Legal Political and Social Issues of Overweight and Obesity - The Global Politics Of Obesity

At the international level, the World Health Organization (WHO) has developed an aggressive plan to combat an escalating global epidemic of overweight and obesity—"globesity"—throughout the world. The WHO guidelines on diet and exercise, The Expert Consultation on Diet, Nutrition and the Prevention of Chronic Disease, released in 2003, advocate such actions as lowering intakes of sugar, salt, and saturated fats. They also recommend sharply limiting the marketing of food to children, and using tax and pricing policies to influence food consumption. The WHO asserts that these measures are necessary to reverse rising rates of the obesity-related illnesses—heart disease, diabetes, and cancer—forecast to account for nearly three-quarters of deaths worldwide by 2020.

The WHO plan was developed by an international team of experts using the latest scientific evidence available and has been commended by public health officials throughout the world. It is not, however, favored by some food manufacturers because among its proposals are restrictions on advertising unhealthy foods to children and the imposition of taxes and farm subsidy changes aimed at increasing prices of sugary and high-fat foods. For example, the International Sugar Research Organization strenuously objects to the recommendation that sugar amount to no more than 10% of food and drink calories consumed per day, calling instead for a 25% cap. Table 8.1 shows how total U.S. consumption of caloric sweeteners increased from 1966 to peak in 1999. After remaining fairly constant through 2002, use of caloric sweeteners declined slightly in 2003 but increased again in 2004.

On January 15, 2004, the United States expressed its opposition to the WHO plan and demanded significant changes to the initiative. Director of the Office of Global Health Affairs and Special Assistant to the Secretary for International Affairs at the U.S. Department of Health and Human Services (HHS) William R. Steiger questioned the validity of some of the dietary recommendations. In a twenty-eight-page critique of the WHO plan, Steiger wrote, "There is also an unsubstantiated focus on good and bad foods, and a conclusion that specific foods are linked to non-communicable diseases." Steiger put forth the U.S. position that all foods can be part of a healthy and balanced diet and called for "greater personal responsibility in battling obesity." According to WHO spokesperson David Porter, Steiger was the only member of the international scientific community to contest the proposed population nutrient intake goals.

U.S. opposition to the WHO proposal has been criticized as a clear effort to appease U.S. food and sugar suppliers. Some WHO scientists and consumer advocacy groups say the U.S. objections—specifically those about the recommendations to limit sugar consumption and reconsider food advertising aimed at young children—aim to protect industries that have recently been under attack rather than to improve public health. However, the food industry itself has publicly pledged to support the WHO plan. The Grocery Manufacturers of America, the world's largest association of food and drink companies, which includes PepsiCo Inc. and Hershey Foods Corp., said it was committed to working with WHO to combat obesity.

TABLE 8.1 U.S. total estimated deliveries of caloric sweeteners for domestic food and beverage use, by calendar year, 1996–2004 "Table 49. U.S. Total Estimated Deliveries of Caloric Sweeteners for Domestic Food and Beverage Use, by Calendar Year," in Sugar and Sweeteners: Data Tables, United States Department of Agriculture, Economic Research Service, September 1, 2005, http://www.ers.usda.gov/Briefing/Sugar/Data/data.htm (accessed January 12, 2006)

TABLE 8.1
U.S. total estimated deliveries of caloric sweeteners for domestic food and beverage use, by calendar year, 1966–2004
Calendar year	Sugara		Corn sweeteners				Honey	Other edible syrups	Total caloric sweetenersb
Raw value	Refined basis	High fructose corn syrup	Glucose syrup	Dextrose	Total
Notes: NA= not available. Data represents per capita deliveries of sweeteners by U.S. processors and refiners and direct-consumption imports to food manufacturers, retailers, and other end users represent the per capita supply of caloric sweeteners. The data exclude deliveries to manufacturers of alcoholic beverages. Actual human intake of caloric sweeteners is lower because of uneaten food, spoilage, and other losses.
aBased on U.S. sugar deliveries for domestic food and beverage use.
bTotal includes sugar, refined basis.
SOURCE: "Table 49. U.S. Total Estimated Deliveries of Caloric Sweeteners for Domestic Food and Beverage Use, by Calendar Year," in Sugar and Sweeteners: Data Tables, United States Department of Agriculture, Economic Research Service, September 1, 2005, http://www.ers.usda.gov/Briefing/Sugar/Data/data.htm (accessed January 12, 2006)
1,000 short tons, dry basis
1966	10,235	9,565	0	952	415	1,367	98	69	11,099
1967	10,474	9,789	3	984	428	1,415	89	50	11,342
1968	10,656	9,959	15	1,031	444	1,489	90	70	11,608
1969	10,950	10,234	33	1,061	459	1,553	101	61	11,949
1970	11,163	10,433	56	1,102	471	1,629	103	51	12,216
1971	11,345	10,603	86	1,163	482	1,731	93	52	12,478
1972	11,487	10,736	121	1,257	485	1,863	105	52	12,756
1973	11,429	10,681	218	1,384	489	2,092	95	53	12,922
1974	10,945	10,229	295	1,480	486	2,262	75	43	12,609
1975	10,302	9,628	527	1,515	473	2,515	108	43	12,294
1976	10,893	10,180	782	1,514	452	2,748	100	44	13,072
1977	11,099	10,373	1,057	1,517	429	3,003	100	44	13,519
1978	10,889	10,177	1,198	1,551	410	3,159	120	45	13,501
1979	10,756	10,052	1,660	1,519	399	3,578	117	44	13,791
1980	10,189	9,522	2,158	1,472	393	4,024	94	50	13,690
1981	9,769	9,130	2,626	1,486	390	4,501	96	46	13,773
1982	9,153	8,554	3,090	1,479	392	4,961	104	46	13,665
1983	8,812	8,236	3,655	1,523	398	5,577	116	47	13,975
1984	8,428	7,877	4,399	1,552	408	6,359	108	47	14,391
1985	8,003	7,479	5,386	1,607	418	7,411	104	48	15,043
1986	7,731	7,225	5,498	1,632	430	7,561	121	49	14,957
1987	8,103	7,573	5,792	1,679	441	7,912	104	53	15,642
1988	8,136	7,604	5,998	1,747	452	8,197	100	53	15,954
1989	8,304	7,761	5,960	1,587	438	7,985	95	51	15,892
1990	8,615	8,051	6,202	1,700	455	8,358	103	52	16,565
1991	8,622	8,058	6,376	1,776	463	8,615	116	52	16,841
1992	8,826	8,249	6,652	1,943	461	9,056	126	52	17,482
1993	8,886	8,305	7,086	2,050	481	9,617	135	54	18,110
1994	9,072	8,478	7,398	2,093	502	9,993	126	0	18,597
1995	9,258	8,652	7,676	2,176	528	10,380	120	0	19,153
1996	9,400	8,785	7,788	2,216	537	10,541	131	0	19,457
1997	9,481	8,861	8,240	2,364	511	11,116	129	0	20,105
1998	9,594	8,966	8,552	2,358	502	11,411	130	0	20,507
1999	9,912	9,264	8,897	2,281	488	11,666	147	0	21,077
2000	9,901	9,253	8,845	2,230	476	11,551	157	0	20,962
2001	9,839	9,195	8,920	2,205	469	11,595	134	0	20,924
2002	9,746	9,109	9,045	2,224	473	11,741	153	0	21,003
2003	9,479	8,859	8,849	2,209	449	11,507	146	0	20,512
2004	9,698	9,063	8,701	2,292	487	11,480	130	0	20,673

Kelly Brownell of the Yale Center for Eating and Weight Disorders, and Marion Nestle, chair of the Department of Nutrition and Food Studies at New York University, compared the food industry's self-serving attempts to delay action on the WHO proposal to efforts made by the tobacco industry to defend the harmless-ness of cigarettes. In "The Sweet and Lowdown on Sugar" (New York Times, January 23, 2004), the nutrition experts asserted that "By making its position on the WHO indistinguishable from that of the food industry, the Bush administration undermines the efforts of more forward-thinking food companies and threatens public health. Its action underscores the need for government to create a wall between itself and the food industry when establishing nutrition and public health policy. Recommendations to cut back on sugars may not please food companies, but it's time to stop trading calories for dollars."

The WHO global strategy did not become official until it was endorsed by member states at the U.N. summit in May 2004. While the plan is not binding, it is considered a guiding document for public health efforts on the issue worldwide. Although the draft gained broad international support, in January 2004 the WHO agreed to U.S. demands for additional time to comment on the final resolution. Nutritionists, public health agencies, and medical professional associations responded with shock and dismay that the United States had succeeded in stalling the global obesity-control plan. Despite U.S. efforts to delay its adoption, at the 57th World Health Assembly, the WHO Global Strategy on Diet, Physical Activity and Health was endorsed by resolution WHA57.17 on May 22, 2004.

The strategy provides member states with a range of policy options to address two of the major risks responsible for the heavy and growing burden of chronic diseases attributable to unhealthy diet and physical inactivity. It explains how healthier diet, nutrition, and physical activity can help to prevent and control these diseases. The document describes roles for WHO member states, UN agencies, civil society, educators, and the private sector in helping to reduce the occurrence obesity. It recommends obesity-prevention measures, including effective food and agriculture policies, fiscal policies, surveillance systems, consumer education, and nutrition labeling. The strategy urges limiting intake of sugars, fats, and salt in foods, and increasing the consumption of fruits, vegetables, legumes, whole grains, and nuts. It also emphasizes the need for countries to develop national strategies with a long-term, sustainable perspective to make the healthy choices the preferred alternatives at both the individual and community level.

Is Sugar the New Tobacco?

The WHO named sugar as the principal culprit in the current epidemic of obesity and obesity-related diseases, diabetes, and cardiovascular heart disease. The WHO approach to food is not, however, comparable to its strategy to combat tobacco use. The food strategy aims to provide member states and other interested stakeholders with a range of recommendations and policy options to promote healthier diets and more physical activity. It will be up to member states to decide how these should be further developed and implemented at the national level. Since the strategy was endorsed at the World Health Assembly, member states are responsible for determining which specific policy options are appropriate to their circumstances. WHO will then provide technical support for the implementation of programs, as requested by member states.

Americans crave sugar. Though the United States is just 5% of the world population, it accounts for a 33% of total global sugar consumption, more than ten million tons annually. Table 8.2 shows monthly estimates of U.S. sugar supply and use during fiscal year 2006. Sugar is the most subsidized U.S. crop. At a rate of nearly $500 per acre annually, U.S. sugar producers receive $1.4 billion in federal subsidies each year. U.S. sugar prices are artificially inflated because of import restrictions that protect producers from competition. Americans pay as much as four times more for domestic sugar than they would if foreign competitors were permitted to market sugar in the United States. Critics of these subsidies observe that the sugar industry makes generous contributions to senators and members of congress of both parties.

Sugar—sucrose, dextrose, fructose, corn syrup, or maltodextrin—is a key ingredient of many processed food products. Table 8.3 lists the names of added sugars that may be principal ingredients of processed foods. A can of soda may contain the equivalent of eight teaspoons of refined sugar. The Center for Science in the Public Interest (CSPI) reports that Americans' sugar consumption has been steadily increasing since the mid-1980s. The average American consumes at least sixty-four pounds of sugar per year, and the average teenage boy at least 109 pounds (http://www.cspinet.org/reports/sugar/addedsugar.html). American adults get 16% of their calories from added sugars, and children aged six to eleven get 18% of their calories from added sugars. Adolescents aged twelve to nineteen get 20% of their calories from added sugars. CSPI also observes that people with diets high in added sugars consume lower levels of fiber, fewer vitamins, and less folate, magnesium, and calcium, among other nutrients. By displacing vital nutrients and foods in the diet, added sugars may increase the risk of osteoporosis, cancer, high blood pressure, heart disease, and other health problems.

Although the health food industry has been warning the public about the perils of over-consumption of refined sugars for more than thirty years, mainstream nutritionists and public health professionals have joined the ranks of those calling for reduced sugar consumption. Along with ending sugar subsidies, they want to sharply limit advertising of sugary products to children, ban the sale of soft drinks in schools, and conduct widespread community public health education programs to inform Americans about the health risks of consuming excessive amounts of refined sugars.