Challenging the Obesity System

Last month, to great fanfare, First Lady Michelle Obama announced her Let's Move initiative to combat childhood obesity.

Tuesday's signing of the historic health reform bill assures that more children, once obese, will actually be able to get treatment for it. The bad news is how ineffective and expensive most obesity treatment actually is. America currently spends $147 billion a year on obesity-related illness.

What's been missing historically is any recognition that the biggest bang for our taxpayer dollars is to prevent kids from getting overweight and obese in the first place. And that's why the White House initiative is so important. It starts the process of making kids' food in schools and communities healthier.

But ultimately, we need to put a spotlight on the fact that our national obesity epidemic is but a single symptom of a more serious illness: our unhealthy food system.

In order to prescribe healthier food, we must rethink the entire system, from the farm to our children's mouths. We wrote about the need for this healthier food system in this month's Health Affairs, which was devoted to child obesity.

Researchers now link obesity with diets rich in added sugars, fats, and refined grains, and of course in the snacks, sweets, beverages and fast foods in which they are so prominent. According to U.S. Department of Agriculture data, in 2007 Americans' average daily calorie intake was 400 calories higher than in 1985, and 600 calories higher than in 1970.

Suprising to many is that the ultimate source of so many of these added calories in the American food supply can be traced to two crops: corn (sweeteners) and soybeans (fats and oils).

But it shouldn't be surprising. For the past 35 years, U.S. farm policy has incentivized the production of a few commodity crops (like corn and soybeans), and the calories that come from them.

In the early 20th century through the 1950s, production of these crops was seen as essential to addressing under-nutrition in the U.S., and throughout the world. U.S. farmers responded by dramatically increasing yields -- up to 600 times higher now than in 1920.

At the same time, depression-era farm programs recognized that overproduction of these crops risked the prices for them plunging below what farmers needed to make a living, or rising above what consumers could afford. As a result, these programs managed supply of these commodities, to keep prices relatively stable, and to keep farmers in business and making money.

But from 1965 through 1996, these supply management programs were gradually dismantled. U.S. farm policy today is designed instead to encourage farmers to grow as much as possible of these few commodity crops, utilizing several different types of subsidies, crop insurance and taxpayer-supported research. Quite rationally, farmers have followed these policy signals, making significant capital investments (new combines, irrigation systems, etc.) to produce these crops.

As a cheap calorie policy, U.S. farm policy has been a success. Foods high in fats, sugars and calories, such as cooking oils, snacks, fast foods and sugared sodas, are some of the cheapest foods in the American diet. But for public health, U.S. farm policy's focus on a few commodities is outdated.

We know, for example, that diets rich in fruits and vegetables can help manage weight and lower risks for cancer and other chronic diseases, especially when they replace calorie-dense, nutrient-poor foods. Yet fewer than one in 10 Americans meet the levels of fruits and vegetable consumption recommended under the latest calorie-specific, healthy eating guidelines. And farm policy historically has overlooked incentives for fruit and vegetable production.

So how do we get farm policy and public health on the same page?

As a start, the executive branch needs to pull together disparate health and agriculture communities around food policy. There needs to be a Healthy Foods Commission -- and it has to be independent. Such a commission, comprised of non-governmental public health, agriculture and food system experts, could work closely with the Administration's Task Force on Childhood Obesity to ensure upstream and downstream food system goals are mutually reinforcing.

Second, America's farmers have got to be key partners in this healthier food system. If the nation is serious about making fruits, vegetables and other healthy foods more accessible, policymakers need to offer at least as much research, financial and other support to growers of these foods as has been offered for decades to growers of commodity crops.

Specific policies to accomplish this might include: reinstating programs to manage oversupply of commodity crops and calories; support for current farmers transitioning from commodity to other crop production; new farmer recruitment, financing and training; an agriculture research agenda that includes a more diverse mix of crops and farming methods; and allowing farmers growing fruit and vegetable to participate in commodity programs of the farm bill.

Third, we need to raise the standards for the National School Lunch and Breakfast programs. These programs should be required to meet the USDA's healthy eating guidelines and this should be codified in the Child Nutrition Act, expected to be voted on soon by Congress.

Today, the quality of the calories produced by U.S. agriculture may be at least as important as their quantity. For us to make long-lasting progress on obesity, we must heal the symptom's source: an unhealthy food system. Let's move!