Since first lady Michelle Obama made childhood obesity her signature project almost two years ago, the issue has had the kind of highly visible national leadership that it previously lacked.
But that isn't enough, say public health leaders frustrated with the slow progress in stemming America's obesity epidemic.
Something more ambitious is needed, they argue — something more like the anti-tobacco movement.
The existence of this "domino effect" has recently been denied by our own dear Deborah Arnott (thereby providing Dick Puddlecote with many laughs - see here and here and here and here). So what does Dr. Stanton "not a medical doctor" Glantz have to say about it?
"When I look at what's going on with obesity, it reminds me of what was going on with tobacco in the '50s, '60s, and '70s, when there was a lot of emphasis on personal responsibility, voluntary self-regulation, and trying to make safe cigarettes," said Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California-San Francisco.
That approach didn't work, and efforts to reduce smoking didn't really have much success until advocates shifted their emphasis from changing individual behavior to community-based activism and holding cigarette manufacturers accountable for harmful products, Glantz said.
Could this be the same Stanton Glantz who said in 2006: "The whole slippery slope argument is fallacious"? It is.
As public health experts committed to stemming obesity study the history of the anti-tobacco movement and look to it for guidance, it is helpful to consider some key similarities and differences between these issues.
Yes. Let's piece it together. Firstly, there's the "think of the children" angle...
Preventing harm to young people is a central goal of both anti-tobacco and anti-obesity campaigns. "First, let's protect our children," said David Ludwig, a child obesity expert at Harvard Medical School
Secondly, we'll need some denormalisation:
Smoking rates have been cut by more than half, intolerance of smoking in public places is widespread, and anti-smoking policies are in place at hospitals, workplaces and venues across the country. Koplan is convinced the same shift in social norms is called for — and achievable — when it comes to childhood obesity.
Then we need an equivalent of secondhand smoke:
The American public was alarmed when it learned that the cigarette smoke that non-smokers breathed in airplanes, bars and restaurants was dangerous, and that no amount of second-hand smoke was safe.
"The notion that my behavior as a smoker can have an effect on you and can make you sick was critically important in accelerating people's intolerance of smoking and their willingness to see the government take action," said Michael Eriksen, director of the Institute of Public Health at Georgia State University.
There is no equivalent in the fight against obesity. "Your being obese does not affect me in the same direct way," Eriksen said.
Oh, but it does, squire. There is "passive obesity" and our old friend Robert Lustig is about to tell you about it.
The best argument might be that obesity consumes enormous health care resources, driving up the cost of medical care for everyone, suggested Robert Lustig, a professor of pediatrics and director of the Weight Assessment for Teen and Child Health Program at the University of California-San Francisco.
Finally, there is the essential prohibitionist trick of painting their crusade as being between "the people"—as represented by bossy, intolerant puritans and quacks—and Big Food/Big Tobacco.
"Some companies are making huge profits off obesity," said Stan Dorn, a senior fellow at the Urban Institute, a public policy research center in Washington, D.C., "and I worry that people who are focused on anti-obesity strategies aren't being tough enough on them."
However, there is an acknowledgement that there may be a few differences between the War on Food and the War on Tobacco.
"Tobacco we can get rid of entirely. We don't need it. It has no intrinsic value. But we have to eat to live and make terms with food as the enemy," said David Katz, director of Yale University's Prevention Research Center.
You've got to love the glib assertion that "we" can get rid of tobacco entirely, as if eradicating a plant that has grown for millions of years and is consumed by 1.2 billion people is a simple administrative matter—as if prohibition has such a glorious track record that the elimination of the world's second favourite drug is easy and imminent. But as much as I like that statement, I think I like the idea of food being "the enemy" even more. And that's not the only "enemy"...
Throughout most of history, humans lived in an environment where food was scarce and hard to get. As a result, we're primed, biologically, to eat food when it's available and "we're very good at storing calories and defending calories once we've got them," said Stephen Daniels, chair of the department of pediatrics at the University of Colorado School of Medicine. "In some ways, you could say that our biology is our own worst enemy when it comes to being overweight or obese."
If food and biology are your enemies and Robert Lustig and Stanton Glantz are your friends, you're probably mixing in the wrong circles. Interesting times ahead...
