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Four ways to regulate causes of obesity

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You've heard it already: Obesity is epidemic in Canada and is contributing to an increased prevalence of hypertension, diabetes, heart disease, stroke, cancer and other chronic conditions. What you don't often hear is that as a result, health-care costs keep rising, posing a threat to the sustainability of our publicly funded health-care system. The obesity epidemic also compromises our workforce productivity and reduces economic competitiveness.

In the face of this burning issue, there has been little government response.

Although at the most basic level obesity is the result of an excess of calories consumed over calories expended, the causes and solutions are highly complex, involving everything from stress levels to social equality to food production and urban design and a cluster of other complex issues. But this complexity must not continue to be a reason to do nothing.

There is sufficient evidence to guide governmental action -- now.

So where to start? Reducing calorie consumption is the highest priority. While physical activity is important for health, research suggests that by itself it is not effective for weight control and so is not the place for governments to begin.

Unfortunately, health-promotion programs aimed at personal dietary choice and responsibility have limited impact in the face of massive advertising and marketing by the food and beverage industries. So far, despite health promotion in schools (reducing junk food and increasing physical activity) and other settings, the prevalence of obesity has remained stubbornly high.

Industry self-regulation also sounds good, but the truth is, it doesn't work.

There clearly needs to be more effective action. But what actions will work?

The best available evidence and experience from other health-risk behaviours (alcohol abuse, drunk driving, seatbelt and helmet use and smoking) shows government action to "nudge" personal reduction in calorie consumption through regulation will most cost-effectively control the obesity epidemic. Here's how.

First, governments (federal, provincial) should introduce a substantial tax on sugar-sweetened beverages (SSBs). These beverages have little or no nutrient value and contribute significantly to excess calorie consumption. Although a few jurisdictions have applied small taxes to SSBs, there has not been an attempt to apply a substantial tax over a sufficient length of time to determine if this will reduce consumption. But economic theory, clinical evidence and experience from tobacco and alcohol suggest this will not only reduce calorie consumption and obesity but also be a revenue source for government.

Second, governments (provincial, federal) should, by regulation, limit the marketing and sales of junk food and beverages, particularly to children. This should include controls on advertising through electronic and print media, sponsorship of sport, cultural, school-based and health-care events and facilities as well as controls on the placement of junk food and beverages at checkouts and similar child-targeted sites. At the municipal level, this should be extended to control the availability of junk foods and beverages near schools.

Third, the federal government should implement a salt-reduction strategy (including warning labels, advertising restrictions and procurement policies, as in Bill C-460). Although salt in itself is not calorific, it is a key ingredient in the production of many junk foods -- and often what keeps us coming back for more.

Fourth, governments needs to introduce a regulatory requirement for better calorie and nutrient information at the point of consumption in restaurants and other food outlets.

But wait: Is this the dreaded nanny statism we've all been warned about? In New York, when Mayor Michael Bloomberg controlled the size of SSBs, he was accused of creating a "nanny state." But when the food and beverage industry makes large profits, leaving taxpayers to pick up the costs of providing health care for the victims of obesity-related disease, this is a failure of the market mechanism. It is governments' role to take corrective measures.

Yes, there may be some unintended consequences from such regulation -- time will tell. But doing nothing is not an option.

Instead, we should move forward now, but closely monitor and assess the results, learning from any mistakes and spreading success to other regions. To wait would be to lose the opportunity to make a real difference now -- for us and for future generations.

John Millar is an expert adviser with and a clinical professor at the School of Population and Public Health, University of British Columbia.

Republished from the Winnipeg Free Press print edition February 23, 2013 J11

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