New York Governor David Patersen has a commentary up on CNN.com today, arguing for an "obesity tax" on sodas and sugary fruit drinks. Though well-intentioned, this kind of proposal gives me the willies. I appreciate the public health challenges posed by the "obesity epidemic," but there are a variety of reasons why fat is not tobacco (a parallel Patersen draws in his opening graf). I wrote a piece to this effect back in 2002--which I would link to if our archives weren't so craptacular. Instead, I'll cut and paste the bulk of it for anyone else out there who's nervous about the fat police eye-balling their Cheez Whiz (or Ho-Hos or pork rinds or Slim Jims...):
...Just a few years back the only people suggesting a parallel between cigarettes and Big Macs were tobacco-industry reps seeking to discredit the anti-smoking movement--and their slippery-slope arguments generally elicited jeers. In April 1998, as Congress squabbled over a tobacco bill, a Washington Post editorial denounced the fatty-foods analogy as an effort "to change the subject." "Tobacco," the Post assured its readers, "is a unique product. Its disastrous effect on public health and the duplicitous history of the industry both make it so. What happens to it is not a threat to other industries."
But the Post (among many others) may soon owe those tobacco executives an apology. As early as 1998 [Kelly Brownell, head of Yale's Center for Eating and Weight Disorders,] who is credited with having popularized the "Twinkie tax," caused a stir by informing multiple media outlets, "To me, there is no difference between Ronald McDonald and Joe Camel." By last year the U.S. government was coming around to a similar view. In his obesity "Call to Action," Surgeon General David Satcher cautioned, "Overweight"--anti-fat advocates use the word as a noun as well as an adjective--"and obesity may soon cause as much preventable disease and death as cigarette smoking." Making an oft-cited comparison, the statement noted: "Approximately 300,000 U.S. deaths a year currently are associated with obesity and overweight (compared to more than 400,000 deaths a year associated with cigarette smoking)."
Taking another page from the tobacco playbook, anti-fat advocates deny that eating is purely a matter of personal choice--highlighting fat merchants' aggressive and dishonest sales tactics. Nestle, whose new book Food Politics details how the food industry manipulates America's eating habits, explained in a recent phone interview that "where the similarities are really unnerving is in the marketing: The use of targeted messages to children, for example. The use of targeted messages to minorities." The unsuspecting fatties who, under relentless marketing pressure and often at an early age, develop a Hostess habit are--at least in part--victims of forces beyond their control.
But here's where the tobacco-fat analogy begins to fall apart. While the industries' marketing strategies may be similar, and the resulting health costs comparable, the products being marketed are not. Nicotine, as the Post rightly implied in its 1998 editorial, is a poisonous, highly addictive substance--addictive in the clinical sense, not in the I-can't-stop-noshing-on-these-Pringles sense. For decades tobacco executives knew this and blatantly lied about it (under oath), even as they worked to hook as many people as possible. McDonald's by contrast may irresponsibly, even intentionally, downplay the unhealthfulness of its fries; but, as even anti-fat warriors admit, those fries are not inherently toxic. And while Keebler tries to entice kids with cartoon pitchmen, no one has accused the company of manipulating the chemistry of Fudge Sticks to ensure clinical addiction.
Most anti-fat warriors admit that their new crusade is trickier than the one against smoking--in no small part because the food industry's argument that any food or drink can be enjoyed in moderation without compromising your health is (though self-interested) basically true. Nonetheless, say anti-fatties, most Americans are either too naive or too weak to resist the persuasive power of fat merchants. "It's not fair," [Marion] Nestle, [the ironically named chair of NYU's Department of Nutrition and Food Studies] told ABC in January. "People are confronted with food in every possible way to eat more. The function of the food industry is to get people to eat more, not less." And, she insisted in our interview, the notion that parents should be responsible for what their kids eat is increasingly unrealistic: "Most parents I know aren't that strong. They're fighting a nine hundred billion dollar a year industry by themselves." Thus, government must level the playing field. CSPI [the Center for Science in the Public Interest] (perhaps the foremost anti-fat organization) has long advocated a restriction on ads for soda and snack food during kids' TV shows. But for better or worse--OK, worse--whipping your target audience into a gotta-have-it frenzy is what advertising is all about. And while using clowns and elves to peddle supercaloric treats to tots may be hardball, it's pretty much par for the course in the jungles of American capitalism. As even Nestle admits, "The seduction of food companies is no different than that of any other companies."
Which is precisely the argument against a government-sponsored war on fat. Does the food industry spend billions each year to make us crave goodies we don't need? Absolutely. So does the fashion industry, the auto industry, and the toy industry. Any number of the products we buy--motorcycles, string bikinis, stiletto heels--can be hazardous to our health when used irresponsibly. There's little doubt that lives and health care dollars would be saved if the government prodded Americans to drop 15 to 50 pounds. We could also reduce skin cancer rates if we taxed flesh-exposing swimsuits and prevent auto accidents if we taxed Corvettes (or teenage drivers). Americans do all kinds of things that are bad for them, and for the most part the government lets us, unless there's a strong likelihood that we will hurt someone other than ourselves.
Which is, incidentally, another important distinction between fatty foods and cigarettes. It's hard to believe the war on tobacco would have gotten out of the barracks were it not for mountains of research demonstrating the health impact of smoking on nonsmokers--innocent bystanders who happened to get in the way of a stray puff in a restaurant or at work. To date, there's no scientific evidence of the dangers of second-hand cholesterol: Watching a co-worker wolf down that Filet-o-Fish may make you want to gag, but it's not going to give you heart disease.
None of this is to say that Americans-- especially children--wouldn't benefit from better dietary education. If HHS, state health agencies, or even the American Medical Association want to run public service ads singing the praises of cantaloupe, fantastic. There is also a compelling case that, during school hours, when kids are under government supervision, every effort should be made to provide a healthful environment. Many states are considering prohibiting or restricting vending machines on school grounds. Nestle and cspi's Jacobson advocate banning junk food ads from the in-class network channel one. And a quick survey of school cafeteria fare--frequently laden with nachos, pizza, burgers, and Tater Tots--suggests that more attention could be paid to the dietary messages we're sending. For that matter, a little classroom time on the ABCs of nutrition and exercise wouldn't hurt either.
But when you move from school to home, and from suggestion to intervention, you quickly enter intellectual quicksand. While anti-tobacco advocates had a clear target, figuring out where to draw the boundary in the fat wars could prove impossibly complicated. As Nestle writes in Food Politics: "Unlike the straightforward 'don't smoke' advice, the dietary message can never be 'don't eat.' Instead, it has to be the more complicated and ambiguous 'eat this instead of that,"eat this more often than that' and the overall prescription 'eat less.'" The upshot is that it's almost impossible to draw clear, bright lines about which foods merit sanctions such as fat taxes or ad restrictions and which ones don't. One approach is simply to create a broad, amorphous category of "junk food," which is more or less what California did when it created a snack tax in 1991 (aimed primarily at closing its budget gap, not improving health). As a result, California's law was filled with nonsensical distinctions. For instance, Twinkies were taxable; doughnuts weren't. (The following year voters repealed the wildly confusing, highly unpopular measure.) Of course, given the massive economic implications, it's likely that, if implemented nationally, such distinctions would quickly become the focus of intense lobbying--meaning that politics, not merely nutrition, would determine which foods took a hit. To avoid such subjectivity, some anti-fat crusaders have suggested levying taxes according to fat content instead. But that would leave out countless crummy, fattening--yet virtually fat-free--foods (such as Skittles and chocolate syrup), while penalizing relatively healthful foods (think nuts and granola) that are high in fat. At present the anti-fat movement's most popular target seems to be America's soda habit. But a tax that applies to Pepsi one and Diet Coke but not to Yoo-hoo, Gatorade, lemonade, Mocha Frappuccino, or any of the countless sugary fruit "juices" on the market seems decidedly unjust. Now, you could argue--and the anti-fat warriors do--that Diet Coke, while not fattening, has absolutely no nutritional value. But if we're going to expand our list of socially unacceptable products to anything that isn't actively healthy (as opposed to unhealthily fat-promoting), then we are wading deep into Huxleyan territory.
And the quicksand isn't simply intellectual; it's cultural as well. The United States is overwhelmingly fat, but it is not uniformly fat. Poor folks tend to be fatter than rich folks. Minorities tend to be fatter than whites--and not simply because inner-city blacks and Latinos can't afford to eat well. As Thacher and others point out, some of the food traditions woven into Hispanic culture contribute to obesity. In some Latino communities, being plump is still a sign of affluence and is therefore considered desirable. It's one thing for anti-fat warriors to attack a global conglomerate like McDonald's for trying to make people porky; it's quite another to tell an entire community to rethink its culture.
What it comes down to, ultimately, is that our relationships to food are simply too complex for the government to oversee. People eat differently in New Orleans than they do in Berkeley. And they do so, for the most part, because they want to. Sure, we would be a healthier society if everyone ate what they eat in Berkeley. But do we really want to live in a country where the government pressures us to do so? Health is only one measure of a good life, and government is far too crude a mechanism to effectively--or humanely--calibrate its importance for millions of different people. Slippery-slope arguments are usually specious, and until recently the fat-tobacco analogy offered by tobacco execs seemed so as well. But, in fact, we are on the exact slope they claimed, and we are picking up speed. ...
Now if you'll excuse me, I'm going to go eat another half-dozen holiday cookies.