The Obama administration's economic stimulus initiatives should include investment in infrastructure to decrease obesity, providing an immediate and long-term boost to the economy and to public health, argues a commentary in the Journal of the American Medical Association.

Health costs attributable to obesity are now thought to top $100 billion per year. The commentators, David Ludwig, MD, PhD, director of the Optimal Weight for Life (OWL) Program at Children's Hospital Boston, and Harold Pollack, PhD, of the University of Chicago School of Social Service Administration's Center for Health Administration Studies, argue that the economic recession threatens to worsen obesity:

Consumption of cheap, poor-quality foods, skewed toward lower-income consumers, is likely to increase. The real price of fresh fruits and vegetables rose 50 percent between 1982 and 2008, while the modern fast-food meal -- high in low-quality carbohydrates, fats and empty calories, and less likely to satiate -- has gotten cheaper and more ubiquitous. Major fast-food companies outperformed the S&P 500 during the 2008 stock market collapse.

Food insecurity has been shown to correlate with obesity," Ludwig said in an interview. "It can cause people to overeat on the cheapest, worst-quality foods because they're not sure where their next meal is coming from. Unfortunately, we have created a food production and distribution system that floods the market with these foods."

Economic stress on families is leaving less time for home-prepared meals and recreational physical activity. Membership in health clubs and athletic leagues is likely to decline, while psychological stress drives people to eat high-calorie "comfort foods."

Budget cuts have already forced schools to cut back on physical education classes and after-school sports, and governments have cut back on measures that encourage physical activity, such as pedestrian paths, bicycle lanes and public transportation, in favor of road construction."

Ludwig and Pollack argue that the economic crisis presents a unique opportunity to change the social infrastructure, launching initiatives to improve the nation's eating and physical activity patterns. "Obama has spoken of using the economic crisis as an opportunity to align the economic system with fundamental values of our society," said Ludwig. "Few projects can compare in importance with building the infrastructure for public health."

Such investment would involve labor-intensive projects that would not only reduce long-term health-care costs, but also provide short-term economic stimulation potentially greater than that of resource-intensive projects like highway-building, they say. Specific suggestions include:

 * Building fully functional school kitchens (many now can only microwave or deep-fry food)

 * Building bike paths, sidewalks, car-free zones, parks and recreation facilities

 * Establishing community centers to provide inexpensive nutritious foods and recreational opportunities in one location

 * Providing loans and grants to revitalize family farming

 * Restructuring farm subsidies to favor more nutritious foods

 * Allowing food stamps to be used at farmer's markets

 * More stringent regulation of food advertisements and marketing to children

The initiative we describe is intended to lay the foundation for our economic competitiveness by improving public health for decades to come," said Ludwig.

 

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