My initial questions focused on addressing the following: why was the soda tax, a legislative proposal that, according to many public health researchers, was expected to be successful in addressing the obesity epidemic, excluded from the Affordable Care Act, a sweeping piece of federal level legislation? Why did Congress pass calorie labeling as a way to impact the obesity epidemic, when experts have more consistently promoted the idea of a soda (or junk food) tax as a potentially more successful policy in terms of obesity reduction? What was it that calorie labeling had that the soda tax did not -- or vice versa -- and more generally, what does this say about the current opportunity for obesity related legislation?
The following is an overview of the answers to these questions that were explored in my thesis:
1. Leading public health researchers believe that food environment is a key cause of the obesity epidemic. To support their conclusion that food environment is a cause of the obesity epidemic, these researchers have extensively examined the biological factors that also contribute to obesity; while biology "allows" obesity, environment "causes" rising rates of obesity in a way that cannot be explained by biology along (Brownell, 2004, p. 24). In order to curb the obesity epidemic, then, a change in the food environment is crucial. Taxes via government legislation are one way to impact this environment by raising costs and "nudging" consumers to make alternate, and potentially healthier, decisions.
2. While the food and beverage industries have acknowledged that obesity is a problem that they should be seen as helping to address, they have also worked hard to keep the definition of the problem and its causes tightly constrained. Both the food and beverage industries identify obesity as a complex issue caused by a variety of factors (American Beverage Association representative, personal communication, November 7, 2011; National Restaurant Association, 2003). Both industries also point to personal responsibility as the best way to solve the epidemic. As a result, the food and beverage industries prefer policies that emphasize consumer education while tending to resist government policies that aim to influence the food environment.
3. Food and beverage industry preferences have been critically important in determining obesity-related public policy and subsequent initiatives. In the ongoing battle between industry and public health/obesity researchers, with regard to preferred strategies for addressing the obesity epidemic, politicians have been more likely to pass legislation that promotes consumer education (such as calorie labeling) and less likely to pass legislation directed towards changing food environment (such as soda tax). However, despite the industry's successes in blocking taxation policy, it seems clear that extended debate, discussion of the obesity epidemic, and heightened awareness about the role of the food environment in shaping the obesity epidemic may actually be leading the industry itself to initiate some changes in the food environment.
In the fight against the obesity epidemic, public health researchers and the food industry each play a significant role in shaping the surrounding politics. However, neither of these stakeholders function in isolation, and the arguments and demands of each group ultimately shape public policy aimed at addressing obesity. This idea is particularly relevant when considering the calorie labeling mandate and the soda tax, the two obesity-oriented proposals that got the most federal level attention.
My thesis argues that the willingness of the industry to support the calorie labeling mandate over the soda tax on the Affordable Care Act is what ultimately resulted in the inclusion of the calorie labeling mandate on the health care reform bill. Taxes are more supported by public health experts, while the food and beverage industry is generally more willing to accept a policy that emphasizes individual choice and personal responsibility; such was the case with the calorie labeling mandate. These differing perspectives led to ongoing debates, ultimately shaping industry behavior and contributing to a continued change in the existing food environment in America today. Though we will never be able to compare the impact of the calorie labeling mandate to a hypothetical soda tax, the preponderance of public health research suggests that the change in environment that the latter proposal would have created would likely have been more effective in fighting obesity than the calorie labeling mandate.
The high profile of the obesity epidemic, calorie labeling mandate, and soda tax called much attention to the issues our country currently faces. The emphasis on the obesity epidemic and the health of our nation motivated the government to step in and take some sort of action against the epidemic; this resulted in the calorie labeling mandate provision within the Affordable Care Act. Moreover, this publicity resulted in industry efforts to change the food environment so that they could offer an impression of helping, and not causing, the obesity problem.
Historically, many public health researchers have turned to legislation as a way to address issues of public health. The "threat" of legislation caused industry to change their own behavior and, at least to some extent, the food environment, too. And we are starting to see the result of a change in the food environment. Rates of obesity in the United States are still incredibly high, but they are not increasing by as much as they had been in earlier decades (Dooren, 2010). Legislation is an invaluable public health tool, but it appears to take more than legislation alone to make a difference.