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Making a Dent in Obesity: Is It Time to Treat Junk Food Like Tobacco?

Janice Simmons, for HealthLeaders Media, July 30, 2009

A few weeks ago as my 12-year-old son was heading to tech camp at a local high school, I heard the jingle of coins in his pocket. When I asked about it, he said it was for the soda machine. Maybe he'd get a root beer, cola, or sports drink that day. And no, it wouldn't be a diet beverage because other kids would make fun of him because "only fat kids drink diet."

Fortunately for him, he is not overweight. But some of his friends are, including one who was recently diagnosed with Type II diabetes. Unfortunately, his generation is one that is facing what is being called the epidemic of obesity. They're caught in an environment where eating right is not valued—and where their quality of health is threatened at earlier ages.

"Obesity [among children] has tripled in just a generation," said Thomas Frieden, MD, director of the Centers for Disease Control and Prevention (CDC) earlier this week in Washington, DC, at the first annual CDC conference on the "Weight of the Nation."

"We know that our genes haven't changed this fast. We know that our preferences have not changed this fast. We are hardwired to like sweet and salty food," he said. "What has changed is our environment, and if we are to make a change in the obesity epidemic, we're going to have to change the environment in order to gain control."

While no easy answers exist on how to tackle this epidemic, Frieden said that the public health community may want to take pages from the playbook on eliminating smoking, the leading preventable cause death in the country. He suggested a three-pronged approach used to reduce tobacco use that could be used to rewire the way children—and even adults—approach food.

Price is the first prong. What has happened during the past several decades—and in his view is "the single most likely explanation for the obesity epidemic"—is that carbonated drinks, sugar, and sweets have gotten relatively less expensive. Meanwhile, fresh fruits and vegetables have become relatively more expensive.

This means that the cheaper junk food becomes the food of choice. One solution, which was done with tobacco products, is to make these junk foods more expensive through taxes. "A substantial soda tax would probably be the single most effective way we could reduce obesity," he said, citing one example where a 10% increase in the price of soda resulted in an 8% decrease in consumption. Meanwhile, focus should be placed on lowering healthy food costs.

"As we think about sources of revenue for health reform or other societal needs, at one cent an ounce, the revenue from a soda tax could be on the order of $100 billion to $200 billion over the next 10 years," he said.

Exposure is the next key intervention. This means increasing exposure to healthy foods through placement in supermarkets or small grocery stores, and making these foods more readily available.

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