bibliography

100 CQ Researcher

Exercise and Obesity

Brink, Susan, “Phys Ed Redux,” U.S. News & World Re-port, June 3, 2002, p. 50.More and more schools are cutting back on or eliminat-

ing physical education entirely, despite concerns over obe-sity in students and other weight-related problems.

Kolata, Gina, “5 Decades of Warnings Fail to Get Amer-icans Moving,” The New York Times, Sept. 10, 2002, p.F5.Public-health experts say they do not know why their ex-

ercise exhortations have gone unheeded for so long, par-ticularly while American inactivity is reaping exorbitanthealth-care costs.

Roan, Shari, “Guidelines Aim for a Head Start on Low-ering Heart Risk,” Los Angeles Times, July 8, 2002, p. S3.American children, already the fattest generation ever, should

undergo “lifestyle training” that includes exercise to helpavoid heart disease later in life, the American Heart Asso-ciation says.

Squires, Sally, “Diet Ads Are Hard to Swallow,” Los An-geles Times, Sept. 30, 2002, p. S5.Too many people buy into claims that say some products

can help them lose weight without exercising or changingeating habits, according to health advocates and experts.

Stein, Jeannine, “Counting on 10,000 Steps to Add UpTo Better Health,” Los Angeles Times, Nov. 11, 2002, p.A5.As obesity levels in the United States escalate and health

professionals continue to look for ways to get people mov-ing, walking continues to rank high as an effective weight-loss program.

Fats vs. Carbohydrates

Campos, Paul, “Weighting Game,” The New Republic,Jan. 13, 2002, p. 17.Concerns about fat are totally overblown. Although fatty

diets and sedentary lifestyles may lead to obesity and healthproblems, being fat in and of itself is not a health risk.

Hellmich, Nanci, “Atkins Diet Meets With Success,” USAToday, Dec. 10, 2002, p. D1.New studies show that some dieters lose more weight on

the Atkins plan than more conventional low-fat diets, butcritics note that other research indicates that the Atkins dietmay increase the risk of kidney stones and bone loss.

Hellmich, Nanci, “Researchers Chew the Fat on Meritsof the Atkins Diet,” USA Today, Aug. 7, 2002, p. 6D.Two new studies show that those who follow the Atkins

diet can lose significant amounts of weight, but other re-search is raising concerns about the safety of the program.

King, Patricia, “Rethinking Our Daily Bread,” Los Ange-les Times, July 29, 2002, p. S1.As obesity and diabetes soar, some U.S. nutritionists and

researchers back off from pushing pasta and rice — theirnew emphasis is on vegetables and fruits.

Liebman, Bonnie, “Big Fat Lies: The Truth About theAtkins Diet,” Nutrition Action Newsletter, November 2002,p. 3.The nutrition advocacy group contends that high-fat diets

are dangerous because saturated fats and trans fats need tobe avoided for good health.

Nash, J. Madeleine, “Cracking the Fat Riddle,” Time, Sept.2, 2002, p. 46.Why have neither low-fat nor high-fat diets lowered rates

of obesity in recent decades? The article surveys the stateof dietary fat and recent molecular science and notes thatAmericans are eating more of all types of foods.

Sagon, Candy, “Butter Is Back — and Other Ideas ThatWill Change Your Diet in 2003,” The Washington Post,Jan. 1, 2003, p. F1.A high-protein diet that stresses meat but cuts out carbo-

hydrates is more successful at helping people lose weightbecause they feel satisfied longer and aren’t tempted to fillup on high-calorie snack food.

Squires, Sally, “New Nutritional Guidelines Tie Exercise,Calories; Report Urges Americans to Consume More Fiberand Less Sugar,” The Washington Post, Sept. 6, 2002, p.A2.New nutritional recommendations set a recommended daily

intake for carbohydrates — a move that will likely influ-ence the debate about a low-carbohydrate vs. a high-car-bohydrate approach to dieting.

Squires, Sally, “Score One For Low-Carb Diet; Atkins Ad-herents Lose More in Brief Study,” The Washington Post,Oct. 29, 2002, p. F1.In a comparison of two different eating plans, the Atkins

diet trimmed significantly more pounds and body fat in obesebut otherwise healthy women than a traditional low-fat diet.

Food Industry

Brownell, Kelly D., and David S. Ludwig, “Fighting Obe-sity And the Food Lobby,” The Washington Post, June9, 2002, p. B7.Food-industry lobbying groups have a vocal presence in

food legislation and dietary issues — activities that draw dis-turbing parallels with the tobacco industry.

The Next Step:Additional Articles from Current Periodicals

Jan. 31, 2003 101CQ on the Web: www.cqpress.com

Burros, Marian, “One Woman’s Showdown With the FoodIndustry,” The New York Times, May 15, 2002, p. F6.Some experts claim that food is, above all, political, and

that with all its money the food industry can influence whatwe eat and how much information we are given about it.

Copeland, Libby, “Snack Attack; After Taking On Big To-bacco, Social Reformer Jabs at a New Target: Big Fat,”The Washington Post, Nov. 3, 2002, p. F1.Those fighting Big Fat frame their enemy as a powerful

industry with enormous influence on the country’s attitudestoward food and nutrition and a considerable stake in get-ting the public to eat a lot.

Cottle, Michelle, “Heavy Duty,” The New Republic, May13, 2002, p. 16.As Americans continue to suffer obesity-related illness and

death in record numbers, the war on tobacco becomes thewar on fat.

Gerrior, S. and L. Bente, “Nutrient Content of the U.S.Food Supply, 1909-99: A Summary Report,” U.S. De-partment of Agriculture, Center for Nutrition Policy andPromotion, Home Economics Research Report No. 55,June 2002.This federal report summarizes the increasing amount of en-

ergy in the U.S. food supply, providing statistical data on 28foods and food groups and 27 nutrients.

Ives, Nat, “Food Companies Are Urged to Act to DeflectBlame for the Nation’s Increase in Obesity,” The NewYork Times, Dec. 4, 2002, p. C4.Some advertising and marketing consultants warn that the

lawsuits against fast-food companies are symptomatic of healthconcerns that may cast them as villains.

Kaufman, Marc, “Some Thoughts for Fast Food; Thomp-son Urges Industry to Offer Healthful Choices,” The Wash-ington Post, Oct. 16, 2002, p. A11.Health and Human Services Secretary Tommy Thompson

met with restaurant-chain executives and urged them to offermore fruits and vegetables and downsize their products.

Kranish, Michael, “Fat Chance,” The Boston Globe, July29, 2001, p. B1.Consumers conscious of their diets say they want healthier

options, but executives in the restaurant and movie-concessionbusiness say that healthier choices don’t sell.

Government Policies

Berman, Richard, “All-Out Assault By Food Cops: WhenWill It End?” USA Today, Aug. 15, 2002, p. 13A.When then-sSurgeon General David Satcher declared in De-

cember that obesity was a major U.S. health epidemic, hestarted the kind of public-health debate that tends to endin one of two places: legislation or litigation.

Besharov, Douglas J., “We’re Feeding the Poor As If They’reStarving,” The Washington Post, Dec. 8, 2002, p. B5.Evidence suggests that federal feeding programs, such as

school lunches and food stamps, are contributing to obesityamong the poor by providing them with too many calories.

Brasher, Philip, “Food Pyramid Out of Shape, CriticsSay,” Des Moines Register, Dec. 16, 2002, p. 1A.The U.S. Department of Agriculture is working on a revi-

sion for 2005 of its decade-old food pyramid, which lacksenough specific information to be a helpful nutritional guide.

Jacobson, Michael F., and Kelly D. Brownell, “SmallTaxes on Soft Drinks and Snack Foods to Promote Health,”American Journal of Public Health, June 2000, p. 854.In their famous “fat tax” proposal, the authors argue that

minor taxes on low-nutrition sodas and snacks would be auseful way to discourage consumption and raise funds forhealth promotion campaigns.

Montgomery, Lori, “Suburbia’s Road to Weight Gain,”The Washington Post, Jan. 21, 2001, p. C1.Land-use designs have led to more driving and less walk-

ing, leading some to surmise that suburban sprawl is help-ing make Americans fat.

Severson, Kim, “Obesity ‘a Threat’ to U.S. Security; Sur-geon General Urges Cultural Shift,” San Francisco Chron-icle, Jan. 7, 2003, p. A1.Addressing the largest-ever conference on childhood obe-

sity, Surgeon General Richard Carmona called obesity thefastest-growing cause of illness and death in the U.S.

Shell, Ellen Ruppel, “Big Food Has Become a Big Prob-lem,” Los Angeles Times, Nov. 28, 2002, p. A15.With more than 30 percent of Americans obese and fully

two-thirds overweight, we continue to consider obesity alifestyle choice rather than the public-health disaster it hasso clearly become.

Tamaki, Julie, “New Soda Tax Idea Reignites an Old De-bate,” Los Angeles Times, March 30, 2002, p. A1.Citing California’s huge budget shortfall and its growing

number of overweight children, a state lawmaker is propos-ing a new tax on soda to fight childhood obesity.

Impact on Children

Allen, Jane E., “Kids At Risk,” Los Angeles Times, Dec.10, 2001, p. A1.Heart-disease indicators may appear in children as young

as 15, but early detection and healthy habits can work won-ders, experts say.

Brody, Jane E., “Fighting the Lessons Schools Teach onFat,” The New York Times, April 16, 2002, p. F7.Because schools are offering children more exposure to

102 CQ Researcher

OBESITY EPIDEMIC

junk food and less opportunity for physical activity, parentsneed to encourage better eating and exercise habits.

Hellmich, Nanci, “Kids Gobbling Empty Calories,” USAToday, April 30, 2001, p. 1D.Teens are eating 150 more calories a day in snacks than

they did two decades ago. And kids of all ages are munch-ing more of the richer goodies between meals than before.

Kolata, Gina, “When Children Grow Fatter, Experts Searchfor Solutions,” The New York Times, Oct. 19, 2000, p. A1.Current studies show that many children are inactive and

suffering with weight problems — and the fat are gettingfatter.

Lieberman, Trudy, “Got Soda? Why Kids Drink LessMilk,” Los Angeles Times, Oct. 15, 2001, p. S1.Critics say empty calories in soft drinks contribute to obe-

sity in children, as obesity rates among children ages 6 to19 have doubled in the last 20 years.

Lindner, Lawrence, “ ‘Child-Onset’ Diabetes; Thanks Large-ly to Poor Diet, A Disease of Overweight Adults is Nowa Childhood Epidemic,” The Washington Post, Dec. 5,2000, p. Z10.Due to weight gain and sedentary lifestyles, children and

adolescents are experiencing a steep rise in Type 2 diabetes,a leading cause of blindess and kidney and heart disease.

Morris, Bonnie Rothman, “Letters on Students’ Weight Ruffle Parents,” The New York Times, March 26, 2002.Some schools in Pennsylvania and other states have sent

letters home to parents warning them that their children aretoo heavy, leading to concerns about damage to student self-esteem.

Olson, Elizabeth, “U.N. Warns That Many Children, Richand Poor, Are Obese,” The New York Times, May 17,2002, p. A8.According to a study of childhood obesity worldwide, de-

veloping countries are rapidly closing the gap with indus-trialized nations in the number of children who are over-weight or obese.

Severson, Kim, and Meredith May, “Growing Up TooFat,” San Francisco Chronicle, May 12, 2002, p. A1.A variety of factors — lack of P.E. courses, increased ex-

posure to fast food — have made children in California moreobese and led to increased health costs.

Race and Class Implications

Auge, Karen, “Obesity’s Effects Vary By Race, StudiesShow,” Denver Post, Jan. 8, 2003, p. A1.A pair of studies indicate that being overweight can shave

years off a person’s life — with more years lost by over-weight African-Americans.

Barboza, David, “Rampant Obesity, a Debilitating Reali-ty for the Urban Poor,” The New York Times, Dec. 26,2000, p. F5.Obesity is a particular problem for African-Americans and

Hispanics, especially those with low incomes.

Ehrenreich, Barbara, “Got Grease?; For Wall Street Weasals,a Low-Fat Diet Has Been the Hair Shirt Under the FurCoat,” Los Angeles Times, Aug. 11, 2002, p. M6.Anti-fat dogma is flattering to the affluent, because high-

fat diets and processed grains are associated with low so-cial rank.

Rauch, Jonathan, “The Fat Tax,” The Atlantic Monthly,December 2002, p. 32.Detecting snobbery in warnings about obesity at a time

when the poor are fatter than the wealthy, this satirical ar-ticle proposes that, rather than taxing fattening foods, fatpeople should be taxed.

School Policies

Becker, Elizabeth, and Marian Burros, “Eat Your Vegeta-bles? Only at a Few Schools,” The New York Times, Jan.13, 2002, p. A1.A typical school lunch is often more in keeping with one

from a fast-food outlet than what the Department of Agri-culture says is a nutritious meal.

Brody, Jane E., “Fighting the Lessons Schools Teach onFat,” The New York Times, April 16, 2002, p. F7.Parents and educators must work to instill good dietary

habits in their children — otherwise, bad habits learned inchildhood often produce obesity in adults.

Egan, Timothy, “In Bid to Improve Nutrition, SchoolsExpel Soda and Chips,” The New York Times, May 20,2002, p. A1.The two biggest states, Texas and California, are moving

toward phasing out junk food in schools, as are many schooldistricts in other states.

Mena, Jennifer, “4 Schools To Help Parents Teach Lessonsin Leanness,” Los Angeles Times, Feb. 20, 2001, p. B1.Recent discussions at four California elementary schools in

predominantly Latino areas will make the parents part of anational campaign to reduce obesity in children.

Monaghan, Carol, “Attention — Students — Shoppers; Ad-vertisers Want Kids’ Biz — And They’re Pitching to Schoolsto Capture It,” Chicago Tribune, Jan. 15, 2002, p. 10.Some experts are concerned by the commercialism in schools,

including soft-drink logos on scoreboards, hamburger ads onschool buses and other attempts to “influence rookie con-sumers.”

Nakamura, David, “Schools Hooked on Junk Food; Re-

Jan. 31, 2003 103CQ on the Web: www.cqpress.com

liance on Vending Proceeds Decried — and Defended,”The Washington Post, Feb. 26, 2001, p. A1.Schools in suburban Maryland take in as much as $100,000

a year from contracts with soft-drink companies. The schoolsare resisting legislative efforts to limit the sales.

Rivera, Elaine, “Playing With Food Has Healthy Result Onthe Lunch Line,” The Washington Post, Nov. 7, 2002, p. T12.Alexandria, Va., public-school officials have spent countless

hours figuring out how to do the nearly impossible: enticestudents in the cafeteria line to eat more vegetables andlower-calorie meals.

Squires, Sally, “Soft Drinks, Hard Facts,” The Washing-ton Post, Feb. 27, 2001, p. T10.The soda industry pays schools millions in its efforts to sell

to students. But research suggests kids who drink a lot ofsoft drinks risk becoming fat, weak-boned and cavity-prone.

Winter, Greg, “States Try to Limit Sales of Junk Food inSchool Buildings,” The New York Times, Sept. 9, 2001, p. 1.A dozen states are considering laws that would limit the

sale of candy, soft drinks and fatty snacks in schools.

Science of Obesity

Brown, David, “When America Was Hungry to Under-stand the Science of Diet, Ancel Keys Stepped up to thePlate,” The Washington Post, Oct. 22, 2002, p. F1.That the connection between eating and health is now so

clear is testimony to the work of thousands of researcherstoiling in dozens of countries over the last half-century.

Goode, Erica, “When Eating Is Disordered,” The NewYork Times, Oct. 24, 2000, p. F1.Over the last two decades, scientists have progressed both

in their understanding of eating disorders and their abilityto treat them — giving some overweight patients hope.

Grady, Denise, “Why We Eat (and Eat and Eat),” The NewYork Times, Nov. 26, 2002, p. F1.Though most researchers advocate exercise programs and

education about nutrition to try to prevent obesity, they saypeople who already have a weight problem need more med-ical help.

Hellmich, Nanci, “Search Is On For the Elusive HungerSwitch,” USA Today, Aug. 26, 2002, p. 6D.Recent discoveries about hormones that make people feel

either full or hungry are helping scientists better understandthe body’s complex appetite mechanisms.

Kolata, Gina, “How the Body Knows When to Gain orLose,” The New York Times, Oct. 17, 2000, p. F1.Instead of endlessly rejiggering diets and exercise regimens,

a new wave of scientists is getting at the molecular causesof appetite and satiety, unraveling elaborate chemical path-ways that control how much people eat.

Maugh II, Thomas H., “Slight Weight Gain Found to In-crease Heart Failure Risk,” Los Angeles Times, Aug. 1,2002, p. A16.Cardiologists have long known that obesity considerably

increases the risk of death from heart failure, but a newstudy shows that being even slightly overweight also in-creases the risk substantially.

Riordan, Teresa, “Patents,” The New York Times, Jan. 7,2002, p. C9.Researchers are exploring the possibility of reducing weight

with drugs used to shrink tumors.

Rosenblatt, Robert A., “Surgeon General Takes Stern Stanceon Obesity,” Los Angeles Times, Dec. 14, 2001, p. A1.The nation’s epidemic of obesity is almost as menacing to

health as smoking, the U.S. surgeon general said, as he calledon Americans to eat less and exercise more.

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CHILDREN/YOUTHCyber-Predators, March 2002Preventing Teen Drug Use, March 2002Sexual Abuse and the Clergy, May 2002

CRIMINAL JUSTICERethinking the Death Penalty, Nov. 2001Intelligence Reforms, January 2002Cyber-Crime, April 2002Corporate Crime, October 2002

EDUCATIONGrade Inflation, June 2002Single-Sex Schools, July 2002Teaching Math and Science, Sept. 2002Homework Debate, December 2002Charter Schools, December 2002

ENVIRONMENTEnergy and Security, February 2002Threatened Fisheries, August 2002Bush and the Environment, October 2002

HEALTH CARE AND MEDICINECovering the Uninsured, June 2002Nursing Shortage, September 2002Food Safety, November 2002

LEGAL ISSUESAccountants Under Fire, March 2002Three-Strikes Laws, May 2002Religion in the Workplace, August 2002Ethics of War, December 2002

MODERN CULTUREFuture Job Market, January 2002Retirement Security, May 2002Living-Wage Movement, September 2002

POLITICS/GOVERNMENTWeapons of Mass Destruction, March 2002Farming Subsidies, May 2002Prospects for Mideast Peace, August 2002New Defense Priorities, September 2002Confronting Iraq, October 2002

Presidential Power, November 2002Campaign Finance Showdown, Nov. 2002Stimulating the Economy, January 2003Oil Diplomacy, January 2003

TRANSPORTATIONAuto Industry’s Future, January 2000Auto Safety, October 2001Future of the Airline Industry, June 2002Future of Amtrak, October 2002

Future Topics

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▲ Organ Donation

Medical Malpractice

Smallpox Vaccinations