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Epidemiologist Examines Nutritional Policies to Curb Obesity

By Eddy Ball
May 2007

Ichiro Kawachi
Kawachi's wit and easy manner, as well as his delightful New Zealand accent, charmed an audience that included scientists, environmental Diseases and Medicine Program fellows and a group of students from UNC-CH. (Photo courtesy of Steve McCaw)

Ichiro Kawachi
The Harvard epidemiologist displayed a number of graphs during the lecture, including this one showing the percentages of poll respondents supporting various regulatory proposals. (Photo courtesy of Steve McCaw)

Ichiro Kawachi, Ichiro Kawachi Honglei Chen
Not surprisingly, the lecture was well attended by young scientists in the NIEHS Epidemiology and Biostatistics Branches. Shown here were (from left) Postdoctoral Fellows Ichiro Kawachi, Ph.D., Ichiro Kawachi, Ph.D., and Honglei Chen, Ph.D. The two women were visiting UNC students. Next to them was Laboratory of Molecular Carcinogenesis Principal Investigator Tom Eling, Ph.D. (Photo courtesy of Steve McCaw)

While economists are fond of warning that "there's no free lunch," Epidemiologist Ichiro Kawachi, M.D., Ph.D., offered his audience at NIEHS a little different caveat - there are no easy answers to curbing the epidemic of obesity. Speaking in Rodbell Auditorium on April 10, Kawachi discussed "'Thinning Out' the Obesity Epidemic: The Role of Nutritional Policies" in a regional event hosted by NIEHS Bioethicist David Resnik, Ph.D.

Kawachi is a professor of Social Epidemiology at Harvard University and the author of several studies on obesity, including a 2006 review( Exit NIEHS of food taxation and pricing strategies with colleague Daniel Kim. In his NIEHS talk, Kawachi surveyed frequently proposed strategies for influencing the food choices Americans make. He examined the extent of popular support for nutritional policies, their cost effectiveness and the advantages and drawbacks of various approaches.

Although he noted that "strong rationales do exist to intervene, especially to combat child obesity," Kawachi was careful to analyze the potentially unforeseen consequences of the policies that have been proposed. "The more you think about that apparently simple question [of when government intervention is justified and what form it should take]," he noted, "the more difficult it is to have a straight answer."

Looking at the issue from both the free market and public health perspectives, Kawachi proposed a rationale for regulation based on the economic view that a market failure can justify intervention. Obesity stems from a failure of information, it creates additional cost to taxpayers for treatment under the Medicaid and Medicare programs, and it endangers children and adolescences - vulnerable populations who make decisions irrationally and with little inclination to delay gratification.

Approaching nutritional policy with a commonly agreed upon rationale is important, Kawachi observed, because the 2003 Harvard Forums on Health Poll indicated that a people are evenly divided on the question of whether obesity is private concern or a legitimate public health issue. In addition, only 35% of people responding to the poll thought that government should have a role. A majority favored interventions by healthcare professionals and the schools instead.

As he evaluated strategies for curbing obesity through public health policies, Kawachi brought up the oft-invoked analogy between tobacco and obesity. "That analogy is useful up to a certain point," he maintained, "but there are many problems with it." Unlike junk food, tobacco is a single product with no nutritional value that creates easily understood health risks for smokers as well as for others exposed to smoke.

Trying to educate consumers, implement taxes or adopt restrictions on foods that promote obesity may not always produce the desired effects, Kawachi argued. Even if they actually pay attention to nutritional disclosures, some people will actually choose less nutritious foods because they equate nutritional value with bad taste. Taxes could end up hurting the very people they were designed to help, and it would be difficult to decide which foods to tax and how much tax to impose. "Taxing Coca Cola from a vending machine is an easy target," Kawachi explained, "but even a cheese burger does provide some nutrients."

Restrictions, such as zoning to keep fast food outlets away from schools and limiting use of food stamps, would create a nightmare for planners trying to define just what constitutes a junk food. Even restrictions that seem to be obvious winners, such as banning soft drink machines and junk food in schools, can cause problems. Poorer schools often rely on drink machine revenues to support extracurricular activities, and bans on junk food could lead to the kind of resistance that developed in Great Britain from "meat-pie moms" who opposed the bans instituted there.

"There are many barriers, I think, to even an apparently simple directive like making restaurants disclose nutritional content," Kawachi concluded. "There are [still] many things we need to know before we can begin to suggest nutritional policies that are realistic or viable."

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