Taxing “Globesity” To Save Our ChildrenContributor: Cristina Falcão Posted: 03/24/2012 12:00:00 AM EDT | 0 Tags: Cristina Falcão | obesity epidemic | obesity costs | obesity | fat taxes | taxation | bariatric surgery In spite of all the scientific and technology advances, the 21st century generation may be the first generation to not outlive their parents. Obesity has reached epidemic proportions globally, with more than 1 billion adults overweight - at least 300 million of them clinically obese - and is a major contributor to the global burden of chronic disease and disability. Often coexisting, paradoxically, with under-nutrition, obesity is a complex condition, with serious social and psychological dimensions, affecting virtually all ages and socioeconomic groups. The rising epidemic reflects the profound changes in society and in behavioral patterns of communities over recent decades. Index: Obesity Epidemic, Obesity in the World, Obesity Costs, Measures and Treatments, the Real Novelty, the Pharma Industry, Conclusion Obesity Epidemic Obesity, defined by the World Health Organization as a body mass index of more than 30, is estimated to be responsible for between 1 and 3 percent of total health spending in most countries - and for between 5 and 10 % in the United States - and costs will rise rapidly in coming years as obesity related diseases set in. Obesity in the World Worldwide, around 1, 5 billion adults are overweight and a further 0, 5 billion are obese, with 170 million children classified as overweight or obese. The prevalence of obesity today varies nearly tenfold among OECD countries, from a low of 4% in Japan and Korea, to 30% or more in the United States and Mexico. In more than half of the OECD countries, the majority of the population is now overweight or obese. OECD projections suggest that more than two out of three people will be overweight or obese in some OECD countries by 2020. In U.S., 35% of the adult population and 17% of children are obese, according to data gathered by the federal Centers for Disease Control and Prevention. According to the world's leading medical journal, Great Britain's Lancet, by the year 2030, half of all Americans will be obese. Obesity Costs Obesity is a major risk factor for the development of type 2 diabetes, asthma, hypertension, stroke, coronary artery disease, cancer and cancer-related mortality, liver and gallbladder diseases, sleep apnea, osteoarthritis and gynecological complications. The effects of the obesity epidemic are immense: taxpayers, businesses, communities, and individuals spend hundreds of billions of dollars each year due to obesity. Obesity-related health problems cost the United States USD 168 billion every year, amounting to 17% of all medical bills, according to a study conducted by researchers from Cornell and Lehigh Universities and released by the National Bureau of Economic Research. The indirect costs of obesity for every country affected reflect the cost of mortality, morbidity, incapacity, and unemployment. Measures and Treatments- Bariatric Surgery, Employers Actions, Government Decisions Bariatric Surgery is No Easy Answer to Obesity Even though surgical methods are becoming more and more successful for the reduction of severe obesity, it would be misleading to present surgery as an easy option. To begin with, its success depends entirely on patient compliance with post-operative guidelines. If patient compliance fails, they tend to regain most of their weight loss and may end up in a worse condition than before. Bariatric surgery is not for everyone; it can only treat a tiny percentage of the population who are severely obese; furthermore, there is not enough long term feedback on the success of these operations. Employers Actions: Employers have a big stake in getting their workforce to lose weight and reduce the enormous costs in medical claims and lost productivity linked to obesity. Recent studies have shown an impressive return on investment spent on prevention and wellness programs. Government Decisions: Chicago’s Mayor Rahm Emanuel initiated in September 2011 a new public employee wellness program to cut in half the USD 500 million-a-year healthcare bill. The program is mandatory for nearly all of the city's unions and its members, including even those members that already abide by their own personal wellness programs; individuals that do not comply with it, will have added fees on their health insurance premiums. Governments all over have started health programs to stop the growing rates of obesity, at least to treat the youngest generation. Health promotion efforts were intensified, particularly through local initiatives and further measures at the school level (e.g. in France, Spain, Italy, Mexico). Coordinated national programs were launched in countries like United States (Let’s Move), United Kingdom (Change4Life), Switzerland (Actionsanté), and others. “Let’s Move!” is a comprehensive initiative, launched by the First Lady, dedicated to solving the problem of obesity within a generation, so that children born today will grow up healthier. The Real Novelty The real novelty of the last three years has been a strong and increasing interest in the use of fiscal measures to limit the consumption of foods high in fat, sugar, and salt. Several OECD countries introduced taxes on unhealthy foods and beverages in 2011 as part of their efforts to counter obesity. Taxes, along with other measures, can improve health by changing eating habits. Taxation of unhealthy foods or beverages is being discussed in a number of other countries. Belgium, Ireland, Romania, and the United Kingdom are among the countries actively considering a levy on unhealthy food and/or drinks. Debates are taking place in the United States and Italy. The Lancet suggests that the United States Government should somehow begin a top down approach to regulating and taxing unhealthy foods in order to reduce obesity, all while reducing the cost of healthy foods and making them more accessible. The Pharma Industry For the Pharma Industry the Holy Grail is the promise of a blockbuster drug to fight globesity without side effects; however, as bariatric surgery is not the answer, new drugs for obesity are far from being successful, as payers do not perceive drug therapy as effective. Conclusion Obesity management continues to be a major challenge to health plans as the prevalence continues to rise. It is unlikely that there will be a pill that "cures" obesity. Will “Fat taxes”affect consumption, and eventually obesity? The impact of imposing taxes on the consumption of certain foods depends on the responsiveness of consumers to price changes, i.e. price elasticity. Caveat emptor: it is difficult to predict how consumers will react to price changes caused by taxation. Will obesity treatment ever be cost effective? Have Your Say Rate this feature and give us your feedback in the comments section below
Think Different Do Different DO IT
domingo, 25 de março de 2012
sexta-feira, 23 de março de 2012
Thelma and Louise revisited in the modern times
Employers are getting the better out of employees such as not paying on time and everybody keeps silent else they lose the job, I believe asking for passwords for social media websites is a way of doing the same, scaring people, especially desperate people. There is always a limit where one asks oneself whether it is worth living like this or simply go away forever. I have found myself thinking about that movie "Thelma and Louisa" more than ever.
The true luxury of the 21st century is having a job.
I see situations in Portugal and Europe where employers are getting the better out of employees such as not paying on time and everybody keeps silent else they lose the job, I believe this is a way of doing the same, scaring people, especially desperate people.
There is always a limit where one asks oneself whether it is worth living like this or simply go away forever. I have found myself thinking about that movie "Thelma and Louisa" more than ever. The true luxury of the 21st century is having a job.The best love affairs ever!
[[posterous-content:pid___0]]
The 1st Affair
A married man was having an affairwith his secretary. One day they went to her place
and made love all afternoon. Exhausted, they fell asleep
and woke up at 8 PM. The man hurriedly dressed
and told his lover to take his shoes
outside and rub them in the grass and dirt. He put on his shoes and drove home. 'Where have you been?' his wife demanded. 'I can't lie to you,' he replied, 'I'm having an affair with my secretary.
We had sex all afternoon.' She looked down at his shoes and said: 'You lying bastard!
You've been playing golf!' The 2nd Affair A middle-aged couple had two beautiful daughters
but always talked about having a son. They decided to try one last time
for the son they always wanted. The wife got pregnant
and delivered a healthy baby boy. The joyful father rushed to the nursery
to see his new son. He was horrified at the ugliest child
he had ever seen. He told his wife: 'There's no way I can
be the father of this baby.
Look at the two beautiful daughters I fathered!
Have you been fooling around behind my back?' The wife smiled sweetly and replied:
'No, not this time!'
The 3rd Affair A mortician was working late one night. He examined the body of Mr. Schwartz,
about to be cremated,
and made a startling discovery.
Schwartz had the largest private part
he had ever seen! 'I'm sorry Mr. Schwartz,' the mortician
commented, 'I can't allow you to be cremated
with such an impressive private part.
It must be saved for posterity.' So, he removed it,
stuffed it into his briefcase,
and took it home. 'I have something to show
you won't believe,' he said to his wife,
opening his briefcase. 'My God!' the wife exclaimed,
'Schwartz is dead!'
The 4th Affair A woman was in bed with her lover
when she heard her husband
opening the front door.. 'Hurry,' she said, 'stand in the corner.' She rubbed baby oil all over him,
then dusted him with talcum powder. 'Don't move until I tell you,'
she said. 'Pretend you're a statue.' 'What's this?' the husband inquired
as he entered the room. 'Oh it's a statue,' she replied.
'The Smiths bought one and I liked it
so I got one for us, too.' No more was said,
not even when they went to bed.. Around 2 AM the husband got up,
went to the kitchen and returned
with a sandwich and a beer. 'Here,' he said to the statue, 'have this.
I stood like that for two days at the Smiths
and nobody offered me a damned thing.'
The 5th Affair A man walked into a cafe,
went to the bar and ordered a beer. 'Certainly, Sir, that'll be one cent.' 'One Cent?' the man exclaimed. He glanced at the menu and asked:
'How much for a nice juicy steak
and a bottle of wine?' 'A nickel,' the barman replied. 'A nickel?' exclaimed the man.
'Where's the guy who owns this place?' The bartender replied:
'Upstairs, with my wife.' The man asked: 'What's he doing upstairs
with your wife?' The bartender replied:
'The same thing I'm doing
to his business down here.'
The 6th & Best Affair Jake was dying His wife sat at the bedside. He looked up and said weakly:
'I have something I must confess.' 'There's no need to, 'his wife replied. 'No,' he insisted,
'I want to die in peace.
I slept with your sister, your best friend,
her best friend, and your mother!' 'I know,' she replied.
'Now just rest and let the poison work.'
Facebook Blasts Password Snooping Employers
Password snooping employers demanding access to Facebook accounts got an earful from Facebook Friday when it issued a harsh statement condemning the practice. Erin Egan, Facebook's chief privacy officer, wrote on a company blog: "We don’t think employers should be asking prospective employees to provide their passwords because we don’t think it’s right the thing to do."
Earlier this week U.S. senator from Connecticut Richard Blumenthal also to pledged to file legislation to outlaw the practice. It's an unreasonable invasion of privacy and should be banned, Blumenthaltold Politico in an interview earlier this week.
He vowed to file a bill to address the practice "in the very near future."
Facebook's Egan echoed the same sentiments adding that seeking a potential employee's password could expose the employer to "unanticipated legal liability" adding " As a user, you shouldn’t be forced to share your private information and communications just to get a job."
Egan said Facebook updated its Statement of Rights and Responsibilities to address this issue.
Password Police to the Rescue
Blumenthal isn't alone in being revolted by job creators squeezing job seekers and others for their social networking passwords. Legislation has been filed in Maryland, Illinois and New Jersey to address the issue.
"This is a huge invasion of privacy," the sponsor of the New Jersey legislation, Assemblyman John Burzichelli, said in astatement.
"It's really no different than asking someone to turn over a key to their house," he contended.
"In this job market, especially, employers clearly have the upper hand," he continued. "Demanding this information is akin to coercion when it might mean the difference between landing a job and not being able to put food on the table for your family."
Burzichelli's bill would:
- prohibit an employer from requiring a current or prospective employee to provide or disclose any user name, password or other means for accessing a personal account or service through an electronic communications device.
- prohibit an employer from requiring a prospective employee to waive or limit any protection granted under the bill as a condition of applying for or receiving an offer of employment.
- prohibit retaliation or discrimination against an individual who might file a complaint or testify as part of an investigation into violations of the law.
Violations of the proposed law would carry a fine of $1000 for each first offense and $2500 for each subsequent violation.
In addition to asking for passwords, the AP reported, employers are asking their charges to "friend" HR managers, log onto their Facebook account during job interviews, and sign non-disparagement agreements to prevent an employee from bad-mouthing a company through social media.
One Human Resources expert was horrified by the growing practice of prying into workers' lives through social media. “Asking a candidate to open up their private profile and network for you to see is not social recruiting," Dan Finnigan, CEO of Jobvite, told PCWorld."It is the old-fashioned behavior of a bully."
Whether it's bullying or not, for the most part, the behavior is perfectly legal.
"Where the government is the employer, people have Fourth Amendment rights not to be searched," Catherine Crump, a staff attorney with the American Civil Liberties Union, explained to PCWorld."And to the extent that employers are requiring employees to hand over this information, one could argue that it's an unconstitutional search."
"Whether it violates the law for a private employer to demand or request a password is a harder question," she continued. "I think in most states right now it's not illegal."
Follow freelance technology writer John P. Mello Jr. and Today@PCWorld on Twitter.
What is the best name for an Internet Yellow Pages?
I agree with Bernard and I would refrain from suggesting names while mentioning a trademark that is so well know.
Limited Facebook during working hours!!! Is it counter productive ?
I have often said I would have no problems with a break in the day for social networks if that boost productivity, 15 minutes each day is not that much, and if the employees feel more productive after that, why not grant them those 15 minutes per day.
Is entrepreneurship is an antedote to unemployment ?
Yes it is. Back in the 30ies and recession, that is how the US started to get over unemployment. Now I see it in my country more and more people choose entrepreneurship to overcome unemployment too. You can ask for the whole of your unemployment subsidy by presenting a business plan and start something new, instead of just receiving it each month.
Humour in personal portfolio site
I have a good sense of humor too but I have seen people joking about themselves in a business context and frankly I did not find it funny; the idea that was transmitted was that they were not that serious about their business. So, I would avoid it in a business context. People can perceive humor in very different ways and sometimes it is not the way you would like it to be.
Do people working in international marketing need to be trained in cultural behaviours of those countries and why ??
They need to be aware of cultural differences because if they don’t know that they will probably offend many other people, will not understand them and the business will not survive that well if you want to impose your ideas, regardless of these differences.
What could be worse than losing control in life or at work?
That is bad, indicates the person is not well, and needs to have some rest and treatment, but she will get back on track. Losing a child is so much worse.
How do you define 'spam' mail?
It is mail that I did not ask for, “something unsolicited which appears to be barking up the wrong tree” and usually is marketing mail, inviting me to spend money this or the other way. I usually don’t read it.
Why and how did you become entrepreneur or freelancer?
The first time it was a natural consequence of life, I studied to be an attorney and I could only be one making money if I started my own business. The second time I had to do it because of the economical situation in my country; I need to have a second job to make ends meet and there are no jobs so I decided to become an entrepreneur.
Why don't companies bother to send out rejection letters anymore?
Probably they don’t think it worth doing it, but I agree with you, it is terrible to send CVs and then wait forever for an answer, even if it is a negative one. We always send a letter, not an email, saying we are sorry but have no vacancies available.
How does your organization engage employees in a sustainability programme?
We did not need clever initiatives, they know and are informed about sustainability and all the measure I told you Portuguese pharmacies do, I meant to say that all the employees are engaged in those measure and understand their importance.
Apart from that, our pharmacy recycles paper we all do it.
Sustainability: in what areas has your organisation collaborated with direct competitors to foster wider impact sustainability programmes ?
Portuguese pharmacies are, as a whole, great contributors to a more sustainable environment.
We pay for several actions towards achieving that goal and we are always investigating more ways to further contribution.
We have “Valormed” to take care of all medicine waste.
We take out of date medicine and old x-rays, from the public, and collect them to ensure they are destroyed in a sustainable way.
We do the same with syringes, blood material, paper, all objects used to the measurement of biological parameters, etc.
We pay for these actions alone, the whole group of Portuguese pharmacies, no government aid.
If you could go anywhere in the world and do whatever you want for 6 months where would you go and what would you do?
Right now I would go to Goa and lie in the beach for the entire six months without one single worry in my head. I don’t have vacations or “get aways” since 2009, I am tired and I could do with some rest and away from crisis and difficulties.
How far do you follow a dream? When do you let go? Does adversity propel you or discourage you?
I can tell you from experience that I will follow my dream to death and adversity only make it stronger and stronger.
Imagine, for a moment, that you are an Earthling visiting planet Linkedin . . . What might you find?
I will find very good people and communicate in plain English because I know most of the people will understand me.
How do you stay organized at work?
Time management is the key; I always ensure I have one half hour free in the morning and another in the afternoon because I know there are always those little problems you were not counting on that will make a difference so I am prepared with time for those. Of course, email filtering is also one major key but I have managed to do that with several procedures including different accounts according with the priority of emails.
What Volunteering opportunities does your organisation offer to its staff?
That is not very common in Portugal, but because of the nature of the business we do a lot of volunteering while working, we go to people’s homes to measure their blood pressure for free, we deliver medicines to people that live a bit too far and have difficulty going to the pharmacy, we listen to them and help them with personal problems.
You will not find that in may pharmacies in Lisbon, for instance, but in the interior of Portugal you will.
quinta-feira, 15 de março de 2012
quarta-feira, 14 de março de 2012
terça-feira, 13 de março de 2012
What's YOUR impossible dream?
I don’t have impossible dreams. As I have often said in this forum my father taught me that “nothing is impossible, everything is possible, everything is difficult” – if you try hard and believe in your dream it will come through
My dreams, so far, seemed impossible, but I made them all possible because I wanted and I was ready to face all the “impossibles” with hard work, tenacity, and ability to be punched by many people and many things that strove to make it “impossible”.
Why do you use LinkedIn so much?
It becomes addictive, especially the Q&A – I started answering questions because I had insomnia and later I realized I liked it, it is my relaxing moment of the day. I log in twice or three times per day, answer my messages, look at questions and group discussions – that takes me about 15 minutes twice and a longer period at night, never more than one hour.
What does 'Las Vegas' mean to you?
“I came here to drink myself to death.” - Ben Sanderson (Nicholas Cage) in “Leaving Las Vegas”(1995)
Ever scanned QR codes?
Yes, several and I have them as business card on the website, I love QR codes, they are very useful to me.
Will Email Be Replaced By Social Media Tools?
My business cannot survive without email, in fact both my businesses, there is no way I can, for example, download a technical translation from a blog.
The Challenge of Implementing Change at Work
The biggest challenge has been how to explain customers why there is change every day in the prices and co-participation on medicines. We live in constant change since 2007, the problem is not with us, we are so used to change we don’t even notice it anymore.
segunda-feira, 12 de março de 2012
The Obesity Pandemic
The news has had much of potential Bird Flu or a Small Pox Pandemics, but obesity? Now the Associated Press says obesity is crowding out other worldwide health problems like a big person in an airplane seat:
"This insidious, creeping pandemic of obesity is now engulfing the entire world," Paul Zimmet, chairman of the meeting of more than 2,500 experts and health officials, said in a speech opening the weeklong International Congress on Obesity. "It's as big a threat as global warming and bird flu."The World Health Organization says more than 1 billion adults are overweight and 300 million of them are obese, putting them at much higher risk of diabetes, heart problems, high blood pressure, stroke and some forms of cancer.The article explains that even though wealthy countries are the fattest. Traditionally leaner countries are also adopting unsavory (or in this case savory) habits:
Thailand's Public Health Ministry, for instance, announced Sunday that nearly one in three Thais over age 35 is at risk of obesity-related diseases."We are not dealing with a scientific or medical problem. We're dealing with an enormous economic problem that, it is already accepted, is going to overwhelm every medical system in the world," said Dr. Philip James, the British chairman of the International Obesity Task Force.The allure of unhealthy eating and exercise habits is very tempting and far reaching. Consider the fate of the Crete, as presented in Dr. Fuhrman’s book Eat to Live:
In the 1950s people living in the Mediterranean, especially on the island of Crete, were lean and virtually free of heart disease. Yet over 40 percent of their caloric intake come from fat, primarily olive oil. If we look at the diet they consumed back then, we note that Cretans ate mostly fruits, vegetables, beans and some fish. Saturated fat was less than 6 percent of their total fat intake. True, they ate lots of olive oil, but the rest of their diet was exceptionally healthy. They also worked hard in the fields, walking about nine miles a day, often pushing a plow or working other manual farm equipment. Today the people of Crete are fat, just like us. They're still eating alot of olive oil, but their consumption of fruits, vegetables, and beans is down. Meat, cheese, and fish are their new staples, and their physical activity level has plummeted. Today, heart disease has skyrocketed and more than half the population of both adults and children in Crete is overweight.11. Kafatos, A., A. Diacatou, G. Voukiklaris, et al. 1997. Heart disease risk-factor status and dietary changes in the Cretan population over the past 30 years: the Seven Countries Study. Am. J. Clin. Nutr. 65 (6):1882-86.
The Obesity Pandemic: Where Have We Been and Where Are We Going?
Obesity, a new pandemic, is associated with an increased risk of death, morbidity, and accelerated aging. The multiple therapeutic modalities used to promote weight loss are outlined with caution, especially for patients who are very young or old. Except for very rare single gene defects, the inheritance of obesity is complex and still poorly understood, despite active investigations. Recent advances that have shed light on the pathophysiology of obesity are the recognition that 1) excess fat is deposited in liver, muscle, and pancreatic islets; 2) fat tissue secretes a large number of active signaling molecules including leptin, adiponectin, and resistin, as well as free fatty acids; and 3) activated macrophages colonize the adipose tissue. Other candidates for key roles in the causes and consequences of obesity include 1) metabolic programming, where food acts as a developmental regulator; 2) the constellation of defects known as the "metabolic syndrome;" 3) cortisol overproduction in the adipose tissue; and especially, 4) insulin resistance. The possible etiologies of insulin resistance include cytokine excess, elevated free fatty acids, and hyperinsulinemia itself, as with transgenic overproduction of insulin in mice.
Childhood Obesity: A New Pandemic of the New Millennium
WHY A PANDEMIC?
The major epidemiologic transition in the 20th century was the shift in mortality and morbidity from infectious diseases to chronic diseases, with cardiovascular diseases leading the list. This transition was primarily attributable to the social, economic, and public health changes that took place in the United States during the first half of the century. The availability of abundant food led not only to better overall nutriture and improved child health, but also to the current population’s state of excess positive energy balance, accelerated by an increasingly sedentary lifestyle in recent decades. At the beginning of this new millennium, a new challenge has emerged—a marked increase in obesity prevalence with a parallel increase in obesity-associated chronic diseases and their clinical onset at ever younger ages. Type 2 diabetes, a condition traditionally associated with middle-aged adults, is beginning to occur several decades earlier as obesity afflicts an ever greater number of children and adolescents in the United States.1–5
A recent publication in Pediatrics presented longitudinal findings from a large multicenter cohort study—the National Heart, Lung, and Blood Institute Growth and Health Study (NGHS)—of 1213 black and 1166 white girls followed for 9 years from ages 9 to 10.6 As can be seen in the accompanying study in this issue by Kimm et al,7 even at age 9, the prevalence of overweight (≥85th percentile of body mass index [BMI] based on the National Health Examination Survey reference population) was about one third higher in black girls than in white girls—31% versus 22%. The prevalence of obesity (≥95th percentile) in black girls was twice as high than in white girls—18% versus 8%. A most alarming finding in this study was the approximate doubling of the rate of overweight and obesity in both groups during the 10 years between ages …
http://pediatrics.aappublications.org/content/110/5/1003.extract
Obesity — The New Frontier of Public Health Law
The law is now firmly established as a powerful instrument of public health.1 Some of the most important public health victories in the United States in the past century — declining lead exposure, reduced rates of smoking, improvements in workplace and motor vehicle safety, and increased vaccination rates — are the result of new legislation, heightened regulatory enforcement, litigation, or a combination of the three.2-4 With each victory, confidence mounts in the capacity of legal tools to be used in combating serious health threats.
One of the newest targets of public health law is obesity.5 The past few years have brought a flurry of legislative initiatives aimed at improving nutrition and physical activity among children and adults, highly publicized personal-injury lawsuits against food and beverage companies,6,7 and new activities on the part of federal regulators.8 Related initiatives in other countries and at the World Health Organization signal growing international interest.9
This new frontier of public health law is welcomed by many health activists, but it has also provoked criticism. A backlash from the food industry is already evident, and rights-oriented consumer groups have decried some measures because they impinge on civil liberties.10 Tensions exist between these interventions and the freedoms of choice, speech, and contract. In this article, we review the rationale for regulatory action to combat obesity, examine legal issues raised by initiatives to date, and comment on the prospects for public health law in this area.
TIME FOR LEGAL ACTION?
The public health law approach posits that the law can be used to create conditions that allow people to lead healthier lives and that the government has both the power and the duty to regulate private behavior in order to promote public health.1 The constitutional source of this authority is the police power, which encompasses both directly coercive interventions and policies such as taxes and subsidies that shape behavior by altering the costs of certain choices. States also enjoy broad powers with respect to taxation of goods and services.
Several factors have led to a reexamination of the historical view that food consumption and physical activity are inappropriate subjects for government regulation. Among the “triggers to action” that have catalyzed government intervention in other areas of private behavior, such as alcohol and tobacco use, are the development of a scientific base and social disapproval.11 Both these triggers are now in play with regard to obesity.
The accumulation of an evidence base is particularly important. Emerging research results about the economic and human costs of obesity12 have galvanized interest in greater governmental involvement by medicalizing the problem (witness the Medicare program's decision to classify obesity as a disease13) and by demonstrating the stake that each employer and taxpayer has in it. A growing literature also links exposure to the advertising of unhealthful foods to decisions about consumption and to overweight and obesity. American children are exposed to approximately 40,000 food advertisements per year, 72 percent of which are for candy, cereal, and fast food.14 Empirical studies, including recent reviews by the American Psychological Association15 and the Institute of Medicine (IOM),16 show that advertisements achieve their intended effects on children — that is, they shape product preferences and eating habits.17-21 Moreover, children younger than eight years of age are generally unable to understand the persuasive intent of advertising and to view it critically.15
The publication of the Surgeon General's report on obesity in 200122 brought the research base to a wider audience and raised the public profile of the obesity epidemic. Popular books23-25 and movies26 also have educated the public, especially about the food industry. The results of recent opinion polls27-30 indicate that a majority of Americans believe that the government should be involved in fighting obesity, particularly by regulating the marketing of “junk foods” to children.
Nonetheless, antiobesity laws encounter strong opposition from some quarters on the grounds that they constitute paternalistic intervention into lifestyle choices and enfeeble the notion of personal responsibility. Such arguments echo those made in the early days of tobacco regulation. There are important differences between foods that are not nutritious and tobacco: people cannot abstain from eating; high-calorie foods may be beneficial to some people and harmful to others; there is no food-related equivalent to harm from secondhand smoke; and no one has shown that foods have physically addictive properties, much less that food companies manipulate their addictive content to encourage dependence. However, a key similarity that undercuts the antipaternalism argument is the use of these products by children, who are highly vulnerable to advertising and marketing15 and whose eating habits tend to persist over the life span.16,21
Ideological battles are currently playing out at both the state and federal levels as regulators seek an appropriate balance between private liberty and public health. Table 1TABLE 1
Key Regulatory Targets and Examples of Approaches to Obesity in Public Health Law.
lists the key regulatory targets and tools.
ACTIVITY IN THE STATES
Within state courts and legislatures and local governments, there has been an outpouring of legal initiatives to address obesity. Litigation is a strategy that we have discussed elsewhere.6 The past four years have brought a spate of highly publicized personal-injury lawsuits against food companies by obese persons seeking compensation for obesity-related health problems. The most highly publicized of these lawsuits has been the off-again, on-again suit against McDonald's brought by obese children in New York.31 This suit alleges that foods from McDonald's were dangerous beyond the extent ordinarily understood by consumers, that McDonald's negligently failed to warn consumers of the risks, and that the company's marketing constituted deceptive business practices under the state's consumer-protection laws. Similar claims have been threatened against soft-drink companies.32
Obesity-related lawsuits face substantial legal hurdles. Plaintiffs must prove that the food or corporate practice actually caused injury and that the dangers were not “open and obvious” to the ordinary consumer.6,33 Moreover, 21 states have enacted “personal responsibility” laws that immunize fast-food companies from obesity-related tort claims.34 The lawsuits attract attention, however, and may have contributed to the decision by some food companies to provide more healthful product offerings.
With regard to state legislative and local regulatory activity, much of the focus has been on schools. The policies of school districts have been criticized for contributing to what researchers describe as a “toxic environment” for children35: about 60 percent of U.S. middle schools and high schools sell soft drinks from vending machines on campus,36 although this is likely to change under guidelines recently established by the beverage industry to curtail such sales by 201037; in most schools, meals prepared under the National School Lunch Program exceed federal limits on total and saturated fats38; and only 28 percent of high-school students participate in daily physical-education classes.39 In response to these issues, states and school boards have crafted policies to reduce students' access to foods that are not nutritious and to boost their physical activity (Figure 1FIGURE 1
State Legislative Initiatives to Combat Obesity in Schools, 1998–2005.
).40 Measures include laws restricting competitive food sales (the sale of foods that compete with school lunch programs). Other measures include closed-campus policies that keep students at school for lunch and the requirement for more and better physical education. Notwithstanding its interest in the success of the National School Lunch Program, the federal government has promulgated no rules concerning the sale of competitive foods in public schools, although the IOM is currently studying the issue under a congressional mandate.41
Some states also have attempted to improve nutrition and fitness beyond the school gates (Figure 2FIGURE 2
State Legislative Initiatives to Combat Obesity in the Community, 1998–2005.
)40 by creating safe and attractive places to enjoy outdoor exercise. Another, more controversial approach is to tax junk foods, typically by excluding them from the general exemption of foods from state sales taxes. As of 2000, 19 states taxed foods that are not nutritious (such as soft drinks and candy). Several other states had such taxes, but repealed them in the 1990s because of pressure from the affected industries and difficulties administering them (for example, some states had difficulty determining which foods met the definition of a taxable item).42
Economic and political barriers hinder more widespread adoption of many of these state initiatives. (Unlike taxes, most measures require revenue outlays.) The evidence base is also thin. To our knowledge, most initiatives have not yet been evaluated. There is no direct evidence that taxes on food affect rates of obesity, but studies have linked food pricing with consumption patterns43 and cigarette taxes with tobacco use.44-46 A commitment by state governments and research sponsors to evaluate the effect of policy interventions on key outcome measures such as consumption of junk foods in schools, children's body-mass-index values, and physical activity levels will be necessary to construct and justify a strategy to use public health law to reduce rates of obesity.
ACTIVITY AT THE FEDERAL LEVEL
At the federal level, regulatory initiatives face similar political, economic, and evidentiary issues. Legal barriers arise as well; these barriers center on the federal government's authority to regulate the commercial activities of the food industry.
There are increasing calls to regulate the advertising of unhealthful foods to children. Many foreign governments prohibit or restrict advertising during television programs that target young children,16,47 and the IOM recently recommended restrictions on television advertising if the food and beverage industries do not voluntarily shift their advertising emphasis away from products that are not nutritious.16
The most common proposals are to restrict the quantity and content of advertisements during children's television programs and to require that broadcasters provide equal time for messages that promote good nutrition and physical activity. Regulation also could target print media, the Internet, in-store promotional campaigns, and product tie-ins to children's television programs. In addition, 19 states have legal restrictions on commercial marketing activities in public schools. Most of these laws are not comprehensive, however, and commercial activities in public schools remain widespread and are candidates for federal regulation.48
The Federal Trade Commission
Federal responsibility for the regulation of advertising lies mainly with the Federal Trade Commission (FTC). By agreement with the Food and Drug Administration (FDA), the FTC has primary authority over food advertising, whereas the FDA regulates food labeling.49 Under the Federal Trade Commission Act, the FTC may regulate “unfair or deceptive” business practices, including advertising.50 “Unfair” practices are those that may cause substantial, unavoidable injury to consumers that is not outweighed by offsetting consumer or competitive benefits. Advertising is “deceptive” if it is likely to mislead consumers in a way that is material — that is, if it is likely to influence misleadingly their decisions regarding the product.
The FTC's regulatory interest in and authority over child-oriented advertising has been curtailed by a bruising history with such efforts. In 1978, the commission initiated an effort known as the Children's Advertising Rulemaking, or “kidvid,” to regulate television advertising of foods with high sugar content to children.51 The commission asserted that advertising to young children is unfair and deceptive because they lack the cognitive ability to understand the bias inherent in advertising.
The proposal drew wide public ire and a vigorous response by the food, toy, broadcasting, and advertising industries.21 Three insurmountable obstacles eventually blocked the FTC's effort.52,53 The first was political. Industry had raised an unprecedented amount of money — $16 million — to fight the proposed rules, and public opinion was unfavorably disposed to the FTC's acting as a “national nanny.”54 A responsive Congress temporarily suspended all funding for the agency, restoring it only after passing legislation that narrowed the FTC's authority to regulate children's television advertising.55
The second barrier was practical: regulators could not find a way to tailor the rules narrowly to the objective. Banning all advertisements aimed at young children, for example, was problematic because it cannot be proved that young children make up the majority of any television show's audience. The third problem was evidentiary: the regulators could not produce sufficient evidence that linked food advertising to long-term eating habits. In 1981, the FTC abandoned the rules but extensively documented its findings about the effects of advertising targeted to children in a staff report designed to serve as a “message in a bottle”52 to future regulators.
Today the FTC is empowered to regulate food advertising only if the agency finds that it is deceptive. Child-oriented advertising is evaluated in light of how it is understood by the target age group. Studies have found that children who watch more television than do other children are more likely to identify incorrectly which of two foods is more healthful.56,57 Studies also have found that about half of all nutrition-related information in television advertisements is misleading or inaccurate.58 Personal-injury lawsuits against food companies, including the McDonald's case, have described examples of promotional materials that are arguably deceptive even to adults.
Thus, there may be room within the FTC's existing legal authority to move against advertising to children. The practical and evidentiary problems associated with kidvid might well resurface, but the evidence accumulated over the past 30 years is likely to strengthen the FTC's hand. For example, there would be less difficulty today in establishing an association between food advertising and children's eating habits and obesity. Technological advances such as the V-chip and digital video recorders provide new ways of ensuring that restricted advertising does not reach young children but can reach interested older viewers.52 Also, a workable definition of “children's television programming” has been developed for purposes of regulation under the Children's Television Act.59
Despite these developments and its general interest in the policy problem of childhood obesity,60 the FTC appears to be ideologically disinclined at present to pursue regulation in this area. Its approach to advertising “favors requiring more information over banning information, and avoids broad restrictions limiting both deceptive and non-deceptive speech.”61 The notion that consumers, young and old, can choose freely from a marketplace of ideas remains strongly rooted.
The Courts
An alternative to probing the limits of administrative rule-making is to enact legislation that expands the FTC's role in regulating advertising of food to children. However, the legislative path has difficulties of its own, the most considerable of which is the constitutional protection of free speech.
The First Amendment shelters “commercial speech” — expression that is related solely to the economic interests of the speaker and audience. The rationale is that even speech of relatively low value, such as advertising, may carry important information to the public. Indeed, some of the earliest cases regarding commercial speech had to do with the advertising of contraceptives and prescription drugs.62-64
Over the past three decades, the Supreme Court has been expanding the protection of commercial speech, which historically was narrow.65 Its decisions have favored the free flow of information even in cases in which the advertised products were acknowledged to pose hazards to public health.66 In the case of Lorillard Tobacco Co. v. Reilly, 67 for example, the Court struck down Massachusetts regulations restricting outdoor and point-of-sale advertising of tobacco products within 1000 ft of schools. Although the Court readily accepted the general proposition that restricting advertising near schools would reduce youths' demand for tobacco products, it questioned the effectiveness of the specific regulations and ruled that they restricted more speech than necessary.
Lorillard elucidates the legal hurdles that regulators of food advertising must overcome. They must show that restrictions are tailored to advertising that is directed to children and that these restrictions will be effective in reducing the incidence of youth obesity. To prove that the regulation is narrowly tailored, they must show that it will not unduly restrict advertisers' ability to communicate with adults.67 This proof will remain challenging, but at a minimum, “opt-in” schemes using V-chip or other forms of blocking technology would withstand constitutional challenge.68 To prove effectiveness, the government must offer evidence that demonstrates the magnitude of advertising's contribution to youth obesity, relative to other factors such as physical inactivity. To do so, it must distinguish the contributions of television watching in general from those of the viewing of advertisements specifically.69 Regulators must also show that the regulation is not irrational in its restrictions on some products but not on others or on advertising in some ways but not in others. These major challenges will require careful rule-making and marshaling of relevant research.
The Food and Drug Administration
The FDA has broad authority to regulate food labels under the Food, Drug, and Cosmetic Act (FDCA) of 1938. The FDCA requires that food labels be truthful and not misleading and that they reveal all facts that are material to their representations and to the possible adverse consequences of consuming the product.70 It also requires food manufacturers to include certain disclosures on food labels.
In 1973, the FDA began to expand its regulation of food labels under a voluntary program. In 1994, under the Nutrition Labeling and Education Act (NLEA),71 the FDA began to require a “nutrition facts” label on most food products. This label provides information about fat, cholesterol, sodium, carbohydrate, sugar, and other content. (Restaurant food is excluded from the mandate except when the restaurant makes health claims about an item.) The FDA may add nutrients to this label if it determines that the information would help consumers maintain healthful dietary practices.
Because consumers give more credence to nutritional information in product labels than in advertising,72 labels may help to counteract the consumption impulses wrought by advertising. Reviewing the findings of empirical studies, the FDA recently concluded that only a small percentage of consumers use nutrition labels for weight-control purposes, but label use is associated with more healthful food choices.8 Findings of studies of product sales after the introduction of labeling requirements point to the same conclusion.73
The FDA has historically exercised its authority to require food labels lightly under the assumption that too much information may overwhelm consumers.74 Recently, however, the agency has invigorated its labeling regulations to address obesity. In July 2003, the FDA implemented a rule requiring food manufacturers to list the trans fat content on product nutrition labels by 2006.75 In addition, it convened an Obesity Working Group. In 2004 this group recommended that the FDA evaluate how the nutrition facts panel might better emphasize caloric values. It also advised the FDA to do the following: consider the authorization of health claims on reduced-calorie or low-calorie foods, encourage manufacturers to make dietary guidance statements and comparative labeling statements to encourage healthful food substitutions, seek restaurants' cooperation in a voluntary program of standardized nutritional information for restaurant food, and enforce the requirement that the serving sizes listed on nutrition labels be appropriate.8 The last recommendation was implemented immediately.76 In April 2005, the FDA issued notices of proposed rules regarding information about caloric content and serving size on nutrition labels.77
The exemption of restaurants from labeling requirements merits reexamination. The exemption has been based on the belief that it is too difficult, given variations in how restaurant food is prepared, to provide accurate information on caloric or nutritional content.33 However, fast food, a major contributor to obesity, is highly standardized. Many fast-food restaurants now provide nutritional information on in-store posters and Web sites (some pursuant to an agreement with state attorneys general78), although these posters are often difficult to find. For other restaurants that do not sell fast food, a limited disclosure — for example, a range of calories for each item — would be feasible.
The FDA's authority to regulate food labeling appears to be broader than the FTC's ability to restrict food advertising. However, the FDA is still subject to the commercial speech doctrine, which the Supreme Court has held applies to “compelled speech.”79,80 Thus, labeling regulations must be tailored to advance materially the government's interest in the prevention of obesity. However, this requirement will be met more easily by a mandated labeling disclosure than by a restriction on advertising. Mandatory disclosures bring more, not less, speech into the information marketplace and thus are viewed as the less restrictive alternative.61,81 By providing consumers with the information needed to make well-informed decisions, labeling requirements that focus on preventing deception are especially likely to withstand constitutional scrutiny.
DEFINING A WORKABLE STRATEGY
Several themes emerge from this review of legal strategies to combat obesity. First, initiatives are most likely to gain acceptance if they focus on children and adolescents. Young people are especially vulnerable to advertising, and there is greater political tolerance for legal interventions on their behalf — this is a clear lesson from the history of tobacco control. Second, the states are living up to their reputation as laboratories, with a variety of innovative initiatives under way. However, a laboratory's mission is to test, prove, and disprove. Careful evaluation of state initiatives is needed.
Third, restrictions on food advertising to children will be difficult to impose in the current legal and political environment. Additional research on advertising and obesity may help build the case for regulation. An alternative is to develop counter-advertising campaigns that encourage better nutrition and alert young consumers to their potential for manipulation by food advertisements. Well-crafted antitobacco advertisements have had considerable effects on youths' tobacco use and attitudes.82,83 However, whereas settlement funds from tobacco lawsuits were available to pay for those advertisements, counteradvertising campaigns to encourage better nutrition would require public funding.
Fourth, the success of government regulation of the food industry will probably fall short of what industry could accomplish alone if it were strongly motivated to do so. Efforts to encourage self-regulation and corporate responsibility60 could go far toward improving the healthfulness of foods sold, provided the industry responses heed the limits of antitrust law and do not displace meaningful external regulation.4
Finally, the initial regulatory strategy should concentrate on improving public awareness of the role of the food industry and the food environment — the social, physical, and economic conditions that affect access to healthful and unhealthful foods — in contributing to the nation's obesity problem.24 Measures aimed at improving consumer information in order to facilitate informed decision making — rather than at limiting the flow of information into the marketplace — are most likely to gain early acceptance. Over time, a greater understanding of the environmental influences on food choices should create the ideological conditions for further regulation. The law is slow to recognize that choices in the marketplace may not be totally free; the burden will be on researchers to demonstrate that some forms of communication may impede rather than facilitate informed choices.
We have focused on affirmative measures that the government could take to curb obesity, but the removal of existing policy incentives that operate to the detriment of this goal may also be effective. A large body of literature discusses the role that agricultural subsidies play in shaping the nation's food supply and the prices of foods with high sugar content relative to more healthful foods.24,84 Removing these subsidies is politically problematic, but doing so could alter the food environment considerably.
This exploration of the frontier of laws to fight obesity illustrates the dynamic nature of the relationship between public health law and the broader cultural and public health environment.6 There are many historical examples of the law's driving social change; however, progressive laws are unlikely to be implemented until the dominant cultural mores are sufficiently favorable. Progress in policy to address obesity will be and should be incremental. It should respond to and drive shifts in ideological, political, health, and economic conditions. At present, these conditions appear to be converging toward the support of a broader public policy approach to obesity, albeit one that focuses primarily on informing personal choices rather than restricting them.85 Crafting a regulatory strategy that within the strictures of the Constitution responds to evolving knowledge about obesity and its prevention may be the single most important challenge for public health law in the 21st century.
Supported by general institutional funds.
No potential conflict of interest relevant to this article was reported.
We are indebted to Ama Boah, Rebecca Haffajee, and Bryan Lee for research assistance.
SOURCE INFORMATION
From the Department of Health Policy and Management, Harvard School of Public Health, Boston (M.M.M., D.M.S.); and Aetna, Hartford, Conn. (T.A.B.).
What does 'WORLD CLASS' mean to you?
It means it is good in any place in the world by any country standards. Healthcare is a good example, “world class” means it is good for the well being of any citizen in the world.
However, cultures are very different and “world class” can have different meanings or priorities in different places; for instance a “world class” senior retirement place may have different standards of excellence, no matter how good it is, to people in Japan and people in Spain; this is a mere example I have no concrete evidence.
Do you ever read a textbook?
Yes, constantly, I need to be updated about new medicines, medical devices and legal subjects because I am both an attorney, chief science officer and I combine both professions in technical translation. Other than the need to keep updated I also love to know new developments in my areas.
Making Your Community Go 'WOW'
Yes, I just came back from an Eco coaching Festival where we all “traded” skills and worked on a small village; we painted walls, planted trees and vegetables, made some construction works on some houses and taught people how to have a healthier life, healthier food habits, checked biological parameters and had medical consultations. We, the team, made a huge difference on the lives of 600 people.
What value can be placed on health?
The question in general has no answer, there is no value to be placed on my health because there is no money on earth that can give me health if I don’t have it.
However, selling the distillation process is like selling a patent and if there is a market for the product bid for the highest value.
"After a lifetime of working, raising families, and contributing to the success of this nation in countless other ways, senior citizens deserve to retire with dignity."
Totally agree with you and it applies to any country but, unfortunately it will not apply to me or anyone from my generation on because the government told us 4 years ago we shall have no retirement – there will be no money to pay us retirement when we get there, although I still make huge discounts for my “retirement”.
Is Greece being slowly pushed out of Euro zone?
No, the balance in EU is too delicate to have Greece out; we have had other hardships before, we will overcome this one too.
How to improve listening skills?
Take theater classes, they are wonderful to learn it because you need to listen to the other actors on stage. I have been learning a lot.
The richest are the most unhappy.
No, I cannot change your mind; the more money you have the more likely you will find something is missing and it cannot be bought. I can tell you from experience.
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