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Obesity policy bill { August 10 2003 }

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Public Policy Targeting Obesity

By Ceci Connolly
Washington Post Staff Writer
Sunday, August 10, 2003; Page A01

As obesity-related health costs soar, policymakers nationwide are pursuing legislative solutions modeled after the anti-smoking campaigns of the 1990s to attack what many in the medical community say is one of the gravest threats to the nation's long-term health.

In the District of Columbia and half a dozen states, lawmakers are debating bills that would require fast food and chain restaurants to post nutrition information such as caloric, fat and sugar content on menus.

Twenty-five states, following successful efforts in Arkansas and Texas, are considering restrictions on the sale of soda and candy in schools. Parent and advocacy groups in Alabama and Seattle are pushing to go one step further, waging campaigns to eliminate junk food advertising aimed at youngsters.

And in New York state, Assemblyman Felix Ortiz (D) has proposed six anti-obesity bills, including one that would tax not only fatty foods, but also modern icons of sedentary living -- movie tickets, video games and DVD rentals -- and use the resulting $50 million for nutrition and exercise programs.

"We have focused on smoking; now it is about time we fight obesity," said Ortiz, a Puerto Rican immigrant who watched his overweight mother suffer through diabetes, a kidney transplant, vision impairment and a heart attack.

Americans have been getting heavier for three decades, and with the extra weight has come serious medical consequences, such as diabetes, heart disease, high blood pressure and kidney failure. Until recently, weight remained the province of physicians, diet gurus and women's magazines.

But now, fiscal imperatives have thrust the issue onto the public policy agenda, triggering a debate between those who view girth as a matter of personal choice and those who argue that the societal toll has made obesity a government problem.

"Obesity is the fastest-growing disease in America," said Health and Human Services Secretary Tommy G. Thompson. "If we're really interested in holding down medical costs and improving the health of citizens, we have to do something about obesity."

So far, state lawmakers have filed more than 140 bills aimed at obesity, nearly double the 72 filed last year, said Deirdre Byrne, policy associate at the National Conference of State Legislatures.

Many, such as a bill enacted this year in Maine, appoint commissions to study the problem; others impose physical education standards in the schools.

"It's something of a free-for-all," said Richard Berman, executive director of the Center for Consumer Freedom, an advocacy group underwritten largely by foodmakers. To counter the trend, conservative leaders and the food industry have developed bills that would insulate restaurants from lawsuits that attempt to hold food purveyors responsible for the negative health effects of obesity.

"It's an individual responsibility issue," Berman said. "If I'm going to shorten my own life by eating too much or being too sedentary, that may not be much different than shortening my life by riding a motorcycle without a helmet on."

Thompson and others, however, say that the $117 billion spent each year on the direct and indirect medical expenses of obesity make it a cause for concern for families, corporations and government.

"The non-obese are forced to subsidize the obese" in the form of higher insurance rates and government health programs such as Medicare and Medicaid, said George Washington University law professor John F. Banzhaf III.

Banzhaf and Thompson are among a growing number of experts who advocate linking health insurance premiums to obesity, just as auto insurance rates are pegged to age, driving record and other risk factors. Thompson has asked Bush administration lawyers to craft an approach that would not run afoul of anti-discrimination laws.

About 34 percent of U.S. adults age 20 and older are overweight, and about 30 percent -- or 59 million people -- are obese, according to the Centers for Disease Control and Prevention, which sets measures based on an individual's body weight in relation to height, known as body mass index. In two academic studies, obesity is identified as the second-leading cause of preventable deaths in the United States. And the bulge once associated with middle age now afflicts an increasing number of youngsters; the CDC found that 15 percent of children age 6 to 19 are overweight, about triple the proportion 20 years ago.

"The word 'epidemic' doesn't even do this justice. It is one of the most profound medical crises we've had in generations," said Eric Topol, who as the chief of cardiology at the Cleveland Clinic treats the most serious obesity-related heart cases. "We are at the point now where it is so profound we have to be creative, and we can't take decades to fix this because it's happening so fast."

Maine state Rep. Sean Faircloth (D) said state officials would be negligent to ignore the problem.

"What other situation would you have where there's an epidemic that affects over 60 percent of the populace and public policymakers don't do anything?" said Faircloth, who persuaded colleagues to form an obesity commission with an eye toward enacting several bills next spring.

Much of the early attention has focused on children. Jim Metrock, president of the child advocacy group Obligation, is helping parent groups in several states fight the in-school television station Channel One, in part because of the commercials it airs for candy, soda and other sweets.

"Public health departments are trying to avert this obesity crisis while the other arm of government -- schools -- is showing motivational films to eat junk food," he said.

Steven C. Anderson, president of the National Restaurant Association, said the efforts miss the point. "We have gotten away from proper parenting," he said in reaction to the proposed school restrictions.

The association opposes mandatory nutrition information on menus, saying it would be impossible to calculate accurate calorie data on meals that customers often tweak to suit their own preferences.

The most vocal anti-fat activists praise Thompson for crusading about obesity but say the federal government has not gone far enough.

The CDC's ad campaign promoting healthy lifestyles for young people began with $125 million in 2001, was reduced to $51 million this year and is slated to receive $5 million in President Bush's 2004 budget, said Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest. "The administration gets an A-plus for talk but a D for action," she said.

"The most telling moment in this administration with respect to obesity was when Secretary Thompson told the Grocery Manufacturers [of America] to go on the offense against critics like us," said Gary Ruskin, executive director of Commercial Alert, a consumer group with ties to Ralph Nader. That advice, delivered last fall in a private session, was posted on the food association's Web site.

Topol applauded the Food and Drug Administration for adding trans-fat information to food labels but said the Bush administration could have followed Europe and banned the "horrible, toxic stuff" outright. If he were a politician instead of a heart doctor, Topol said, he would have every American weigh in at the post office on tax filing day each year.

Slender taxpayers would receive a credit, while "the people ruining our health care economics would pay the standard tax," he said.

"People who are able to be disciplined and lose weight should be rewarded."

2003 The Washington Post Company

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