Consumers Favor Simpler Labels, “Fat Tax” for Combating Obesity

The U.S. spends as much as $210 billion a year treating obesity-related diseases. One would think that health care workers should know better, yet at the Texas Medical Center (TMC), the world’s largest medical complex with 21 hospitals, 4 medical schools, 6 nursing programs and 23 other members, more than three-fourths of employees were recently found to be obese or overweight.

As a researcher who has studied health policy worldwide, I have long believed that we in the health care profession should set a better example when it comes to obesity.

Earlier this year, every one of the 56 TMC members agreed to combat obesity. On May 1, the most popular program among 34 TMC members kicked off a new color labeling system to identify high-calorie vending machine snacks — green for foods under 140 calories, yellow for those between 140 and 200 calories, which should be enjoyed in moderation, and red for those over 200 calories.

This sort of labeling system already has widespread support among the public, as evidenced by the Texas Medical Center Health Policy Institute’s Second Annual Health Care Consumer Survey, which we released on May 18. The survey, conducted by Nielsen, asked 5,000 people (1000 in each of five states) — Texas, New York, California, Florida and Ohio — about health issues, including the “stoplight” style food labeling.

Two-thirds of those surveyed said they would find labels like these helpful. The support is evenly distributed among men and women, as well as by political affiliation. It was favored by 61 percent of respondents who said they were Republicans, 66 percent who said they were Democrats and 64 percent who called themselves independents.

Not surprisingly, the idea is more popular (72 percent) among respondents who have children under 18 years of age than those who don’t (59 percent). Only 60 percent of white respondents favored the labeling system, compared with 70 percent for blacks and 74 percent for Latinos.

We already know from studies in the U.K. that this sort of “up front” labeling can change consumer behavior and attitudes. My students and I have done other studies that found a labeling system like this tends to change the snacks that people buy — they buy fewer “red” items — and the overall sales go up over time. In other words, if presented with clear and simple nutritional comparisons, consumers favor healthier choices.

Our survey explored this issue in more detail, asking the question: “should foods that lead to obesity be more expensive?” More than half of the respondents said yes. In particular, they favored a higher price for sugary drinks. The survey then asked how much of an increase was warranted. Sixty-eight percent of those who favored higher costs for obesity-linked foods said prices should increase by 25 cents for every dollar, and 44 percent favored a 50-cent increase.

For a $10 meal, 63 percent of those favoring higher prices said a $2.50 cent increase was appropriate. It is heartening to see public support for a higher price on foods and drinks that could lead to obesity because the World Health Organization tells us that higher prices for cigarettes has provided the greatest stimulus for people to stop — or not start– smoking.

The results reflect a broader public attitude that individuals should bear a greater portion of the cost and responsibility for making less healthy food choices.

Where do people seek care and why

We also wanted to know more about consumers’ views and habits regarding the health care system in general. For example, when patients have a medical issue — whether it’s related to obesity or not — where do they go to seek care?

With the expansion of health care coverage, more people are seeking medical care, but most are still going either to the doctor’s office or the emergency room.

About half the people we surveyed used the emergency room for non-emergencies. This is an astonishingly high number for the most expensive kind of care. Most of those who didn’t need to be there gave a simple reason for why they were: the doctor’s office was closed.

While the uninsured in the states we surveyed use the ER more often than patients with insurance, the gap varies by state. In California, for example, only 5 percent of the uninsured said the ER is the facility they turn to most frequently for health care, compared with 4 percent of insured patients. In Florida, however, it’s 31 percent for uninsured versus 4 percent for insured.

One of the lessons from these findings is that the health care community must develop alternatives to doctor’s visits and the ER.

Medicaid Expansion

Our survey also included questions about the expansion of Medicaid and on how much health care influenced respondents in choosing a political candidate.

In the two states that did not expand Medicaid, Texas and Florida, about two-thirds of the people responded that they were in favor of Medicaid expansion (63 percent of Texans and 68 percent of Floridians). We then asked people in the three states that did expand Medicaid if they would keep or repeal it. More than three-fourths wanted to keep it.

Eighty-four percent of the Democrats in our survey said a candidate’s views on Medicaid expansion would factor in to their choice of a candidate, compared with 50 percent for Republicans.

You can find more detail from these survey results at

Dr. Arthur “Tim” Garson, Jr. is the director of the Health Policy Institute at the Texas Medical Center, and an author and consultant on health care policy issues worldwide.

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