Researchers have slammed the US government's plans to combat the country's obesity epidemic. Experts say the focus on changes in personal choices is flawed, and ignores the role of government and the food industry in shaping people's decisions.

The strategy, announced on 9 March by Tommy Thompson, head of the Department of Health and Human Services, combines a nationwide education and advertising campaign with a revamp of obesity research across the National Institutes of Health (NIH).

A public-awareness campaign, dubbed ‘small steps’, will try to educate Americans by highlighting healthier lifestyle options, such as walking up stairs instead of taking a lift. Thompson also wants voluntary measures to encourage restaurants to put calorie information on menus and to improve the accuracy of calorie counts on food labels.

Obesity experts say that education is fine, but they are angry that the government has not addressed what they believe to be the main cause of obesity — the easy availability of cheap, calorie-rich foods. For example, a study released last month by the Center for Science in the Public Interest, a Washington-based group that campaigns on nutrition issues, showed that the main courses of children's meals in US chain restaurants typically contain 700–900 calories, more than half the total recommended daily amount.

And according to a study by the Centers for Disease Control and Prevention in Atlanta, Georgia, around 64% of US citizens are overweight or obese (A. H. Mokdad et al. J. Am. Med. Assoc. 291, 1238–1245; 2004), with obesity accounting for 400,000 preventable deaths in 2000, second only to tobacco.

Regulating the food industry is the best way to tackle the problem, say public-health experts and nutrition scientists. They recommend banning soft drinks and fast foods in schools and food advertising directed at children. They also want compulsory labelling of the calorie content of restaurant menus.

“The campaign says nothing about what the government or the food industry could do to help people to eat less and move more,” says Marion Nestle, chair of the Department of Nutrition, Food Studies and Public Health at New York University.

The other component of Thompson's plan — changes to NIH obesity research — has been welcomed by obesity experts. Under the scheme, put together by a cross-agency task force set up by NIH director Elias Zerhouni, the institutes will focus on behavioural and environmental approaches to modifying lifestyle. It will also support clinical trials of diet strategies (see page 252).

Increased focus on research to prevent obesity is essential, says Kelly Brownell, director of Yale University's Center for Eating and Weight Disorders. He points out that the NIH has been criticized for focusing too much on the genetics, pharmacology and treatment of obesity. Research in these areas will continue under the plan, which could be funded by a $40-million increase for obesity included in the 2005 NIH budget request.

But many scientists worry that marking obesity as a research problem risks ‘medicalizing’ the issue and reinforcing public belief that it is a disease requiring treatment.

→ http://cspinet.org/new/pdf/kidsrestfood.pdf

→ http://obesityresearch.nih.gov