Correspondence

Obesity and Public Health Law

N Engl J Med 2006; 355:1283September 21, 2006

Article

To the Editor:

Mello et al. (June 15 issue)1 discuss obesity as the new frontier of public health law. Public strategies including legislative regulation against obesity must take into account the fact that obesity is closely associated with low income.2 Obesity in low-income families originates at an early stage of life, possibly through unhealthy food selection3 and eating patterns and a sedentary lifestyle.4 Aside from economic considerations, a lack of knowledge about5 and a limited access to6 healthy food choices seem to be crucial aspects of the problem. Therefore, strategies against obesity need to encompass educational efforts to promote a healthy lifestyle and remove obstacles to the achievement of that goal for persons at high risk for obesity.

Takeharu Koga, M.D., Ph.D.
Atsushi Kawaguchi, Ph.D.
Hisamichi Aizawa, M.D., Ph.D.
Kurume University School of Medicine, Kurume 830-0011, Japan
kogat@med.kurume-u.ac.jp

6 References

1. 1

   Mello MM, Studdert DM, Brennan TA. Obesity -- the new frontier of public health law. N Engl J Med 2006;354:2601-2610
   Full Text | Web of Science | Medline

2. 2

   Miech RA, Kumanyika SK, Stettler N, Link BG, Phelan JC, Chang VW. Trends in the association of poverty with overweight among US adolescents, 1971-2004. JAMA 2006;295:2385-2393
   CrossRef | Web of Science | Medline

3. 3

   Turrell G, Hewitt B, Patterson C, Oldenburg B, Gould T. Socioeconomic differences in food purchasing behaviour and suggested implications for diet-related health promotion. J Hum Nutr Diet 2002;15:355-364
   CrossRef | Web of Science | Medline

4. 4

   Bowman SA. Television-viewing characteristics of adults: correlations to eating practices and overweight and health status. Prev Chronic Dis 2006;3:A38-A38
   Medline

5. 5

   Dibsdall LA, Lambert N, Bobbin RF, Frewer LJ. Low-income consumers' attitudes and behaviour towards access, availability and motivation to eat fruit and vegetables. Public Health Nutr 2003;6:159-168
   CrossRef | Web of Science | Medline

6. 6

   Baker EA, Schootman M, Barnidge E, Kelly C. The role of race and poverty in access to foods that enable individuals to adhere to dietary guidelines. Prev Chronic Dis 2006;3:A76-A76
   Medline

To the Editor:

As Mello et al. state, legal as well as voluntary measures are needed to prevent the health consequences of obesity, but they do not mention the importance of the size of food portions. Fast-food outlets tend to encourage the sale of large portion sizes, with the financial incentive that the large size is just a little more expensive than the standard size. In 2004, Willett and I1 suggested that standard portion sizes should be specified for selected high-calorie food items (e.g., hamburgers, pizzas, and sugary drinks), and larger sizes should be priced in a manner that is proportional to size, so that double-sized portions should cost at least twice as much as standard portions. Financial and health goals would then be better aligned, and there would be one policy for all vendors, in which competition over the standard-portion price would be preserved.

Public health agencies have used pricing to influence consumption in effective ways (e.g., in reducing the sale of cigarettes). Changes in pricing with respect to the size of food portions should be explored, alongside accepted strategies that include education, food labeling, and the provision of healthier institutional meals.

Nicholas J. Wald, F.R.S.
Wolfson Institute of Preventive Medicine, London EC1M 6BQ, United Kingdom
n.j.wald@qmul.ac.uk

1 References

1. 1

   Wald N, Willett W. Reversing the obesity epidemic. Lancet 2004;364:140-140
   CrossRef | Web of Science | Medline