American Journal of Law & Medicine

The obesity agency: centralizing the nation's fight against fat.

I. INTRODUCTION

Fat. Many love to eat it, but hate to carry it. The majority of people in the United States struggle to get out of this love/hate bond. Unfortunately, they find themselves stuck in an abusive relationship.

Obesity is the "fastest-growing major health problem in the United States." (1) Approximately two thirds of American adults are overweight or obese. (2) In addition, 15 percent of children are overweight. (3) The number of people suffering from this chronic ailment dwarfs the number of people afflicted with other diseases such as HIV/AIDS, cancer, diabetes and heart disease. (4) Obesity leads to over 400,000 deaths a year, (5) and it costs the United States over $117 billion per year. (6) The prevalence and cost of the disease "warrants an increased emphasis on prevention and treatment." (7)

Despite the increased need for prevention and treatment, no large-scale effort has taken place to institute preventative and therapeutic measures. In fact, no one wants to take responsibility for the problem. The food industry blames those who do not make proper choices in what foods they eat. (8) Likewise, those blamed for not making proper choices accuse the food industry of facilitating their addiction to its fatty and unhealthy food. (9) Not even the government, which may have the greatest ability to effectuate positive change, (10) can say it has taken sufficient steps to fight this problem. (11)

This Note investigates the government's role in creating and implementing public policy to deal with obesity. Part II discusses the problem of obesity and explores current causes of the disease within the scope of three theoretical models. Part III suggests a fundamental step the government should take to address obesity: the creation of a public health agency dedicated solely to alleviating the obesity epidemic. Part IV evaluates the political and social backdrop in which public health agencies currently operate and analyzes challenges that a new agency will face in dealing with obesity. Finally, Part V concludes that the government can and should lead the way in creating policy to initiate behavioral, social and environmental changes that will improve nutrition and increase participation in physical activities. These improvements, in turn, should effectively reduce the prevalence of obesity.

II. THE PROBLEM OF OBESITY

A. THE SCOPE OF THE PROBLEM

As stated above, the "battle of the bulge" affects the majority of people in the United States. (12) The number of people suffering from weight problems has increased over the past four decades. (13) This weight increase plagues people of all ages, racial and ethnic groups and genders. (14) While many people focus on the cosmetic concerns related to excess weight, the morbidity and mortality rates due to excess weight suggest more than just an aesthetical problem. (15)

Overweight people have a greater risk of developing high blood pressure, diabetes, abnormal blood fats, coronary artery disease, stroke, osteoarthritis, sleep apnea, cancer (uterine, colorectal, gallbladder, and prostate), gallstones, gout and joint disorders. (16) Furthermore, the risk of death rises as weight increases. (17) Obese individuals have a "50-100% increased risk of premature death from all causes, compared to individuals with a healthy weight." (18) Overweight individuals also suffer psychological effects from their weight. Overweight people, for instance, are more likely to suffer from social stigmatization, discrimination, depression and lowered self-esteem. (19)

B. DEFINITION OF OBESITY AS A DISEASE

The public health discipline uses three primary theoretical models to explain the origin of diseases: the microbial model, the behavioral model and the ecological model. (20) Each model attempts to describe how a given disease affects society. These models diverge in their conceptions of what makes people healthy, the types of measurements used to evaluate a disease and the policy problems that the model addresses. (21)

1. The Microbial Model

Under the microbial model, disease stems from microbial infection (or exposure to toxic substances of some other sort). (22) Public health agencies must "identify the pathogen and ... eliminate or contain it." (23) For example, public health agencies involved in water purification and meat inspection "help prevent harmful bacteria from entering the food chain." (24) In short, agencies measure health under this conception through "testing and screening for infection, reporting cases of notifiable diseases to public health departments, and conducting surveillance or epidemiological investigations that monitor the incidence and prevalence of disease." (25)

2. The Behavioral Model

Human behavior has become known as one of the most important determinants of health. (26) In fact, 50% to 70% of health status stems from behavior, making it the most significant determinant of the three models. (27) This notion of disease emerges from modern emphasis on the role of smoking, diet and sedentary lifestyle in the development of conditions such as cancer, heart disease and stroke. (28) Additionally, the model encompasses the influence of behavior on causing injuries and accidents (e.g., the use of seatbelts, bicycle helmets and firearms) and in transmitting infection (e.g., sexual or needle-sharing behavior). (29)

3. The Ecological Model

The ecological model conceives of illness as "a product of society's interaction with its environment." (30) Thus, while ecological theorists do not ignore the other models, they "emphasize social institutions and activities, human inequality, and economic activities as the major health risks in a population." (31) Contributing factors to health under this model include money, knowledge, power, prestige and the interpersonal resources embodied in the concepts of social support and social network. (32) Ecological theorists treat smoking, for instance, not as a personal choice, but as a product of a smoker's environment. (33) Accordingly, the government responds with laws regulating the price of cigarettes and banning smoking in public places. (34)

4. The Mechanics of Weight Gain

Empirically, excess weight results from "an imbalance involving excessive calorie consumption and/or inadequate physical activity." (35) In other words, a person gains weight if she or he consumes more calories than she or he uses, thereby causing the body to store those excess calories as fat. (36) Consequently, overweight and obesity issues stem mainly from behavioral and environmental factors such as a sedentary lifestyle. (37) These factors provide the greatest opportunity for "actions and interventions designed for prevention and treatment" of obesity. (38) Government intervention, therefore, must focus on the behavioral and ecological models of disease. (39) Specifically, successful interventions or improvements in the obesity epidemic depend on reductions in risky behavior that causes morbidity and premature mortality and the environmental factors that produce or allow this behavior. (40)

C. IMPLICATIONS FOR THE FUTURE

If the nation does not adequately address obesity now, the problem will only worsen. The relationships between obesity and heart disease, diabetes and several cancers are now "firmly enough established that we can predict the obesity epidemic will have substantial adverse effects on the future health of Americans." (41) Despite the declining death rates in heart disease and cancer due to changes such as tobacco control, blood pressure treatment and cholesterol reduction, (42) the obesity epidemic will substantially hinder future gains. (43)

III. THE FUNDAMENTAL STEP TO DEALING WITH OBESITY PROBLEMS

The problems of obesity stem from a complex mix of genetic, behavioral and environmental factors. Many people have offered positive and beneficial solutions. …

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