A 10-Point Plan to Restore Healthy Food as a National Security Priority
See also: Lifespan Weighed Down by Diet. JAMA Online First, April 4, 2016
In 2005, colleagues and I predicted in the New England Journal of Medicine that life-expectancy would decline in the US by mid-century due to the obesity epidemic. But I was stunned to see evidence for this prediction so soon in preliminary data just released by the Centers for Disease Control and Prevention. Age-adjusted deaths rates for the first 9 months of 2015 increased significantly compared to the same time period in 2014, most notably involving obesity-related conditions like heart disease, diabetes, stroke and Alzheimer’s.
Although these data are preliminary, the downward trend in longevity will almost certainly accelerate as this generation of children — heavier from earlier in life than ever before — reaches adulthood. It’s one thing for someone to develop obesity at age 45, diabetes at 55, and heart disease at 65. But what if the clock starts ticking at age 10?
In addition to the human toll, the economic impact of obesity-related disease is already massive and predicted to get much worse. Direct medical costs reached $190 billion annually in 2005, a figure that does not include losses from lower worker productivity. By 2020, the costs of diabetes alone may approach $500 billion. These sums could mean the difference between stability or bankruptcy of Medicare, and between investment in or neglect of our social infrastructure (including education, research and transportation).
The combination of rising medical costs and declining worker productivity will place an increasingly unbearable strain on the economy, threatening our international competitiveness and perhaps even our social cohesiveness. The epidemic has greatly increased federal healthcare expenditures and lowered tax revenues, contributing directly to the national budget deficit. This bleak fiscal outlook has probably fueled political polarization in Washington, as both parties fight ever more fiercely over shrinking discretionary spending.
Although many factors have contributed to this crisis — including a wildly misdirected focus on reducing fat in the diet since the 1970s — the obesity epidemic can be largely attributed to politics that place short-term special interests above public health.
Unless we change course, diet-related chronic diseases will cause tremendous suffering, drain the economy, and undermine our international strength. But this major threat to national security can be averted, with a comprehensive (if politically difficult) action plan, as summarized below.
1. Create an intergovernmental food policy commission. Until we can pass campaign finance reform, the food industry will continue to have inordinate influence in Washington. But we can insulate policy from politics, as we do with other issues of national security (such as military base closings) with an independent commission empowered to make objective determinations on all matters of national food policy — ranging from agricultural subsidies to school lunch guidelines.
2. Reform the process of revising U.S. Dietary Guidelines. Move primary responsibility for guideline development to the Institute of Medicine or other independent body, to avoid conflicts of interest at the USDA arising from its mission to promote corn and other commodities.
3. Tax all processed foods and restaurant fast foods, so that the long-term costs of these products become incorporated into the purchase price. Redirect the resulting revenue to subsidize vegetables, fruits, and other whole foods.
4. Regulate food advertising. The First Amendment doesn’t guarantee the right to advertise demonstrably unhealthy products, especially when children are involved. At a minimum, consumers should be given appropriate health warnings. If commercials for Viagra must mention rare complications like prolonged erection, why don’t commercials for sugary beverages list common consequences, like excessive weight gain and diabetes?
5. Minimize conflicts of interest among academics and professional nutrition societies. The government should adequately fund high-quality nutrition research through the National Institutes of Health so that food industry sponsorship will be less necessary and bias from industry studies will be diluted. Professional societies should avoid financial relationships with industry that detract from their public health mission.
6. Adequately fund schools so they can offer high-quality breakfast and lunch, daily physical education classes, and after-school recreational programs.
7. Design new restaurant options, providing convenient, inexpensive meals prepared from whole foods.
8. Formulate healthier processed foods. The food industry should use higher nutritional- quality ingredients instead of relying primarily on processed grains and sugar. In addition, many conventional products can be marketed in less severely processed forms (for example, stone-ground bread or steel-cut oats).
9. Vote with the ballot. The public can elect politicians with the courage to place public health ahead of short-term special interests.
10. Vote with the fork. The public can incentivize food companies to formulate and market healthier foods by consuming a diet based on whole foods instead of highly processed products.
With these actions now, we can prevent another prediction from coming to pass: That this generation of children will have shorter, less healthful lives than their parents.
10-Point Plan Adapted from:
Always Hungry? Conquer Cravings, Retrain Your Fat Cells, and Lose Weight Permanently (Grand Central Publishing, 2016)