Tracking the Taxation Movement

Warning SignIn the struggle to reverse the childhood obesity trend, one of the most pervasive tropes about junk food is to “tax it like tobacco.” In 2008, at the National Childhood Obesity Congress, Dr. Pretlow met Steven K. Galson, who was at the time the acting U.S. Surgeon General. They talked about the feasibility of taxing junk food, and the official felt that neither consumers nor food companies would allow it to happen.

The anti-tobacco movement had, and has, unavoidable political implications. Nicotine was proven to be habit-forming, and many of the 400-odd ingredients of cigarettes were shown to be carcinogenic. The public learned that the industry had been covering up these guilty truths. Since there are laws around selling addictive drugs, and the intentional and conscious causing of disease, and lying to the public, the issues seemed clear. It seemed reasonable to impose a heavy tax and make the industry pay for some of the damage.

From Tobacco to Soft Drinks

It seemed totally logical to make a parallel case against the manufacturers of junk food and sugar-sweetened beverages. In contemplating any law, even before asking, “Can it be done?” we should be asking, “Should it be done?” The question of taxing sugar-sweetened beverages is still in this initial questioning phase. Once the idea of taxing harmful foods was proposed, various schools of thought sprang into being. According to one of them, the co-morbidities of obesity were costing the public health system an unacceptable amount of money. It seemed only fair that the consumers and the industry should help pay the tab.

Of course, as soon as that argument gained traction, someone had to come along and refute it. The spoilsports were members of a research team whose work showed that while, in the short term, prevention can reduce the costs (and human suffering) resulting from obesity-related disease, the big picture tells a different story. In its Discussion, the study group wrote:

Obesity increases the risk of diseases such as diabetes and coronary heart disease, thereby increasing health-care utilization but decreasing life expectancy. Successful prevention of obesity, in turn, increases life expectancy. Unfortunately, these life-years gained are not lived in full health and come at a price: people suffer from other diseases, which increases health-care costs.

So, while obesity avoidance can add to a person’s years, those extra years bring other illnesses and other expenses. In fact, “total lifetime health spending was greatest for the healthy-living people.” The obese group were in the middle, and smokers incurred the lowest lifetime health spending. In other words, obesity costs the health-care system more than smoking—but healthy people cost the health-care system more than either group. Which just goes to show that numbers are not the answer to everything.

This is only one reason why, as Marc Armbinder pointed out in The Atlantic, anti-nicotine tactics can’t be seamlessly transposed into the struggle against harmful food products:

Obesity belongs in a different category of social illness. You can’t become a smoker until you decide to start smoking. For all the peer pressure and advertising that helped turn many 20th-century Americans into walking chimneys, you don’t have to smoke to live.

This very basic and obvious point has been made time and time again, mostly in discussions about how the venerable 12-step program blueprint has to be modified to fit the reality of food consumption. The abstention model can’t work, so what can? Does increasing the price of foods and beverages help people to cut down on them? Does junk-food taxation equate to obesity prevention?

Your responses and feedback are welcome!

Source: “Beating Obesity,”, 04/13/10
Source: “Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure.”, 02/05/08
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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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