Why U.S. Anti-Obesity Policies Fail to Reduce Obesity Rates

Introduction: The Scope of the Obesity Problem

Few public health issues have drawn as much attention or garnered as much support for policy and programming as obesity. Obesity programs have been initiated and implemented at the federal and state levels, and all fifty states currently have early childhood education physical activity and healthy eating regulations and policies (The State of Obesity, 2018). All the major national public health research organizations—including the Centers for Disease Control and Prevention and the National Institutes of Health—likewise inform and promote obesity-related policies and programs. Government agencies like the Food and Drug Administration and the USDA also maintain distinct policies and programs.

In spite of the abundance of both private and public funding for anti-obesity research, policy development, and programming, the majority—two-thirds—of American adults are overweight or obese, and more than a fourth of all healthcare costs in the nation are consumed by obesity-related issues (Levi, Vinter, Richardson, et al., 2009). With few exceptions, obesity policies in general have been relatively ineffective at reducing overall rates of obesity or changing public health trends.

Effectiveness of School-Based Anti-Obesity Programs

The most effective anti-obesity programs implemented in the United States have been school-based ones, particularly those that combine in-school programming with home and community involvement (Wang, Cai, Wu, et al., 2015). School-based physical activity programs have been evaluated for their effectiveness at increasing fitness levels, reducing sedentary activities like television viewing, and reducing cholesterol—but not necessarily BMI (Levi, Vinter, Richardson, et al., 2009). Even when effective, program evaluation results have been "moderate" at best, and the majority of interventions have yielded few promising results (Wang, Cai, Wu, et al., 2015).

The CDC has likewise proclaimed inconclusive evidence supporting its own school-based initiatives (Levi, Vinter, Richardson, et al., 2009). Similarly disappointing results have been found when measuring the effectiveness of obesity prevention programs administered through early childhood education in other countries. For example, one UK study showed that school-based programs led to no statistically significant reduction in overall BMI scores. The results indicate that "schools are unlikely to impact on the childhood obesity epidemic by incorporating such interventions without wider support across multiple sectors and environments" (Adab, Lancashire, Hemming, et al., 2018, p. 1).

Systemic and Socioeconomic Barriers to Obesity Prevention

Among all populations, the most important reason why anti-obesity policies and programs have been ineffective is that they have failed to address some of the systemic issues at stake. Some of the overarching, systemic concerns include socioeconomic class, disenfranchisement, and persistent disadvantage—social factors that are linked with higher prevalence of the disease. In almost all countries, obesity rates are higher among lower socioeconomic groups (Kornet-van der Aa, Altenburg, van Randeraad-van der Zee, et al., 2017).

The connection is due to a number of variables, including the higher cost of healthy versus unhealthy foods. For example, the cost of fruits and vegetables has risen, whereas the price of soda, sugar, and other junk food has remained "fairly steady" over the past several decades (Levi, Vinter, Richardson, et al., 2009, p. 46). In fact, unhealthy foods cost about a tenth of the price of healthy foods (Levi, Vinter, Richardson, et al., 2009, p. 46). Some states have initiated policies that reduce taxes on healthy foods or, alternatively, impose taxes on unhealthy foods, but these policies have yet to reveal any real measurable effects in reducing overall obesity rates because they have been implemented in a piecemeal fashion (Levi, Vinter, Richardson, et al., 2009).

Other factors linking low socioeconomic status to obesity rates include community design. Low-income neighborhoods have less access to the means by which residents can remain physically active, such as well-maintained and safe parks and sidewalks (Kornet-van der Aa, Altenburg, van Randeraad-van der Zee, et al., 2017; Levi, Vinter, Richardson, et al., 2009).

Conclusion

The evidence reviewed here consistently demonstrates that fragmented, single-sector interventions are insufficient to meaningfully reduce obesity rates. Programs that fail to account for systemic socioeconomic factors—including food price disparities, community design, and limited access to safe recreational spaces—are unlikely to produce lasting results. Multi-sector coordination that engages schools, families, communities, and the private sector simultaneously represents the most promising path forward for effective obesity prevention and policy.

References

Adab, P., Lancashire, E. R., Hemming, K., et al. (2018). Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study). BMJ, 360, k211.

CDC (2018). Overweight and obesity policy resources.

Kornet-van der Aa, D. A., Altenburg, T. M., van Randeraad-van der Zee, C. H., et al. (2017). The effectiveness and promising strategies of obesity prevention and treatment programmes among adolescents from disadvantaged backgrounds: a systematic review. Obesity Reviews, 18(5), 581–593.

Levi, J., Vinter, S., Richardson, L., et al. (2009). F as in fat. http://healthyamericans.org/reports/obesity2009/Obesity2009Report.pdf

The State of Obesity (2018). State policies to prevent obesity. https://stateofobesity.org/state-policy/

Wang, Y., Cai, L., Wu, Y., et al. (2015). What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obesity Reviews, 16(7), 547–565.