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Application of Law to the Childhood Obesity Epidemic

Published online by Cambridge University Press:  01 January 2021

Extract

Childhood obesity is a national public health problem. Regardless of gender, race, socioeconomic status, or geographic location, children are “gaining weight to a dangerous degree and at an alarming rate.” Since 1980, the number of overweight children has doubled; among adolescents the number has almost tripled. Today, among children who are more than six years old, about nine million are obese. Many of the factors that contribute to obesity occur at a societal level, prompting the Surgeon General to conclude that preventing obesity is a “community responsibility.”

Childhood obesity is, in many important respects, a result of legal policy. Law shapes the situational and environmental influences that drive both dietary intake and physical activity. Government, public health advocates, and the food industry all use the law to alter these influences in furtherance of their respective goals. Public interest advocates attempt to persuade government and corporations to act in the interest of public health while the industry focuses on profit.

Type
Symposium
Copyright
Copyright © American Society of Law, Medicine and Ethics 2007

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References

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Although the wellness committees and the ABA/Clinton agreement are both quite new, media reports have appeared relating instances in which wellness committees are seeking to provide healthier vending machine options in their school districts. See, e.g., Farnam, J., “ISD 166 to Ban Soda Pop at School,” Cook County News-Herald, June 22, 2006.Google Scholar
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From 1989 to 1993, Congress seemed aware of the issue but did little beyond encouraging general public awareness. For example, the 101st Congress enacted programs such as National Checkup Week and National Weight Loss Month. It first mentioned the obesity epidemic in 1993, when the National Institutes of Health Revitalization Act of 1993 called upon the NIH to research obesity. Although many programs have been proposed at the state and local level, fewer have actually been enacted.Google Scholar
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A 1965 panel focusing on children's advertising, moderated by former FTC chairman Newton Minow, debated “whether advertisers ‘are using five year olds to pressure parents into buying their products.’” Gavin, J. M., “Panel Doesn't Kid Around about Effectiveness of Children's Ads,” Chicago Tribune, July 13, 1965, at C8. A subsequent FTC chair, Lewis Engman, chastised the ad industry, already spending $400 million in the early 1970s on children's advertising, for its lack of effective self-regulatory standards. He predicted: “If television advertising…fosters dietary habits which endanger their health .I think TV ads directed at children will soon find itself circumscribed by legal restrictions and legal requirements.” Shifrin, C., “A Look at Children's TV Advertising,” Washington Post, August 7, 1973, at B4. Minow subsequently wrote a scathing indictment of the FTC and industry's failure to adequately protect children. Minow, N., LaMay, C., Abandoned in the Wasteland: Children, Television, & the First Amendment (New York: Hill and Wang, 1996).Google Scholar
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Testimony by nutritionists, dentists, and doctors on the negative health impacts of advertising foods led the Committee's conclusion that “[t]elevision advertises food to children which is bad for children's health…and are linked to major medical problems including obesity, diabetes, and heart disease.” Id., at 60–61. Many of the arguments currently offered in support of government regulation of children's advertising from a public health standpoint were already substantially developed decades ago.Google Scholar
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Both agencies derive their authority to regulate advertising from the Commerce Clause of the Federal Constitution, which grants the federal government jurisdiction over commerce among states. The legal implications of Commerce Clause authority will be discussed in Part V. In 1974, CSPI (unsuccessfully) petitioned the FDA to require health warning labels on sugary cereals. Rice, W., “Proposing a Public Caveat on Sugar Cereals,” Washington Post, August 2, 1974, at B1. Michael Jacobson had proposed that cereals that contained more than 10 percent sugar would have to be promoted as a snack rather than a breakfast cereal and carry a label stating “Contains….% Sugar[.] Frequent Use Contributes to Tooth Decay and Other Health Problems.” Id. This predated the NLEA. At the time, cereal companies' practices differed with regard to the disclosure of sugar content in cereals and other foods.Google Scholar
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In 1982, Timothy J. Muris, then Director of the FTC's Bureau of Consumer Protection, wrote: “When we arrived at the Commission, there was disrespect for the agency among businesses, on Capitol Hill, and in the legal community. This disrespect was well-earned. The Commission in the 1970s saw itself as the second most powerful legislature in Washington. The leaders of the previous administration had a deep distrust for business. Ill-considered proceedings resulted, such as the infamous children's advertising rulemaking.” Muris, T. J., “The Consumer Protection Mission: Guiding Principles and Future Direction,” Antitrust Law Journal 51 (1982): 625632, at 625; see also Applbaum, A., Mike Pertschuk and the Federal Trade Commission (John F. Kennedy School of Government, Harvard University, 1981).Google Scholar
The staff proposed several alternatives: Ban all TV for any product young children below the age of 8, ban ads for sugared products for children below the age of 12, and require that TV ads aimed at children older than 12 be balanced by nutritional or health disclosures. Each of these recommendations focused upon an environmental solution to prevent childhood disease by preventing television advertisements from entering the home as a public health intervention rather than requiring parents to act as a human shield against the bombardment. See FTC Staff Report on Television and Advertising to Children, supra note 163.Google Scholar
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In its Motion the industry relies on a series of cases to show irreparable harm. What is interesting is the industry's reliance on cases that involve political speech on the part of individuals. Industry seeks to collapse the appropriate distinction between the reduced protections for commercial speech and the high protections afforded the political speech of citizens. Elrod v. Burns, 427 U.S. 347 (1976) and Newsom v. Norris, 888 F. 2d 371 (6th Cir. 1989), cited in Motion at 27. While this language can be partially attributed to zealous advocacy, such an absolutist position by commercial interests is not uncommon.Google Scholar
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Collapsing the distinction between commercial speech and non-commercial speech and subjecting both to the same judicial scrutiny would undermine the state's ability to protect the health and welfare of the population. See Parmet, and Smith, supra note 27.Google Scholar
See, e.g., Terilli, S., “Nike v. Kasky and the Running-but-Going-Nowhere Commercial Speech Debate,” Communications Law & Policy 10 (2005): 383432.CrossRefGoogle Scholar
On the question of whether litigation should be employed as a means to force reformulation of fast foods or more complete and available nutritional information, industry promotes the oftcited statistic that 89% of consumers “strongly disagree that lawsuits should be slowed against fast food chains” as a means of combating obesity. Fifty-four percent of those polled “believe that the individual, and not the corporation, is solely responsible for healthy eating.” That leaves a sizable forty-six percent casting a critical eye on corporate responsibility. Fried, E., in Crawford, D. and Jeffrey, R., eds., “The Potential for Policy Initiatives to Address the Obesity Epidemic: A Legal Perspective from the United States,” in Obesity Prevention in the 21st Century: Public Health Approaches to the Obesity Pandemic (London: Oxford University Press, 2005): 265283.Google Scholar
Pelman v. McDonald's, often derided as frivolous and the catalyst for legislation that shields the food industry from litigation based on claims of obesity, continues its journey through the courts four years after its predicted dismissal; claims of deceptive advertising remain to be adjudicated. Pelman v. McDonald's Corp., 396 F.3d 508 (2nd Cir. 2005); motion granted by Pelman v. McDonald's Corp., 2005 U.S. Dist. LEXIS 24869 (S.D.N.Y. 2005) .Google Scholar
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See Part V for a more complete discussion of litigation as a public health strategy.Google Scholar
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For a discussion of several of these cases, see Parmet, W., “After September 11: Rethinking Public Health Federalism,” Journal of Law, Medicine & Ethics 30 (2002): 201211, at 204.CrossRefGoogle Scholar
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See, e.g., id. (invalidating state law mandating that highway trucks be no more than 60 feet long as a burden on interstate commerce); see Parmet, and Banthin, supra note 27 (discussing the difficulty of effectively controlling internet tobacco sales under modern dormant commerce clause doctrines); Allen, D. M., Annotation, , “Validity Under Commerce Clause (Art I, §8, cl 3), of State Statutes Regulating Labeling of Food,” American Law Reports Federal 79 (2006): 246272.Google Scholar
Preemption was an issue when public health advocates tried to protect the public by restricting smoking. The tobacco industry sometimes supported statewide anti-tobacco laws because the laws were weakened by political compromise and preempted stricter local measures. Siegel, M. et al., “Preemption in Tobacco Control: Review of an Emerging Public Health Problem,” JAMA 278 (1997): 858863. This could also become a problem with obesity-related laws.CrossRefGoogle Scholar
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Protection of public health has been and is a long-standing role of state and federal governments that has been a long-understood facet of state power. Public health has a rightful and traditional role in shaping the relations of the states and the federal government. See, e.g., Parmet, W., “From Slaughter-House to Lochner: The Rise and Fall of the Constitutionalization of Public Health,” American Journal of Legal History 40 (1996): 476505.CrossRefGoogle Scholar
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Gostin, Compare L., “When Terrorism Threatens Health: How Far are Limitations on Personal and Economic Liberties Justified?” Florida Law Review 55 (2003): 11051170; with Parmet, W. E., “Liberalism, Communitarianism, and Public Health: Comments on Lawrence O. Gostin's Lecture,” Florida Law Review 55 (2003): 12211240; and see Mariner, supra note 31. Also see Daynard, R. A., “Regulating Tobacco: The Need for a Public Health Judicial Decision-Making Canon,” Journal of Law, Medicine & Ethics 30 (2002): 281289 (discussing the importance of judicial training to ensure that courts can recognize this tension when presented with it).Google Scholar
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Id., at 84–85. It is also important to mention the transaction costs of litigation. Facing large expenses and small awards, many lawyers may be reluctant to bring such lawsuits even if they are highly beneficial to the public. Brunet, E., “Debunking Wholesale Private Enforcement of Environmental Rights,” Harvard Journal of Law & Public Policy 15 (1992): 311324, at 313. Likewise, if fees are too high, lawyers may encourage clients to bring cases of limited merit. Further, causation requirements and damage calculation in tort law are designed for individual plaintiffs. See Smith, , “Setting the Stage,” supra note 11. Class actions may help address this problem, but they are not always appropriate for plaintiffs whose exposure to an agent or severity of disease varies, eg., Lin, A., “Beyond Tort: Compensating Victims of Environmental Toxic Injury,” Southern California Law Review 78 (2005): 14391528, at 1516–1517, and can end up benefiting lawyers more than class members. Coffee, J. C. Jr., “Understanding the Plaintiff's Attorney: The Implications of Economic Theory for Private Enforcement of Law through Class and Derivative Actions,” Columbia Law Review 86 (1986): 669727, at 678–79.Google Scholar
Pelman v. McDonald's is a good example. The court dismissed many of the plaintiff's individually-focused claims but allowed a consumer protection claim based on harmful advertising to proceed. The court ruled that the plaintiffs did not need to allege highly specific causation, only a general connection between their injuries and McDonald's conduct. Pelman v. McDonald's Corp., 396 F.3d 508 (2nd Cir. 2005). The court thus directed the plaintiffs' focus to broader issues than their own personal experiences. See Smith, , “Setting the Stage,” supra note 11.Google Scholar
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Advocates and the public need information to ascertain the true costs of health-affecting behaviors, eg., Givelber, D. and Robbins, A., “Public Health Versus Court-sponsored Secrecy,” Law and Contemporary Problems 69, no. 3 (2006): 131139, available at <http://www.law.duke.edu/shell/cite.pl?69+Law+&+Contemp.+Probs.+131+ (summer+2006)> (last visited November 30, 2006), and if there is enough causation to settle, there may also be enough to necessitate action on the part of public health officials. Id. Settlements may be beneficial to plaintiffs, who can then avoid a long and expensive lawsuit, and to defendants, who can reduce exposure that would lead to future litigation or regulation, but they pose a problem for the public. For example, an asbestos producer settled with 11 plaintiffs in 1933 but continued to use asbestos for the next 40 years because the settlement was unknown to the government or to the public. Id.Google Scholar
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Here we to refer to not only the food industry as corporations but also to business associations, trade groups, and self-regulatory bodies that represent purely free market interests and public interests secondarily if at all.Google Scholar
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In the Civil War era, consumers enforced their rights mostly through private litigation, suing tort law to protect their property. Courts were resistant to governmental regulation (as in Lochner), and when regulation did occur it was highly susceptible to corruption, such as bribery. Glaeser, E. L. and Shleifer, A., “The Rise of the Regulatory State,” Journal of Economic Literature XLI (2003): 401425, at 404–05. Regulatory oversight began slowly beginning in the late 1860s and greatly expanded during the first two decades of the 19th century. Examples include the Interstate Commerce Act of 1887 (restricting railroad contracts), the Sherman Act of 1890 (establishing federal oversight of monopolies and trusts), the Pure Food and Drug law of 1906 (controlling the sale of medicine), the Federal Reserve Act of 1913 (implementing controls on banking), and the Clayton Act of 1914 (further regulating monopolies). Id. However, during World War I, though the federal government continued to pass laws controlling industry, support for regulation again decreased as efficiency of production became the primary goal. The head of the Food Administration at this time, Herbert Hoover, viewed the role of regulatory agencies as facilitating cooperation between private entities. Rabin, R. L., “Federal Regulation in Historical Perspective,” Stanford Law Review 38 (1986): 11891326, at 1235–1237. In the 1920s, regulations were oriented more towards allowing government and industry to work together. Id., at 1235–41.CrossRefGoogle Scholar
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Some postulated that industry capture of agencies made regulation inefficient and ineffective. Hanson, J. and Yosifon, D., “The Situation: An Introduction to the Situational Character, Critical Realism, Power Economics, and Deep Capture,” University of Pennsylvania Law Review 152 (2003): 129346, at 203–04. However, powerful entities like the Teamsters opposed deregulation, as did Congress. Moore, T. G., “Moving Ahead,” Regulation 25, no. 2 (2002): 613, at 6–7. But in general, the public was opposed to regulation: “[T]he deregulation movement was…a one-shot response to the peculiar political conditions of the late 1970s[:]…disillusion[ment] with the efficacy of government intervention.” Peltzman, S., “The Economic Theory of Regulation after a Decade of Deregulation,” Brookings Papers on Economic Activity, Special Issue (1989): 159, at 2.CrossRefGoogle Scholar
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Some commentators credited deregulation with the creation of massive wealth in the United States. See, e.g., Barnard, B., “Freeing Europe's Economy: Deregulation Could Save Europeans Billions but Proponents Worry the Drive to Cut Red Tape is Running Out of Steam,” Europe (April 2002): 1617 (comparing the growth in the 1990s of the deregulated American economy to that of heavily-regulated Europe). In the 1970s and 1980s, many supporters of deregulation argued that regulating industries, whether through price controls, licensing, or setting minimum standards, inhibits competition and leads to economic inefficiency. See Rabin, supra note 245, at 1317–1318. Some see the growth of the American economy in the 1990s as a vindication of this viewpoint. As public trust in industry increased, industry has become bolder, emphasizing “self-regulation and voluntary compliance.” Estlund, C., “Rebuilding the Law of the Workplace in an Era of Self-Regulation,” Columbia Law Review 105 (2005): 319404, at 340–341. Nonetheless, deregulation is hardly a simple solution. Some scholars believe that deregulation in one sector of the economy can lead to “bottlenecks and market imperfections” in other sectors, necessitating further regulation. Rose-Ackerman, S., “Defending the State: A Skeptical Look at ‘Regulatory Reform’ in the Eighties,” University of Colorado Law Review 61 (1990): 517535, at 520–22 (discussing the airline deregulation efforts).Google Scholar
Such scandals include The Savings and Loan crisis and more recent incidents involving Worldcom and Enron. Kahn, F. S., “Bombing Markets, Subverting the Rule of Law: Enron, Financial Fraud, and September 11, 2001,” Tulane Law Review 76 (2002): 15791643, at 1623, n. 123.Google Scholar
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