Americans are fatter than ever. According to a study at Johns Hopkins University, 75% of all Americans will be overweight by 2015.

With the proliferation of 24-hour McDonalds’ and cheap doughnuts, it is easy to see why.

Although the health risks associated with obesity are constantly reported in the news, the ubiquity of the message is not prompting Americans to change their habits, as evidenced by the continuous increase in the obesity rate. If people can form addictions to food that neurologically mimic an addiction to alcohol, it may require more than a flashy commercial reminding them that “fat is bad” to create a change in habits. Action and adjustment are clearly needed, but what measures are appropriate?

The Government’s Role in Controlling Obesity
At the October 12, 2007 Stanford Ethics@Noon seminar, Michelle Mello, the C. Boyden Gray Associate Professor of Health Policy and Law at the Harvard School of Public Health and an alumna of Stanford University (’93), argued that the government should take a greater role in the fight against obesity. While government intrusion may seem like a limitation of personal freedom, Mello contends that there are moral and philosophical counterarguments that can be raised to show that intervention is ethically defensible.

Mello cited work by political scientists, Rogan Kersh and James Morone, which concluded that governmental regulation of “vices” often begins when cultural “triggers,” including accretion of a scientific base and social disapproval, are present. In the case of obesity, it appears that these two triggers are present; in fact, several measures have been enacted to ameliorate the food options in public schools.

This government interference in individual lifestyle choices contrasts with what is generally accepted in our society. Most adults expect the freedom to make decisions which they believe are in their best interest. Mello argues, however, that physical and informational barriers often limit people’s options such that they are never given complete autonomy.{gallery}printed_articles/volume-6-issue-2/weight-government{/gallery}

A significant fraction of obese and overweight individuals have been shown to be of lower socioeconomic status. These individuals often reside in neighborhoods without access to gyms or safe locations for outdoor activity. There may also be a relatively limited selection of affordable, fresh produce at neighborhood grocery stores. This environment makes it more difficult for people to make healthy lifestyle choices. In Mello’s view, governmental regulation can help in this situation by, for example, restricting the number and location of fast food restaurants and providing better public recreational facilities. By playing a greater role in shaping people’s choices, the government would not be taking away personal freedom, but instead leveling the field such that one can make healthy choices with fewer obstacles.

Encouraging Educated Choices
Mello notes the widespread advertising of sugary cereals and soft drinks that bombards children during television programming; American children are exposed to 40,000 advertisements each year, 72% of which promote junk food. According to the Harvard Public Health Review in Spring 2006, this is in tandem with a 2 to 3-fold increase in childhood obesity over the last 25 years. Furthermore, in a recent report in the New England Journal of Medicine, Mello cited studies by the American Psychological Association and the Institute of Medicine showing that advertisements achieve their intended effects of changing the eating habits of children. The one million dollars spent annually by the National Cancer Institute to encourage people to eat more fruits and vegetables is trivial compared to the $33 billion spent by food industries to advertise junk food. To counter these effects, Mello suggests that the government could promote healthy lifestyles by implementing the same advertising techniques that sell food products.

In addition to regulating advertising, the Food and Drug Administration has the power to modify food labels to make it easier for parents to make nutritional choices. While it is not necessary to put a skull and crossbones on a box of Lucky Charms, current nutritional information could be modified to give a more accurate idea of calories and portion sizes. According to Mello, “better food labels may help to counteract the consumption impulses wrought by advertising and prevent the continued increase in childhood obesity and its associated ailments.” In her view, fostering good eating habits at a young age is crucial because these habits become ingrained in the individual’s lifestyle.

The Impact of Obesity: a Call for Action
While recent reports call the “obesity epidemic” overrated and studies show that a few extra pounds may not significantly decrease one’s lifespan, research suggests that being overweight has significant emotional implications. A 2003 University of California, San Diego study found that the quality of life for obese children was equal to that of children going through chemotherapy. According to Mello, when it comes to children, some degree of paternalistic intervention by the government to prevent obesity may be warranted.

In the past, the government has set restrictions on personal freedoms when the product has been shown to harm public safety such as in the cases of cigarettes and alcohol. It should be noted, however, that moderate alcohol consumption has also been shown to have beneficial health effects; as with food, abuse of alcohol is responsible for the associated health issues. Food is also more difficult to regulate than alcohol or cigarettes as it is an obvious necessity of life. Nevertheless, with a health care issue of this magnitude and significance, Mello contends that it is clearly time for policy makers to take action.