Recipe To End Obesity

To wrap up my series on obesity, I thought I would present some possible policy solutions to the problems that I have discussed. I’m not a huge policy-wonk, and I’m not a Washington insider, so I don’t have the greatest feel for what is feasible. Perhaps I’m too idealistic, but I tend to think that anything is possible, and when we stop striving for our ideals, we’ll fail as a people and as a nation. So, this is my best attempt at applying my ideals to practical solutions.

First, we need to change our development policies and processes. Currently, a city sets a zoning code for a plot of land, and developers must either conform to that code (which includes type and use of structure, density, setback distances, etc.) or apply for a conditional use permit with the city council. Most of the time, conditional changes in zoning are not granted for land uses that are seen as drastically different or incompatible with current surrounding areas. Some municipalities are stricter than others. One city might allow multi-family housing in a predominantly single-family neighborhood while another may not. Similarly, some cities might permit certain industrial sites to be converted to commercial uses while others would not. Very few cities, however, will allow a plot in a residential zone to be converted to commercial. There are a variety of reasons why this is frowned upon, one of which involves a fear among residents that a corner store or restaurant will bring too much unwanted traffic into their neighborhood, which may cause their property values to decrease. While this fear has not been corroborated by evidence (in fact, mixed-use neighborhoods tend to be better valued and are steadier over time), the NIMBYs (residents that have a history of opposing any changes to their neighborhoods by saying, “Not in my backyard!”) have significant power in local decision-making.

The problem with this system is that, while the zoning policies sound good on paper, once those policies are used to guide design and development, the results are often disappointing. Surveys have shown that the majority of Americans who admit that their ideal neighborhood is a bedroom community (only upscale single-family homes) think that current suburban bedroom communities are not visually appealing and are not ideally designed. According to my thesis findings, the reason for this disconnection between policy and design lies in the fact that we set the zoning policy before we have any clue what the resulting design should look like. Anton Nelesson, a New Jersey planner, found that when, in fact, residents of an area were gathered and asked to design and make a model their ideal neighborhood, people in every case (he conducted dozens and dozens of these workshops) built traditional, walkable, mixed-use neighborhoods. What does this tell us about how our zoning process should be changed? We need to take a cue from the Germans (who gave us the concept of zoning in the first place about 100 years ago) and design before we zone. Codifying a policy before we have an accurate vision of what it will result in is backward, but this is exactly what we do. A great deal of experience and research tells us that neighborhoods which are developed based on design, and not code, encourage more physical activity. So, Policy #1: Design before we zone.

Second, we should look seriously at how our land use and transportation policies can be better coordinated to provide for more options for people to get around. Currently, most cities and regions set land-use policies based on computer models that can only interpret automobile impacts. After land-use and road designs are set, then alternative forms of transportation are considered. This is the biggest reason why transit systems are ineffective and inefficient in most cities in which they operate. When an automobile-based environment is built, it is very difficult to go back and retrofit it with features that encourage transit use, walking, or biking. Most cities are unwilling to make the necessary changes, and for good reason: most of them would need to change so drastically that it would hardly be feasible. The solution lies in either laying a comprehensive transportation network first and building the city around it (which takes an up-front commitment that most cities are unwilling to make), or design land-use and transportation in tandem. While this is inherently more complicated than doing one before the other, its results would be much more equitable for all forms of transportation, including walking and biking. Marrying land-use to transportation policy 60 years ago would have made sloppy suburban development virtually unheard-of. Policy #2: Plan for land-use and transportation simultaneously and co-dependently.

Third, there is too much inconsistency and inefficiency in the divisions and collaborations between neighboring municipalities. This can be seen on the west side of Bethlehem where the city ends and Allentown begins. West Broad is a great mixed-use street with residences and local businesses; but as it crosses Pennsylvania Avenue into Allentown, it becomes predominantly commercial, which serves to bring in more traffic into the Bethlehem area than would otherwise occur. This has the effect of suburbanizing a perfectly good walkable urban neighborhood. Problems of this nature can be rectified through the authority of a strong regional planning body that can coordinate land-uses in areas in which one municipality transitions into another. Policy #3: Give strength to regional planning organizations.

Once the first three policies are in place, we can begin to look at laws that focus on public health initiatives, commercial disincentives for offering unhealthy foods, and consumer protection from those foods. Our fourth policy would actually be a set of policies that mandate the use of social marketing principles in every community to increase physical activity behaviors as a form of disease prevention. Social marketing is a well-established set of business and psychology strategies that seek to discover a population’s specific barriers to performing certain behaviors as well as discern the benefits that people experience from those behaviors. The goal of the research is to inform how best to implement an intervention that will break down those barriers while increasing the perceptions of the benefits. For example, a public health official might find through administering surveys to a random sample of city residents that the largest barrier to engaging in regular moderate exercise is that people are self-conscious about being seen exercising alone. Similarly, it is found that the benefit to exercising most identified by the same residents was the sense of accomplishment that is obtained. In order to address these two issues, the health official might decide to institute city-sponsored exercise clubs that double as support groups. These groups would allow residents to identify neighbors that enjoyed similar physical activities so that people could connect with the purpose of exercising in groups and encouraging each other to reach set goals. A set of policies that mandate city-specific interventions would go a long way in encouraging people to exercise more, thereby preventing obesity-related illnesses. Policy set #4: Obesity prevention through city-level social marketing strategies.

Fifth, while I would personally like government to ban certain foods outright, I know that this is not a popular or realistic solution. As an alternative (and probably more effective) solution, the federal government needs to create an incentive program for food producers, distributors, and restaurants. To begin with, food producers and distributors need to be rewarded with tax breaks and subsidies for meeting very stringent nutritional levels and punished with higher taxes for foods that have little nutrition or that are unnecessarily high in fat, sodium, or sugars. I’m not a nutritionist, so I can’t give specifics on how incentives could be tied to calories, fat, sodium, or sugar (mostly high fructose corn syrup) levels, but I don’t have to be a food expert to know that overkill on any one of those things should be discouraged and moderation rewarded. The two-headed goal would be to discourage unhealthy food while making it more expensive than good quality food (which is exactly opposite of how it is currently). Next, grocery stores should be encouraged to open in under-served areas (called “food deserts”) where low-income people often lack adequate access to high quality nutritious food. Tax incentives could be tied to the number of blocks away from under-served areas that the store locates. To top off this set of policies, portion sizes and calorie levels at restaurants should be incentivized to encourage healthier dining. As I discussed in a previous post, we are notoriously poor at recognizing how portion sizes impact our eating habits, and restaurants have taken advantage of this. In the case of restaurants, tax incentives need to be applied to an average of the establishment’s calories per order, which would be publicly displayed at each restaurant. Policy set #5: Encourage the production and sale of healthy foods and portions.

Finally, since we can only disincentivize and not eliminate unhealthy food environments, policies are needed to better protect consumers. Consumers should have the right to know what exactly it is that they are consuming (in the case of most soft drinks, 99% high fructose corn syrup… in case you didn’t know), where the food is coming from (the local farm or an industrial feed lot?), what unnatural chemicals or antibiotics were used to grow the food or to keep it from dying (please read Michael Pollan’s “Omnivore’s Dilemma”), exactly how many calories are in the meal (taking portion size into account) set in front of them, and how many miles the average person would need to walk or run to work off those calories. Consumer rights should unequivocally be placed above industry rights, and consumers should not be afraid or feel powerless to raise hell when something isn’t right. If it isn’t the job of the government to protect its people, then what is? Policy set #6: Protect the consumer over industry.

This has, by far, been the longest post yet (and probably the longest I will ever do), and I won’t apologize for it, because I think this subject is extremely important (and this post the most important of the obesity series). If any of you have suggestions for further policies, concerns with the policies I’ve mentioned, or want to debate me as to whether I’m making too big a deal over this issue, I welcome any of your comments.