Fat as a Matter of the State

Does the government have the right to regulate what people eat in order to combat obesity? The United States has initiated a debate between those who believe that the state must treat obesity as an epidemic, dissuading people however from consuming high-calorie or too fatty foods, and those who think that obesity is an individual choice and that being overweight, as a medical condition, should be treated medically only, case by case, without any intervention from the public administration. The decision from the city of San Francisco to ban the distribution of toys with high-calorie menus at the fast food chains has reopened the debate, which goes further than just the nutritional field, and has become a sociological and political discussion that may end up with the birth of a nutritional denial wave.

San Francisco has declared war on the Happy Meal, the colorful McDonald’s children’s menu. In it, children get a soft drink, a French fries order, four chicken nuggets or a small hamburger and a dessert. Since the menu was launched in 1979, McDonald’s has sold 20 million Happy Meals in the U.S. The price runs anywhere from $2 to $4. It also includes a toy, something very popular among little children. According to the nutritional charts of the company that sells them, the calorie content is very close to 600 calories. There are some options, such as the cheeseburger, which fall within the 780 calories. Nutritionists agree on placing the normal calorie intake of a child over four years at about 1,200 calories daily.

For decades, the great appeal of McDonald’s has been the fact that it is a mix of playground and restaurant where kids like to go with their families. For San Francisco local rulers, however, the problem arises when the children get their meals at McDonald’s, Burger King, Wendy’s or any other fast food franchise habitually — it becomes the rule rather than the exception. Bearing in mind that 13 percent of North American children are obese, the City Board of Supervisors has passed an ordinance according to which toys can’t be given away along with menus that provide more than 600 calories, more than 35 percent of total calories from fat, over 10 percent of saturated fat, more than 640 milligrams of sodium or do not include a serving of fruit or vegetables.

The measure will take effect in December 2011, and although the city mayor, Gavin Newsom, announced that he will veto it, the proposal has gotten enough votes (eight to three) to overcome the veto. The San Francisco supervisor who proposed the rule, Eric Mar, has no doubts: “Our legislation will encourage restaurants that offer unhealthy meals marketed toward children and youth to offer healthier food options with incentive items or toys. It will help protect the public’s health, reduce costs to our health care system and promote healthier eating habits.”

It is a widespread view among many U.S. politicians: Obesity is an epidemic, and should be treated as such. And the White House shares that view. Traditionally, in every presidency, the first lady assumes a social cause on which to focus her efforts. Nancy Reagan focused her efforts on the fight against drug abuse. Laura Bush promoted reading. Michelle Obama fights childhood obesity. “Nearly one-third of our children in this country are overweight or obese,” she said in a speech in Las Vegas last June. “That’s way too many. It’s more than what it was when all of us were growing up. Things just weren’t like that. That means that these kids are at greater risk for obesity-related conditions like heart disease and diabetes and cancer. I mean, this is the fate that we’re handing over to our kids. And it’s not just a health crisis, as Senator Reid said. It’s an economic crisis. We are spending nearly $150 billion a year to treat obesity-related illnesses. And if we don’t act now, if these kids now grow up to be adults, then that number is just going to continue to go up. And none of us wants that kind of future for our kids. We don’t. And we definitely don’t want that kind of future for our country.”

In May, during the debate that took place in Congress on the health reform led by President Barack Obama, the Senate considered a proposal that, among others, had already been raised by New York: imposing an extra tax on high calorie drinks. Many nutritionists believe that soft drinks and shakes are a source of calories far more dangerous than fast food restaurants. For example, despite the debate sparked about the Happy Meal, McDonald’s offers the Chocolate Triple Thick shake, which has 1,160 calories, more than half of an adult’s needs for an entire day.

Against the governmental offensive on the fat, the U.S. libertarian movement has started to charge with ideological weapons. The respected law professor at the University of Chicago, Richard A. Epstein, a bastion of that current and deeply suspicious of government intervention, has opposed for years to consider this condition as an epidemic. “We should be very skeptical of any effort to solve this matter by government intervention, whether in the form of regulation, taxes, or liability rules,” he said. “The person who counts calories and exercises faithfully is penalized because she chooses to eat a cream pie as part of a sound overall diet.”

“And banning the promotions [as San Francisco already did] can make the children who want calories search ways to get them. Parental control is a much better mechanism when it really works, something that happens to a greater extent in the upper-middle class families. It is usually weaker in other social strata. Schools and companies may try to modify the menus, but there is a risk that children spend their weekly allowance in unhealthy foods [as sweets or processed baked goods]. It is a difficult problem, but the Government solution doesn’t provide any benefits.”

Some leading experts, including Thomas J. Philipson, Professor of Public Policy at the University of Chicago, and Judge Richard A. Posner have proposed a medical solution. Philipson explains: “Innovation has already occurred in the form of bariatric surgery, such as gastric bypass and gastric banding, currently the most successful treatment for morbid obesity. New drugs for obesity may replace the $17 billion annual market for the high-cholesterol medicine Lipitor, which is now the best-selling drug in the world. Vivus’s new weight-loss drug, Onexa, likely to be approved by the Food and Drug Administration this fall, is surely the first of many. Technological change thus may be more successful reducing obesity than attempts to change people’s eating and exercise habits have been.”

Ideas like that are moving in the direction of making the government look redundant in its fight against malnutrition, a phenomenon that didn’t encounter any serious opposition during the last decade. Today, however, with the spreading of the radical Tea Party — an extremist faction of the Republican Party that advocates for a reduction of government intervention to a minimum — the government’s insistence on criminalizing manufacturers and consumers of junk food is increasingly seen as an illegitimate intrusion into the private lives of the citizens.

This is an emerging trend, but with substantive arguments. Some experts see the crusade against obesity as a cultural demonization, comparable to McCarthyism, the anti-communist witch hunt in the U.S. Senate in the 50s. So says Paul Campos, Law professor at the University of Colorado. “It’s the classic pattern of moral panics,” he explains. The term “moral panic,” coined by sociologist Stanley Cohen in the 70s, defines the overreaction from a powerful or majority social sector which perceives another minority as distorted and inaccurate, and therefore demonizes it. This “has transformed the heavier than average into folk devils… As public concern about the damage being done to the fabric of society by the folk devils increases, increasingly intense demands are made on public officials to ‘do something’ about the crisis, usually by eliminating the folk devils.”

Campos defends this view with three arguments. On the one hand, he says that pharmaceutical companies are interested in the state treating fatness as a health crisis, to sell more drugs. Moreover, American popular culture, exported to almost all Western countries, is more tolerant of other eating disorders such as extreme thinness. Finally, food consumption is the only one that maintains an inverse relationship with purchasing power. That is, the more resources a family has, the better its members eat. In contrast, dollar burgers deals are a common meal among the American lower class.

“It is no coincidence that the only expression of consumer excess that maintains an inverse correlation with the purchasing power and consumer social status is the one social elites charge against,” said Campos. “I’m not saying it is a conscious attack. But I think it is a bias associated with social status. It is common to see a criticism against fat in a way that can sometimes become even moral, and, as I said, demonizing.”*

There is no scientific doubt that excessive fat is very unhealthy. It is also true that 26 percent of Americans are obese because they have a body mass index equal to 30 or higher, according to the Quetelet index. But there have been campaigns that have pilloried many overweight people who suffered public humiliation, such as initiatives from the airlines to charge two-seat tickets to people who are considerably overweight or statements by various politicians about the increase of health care costs and insurance policies prices because of obesity.

In the case of toys in the Happy Meal in San Francisco, there are parents and educators who express their rejection to the idea of the state intervention or prohibition of any food choice. “San Francisco is developing its own Ministry of Plenty it seems, leaving out the rights of parents to choose what they want to feed their own children,” said Luanne Hays, teacher at Ovilla Christian School of Texas and Teacher Voice columnist.”When George Orwell wrote about government control in his novel 1984, McDonald’s hadn’t even invented the Happy Meal yet. Little did Orwell realize that a modern Ministry of Plenty would be put into practice in the 21st century.”

According to this new vision, the government is taking, with its nutrition policies, the way of the Orwellian Big Brother. It is the central part of what is becoming a social and political debate in the United States — the question of whether overweight and obese people have a right to choose to live that way. Experts ponder on whether theirs is a personal choice or a group irresponsibility that ends up affecting society as a whole and, by imitation, children who copy the patterns they learn from their parents. The big question is if a strong movement of skeptics will appear, as it did with climate change, and eventually create a nutritional denial wave.

Knowing the calories you eat helps you lose weight

New York, exceptional as it is among American cities, has been the main laboratory for the U.S. nutritional experiments. First, health centers in the metropolitan area were forced to report patients’ glycated hemoglobin levels in order to develop a municipal register of diabetes. Subsequently, trans fats were banned. Finally, since 2008, restaurant chains with 15 facilities or more throughout the country are required to publish the calorie content of each menu item in a visible place, with up to $2,000 fines if they do not comply with the law.

As Thomas Frieden, New York City Health Commissioner, said, the purpose of posting calories is eminently deterrent: “You might think that tuna salad, because it says it’s salad, is healthier. But you might see it’s many more calories than a roast beef sandwich. And you might prefer the roast beef sandwich, too. You were having the tuna salad because you thought it was healthy.”

Three researchers from Stanford University (Bryan Bollinger, Phillip Leslie and Alan Sorensen) led a study last year on the real impact of this measure in the great nutritional laboratory New York had become. Its main intention was to find if seeing the calories next to the price of a certain product would affect the consumer behavior. They compared the buying habits of Starbucks customers in New York (222 stores) to those from Philadelphia and Boston (94 stores), where the rule is not implemented. The study found that calorie posting at Starbucks led to a 6 percent reduction in calories per transaction, from 247 to 232 average calories per transaction. Only six out of 100 buys were affected by this policy.

For those consumers who averaged more than 250 calories per transaction, calories per transaction fell by 26 percent. In general, they estimate that, on average, the reduction is 30 calories per day per person. And dieticians recommend that, in order to lose weight, the calorie intake must be reduced between 500 and 1,000 calories per day, as a strategy to lose up to one kilo per week. The number of calories that an adult should eat per day varies from 1,500 to 2,000.

*Editor’s Note: Quote could not be verified.