We cannot treat our way out of the obesity epidemic

A spate of recent reports on obesity shows that the U.S. continues its extraordinary 40-year rise in obesity. The reporting focuses on its genetic roots and the need for more treatment. 

In a segment on 60 Minutes, Leslie Stahl interviewed Dr. Fatima Cody Stanford who stated that the number one cause of obesity is genetics. Similarly, New York Times reporter Gina Kolata summarized the American Academy of Pediatrics (AAP) new guide in a podcast episode, which also notes genes as part of the problem. The guide calls for pediatricians to encourage vigorous behavioral interventions even for very young children, as well as drug treatment or surgery for adolescents.

The glaring oversight in these assertions is the failure to describe the huge influence of the food industry on the obesity epidemic and the dire need to halt the harmful marketing of unhealthful foods. Doing so would prevent obesity before young people need medications and surgery.

Certainly, genes contribute to obesity. But genes could not possibly account for the epidemic of obesity. In 1985, no state had a prevalence of obesity above 14 percent. Now, the Centers for Disease Control and Prevention reports that 20 states have rates between 30 percent and 35 percent, 14 states have rates between 35 percent and 40 percent, and two states have rates above 45 percent. Surely the genetic makeup of Americans has not changed during that time.  

Optimism about the benefits of treatment is not warranted. The 60 Minutes piece touts a new drug — Wegovy — that has proven beneficial in reducing weight. Its sustained use will keep the weight off. However, the drug costs $1,300 a month, is in short supply, and is often not covered by insurance. Its long-term side effects are unknown.

The AAP report calls for intensive behavioral therapies and drastic interventions such as bariatric surgery. But there is no evidence that any weight loss strategy — including bariatric surgery — produces long-term reductions in obesity, and surgery carries with it significant risks. Moreover, it is inconceivable that these remedies will reach the enormous number of people who are obese.  

The only way to reverse our obesity epidemic is by preventing obesity in the first place. The practices of the food industry are clearly the major cause of this epidemic. Over the past 50 years, the industry has learned how to design processed foods with an irresistible taste. The key ingredients are salt, sugar and fat. The best-selling foods are loaded with them. 

The industry has become adept at marketing these foods. The Rudd Center for Food Policy and Health reported that the industry spends $1.8 billion a year marketing food products that are high in fat, sugar and salt and have little nutritional value. Only four-tenths of one percent of the companies’ marketing is spent advertising fruits and vegetables. 

Youth exposure to ads has been increasing, with children seeing an average of 12.8 ads per day and teens seeing 16.2 per day. Youth are also exposed to product placement in TV and movies. One study found that of the 20 most popular movies between 1996 and 2005, 69 percent had at least one food or beverage; a total of 1,180 brands were displayed in these movies. And a recent report from the Rudd Center showed that millions of children, some as young as 3, are being exposed to junk food on YouTube.  

The food industry has steadily increased the size of servings. For example, over the past 70 years the typical size of soft drink bottles has gone from 6.5 ounces to 12 ounces, then 20 ounces, and then to 42 ounces. By 2004, children were getting 11 percent of their calories from soft drinks. The number one calorie source for teens is sugary drinks.  

Like other industries that harm children’s health (e.g., tobacco, alcohol, social media) the food industry blames parents for their children’s unhealthy behavior. However, research has shown that whatever the level of parental vigilance, children exposed to ads for fast food increase their preference for them. 

The tobacco control movement is a model for how to address obesity. We need to limit the advertising of unhealthful food to children. Since the marketing of cigarettes to young people has been restricted, the rate of teen smoking has declined considerably. Increased taxation on tobacco and alcohol reduces youth use and addiction. Similarly, taxes on sugar-sweetened beverages have been shown to reduce sales.  

The problem with obesity points to the fundamental flaw in American health care. We spend more money than any other country in providing treatment for diseases, but we fail to address the social conditions that cause disease. These conditions include not only the marketing of tobacco, alcohol, unhealthful food and guns. Poverty, homelessness, economic inequality and discrimination account for a huge proportion of illnesses that results in premature death.  

The reform of our system begins with making the well-being of our population a higher priority than limiting the regulation of corporations.   

Anthony Biglan, Ph.D. is a senior scientist at Oregon Research Institute and president of Values to Action. Diana Fishbein, Ph.D., is a senior scientist at the Frank Porter Graham Child Development Institute, University of North Carolina-Chapel Hill, part-time research faculty at The Pennsylvania State University and president of the National Prevention Science Coalition to Improve Lives.