As with almost everything, there's the soft sell, the hard sell, the dumb sell and the smart sell. In NYC, Mayor Bloomberg banned the BIG GULP to fight obesity in what many observers see as the hard, dumb sell. Aside from public health practitioners, the general reaction has been Nanny-state negative, including Jon Stewart.
To complicate an already-complex issue, a new video circulating shows a newscaster taking down a viewer email as an example of bullying. Without a doubt, the email used a hard, dumb sell:
So is Bloomberg a bully? Not at all - he broached the subject in the right way by (1) picking the right object in super size sodas and (2) framing it as a budget issue.
In fact, health care costs are the budget issue of our time, and obesity is a main reason. An obese person incurs medical costs that are $2,741 higher (in 2005 dollars) than if they were not obese, according to the newest study on the topic. Nationwide, this translates into $190.2 billion per year, or 20.6 percent of national health expenditures (this is up from 17% two years ago). Moderate obesity increases health care costs by 30% compared to those at a healthy weight; severe obesity more than doubles health care costs. How are we going to have a conversation where, on the one hand, pointing out a person's extra weight is bullying, but on the other hand, if she and I share the same health insurance company, I am paying. To borrow a phrase from smoking campaigns, I am experiencing second hand health care costs.
This conversation is already evolving. To whit:
1) Last month, a group of former military leaders joined forces to begin attacking childhood obesity as a national security issue. They cannot find healthy recruits. This begins to put the obesity fight into a conservative frame, where to date, public health admonitions on obesity have been viewed skeptically as nanny-statism.
2) The Robert Wood Johnson Foundation is so frustrated, their latest report just comes right out and says it in the title: "F is for Fat"
3) Supporters of active living and better neighborhood design have a huge role since we are the smart sell. Even people with genetic predisposition for obesity benefit from low impact activities like walking. Those of us who work hard to make functional, walkable communities are not just public health promoters, but deficit hawks as well. Time to start making that point harder because, to quote Bill Clinton, it's arithmetic.
I just found this other gem from NYC from May of this year called "Reversing the Epidemic." The obesity crisis hits lower income families harder for a variety of reasons. Because of this, the efforts to bring fresh food, community gardening, urban gardens, green carts are incredibly important and part of building respectful, effective solutions.