Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 14
Promising interventions —
regulating the food environment
A wide variety of interventions are likely to be successful
if they address our natural proclivity to be attracted
to food, to be stimulated to feel hungry when confronted
with food cues (regardless of how full we are),
and to maximize the quantity and variety of food we
eat. The following are be discussed:
• price incentives
• regulating portion sizes and labeling calorie
information
• counter-advertising campaigns
• controlling food cues
• regulating food accessibility.
There is limited evidence for the effectiveness of
these interventions, since they have never been tried
on the scale needed to have an impact. Given that
these would address pathways shown to be causally
related to overconsumption, they are, nevertheless,
the most promising.
While regulating the food environment may seem
heavy handed, what people fail to appreciate is how
much it is currently being engineered so that people
will automatically eat more than they need, eat more
unhealthy foods than they should, and, as a consequence,
develop chronic diseases that shorten their
lifespan. The limitations of human cognition make it
very difficult for people to have insight into the
process. People cannot naturally identify which nutrients
and calorie amounts are present in specific foods,
particularly those that are processed and transformed
from raw ingredients, nor can they prevent being artificially
stimulated to desire foods that are high in sugar
and fat. Thus, there is a role for government to regulate
the food environment so that people will automatically
have the optimal quality and quantity of
food available for them to choose.
Regulating prices
Currently, unhealthy foods like salty snacks, cookies
and candy and sugar - sweetened beverages are less
expensive per calorie than healthier foods such as
fruits and vegetables. 43,44 Taxing the unhealthy foods
and subsidizing the healthy ones has been proposed,
and has been implemented in a very minimal way in
several states in the USA. 45 However, the fact that
people are very price sensitive when it comes to food
purchases, suggests that this is a promising approach.
There is enormous scope for adding taxes to unhealthy
foods, which could be used to subsidize healthy ones.
Labeling and regulating portion sizes
Labeling of calories in food items is beginning to
have some traction in the United States. Although
New York City has implemented a rule that requires
certain restaurants and food outlets to label food
items, it has been held up by litigation at the time of
writing. 46 Point-of-purchase labeling and signage do
appear to have a significant impact on behaviors. 11,47
However, given people ’ s limited cognitive capacity, it
may be difficult for many to keep track of all the calories
they consume over the course of a day. Another
solution that might be helpful to individuals would be
to regulate the portion sizes, so that when a person is
served, they are given a default amount that is appropriate
to their needs. For example, a person would be
given an entire cup of vegetables, rather than half a
cup, but only 3 – 5 oz of meat in any given meal, or only
150 calories worth of French fries, and a small beverage
or a no - calorie beverage. (The McDonalds small
portion of French fries is now 2.6 oz and 250 calories
and the small fountain soda is 16 oz for an adult at 150
calories. www.mcdonalds.com/app_controller.nutri
tion.index1.html ). Currently, the smallest sizes of
many items may be too large for most people.
Requiring food outlets to make smaller portions available
would help people obtain more appropriate
quantities of food.
Counter advertising/restricting cues
Currently, there are minimal, if any, counter -
advertisements that can help people resist the ubiquitous
cues that stimulate hunger and the desire
for food. In the anti - tobacco campaigns it was
documented that even having only one counter -
advertisement for every 12 pro - tobacco advertisements
was effective in helping to reduce tobacco
consumption. 48,49 If people are reminded of the appropriate
and preferred behaviors, automatic responses
to food cues can be interrupted, and it may be easier
for people to resist foods. A barrier to negative advertising
is the perception that negative messages may
increase food problems such as anorexia and bulimia,
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