To the Editor: Mello et al. (June 15 issue)1 discuss obesityas the new frontier of public health law. Public strategiesincluding legislative regulation against obesity must take intoaccount the fact that obesity is closely associated with lowincome.2 Obesity in low-income families originates at an earlystage of life, possibly through unhealthy food selection3 andeating patterns and a sedentary lifestyle.4 Aside from economicconsiderations, a lack of knowledge about5 and a limited accessto6 healthy food choices seem to be crucial aspects of the problem.Therefore, strategies against obesity need to encompass educationalefforts to promote a healthy lifestyle and remove obstaclesto the achievement of that goal for persons at high risk forobesity.
Takeharu Koga, M.D., Ph.D. Atsushi Kawaguchi, Ph.D. Hisamichi Aizawa, M.D., Ph.D. Kurume University School of Medicine Kurume 830-0011, Japan kogat{at}med.kurume-u.ac.jp
References
Mello MM, Studdert DM, Brennan TA. Obesity -- the new frontier of public health law. N Engl J Med 2006;354:2601-2610. [Free Full Text]
Miech RA, Kumanyika SK, Stettler N, Link BG, Phelan JC, Chang VW. Trends in the association of poverty with overweight among US adolescents, 1971-2004. JAMA 2006;295:2385-2393. [Free Full Text]
Turrell G, Hewitt B, Patterson C, Oldenburg B, Gould T. Socioeconomic differences in food purchasing behaviour and suggested implications for diet-related health promotion. J Hum Nutr Diet 2002;15:355-364. [CrossRef][Web of Science][Medline]
Bowman SA. Television-viewing characteristics of adults: correlations to eating practices and overweight and health status. Prev Chronic Dis 2006;3:A38-A38. [Medline]
Dibsdall LA, Lambert N, Bobbin RF, Frewer LJ. Low-income consumers' attitudes and behaviour towards access, availability and motivation to eat fruit and vegetables. Public Health Nutr 2003;6:159-168. [CrossRef][Web of Science][Medline]
Baker EA, Schootman M, Barnidge E, Kelly C. The role of race and poverty in access to foods that enable individuals to adhere to dietary guidelines. Prev Chronic Dis 2006;3:A76-A76. [Medline]
To the Editor: As Mello et al. state, legal as well as voluntarymeasures are needed to prevent the health consequences of obesity,but they do not mention the importance of the size of food portions.Fast-food outlets tend to encourage the sale of large portionsizes, with the financial incentive that the large size is justa little more expensive than the standard size. In 2004, Willettand I1 suggested that standard portion sizes should be specifiedfor selected high-calorie food items (e.g., hamburgers, pizzas,and sugary drinks), and larger sizes should be priced in a mannerthat is proportional to size, so that double-sized portionsshould cost at least twice as much as standard portions. Financialand health goals would then be better aligned, and there wouldbe one policy for all vendors, in which competition over thestandard-portion price would be preserved.
Public health agencies have used pricing to influence consumptionin effective ways (e.g., in reducing the sale of cigarettes).Changes in pricing with respect to the size of food portionsshould be explored, alongside accepted strategies that includeeducation, food labeling, and the provision of healthier institutionalmeals.
Nicholas J. Wald, F.R.S. Wolfson Institute of Preventive Medicine London EC1M 6BQ, United Kingdom n.j.wald{at}qmul.ac.uk
References
Wald N, Willett W. Reversing the obesity epidemic. Lancet 2004;364:140-140. [Web of Science][Medline]
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