Federal Government Takes Bigger Role in Combating Obesity

Far-reaching Initiatives Aim to Halt National Epidemic

May 17, 2010 08:05 am James Arvantes

The federal government has made the prevention and treatment of obesity a major part of its campaign to improve the health of America by launching a series of initiatives that are likely to have a long-term impact on stemming the tide of obesity in this country. That's according to analysts interviewed by AAFP News Now.

In early February, U.S. Surgeon General Regina Benjamin issued her first release to the country. "The Surgeon General's Vision for a Healthy and Fit Nation 2010(www.surgeongeneral.gov)," highlights the growing number of overweight and obese Americans and reviews the causes and health consequences of obesity. The report also offers steps consumers, parents, schools, communities and physicians can take to reverse the trend.

It was only a few days later, on Feb. 9, when first lady Michelle Obama unveiled her Let's Move(www.letsmove.gov) campaign to combat childhood obesity. The campaign outlines a wide range of initiatives to attempt to end childhood obesity within a generation. The Let's Move campaign encompasses support for parents, the provision of healthier foods in schools, more physical activity for kids and the availability of affordable healthy foods in communities.

Then, in late March, Congress passed and the president signed a comprehensive health care reform bill into law. The legislation contains several measures to help reduce the rising rates of obesity in the United States.

"We are moving in the right direction," said former U.S. Surgeon General Richard Carmona, M.D., the health and wellness chair of the Strategies to Overcome and Prevent, or STOP, Obesity Alliance(www.stopobesityalliance.org). "It is about incremental change over time."

After all, Carmona said, "it has taken us a generation to get here." Solving the nation's obesity crisis mandates a long-term approach that requires a cultural change. This entails a shift in buying, eating and sedentary habits, said Carmona in an interview with AAFP News Now.

"It is not about (saying that), 'Next month, everybody is going to be healthy, and obesity is going to go away,'" Carmona said. "The culture is the most difficult thing to change."

Assessing the Impact of the Surgeon General's Vision

Experts interviewed by AAFP News Now were divided on the likely impact of the surgeon general's report on obesity. Some said the report could serve as a landmark paper, while others described it as "very informative but largely targeted to health care and public health," and, thus, limited in scope.

Carmona had a different perspective. He pointed to the effect of the report(www.surgeongeneral.gov) he released in 2006 as surgeon general on the effects of secondhand smoke.

"When it was first released, it was kind of a little blip on the radar screen, and nobody thought it was going to be anything," said Carmona.

Within a year of its release, however, the report prompted about half of the states in the United States and nearly every continent in the world to create smoke-free environments, making it one of the most important reports ever issued by a surgeon general, said Carmona.

The current surgeon general's report on obesity should be looked at within that context, he said. "We have to look at it retrospectively in a couple of years and ask, 'Did it have incremental value?' I predict it will."

Major Programs

The recent initiatives coming out of Congress and the White House have created an environment that will help physicians "modify the trajectory of obesity as it grows in the country," said family physician Paul Jarris, M.D., M.B.A., executive director of the Association of State and Territorial Health Officials.

Jarris is convinced that the first lady's Let's Move campaign represents a major turning point in the nation's fight against obesity because of its extent. The campaign involves the public and private sectors, business, education, agriculture, food producers, and all parts of the federal government, said Jarris.

But, perhaps most importantly, the president and the first lady have made healthier living a national priority through the Let's Move campaign. They are providing critical leadership and resources to combat the problem of childhood obesity, and the campaign enjoys broad bipartisan support.

"The bipartisan support for the national obesity initiative is incredibly important," said Jarris. "What we were lacking in this country was that national leadership in establishing this as a national priority."

The Let's Move campaign is based on a four-pronged approach that encompasses healthy choices, healthier schools, physical activity, and accessible and affordable foods that are healthy. It is supported, in part, by a recently formed federal task force on childhood obesity that is composed of representatives from key federal agencies that will review every program and policy relating to child nutrition and physical activity. The task force plans to issue a report within the next few weeks.

The Let's Move campaign is committed to ending food deserts (i.e., communities without supermarkets) within seven years, while promoting healthier foods in schools, thus addressing two major challenges to healthier living.

"Let's say the doctor does the (body mass index calculation), writes a prescription, and talks about lowering calories and eating more fruits and vegetables," said Jarris. In many instances, he noted, children do not have access to healthy foods in their schools or neighborhoods, making it difficult -- if not impossible -- for children to follow their physician's advice.

The Let's Move campaign will endeavor to change that situation by giving children access to healthy foods in their schools and neighborhoods, making successful interventions more likely, Jarris said.

Health Care Reform

The recent enactment of health care reform also will play a major role in combating obesity, according to experts. For example, the legislation provides $500 million for prevention and wellness grants in 2010, an amount that increases to $15 billion during the next 10 years.

One of the most important provisions in the new law is buried deep within the legislation itself. That provision will require any restaurant with 20 or more locations to include calorie counts on individual menus, menu boards and drive-through menus. The provision, which takes effect in 2011, also will apply to foods sold in vending machines, including foods that do not have calorie listings on the front of the package. The FDA is responsible for enforcing the requirements.

Jarris said he expects the menu labeling requirements to have a big impact on the choices that consumers make and even the formulation of foods. The first goal of menu labeling is to inform, which is a critical component because most calories now are consumed outside of the home, he said. With menu labeling, consumers are more likely to change their food choices, prompting restaurants to alter their food formulations to make them healthier, according to Jarris.

Smaller, nonchain restaurants located near larger chains likely will follow suit and adopt menu labeling to stay competitive, Jarris said. "It will actually spread throughout the industry," he predicted.