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Food warning labels on FDA's plate

US anti-obesity strategy debated

ROCKVILLE, Md. -- Federal health officials are considering placing warning labels on packages of foods deemed unhealthy by government scientists, perhaps the most far-reaching proposal in the unfolding government campaign to shrink the American waistline.

In an interview with the Globe, the acting commissioner of the Food and Drug Administration, Lester M. Crawford, said that food labels -- the boxes listing calories, fat, and other dietary information on every commercial food package -- could be transformed ''from providing information into providing warnings."

The idea remains only in the discussion stage among high-level government officials, said Crawford, and any warning label on food would be less harsh than those on cigarette packs. ''We could consider saying, 'If you indulge in this, there may be health consequences,"' said Crawford.

The suggestion comes as federal officials are mounting perhaps the most ambitious and difficult public health crusade in a generation, trying to bring about a radical shift in deeply ingrained American behavioral habits involving food and exercise. About 129.6 million American adults, or 64 percent, are obese or overweight by government standards. Nine million children also fall into that unhealthy category.

Yesterday, a top FDA scientific panel met to review progress on the government's obesity campaign, hearing from a series of government scientists on strategies and the difficulties they are encountering in fighting America's growing weight problem.

Last month, US Health and Human Services secretary Tommy G. Thompson announced the effort, saying, ''We're just too darned fat," and disclosing that his staff had been put on a diet, generating considerable public attention.

In fact, the anti-obesity campaign has been churning along quietly for more than a year, with numerous government panels attempting to determine the most effective strategies to employ. Its three primary prongs are developing anti-obesity drugs, designing healthy lifestyle commercials, and persuading the food industry to cooperate.

Much of the meeting yesterday of the FDA's Science Board was spent discussing the limits of current approaches. The food-labeling proposal was not publicly discussed.

At the moment, no promising anti-obesity drugs are on the horizon, said Dr. David G. Orloff, the FDA's director of metabolic and endocrine drugs. Current drugs ''only induce modest amounts of weight loss," he said. And there is virtually no data on whether the drugs reduced mortality rates, a ''big hole in our understanding," Orloff said. But he said 24 different genes and molecules possibly involved in obesity are under study, and could lead to pharmaceuticals later this decade.

''But diet and exercise remain the mainstays of prevention and treatment of obesity," Orloff said.

However, FDA scientists, after conducting numerous focus groups over the last year, have concluded that persuading people to diet and exercise is far from the straightforward proposition it seems. They are assembling an extensive television and print advertising campaign pushing calorie reduction and exercise. But focus group data showed that many overweight Americans do not consider their weight a problem and may ignore the messages.

For instance, the FDA found many Americans do not consider being overweight, as opposed to obese, a health risk, though data indicated that overweight people face greater risk of heart disease, diabetes, and some cancers. Moreover, men often underestimate their weight, surveys found. ''The most critical element of all this is understanding consumers," said the FDA's director of food safety and security staff, David Acheson.

Acheson also said that talks with the food industry were underway, with a third-party intermediary whom he would not name, to persuade fast-food and sit-down restaurants to consider putting nutritional information on menus, wrappers, or placemats. More than 40 percent of the average American food budget is spent outside the house, according to federal surveys. But the industry has balked at some of the suggestions, federal health officials and independent specialists said.

Some restaurants, including McDonald's and Subway, voluntarily provide nutritional information in the store, while others provide it to customers on request. The majority of restaurants do not offer the information.

''There's some concern [among food companies] about labeling something a 'bad food,' " said Susan Kay Harlander, a health specialist at New Brighton, Minn.-based Biorational Consultants and a member of the FDA panel.

Any effort to slap foods with a new warning label could take years to enact. Though the FDA has broad authority to regulate food labels, the agency must conduct extensive scientific tests to establish which foods would receive which warnings. In addition, numerous political hurdles would probably emerge, often the case when the agency seeks broad regulation of a powerful industry. Current dietary labels, for instance, were more than a decade in the making.

Dr. Arthur Frank, medical director of George Washington University's weight management program, said attempts to reduce obesity with advertising or labels would probably fail. ''The message, 'eat less and exercise' . . . has been a monumental failure," he said. ''Telling an obese person to eat less is like telling a depressed person to just pull it together. . . . It may be as difficult to control eating in a sustained way as it is to control sleeping and breathing."

Of the entire obesity effort, panel chairman Dr. Kenneth Shine, a University of Texas cardiologist, summed up: ''We don't know what works. . . . There is a lot of experimentation going on."

Raja Mishra can be reached at rmishra@globe.com.

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