Reversing the obesity epidemic: the importance of policy and policy research.

J r a s o r r d t p s The British epidemiologist Geoffrey Rose wrote that “mass diseases andmass exposures needmass remedies.”Whenhealth problemsbecome soprevalent that large segmentsofapopulationhave them, theycanstem only from social and environmental causes and can be solved only by policy and environmental solutions. The epidemic of obesity clearly falls in this category. Two thirds of Americans are obese or overweight. The doubling of obesity in America in the past 30 years has occurred not because humans or their genes have changed, but instead because the environment has changed to one that promotes energy storage as a default. Theway to reverse this epidemic is by altering that environment again, through policy and system changes that make the new default behaviors those that maintain energy balance. Policy solutions to social problems often are controversial because of the fear of change and because of vested interests in the status quo. For example, calorie posting on menus met fıerce opposition from the restaurant industrywhen it was introduced in 2006 inNewYorkCity. That means it is particularly important to have solid data in developing public health policies. Unfortunately, data on key questions that arise during policy development are often lacking. For example, in 2010, the New York State Offıce of Temporary Disability Assistance, in collaboration with the New York City’s Department of Health and Mental Hygiene and Health Resources Administration, submitted a proposal to the U.S. Department of Agriculture to remove sugary drinks from the list of purchases allowable with Supplemental Nutrition Assistance Program (SNAP; formerly Food Stamp) benefıts. At the time of the submission it was known that obesity was prevalent among SNAP recipients, that sugary drinks were a major contributor to obesity, and that soda accounted for almost 6% of total caloric intake in SNAP households. However, there was little information available on the stores from which SNAP participants purchased their sugary drinks (e.g., supermarkets vs corner stores); the degree to which SNAP participants would respond to a restriction by pur-