Americans eat way too much. Our diets are laden with dangerous amounts of salt, empty calories from corn syrup and artery-clogging trans fats.  Now the politicians at City Hall want to do something about it. In an effort to curb obesity and improve heart health, city and state public health officials across the country are cracking down on fast food, sugary sodas, trans fats and other unhealthy ingredients. They are banning fast food in certain neighborhoods, demanding that restaurants post calorie counts, and considering taxes on sweetened soda.  Ever the trend-setter in this arena, New York City announced in January it was leading an initiative to lower salt levels in packaged and restaurant-prepared foods. The move, says health commissioner Dr. Thomas Farley, is based on evidence that most Americans consume too much salt, putting them at higher risk for heart attacks and strokes. Many packaged foods contain sky-high amounts of salt.  In Depth: Eight Ways Politicians Regulate What You Eat  It sounds like good public policy. But critics bemoan the lack of evidence showing that this and other initiatives will improve public health and make unhealthy eaters change their ways. Some researchers say the new laws and initiatives represent uncontrolled experiments that could backfire and end up having as many negative consequences as positive ones.  No one has ever conducted large-scale clinical trials to measure the effects of reducing salt intake in the general population, for example. The same is true for bans on trans fats, and few studies have looked at the calorie labeling requirement at restaurants.  In an article published last week in the Journal of the American Medical Association, epidemiologist and Albert Einstein College of Medicine professor Michael H. Alderman argues that lowering salt content in the population may in fact be harmful. He points out that in some clinical trials, reductions in salt levels has led to decreased insulin sensitivity and increased production of a blood pressure-regulating hormone. Alderman has served as a scientific adviser to the pro-industry Salt Institute since 1996.  Farley stands by the city's decision. While the evidence on salt reduction is not yet definitive, he says, most experts are convinced of the potential health benefits. He also says tackling high blood pressure by targeting consumer products is a necessary approach.  "The way that public health has been most successful is when we create environments that make it easy for people to live in a healthy way," says Farley.  That's been the thinking behind the city's many public health interventions of late. In 2006, the city council voted to ban artery-clogging trans fats from restaurants. In 2008, it passed a law requiring chain restaurants to clearly post calorie counts on their menus. Last November, Farley and the state's governor advocated for a tax on sodas to bring in close to a billion dollars annually and discourage consumption of the sugary beverage, which is associated with obesity. The idea hasn't gotten legislative traction yet.
Fed up with high obesity rates, states and cities are trying to force people to eat better. Will it work?