Fat of the land

Among the mountains of data on the problem of obesity in America , the avalanches of surveys and studies, indices and cross indices, fever lines and pictograms , one statistic in particular is especially jarring, and it is simply that obesity now ranks second only to cigarette smoking as the leading cause of mortality in the U.S.  In other words, Americans are eating themselves to death in record numbers.  Comparisons between cigarette smoking and overeating don't end there. With the nation's expanding waistline showing no signs receding, legislators from all branches and levels of government are scrambling to address the problem in ways that may sound familiar to smokers. There are proposals to ban food vending machines containing chips, sodas and candy bars from school cafeterias and other public places, proposals to curb or eliminate television commercials marketing fatty foods to children, proposals to make fast-foods chains post on-site nutritional information about the foods served at their restaurants. Then there has been the resurrection of the so-called fat-tax. To date, some 17 states have imposed such levies, most of which target foods high in fat, sugar and carbohydrates, such as sodas, french fries and candy bars, albeit in amounts that aren't likely to dissuade consumers from purchasing those items. "Most of those states impose levies of about 1 percent of the purchase price," says Jeff Cronin, communications director for the Center for Science in the Public Interest (CSPI). However, the majority of the money, he says, is typically allocated to General Funds, meaning that very little, if any, is specifically earmarked to promote fitness and nutrition among constituents.  That may change. In late spring, Brooklyn Democratic Assemblyman Felix Ortiz made news by introducing a bill that would impose a 1 percent fat tax on all obesity-linked snacks, soft drinks and junk foods sold in New York, with the resulting funds , about $50 million per year by his estimates , allocated toward nutrition education for children, as well as after-school fitness and recreation programs. Since making his proposal in early June, Ortiz has been a busy man, having traveled to Arizona, Georgia, Maine, Massachusetts and other states that are interested in using his proposal as a template for similar measures. Though his own bill won't be decided by New York's legislature until at least September due to summer recess, Ortiz is confident it will have the support of his fellow lawmakers whenever the vote finally occurs. He says he has even received support from members of the food industry. "Food manufacturers know the problem is here and that they need to be a part of the solution before it's too late," he says. "They also know that I'm not going to stop until this problem has been solved." Crisis proportions

If Ortiz sounds like a zealot, well, he is. As chief of the State of New York's Task Force on Nutrition, Food and Farm Policy he spent innumerable hours and days at roundtables, debates and public hearings on obesity, and walked away convinced that the problem is reaching crisis proportions in New York, threatening not only the public's health, but the health of the state's health care system, which he says cannot support the strain that obesity has put on it. Something had to be done, he says. "Understand that my bill isn't telling people what to eat," he explains. "The goal is to educate people about nutrition so they can adopt a more well-rounded diet. We're not trying to tell them not to buy a candy bar" While food industry representatives agree on the importance of nutritional education programs, they don't necessarily believe that a food tax is the most desirable means of achieving that end, particularly a tax that categorically brands certain food types as unhealthy. "We need to focus on education and programs on how to eat and live a healthy lifestyle rather than promote the idea that there are ,'good foods' and ,'bad foods' as defined by a so-called sin tax," says Robert Earl, MPH, RD, senior director of nutrition policy with the National Food Processors Association (NFPA).  Ortiz doesn't agree that fat taxes necessarily stigmatize fatty foods , or at least their makers.  "When the tax is coupled with public education effort, it tells consumers that manufacturers are part of the solution," he says. A slippery slope

Still, the majority of food manufacturers are "appalled" by the prospect of fat taxes, evenly if they don't publicly admit it, according to Dr. Marion Nestle, chair of the Department of Nutrition and Food Studies at New York University and author of Food Politics: How the Food Industry Influences Nutrition and Health. "A food tax , any kind of a food tax , puts them on a slippery slope," says Nestle, who isn't a huge supporter of fat taxes, though not for the reasons one might expect. "No one wants to talk about calorie intake, which is the real problem. All of the talk about fats or sugars only serves to confuse the issue , and the consumer."According to Nestle, who in the mid 1980s worked for the Public Health Service to create the Surgeon General's Report on Nutrition and Health, Americans aren't eating too much fat and sugar; they are eating too much, period. If food companies and restaurants think that puts the ball back in the consumer's court, they're wrong. It's these very companies, Nestle contends, that are actively promoting overeating. All one needs to do is the math, she adds. "According to the Department of Agriculture, our food supply provides an average of 3,900 calories per day for every man, woman and child in this country, about 600 calories more than was available just a few years ago and roughly twice what the average person needs." Nestle says this tremendous surplus of food, itself the result of falling commodity prices, as well as government subsidies for the production of the basic components of fast food and soft drinks, such as corn, soy beans, wheat and sugar, has made the food industry extremely competitive. "So it becomes the job of the industry to either get people to eat their products, or to get people to eat more in general." The result, she says, has been the super-sizing of every day items such as muffins and bagels, both of which have ballooned from two ounces to six ounces in recent years. Earl agrees that food has become available in a variety of sizes and formats, but that larger or jumbo-sized prepared foods still carry recommended serving sizes , along with other nutritional information -- on their labels. The rest is up to the consumer. "Most of larger-size formats feature high-calorie fare because those foods happen to be cheaper to manufacture," Nestle counters. "Manufacturers can price those items more cheaply and still make a profit. And what is the consumer going to do? You feel like an idiot when you buy less if you can get more at a bargain." The computer veg

She acknowledges that changing social norms, too, have created a culture conducive to grazing thoughtlessly from morning to night , at book stores and shore stores, hair salons, convenience marts and vending machines. At work, microwaves are just a few feet away, and microwave snacks just seconds. If the food industry hasn't engineered these mores, and Nestle isn't so sure they haven't, then they have certainly reaped their rewards, she contends.  NFPA's Earl has a different vision of the nation's altered landscape, one characterized by increasing work pressures, decreasing recreation time and new technologies that promote sedentary lifestyles, all of which have resulted in a 60 percent decline in physical activity in recent years, he says.  Nestle says she can produce Centers for Disease Control (CDC) studies indicating there has been no real declines in physical activity among Americans in the past few decades. Television in some cases has merely been supplanted by computers, though the total time spent in front either "hasn't changed," she says. "If it has changed, it's been a small change. So, people must be eating more."   Nonetheless, many food industry members understandably have chosen to emphasize exercise and fitness as a means of combating obesity. Coca-Cola's Step With It! campaign, which the soft drink maker developed in conjunction with the National Association for Sport and Physical Education (NASPE), challenges students ages 10 to 14 to maintain good health by taking a minimum of 10,000 steps per day. McDonald's Restaurants and others have since followed suit. "Their whole spiel is about making sure kids get enough exercise, but these companies never mention the concept of moderation in their ads to consumers," says CSPI's Cronin. "It's all about super sizes and consumption."The campaign against obesity "needs to be a joint effort between industry, government and the public" if it is to succeed, says Earl, who notes the industry already has participated extensively in efforts to provide nutritional information and recommended serving sizes on labels, as well as shape the Food Guide Pyramid. Ortiz, meanwhile, credits food companies such as Coca-Cola for developing new products that are healthier for children, such as the new Swerve milk-based drinks, which will be distributed in vending machines in middle and high schools. However, parent and industry groups already are complaining that Swerve, along with Dr Pepper/Seven Up's Raging Cow, another milk-based drink, are too rich in sugar. Susan Ruland of the International Dairy Foods Association (IDFA) told Scripps Howard News Service, "It's not just the calories. I don't like the idea of packaging junk as healthy foods." Buyer beware

Nestle isn't surprised. She notes that even as orange juice manufacturers work to promote the healthy aspects of their products, they fail to warn consumers that those attributes are accompanied by high calorie counts. "Everything in moderation," she says. "A glass or two of orange juice is fine. What consumers don't realize is that those drinks contain the same number of calories as a soda." Even Frito-Lay, which last year announced plans to eliminate hydrogenated oils and instead use trans fat-free corn oil in the production of its Doritos, Tostitos and Cheetos brands, acknowledges that consumers of such products aren't likely to shed calories as a result of these reformulations. "The switch from trans fat does not lower the total amount of fat in the products, though it does remove those that are associated with bad cholesterol, which studies have shown are linked to heart disease," says a company spokesperson. It's a step in the right direction. Manufacturer Kraft Foods arguably took a much larger one when earlier this month it announced plans to improve product nutrition by reducing sugar, fat and calories in most of its products and shrinking the size of its single-serve portions. The question is whether other food companies will follow suit.     "The food industry puts so much pressure on growth. That may be uniquely American," Nestle observes. But the war on obesity, she continues, can't be won unless food companies, either by force of reason or sheer force, alter some of their practices, and revise their earnings forecasts accordingly. "Not everyone can win," she says. "It can't be a win-win for everyone."    As if McDonalds and Burger King don't have enough headaches as major fall guys for the nation's obesity epidemic, they may now face lawsuits alleging the two chains conspired to withhold information about properties that make their foods addictive, or so says attorney John Banzhaff, whose crusade against the tobacco industry in the 1970s resulted in a ban on cigarette commercials.  SIDEBAR  1HEAD: Four steps to a trimmer America Though Dr. Marion Nestle, chair of the Department of Nutrition and Food Studies at New York University and Food Politics: How the Food Industry Influences Nutrition and Health, contends that overeating is largely to blame for the nation's skyrocketing obesity rates, she also acknowledges that solving the problem won't be easy.Nonetheless, she says the following initiatives might help get the ball rolling:1)       "Get television commercials for children's junk food off the air." 2)        "Create a federal agency responsible for nutrition education programs." 3)        "Adjust farm supports to encourage healthier foods."4)       "Limit campaign contributions from corporate interests. It would create a more level playing field."     SIDEBAR 2No one can eat just one!Ever wonder why that first cookie invariably leads to a second, and then a third? A few years ago, Dr. David Ludwig, an assistant professor of pediatrics at Harvard University and director of the obesity program at Boston Children's Hospital, demonstrated that high glycemic foods, such as sugary breakfast cereals and hamburger buns, may actually make consumers hungrier after eating them. So , surprise! , they eat more. When eaten alone or without much else, high-glycemic foods rapidly raise blood sugar, leading to a sequence of metabolic events that cause blood sugar to fall below fasting levels a few hours later, thus triggering excessive hunger and overeating in susceptible people -- or so goes Ludwig's theory, which was based on his studies of obese teenage boys.