No easy answers in fight against fat (Note: Obesity epidemic in USA)

The following article is from Saturday Special Report (by Chua Chin Hon) of the Straits Times dated 24 July 2010.

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No easy answers in fight against fat
Obesity epidemic in US is due to social, economic factors
By Chua Chin Hon, US Bureau Chief

AT FIRST sight, the way to tackle the obesity epidemic seems painfully obvious: get people to exercise regularly and eat more healthily, and the problem will be resolved in no time, right?
Scratch below the surface, however, and it becomes apparent that the problem is often more than just a matter of personal discipline.

Long-held cultural norms as well as broader economic and political forces beyond the individual's control often present formidable obstacles.

While it is always tricky to compare one country's situation with another, Huntington's struggle with obesity nonetheless offers some food for thought for policymakers in rapidly urbanising parts of Asia, where the local diet is changing fast.

Food - large quantities of it - plays a central role in the social life of Huntington residents, and there's an immediate knee-jerk reaction against any criticism of or interference with the way they've been eating for generations.

But with obesity becoming such a huge problem, its residents are increasingly open to the idea that the battle against obesity should be fought in the same way as that against smoking and the tobacco industry in the 1960s and 1970s.

Its proponents argue that tough measures similar to tobacco taxes are warranted because, like smoking, obesity adds to the country's health costs.

Nationwide, the estimated costs of obesity-related hospitalisations have risen from almost US$126 million (S$173 million) in 2001 to almost US$238 million in 2005.

Some of the more popular suggestions include the imposition of a 'fat tax' or a 'soda tax', as well as the use of graphic labels to warn consumers of the dangers of consuming too much junk food or soft drinks.

In Asia, much of the emphasis seems to be on campaigns aimed at educating people about proper nutrition and exercise. But a recent study by Dr Jason Block of Harvard Medical School found that educational campaigns on their own do not stop consumers buying soft drinks; sales dropped visibly only upon the imposition of a significant 'soda tax'.

It won't be easy to take on the powerful sugar, beverage and fast-food industries in the US. But Asian countries less beholden to these industries might yet be able to take the lead with new measures adapted from the tobacco wars.

One of the most striking things about daily life in the US is how fresh fruits and greens can often cost more than processed food. One main cause for this price distortion is the country's agricultural policies. Each year, the US government hands out about US$20 billion in subsidies for the production of corn, soya bean and wheat, but gives less than 1 per cent of the funds to fruit or vegetable farmers. Corn, soya beans, and wheat are now produced - and used - in such abundance that they've artificially lowered the prices for items further along the food chain, such as dairy and meat products, snacks and confectionary.

This distortion, the experts argue, is one major reason a meal of hamburgers, fries and Coke can cost less than a bag of oranges or a salad bowl in the US.

It is not surprising, then, that many Huntington residents say that the low cost of processed food is a big factor in why they stay fat.

Should subsidies also be given then to broccoli farmers, for instance? Where will it stop?
Or should market-distorting subsidies in themselves be done away with?

There are no easy solutions, but it highlights the point about whether you can successfully tackle obesity as a health issue without also addressing the broader economic policies that helped cause it.

For years now, food experts in the US have warned that the country's US$17 billion school lunch programme pays little more than lip service to nutritional quality.

It took celebrity chef Jamie Oliver's Huntington-based reality TV show to really drive home the point of just how bad things have become: children getting pizzas for breakfast and flavoured milk with more sugar than a can of soft drink.

Since the show aired, concerned parents and teachers have called for a review of the guidelines set by the US Department of Agriculture, and how they are being implemented by the food industry and schools.

Dr James Bailes, a paediatrician in Huntington who specialises in childhood obesity, goes further by suggesting that the US should reconsider the recommended food pyramid, which is traditionally heavy on carbohydrates. A preferable 'food model', he argues, would be a 'food cylinder' that is as thick at the top as it is at the bottom.

Or in a nutshell: more proteins, less carbohydrates.