Should local governments in Wisconsin consider regulating the sale of French fries and cheeseburgers the way they control the sale of alcohol and cigarettes?
State public health officials think so.
Wisconsin's new 10-year public health plan, released Wednesday, suggests that municipalities use zoning regulations to limit the number and density of fast-food restaurants, particularly in low-income neighborhoods.
The proposal is among a list of strategies state health officials say can help reduce obesity and other health disparities in Wisconsin, where surveys have found 64 percent of adults are overweight or obese. A recent national report found that the state's African American residents had the highest rate of obesity in the country.
"Preventing obesity is more than just telling people to eat better and be active. We have to create environments where people have healthy choices available to them," says Amy Meinen, a nutrition coordinator with the state Department of Health Services.
A couple of years ago, the city of Los Angeles, citing health concerns related to obesity, passed an ordinance prohibiting construction of new fast-food restaurants in a 32-square mile area of the city inhabited by mostly low income people, many of whom are minorities. But nothing like this has been tried before in Wisconsin.
"What we have seen is that simply relying on spreading information about obesity and trying to bring new businesses (into low-income areas) isn't necessarily sufficient on its own. This is really trying to put some more oomph behind this effort," says Tom Oliver, associate director for health policy at the University of Wisconsin Population Health Institute.
The state health department's 10-year plan also seeks to increase access to good, nutritious and affordable foods; one suggestion would encourage more farmers' markets to accept food stamps in payment; only 1.1 percent of the fresh produce markets do now in Wisconsin, compared to 7.6 percent nationally. The report also suggests expanding longstanding efforts in the state to encourage breast feeding, push for more grocery stores in underserved neighborhoods, and expand opportunities for exercise and play in areas with few parks and green space.
Healthiest Wisconsin 2020 is a game plan and not a mandate. While the Wisconsin Legislature requires a health improvement plan for the state each decade, decisions about which of the recommendations to follow are largely left up to local jurisdictions.
If the reaction of one local official is any measure, it could take some persuading. "Hmmm... Interesting," says Mark Clear, president of the Madison City Council, when told about the state's proposal. "I'd like to see the research. Obesity is one of those problems, like alcohol, we have to get serious about. But with alcohol, you can draw a direct correlation. Alcohol is the main cause of alcohol abuse. But if I stop eating fast food, there's no guarantee that I won't still be 20 pounds overweight."
Pete Hanson, a lobbyist with the Wisconsin Restaurant Association, says the trade group would oppose such a measure. "It would be an ill-advised public health policy. I say that because 70 percent of meals consumed by Americans are still prepared at home. So is banning fast food restaurants really the thing that will stem obesity in America?" he asks. "Probably not."
Besides, Hanson says, franchises don't force customers to eat Big Macs. They offer plenty of "healthy choices" these days, too. But not many people eat them. "You don't have to have fries with your hamburger at a fast food restaurant," he says. "You can have a fruit cup. You can order salads. You can have a grilled chicken sandwich instead of fried chicken. There are plenty of healthy choices, but customers have to choose them."
Supporters say that cheeseburger zoning and other regulatory measures seem to be gaining momentum. If a Wisconsin city alarmed by the obesity epidemic has the political will to pass such an ordinance, it should stand up in court, says Stephen P. Teret, a lawyer and director of the Center for Law and the Public's Health at Johns Hopkins and Georgetown Universities. Teret cites a 1905 Supreme Court ruling he calls the foundation for public health intervention and law that determined that a Massachusetts man had no right to refuse to be vaccinated against smallpox. That precedent has also been used to set public policy and regulations applying to the use and sales of cigarettes and alcohol.
Figuring out the balance between individual rights and what the Supreme Court deemed the "common good" is relatively easy when talking about infectious diseases that can wipe out entire populations, or the toll of drunken driving and secondhand smoke.
When it comes to obesity, people may argue that they have the right to eat as much as they wish and to be as fat as they like. But similar arguments have often failed when used by motorcyclists who, in refusing to wear helmets, claim they'd only be hurting themselves in the event of an accident. "Motorcyclists by and large did not win those cases because the courts recognized that while it may be the head of the motorcyclist, it was the pocket of everybody," Teret says.
Obesity is a major contributor to cardiovascular and kidney diseases and diabetes, among other conditions. Nationally, experts estimate that the annual tab for obesity-related health problems is more than $102 billion. Here in Wisconsin, medical expenditures due to adult obesity alone totaled nearly $1.5 billion in 2003. "When an individual gets injured, we all pay a portion of the costs," Teret says. "That's true about obesity. Obesity leads to disease. And we all share the burden of paying for it."
Obesity is just one area where alarming gaps exist between the health of Wisconsin's white and minority residents. A key goal of Healthiest Wisconsin 2020 is the elimination of these disparities, among the worst in the nation.
More than 1,500 people statewide participated in the development of the plan, with implementation scheduled to begin this fall. Plan objectives, according to a press release distributed today by the state Department of Health Services, "will be integrated" into the work of foundations, universities, state and local government agencies, private industries, and health organizations.