Current rates of obesity and poor diet in the United States cannot be sustained. A recent report by the McKinsey Global Institute examined the economic costs of obesity and concluded that obesity rates have reached “crisis proportions.” Two-thirds of adults and one out of every three children under age 18 are overweight, triple the rate 40 years ago. The consequences are devastating. Diet-related diseases, including Type 2 diabetes and hypertension, once affected only adults but now are increasingly common in children. U.S. healthcare costs associated with obesity total $190 billion annually, $14 billion of that devoted to caring for children. Once a child becomes obese, he or she is likely to suffer from obesity for life. As a result, today’s children may be the first generation to live fewer years than their parents.
Officials in local communities experience the consequences of childhood obesity firsthand, and they have increasingly taken the lead to establish healthy communities that allow parents to raise healthy kids through policy initiatives. Such policies often include increased opportunities for children to engage in physical activity, as well as public health campaigns to inform parents and kids about the importance of healthy eating. Despite these efforts, increasingly it has become clear that the crisis of childhood obesity cannot be reversed without widespread systemic changes to the food environment that surrounds today’s children – an environment where high-calorie foods and beverages containing unhealthy amounts of sugar, saturated fat and salt are the cheapest, easiest, and most readily available and heavily marketed choices.
As a consequence, almost 40% of calories that young people consume consist of empty calories from solid fat and added sugars, and more than one-third of children’s calories come from snack foods (primarily desserts and chips) and sugary drinks. Sugary drinks (including sodas, fruit-flavored drinks, sports drinks, energy drinks and flavored waters) are the single largest source of calories and sugar in children’s diets. Every day, one-third of children and 40% of teens consume fast food, contributing an incremental 300 calories from sugar and saturated fat. In contrast, vegetables represent less than 5% of calories consumed by youth.
So what is the solution to this crisis of poor diet and obesity among children? I often hear that healthy eating is parents’ responsibility. Shouldn’t parents (and teachers) teach children the importance of healthy eating and exercise? Educate them about advertising and the tricks that advertisers use? Just say “no” when their kids pester them for unhealthy foods? Yes, of course. But parents can’t compete with the overwhelmingly unhealthy food environment surrounding their children as soon as they step outside the front door. Increasingly, parents have become aware of how difficult it is to raise healthy children in this environment and express widespread support for policies that would help them do so.
Comprehensive reviews of the literature on childhood obesity from the Institute of Medicine and the a White House task force also have concluded that key actors – including food and beverage companies, restaurants, retailers, trade associations, media, government, and others – must create an environment “that supports, rather than undermines, the efforts of parents and other caregivers to encourage healthy eating among children and prevent obesity.” Similarly, McKinsey concluded that “a combination of top-down corporate and government interventions with bottom-up community-led ones is required to change public-health outcomes.” All agree that parents cannot solve the childhood obesity crisis on their own.
While these experts recommend public policy solutions, they also call on the food industry to use its enormous creativity and resources to improve children’s diets. In response, the food industry has reversed its stance on industry’s role as compared to ten years ago. Through industry self-regulatory initiatives, such as the Healthy Weight Commitment, the Alliance for a Healthier Generation, and the Children’s Food and Beverage Advertising Initiative (CFBAI), trade groups and individual companies now promise to be part of the solution to childhood obesity – pledging to develop and promote healthier lower-calorie products.
Yet industry self-regulatory programs have produced only minor improvements in the unhealthy food environment that continues to surround children. Self-regulation of food marketing to children and teens – arguably the most harmful aspect of this food environment – provides a well-documented example. In response to growing pressure to reduce the enormous amount of unhealthy food marketing to children, the Council of Better Business Bureaus established the CFBAI in 2007. Today, most major food and beverage companies belong and pledge to promote only “healthier choices” in “child-directed media.” Similarly, members of the American Beverage Association promise to advertise only milk, water, and 100% juice to children under 12.
Almost eight years later, how has food marketing to children changed? Companies continue to spend almost $2 billion per year on food marketing that specifically targets children and teens, and 90% of those expenditures promote fast food, sugary drinks, salty and sweet snacks, and sugary cereals. In 2009, 86% of food ads that children viewed on TV promoted products with unhealthy levels of sugar, fat, and sodium, compared with 94% of ads in 2003. In 2013, despite declines in time spent watching TV, children under 12 viewed on average 13 TV food ads per day – 8% more than they viewed in 2007 – and teens viewed 16.5 ads per day, an increase of 25%.
Food and beverage companies have substantially reduced advertising on children’s television programming (e.g., Nickelodeon, Cartoon Network) and discontinued several major websites targeting children with games promoting food brands (i.e., advergames). But at the same time, they increased TV advertising aimed at 12- to 14-year-olds. Food and beverage companies also have been early adopters of youth-targeted marketing disguised as entertainment – such as product placements in TV, movies, and song lyrics, branded games on the internet and mobile apps, and concert and event sponsorships – as well as social media and other forms of viral marketing disguised as messages from friends.
Increasingly, policymakers have come to realize that government cannot cede responsibility for solving childhood obesity to the food industry. Companies’ primary obligation is to their shareholders. They must maintain market share against competitors – who may not be similarly disposed to act in the best interests of children’s health – and grow sales of their core businesses. Even the most well-intentioned company cannot risk disrupting a successful business model. As noted by one former food industry executive, “Change [by the food industry] will have to be forced — by public pressure, media attention, regulation and litigation.”
In the United States, government agencies, including the FDA, FTC, and USDA, have the authority to regulate various aspects of the food environment. However, even the weakest proposals for government intervention have met fierce industry resistance. For example, four government agencies proposed voluntary guidelines on responsible food marketing to youth in 2011. Despite overwhelming public support, extensive lobbying by the food industry effectively killed their publication. Similarly, 80% of parents support nutrition standards for foods sold in schools, such as those established by the Healthy Hunger Free Kids Act, but companies continue to lobby for watered-down standards. From 2009 to 2012, food and beverage groups spent an estimated $175 million in federal lobbying.
So that leaves policymakers in local municipalities and states. Fortunately for our children, many local officials have concluded that they cannot wait for the federal government or industry to take meaningful action to reduce unacceptable rates of childhood obesity. Establishing taxes on sugary drinks is just one potential tool in the local policy toolbox, but also a logical one. Sugary drinks are the largest single source of calories in children’s diets. They provide zero nutritional value. And they directly contribute to obesity and related diseases. Beverage companies spend almost $1 billion annually to advertise sugary drinks, much of it aimed at teenagers, as well as black and Latino communities. Economists have concluded that increasing the price of sugary drinks will reduce demand, especially among youth who have less disposable income and are the heaviest consumers. The over $100 million spent by the beverage industry to oppose local sugary drink taxes also suggests that companies believe that taxes would reduce sales. Evaluations of the recently enacted tax in Berkeley should provide additional proof.
Will sugary drink taxes – or any other single local policy action – solve the childhood obesity crisis? Of course not. As with tobacco, a combination of taxes, limits on sales and marketing to young people, increased understanding of the long-term negative consequences of poor diet in childhood, and changes in norms around consumption of unhealthy foods and beverages will all be required. But in the meantime, public policy must address the crisis of childhood obesity. Bravo for local policymakers who have stepped up to take the lead!