Policymakers have been trying to make Americans thinner, but it’s turning out to be a lot harder than many anticipated.
Last week, the Centers for Disease Control and Prevention released a discouraging finding for health advocates: Nearly 38 percent of U.S. adults were obese in 2013 and 2014, up significantly from 32 percent a decade earlier. Obesity rates have remained flat among youth. And there’s a widening gap in obesity rates between the well-educated and those who aren’t.
That’s despite a patchwork of prevention efforts over the past decade that once had policymakers hopeful they’d be able to turn back the dial on obesity rates that have caused healthcare costs to skyrocket in the U.S.
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Some policies are aimed at improving access to healthy foods, like new federal school lunch requirements that first lady Michelle Obama has championed through her “Let’s Move!” campaign to reduce childhood obesity.
She’s also forged partnerships with food chains like Walmart and Save-A-Lot which have opened hundreds of stores in so-called food deserts — areas where residents don’t have access to fresh, healthy and affordable food.
Other policies rely on providing the public with more information, such as requiring caloric and nutrition information to be displayed prominently in restaurants. Or they create economic incentives, as Berkeley, Calif., has done by taxing sugary drinks to make them less attractive for consumers.
But evidence for many of these policy changes is spotty at best, and even those that have been shown to work have only marginally changed the behavior of kids and adults. The habits of overweight and obese Americans present such a complex problem that experts are starting to warn against placing much confidence in any one solution.
“They’re not as effective as the proponents of all these policies promise,” said Robert Kaestner, an economist at the University of Illinois who specializes in health policy. “I think a fair assessment is there’s no strong evidence these things are very effective.”
At the end of next year, restaurants will be required to post calorie counts on their menus as part of the Affordable Care Act. But six years after New York City passed its own mandate, consumers don’t appear to be visiting fast food restaurants less or ordering healthier items.
After analyzing receipts and survey responses from thousands of consumers at four fast-food restaurant chains in the city, New York University School of Medicine researchers found no statistically significant reduction over time in the calorie or nutrition content of the foods they purchased in a study published this month in Health Affairs.
There’s also mounting evidence that simply making healthier foods available for purchase doesn’t mean those living in low-income communities will actually buy them. In 2010, New York City heavily subsidized a new grocery store in a low-income neighborhood in the Bronx, but researchers later found little to no change in the diets of nearby residents.
Another paper by the National Bureau of Economic Research found that whether a grocery store is available to people only determines a tenth of the variation in the food they buy, with a much stronger indicator being their level of education.
And while there’s some evidence that taxing sugary drinks does reduce consumption, studies have found that tax has to be significant to have any notable effect, and there’s no guarantee that people won’t replace the sugar with some other junk food.
“There’s no overwhelming evidence for anything,” said Marion Nestle, a public health professor at New York University. “There’s evidence for small changes.”
Congress is debating whether to keep new school nutrition standards signed into law by President Obama as part of the 2010 Healthy, Hunger-Free Kids Act. Under the nutrition guidelines, school systems must provide students with more fruits and vegetables, use less salt and more whole grains in prepared foods and follow other rules in order to get meals reimbursed by the federal government.
Republicans want to ease the federal guidelines, arguing that kids are just throwing away the healthier food instead of eating it. They’ve pointed to a September report by the Government Accountability Office that found participation in the federal lunch program, which provides low-cost or free meals to qualifying kids, has dropped 4.5 percent since the new standards were passed.
The decrease was driven primarily by children from higher income families who must pay full price for the meals, the agency reported. State and school officials interviewed by the GAO said a reason for the decline among those students is because they didn’t like the nutritional changes made to the meals.
The School Nutrition Association has said that 70 percent of school meal programs have experienced financial losses since the requirement went into effect, reporting that the healthier food both costs more and students are more often wasting it.
“School districts are being forced to financially subsidize meals at the expense of educational programs,” the SNA wrote in a letter to Congress last month asking for a lightening of the standards.
Yet some anti-obesity advocates say it’s too early to tell whether the nutrition standards will have the desired effect.
In its annual State of Obesity report, Trust for America’s Health points to some areas where school districts have successfully lowered obesity rates by combining healthier lunches with other efforts increasing students’ physical activity. Overweight and obesity rates in public schools in Seminole County, Florida, have dipped nearly 5 percentage points since 2007, down to about 30 percent.
Health advocates also note hopefully that the national obesity rate among kids has at least stabilized at 17 percent, where it’s been since 2004. That’s an important distinction when compared to the rising rate among adults, which policy efforts have failed to stem.
“I think what all of this tells us is that preventing obesity is a lot easier than reversing obesity,” said Jeff Levi, executive director of Trust for America’s Health.
