The tobacco industry hooks youngsters on a highly addictive and deadly product.  Its customers die 13 years before they reach the end of their normal life expectancy. The processed food industry hooks youngsters on addictive, obesegenic foods (the increases in calorie consumption in the U.S. since 1970 are almost entirely a result of upsurges in processed sugars and oils, both of which are increasingly recognized as addictive). The obese customers of Big Food die on average 8 -13 years prematurely.

Is it fair to compare Big Tobacco and Big Food? Is this just some politically correct hype? Or could lessons learned from tobacco control be applied to combatting the obesity epidemic? “Very likely the war on tobacco can teach us a thing or two” argues Dr. Cheryl Perry at The University of Texas School of Public Health. Up until now, our approach to combatting obesity has been to admonish fat people to engage in repeated attempts to lose weight. Dr. Perry, along with other experts such as Marion Nestle and Kelly Brownell argue that it is time to stop blaming the victims and start exercising the same kind of moral outrage towards Big Food as we feel toward Big Tobacco.

The notion of moving the focus of combatting obesity from individuals to industry relies on the use of innovation tools called “reversal” and “re-framing” in which we think of the problem from a very different perspective. The parallel between tobacco and food is an “analogy”. All of these classic innovation tools can be learned (see Innovation Generation: How to Produce Creative and Useful Scientific Ideas). These tools guide solutions that are far from conventional.  

Tobacco use has fallen 60 percent in the past 50 years. In contrast, America has made little progress in reducing the public health problem of obesity which now affects one-third of all Americans and will soon become the most costly health problem in America. Dr. Perry summarizes the following interventions that worked in reducing tobacco use: 1) educating the public; 2) increasing cigarette prices; 3) restrictions on marketing; 4) bringing forth evidence; 5) keeping tobacco companies accountable. How would such strategies apply to Big Food? 

First, knowledge is power. Did you know that two slices of pepperoni pizza, the most popular food item in the world has about 600 calories and 24 grams of fat? This is about a quarter of your daily allotment of calories and half your daily allowance of fat. Few Americans truly understand nutritional recommendations and food labels. We adults need to know and our children need to know.

Second, keeping food cheap has been American policy for decades. America spends billions of dollars each year on corn, wheat and soybean subsidies, contributing to a glut of low nutritional content foods. Shouldn’t we instead be subsidizing fruits and vegetables – kids eat more of these in schools when they cost less. Brownell has argued eloquently both for such subsidies and for leveraging a sugared soda tax.

Third, from 1967-71, Perry reminds us that America instituted a “Fairness Doctrine” which mandated that for every three cigarette TV ads there needed to be an anti-smoking ad. How about a Fairness Doctrine for food? Or even better, how about a ban on processed food ads on TV?

Fourth, the 1964 Surgeon General’s Report was a watershed in tobacco policy – an evidence-based document that turned the tide on rising tobacco use. How about annual Surgeon General’s Reports for food providing a scientific basis for policies and legal action?

Finally, legal action against Big Tobacco was possible when government agencies began to hold them accountable, asking, “Is evidence being suppressed?”  “Are consumers, particularly children, being manipulated?”  “How are companies benefitting financially?” Such questions could not be more timely for Big Food.

Thus, solutions to the obesity epidemic learned from those of tobacco control are striking. However, many argue that tobacco and food are simply not analogous. Cigarettes are not needed for sustenance whereas food is, they say. But I say, “French fries and funnel cake are not needed for survival and those are the kinds of foods that drive the obesity epidemic.” Cigarettes are highly addictive and food is not, some argue. Yet is that really true? Processed foods generally include dozens of food additives with unknown psychological and physiologic consequences. Moreover, animals fed on high fat/sugar diets react to stimuli just as addicts do. 

What America may need is just what Dr. Perry and others argue - to shift the frame from individual reprimands to responsible policies. To shift the onus of action from big people to Big Food.

 

About the Author

Roberta B. Ness, M.D., M.P.H.

Roberta B. Ness, M.D., M.P.H., author of Innovation Generation, is the dean of The University of Texas School of Public Health.

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