A Big Fat Crisis (22 page)

Although we might be able to resist buying chocolate at the hardware store, we cannot prevent the craving that the sight of sugary or savory foods ignites. We may not be aware of or even able to prevent the excessive eating that may subsequently occur once we are stimulated or primed. It also may be very hard to refuse the free candy at the bank or the hair salon when we are preoccupied with other thoughts. Food that increases the risk of chronic diseases should not be sold or distributed in retail outlets other than those fully dedicated to food. If we really want to eat, we will go to a food outlet.

Impulse marketing works not just by placing candy at the cash register, but also by making such items salient among a crowded food-scape and reducing the effort people might otherwise make to search for a better option. The placement of items on a menu (e.g., first on the menu board, upper-right corner of the menu) can influence our choices. A couple of controlled studies have shown that the order in which food appears on a menu influences what people buy.
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Because customers quickly scan a menu, they tend to choose items listed either first or last on a list, as these items are more salient. Even at a salad bar, people are more likely to select items that are at the edges rather than in the middle.
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Ease, convenience, and salience often trump individual preferences.

Earlier I described how “combo” meals are often preferred because they reduce the effort people have to make in choosing what to eat and because of price manipulations that highlight potential savings.
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One regulatory option would be to restrict the sale of meals as “combos” or “value meals” if they contain any food that is considered “low nutrient” or that has too much fat, sugar, salt, or calories. This restriction wouldn’t prohibit people from buying whatever food they want, but it would prevent people from automatically getting something that could harm them just because they made a choice without thinking carefully. Regulations that help people make deliberate choices rather than automatic ones are common in many other settings where people have to make important decisions.

Our society caters to impulse buying, and in doing so it fosters it. Anything that triggers an emotional response and makes it easy to act quickly on the emotion should be considered impulse marketing. It has been shown that restrictions on hours and days of operation are effective in controlling drinking and other alcohol-related problems. Typically bars close at 2 a.m.—but not everywhere. When closing times of bars and other alcohol outlets are relaxed, alcohol-related problems tend to increase.
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Limiting hours of operation for food outlets could also have a beneficial effect. It has only been in the past thirty years that large numbers of supermarkets, convenience stores, and even restaurants are routinely open for twenty-four hours per day. Having food available all
the time allows people to wait until the last minute and allows fleeting moods to govern people’s choices. The food suddenly desired might have just been featured on TV. A craving could be triggered by a billboard or a smell. And more likely than not, impulse buying and eating lead to choosing foods that are higher in sugar and fat.
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When people are more thoughtful about choices, they are less likely to choose unhealthy items.
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Restricting the hours of food outlet operation would require people to make a greater effort to plan their shopping, and could reduce the frequency of impulse buying.

Most localities want to discourage drinking and driving. To that end, nearly all prohibit the sale of alcohol through drive-through windows. After New Mexico banned drive-through alcohol outlets in 1998, sales of alcohol decreased and rates of alcohol-related fatalities dropped substantially.
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The city of New Orleans, however, still has drive-through daiquiri shops and among the highest rates of alcohol-related traffic fatalities in the nation.

Just as limiting drive-through alcohol sales reduced alcohol sales and drinking, limiting the use of drive-through windows for food sales would likely reduce impulsive eating behaviors and would require people to do more planning to obtain food. Outright bans may not be acceptable, but reduced hours for the drive-through windows would certainly help curtail impulsive eating behaviors—e.g., windows open only during peak hours, such as 12 to 1 p.m. or 5–7 p.m. This would reduce the likelihood that people might add an extra meal to their intake just because they passed a drive-through that is open at 3 in the afternoon or 10 at night. If they were really hungry they could park, and go inside or walk up to the window to order.

Counter-Advertising

A lot of attention is being paid to media advertising that targets children; indeed, some claim that this one component of marketing is the largest driver of childhood obesity.
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Although I agree that targeting children with junk food advertisements is a heinous practice because children lack the capacity to respond critically, I still think it is better to create counter-advertising than to ban such advertising. Furthermore,
our society is dedicated to the protection of free speech, and I expect it will be a long time before we are ready to be more stringent on regulating commercial speech—even though, legally, commercial speech is not protected.

From 1968 to 1970, the Fairness Doctrine allowed the placement of anti-tobacco advertising to counter tobacco advertising. One of the most effective ads shown during that time was called “Like Father, Like Son,” which pictured a young child mimicking whatever his father did. The opportunity to be better role models gave parents a good reason to quit smoking. With strong anti-tobacco ads, tobacco sales fell by 15 percent—without any increase in tobacco taxes and before there was widespread institution of clean air laws.
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Thus, counter-advertising will likely be a promising avenue for countering the promotions of low-nutrient foods. Not only could counter-ads frequently remind us in a strong and convincing way of how unhealthy some foods really are or point out how advertisements manipulate us, they could also function as primes to help us resist junk food and extra-large portions.

Currently there are hardly any counter-ads that discourage people from eating unhealthy foods. Instead, the emphasis is on promoting fruits and vegetables, which has not been shown to reduce weight.
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For people to lose weight by adding fruits and vegetables to their diets, they would have to give up other foods, which apparently most do not.

Where counter-advertising has been used, it has often been successful in influencing behaviors. People typically pay more attention to negative messages, which is why they are invariably used in political campaigns.
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When messages include warnings, they can help people avoid foods and consume less.
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A limited number of campaigns have been directed against food products. The British Heart Foundation launched a campaign against “crisps” (potato chips), and New York City has launched a campaign against sugar-sweetened beverages.

No formal evaluation has yet been published about the impact of these campaigns. Yet early results from New York City are promising. Dr. Tom Farley, the city’s Commissioner of Health and Mental Hygiene, reports that soda consumption there is beginning to decrease.

However, both the British and New York City campaigns were handicapped in that neither had the capacity to directly label these products, thereby allowing people to see the negative information about the product at the point of purchase.

I think that standardizing portion sizes, limiting impulse marketing, and running counter-advertising are the three policies that could make
the biggest difference for the most people in the shortest amount of time, if they were adopted. However, there are at least six other interventions that build on our historic experience with alcohol control and are well worth examining. Let me briefly review these below.

1. Density Restrictions

Most states limit the number of outlets that can be licensed to sell alcohol. Why not do the same to limit the number of outlets that primarily sell food that is associated with chronic diseases, like doughnut shops, candy stores, and ice cream parlors? How many of these do we really need? Does it make sense for every office building to have junk food vending machines on every floor? Isn’t it plausible that having candy and sodas on every corner and in every building causes people to consume more of these unhealthy foods? Having fewer junk food outlets will likely reduce the frequency with which we consume such foods.

2. Pricing

Increasing alcohol taxes has been shown to reduce drinking, and restrictions on alcohol price promotions are also common. Most US states and localities prohibit “specials,” like “all you can drink” nights and “ladies drink free” nights. These policies reduce alcohol use and other alcohol-related problems.
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Similarly, increasing the price of foods most strongly associated with the risk of obesity and other chronic diseases could lead to reductions in consumption. Restrictions on “all you can eat” buffets and prohibitions on price reductions for junk food, like “ten for $10” or “two for the price of one” should be considered.

3. Warning Labels

Until now, in the United States, the warning labels for alcohol and tobacco have been limited to words. However, in Canada, graphic images showing the harms of tobacco are displayed on cigarette packages. Such images are effective in discouraging smoking and helping people quit.
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Why not use graphic warnings for foods that increase our risks of chronic diseases? How many mothers would pack children’s lunch bags with bologna sandwiches if the package had a symbol indicating that frequent consumption of bologna is associated with an increased risk of cancer? (It is.) We could create symbols that let consumers know which foods increase the risk of heart disease (e.g., foods high in sugar and high in saturated fat) and other chronic diseases (e.g., salty foods increase the risk of hypertension and stroke), and make sure vivid, graphic warnings are on the package and easily visible right at the point of purchase.

4. Workplace Interventions

Drinking on the job is prohibited everywhere, even though that wasn’t always the case. Businesses can establish policies that protect their workers as well as support healthy behaviors during the workday. They could offer walking and exercise breaks for sedentary workers, and establish policies that would reduce the consumption of food—especially junk food available in vending machines, the company cafeteria, at meetings, and in shared workspaces.

5. Server Training (Responsible Beverage Service)

Many localities require anyone who serves or sells alcohol to undergo a server-training program to learn how to protect both the business and consumers and how to adhere to alcohol laws including checking for legal proof of age.
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Server training may potentially be relevant to obesity prevention if additional regulations that govern sales of foods are adopted and workers need to understand their role in enforcing the regulations or recommending items most likely to support a healthy diet.

6. Age Limits

Raising the drinking age to twenty-one has been a very effective policy, saving tens of thousands of lives.
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Efforts are already under way to restrict the sale of unhealthy foods to children in school settings. Although prohibitions on the sale of these foods to children
outside school might not be politically or socially acceptable, labels on foods that are not allowed in school can help parents identify what to avoid in the supermarket, empowering them to control their children’s intake of junk food. Such age-based labels could be very powerful in changing norms concerning children’s routine consumption of low-nutrient foods.