War On Smoking Offers Some Lessons To The Fight Against Obesity

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 similarities between the two public health challenges are compelling. Tobacco use is the nation’s No. 1 cause of preventable deaths in the U.S., killing 467,000 people in 2005, according to a landmark study by Harvard University researchers. Being obese or overweight caused an estimated 216,000 deaths from heart disease, diabetes and other conditions, researchers estimated, while another’1,000 deaths resulted from being physically inactive – another key contributor to expanding waistlines. In terms of health care costs, obesity is now the larger concern, accounting for $147 billion to $190 billion in yearly expenditures, compared to $96 billion for tobacco.

After decades of lawsuits, damning reports about industry practices, and stop-smoking campaigns, smoking rates have plummeted, from a high of 42 percent of adults in’65 — a year after the first Surgeon General’s report on smoking and health — to just over’ percent today. Meanwhile, obesity has been soaring since the’80s and only last year reached a plateau, which experts say may be only temporary. Currently, 45 million American adults are smokers, while 78 million adults and almost 13 million youngsters are counted as obese. Some public health advocates see other parallels. “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. A similar shift is needed today in the fight against America’s expanding waistlines, many experts believe. Instead of approaching obesity as a personal issue, it needs to be redefined as a community challenge that calls for collective action and wide-ranging policy changes such as more informative food labels, limits on marketing to children, and taxes on unhealthy products, they argue.

But there are many hurdles. The scope of the obesity problem is much larger than tobacco ever was: it touches on the food we eat, the beverages we drink, the amount of television we watch, how much we exercise, the way our cities are designed, and more. While the variety of policy changes proposed are therefore broader, the political will to enact them has not materialized, in part because “people don’t yet perceive a significant personal threat,” said Dr. William Dietz, director of the division of nutrition, physical activity and obesity at the U.S. Centers for Disease Control and Prevention.