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.
And it means turning healthy foods into "picker" foods: "If you think about the difference between unhealthy foods and healthy foods, one of the [distinctions] is that you can pick up unhealthy foods a lot more easily than you can pick up healthy foods—with the possible exception of carrot sticks, and you can't only have carrot sticks," he said.
Decreasing exposure to unhealthy foods—like decreasing exposure to tobacco—is another avenue, albeit a tricky one. At schools, for instance, many kids are exposed to these foods through vending machines, which help in part to finance school activities. "Principals face a devil's dilemma of whether they get revenues for very important programs in incredibly strained fiscal times or whether they try to have a commercial-free environment for children to learn in through graduation."
Image is the third key area. "Food ads for children are extensive," Frieden said. "I think when we look back 20 to 30 years from now, we'll say 'what in the world were they thinking'?—allowing the kind of advertising that occurs today still to exist in the midst of an epidemic of childhood obesity."
In the future, the ads on TV and Internet today "will look as anachronistic to us then as the tobacco ads from a generation or two ago looked to us now," he said. But the reality is that today, children continue to be exposed to extensive marketing and promotion.
One way to approach this is counter advertising—much like was done with tobacco ads. "Counter advertising works to change the image. What works unfortunately are not positive ads about smoke-free living. Those have limited or no impact." he said.
Instead, the ads should show that "human impact of a product but should never attract the victim. It should show only the reality of what the product causes in terms of illness, disability, and death," he said. "Counter advertising is essentially untested in obesity prevention and control. It is, in my personal opinion, very likely to be effective. It is certain to be very controversial."
Overall, as a society, "I do not think that we can wait for perfect evidence" to tackle obesity now, he said. "The question, I think before us—and what we have to weigh as a group as we consider the 'Weight of the Nation'—is whether we as a society are willing to take the actions necessary to reverse the epidemic of obesity."
Note: You can sign up to receive QualityLeaders, a free weekly e-newsletter that provides strategic information on the business of healthcare management from around the globe.