Like taking candy from a baby

A New England Journal of Medicine Perspective (Candy at the Cash Register — A Risk Factor for Obesity and Chronic Disease) argues that, “the prominent placement of foods associated with chronic diseases should be treated as a risk factor for those diseases. And in light of the public health implications, steps should be taken to mitigate that risk.”

In other words, the authors would like to see the concept of New York City’s ban on large, sugary drinks taken a step further: restricting where within a store potentially harmful products are placed. A decade or two ago the tobacco industry unsuccessfully tried to defend itself from smoking bans by claiming that this line of reasoning would lead us down the path toward restricting unhealthy foods, like cheeseburgers.

At the time I thought the tobacco campaign was disingenuous and the fears were ridiculous. Second hand cigarette smoke was annoying and dangerous to bystanders, whereas people who eat unhealthy food mainly harm themselves. It seemed implausible to me that we would actually get to food bans. Looking back, I can see that Philip Morris et al. were actually on to something. I’ve even gotten to the point where I can see the logic of rules that restrict the sale of soda in schools, for example.

But that’s as far as I think we should go. While it’s undoubtedly true, as the authors argue, that “food choices are often automatic and made without full conscious awareness,” I don’t agree that this provides sufficient cause to take regulatory action. Instead it would be better to educate people about how their choices may not be as autonomous as they think. Once they understand that, marketing and placement of products may still be effective, but I’m more confident leaving choices in the hands of the consumer.

This education about marketing should be extended further, and I’d particularly like to see physicians have a better understanding of how they are affected by industry marketing and how patients are influenced by drug company ads.

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