Policy Innovations Digital Magazine (2006-2016): Commentary: Fighting Obesity Requires a Choice: Profit or Public Health?

In the last three decades, the prevalence of obesity has increased rapidly worldwide. The World Health Organization estimated that each year over 2.8 million people die because of being overweight or obese. Unless governments take steps to promote healthy diets and discourage consumption of ultra-processed products, chances to stop and reverse the obesity epidemic remain quite slim. Until now, market-oriented solutions have proven incapable of solving this societal problem.

Although for decades many have found the justification for obesity in genetic predisposition or individual choice, researchers are now directing their attention to how the social environment influences dietary patterns at the population level. In a recent report, the Pan American Health Organization (PAHO) identified market deregulation, trade, and agriculture policies as determinants of the quality of food supply, and thus dietary patterns (PAHO, 2015). The report built on previous evidence showing that economies which have adopted more aggressive policies of market deregulation since the 1980s have experienced faster increases in both fast food consumption and body mass index. The globalization of markets and the rapid growth of transnational food oligopolies contributed to a dramatic dietary transition towards fast food and soft drinks, first in the developed world and later in low- and middle-income countries. According to Oxfam, there are 7 billion food consumers and 1.5 billion food producers in the world, yet no more than 500 companies control about 70 percent of the entire population's daily food choices. The dominance of these companies contributes to the obesity epidemic, not only by favoring the sales and advertisement of ultra-processed products, but also by forcing small farmers and local food producers out of the increasingly globalized and export-oriented market.

Nowadays, ultra-processed products are more available and affordable than fresh food, such as fruits and vegetables. These ultra-processed products provide a convenient alternative to the staple diet of poorer populations. They contain fat, sugar, and salt, which make them highly desirable, even addictive, for most consumers. The frequent consumption of ultra-processed products has major impacts on public health: obesity is a major risk factor for numerous non-communicable diseases, including type II diabetes. There are about 382 million people living with type II diabetes worldwide and the number is expected to rise to 591.9 million by 2035.

If we are serious about curbing the spread of the obesity epidemic, we will need to tackle the underlying structural causes that influence obesity rates. Trying to trigger individual behavioral change is not enough. Ads promoting the use of anti-obesity medication, inviting people to buy self-help books, or encouraging them to enroll in weight-loss programs, do not address the root causes of the problem.

Fortunately, there is growing literature on public health that identifies a list of policies that, if systematically applied, could reduce obesity at the national and global level.

Economic tools such as taxes on ultra-processed products and subsidies on healthy food items—like fruits and vegetables—are necessary and urgent. Alarmed by the pervasiveness of the problem, numerous countries have already adopted various economic measures to curb the obesity epidemic. Soda and junk food taxes have been implemented in a few nations, including Mexico. Some governments have also adopted subsidies for small farmers growing healthy foods. In countries such as Switzerland, with strong policies in place to support local (small) farmers, there is a lower incidence of obesity than in countries whose agricultural system is dominated by food oligopolies. In Brazil, the law now requires 30 percent of the national budget devoted to school meal programs to be invested in unprocessed food and products from local family farms.

Of course, curbing the obesity epidemic requires multiple approaches. Special attention should be given to food advertising directed at young children. In 1991, Sweden prohibited all TV advertising (including marketing) of junk food aimed at children under the age of 12. Bans on TV ads directed at children have also been adopted in Norway, Greece, and the Canadian province of Quebec.

Government interventions should also address the food oligopoly system that is at the root of the growing consumption of ultra-processed products worldwide. Anti-trust laws, requiring free trade agreements to incorporate health impact assessments, and intergovernmental efforts to monitor and sanction possible abuses of transnational food companies should be considered. This seems increasingly difficult in a time when democracies are increasingly influenced by the lobbying power of "big business." Yet, voluntary approaches and self-regulation, so much advocated by the food industry and "corporate libertarians," have utterly failed to ensure the nutritional quality of our food.

Policy interventions to improve diet and reduce obesity should also consider income inequality and poverty. Evidence shows that in "advanced economies" with high-income inequality and weak welfare policies, obesity and fast food consumption are more prevalent than in more egalitarian nations. High inequality is, in fact, associated with a higher proportion of people living in poverty who cannot afford healthy food items, which are usually more expensive than ultra-processed products.

Finally, policies aimed at reducing the consumption of soft drinks in the developing world should include the provision of safe water as a priority. This would be the best way to ensure that people have healthy alternatives to sugary drinks such as Coca-Cola and Seven Up.

Ultimately, the fight against obesity depends on the political will of nations and global institutions to make a choice between profit and public health.