Friday, July 1, 2011

State Bans on Municipal Obesity Prevention Measures?

As states make hard decisions about budgets, some lawmakers are eying up public health initiatives to cut costs. Under pressure from the restaurant industry and business owners to reduce burdensome restrictions, some legislators concerned that government intervention in private industry will harm economic growth, feel emboldened to pass measures that effectively tie the hands of municipalities to regulate harmful business practices that affect their local residents. Many of these legislators justify such measures further because they believe that consumers are to blame for their “choices”. For example, on the topic of labeling requirements and restrictions on trans fats, Ken Johnson, a member of the Alabama House of Representatives, recently stated in a New York Times article that “It’s a lack of self-discipline many times, and even if we, say, limited a hamburger to being no more than 200 calories, it doesn’t mean I won’t choose to eat four of them.” He supported legislation in Alabama to prohibit municipalities from passing regulation on restaurants even though no municipality in that state had adopted regulations around nutritional labeling or nutritional standards for to date. Ironically, as a measure to reduce obesity, these types of regulations are aimed at helping consumers make better choices by giving them knowledge about what they are consuming. 

If economic austerity is the concern, then nothing provides a better return on investment then prevention. The US Department of Health and Human Services’ Agency for Health Care Research and Quality (AHRQ) estimates the potentially preventable costs of diabetes to Medicare was $1.3 billion in diabetes-related hospital costs and $386 million in potentially preventable hospital stays costs to Medicaid(Agency for Healthcare Research and Quality, 2005). The American Dietetic Association’s Diabetes Care and Education group’s cost-effectiveness review of preventive programs found that lifestyle interventions were cost effective and in their findings state that “prevention is more cost-effective than intensive treatment of diabetes”(Patti Urbanski, Wolf, & Herman, 2007).

Obesity and obesity related diabetes are multifaceted health problems that are much more complicated then saying people need to make better decisions. For example, the American Academy of Pediatrics just issued a policy statement based on new research calling for a reduction in screen time for children and a ban on junk food advertising because it encourages sedentary behaviors, mindless eating and targets children as consumers for poor quality foods (American Academy of Pediatrics, 2011).  In that statement, Victor Strasburger, MD, FAAP, a member of the AAP Council on Communications and Media, stated that “Thirty years ago, the federal government ruled that young children are psychologically defenseless against advertising.  Now, kids see 5,000 to 10,000 food ads per year, most of them for junk food and fast food,”. Clearly, the problem of obesity and obesity related diabetes can’t be reduced to a moral argument about “self-control”. 

Municipalities need to be able to implement disease prevention programs and initiatives. Without the legal authority to do so, the Santa Clara County supervisors would not have been able to adopt a policy that forbids fast food restaurants from selling meals with toys in an attempt to reduce the influence of marketing on children’s eating habits. The AAP clearly thinks that this type of advertising affects children. While the jury is still out on the effectiveness of these types of regulations, state level prohibitions on a municipality’s ability to control harmful business practices will eventually end up costing rather than saving money.  These types of bans make it harder for cities and towns to implement effective policies aimed at reducing public health concerns specific to the conditions and drivers of that community.

Many communities are introducing interesting and potentially fruitful policies to encourage healthy eating and increased activity. (Check out the links below) Should State legislators be able to prohibit these measures?

Boston’s Mayor Menino Issues Order to End Sugary Drink Sales on City Property

Santa Clara’s Fast Food Toy Ban

Sugary beverages bans see earlier post -

               Agency for Healthcare Research and Quality. (2005). Economic and Health Costs of Diabetes: HCUP Highlight 1. . Retrieved from
               American Academy of Pediatrics. (2011). MEDIA, KIDS AND OBESITY: IT'S NOT JUST ABOUT COUCH POTATOES.
               Patti Urbanski, et. al.  (2007). Cost-effectiveness Issues of Diabetes Prevention and Treatment. Retrieved from
               Strom, S. (2011). Local Laws Fighting Fat Under Siege. The New York Times. Retrieved from

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