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By Bernice Yeung, Health and Welfare Reporter at California Watch
According to a recent analysis of medical costs in the research journal Obesity, California spends an estimated $15.2 billion on obesity-related health problems each year - the most in the country.
The California Department of Public Health's Obesity Prevention Plan seeks to reduce obesity rates among Californians, calling for strategies ranging from easing access to fruits and vegetables to building roads and sidewalks to make walking easier.
It also wants to limit children's exposure to "unhealthy" food and beverage advertising. One in nine California kids is obese or overweight, and a disproportionate number are minority and low-income children, according to the state Department of Public Health.
"California and the nation face a growing obesity epidemic that threatens the life expectancy gains of past decades and portends greater increases in health care costs," the plan states.
The new federal nutritional rules for government-subsidized school-based meals that were announced this week are being hailed by public health advocates as a strong obesity prevention measure. But federal efforts to address the connection between obesity and food marketing to children recently stalled, when funding for a set of proposed national marketing standards became contingent on a cost-benefit analysis mandated through an appropriations bill passed in mid-December.
Much of the national attempt to address food advertising to children has been focused on these proposed marketing standards, drafted by the Interagency Working Group on Food Marketed to Children. The group was created by Congress in 2009 to recommend standards for advertising food to kids. About $1.6 billion is spent annually on ads targeting kids through TV commercials, social media, mobile phones and recently via computer-based "advergames," or food company-branded online games.
Public health and child advocates argue that advertising by fast food and junk food companies encourages poor eating habits and puts children at risk for obesity. A recent study by researchers at Yale University's Rudd Center for Food Policy & Obesity, for example, found that "after playing unhealthy food advergames, children consumed more nutrient-poor snack foods and fewer fruits and vegetables" and concluded that restrictions should be placed on food-related advergames.
Last year, the working group - made up of the U.S. Department of Agriculture, Food and Drug Administration, Centers for Disease Control and Prevention, and Federal Trade Commission - issued draft voluntary guidelines [PDF] that call on the food industry to reformulate some products to meet specific nutritional guidelines if they are to be advertised to children.
It was met with opposition from food, advertising and media companies.
"We felt the guidelines were overly restrictive and inappropriate," said Dan Jaffe, executive vice president of government relations for the Association of National Advertisers. "For the 100 most popular foods in this country, 88 would not have made the cut, including whole wheat bread, most yogurts, virtually all cereals and many things that parents would be thrilled for their kids to be asking to eat, particularly those who are health conscious."
The Sensible Food Policy Coalition, made up of the country's largest food manufacturers, launched a "Keep the Government Out of Your Kitchen" media campaign. Food manufacturers also argued that the industry already self-regulates its advertising to children through organizations like the Council of Better Business Bureaus' Children's Food and Beverage Advertising Initiative.
"Industry has gone to great lengths to improve its products," said C. Lee Peeler, an executive vice president for the council. "Look at what has happened in the fast food industry, where fast food products that are advertised to kids are now low-calorie and a fruit or a vegetable is included. These improvements are driven by the marketplace. Self-regulation on this issue has been successful, and it will continue to grow."
But public health advocates say there are too many loopholes to the Council of Better Business Bureaus' self-regulation.
"Part of it is that the food and beverage companies want to say that they are changing the way they market to kids without really having to change their marketing in any meaningful way," said Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest. "The guidelines would help to show how weak their current self-regulation efforts are."
The proposed guidelines also have sparked a legal debate: Food industry representatives have resisted the draft guidelines because they argue that limitations placed on advertising violate food companies' First Amendment rights to free speech.
"By using the coercive force of government agencies to suppress truthful advertising about a broad range of healthy, legal products for every segment of the public, the proposal clearly violates the First Amendment rights of both marketers and consumers," the Association of National Advertisers' Jaffe told legislators in October.
But Public Health Law & Policy's Samantha K. Graff called the argument "ridiculous."
"They are voluntary guidelines from the U.S. government and do not violate the First Amendment," she said. "Agencies do this kind of thing all the time; it's basic government doing its job. They are trying to distort the First Amendment and throw it into the mix to intimidate lawmakers."
A paper to be published in February's American Journal of Public Health by Graff and the Rudd Center's Jennifer L. Harris further argues that federal policymakers have the ability to regulate food marketing aimed at children without violating free speech laws through "carefully tailored government actions."
Public health advocates said food and beverage industry lobbyists pushed for the delay of the final marketing report and guidelines through the December bill, which made funding contingent on additional analysis of the suggested standards. The top 10 industry donors made about $2.3 million in political contributions in 2011.
"There was so much momentum and support for the guidelines, and yet it's been really difficult to get these published," said Juliet Sims of Oakland's Prevention Institute, a health organization. "We will continue to really push for the guidelines to not be held up, so we have a scientific baseline. I think it's just an indication of the fact that Congress is putting the industry's interests before children and family health."
An ongoing campaign by the Prevention Institute urges the federal government to take stronger actions on what it has dubbed "deceptive" advertising by junk food and fast food companies. It has launched its own campaign to appeal to President Barack Obama and federal lawmakers, arguing that food and beverage companies claim to "have our kids' best interest at heart, so why are they doing things like launching marketing campaigns disguised as charities right in our schools?"
In California, addressing "unhealthy" food and beverage marketing continues to be one prevention strategy.
"We have learned from our successful work on tobacco control that the social environment and social norms are very important in shaping behavior," Ken August, a California Department of Public Health spokesman, wrote in an e-mail. "It is important to provide balance in the messages that young people receive. ... The California Obesity Plan is not just a plan for CDPH or state government. Our vision for the Plan is to engage all aspects of our communities - from health care to employers, child care and schools, community organizations, the food and entertainment industries, and professional sports."