1. Politics, Regulations and Obesity Warisa Panichkriangkrai DDS, MPH International Health Policy Program Fellow Ministry of Public Health, Thailand risapanich@yahoo.com

2. apps.who.int/infobase/report.aspx?rid=118&print=1 2005

3. apps.who.int/infobase/report.aspx?rid=118&print=1 2015

5. The Politics of Obesity: A Current Assessment and Look Ahead Rogan Kersh, New York University The Milbank Quarterly, Vol. 87, No. 1, 2009(pp. 295-316)

6. Outline 1.Obesity Politics: An Issue regime Emerges 2.State and Local policy responses 3.Looking Ahead: Promising Approaches

8. Lifest yle Medi cal treat ment Econ omic Medi a OBESITY “ Supersizing of America ” Health Effects $120 billion lost NEWS and Reports

9. “ISSUE REGIME” BIG & CHAOTICSMALL & SYSTEMATIC ideas, argume nts, viewpoi nts, opinions from many parties

10. Issue regime 1. Familiar voices 2. Solidifying frames 3. Limited national options

11. 1. Familiar Voices ME DIA Food and beverage industry and lobbying organization Obesity Society and The Center for Science in Public Interest (CSPI) Medical- industry representatives Policy makers, Politicians

12. www.ific.org/research/obesitytrends.cfm

13. 2. Solidifying Frames 2.1 Personal responsibility 2.2 Environmental frames

14. 2.1 Personal responsibility = concern of individual consumers overeating and consuming high-fat, low nutrition foods

15. Responsibility and Political effect Obesity = Personal failure difficult to mobilize point away from robust legislative solutions “ SOFT MEASURE ” Government-sanctioned nutrition education Exercise promotion

16. 2.2 Environmental frames expanding portion sizes foods high in fat, sugar and sodium availability of food at outlets advertising of high-fat, low-nutrition foods “ induced demand ”

17. 3. Limited National Policy Options exercise promotion obesity- education program consumer- injury lawsuits No policy change effort

18. 3. Limited National Policy Options Regulatio ns Succes sful food- industr y lobbyin g Little support from Congress subsidizing healthy food, restricting advertising, limiting unhealthy food sales, offering economic incentives, Federal litigation

19. Issue regime Minimal federal government action Positive sideNegative side Source of political stability Shape and guide policy action Deterrent to innovative reforms Difficult to alter the path of action

20. State and Local policy responses 1. Calorie Menu Labeling 2. School Policies

21. 1. Calorie Menu Labeling www.worldchanging.com/a rchives/007241.html

22. http://www.restaurantdietitian.com/menu_labeling_law.html

23. Menu Education And Labeling Act

25. Calorie menu labeling Reduce portion size Too much body image concern + -

26. Calorie Menu Labeling Questions remain: consumers see or understand label? any difference in consumers behavior?

27. 2. School Policies Limits on sugar, fat and sodium consumption in school cafeterias Voluntary bans on sodas in vending machines School Nutrition Policy Initiative (SNPI)

28. SNPI removing all sodas encourage the consumption of nutritious foods 50% reduction of obesity incidence Nationwide D+ Pennsyl vania

29. Looking Ahead: Promising Approaches 1. Foods of Minimal Nutritional Value (FMNV) 2. Reformulation

30. 1. Foods of Minimal Nutritional Value(FMNV) List of reducing soft drinks water ices chewing gum certain candies Remain unchanged since 1980 !!!

31. 2. Reformulation Removal or reduction of ingredients that linked to rising obesity rates ( fat, salt, sugar ) Government effort a moral-suasion campaign creating a low-interest federal loan program for food and beverage industry Potential danger = food safety risk

32. Conclusion Policies that gain legislative favor Clear plan of action A program of “rapid-response” research The genetic component research

33. www.who.int 2005

34. www.who.int 2015

35. Ecological Model Public policy Communi ty Organizat ional Interpers onal Individua l Personal responsibili ty Environme ntal frames VS

36. Public policyCommunity Organizatio nal Interperson al Individual Policy changeRegulations Policy analysis research, Media, Food industry Help group Concern about obesity problem

37. The National School Lunch Program Schools get cash subsidies from USDA Schools must serve lunches that meet Federal requirements

38. http://www.youtube.com/ watch?v=tVfAWbitBTs

39. http://www.opensecrets.org/lobby/indusclie nt.php?year=2008&lname=N01&id=

40. Regulatory axes on food advertising to children on television Elizabeth Handsley, Kaye Mehta, John Coveney and Chris Nehmy Australia and New Zealand Health Policy 2009, 6: 1

41. Outline 1. The type of program 2. The type of product 3. The target audience 4. The time of day 5. The content of the advertisement

42. The type of program: Dedicated children’s program Australia“ C ” program Commercial free program SwedenFor children under 12 year old No advertising during and immediately before or after a program BritainPrograms specially made for children

43. The type of product Food generallyLesser restriction Not contain any misleading or incorrect information Junk foodHow to define? - UK: High fat, sugar and salt - High sugar VS beneficial nutrients Advertisements for brand VS products Children’s foodAdvertiser Code for Advertising to Children (ACAC) - aim to children Should include foods that children have too great preference?

44. The target audience Age Not for children under 13 year old Criteria Advisory note nature of product theme of commercial story line visual used in commercial language age of actor target audience

45. The time of day Classificati on How children spend their day and when they watch TV? When children make up a given proportion of audience? At a given time, what is the proportion of children to be expected watching TV? WatershedExact time

46. The content of the advertisement Factors limit the effectivenes s of regulations Personalities Premiums Pester power Misleading Promoting unhealthy lifestyles

47. Conclusion The most effective means Limit time that children expose to food advertising Consumers can understand the criteria

48. Program: Thailand view No commercial free program 42 snack advertisements / 1 hour program

49. Thailand view government: strong regulations, strong action broadcast system: moral consumers: breach finding & complaint system