Think Tank

How Should California Deal With Obesity?

The fight against obesity is gearing up on several fronts — from a proposed tax on sugary drinks in a small Northern California city to national efforts by commercial giants and the White House.

Some of the notable battlegrounds:

  • The city of Richmond proposes a one-cent-per-ounce tax on sugar-sweetened beverages. If voters in November approve the nation’s first municipal tax on sugary beverages, the estimated annual revenue of $2 million to $8 million would go toward diabetes treatment, school gardens, soccer fields and other anti-obesity efforts;
  • The Walt Disney Company announced this month that all products advertised on its child-focused television channels, radio stations and websites must comply with a strict new set of nutritional standards. The company said the new policy is an effort to address concerns about entertainment’s role in childhood obesity;
  • New York City Mayor Michael Bloomberg wants to ban large sugary drinks from the country’s largest city;
  • “The Weight of the Nation,” a four-part film documentary presented by HBO and the Institute of Medicine, examines America’s obesity crisis, its consequences for individuals and the challenges it presents our society; and 
  • First lady Michelle Obama has used her bully pulpit to encourage markets and restaurants to offer healthy options in “food deserts.” She planted a vegetable garden at the White House and wrote a book about it. Her Let’s Move campaign encourages kids to be more active.

In the California Legislature last year, a statewide version of the proposed tax in Richmond fell flat. AB 669, by Assembly member Bill Monning (D-Carmel), proposed a one-cent tax for each ounce of sweetened beverage sold in California.

Although there is little dispute about the problem — more than 63% of Americans are overweight or obese and at greater risk for a variety of health problems including diabetes, stroke, cancers and heart and lung disease — there is dispute about what (if anything) should be done about it.

The California Department of Public Health updated its California Obesity Prevention Program in 2010, but the number of obese Californians — especially children — continues to rise, according to CDC.

We asked stakeholders and experts how California should deal with the problem.

We got responses from:

Greatest Potential for Progress in Low-Income Areas

In a recent Field Poll, California voters overwhelmingly identified obesity as the top health problem among children and youth. They recognize that doctors alone cannot solve the obesity problem, and they support broad measures by government and the private sector to help to address it.

California is a pioneer and national leader with respect to state and local policy and environmental change to prevent obesity. With modest funding from private foundations and government, model programs in dozens of communities across the state are working across sectors to promote healthier food and beverages in schools, menu labeling in restaurants, school grounds opening after hours, more and safer places for people to walk, ride bikes, and play, and other changes that support healthier lifestyles. These types of changes make it possible for people to eat healthier and exercise more, helping to prevent obesity, type 2 diabetes, heart disease and cancer, as well as aiding treatment outcomes for people already with these conditions. California needs to promote these types of efforts all across the state.

The greatest gains in preventing obesity can be made in low-income areas with high rates of obese and overweight residents, where disability, the high cost of health care and low productivity are the least afforded. People living in these places need training and tools to help them tackle the tough social and environmental inequities that underlie health risks, poor health outcomes and consequently high costs for otherwise preventable medical care.

One challenge is to reframe the public image of obesity from an individual’s weight management problem to a community-wide problem about productivity, economic and social well-being, and health. It’s not just about doctors and dieting. It’s about lowering risk and lowering costs of medical care. It’s about creating conditions at home, work, school and in neighborhoods for living well and living long. Californians need to recognize that solving the problem of obesity is primarily in their hands and in their neighborhoods, not just in a doctor’s office or in Washington, D.C.

Resources are needed to fuel efforts to prevent obesity. The Field Poll found a high level of support among California voters for government spending to prevent obesity. It also found broad support for raising new funds for this purpose, including by taxing food and beverages that contribute disproportionately to the problem.

By whatever means, it is in the state’s best interest for a healthy economy, competitive advantage, and the health and well-being of all Californians to support an “all hands on deck approach” to prevent obesity.

Soda Tax May Be 'Single Most Effective Measure'

We parents do so much to protect our children. We place them securely in car seats and buckle them up each and every time we drive. But many parents don’t know that they are doing their children real harm by allowing them to drink sugary sweetened beverages.

We used to think that any food or beverage could be part of a balanced diet. But recent scientific discoveries now show that sugar-sweetened beverages, like sodas, cause heart attacks, weight gain, type 2 diabetes and some cancers.

Our livers are not able to process the huge sugar load in these beverages. We turn the sugar into unhealthy fats. We are aware of the fat we see around our waistlines. It’s the fat we don’t see that causes the real harm.

The liver gets packed with fat and begins to malfunction. The fatty liver becomes “deaf” to the signal it receives from insulin, the hormone our body secretes to use sugar. The pancreas responds by making more insulin. Eventually the overworked pancreas poops out. The result: diabetes.

Other unhealthy fats, like small dense low-density lipoprotein (LDL) particles are released from the liver into the bloodstream. This “bad” cholesterol plugs up the heart’s arteries and a heart attack results. Sometimes this is fatal. Sometimes it results in chronic heart failure. 

I am part of an effort in Richmond to tax sugar-sweetened beverages in order to reverse the epidemics of obesity, diabetes and coronary heart disease. The sugar-sweetened beverage tax is supported by the American Heart Association, the American Academy of Pediatrics, the American Public Health Association and the United Nations.

Thomas Frieden – director of CDC, the country’s head doc when it comes to prevention – said that a one-cent-per-ounce sugar-sweetened beverage tax might be “the single most effective measure to reverse the obesity epidemic.”

Fully one-third of Richmond’s African-American and Latino fifth- and seventh-graders are obese. If we are not successful in discouraging behaviors that lead to weight gain — like drinking soda — most of these children and those that follow after them will have shorter lives than their parents.

We can change this.

Let’s put our children’s health and well-being front and center. Support Richmond’s sugar-sweetened beverage tax. Ask your city to place it on the November ballot 2012 so you can protect your kids, too.

Let’s do it for our kids.

Act Locally: How Cities, Counties Can Fight Obesity

When it comes to ways to counter the obesity epidemic in California, local governments throughout the state have a major role to play. We need city and county officials to take the lead in enacting new policies that improve the quality of life for their own residents while building momentum for similar initiatives statewide.

In California alone, the annual cost of health care and lost productivity from obesity and related conditions has topped $40 billion. Lower-income Latino, African-American and other communities of color have the highest rates of obesity but the least access to medical care or prevention.

A recent report issued by the Institute of Medicine offered a roadmap for policymakers, focused on five critical goals for preventing obesity:

  • Integrating physical activity into people’s daily lives;
  • Making healthy food and beverage options available everywhere;
  • Transforming marketing and messages about nutrition and activity;
  • Making schools a gateway to healthy weights; and
  • Galvanizing employers and health care professionals to support healthy lifestyles.

Realizing these goals means making changes in cities and towns across the state. It means redesigning neighborhoods to make them more walkable and bikeable — prioritizing transit-oriented developments that integrate different types of “uses” (like housing, stores and workplaces) so people can get to their daily destinations without needing a car.

It means working with economic development and the business community to attract new grocery stores, to make sure corner stores get the support they need to carry healthy foods, and even perhaps to set up a local licensing program requiring retailers to stock a certain amount of produce and staple foods in order to have a license to sell groceries.

It means enacting local laws aimed at limiting junk food and soda marketing to kids, like setting nutrition standards for kids’ meals packaged with toy giveaways.

It means working with school districts to draw up agreements sharing the costs and responsibilities of opening gyms, sports fields and other recreational spaces to the public after school and on weekends.

It means making healthy changes in public buildings to promote workers’ health and to set a model for the private sector — requiring bike parking and opening building stairwells so employees can easily work some exercise into their day, and setting higher nutrition standards for foods purchased with tax dollars, like public vending machines, schools and hospital cafeterias.

City and county officials have not only the authority but the responsibility to pursue policies like these. Local government has a duty to address public health crises in their communities — and there’s no question that California’s epidemic rates of obesity, diabetes, heart disease and other preventable health problems qualify as a crisis. Local agencies can and must act now.

Focus on Community-Wide Health Promotion

While I was disappointed by the opposition to my bill (AB 669), which would have directed $1.7 billion annually to childhood obesity prevention programs, I am encouraged by the many local, state and national efforts to tackle the obesity crisis. Obesity is a multifaceted problem, and there are many ways as a society we can curb the epidemic. Social, economic and environmental factors all influence health. People with a quality education, stable employment, safe homes and neighborhoods, and access to high-quality preventive services tend to be healthier throughout their lives and live longer.

A focus on community-wide health promotion and disease prevention will improve the health of Californians and also help to reduce health care costs and improve the quality of care. By addressing the causes of chronic disease and the factors that influence health, research indicates that the nation can move from a focus on treating sickness and disease to one based on advancing wellness and prevention. 

Preventing disease requires more than providing people with information to make healthy choices. While this knowledge is critical, communities must reinforce and support health, for example, by making healthier choices easy and affordable. When sectors such as housing, transportation, labor and education promote disease prevention-oriented environments and policies, they all contribute to improving public health. 

To ensure that everyone shares in the benefits of prevention, it is important to focus on those who are disproportionately burdened by poor health. Significant health disparities exist and these disparities are closely linked with social, economic and environmental disadvantages, such as lack of access to quality affordable health care and healthful food; safe opportunities for physical activity; and educational and employment opportunities.

Establishing a clear ambitious strategy for community-wide health promotion and disease prevention in California is a key to addressing the growing epidemic of chronic diseases. I am optimistic about participating on Gov. Jerry Brown’s (D) recently created Let’s Get Healthy California Task Force, which is charged with developing a statewide strategy and a 10-year plan that will establish baseline data and target goals for reducing chronic conditions.

If the Legislature works across sectors toward establishing policies that positively influence social and economic conditions and those that support changes in individual behavior, health can be improved for large numbers of people in ways that can be sustained over time. Improving the conditions in which people live, learn, work and play will create a healthier population, society and workforce.

Policy Decisions Can Promote Healthy Choices

The California lifestyle is portrayed as healthy, active and fun. Scratch the surface, though, and you’ll find that California is ranked as only the 24th healthiest state in the country, according to the United Health Foundation. But we rank first in spending on the health consequences of obesity — $21 billion per year, according to researchers. And California’s children of color bear the brunt of this obesity crisis — 46% of Latino, 39% of African-American and 33% of Pacific Islander children are overweight or obese, according to the California Center for Public Health Advocacy.

Fortunately, California has two programs aiming to address obesity by improving access to healthy food. PolicyLink contributed to the development of the programs and continues to be involved as an adviser.

The 2010 California Healthy Food Financing Initiative focuses on improving health and economic conditions for the nearly 1.7 million California residents living in low-income communities with limited access to healthy food. 

The California FreshWorks Fund is a public-private partnership loan fund that has raised $264 million to invest in bringing grocery stores and other healthy food retail to underserved communities. Community engagement is an essential component of the program. When organizations apply for funding through FreshWorks, community involvement is given high points.

There are no silver bullets to reverse the obesity epidemic. But making healthy choices can be aided by policies and environments that support healthy behaviors. These two programs help California’s children have a better chance to be healthy, happy and active — just like the images used to draw visitors to the state.