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It's the left that's turning conservative. Well, not conservative, but pushy. Weisberg put his finger on the underlying trend: "Because Democrats hold power at the moment, they face the greater peril of paternalistic overreaching." Today's morality cops are less interested in your bedroom than your refrigerator. They're more likely to berate you for outdoor smoking than for outdoor necking. It isn't God who hates fags. It's Michael Bloomberg.
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New York City Health Commissioner Tom Frieden has just been named to head the federal Centers for Disease Control and Prevention. In announcing his new job, the White House touts his expertise in health care reform, swine flu, and tuberculosis. But Frieden's distinctive expertise isn't in infectious diseases. It's in chronic diseases associated with eating. Frieden is the world's most ambitious innovator in redefining unhealthy foods as not really food. By rhetorically pushing these items out of the category of sustenance, he's paving the way for more aggressive regulation of what you eat.
First Frieden went after trans fats. There, he had a good case that the targeted ingredient was industrial, not nutritional. But he wasn't shy about exploiting that angle. In its two documents explaining the city's ban on trans fats, Frieden's health department uses the word artificial 77 times.
Then he went after salt. Only 10 percent of the salt we consume "is found naturally in food," the health department declared in a bulletin devoted to topic. The vast majority was "processed" and "packaged" by "manufacturers." Frieden used this point in his campaign to pressure food companies to halve the salt content of high-sodium foods.
Then, last month, Frieden and Kelly Brownell, the director of Yale's Rudd Center for Food Policy and Obesity, propose a penny-per-ounce excise tax on "sugared beverages." Writing in the New England Journal of Medicine, they rejected the notion that soft drinks were sacred "because people must eat to survive." On the contrary, they argued, "sugared beverages are not necessary for survival."
I'm not saying these initiatives are out of line. I detest trans fats, soda, and excess salt. But let's be clear about what's going on: We're recategorizing things so we can get away with aggressively regulating them.
Americans don't like the idea of bureaucrats banning or restricting unhealthy food. We tend to think it's none of the government's business. But food-related disease, particularly obesity, has become a huge problem for any government agency charged with disease control and prevention. If Frieden can persuaded us that trans fats are artificial, sweet drinks aren't necessary for survival, and most of the salt we eat is unnatural, then maybe we can accept restrictions on them as akin to regulation of tobacco or additives, not a jackbooted assault on eating in general. And if we do, I'll be curious to see what Frieden goes after next.
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A month ago, when advocates of a federal soda tax laid out their case, revenue generation was a secondary point. Today, as Congress looks for ways to finance universal health care, it's front and center. At a Senate finance committee hearing this week, proponents argued that a soda tax would help fund medical care while improving public health.
How much money would a tax bring in? The Congressional Budget Office says a tax of 3 cents on each 12-ounce container would generate $6 billion per year; the Center on Budget and Policy Priorities claims a penny-per-ounce tax would produce $10 billion per year.
Will Congress agree to such a tax? According to the Wall Street Journal, "Senior staff members for some Democratic senators at the center of the effort to craft health-care legislation are weighing the idea behind closed doors." But Politico reports:
There appeared to be a bubble of support among the experts for taxing bad behavior, including a $2 tax on a pack of cigarettes and a higher excise tax on alcohol. But soda and sugary drinks found a friend Tuesday in Sen. Chuck Grassley (R-Iowa), the ranking member on the Finance Committee. He categorically rejected the idea during a conference call with reporters. "No," he said swiftly, when asked if there was any chance of taxing it. "I think, quite frankly, the only reason it's being brought up is to get it shot down early so it doesn't become part of the debate. I don't think it's going to have any legs at all."
Human Nature's interest in this subject isn't about the money. It's about how we think about food, drink, and drugs. Why do we treat marijuana, but not alcohol, as a forbidden drug? Why do we regulate nicotine but not caffeine? And how do we reshuffle these categories? How do we recast french fries as a dangerous substance? How does soda, which used to be a drink, become a target of sin taxes, like alcohol and tobacco?
Our sister publication, The Big Money, has a good post on the soda tax debate that illustrates this struggle to reframe food. Dan Mitchell notes that the American Beverage Association is calling the chief soda-tax advocacy group, the Center for Science in the Public Interest, a branch of "the food police" who "make their living ... by bashing foods and beverages." Mitchell replies that "people in the food industry make their living ... by persuading Americans to consume a lot of crap."
That's the cultural struggle underway as Congress looks for revenue sources to fund health care. Can Republicans and the beverage industry protect sugary soft drinks from being lumped in with booze and cigarettes as a deserving tax target? And as money gets tighter and Americans get fatter, how long will that defense last?
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The food police are closing in on their next target: a soda tax.
Writing in the New England Journal of Medicine, they propose a penny-per-ounce excise tax on "sugared beverages." That's nearly $3 per case. Why so much? Because this tax, unlike the petty junk-food taxes of yesteryear, is designed to hurt. Its purpose is to discourage you from buying soda, on the grounds that soda, like smoking, is bad for you.
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The war on junk food is forging ahead. New York, Philadelphia, and Boston have banned trans fats. New York is forcing restaurants to post calorie counts. Britain has outlawed junk-food ads during kids' TV shows. South Korea's capital has banned soda from schools. Berkeley and other jurisdictions have prohibited new fast-food restaurants in certain neighborhoods, and last year, Los Angeles considered doing the same.
When I first outlined this crusade, I said it would rely on three arguments: that we should protect kids, that fat people are burdening the rest of us, and that junk food isn't really food. All of those arguments are certainly in play.
But a fourth argument has joined the mix as well: Junk food, like cigarettes, is addictive and should be similarly regulated. Initially, this was just a metaphor. Now it's becoming more than that. Scientists are trying to show that food literally addicts you like drugs.
Two days ago, Alain Dagher and colleagues from the Montreal Neurological Institute published a study in Cell Metabolism on the effects of ghrelin, a hormone associated with appetite. They concluded that "metabolic signals such as ghrelin may favor food consumption by enhancing the hedonic and incentive responses to food-related cues." The word addiction never appears in the journal article, but it's all over the spin and the coverage. Here are excerpts. Keep an eye on the phrases I've bolded.
First, the press release from Cell Metabolism:
The reward centers linked to ghrelin in the new study are also those involved in drug addiction. "That shows it's reasonable to think of high-calorie food as having addictive potential," Dagher said. If so, he suggests that the results could provide the basis for new policies aimed at treating fast food more like cigarettes—for instance, banning its sale in school cafeterias.
Here's the press release from MNI:
The study supports the view that obesity must be understood as a brain disease and that hunger should also be looked at as a kind of food addiction. Obese individuals may eat too much largely due to excess hunger. Dr. Dagher and colleagues found that ghrelin worked on regions of the brain known to be involved with reward and motivation, the same regions implicated in drug addiction. ... "These areas work together to assign incentive value to objects in the world and to actions, and exert very powerful control over our behavior. They are all targets of addictive drugs (like cocaine and nicotine), and are also targets of feeding signals like ghrelin," explains Dr. Dagher. ... This research may also inform public policy. If food is thought of as potentially "addictive," this would support action to limit or ban fast food from schools and junk food advertisements geared toward children, in the same way that results proving nicotine to be addictive spurred the current public policy toward nicotine.
In the Telegraph of London, Dagher links tobacco, cocaine, and chocolate:
Interestingly, the brain response to smoking pictures (in smokers) is very similar to the brain response to food pictures. In a previous study from our research unit, the brain response to eating chocolate was similar to the response to cocaine (in cocaine addicts). Finally, the evidence that high calorie foods are, in a way, addictive (something soft drink and fast food merchants have known for years) provides a justification for public policy.
In fact, Dagher suggests that food addiction may be the basis for drug addiction, rather than the other way around. Here's his interview with LiveScience:
"One theory is that addictive drugs act on brain systems designed to control food intake," Dagher said. "Our brains didn't evolve to make us vulnerable to addictive drugs." Neuroscientist and psychologist Dana Small at the John B. Pierce Laboratory affiliated with Yale University, who did not participate in this study, said these findings suggest it might make sense "to use what we know about drug addiction to understand and treat obesity." It may be reasonable to think "of high-calorie food as having addictive potential," he added. "If food can be thought of as 'addictive,' this supports doing things like banning fast food shops from schools, or advertising junk food to children. Note that public policy aimed at tobacco was really spurred by the science showing that nicotine was addictive."
In a HealthDay wire story, Dagher combines the addiction and harm arguments to make a direct case for regulating food like tobacco:
[I]t makes sense to think of appetite as a kind of addiction. So, if we want to address the fact that obesity is now the number one killer in the world, we're going to have to tackle the problem in the same way that we tackle cigarette smoking.
Scientifically, the evidence for food addiction isn't nearly this simple. Endocrinologist Barbara Kahn points out:
Overeating and drug addiction may converge on some of the same neurons. But other pathways are also involved. And from a biochemical point of view, the two are not the same thing. Drug addictions are much stronger. So to suggest that they are the same makes people feel that they can't do anything about overeating. That it's out of their control. So, I don't really buy that parallel. There may be aspects of overeating that may be related to aspects of addiction. But overeating is not just another addiction.
As a scientific matter, I suspect that Kahn is right and that Dagher is overselling the data. But as a media matter, simplicity beats complexity, and a good metaphor wins every time. Just look at the headline on New Scientist‘s report: "Stomach hormone turns hungry people into junkies."
As neuroscientists focus their attention on obesity, you can expect to see more studies comparing food cravings to drug addiction. As these studies accumulate, you can expect to hear them cited in campaigns to regulate junk food. But the people pushing this analogy had better hope the science is exaggerated. Because if we really do crave junk food the way addicts crave drugs, good luck prying those cheeseburgers from our hands.