Whitt Flora

Now that the American Medical Association has declared obesity a disease, it’s time to consider our longstanding failure to address it responsibly.

America’s war on fat is entering its fourth decade and it’s stunning that 98 percent of obese Americans haven’t been significantly helped. A recent report by the World Health Organization found severe obesity still affects 15.5 million adult Americans.

Despite years of government warnings and new efforts to reduce consumption of unhealthy foods by taxing, limiting the proportions that can be served and, in some cases even banning them, obesity has become the health crisis of this generation and quite probably the most pressing health concern in human history.

The problem is particularly acute in the United States, where the WHO recently estimated that 77 percent of females and more than 80 percent of males aged 15 and older are overweight or obese.

Excess fat causes untold numbers of premature deaths and afflicts Americans with such serious maladies as heart disease, diabetes and even forms of cancer that could, in many instances, be avoided. Not to mention the negative mental effect of unneeded and useless angst.

How can we be spending billions and billions of dollars each year on the fight against fat each year and still be losing it?

One likely reason: We’ve been setting ourselves up for failure by raising expectations far beyond the norms of reality. Obese Americans are bombarded with messages that suggest shedding pounds will turn women into bikini models and men into super athletes bristling with muscles.

The truth is that only really good reason for shedding weight is improving your health — not your looks.

If a 250-pound woman loses 22 pounds, or about 24 percent of her excess body weight, it may not sound like much, but from a health perspective it can be profoundly important. The question is how to do it without the possibility of suffering unhealthy side effects.

Few Americans want go through some of the traditional surgical interventions modern medicine has come up with to trim weight SEmD and who can blame them?

Most come under the rubric of major surgery with a possibility of significant complications.

Procedures like sleeve gastrectomy, which removes more than 80 percent of the stomach, is irreversible. Or gastric bypasses that reroute the intestines to reduce the digestion of food also come with severe complications.

Even the more benign lap-band surgery chosen by New Jersey Gov. Chris Christie to restrict his stomach’s capacity comes with a laundry list of warnings. Reoperation may be required if the band slips or if too rapid weight loss occurs. Recipients may experience difficulty swallowing, infections, nausea and vomiting.

Fortunately, medical scientists in many countries around the globe, including the United States, are working overtime to come up with better solutions.

One small medical device company in Minnesota — EnteroMedics — is working on one that could prove a winner. Its so-called VBLOC therapy is delivered by a small, implantable device that use electrodes that deliver low-energy electrical impulse to the vagal nerve that help patients control hunger sensations.

Studies soon to be scrutinized by the U.S. Food and Drug Administration have shown that blocking the vagal nerve signals help patients control hunger sensations — resulting in a feeling of early fullness at meals. The device may be turned off and is designed to be reversible, programmable and adjustable from outside the body.

In the biotech arena, MedImmune, a Gaithersburg, Md. biotech company, just announced it will work with NGM Biopharmaceuticals to develop a new treatment for obesity and diabetes which is focused on enteroendocrine cells that are naturally found in the gastro intestine I tract.

• Whitt Flora is a former chief congressional correspondent for Aviation Week & Space Technology magazine.

Beth Meyerson

Issues of obesity exist at the nexus of civil liberty and collective responsibility. We claim freedom to eat anything despite health or financial consequences. But the costs are not solely ours.

A sample of obesity’s consequences include heart disease, type 2 diabetes, stroke and osteoarthritis. Heart disease, stroke and diabetes are the first, fourth and seventh leading U.S. causes of death. Annual obesity-related medical costs are estimated at $150 billion to 190 billion.

Balancing liberty and collective responsibility for health, then, is a primary challenge of public health. The Obama administration leads our collective effort with focus on primary drivers of obesity: healthy eating and physical activity. Success depends on these efforts and upon reform of yet another expression of civil liberty: lobbying.

In 2010, the Obama administration initiated a National Task Force on Childhood Obesity, the first such Cabinet-level effort. Examples of outcomes include a campaign to increase physical activity, production incentives to increase availability of healthier foods, revised food labeling, physical activity and nutritional standards; monitoring food marketing to children and increasing access to healthy food retailers in underserved communities.

A specific example is a shift in the national children’s nutrition effort to support purchase of fresh fruits and vegetables, and vouchers at farmers markets across the country.

We might also associate the administration’s efforts with first lady Michelle Obama. She has normalized conversation about healthy eating and exercise through the White House Kitchen Garden, while speaking openly about feeding her family in the face of overwhelming junk food marketing to children. She uses her role well with industry and engages communities to increase physical activity with the Let’s Move! campaign.

Efforts appear to be paying off. CDC’s recent report that obesity rates dropped in most states between 2008 and 2011 is an encouraging sign that we may be headed in the right direction.

While we are seeing glimpses of improvement, there are miles yet to go because our weight is triple what it was 30 years ago, our portion sizes are astronomical, we walk half as much, and many communities are reducing physical activity in schools. Lasting impact on obesity will not be seen right away SEmD or at all SEmD unless we engage in lobbying reform.

The administration’s efforts are bold and could be more so, but they have been met with tremendous industry resistance.

Recent analyses by Reuters described a threefold increase in lobbying efforts and resource directed toward this administration by the food and beverage industry. This began in 2009 as Congress was considering a soda tax, and continued with focus on nutrition, labeling and junk food marketing.

It is no surprise that in 2011 Congress rejected proposed USDA school lunch standards while assuring that tomato paste continued to have four times the “extra vegetable serving credit” than it actually had.

Such insular outcomes are reinforced by the revolving door between Congress and lobbying firms. This year, the Center for Responsive Politics reported that 57.2 percent of food and beverage industry lobbyists are “revolvers” SEmD rotating between federal government and roles as consultants and strategists on K Street.

Leading the change in the obesity epidemic requires vision and courage. We see evidence of both in the administration’s public health policy efforts.

Now we have to assure the conditions that will facilitate change. We as citizens need to “step it up” SEmD in the words of Michelle Obama SEmD not just to eat well and increase physical activity, but to call for lobbying reform in the name of public interest.

Without it, we essentially tie one hand of the administration behind its back in the fight against obesity. This problem is not reserved for the obesity policy arena, but is a structural challenge to democracy that must be addressed for the public good.

• Beth Meyerson is an assistant professor at the Indiana University School of Public Health.

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