Having worked in the service industry for several years now, and as a self-designated “restaurant explorer”, my attention was caught immediately by an article recently featured on National Public Radio. The write-up demonstrated how, when given the option to down-size a meal, coupled with information on the number of calories saved by doing so, the majority of customers opted for the smaller plate and tended to eat a more size-appropriate amount. Although it is not overtly stated, the writer seems to be hinting towards the idea that perhaps it should be responsibility of restaurants to offer healthier portion sizes in best interest of the public’s health.

Recalling the days I spent on the dinning floor as a waiter, I cannot readily imagine how it would be plausible for servers to follow a model based on the above study—that is, to suggest that customers order less at their own establishment. Firstly, servers are not nutritionists and are not trained to deliver health-related information. Moreover, this system seems to go against the principles of business. And lets be honest, the first priority of a restaurant is not to ensure their customers are living healthy lives, but that they are investing their dollars into the restaurant.

Still, it does make sense that it becomes much easier to help people control overeating if it is addressed ahead of time, before the food is put before them. Once halfway through a meal, temptation and socio-cultural motives (your mother’s reprimands to “finish your plate” ringing in your ear) make it harder to keep from over indulging. As noted by psychologist Janet Shwartz, lead author of the study that gave rise to these findings, “People are willing to downsize, but you have to ask them to do it.”

But the ultimate question is: whose job is it to ask the public to downsize?

  If individuals are unable to monitor their own eating habits, should it be a restaurants priority to restrict their diet. I have already argued against this notion. How about doctors? Of course, it is a physician’s duty to promote healthy lifestyles for his patients, not only to guard against disease but also to improve overall wellness. However, doctors cannot realistically supervise their patients twenty-four-seven; the only opportunities to do so are within the brief lengths of time during a consultation.

Finally, what of the government? Has obesity reached a point to which it can be considered a national—or even international—epidemic that requires fervent, federally-backed intervention. Some would argue that government involvement already oversteps its boundaries in both public and private affairs. I can only predict that such sentiments would exacerbate were there to be strong federal authority governing what we can and cannot eat.

So how do we go about tackling these issues?

  The United States has become quite infamous for its meal portions. When it comes to food, the general mantra in the U.S. has been “the bigger the better” or “the more the merrier”, in most cases. Whether it be combos, specials, “super-sizes” or meal deals, we have it all. Even during my own travels I have had foreigners from all over the world comment or ask about the rumored endless amounts of BBQ, burgers and fries in America. Fantasy and humor aside, such eating habits have led to dire consequences. As it was shown in reports published by the Organization for Economic Co-operation and Development (OECD), the U.S. remains a nation with one of the highest, if not leading, rates of obesity in the world.

What’s more, the Center for Chronic Disease estimates that as many as one-third (33.8%) of adults in the U.S. are obese. Rates among children and adolescents (aged 2-19) clock in at around 17 percent—that’s 12.5 million youth that are being affected and put at risk for developing a number of non-communicable diseases, including cardiovascular disease and diabetes, which are two of the leading causes of death in nation.

Certainly, “fast food culture”, sugar consumption, and the prevalence of fat-rich foods have been major contributors to this nutritional epidemic. These foods are ubiquitously available via the endless presence of fast food chains, vending machines and newsstands that sell all sorts of candies and chocolates. Nowadays, it is far more difficult—and expensive—to get hold of fresh fruits and vegetables as compared to the former food types.

  A report published by Washington University in St. Louis demonstrates how the rate of Type II Diabetes, which was previously known as “adult-onset diabetes”, has skyrocketed amongst adolescents, who continue to feast on processed foods laden with fat, sugar and salt.

A prime example of such trends and the risks they might bare is shown in the case of 17-year-old Stacey Irving, who resides in the United Kingdom. Ever since she was a small child, this young woman claims that she has eaten nothing but McDonald’s Chicken Nuggets—her lips have never touched fresh fruits and vegetables, according the report. Specialists have referred to her habits as a “chronic nugget addiction”, and have warned Irving that her monotone diet is seriously imperiling her health; note that that was after the teenager was rushed to the hospital after collapsing from breathing problems and severe anemia.

  Diabetes remains one of the leading causes of death in the U.S., and merely having the disease puts one at risk for a number of other health complications, including: high blood pressure, heart disease and risk of renal failure. Despite these threats, debates have continued to rage on how to address the dilemma of obesity—the most recent of arguments centered on federal involvement in navigating the issue.

Divides between whether or not the situation has reached the point of governmental regulation is most aptly articulated in a live debate between two teams: Dr. Pamela Peeke, WebMD’s Chief Lifestyle Expert, and Dr. David Satcher, the 16^th surgeon general of the United States, forming the team in favor of dietary regulation via federal involvement; with Paul Campus, a law professor at University of Colorado in Boulder, and John Stossel, a host on the Fox Busines Network, forming the opposition.

Both Dr. Peeke and Dr. Satcher take the position that it is a government’s duty to protect the lives of its peoples—even from their own doings or habits. Satcher notes that “between 1980-2000, the rate of obesity has tripled among youth and doubled among adults”—an exponential rate that has had strong correlations with the numbers inflicted with chronic illnesses in the nation. Peeke also supports that the crisis has grown to levels that can no longer go overlooked. Her concerns go far beyond merely “demonizing sugar,” and she openly states she hopes a spectrum of industries, backed by the government, can synergize their efforts to tackle the issue that is threatening the U.S. population.

  On the other hand, Campos argues that a population-based approach only serves to weaken the argument that obesity is the government’s business. “We do not know how to produce long-term weight loss…we do not even know if long-term weight loss would be beneficial,” states Campos, pointing towards a gap in scientific research data. “The [one] thing we do know is that public health interventions designed to produce weight loss, do not produce weight loss…in children or adults.” Moreover, Campos fears that the public will interpret government mobilization as an aim to “eliminate body diversity.” This last concern, I believe, is particularly noteworthy: It is true that bodies come in all shapes and sizes, and we have been taught—by our parents, by the media, and by many educational institutions—to love the skin we are in and accept our body as is; with this mindset in place, it would only be natural that some may become viscerally defensive against any actions that take place to change their body, especially when imposed by the government.

Similarly, Stossel echoes notions that denounce government right to intervention. He even goes so far as to label such an initiatives as a “formula for totalitarianism,” warning us that allowing the federal authority this much power over personal choice will turn it into a “leviathan who plans our meals.”

  Sadly, the critiques brought up by Campos do not seem to be too far from the truth: we continue to struggle in finding a healthy, sustainable public health intervention for weight loss. Especially within recent decades, it has become increasingly popular to turn to invasive, “quick-fix” procedures in attempt to remedy the problem with haste. In cases of extreme obesity, some insurance plans now help cover the cost for patients seeking procedures such as lap-band placement (putting a constricting silicone ring around the stomach to help restrict food intake) and gastric bypass surgery (surgically own-sizing the stomach itself).

Some doctors now push for these procedural forms of intervention as an alternative to the grueling experience of dieting, which often produces cyclical trends resulting in failure. But, addressing health with said “magic-bullet solutions” has never proven to be as successful as we have hoped; we cannot expect successful, sustainable outcomes without doing the groundwork. This notion applies particularly to cases of obese adolescents and teenagers, who are many times led to believe that they are merely one operation away from achieving their goal weight and attaining their dream body.

  The New York Times followed a 17-year-old morbidly obese American girl, Shani Gofman, as she went through such a process. At the tender age of 18 she underwent a surgical lap-band procedure under the guidance of her physician. Prior to the surgery, Gofman was warned by her doctor that she would have to monitor her diet; she would no longer be able to eat the portion sizes she had previously been used to, due to the restricted size of her stomach. Gofman reassured him of her commitment. But saying you will do something and actually following through on those words are two difference things.

At first, all seemed to go well with the procedure, and Gofman began seeing results. However, it was not long until old habits resurfaced, and Gofman began to slip on her diet, consuming food in larger quantities and at a faster pace. This, compounded with financial and personal reasons that deterred her from attending her routine check-ups, culminated in a backsliding of her progress. Gofman began to regain her weight.

Although the final number of pounds the teen weights at the end of the year is never stated, we are left to assume that it is less than satisfactory. Clearly, when it comes to food, diet and nutrition, the influences are multifaceted and complex—quick fix solutions are bound to fail without the proper support or education. Dr. Wendy Scinta, a family practitioner based in Syracuse, New York, sums up the underlying theme of this account rather succinctly: “I think it’s pretty extreme to change the anatomy of a child when you haven’t even tackled the other elements.”

  It has become obvious that tackling obesity will surely prove to be a great challenge within the health realm. However, one thing remains certain: if we hope to create any form of sustainable health change regarding diet around the world, it’s going to have to start on the level of habit, which is no easy feat.

What one chooses to eat is an entirely personal decision; you cannot force someone to eat healthily. We can place laws that govern and prohibit inherently dangers or destructive behaviors (drug use, murder, theft, etc.), however eating in itself is a completely natural and necessary act—it only becomes endangering to one’s health after a certain point. Thus, justifying and normalizing any form of governmental intervention will surely prove difficult.

  This makes it a little more difficult for policy to directly target obesity. Rather, we must rely on campaigns and policy that may help curb public appetite towards getting their 5 fruits and vegetables a day, rather than a burger and bag of potato chips. One such example is demonstrated in a recent initiative executed in New York by the Health Department, which was meant to deter citizens from overeating, and instead encourage them to control their portion intake, especially in regards to fast food:

While the intentions of this health campaign were noble, the execution was rather sloppy. It was discovered that the man’s “amputated” leg in the poster had actually been Photoshoped, and the man himself was not know to be diagnosed with diabetes. The NYC Health Department took a blow for “falsified” advertisement, which ultimately discredited their message.

Other proposal have included placing higher taxes on food products such as sugar, in hopes of deterring individuals from buying and using these food products. But still, others argue this will only cause those with limited economic resources to use more of their money on sugar, leaving less money available to buy healthy and essential food products.

  And these circumstances are by no means limited to the U.S. or other industrialized nations alone. In fact, adding an international scope to this health crisis only serves to complicate an already disputed issue, highlighting its severity. Ever increasingly, low and middle-income developing countries are also facing similar health challenges. National Public Radio reported on the health concerns that are arising alongside China’s middle class, who now have access to the “pleasures” of western fast food. China’s economic growth has led many to adopting similar eating patterns to that of the U.S., as noted by market researcher Paul French. “More, more, more of everything — larger portions, with more ingredients, more salt, more sugar, more oil, more fats.” Needless to say, this has correlated with an increase in the number of health risks and complications that are tethered to unhealthy diets.

  Howe we decide to address these trends within the upcoming years will prove to have an immense impact on the international health arena. While we may continue to argue as to who has the sovereign right to intervene on the public’s “personal choices”, it still does not change the fact that chronic diseases remain the leading cause of death globally—among such illnesses, Diabetes and Obesity have taken their place as major contributors to the endangerment of health. One way or another, we have to change our habits, our culture and our relationship to food in order to promote healthier bodies and lifestyles. Of course, we should enjoy the pleasures of food and the beautiful power that a meal has to bring people together; but remember that good things are best in small doses: Moderation is key.