Running head: ANALYZING PROPOSED POLICIES TO FIGHT THE OBESITY EPIDEMIC 1

Analyzing Proposed Policies to Fight the Obesity Epidemic in America

Jordan Susa

PSC 325

University of New England

Introduction

In the United States, 39.8% of adults and 18.5% of youth are obese (Prevalence 2017).

Those numbers have been climbing since the 1970s, and data suggests that those numbers are

still growing (Mitchell 2012). Obesity is particularly dangerous, because, while it can cause

some serious physical ailments that people are generally aware of, it can lead to some

debilitating mental conditions as well (Simon 2006). Its increasing prevalence, when working in

tandem with the broad spectrum of health conditions that can accompany it, are what make

obesity such a pressing health concern. Unfortunately, existing programs that have been

implemented to combat obesity have been not been met with the level of success officials

might have hoped (Chan 2010). This paper outlines and analyzes a public health policy that will

hopefully be effective in the reduction of obesity in the United States.

Background

Obesity is defined by body mass index, or BMI. If someone has a BMI of over 30kg/m2,

they are considered to be obese. With no regard towards sex, age, race, or socio-economic

status, obesity rates in the United States have been on the rise since the 1970s, when only

about 12% of the population was considered obese (Mitchell 2012). As previously mentioned,

today nearly two out of five American adults and one out of five American children battles

obesity. These high rates have potential to cause disastrous health outcomes, as obesity is well

known to put its victims at an increased risk for high blood pressure, high cholesterol, type 2

diabetes, and stroke among others. In addition to the more physical consequences, obesity can

also lead to serious mental disorders, including anxiety and depression related to the stigmas

associated with the disease (Adult 2017). Even though obesity has become more prevalent
Running head: ANALYZING PROPOSED POLICIES TO FIGHT THE OBESITY EPIDEMIC 3

across all populations, it is found in greater rates among those with lower incomes and lower

education levels, who may not have the proper access or information to make well-informed

health decisions (Mitchell 2012). When grouped by race, non-Hispanic black and Hispanics face

the highest rates of obesity in child and adulthood in comparison to other demographics,

specifically on average about 48% of non-Hispanic black adults and 42.5% of Hispanic adults are

obese (Arroyo-Johnson 2017). People in this group are already predisposed to a wide range of

health problems, including a higher mortality rate than their wealthier counterparts (Adler

2002). This supports the belief upheld by many obesity researchers; that while obesity is

directly caused by poor diet and lack of physical activity, our physical and social environments

have a larger role in the obesity epidemic than the individual’s choice (Mitchell 2012).

The problem of obesity is a complex one. Unlike some health conditions, obesity affects

several environments, includes the involvement of several industries, and affects both the

manners in which energy is consumed and expended by the human body. Therefore, a complex

solution is necessary to minimize the epidemic. Due to the success that population-based

reduction approaches had on tobacco use, public health officials believe the key to reducing

obesity rates also lies in broad public policy that will work in a bottom-up manner, meaning

local governments will first enact obesity public policies that will eventually make their way to

the state level. Although many public policies to combat obesity already exist at the federal

level, like the Healthy and Hunger-Free Kids Act, more localized policies seem to be the most

promising for battling a health issue of this magnitude (Chriqui 2013).

Options
Running head: ANALYZING PROPOSED POLICIES TO FIGHT THE OBESITY EPIDEMIC 4

As far as proposed policies to address the epidemic, there are three that will be

analyzed in this paper. The first policy suggested would be a tax on “sugary” beverages and soft

drinks. Due to the near universal consumption of soft beverages and soda in the US, and their

contribution to the obesity epidemic, evidence strongly suggests that a tax on those beverages

would lower obesity rates (World Health 2017).

The next proposed policy option would be higher private health insurance premiums for

the obese. Because obesity predisposes for some other serious conditions, the insurance

agencies would want to ensure they would cover the healthiest people. This fine would then

act as a disincentive to a person afflicted by obesity. In turn, this would motivate the obese to

improve their health so they can be covered by insurance at a lower rate.

Lastly, is the proposal to incorporate mandatory weight management programs into

workplace health promotion. Besides sleep, nothing consumes as much time in a working

adult’s life as work does. Even though it takes up a majority of the day, a lot of jobs have few

physical components to them, resulting with many living stagnant lifestyles. A policy to address

obesity in the workplace specifically would be a great medium in which to address the obesity

epidemic.

Public Health

In terms of public health, the first policy narrows right down on the issue, and while it

doesn’t completely disregard civil liberty and ban soda, it applies a price increase to gently

dissuade consumers from drinking unhealthy beverages. However, are “sugary” beverages

really the most powerful food item that can be taxed to reduce obesity? The research suggests

that maybe they are. Between 1970 and 1997, the US soft drink consumption levels rose 86%,
Running head: ANALYZING PROPOSED POLICIES TO FIGHT THE OBESITY EPIDEMIC 5

and obesity rose by approximately 112% in that time frame. Additionally, comprehensive

reviews of studies done between 1938 and 2007 report that, on average, a 10% increase in the

cost of soft drinks would reduce their consumption by 7.9%. Furthermore, a study published in

2012 found that a tax that raises soft drink prices by 20% would reduce their consumption by

24%. A potential problem with this policy, however, is that research suggests that taxes would

need to be relatively high to lead to significant changes in weight. This may pose a problem in

itself due to likely pushback the policy will face from stubborn consumers who argue that they

should be able to drink whatever they want. On the other hand, increased revenue from the

higher taxes may lead to better obesity awareness, prevention, and reduction programs, which

will further lead to fewer people with obesity, as was the exact case with tobacco (Powell

2012).

The second policy also dissuades consumers from living a sedentary lifestyle, but in a

more aggressive manner. Charging the obese higher rates for health insurance makes sense

from an insurance stand point; those with obesity are significantly more likely to develop worse

health conditions, meaning insurance agencies would have to spend more money to cover that

person. However, it doesn’t really focus on fighting the problem of obesity itself. In 2017, about

8.8% of American adults did not have any health insurance for any point in the year (US Census

2019). Not only would this policy be virtually useless to roughly 10% of America, but research

has shown that that a significant amount of people living with obesity are the uninsured, who

are unable to afford an insurance policy (Levine 2011). Not only does this policy then miss a

significant portion of its target population by not being accessible through socioeconomic
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classes, it fails to provide information on health education and healthy behaviors, which are

methods proven to be successful in combatting obesity (Chan 2010).

The last proposed policy, mandating workplace health promotion, is an excellent

approach to the public health problem. Oftentimes, a work environment does not involve a lot

of physical activity, and even if it does it usually does not also address imponent components of

a healthy diet. Most Americans are stuck in these environments for 40 or more hours per week,

which is not conducive to the lifestyle of someone trying to fight obesity. Additionally, all the

time spent at work minimizes the time that could be spent learning about healthy behaviors to

fight obesity. According to the CDC, workplace health promotion efforts can be quite successful,

and even more successful if a specific health issue or population is addressed at a time

(Workplace 2016). Several studies back up the fact that workplace health promotions can be

successful in controlling obesity, including simple nutrition and physical activity interventions

(Anderson 2010). One reason behind their success could be that workplace programs like these

oftentimes covers topics material not covered in legislation, like the promotion of healthy

lifestyles (Workplace 2010).

Political Factor

Policies raising taxes on a product will no doubt be met by angry consumers. While

about 60% of the population would oppose a tax on sugary beverages because it doesn’t

disincentivize other unhealthy foods, about 54% of Americans thought the tax was an intrusion

into Americans’ lives, and about 50% just generally did not support a tax on sugary beverages

(Barry 2013). Pushback won’t just be met from consumers, though, the soft drink industry will

also want to fight the policy. In fact, in San Francisco, when the city was voting on a proposed
Running head: ANALYZING PROPOSED POLICIES TO FIGHT THE OBESITY EPIDEMIC 7

sugar tax, and American Beverage Association spent 19 million dollars opposing the city’s

proposal (Roache 2017). Because of political capital, politicians will then be less likely to publicly

support sugary beverage taxes, so they do not become unpopular amongst the voters.

Life insurance premiums are already higher for obese people, so higher premiums for

health insurance based on that same premise would not be a completely ludicrous idea.

Actually, people living with obesity who get their health insurance in private markets (usually

through the workplace) are more likely to have higher insurance premiums, as a way to pay for

their likely greater need for medical care (Bhattacharya 2009). This policy would be most

supported then, by the private insurers, as it would be a way for them to maximize profit. The

policy however would most likely be unpopular among the obese populations who need to

insurance, especially those who rely on the private insurance offered through the workplace.

The policy proposing mandatory workplace health interventions would be supported by

employers and employees alike. For the employees, a workplace health program has the

potential to improve overall health, like their health behaviors; current health status; and

health risks for disease, which is especially important with obesity as it can lead to a number of

unhealthy conditions. The employers may be motivated by a workplace health program, as it

has the potential to improve areas such as health care costs, absenteeism, productivity,

workplace culture and employee morale (Workplace 2016).

Economic Factor

There is some evidence that suggests that, since the overconsumption of sugar via

sugary beverages is so widespread, that the imposition of a tax would save the United States a

significant amount of money on health care spending (Roache 2017). However, there is some
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evidence from cities, such as Philadelphia that already have a sugary beverage tax imposed,

that a tax like the one in question can drive shopping away from these cities, an effect that

could have severe consequences on the local economy (Frazee 2018).

Imposing higher premiums, which are already on the rise as it is, for private health

insurers to cover people living with obesity may only contribute to rising health care costs,

which further dampens the US economy. Research also indicates that spending from public

insurance, like Medicaid and Medicare, is expected to rise as well, which will only further drive

up health care spending (High 2019). However, if both public and private insurance rates are

climbing, perhaps a higher premium for obesity would go relatively unnoticed.

As previously mentioned, workplace health programs can lead to better productivity

amongst employees, which should maximize company profits. Conversely, time spent focusing

on obesity interventions may distract and take time away from the work day, resulting in fewer

hours of productivity (Workplace 2016).

Social Determinants

Research suggests that a sugary beverage tax is regressive, meaning most of the

financial burden would fall among the lower socioeconomic groups, some of which are

populations most affected by obesity. Moreover, these groups often do not have the means to

drive to another city or location not affected by the tax, meaning they are forced to pay the tax.

However, seeing as the point of the tax is to avoid the purchase of sugary drinks, perhaps this

means it will positively impact lower socioeconomic groups in terms of their health (Frazee

2018).
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According to the CDC, people of lower socioeconomic groups in the United States are

less likely to have any kind of health insurance, so this policy would probably minimally affect

them (Health Disparities 2018). However, public insurance via Medicaid is still optional, and the

policy would not affect public insurance, so perhaps those who are able to afford insurance will

be able to be insured by the public system. Those who do have a lower SES and are insured

privately however might face some undesirable consequences. A study published in 2014 found

that obese workers who received health insurance through the workplace paid for their likely

expensive medical bills by earning lower wages than healthier employees (Bhattacharya 2009).

In the workplace, socioeconomic differences in quality of work correspond to

differences in health (Aittomäki 2003). Not only would the workplace health intervention

remedy this by boosting productivity and work ethic, it would also teach members of the lower

socioeconomic groups valuable health information they would not be able to obtain elsewhere,

due to lack of education, resources, etc. (Workplace 2010).

Legal Factor

There are some legal issues at both federal and local levels regarding a tax on sugared

beverages. At the federal level, legal issues could come up in regard to due processes or equal

protection because it singles out sweet drinks, however courts have been lenient with this

because there is a “rational basis” for the tax. At the local level, the issues arise from whether

the state or local government has the authority to set the tax, as each state does not follow one

clear structure for tax policies. Additionally, some states, such as New York, reserve powers of

setting tax to larger cities, like New York City, which has an additional cigarette tax (Francis

2016).
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It is legal for insurance companies to charge higher rates for a higher BMI, which is

linked to obesity (Epstein 2019). However, this system may be flawed, as BMI doesn’t take into

account fat to muscle ratios, only the weight as compared to the height (Mitchell 2012). As a

result, people who are not actually obese, maybe just have more weight due to muscle, may be

charged the premium usually reserved for someone with obesity.

Although there is no definition of a “wellness program” from a legal perspective, the

question becomes should employers reward their employees for participating in the health

programs, or should employees be penalized for not following the healthy behaviors. A delicate

balance has to be maintained to ensure that no issues arise from the health program to such an

extent that the employer is taken to court over them (Mujtaba 2013).

Recommendation

Based upon the three policies analyzed, I would say that the third, the mandated

workplace health intervention, would be the least problematic to establish and follow and

would yield the best results. The insurance policy really didn’t address the public health issue at

hand, and also seemed to only further the gap between socioeconomic classes. While the

sugary beverage tax also had some potential, there would’ve been too many obstacles in the

way, between stakeholders in the industry and also possible pushback from politicians. The

workplace prevention intervention is already being utilized by some companies, and both the

CDC and the WHO claim they can drastically improve the health of the employees. These

programs shall aim to spread a message about healthy behaviors and teach employees how

they can better fight the obesity epidemic.

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