High Hopes and Hard Outcomes in Obesity Policy

Public health policymakers have high hopes for reshaping the food environment to tackle obesity. In 2004, Kelly Brownell proposed that a toxic food environment lies at the root of the obesity epidemic. That idea has impressive staying power. But a new paper in PLOS ONE finds little cause for joy when it looks at the hard outcomes of efforts to reshape that toxic environment. The authors conclude:

The evidence assessed in this review suggests that current policies are generally falling short of anticipated health impacts.

To reach that conclusion, researchers from the University of Adelaide conducted a realist systematic review.

Mixed Results from Six Prevention Policies

Menu labeling (for calories) was the most extensively studied policy. Labeling made little impact on consumer purchases. Likewise, it made little impact on frequency of visiting fast food businesses. Changes in consumer knowledge varied between studies and study locations. Menu labeling only prompted menu changes (movement to lower calorie options) in chains, with little spillover effect into other restaurants. And finally, regional menu labeling requirements led to some spillover of those changes into the rest of a national chain.

Studies of food infrastructure examined efforts to limit fast food outlets or promote more vendors for fruit and vegetables. In both cases, the studies found little measurable effect – either on diet or on obesity.

Studies of subsidies to promote fruits and vegetables showed mixed results. In Philadelphia, incentives to use SNAP benefits for fruits and vegetables produced self reports of more consumption. In New York, incentives had no measurable effect.

Taxes on unhealthy foods showed promise for reducing consumption of the targeted foods. But such taxes can also prompt changes in consumption of other foods to reduce the benefits.

Only one study tested the effect of purchasing standards to raise the quality of food in public institutions. And that study found positive effects.

Finally, the researchers found evidence that nutrition labeling requirements might not yield very accurate information. They reported a study that found only 7% of 350 products had labels with accurate nutrition information.

A Long Slog

We hear many calls to tame the toxic food environment and prevent obesity. Yet, these findings suggest that present policies might not bend the curve of obesity trends very quickly. Perhaps we need more effective tools. Or perhaps we need more patience.

A bit more objectivity would probably help, too.

Click here for the study in PLOS ONE.

Monhegan (Hope), painting by Nicholas Roerich / WikiArt

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August 9, 2017