“We need you all to step it up,” she told a meeting of the Grocery Manufacturers Association. Just a month earlier, she’d launched the Let’s Move campaign, the Obama administration’s flagship anti-obesity program, which is aimed at reversing the childhood obesity epidemic by 2030.
The first lady hit talking points that would make any children’s health expert happy. She urged the manufacturers of products like Doritos, Froot Loops and SpaghettiOs to make them healthier, to cooperate with the government on new food labels, and to get serious about reining in junk food marketed to kids. “What does it mean when so many parents are finding that their best efforts are undermined by an avalanche of advertisements?” she asked. The speech was a thrilling display of Mrs. Obama’s mettle and a watershed moment, raising expectations among health advocates. Marion Nestle, professor of nutrition, public health and food studies at New York University and a tough critic of Big Food, put it this way: “It was a knockout. An absolute knockout.”
That spring seemed to be a season of promise that the blight of childhood obesity—which is on track to make today’s kids the first generation of Americans to live shorter lives than their parents—might still be beaten back. Seedlings were pushing up through the soil in the White House kitchen garden, which was in its second season since the first lady had resurrected it; now she was using it as a focal point for a national conversation about food. A presidential task force was charting an ambitious action plan to meet the goals of Let’s Move. And at the forefront of it all was the enormously popular mother in chief, who had surprised and impressed many when she chose to make the contentious issue of childhood obesity a focus of her White House tenure.
But three and a half years since the ground was broken on the White House garden, many of those who’d had high hopes say the first lady has logged only modest successes. Experts credit Mrs. Obama for her instrumental role in reforming school lunches, limiting TV watching and increasing healthy food at childcare centers—and, perhaps most important, using her bully pulpit to bring issues of food and nutrition to national attention. But, they say, reversing the childhood obesity epidemic in a generation requires more of the bold action that Mrs. Obama hinted at in her address to the Grocery Manufacturers Association.
From that inspiring moment in March 2010, the administration’s strategy appears to have shifted. Or perhaps its resolve has eroded, for it remained mute during a bitter fight to limit junk-food marketing to kids. It has also forged controversial—some say compromising—partnerships with food manufacturers.
“Looking back on it, it’s enough to make you weep. So little has been able to be achieved,” said Nestle.
Observers put the blame less on a lack of goodwill than on the political realities of taking on the multibillion-dollar food industry, which has lots of lobbying money and friends in Congress and no qualms about fanning the fears of government overreach when it perceives a threat to its interests. “It’s a real example of the power corporations have over American government and American life,” Nestle said.
It also raises fundamental questions about whether the goals of public health and those of the food industry are at irreconcilable odds. Should those who seek to address the obesity crisis treat food companies as collaborators or as adversaries?
* * *
It’s hard to imagine a better spokeswoman for the problem of childhood obesity than Michelle Obama. She’s not just charismatic and glowingly fit, but whether dancing the Dougie with school kids or digging in a carrot patch, she puts forth a disarming everymom persona that doesn’t wag a finger but says instead, “We’re all in this together.” She has couched the political in the personal by sharing her struggle to put healthy food on the table and keep her girls at a healthy weight. She even wrote about it in a gorgeous book published this year about the White House garden. It’s all gone a long way to scrubbing off the elitist label that often tarnishes advocates who seek to change the food system and make the obesity issue a national concern. “In order to make progress on something like childhood obesity, you need the nation to care about it. She’s been helpful in that respect,” said Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University.
The proportion of obese or overweight kids has nearly tripled in the past thirty years—the figure is now one in three—and doctors have detected disturbing signs of heart disease and what was once known as adult-onset diabetes in young people. While there are indications that the epidemic is plateauing, it hasn’t started to recede yet, though cities like New York and Philadelphia and states like Mississippi and California have recently reported modest declines in childhood obesity rates. But these are “tiny drops compared to the tidal wave of bad things,” Brownell said.
Buoyed by her garden’s success, in 2009 the first lady set her sights on school lunches, which hadn’t been updated in a generation and, amazingly, had minimum calorie levels set but no maximum. This change could have a big impact on low-income kids, who eat most of their meals at school. Mrs. Obama and her staff worked behind the scenes to get a reform bill passed. There was no shortage of drama: Congress inserted itself into the debate to keep french fries on school lunch trays and to count the tomato paste on pizza as a vegetable. But school lunch reform, signed into law in December 2010 as the Healthy, Hunger-Free Kids Act, was ultimately a triumph for the first lady: it gave the Department of Agriculture, for the first time, the power to regulate foods sold in à la carte lines, vending machines and school stores. Margo Wootan, nutrition policy director at the Center for Science in the Public Interest (CSPI), said that Mrs. Obama and her staff were key: “I don’t know that we could have passed the bill without their efforts.”
As the first lady battled behind the scenes to push through school lunch reform, she also unveiled the Let’s Move campaign in February 2010. It had a highly ambitious goal of rolling back the childhood obesity rate to 5 percent, the level it was in 1976, before the epidemic began. To get there, Let’s Move would organize its work around five pillars: giving kids a healthy start in life; empowering parents and caregivers to make healthy choices for kids; improving school food; ensuring access to healthy food; and promoting physical activity.
Just three months after Let’s Move was launched, the White House Task Force on Childhood Obesity released a report billed as the campaign’s action plan. Among its seventy recommendations was one urging food companies to develop uniform voluntary standards for marketing food to kids that conform to federal dietary guidelines. Children’s health advocates have long sought to restrict junk-food advertising to kids, which the Institute of Medicine says contributes to obesity. If these voluntary measures didn’t work, the report said, federal agencies could step in and regulate. It also called, among other things, for the regulation of the foods sold in schools and clearer nutrition labels for packaged foods: hot-button issues for an industry resistant to such changes.
In a speech announcing the report, the first lady stressed the need to work together: “No one gets off the hook on this one—from governments to schools to corporations to nonprofits, all the way down to families sitting around their dinner table.”
At the same time that the administration hinted at the possibility of new regulations, it also sought out partnerships with the food industry in what might be viewed as a carrot-and-stick approach. The question raised by this tactic was: Do voluntary partnerships actually work, or do they merely allow food companies to burnish their image, even as their Washington lobbyists battle real reform measures?
Brownell, of the Rudd Center, spelled out the divergent views in a commentary for the journal PLOS Medicine in July. On one side are those who believe that food manufacturers shouldn’t be regulated in the same way as tobacco or alcohol companies. (Wootan at CSPI takes that position: “People don’t need tobacco, and you want everyone to stop smoking.” But with food, “the goal is to get those companies to shift their mix of healthy products.”)
“The assumption is that this industry is somehow different than others, and that because people must eat, the industry is here to stay, and like it or not, working with them is the only solution,” Brownell wrote.
But after thirty years’ work on policy and public health, Brownell has concluded that this position is “a trap,” writing: “I expect history will look back with dismay on the celebration of baby steps industry takes (such as public-private partnerships with health organizations, ‘healthy eating’ campaigns, and corporate social responsibility initiatives) while it fights viciously against meaningful change (such as limits on marketing, taxes on products such as sugared beverages and regulation of nutritional labeling).”
While Brownell concedes there are small victories to be gained by working with industry, he insists that the childhood obesity crisis won’t be solved without forcing food companies to do the things they don’t want to do. History is littered with unfulfilled industry promises to protect kids’ health, he said in an interview. A recent example was the “Smart Choices” label, introduced in 2009 by fourteen major food companies, including Kraft, Kellogg, PepsiCo and Unilever. The program gave Fudgsicles, Lucky Charms and Kid Cuisine Magical Cheese Stuffed Crust Pizza a little green check mark designating them as “smart” choices. Nutrition experts argued they were anything but healthy.
Or as Brownell put it: “How many more times are we going to get sucker-punched by the industry?”
Mrs. Obama’s remarks to the grocery manufacturers, though, implied an awareness of the historical tensions between the food industry and public health efforts. In her speech, she harked back to the early twentieth century, when adulterated foods—including the tubercular beef that Upton Sinclair described in The Jungle—led to the passage of the 1906 Pure Food and Drug Act and laid the groundwork for today’s Food and Drug Administration. “Instead of opposing that law and instead of viewing it as a threat, many manufacturers decided to embrace it,” Mrs. Obama said. Calling the obesity epidemic a “similar opportunity,” she added, “They also realized that increasing public trust and improving products all across the industry as a whole would benefit each of them individually.” It was both a subtle defense of regulation and a signal to food companies that their interests and that of the government weren’t necessarily at odds.
In that spirit, Let’s Move has taken a collaborative approach, forming a nonprofit group called the Partnership for a Healthier America to create and manage private sector alliances. “We don’t want to be pushing people from the table; we want to be bringing people to the table,” said Larry Soler, the group’s CEO, a former executive with the Juvenile Diabetes Research Foundation. The problem of childhood obesity is so broad and complex that no single approach will solve it, Soler added: “Virtually everyone has a role to play in this fight. It’s not just food companies; it’s schools and families. There’s a big problem here, and we’re going to need everyone to play a part.”
One of the advantages of the voluntary approach, Soler said, is that changes can be put in place quickly. Changing regulations or writing new ones is a slow process, though he noted that his group’s voluntary agreements have not interfered with legislative or policy-making efforts. Observers have pointed out that a collaborative approach might also result in less blowback from Republicans and industry-friendly Democrats who have sought to shut down regulatory efforts in Congress, for example, by limiting appropriations.
While seeking cooperation, the organization has also taken steps to avoid the industry’s “sucker punch.” For starters, it signs partnerships only with companies it believes will have a real impact, and it seeks out the advice of nutrition experts to help make that call, like the CSPI’s Wootan, who recently became an informal adviser. Many of the conversations between the group and would-be partners never result in an agreement, Soler said, because some companies find the organization’s standards too strict. (The group is also funded by foundations with health-related missions—not industry money.)
For example, companies that partner with Soler’s group must agree to an evaluation that determines whether the company followed through on its commitment; the results are made public. “The companies that make it through our process are very serious and are extremely committed,” Soler said.
Partnerships like these aren’t unique, even for public health advocates. “Partnerships with industry are essential to addressing nutrition and obesity issues,” Wootan said. “You can’t not talk to companies.”
But there is concern about a group closely allied with the government collaborating with entities the government is supposed to oversee. “It normalizes this idea of voluntary partnerships [with] industry as a substitute for real policy-making,” said Michele Simon, a public health lawyer and frequent food-industry critic.
* * *
The first corporate agreement the Partnership for a Healthier America announced came in 2010: it was with the Healthy Weight Commitment Foundation, a coalition that includes food giants PepsiCo, Nestlé and Coca-Cola and industry groups such as the Food Marketing Institute. The coalition, which has pledged to cut 1.5 trillion calories from its members’ products by 2015, will undergo a multimillion-dollar evaluation by an independent team funded by the Robert Wood Johnson Foundation.
While “1.5 trillion calories” makes for a good sound bite, it would, however, take us back only to 2007 levels, and it’s not even close to the 69 trillion calories that would have to be removed from the food supply to take us back to 1970 levels, according to calculations by Hank Cardello, a former executive with Coca-Cola and other food companies who now directs the Hudson Institute’s Obesity Initiative. It won’t be difficult at all for the companies to meet their mark, said Barry Popkin, a professor of nutrition at the University of North Carolina at Chapel Hill who is leading the evaluation. “It’s easy. They can cut a little fat or take some fat out and add some sugar in. They could just cut a few calories out of their beverages and do it.”
Popkin’s evaluation will look at national health data to see whether the calorie cuts improve health. The hard part, he said, will be getting consumers to buy the healthier foods. (There is also the worry that tweaking processed foods to make them slightly less unhealthy might lead people to eat more packaged products rather than the whole foods health experts advocate.)
But even incremental change is worth celebrating, said Lawrence Cheskin, director of the Johns Hopkins Weight Management Center. “Everything that will lead us in the right direction should be applauded. Purists will argue this is just window-dressing, but it is a step in the right direction.”
Even more controversial has been the first lady’s alliance with Walmart. In January 2011, the chain said it had made an agreement with the Partnership for a Healthier America to cut prices on healthy foods, reduce the sodium and sugar in packaged foods, and open stores in “food deserts”—neighborhoods lacking fresh grocery retailers. “It’s a victory for parents…it’s a victory for families…and, most of all, it’s a victory for our children,” Michelle Obama said at the press conference.
When a giant like Walmart takes even a small step, it can affect millions, and public health experts have praised some of its efforts, including a stricter food labeling system. To some, the Walmart partnership was a sign that Mrs. Obama was putting politics aside in a pragmatic bid to make real change in the food system. The chain’s plans to move into food deserts, however, were dismissed by some as an expansion strategy cloaked in social responsibility. The company had been looking to crack urban markets (particularly in progressive cities where it is unpopular) for years, and Mrs. Obama’s endorsement was a public relations dream [see “Walmart’s Fresh Food Makeover,” October 3, 2011]. Putting Walmarts in food deserts, critics worried, could harm the infrastructure of urban farms, food co-ops and farmers’ markets that have taken root in such places in recent years. Michel Nischan, the CEO of the nonprofit Wholesome Wave, which doubles the value of food stamps at farmers’ markets in twenty-eight states, isn’t too concerned. “There’s plenty of need to go around,” he said.
But the bitterest food fight of the Obama administration took place in 2011 over an effort to limit junk-food marketing to kids. In Mrs. Obama’s 2010 speech to food manufacturers, she took the industry to task for marketing unhealthy foods to kids. “Parents are working hard to provide a healthy diet and to teach healthy habits,” she said, “and we’d like to know that our efforts won’t be undermined every time our children turn on the TV or see a flashy display in the store.”
In 2009, Congress had ordered four federal agencies—the Federal Trade Commission, the Food and Drug Administration, the Centers for Disease Control and Prevention, and the Department of Agriculture—to form what became known as the Interagency Working Group and develop a set of guidelines for marketing foods to kids. The standards were to be voluntary, but were nonetheless seen by health advocates as a significant improvement over the current practice, in which each company creates and follows its own marketing guidelines. Now, at least, there would be wider input and standardization.
The industry saw the guidelines as a precursor to regulation. After the first draft was released for public comment in April 2011, the industry released a report that said the guidelines would kill 75,000 jobs. The US Chamber of Commerce said the standards reflected “an unhealthy federal intention and impulse to ban free speech.” Food companies began a lobbying and spending frenzy that convinced nearly a third of the Senate and 40 percent of the House to write letters to federal agencies criticizing the proposed rules, according to an analysis of congressional correspondence by the Sunlight Foundation. Food and media companies also pleaded their case at the White House: logs examined by Reuters showed that top executives from Nestlé, Kellogg, General Mills and the media companies Walt Disney, Time Warner and Viacom (which owns Nickelodeon) visited the White House together in July 2011. Two people present at the meeting told Reuters they were there to speak out against the standards. All three food companies are members of the Healthy Weight Commitment Foundation, the Let’s Move partnership that agreed to cut calories from their products.
The guidelines’ supporters assumed they had an ally in the Let’s Move campaign. Public health groups widely supported the proposed rules, which also appeared popular with the public: the FTC received 28,000 public comments in favor and just 1,000 against. Health advocates hoped Mrs. Obama would deploy the quiet leadership that had helped pass the school nutrition bill in support of the guidelines. They were wrong. “On food marketing to kids, we haven’t gotten any help from Let’s Move,” said Wootan, of the Center for Science in the Public Interest.
Wootan, who had originally come up with the idea of government-led voluntary standards, said she and other advocates called and visited the White House, including the first lady’s office. They spoke to the agencies involved, and even suggested ways for the administration to rebut what she calls the industry’s “bogus talking points.”
“The White House was silent,” she said, referring to both the West and East wings. Wootan says she never got a satisfactory answer from the Obama administration as to why they wouldn’t support the proposed rules. Agencies and offices pointed fingers at one another, she said. White House officials, however, maintain that they supported the effort and blamed Congress for the lack of progress. “We were disappointed when Congress granted the food industry’s requests and placed new demands on the working group,” said Nick Papas, President Obama’s assistant press secretary.
In December 2011, Congress passed a budget bill with a rider that blocked the FTC from working on the marketing standards until it completed a cost-benefit analysis. An administration official said in September that the rider in effect killed the standards, since there was no “credible way” to conduct a cost-benefit analysis on voluntary guidelines.
Eight months later, the first lady announced that Disney—one of the companies that had lobbied against the Interagency Working Group’s voluntary standards—had agreed to end junk-food marketing to kids by 2015. But Disney’s standards aren’t as strict as the guidelines it opposed, and it’s unclear how they will be evaluated. They are comparable instead to the voluntary rules adopted by the Better Business Bureau’s Children’s Food and Beverage Advertising Institute, which cover about 80 percent of foods advertised, including those of Kraft, PepsiCo and Kellogg, Wootan said. These are the kind of voluntary industry-led rules that child health advocates have found so wanting. At the announcement, Disney chief executive Bob Iger stood beside top regulators involved in the Interagency Working Group and told reporters that actions like Disney’s could “create huge change without having the government step in to directly regulate or legislate our efforts,” Reuters reported at the time. A Disney spokesman would not elaborate, saying only that the company had been working on childhood nutrition initiatives since 2006 and was strongly supportive of Let’s Move.
* * *
In November 2011, speaking at a summit organized by the Partnership for a Healthier America, Mrs. Obama heaped praise on the food companies. She congratulated manufacturers for cutting sugar and salt, restaurants for overhauling kids’ menus, and grocery stores for building in food deserts, and she also praised the efforts of parents and schools. Then she pivoted: “I want to talk about the crisis of inactivity that we see among our kids and what each of us can do to start solving that problem.”
Eddie Gehman Kohan, founding editor of Obama Foodorama, a blog that has chronicled every food-related facet of the administration, called it “a fundamental shift.” Nestle, Simon and others registered dismay at what they saw as a departure from the politically charged arena of food. Food companies like to talk about exercise because it shifts the emphasis from their products and reinforces the industry’s insistence that any food can have a place in a healthy diet. It also shifts the conversation from one about systemic problems—such as food marketing—to individual lifestyle choices (i.e., “just exercise more!”). But studies show that exercise, while offering huge health benefits, cannot by itself address obesity or ward off the weight gain that arises from eating junk food.
Sam Kass, assistant chef and senior policy adviser for healthy-food initiatives at the White House, insists that reports of a “fundamental shift” are incorrect and that exercise was one of Let’s Move’s pillars from the beginning. “The notion that we were somehow moving away from nutrition was simply wrong,” he said.
Gehman Kohan, writing in an e-mail, added: “It makes for an attention-grabbing headline to accuse the First Lady of ‘caving’ to greedy private interests that might donate to the Obama campaign during an election year, but that simply was not the case.”
An examination of press releases from both Let’s Move and the Partnership for a Healthier America put out since the first lady’s speech in November 2011 shows that the number of food- and exercise-related announcements have been about even. Before Mrs. Obama’s November speech, however, food announcements greatly outnumbered those related to exercise by more than two to one, which might explain why some perceived a shift. Soler said exercise partnerships have been in the works for some time but have taken longer to coalesce.
The trajectory of Let’s Move has left many of those initially optimistic about the program feeling doubtful that it will accomplish much more: the best of intentions appear to be mired in the unhappy realities of American politics. “It’s dead in the water,” Nestle said. “They can get some little tweakings through, maybe, but the force of it is gone. It’s compromised at this point.”
Kass is much more enthusiastic: “We’ve made progress beyond anything we could have dreamed of two and a half years ago. We’ve seen this issue become front and center in the minds of millions.”
That’s due largely to Mrs. Obama’s leadership and persuasion. But her sole authority is moral authority. While she’s brought tremendous attention to obesity and healthy living, she doesn’t have the power to make the regulatory changes that public health experts say are key. “It’s not her fault,” said Simon. “She’s just in the wrong wing of the White House.”
Brownell likewise said he doesn’t blame the Obama administration and Let’s Move for failing to accomplish broader change. “Citizens United didn’t help, the fact that we’re in an election year will slow things down, and regulatory agencies have been gun-shy,” he said. Noting the campaign’s substantial victories, such as school lunch reform and improved nutrition at daycare centers, he added: “Those are some pretty big changes, but not signs the food industry is changing its ways.”
If leaders are to take the bold steps, such as soda taxes and marketing restrictions, that public health advocates urge, they’ll need to be backed—and pushed—by a more vigorous movement. “What they need is a public that demands these things and that gives politicians cover to take these actions,” Brownell said. Without that, Let’s Move may well have done all the moving it can.