If obesity were a symbol of success, the United States would be a boomtown on the frontier of flab. But excess fat isn't a measure of achievement. It's a badge of bad health carried by more than 70 million people in this country. Faced with this epidemic, which is poised to replace smoking as a sinkhole of lives and healthcare dollars, Americans are willing to do...well, not much, says Taeku Lee, assistant professor in public policy at the Kennedy School of Government. In the first study of its kind, Lee and colleague J. Eric Oliver of Princeton surveyed popular attitudes toward obesity and obesity-related institutional policies. They found their topics so "new" to public consciousness that most Americans didn't consider them a problem.
True, obesity isn't a new crisis. In the last 20 years, American bellies have ballooned and public-health expenditures on obesity-related illnesses, including heart disease, diabetes, and certain kinds of cancer, now top $40 billion annually. Yet as a health issue, obesity remains a silent epidemic, largely underreported by the media and absent from public debate. Obesity's low profile offered Lee and Oliver a rare opportunity to study public opinion as it coalesces, and as rising social and economic costs provoke a political response. The researchers surveyed a random sample of 909 Americans about the origins of obesity, then probed their interviewees' feelings about potential government policies aimed at fighting flablike taxes on snack foods, publicly funded exercise parks, bans on vending machines in schools, or regulation of food advertisements targeting children. Their results, presented last December at a meeting of Columbia University's Political Psychology Seminar, reflect a picture of indifference.
Although Americans agree that they live in an unhealthy food environment (awash in cheap, salt- and sugar-blasted fast foods), most aren't concerned about their weight and don't consider obesity a national health crisis. Respondents generally showed little enthusiasm for fat-fighting policies, although responses varied widely. Older respondents, for example, were more likely to support government action on obesity; high-income families resisted it; Latinos seemed to support taxes on snack foods; African Americans opposed banning snack concessions in schools. The greatest support (particularly among women in general and parents) materialized for regulation of food ads aimed at kids: 57 percent of respondents said they favored government regulation.
Still, the survey underscored a national reluctance to tackle obesity. Why does this issue cruise below our radar, when 60 percent of American adults are overweight, 27 percent are obese, and children are fatter than ever before? Because, Lee explains, fat is personal.
"The most commonly attributed cause of people being overweight and obese is this idea that they have a weakness of will and the inability to maintain a regular diet and exercise regimen," Lee says. Sixty-five percent of respondents blamed obesity on this individual moral failure. Health experts disagree, blaming factors like genetics, social inequalities, and sedentary lifestyles. But experts alone can't shove concerns about obesity into the mainstream. Lee notes one of their most striking discoveries: "Because this issue is still so new, partisanship and liberal-conservative ideology literally don't matter." Americans, he adds, need to agree that obesity is an epidemic before they will back proactive policies. That recognition requires real noise from elites like politicians, doctors, public health advocates, celebrities, and reporters. One positive sign may be the study's discovery that survey respondents who supported government's role in regulating tobacco were likely to support similar actions against fat.
The obese may not face higher health insurance premiums yet, but Lee and Oliver note that signs of change have begun to appear. Recently, Southwest Airlines stumbled into controversy with its policy of demanding that overly large passengers who require two airplane seats purchase two tickets. President Bush kicked off a national physical-fitness campaign, targeting the high cost of poor health and calling health an "individual responsibility." And a 56-year-old, 270-pound New Yorker filed a class-action suit against four fast-food chains, holding them responsible for his diabetes and two heart attacks.
If obesity someday evokes public condemnation, as smoking does today, will it trigger an avalanche of lawsuits against McDonald's and other junk-food titans? More suits may come, Lee says. But he doesn't predict multimillion-dollar settlements like those for tobacco. He doubts politicians pushing an obesity agenda will find it easy. "One of the characteristics of the American political tradition is freedom of individual choice," he says. "I think people will resent the idea of government imposing any regulations about what we can and cannot eat."
