Creative labeling techniques, food tax suggested to combat pediatric obesity epidemic

VANCOUVER, British Columbia — Color coding meal options from least to most healthy, imposing fast food taxes and creating zoning laws that encourage healthier food distributors in low-income neighborhoods were among techniques to curb obesity proposed by speakers at the 2010 Pediatric Academic Societies Annual Meeting.

In recent weeks, major medical organizations including the American Heart Association and regulatory agencies such as the CDC have called on Americans to reduce excess sodium and dietary sugar consumption. The debate as to whether the solution to the obesity epidemic is a matter of personal or societal responsibility continues and took center stage at the meeting.

About one-third of adults and one-sixth of children are obese. Related illnesses equate to an average of 20 lost work days per year for employers, and total obesity related health-care costs tally approximately $200 billion per year.

“For the first time since the Civil War, life expectancy in the United States is expected to decrease due to diseases associated with obesity,” Arthur Garson, Jr., MD, MPH, provost of the University of Virginia in Charlottesville and former dean of the school of medicine, said here.

Garson and Laura Schmidt, PhD, MPH,associate professor in the department of anthropology, history and social medicine at the University of California, San Francisco, said public health campaigns designed to reduce tobacco and alcohol consumption hold important lessons in the age of obesity.

“Forty-five years ago 42.3% of America smoked. In 2007 this figure had been more than cut in half to 19.8%,” Garson said. He attributed these decreases to legislation first passed in the 1960s that added health warnings on tobacco packages, banned cigarette advertising in broadcast media, prevented youth from purchasing tobacco and significantly increased taxes on tobacco products.

Like earlier tobacco legislation, making nutritional information on food packaging clear and simple is the first step in a series of moves that can help Americans make better informed dietary decisions, according to Garson. But, he suggested retailers go a step further than simply labeling caloric content.

Creative solutions

Garson shared a labeling methodology instituted across 121 vending machines on the University of Virginia campus, in which foods were labeled red, yellow or green — like a traffic light — based on fat content. After the program was implemented, vending machine sales for red-labeled products decreased 5%, yellow-labeled products increased 31%, green-labeled products increased 17% and overall sales increased 8.3%.

In addition to labeling changes, Garson suggested adding a fast food tax to further reduce high-fat food consumption, and revenue earned could be used to benefit low income socioeconomic groups — the group taxation opponents say would be most disproportionately affected by such measures.

Garson suggested tax revenue be used to increase food stamp allotments, subsidize health insurance programs and provide grants to manufacturers to create better tasting, cheaper, healthier food. He said that taxing sugary beverages one cent per ounce could reduce consumption by 10% and generate $10 million in revenue.

An additional 10% tax on fattening foods could yield more than $500 billion over 10 years for the United States, which Garson said, is surely needed as America begins to cover the uninsured,” he said.

“It is known that many of the currently low-income uninsured would benefit a great deal from having health coverage aimed at prevention and treatment efforts for diabetes and other diseases stemming from obesity,” Garson said. “While this seems like a great deal of money, a 10% tax is still modest compared with the 17.5% tax the United Kingdom has imposed on ‘unhealthy food.’”

Bundling policies

Schmidt suggested incorporating techniques from alcohol-control policies in Nordic countries into American efforts to reduce obesity. She believes bundling policies to combine local zoning ordinances with state and federal pricing strategies would be most effective in controlling the obesity epidemic.

Instead of one flat tax, Schmidt proposes a graduated tax on foods high in sugar, fat and sodium, similar to a system in Sweden in which liquor taxes are three-fold higher than beer and wine taxes.

“Put a very high tax on most concentrated and a smaller tax on less concentrated items, so no one feels deprived. This is not prohibition, but it will steer people toward healthier options,” Schmidt said, noting this would also help target younger people without a lot of disposable income — the population the obesity epidemic is affecting the most.

Schmidt also calls for state and local ordinances that will make it harder for fast food venues to open up in low income areas and more conducive for grocery stores and farmers markets in these communities.

Lastly, Schmidt suggests eliminating the corn subsidy.

“If we are able to lower or end the corn subsidy, effectively what we would do is make it more expensive for people to manufacture corn syrup,” Schmidt said. “Ending the corn subsidy would in one fell swoop fix a lot of problems.”

Both Garson and Schmidt acknowledged that backlash to such policies are inevitable. “We have not succeeded in denting the rise in obesity and our life expectancy is falling,” Garson said. “We all agree that we are facing a crisis. Government intervention seems appropriate in a national crisis, just like 45 years ago with smoking.” – by Nicole Blazek

Obesity in children has traditionally been considered a medical issue. Yet, counseling in the physician's office in an attempt to encourage youth to change their lifestyle by decreasing calories and increasing activity has rarely been effective in achieving weight loss. And, the medical consequences of dyslipidemia, hypertension and abnormalities of carbohydrate metabolism — all risk factors for early cardiovascular disease — are predicted to be extremely costly, both in terms of quality of life for the individual patient and in terms of financial burden to the health care system.
This is not a problem that can be addressed using a medical model. This is a societal issue that must be addressed by innovative programs designed to change behaviors. In order to change behavior, the environment in which these children live must change. Some of the changes must address limiting access to foods that are high in calories but low in nutritional value and making healthy, high-fiber foods, including fruits and vegetables, more affordable and more accessible, especially in low-income neighborhoods. The taxation of sodas and other high-calorie, low-nutrition foods, subsidizing farmers to grow fruits and vegetables, and giving vendors inducements to sell fresh produce in low-income neighborhoods at reasonable prices are all potential solutions that might encourage healthy eating practices. Evaluation of outcomes following implementation of these policies is essential. We can expect to see more studies reporting outcome data over the next few years.

– Janet H. Silverstein, MD
Chief, Department of Pediatrics University of Florida
Gainesville, Florida

For more information:

• Garson A. #2750. Presented at: 2010 Pediatric Academic Societies Annual Meeting; May 1-4, 2010; Vancouver, British Columbia.