Fighting to shed a few pounds and control that waistline? For the soaring number of Americans who are becoming dangerously overweight, states and cities across the country want to help.
With the U.S. Surgeon General calling obesity an epidemic, legislators nationwide are offering measures to encourage healthy food choices and ban the worst temptations.
Skeptics say government should stay away from trying to legislate something as personal as what we eat. But supporters say they can't ignore a growing public health problem or how it drives the ever-rising cost of health care.
Few ideas have become law yet. But states have considered scores of bills this year that would, among other things: get kids exercising; warn restaurant eaters about fat, sugar and cholesterol on the menu; and, ban sugary sodas and fattening chips from school vending machines.
In a Louisiana experiment, the state will pay for a few government employees' gastric bypass surgery, or stomach stapling, to see if it reduces health care costs.
'We are in an epidemic'
"As a country, we have to wake up. We are in an epidemic," said Nevada state Sen. Valerie Wiener, who has had her own battles with weight but now is a champion weightlifter.
She heads a state committee gathering data on obesity, and how the legislature, food companies, the health care system and schools can act. "We're all paying the price," she said.
Under the laws that have passed, states will:
- Test the BMI, body-mass index, a ratio of height to weight, of students in six Arkansas schools, and send results home. Pediatricians say regular tests like this should be performed nationwide to track children at risk of becoming obese.
- Ban junk food from vending machines in California. New York City, in an administrative decision, banned hard candy, doughnuts, soda and salty chips from its vending machines.
- Require physical education programs in Louisiana schools, and encourage it in Arkansas and Mississippi. Though once a staple, such daily classes are now only required by state law in Illinois; other states let local officials decide or require exercise less often.
Public campaigns aimed at getting people to change their eating habits also remain popular. Billboards across West Virginia, featuring photos of bulging stomachs and couch potatoes, exhort people to "Put Down Chips & Trim Those Hips." Houston, Philadelphia and San Antonio, Texas have started "get fit" drives.
The statistics show the need for such efforts. The number of obese adults has doubled in 20 years, and is now up to nearly 59 million people, or almost a third of all American adults.
Childhood obesity has tripled, with one child in six considered obese.
As the pounds add up, so do the health care costs, because obesity is linked to diabetes, heart disease, and deaths from cancer, among other ailments.
West Virginia found that, for state employees, costs for obesity have more than doubled since 1995, rising from $37 million to $78 million, now nearly a fifth of the employees' $400 million health plan.
Still, some are critical both of the statistics and the proposals.
"There's a lot of fear and hysteria," said Mike Burita at the Center for Consumer Freedom, an advocacy group for the restaurant and food industry. "We're allowing government and these public health groups to dictate our food choices to us."
Among his top targets is the Center for Science in the Public Interest, a consumer advocacy group that produces a steady flow of warnings about unhealthy food, from movie popcorn to Chinese takeout.
"It's OK to have a cheeseburger and fries, but it shouldn't be a mainstay of your diet," Burita said. Exercise and education are the solutions, he said. "Kids went from playing dodge ball to playing computer games."
Most efforts have failed
The skeptics are being heard. A Texas proposal to limit school children's access to snack and soda vending machines died after the state soft drink association complained. Most of the 80 or so obesity-related bills around the country also failed to pass.
"It's difficult to want to tackle something like this, something as huge as this," said Weiner, the Nevada lawmaker. She plans to bring together people from the food industry and the public health community to work with lawmakers.
The federal government is acting, too. The Bush administration urged insurance companies to offer premium discounts to people with healthier lifestyles. It has started giving grants to cities to target unhealthy habits.
More immediate changes are brewing on the state and local level.
In West Virginia, the state agency that insures public employees has started offering exercise benefits and diet counseling, in addition to the state's advertising campaign.
"If we don't get a handle on this, this generation of kids coming up will have a shorter life span than their parents," said Nidia Henderson, wellness manager at West Virginia's Public Employees Insurance Agency. "That's scandalous."