138 Obesity
1997). School-based physical activity programs that pro-
vide for enjoyable and regular exercise participation for all
students are a must. In addition, schools should promote
healthy eating patterns by ensuring that cafeterias and
vending machines offer a variety of low-cost, nutritious
foods and snacks. Alternatively, it is not too soon to begin
a prohibition against two disturbing trends, speci“cally,
the establishment of fast-food operations on school
premises, and contracts with soft-drink companies that
provide “nancial incentives based on student consumption
of products with •empty calories.Ž We need to decrease
access to high-calorie, nutritionally poor foods and pro-
vide greater opportunities for students to select healthy
foods. An effective school-based intervention may require
multiple components including a behavioral curriculum,
parental involvement, changes in the school food program,
and support from the food industry (Story et al., 2000).3.Regulate advertising of junk foods.In the course of a
typical year, the average child sees more than 9,500 TV
commercials advertising fast food, soft drinks, candy, and
sugared cereals. Moreover, restaurant, soft drink, and
candy companies spend more than $400 billion per year to
advertise their products, often targeting their messages
to young people. In contrast, very little is spent on adver-
tising to promote healthy dietary practices. For example,
the National Cancer Institute•s entire annual budget for
the •5 a DayŽ campaign to increase fruit and vegetable
consumption is a relatively paltry $1 million (Battle &
Brownell, 1996). This dramatic inequity requires atten-
tion, and more stringent regulation is needed to decrease
the advertising of unhealthy foods, particularly during
children•s shows. Moreover, it may be helpful to require
TV commercials to disclose prominently the nutrient val-
ues (e.g., calories, calories from fats, per serving) of ad-
vertised products, particularly snack foods.
4.Impose a “fat tax.” Brownell and his colleagues
(Brownell, 1994; Jacobson & Brownell, 2000) have sug-
gested a controversial approach toward modifying the
environmental factors that promote weight gain. They rec-
ommend adoption of a tax on unhealthy foods with the
revenues from such a tax used to fund public health initia-
tives to promote healthy eating and exercise habits.
Brownell (1994) originally advocated a steep tax to serve
as a deterrent to unhealthy food purchases. Such an ap-
proach is unlikely to gain general acceptance. A more
modest tax such as one penny per 12-oz soft drink or per
pound of snack foods could go toward subsidizing health-
ier food choices, such as fruits and vegetables (or under-
writing the cost of a national campaign to improve the
nation•s eating habits). Small-scale studies have shown
that the consumption of healthy foods can be increased by
lowering their costs (e.g., French, Jeffery, Story, Hanna, &
Snyder, 1997). In addition, a recent national survey
showed that 45% of adults would support a penny tax if
the revenues were used to fund health education programs
(Center for Science in the Public Interest, 1999).CONCLUSIONOver the past two decades, the rates of overweight and obe-
sity in the United States have increased at an alarming pace.
Obesity constitutes a major public health problem because it
confers increased risk for morbidity and mortality on the ma-
jority of the adult population. Understanding the factors that
contribute to obesity may help in its control. Although genet-
ics predispose some individuals to obesity, environmental
factors are the major contributors to the current epidemic of
overweight. Continuous exposure to an overabundance of
high-calorie and high-fat foods, coupled with decreased oc-
cupational and leisure-time physical activity, has produced
the signi“cant increases in body weights observed over the
past two decades. Weight loss can reverse many of the disad-
vantages associated with obesity, and progress has been made
in the development of weight-loss treatments. Behavioral
(lifestyle) interventions can produce weight reductions of
suf“cient magnitude to decrease the risk for many diseases,
and new drug treatments can enhance the effectiveness of
lifestyle interventions. Furthermore, gastric bypass surgery
now provides a viable treatment option for the very severely
obese. Nonetheless, with the exception of surgery, all weight-
loss interventions suffer from the problem of poor long-term
maintenance. Providing obese patients with extended treat-
ment and long-term care has shown some bene“ts in this re-
gard, but more research on the long-term management of
obesity is clearly needed. Moreover, reversing the epidemic
of obesity will require a major public health initiative aimed
at identifying and implementing effective behavioral, educa-
tional, and environmental strategies for the prevention and
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