Commentary: Let Them Eat Cake -- If They Want To

The U.S. take on obesity: Personal responsibility

How do you change the eating habits of several hundred million people? That's the daunting problem the World Health Organization (WHO) is trying to solve with a proposal for fighting obesity worldwide. It's a bold and necessary effort, but unfortunately, it may be undermined by the world's fattest nation: the U.S. The U.N. estimates that 300 million people worldwide are obese and a further 750 million are overweight, including 22 million children under 5. Health experts around the world are unanimous in saying that something must be done. And that's where the unanimity ends.

The WHO has spent the past year hammering out a series of nonbinding actions that governments could undertake to address their own citizens' weight problems. The initiative is slated for adoption in May, but the U.S., with backing from the powerful food lobby, is working furiously to water down the proposals. These include restrictions on advertising, changes in labeling, increased taxes on junk food, and the elimination of sugar subsidies.

The playbook for the Administration's attack is much the same as the one it used to block international action on global warming. It is charging that the WHO's conclusions are not supported by "sufficient scientific evidence" that fats and sugars cause obesity.

The effort is starting to pay off. The U.S. managed to delay the issuance of a final draft of the proposals for a month, until the end of February, to allow further comment. And now it has company: On Feb. 9, trade ministers from developing nations, many of them sugar producers, rejected the science behind the proposals.

INFURIATING. Technically, the U.S. has a point. William R. Steiger, the lead delegate to the WHO from the Health & Human Services Dept. (HHS), complained in a letter to the organization that the evidence linking sugar and fats to obesity comes from epidemiological studies rather than stringently controlled clinical trials. "In this country, you can't make a scientific claim unless you have the evidence to back it up," argues an HHS spokesman.

This argument infuriates nutrition experts. "The U.S. really isn't refuting the argument. It's saying it is not a tight enough case," says Shiriki Kumanyika, epidemiology professor at the University of Pennsylvania. It is, in fact, almost impossible to prove the cause of noninfectious diseases. For example, there is no absolute proof that smoking causes cancer. "Most major public health actions involve the best evidence available. Otherwise, we'd never do anything," she says.

Even the U.S. does not advocate doing nothing. The Centers for Disease Control estimates that one in every three adults in the U.S. is obese, and 15% of children are overweight -- double the rate of 10 years ago. Steiger says in his letter that the U.S. favors guidance that "promotes the view that all foods can be part of a healthy and balanced diet, and supports personal responsibility to choose a diet."

"IMMORAL". Poor self-control is only one aspect of the obesity problem, however. "Are we so much less responsible than we were 10 years ago?" asks Kelly D. Brownell, director of Yale University's Center for Eating & Weight Disorders. "There are huge obstacles to making healthier choices." Among them: larger portions, inadequate nutritional information on food labels, fast foods sold in schools, and cutbacks in physical education programs.

Health experts have not lined up en masse behind all the WHO's proposals. Some are uncomfortable with taxing food low in nutritional value, even though the tactic has worked against smoking. "Food is something we need to live," says Dr. C. Ronald Kahn, president of the Joslin Diabetes Center in Boston. "What we really need to do is eat less of it."

The idea of eating less is anathema to the food industry, however, and this suggestion is nowhere to be found in the proposals. The WHO, however, does recommend restrictions on advertisements that exhort us to eat more, particularly those aimed at children. "Advertising junk food to children is unethical and immoral," says Dr. Walter C. Willett, head of the department of nutrition at Harvard University's School of Public Health.

Ultimately, the WHO proposals form a multifaceted approach, combining education and regulations. With the same combination, the U.S. was able to cut the smoking rate in half, even though it took 40 years. "It will take at least that long to cut obesity rates by half," Willett predicts, and then only if the U.S. government gets serious about tackling the problem. So far, there is little scientific evidence proving that it is.

By Catherine Arnst

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