Institute of Medicine: Progress in Preventing Childhood Obesity

The Institute of Medicine this week released its report on Progress in Preventing Childhood Obesity, a follow-up to earlier publications on childhood obesity and food marketing to children.

The headline message from the report summary is characteristically bland (admirers of the IOM's work in this area have learned that articulate observations and criticisms can be found buried in the chapter texts). For the new report, the headline message that was picked up in the media may be paraphrased:

We are not trying hard enough as a nation to solve the problem of childhood obesity.

But, isn't that message to the nation a little like the long-discredited practice of lecturing obese people that they should exercise some will power?

My sincere and friendly recommendation to the IOM and to this report's funders at the Robert Wood Johnson Foundation is that, one way or another, they should to come to grips with the futility of voluntary industry restraint on selling children bad food. Telling the industry to forego profits is like telling a hungry person not to eat -- it is a psychological impossibility.

Healthy eaters use a wealth of self-imposed constraints on their future eating decisions, and then find it easy and entirely agreeable to eat well later. Just so, I think well-meaning captains of industry who have developed an uncomfortable conscience on the issue of childhood obesity must begin to advocate for government regulations that bind their decisions in a sensible way without bankrupting their business. The IOM report reviews a drum-beat of failed industry attempts to introduce healthy options (McLean Deluxe, Taco Bell Border Lite, ...) without having the courage to admit the logic of the developing pattern. If one company (McDonald's, say) pursues a set of healthy menu options, a competitor (Hardees, say) will run them through with a scimitar. The people at McDonald's corporate responsibility must at some point call for well-designed binding rules to provide clear and prominent nutrition facts information, restrict fraudulent health claims, and restrict marketing to children, or they should admit to themselves that they are just hired grifters.

In a highly competitive industry, the companies face pretty much the same profit picture whether regulations on children's marketing are strict or lenient. To use another analogy, the game of soccer might be a great sport under current rules, and it might be an equally great sport if goalies were denied the right to catch the balls with their hands. No team could ever single-handedly (ha) forego the use of a goalie's hands, but so long as both teams were subject to the new rule, the game might be no worse for the rule change.

The IOM report has some fairly mild language about improving the Children's Advertising Review Unit, but it largely fails to call for sufficiently strong medicine to address the disease. Instead, it almost sets the necessary conversation back through undeserved praise for a wide range of industry efforts to brand healthier products, market smaller servings with more packaging at the same price (really), offer trivially more healthy variations on current unhealthy offerings (blech), and so forth. A low-point of the report is the favorable description of the Healthy Arkansas awards given to McDonald's, Subway, and Yum! brands restaurants like Pizza Hut.

I hope my criticism hasn't been so sharp that I have sacrificed the chance to get an open-minded hearing from the authors and sponsors of this report. Please hear my friendly and sympathetic suggestion. The big conceptual shift that is required is not a more elaborate evaluation framework (click below for larger image), but a clear vision for how shared agreement on stronger rules of the game can liberate the aggressive competitors on the field to better serve the goal of providing a healthier future for our children.