The decline in childhood obesity rates is one achievement within a larger failure. By focusing so much attention on the young, in the hopes that avoiding unhealthy weight gain in childhood would prevent adult obesity, we made the same mistake health advocates made in the battle against smoking 25 years ago. Ultimately, we learned an important lesson in the power of marketing that we should apply today.
The stakes are high. The 38 percent of American adults who are obese are at risk of developing diabetes, heart disease, stroke, cancer and depression. According to a recent study published in JAMA, half of adults have either diabetes or pre-diabetes. A decade ago, when rates were lower, one study estimated that obesity was responsible for some 100,000 excess deaths in a single year. Beyond the human tragedy, obesity and diabetes are top drivers of increases in health care costs, which are gobbling up the finances of governments and families.
The obesity rate in children ages 6 to 11, after big increases, has now flatlined, at 18 percent, and the rate in children ages 2 to 5 has fallen below 10 percent for the first time since the 1980s.
We shouldn’t be surprised by the diverging trends. Health advocates are succeeding at what they set out to do. The Robert Wood Johnson Foundation has spent $500 million since 2007, and pledged another $500 million, to prevent childhood obesity — the largest investment of its kind I know of. Michelle Obama’s Let’s Move campaign also focused on children. Many health organizations have followed their lead. They drew the nation’s attention to schools and day care centers, which, as a result of federal law and other rule changes, now offer more fruits and vegetables in cafeterias and fewer sugary drinks in vending machines.
In the early 1990s, government antismoking programs focused almost exclusively on youth. Their rallying cry was “we don’t want kids to smoke,” a goal so unquestionable even the tobacco companies endorsed it. That led to antismoking programs in schools and efforts to stop stores from selling cigarettes to teens.
It backfired. The focus on youth amounted to telling teenagers that “smoking is for adults only.” But teenagers aspire to be adults. For years tobacco companies had been profiting from that urge with a marketing strategy that showcased cigarettes as, in their own words, “one of the few initiations into the adult world.” Now the youth focus was playing into the industry’s hands. In the early to mid-1990s smoking rates actually spiked upward among teens and plateaued in adults.
In fact, we don’t want anyone to smoke. When health advocates owned up to that, it led them to cigarette taxes, smoke-free-air rules and media campaigns showing cigarettes not as guilty pleasures but as indiscriminate killers. In the late 1990s and 2000s, that package cut smoking rates in adults, and even more in teens.
Focusing our obesity fight on children falls into a similar trap. It assumes that adults are capable of making sound food choices, and that if children turn 18 without excess body fat they’ll stay that way.
Sure, children are too immature to make good food choices, so the only foods schools serve them should be healthy ones. But that avoids the central problem: The obesity epidemic is characterized mostly by weight gain during adult years. While obese children tend to become obese adults, about 80 percent of obese adults were not obese as children, and more than half were not even overweight, according to my calculations.
Seven in 10 adults — including plenty of Ph.D.s — are overweight. When a nation is constantly adding layers of fat, the problem isn’t victimized children or uneducated adults. The problem is normal people overwhelmed by food marketing. Food companies use all the tools at their disposal to sell processed junk full of the salt, sugar and fat that we crave. Leading chain restaurants, packaged-food companies and beverage companies together spend more than $14 billion a year placing ads. Food marketing works because it bypasses our rational minds. Of course children can’t resist all this marketing, but neither can adults.
Most health advocates get this. They talk about children not because they believe adults can avoid unhealthy weight gain, but because — in what has become a political battle against Big Food — declaring a goal to protect the innocent helps rally support. No one can blame them. It’s hard to win against such powerful adversaries. But, as with smoking, these calculations have trapped us in a failed strategy.
Stopping the obesity epidemic will require fighting the marketing of junk foods everywhere, not just in schools. We need taxes on sugary drinks, counter-advertising and limitations on where in our everyday world those foods tempt us. (Do we really want candy and soda at every cash register, for example?)
Only then will we reach the adults who are on the verge of developing diabetes. And because children spend so much of their time with adults and outside of schools, these reforms will help end the obesity epidemic in children, too.