by Marion Nestle
Feb 8 2010

The Surgeon General’s Vision for a Healthy and Fit Nation

I recently received this request from Daniel posted to Feedback:

Would you mind writing a blog post on the new surgeon general’s obesity report? …Is there a food politic element to why this has gone under the radar? …I find it ironic that Michael Pollan’s Food Rules generated substantially more press than a report by the United States Surgeon General.

I’m not surprised.  Pollan’s book is a hot best seller (it’s #1 on Amazon books, and for good reason, in my opinion).   The need to prevent obesity and how to do it is not exactly front-page news.  And the new Surgeon General, Dr. Regina Benjamin, is still relatively unknown as a political force.

But let’s give Dr. Benjamin credit for taking on obesity in one of her first public actions: the release of “Vision for a Healthy and Fit Nation.”   The Vision, which comes with a press release and a fact sheet, recommends these actions to prevent obesity:

  1. Reduce consumption of sodas and juices with added sugars.
  2. Reduce consumption of energy dense foods that primarily contain added sugars or solid fats.
  3. Eat more fruits, vegetables, whole grains, and lean proteins.
  4. Control your portions.
  5. Drink more water.
  6. Choose low-fat or non-fat dairy products.
  7. Limit television viewing time and consider keeping televisions out of children’s rooms.
  8. Become more physically active throughout the day.
  9. Breastfeed exclusively to 6 months.

These are all useful suggestions but we have heard them before.  The real issue is how to achieve them.  Here, the report disappoints.

The first two items should have grabbed attention: targeting soda reduction as as the first line of defense against obesity, and eating less junk food (my translation) as the second.

But Dr. Benjamin assigns parents the responsibility for feeding kids healthfully.  Fine, but what about about public health approaches to reducing soda consumption?  To pick a non-random example, soda  taxes are under intense debate right now.  Does Dr. Benjamin weigh in on such approaches?  Alas, no.  Only on the second-to-last page does she summarize suggestions from the Centers for Disease Control and Promotion (CDC), among them:

  • Increase availability of healthy, affordable food and beverage choices in public service venues.
  • Improve geographic availability of supermarkets in underserved areas.
  • Improve access to fresh fruits and vegetables by providing incentives for the production, distribution, and procurement of foods from local farms.
  • Limit advertisements of less-healthy foods and beverages.

I wish the report had focused on such ideas, instead of leaving them to an afterthought and personal responsibility. It’s great that the nation’s doctor cares about obesity but her Vision isn’t nearly as tough or realistic as it needs to be.  For that, we need the CDC or the report on food marketing to kids that the Institute of Medicine produced in 2005.

In 2001, Surgeon General David Satcher released the first government report on preventing obesity.  It got press. If this one didn’t, it could well be because it doesn’t break enough new ground.  Surely, it’s high time we got beyond blaming parents and instead started focusing on the need to create a food environment that makes it easier for parents and everyone else to make better food choices and be more active.

I hear that Michelle Obama will soon announce (tomorrow?) a new program to address childhood obesity.  I’m hoping that her program will take on some of the factors in the food environment that make it so difficult for everyone to eat healthfully.

  • Sarah Smedley

    I suggest the follwing edits to the 2nd bullet point:
    Improve geographic availability of supermarkets THAT OFFER AFFORDABLE AND NUTRITIOUS/FRESH FOOD AND BEVERAGE CHOICES (like seasonal fresh fruits and vegetables that don’t cost a fortune, and a choice of drinks without added sugar)in underserved areas.

    Why is it important NURITIONALLY that food come from local farms? I like to eat oranges this time of year. I live in NYC. What’s so bad abotu the Temples from Florida?

  • Anthro

    Given the current political climate (attacks on ANYTHING from the Obama administration), I think it’s pretty good. Any attempt to recommend any overt regulation will only be met with howls of “nanny state” for the party of “personal responsibility”. I would have thought that this report would have accompanied Mrs. Obama’s initiative, but perhaps the First Lady hopes to build on this and go a bit further as you suggest. On second thought, I think she’ll try hard to avoid controversy and stay with the “middle way”.

    @Sarah Smedley – I think the reference to “local produce” may be intended to include veggies more so than fruit, but I noticed that as well. The main thing should be to get fresh produce readily available. There are lots of good things about local, but it shouldn’t necessarily be a first step. I emphasize “local” in my own shopping, but allow for a percentage of “imports” such as spices, coffee, and certainly, oranges! If you live in NY, I would say that if you are getting your oranges from Florida instead of California, then you are being “local”–which isn’t defined anywhere that I’m aware of anyway. Some people are committed to only eating things outside a certain mile radius only seasonally. There are all degrees of the “local” thing, like vegetarianism. That’s why the reference to “local produce” caught my eye as well.

  • DennisP

    The actions recommended by the Surgeon-General have all been components of one published diet book or another over the years; interested people are all familiar with them, nothing newsworthy. More important is the idea that bad nutrition is a result of our social system. It is not sufficient to tell parents to set the bounds for eating by their kids. Walk into any supermarket and see what the “adults” are buying!

    Ours is a market system dominated by profit-seeking corporations. The quickest way to large profits is producing foods that are sweet, fat, and salty – see Dave Kessler’s End of Overeating. An outside agency – popular public demand, a government agency – is necessary to cause any real change in the system, to set appropriate limits. The “market” is a useful institution; it is NOT the magical answer to all our problems.

  • Kate

    I’d really like to see a change to Federal food stamp rules. Food stamps should double in value if they are used to purchase fresh (or frozen and minimally processed, or even canned with minimal additives) fruits, vegetables, grains, beans, and lean meats. This would essentially subsidize the purchase of healthier foods for those who are most in danger of avoiding them. (It doesn’t necessarily have to be doubled. It should be whatever factor is appropriate to make the prices comparable.) There would need to be specific, quantitative rules on what would qualify for the subsidy (so that, for example, frozen dinners and baked beans wouldn’t count).

    Do I think this would help high-risk (i.e., low-income) families eat better? Yes. Do I think it will ever happen, as long as big business controls the government? No.

  • Alex

    Hi Marion,
    Thanks for your insights on this. I felt exactly the same way.

  • Good post.

    My feeling is the only way you can get your kids to eat healthy is if we as parents set a good example and eat healthy ourselves. I’m also in favor of making it as easy as possible for kids to make healthy choices at school.

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  • Hi Marion, a very good post. thank you.
    Few thoughts of my own
    1. Local food. at some point in my life i was very much for that, but it very expensive for family of 4 and difficult to have “local” food in Jan. and Fab. in Connecticut. Now i have nothing against potatoes from Idaho or oranges from CA in winter (on the same page with Anthro).
    2. @DennisP: correct with the statement that ideas from Dr. Benjamin are familiar to people who are interested in the topic of health. how we can make other people familiar with them?
    A) @Kate: Federal food stamp rules!! Great!
    B) TAX more processed food! Yes!
    C) more publicity, education about Junk food!! YES,YES!!
    How we can do that?
    Regina Benjamin can not say more then “reduce consumption of soft drinks and juices..” Remember, who has the money?
    Remember, how Michel Obama was criticized for building her organic garden? However, it is a start. Personally, i do not think that big changes will take place. As @Kate: as long as big business controls the government. NO.

  • @Sarah Smedley – as I recall, the closer a food is eaten to it’s point of origin, the higher the nutritional content of the food. So there is a nutritional component to eating local. Since those of us in northern latitudes can’t eat local citrus, we’re relatively exempt from that – but we can eat local potatoes, and should.

    Beyond that, there’s also the simple economic benefit of buying from local sources. The difference in money that stays in the community when you purchase local versus national corporation is pretty astonishing. And that is an important consideration when thinking about food wastelands; they are very often communities that will be over-all enhanced by keeping as much money within the circulating community as possible.

    My issue with Dr. Benjamin’s summary of the CDC’s suggestions on the last page are relatively simple: with this suggestion of increasing grocery store distribution to include food deserts, especially to bring in healthy food, is anyone going to talk about the need to subsidize these stores? I doubt they’re going to happen without that.

  • Marion, thanks for writing this. Not only does the report disappoint by putting the onus on parents to deal with the obesity epidemic, it raises the question of whether Dr. Benjamin will be able to fully be an advocate for the pubic health, given her previous ties to the food industry.

    As a former nutrition adviser to Burger King, will she take the industry line that our epidemic of diet-related disease and obesity in children is purely a matter of parental vigilance, or will she hold food corporations accountable for their role as well? She has a powerful bully pulpit, one that could help shift national conversation – if she has the will to do so. Let’s hope the same for Mrs. Obama’s initiative…

  • Jenna

    Doubling the value of food stamps for fresh fruit or veggies is a brilliant idea!!

  • Lorraine Ottens

    The recommendations are fine as are everyone’s comments. I am saddened by the fact that exercise ranks 8 on a list of 9 suggestions. Even if we eat a healthy diet we can not be truly healthy unless we get up and move. Exercise makes you feel better physically, mentally and emotionally. When you start moving and working out on a regular basis most people find they crave junk food a little less and hopefully a lot less. Drinking water should be number 2 on the list; very often we eat because we think we are hungry when actually we are dehydrated. Drinking more water also helps reduce the risk of overeating.

  • I agree, @Sarah, there are a lot of places in this country that just don’t have easy access to grocery stores, let alone farmers markets/CSA’s, and typically these are the poorer areas, and these are the areas with higher rates of obesity. Think about the fact that 34% of U.S. food consumption comes from fast food (Ruppert’s Confronting Collapse p. 92) and yet, there are a lot of us that don’t eat hardly any or no fast food–meaning there are people in this country who are eating almost entirely fast food–laden with chemicals, hormones, pesticides, and, for the obesity topic, tons of sugar and fat.

    The access to healthy food is a huge problem, but like this blog gets to, it comes down to the politics behind it all, the government subsidies and legislation.

  • Emily

    I think that Michael Pollan (admittedly a hero of mine) has captured public attention so much precisely because he’s not a doctor. His advice is so common-sense, so focused on food as a complex whole, that he frees us of the kind of advice Marion so intelligently tackles in her books. “Reduce consumption of energy dense foods that primarily contain added sugars or solid fats”? “Eat more fruits, vegetables, whole grains, and lean proteins”? I really think this debate needs to be about food instead of nutrients.

  • sarah

    and WHY can’t our schools and public preschools be held accountable to these standards…it seems that I keep these foods out of our house, but I send my kids to school and the “healthy” snack consists of “gogurt and vanilla wafers”–this is SO frustrating. There is a felt need for MORE education for parents and teachers alike– can the surgeon general put out a public policy regarding the definition of “healthy snack?” Putting out a statement is not enough- can there be some incentives for schools to keep fast food out and bring healthy food in? It seems that we are able to hold schools so accountable for math and reading skills, but are leaving behind the BASIC elements of life here- nutrition!

  • Colleen

    Kate is right.
    Food banks, in accordance with government regulation and as justification of their meager provisioning, are required to tally up the number of serving sizes provided to their clients. This entirely unscientific analysis is reliant upon the suggested serving size listed on product labels. The recent attempts by government agencies to review these suggested serving sizes might indicate a need for similar reappraisal of resource allocations, emergency food distribution services, and disparity of access to nutritionally adequate food.

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  • Scarlett

    There is only one final solution to this horrific problem and it won’t be met without some resistance but since the resistance is likely obese themselves they won’t stand much of a chance against us.

    What we need to do is have the government take over all production of foods, all distribution of foods, etc.

    The next thing that should be done is to eliminate all money. All people’s earnings should be given to government for them to distribute equitably.

    All citizens will be given an EBT card and it will become a felony to sell someone food without one. If someone is caught with black market food they should be immediately arrested and sent to jail, the same way we would send someone to jail for posessing illegal drugs.

    Food should be strictly rationed and if you are overweight or your children overweight then you should be sent to a reeducation labor camp. Maybe we can save some money building roads and bridges by forcing the fat to build them?

    If parents are letting their kids become obese the parents should be harshly punished, perhaps with physical punishments and pain. After all, what are they doing to their kids?

    People can be critical of Mussolini all they want but the man controlled his people. Look what freedom has brought America? Nothing. Freedom is overrated. We need fascism NOW!

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  • Tif

    LOL I love how you’re telling us that the government should basically become a nazi dictatorship with internment camps to “punish” those who are overweight (instead of one racial group, like the Jewish).

    Because the government is infallible and will not become power hungry in this endeavor and become even more corrupt. Because giving up democracy in America is a good thing. I mean, just look at countries without democracy and how well they’re faring… no civil war or human rights abuses. And you’re ignorant enough to believe that the US government, simply by being founded on just principles, will maintain these through tyranny?

    And forget about capitalism and freedom. Tocqueville was right, at least in your case, that we are more likely to trade freedom for equality. Should all businesses be run by the government too, then? Because Cuba’s government worked so well for them… You are advocating for Communism, and even worse, tyrannical communism. Perhaps statism?

    And that’s fabulous that you feel the need to make more things illegal, to open MORE opportunities for criminals to get money by selling… Food? Are we not allowed to grow gardens in our own backyard? Would that be considered “black market” food? And where would the money for the prisons come from to house the thousands more inmates that would come in? Would they be housed next to murderers and rapists? Oh, welcome to America, where those who buy Twinkies are housed next to rapists.

    And don’t even get me started on your internment camps for fat people. It sounds like you HATE fat people. Are you an adiposephob? I love how forced labor is part of your internment camp too. Hitler would be so proud of you! It’s no wonder people in Germany bought into his Jewish scheme… They needed someone to blame. Do you seriously think that OBESITY is such a terrible problem, that obese people pose SUCH A THREAT to you and I that we need to lock them up IN JAIL and force them to do labor in internment camps?

    OH AND THE PAIN!?!? I simply cannot get over this point of yours. I love the Machiavellianism of it, the Hitlerism, the Stalinism, the Mussolinism of it. In fact, I’m so overwhelmed by your ignorance and stupidity that I can’t tell if you’re being serious or having a serious joke at obese people’s expense. I have one question for you: what do Hitler, Stalin, and Mussolini have in common? They tortured people until they were BROUGHT DOWN, their regimes DISMANTLED, and their people set free TO EAT AGAIN!!!! The horror!

    One more point: tell your point about fascism to the thousands of soldiers who died to bring freedom to America. (And if you make a point about that, think about how many more died involuntarily defending fascism, dictatorships, etc.)