IT鈥橲 no secret that the US has a weight problem, but the numbers are staggering: . Cases of heart disease, type 2 diabetes and strokes 鈥� which kill hundreds of thousands each year and are linked to obesity 鈥� are set to between 2010 and 2020. By 2030, the annual medical bill for the nation鈥檚 bad eating habits could top $66 billion.
Statistics will not scare people into better health, though. 鈥淭he big question is: how do you encourage folks to eat better?鈥� says at the US Department of Agriculture.
Carlson and his colleagues at the USDA and the Massachusetts are trying to answer that question. Through a programme called the (HIP), they have put themselves at the forefront of a growing war on obesity that involves elements of federal, state and local governments, researchers, and even private industry. No one knows what strategy will ultimately work, so everything is being tried. The initial results are encouraging.
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The idea behind HIP is simple: make healthy foods more affordable. Over 14 months, from November 2011 to December last year, 7500 residents of Hampden, Massachusetts, who get government assistance when buying groceries, received 30 cents of food-buying credit for every dollar of their allowance that they spent on fruit and vegetables.
Carlson and his colleagues are still in the process of evaluating the impact of the HIP scheme, but he says: 鈥淲e have some pretty strong indications that this investment did increase the amount of fruit and vegetables consumed by these low-income families.鈥�
Elsewhere, health insurance company Humana is offering broad incentives through its . Clients who sign on have their health assessed and then collect points for healthy activities. Each time a member visits the gym, for example, they can swipe a card to receive points. 鈥淵ou can use those reward points for an Amazon gift card or a pedometer, or to book a vacation,鈥� says Stuart Slutsky, who oversees product development at Humana Vitality.
Humana has started offering the Vitality scheme as a standalone product, without insurance, to other companies. Car manufacturer Toyota, which employs about 30,000 people in the US, has enrolled its employees in the scheme. Some signed-up companies have even taken things a step further, imposing financial penalties on employees who fail to make the most of the scheme.
Chew on this
Plans like Vitality have been in place in South Africa and the UK since the late 1990s, and members have already reaped rewards. , for example, companies in South Africa saw employees shedding excess weight and rates of high blood cholesterol also fell.
Clients signed to the insurance programme are also encouraged to buy healthier foods at Wal-Mart, the largest food-seller in the US. Last October the company began labelling fruits, vegetables and low-fat, low-sodium food items with a 鈥溾�� icon. Members of the Humana Vitality scheme get a 5 per cent discount on these items. 鈥淪o far we鈥檝e seen very strong shopping trends for our members as they鈥檙e activating the benefit,鈥� says Slutsky.
Another obvious approach is to make unhealthy foods more expensive. But fat taxes don鈥檛 go down well in the US or elsewhere. A recent attempt to impose a tax of 16 Kroner (then about 拢1.50) per kilogram of saturated fat in food products in Denmark failed, as Danes started to buy their fix of cheap, fatty foods. Sugar-sweetened beverages, on the other hand, represent a clear-cut target, says at Yale University鈥檚 Rudd Center for Food Policy and Obesity.
鈥淲e鈥檝e got such solid science that shows there is a relationship between consumption of sugar-sweetened beverages and type 2 diabetes, cardiovascular disease, gout and tooth decay,鈥� she says. It is thought that sodas contribute about 7 per cent of the caloric intake of the average US citizen. 鈥淭hey don鈥檛 offer any nutrition鈥� and there鈥檚 proof they鈥檙e damaging to your health.鈥�
The prevailing sentiment among health researchers is that a penny-per-ounce tax on sugar-sweetened drinks would significantly reduce their consumption and improve public health. Such a tax would increase the cost of a 20-oz (568-millilitre) soda by about 20 per cent.
鈥淎 20 per cent rise will have a bit of an impact, but it may not be enough,鈥� worries neuroendocrinologist at the University of California, San Francisco, who treats children with obesity-related illnesses. But a study published last year offers hope. It concluded that a nationwide penny-per-ounce tax would decrease overall consumption of sugar-sweetened beverages by 15 per cent among 25 to 64-year-olds. Over 10 years, such a reduction would avert 95,000 coronary heart events, 8000 strokes, and save more than $17 billion in medical costs alone, the study鈥檚 authors claim ().
A bill introduced in the California legislature by Democrat aims to do exactly that. 鈥淪enate Bill 662 would place a 1 cent per fluid ounce excise tax on sugar-sweetened beverages, and the money collected would go to a California children鈥檚 health promotion fund,鈥� Monning says.
Attempts to put such a tax in place in other states have so far proved unsuccessful. 鈥淭here have been huge amounts of money and lobbying from industry,鈥� says at the Rudd Center. He likens the beverage industry鈥檚 strategy to that of tobacco companies in the 1950s. 鈥淭hey鈥檝e gone right with the tobacco playbook,鈥� he says. 鈥淏ut people are becoming highly sceptical of the companies. They鈥檙e probably not going to be able to lobby their way out of this for much longer.鈥�
Public health researchers are pinning their hopes on Monning鈥檚 bill. 鈥淐alifornia leads the country; we鈥檙e a laboratory of democracy,鈥� says Lustig. 鈥淚t will happen here before it happens anywhere else. But is California ready for a soda tax?鈥�
It might just be. suggests that 68 per cent of Californians favour the bill. 鈥淐alifornia has always been a pioneer and an innovator,鈥� says Monning. 鈥淲e don鈥檛 underestimate the uphill nature of this fight鈥� but we see a growing public sentiment that is supportive and that will hopefully move legislators forward on this issue.鈥�
鈥淲e don鈥檛 doubt the uphill nature of this fight, but public sentiment is growing鈥�
Eating with your eyes
Tweaking food prices may be the best way to alter eating habits, but playing tricks on our eyes works, too.
All it takes for schoolchildren to choose a carton of milk over a chocolate drink, for example, is moving the chocolate drink to the shelf鈥檚 back row. 鈥淭he consumption of chocolate milk goes down because people like to pick up what they see first,鈥� says Kelly Brownell at Yale University鈥檚 Rudd Center for Food Policy and Obesity.
Similar tactics could be employed to prevent people from overeating. After the age of 3, we tend to stop regulating our food intake by when we feel full, and instead finish what鈥檚 in front of us.
But people do tend to regulate their intake when a serving is partitioned. Individuals ate fewer Pringles, for example, when they encountered a red-coloured crisp after every seven they consume (). Elongating a packet of crisps can also lead a person to think they are eating more than they are. The same goes for the shape of a vessel a person drinks out of: taller, thinner glasses can trick a person into thinking they have consumed more than if they had drunk the same amount from a shorter, wider vessel.
