Preventive Services Task Force Guidance for primary care providers in screening for obesity and offering or referring to comprehensive, intensive behavioral weight management interventions.

The American Academy of Pediatrics Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity aims to inform pediatricians and other pediatric health care providers about the standard of care for evaluating and treating children with overweight and obesity and related comorbidities.

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Imposing the tax may not create a strong incentive for consumers to make changes. First, to influence consumer choices, the tax must be passed on to retail consumers. If snack food companies operate in competitive markets, the tax would be passed on to consumers because the companies are paying competitive prices for their inputs and cannot push the tax onto suppliers.

When food suppliers have some ability to set prices, the relation between taxes and retail prices is less direct. Second, the tax base—the foods that are taxed—has to be sufficiently broad to induce better choices. The tax base has to include nutritionally equivalent foods, however infrequently the latter are consumed.

No benefits accrue if the tax simply induces substituting one snack food for another—pork rinds for potato chips. Many economists have studied demands for broad classes of foods for example, substitution among beef, pork, chicken, and fish. How consumers might substitute away from particular types of highly processed food is not yet clear.

Tax proponents might hope that consumers would substitute fruit and vegetables for snack food. Third, consumers would have to respond to changes in retail prices. Looking at household expenditures in relation to income reveals that consumers are unlikely to be greatly influenced by a tax.

Household expenditures on the entire class of salty snack foods chips, nuts, pretzels, cheese puffs, and popcorn are for most households about 0. Consumers are not likely to pay much attention to changing retail prices for small expenditures. Other goods, like homes and cars, will command much more of their interest in prices.

ERS research estimating household demand for snack foods confirms that salty snack foods are not very responsive to prices. Estimated price responsiveness was similar in magnitude to that found in other empirical research for cigarettes and alcoholic beverages.

That is, price increases may reduce purchases, but the reduction will be much smaller than the tax-induced price increase. A relatively small tax on snack food, say 1 percent, would have vanishingly small impacts on dietary choices and thus negligible impacts on weight or health.

Since calculations were made under the assumption that the entire tax would be passed forward, the actual impacts may be smaller still. Higher tax rates, say 30 percent, appear to influence consumer food choices and weight so long as the tax base is broad.

But such results are tentative since the full range of consumer substitution possibilities is difficult to model and may not correspond to previously observed consumption patterns. Some health researchers and health policy activists have recommended placing restrictions on food advertising.

Some have proposed eliminating ads for candy, soft drinks, fast foods, and sugared cereal aimed at children. If children were no longer exposed to frequently repeated advertisements, other foods could compete for their attention.

The food industry spends enormous amounts on advertising; however, it is not clear to what extent these expenditures increase overall calorie consumption or how much consumption would drop if advertising expenditures were curtailed. Little direct evidence links food advertising and overall diet quality.

Studies that link the demand for individual food products and advertising are legion—many show that advertising does increase sales, and some show that advertising is cost-effective.

Even generic advertising studies usually show demand increases in response to such expenditures. But, because food encompasses many products and varieties, increasing demand for one food or even a class of foods says very little about overall diet quality. Evidence from the cigarette industry—where advertising has been restricted—offers some insights.

Numerous studies, though ongoing, largely conclude that aggregate cigarette advertising has a small or negligible impact on overall cigarette smoking. Promotional expenditures sway consumers from one cigarette brand to another, leaving the number of smokers and the number of cigarettes smoked unchanged.

If advertising affects food consumers similarly, then restrictions on food advertising may have a larger impact on brand choices than on overall food groups consumed or diet quality.

Food markets, for the most part, have stable aggregate demand, and advertising levels are strategically used to maintain market or brand share. Additional evidence from cigarette market studies suggests, however, that advertising effects may be different for children. For children, cigarette advertising may be more inducement than brand identification.

Potential benefits of restricted food advertising could be complicated in that across-the-board restrictions could result in lower prices and increased consumption of foods bearing the advertising restriction.

Some studies found that aggregate cigarette consumption actually increased after the U. banned broadcast cigarette advertising. Cigarette companies, no longer allowed to compete through broadcast commercials, were forced to compete more on price, and were able to do so from advertising savings.

If restrictions on food advertisements have similar effects on price and consumption, then Americans could end up fatter, not fitter. Weight status—underweight, healthy weight, overweight, or obese—is, for most people, an outcome of personal choices: what and how much to eat and whether and how much to exercise.

Changes in habits are possible—recent statistics from the Centers for Disease Control and Prevention indicate that former smokers now outnumber smokers. Furthermore, habits would not have to change drastically to lead to reclassifying the weight status of most Americans.

The American Dietetic Association says that each additional 3, calories a person consumes results in an additional pound of body weight. The list of unintended consequences stemming from obesity policy is probably longer. Even the most apparently straightforward policy proposal can have surprising effects: mandatory nutrition information at fast food restaurants could lead to reformulations or price promotions that do not necessarily contribute to healthier diets; taxes on snack foods could lead some consumers to substitute equally unhealthy foods for the taxed food; and restrictions on food advertising could ultimately lead to lower prices for food subject to the restrictions.

Food policy overflows with unintended consequences. The trick is making sure they do not overwhelm the intended ones. Scenario 1 : Producers are not responsive to consumer demand and do not supply the types of food desired by consumers. Processing, storage, transportation, and communication technology have enabled food manufacturers to both gauge and satisfy the subtlest variations in consumer preferences.

Competition to attract and keep customers extends to the fast food and restaurant industries. Large portions and high-fat foods are one way to draw customers. Competition also extends to low-income consumers. In urban areas, Asian, Caribbean, Indian, and South American stores offer indigenous foods and produce for their customers, many of whom are low-income recent immigrants.

All in all, there is little evidence that the U. food industry is unwilling or unable to supply the types of foods that consumers desire. Scenario 2: Consumers do not have enough information to make informed choices and inadvertently demand and consume diets high in calories.

The sheer volume of media coverage devoted to diet and weight makes it difficult to believe that Americans are unaware of the relationship between a healthful diet and obesity. consumers have basic nutrition knowledge and that they can discriminate among foods on the basis of fat, fiber, and cholesterol.

Most are aware of health problems related to certain nutrients. One consumer information gap may involve perceptions of appropriate weight. ERS researchers found that 41 percent of individuals whom health professionals would classify as overweight, but not obese, did not perceive themselves to be overweight.

Among individuals whom professionals would classify as obese, 13 percent said that their weight is about right or even too low. These misperceptions about healthy weight may lead to misinformed consumption choices. But the facts admit an alternative explanation: the available information does not allow researchers to distinguish misinformed weight perceptions from informed disagreement with public health weight norms.

Another information gap may exist with respect to the nutritional quality of food sold at restaurants. Restaurants offer foods high in fat and calories because these foods taste good, and they are not anxious to advertise their nutrition information for potentially skittish customers.

Do these limitations to nutrition disclosure at restaurants hinder the ability of consumers to make informed decisions? On the one hand, most consumers suspect that food served at fast food restaurants is not the healthiest. A Gallup Poll survey found that two-thirds of consumers thought that most food sold at fast-food restaurants was not good for them.