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Pandemic Obesity: What Is the Solution?

Tillotson, James E. PhD, MBA

Nutrition Today:
Business and Nutrition

“What is the practical solution to the obesity problem?” is the perceptive question I was recently asked by Linda Hirsh, Field Producer for the Peter Jennings’ Show. She was preparing a television show on the American obesity problem for fall viewing on ABC. This column looks at whether there is a practical solution yet, and, if there is, what is it? Here goes!

In this series on our pandemic obesity, we’ve seen how certain of our agricultural and industrial policies have had the unintended and unforeseen consequences of increasing overweight and obesity. I have argued that our government’s present nutrition policies are a dismal failure because more of us are fat than thin by a wide margin. Health professionals don’t have anything to crow about either. The 1990s were supposed to be the nutrition decade. Nutrition and nutritionists were at center stage in print, media, and talk shows, and the public was captivated by various diet crazes. However, it was in the 1990s that we reached new highs in fatness as a nation.

We should have called the 1990s the decade of Great Expectations or Great Illusions, not the Nutrition Decade. The high hopes that the nutrition community shared for improving American diet and health with the passage of the Nutrition Labeling and Education Act in 1990, with its required nutritional labeling of all packaged foods, was misguided. Belatedly, nutritionists discovered that most people, including nutritionists, rarely used nutrition fact labels. Much of what Americans eat doesn’t have a nutrition facts label; we rely increasingly on unlabeled ready-to-eat foods and, as the fast-food ads say, “lovin’ it!”

What is the problem? The ultimate problem, of course, is obesity, but why do we have a problem in solving the pandemic obesity?

A few weeks ago when reading Advertising Age, I saw an item that helped me crystallize the problem we face between environmental factors and individual behavior as they relate to obesity. The article showed how immense the problem is as we try to rein in Americans’ ravenous eating.

It was Advertising Age ’s yearly summary of the Top 200 Megabrands—ranked by spending on US measured total advertising spending (television, radio, magazines, newspapers, etc) in 2002. 1 This shouldn’t be confused with total company advertising spending; rather, it is the total advertising spending muscle put behind a company’s individual brands, such as Gillette shaving products, Ford cars, Kodak film, Hallmark cards, Clorox detergent, as well as food brands, such as Coke beverages, Campbell’s soup, KFC restaurants. These advertising dollar numbers are a better measure of effective firepower aimed at consumers to buy a product than companywide spending. These are real purchase-motivating dollars put behind a specific consumer product.

I did a little arithmetic with the list of the 200 top brands and counted that 25 (12.5%) were food brands (Figure 1). Of these 25, 9 were the nutritionists’enfant terrible fast-food chains (McDonald’s, Burger King, KFC restaurants, etc.), 6 beverage companies (Budweiser, Coca Cola, Pepsi, etc.), 5 cereal and bakery companies, and 5 miscellaneous companies (soup, gum, dairy brand, diet drink, etc). Certainly, the most highly promoted foods don’t constitute a balanced diet.

The total spending for these 25 food brands came to $4.71 billion for total measured media spending in 2002, ranging from $548.2 million down to $95.8 million for a dairy brand. Remember, this is advertising for a single consumer item, not total company advertising. In advertising at this level, these companies are exercising their constitutional right of commercial free speech. These food products are the on-again off-again darlings of the financial sector. However, they make up a lot of the firepower behind high-caloric eating for already-hefty Americans.

Advertising in this league is the “go-the-for-gut, anything-that-gets-by-the-FTC” type of advertising that is designed by highly creative people in leading ad agencies. The agencies are in a constant war with other agencies to attract the high-roller, big-spending, prime-time, fast-food chain advertisers. Of course, the advertisements are successful at getting consumers into fast-food outlets. The chains spending the advertising dollars also get the sales numbers. If advertising didn’t work, why would they spend all that money? Besides being perfectly legal, this is a necessary expenditure for any fast-food player in the American economic system. This is the reality of the business situation.

Let’s dig a bit deeper with the fast-food marketers in this high-advertising group of companies. Checking with the Food Marketing Institute on leading fast-food chains, I looked at who had the largest total numbers of fast-food individual restaurants for the top 5 fast-food chains in the United States for 2002. 2 To get the total number of outlets, I first looked at the co-owned outlets (Table 1) and then at franchised units (Table 2). This gave me 2 lists of 5 fast-food chains on each list.

There were 2 chains represented on both lists (McDonald’s and Pizza Hut) of the total 10 chains shown in the 2 lists, for a total of 8 different fast food chains in the 2 lists (Subway, McDonald’s, Burger King, Pizza Hut, Taco Bell, KFC, Jack in the Box, and Starbucks). I dropped Starbucks from my calculations, because it is mainly a coffee chain and not a full eatery. This left me with a list of the leading 7 fast-food chains in restaurant numbers in the United States.

Then I cross-checked these 7 chains with my list of the 9 fast-food chains among the top 200 megabrands advertisers (McDonald’s, Burger King, Wendy’s, KFC, Subway, Taco Bell, Pizza Hut, Domino’s Pizza, and Arby’s). As expected, 6 big advertising-spending fast-food restaurants were on my list of 7 outlet chains, spending a total of $1,675.7 million in 2002 (Table 3).

I understand that it is common for the fast-food outlets in this top tier to sell, at a minimum, more than $1 million worth of food a year. Therefore, these 6 top fast-food chains in outlet numbers (49,198 in 2002), with their franchisers, sell a minimum of approximately $50 billion of fast-food a year, spending $1.68 billion on advertising! Just these 6 fast-food chains, based on US Department of Agriculture estimated total US away-from-home sales in 2002 of $425.5 billion, sell Americans 11.8% of this type of food! (The advertising effectiveness of their commercial messages to potential customers is demonstrated by an industry study for the third quarter of 2003, showing that 8 fast-food television commercials were among the top 20 most remembered commercials of all advertised products by polled viewers.) 3

In short, they have a powerful influence on the American diet.

Now remember, there is no required nutritional labeling here. I don’t remember seeing any mention of this type of food in official government advisories. Plus the advice I receive on fast foods from my “card-carrying” nutrition associates runs the gamut from “avoid” to “take in small doses,” just like Victorians’ views of sex! This is interesting but not likely to be easy to follow in today’s American lifestyle, given the realities of our current food supply.

Remember—in the real world, fast-food restaurants account for 74% of the average 206 meals purchased at commercial establishments for those both eaten out and taken home to eat by Americans last year. 4 That’s what is going on in the 277,208 such fast-food restaurants in the United States! This feat is possible, according to Technomic Inc, the well-respected food consulting group, because our ready-prepared food production system has now reached 1 fast-food outlet for each 1,000 Americans, up from 1 in 1,400 people in 1990 and 1 in 2,000 in 1980. 4 There may be more fast-food restaurants than churches!

This is based on only advertising spending and outlet numbers of these 6 leading fast-food chains. Regarding their influence on the diet, you must consider that their food is inexpensive, great tasting, available everywhere at all hours, and usually in shiny clean surroundings, catering to people’s eating desires. These chains are doing just what they should be doing as marketers in the American economy—satisfying their consumers’ wishes and desires.

Speaking of marketing, these chains have crack marketing professionals, designing hard-charging, volume-increasing, total-marketing plans, using all the advances available in modern marketing, based on cutting-edge social and motivation psychologies—branding, endorsements from sports heroes and movie characters (Disney figures), deals (dollar deals and give aways), product placements, etc. Nothing illegal or out of the ordinary in consumer marketing here, but again, the unforeseen and unintended consequences that are present throughout our pandemic obesity problem. Remember, this is only one part of one food sector (fast food); similar cases of hard selling are replicated many times throughout our present $920 billion consumer food market. Do we have anything in our current arsenal of public health options to counter such overwhelming marketing power?

What should we do?

To start, can you rationally imagine, except in some Walden Pond or 19th-century Utopia, that Americans wouldn’t always use fast-food feeding in some manner. Under our constitutionally protected free speech (commercial free speech), fast food will always be overaggressively promoted with our brand of capitalism. Will it result in any other social order?

Remember that consumers who are entering these fast-food outlets everyday do so by free choice—with all the other places to eat they pick this type of restaurant. The numbers show they return again and again. The food, price, quality, and convenience squarely fit their daily needs! Also by now, every American has a fair idea that big-time eating of fast food leads to big middles. Yet, the number of people eating fast food increases every year, especially if you include the new fast casuals! 5

Fast-food chains have grown and prospered since the 1950s. This was during the same period when nutrition made its largest advances in understanding diet and health relationships! Has nutritionists’ hectoring of the public about fast-food eating done much good in reducing obesity rates?

Currently, the courts and Congress don’t look as if they will make fast-food illegal or sue the chains out of existence as happened with cigarettes! Public-opinion surveys show that many Americans don’t want the government telling them what to eat, unless it is for their children. A recent study by Euro RSCG Tatham Partners, an international marketing group, reported that some 90% of Americans polled believed that they are personally responsible for their weight condition and are not blaming fast foods. 6

After the lack of progress on agricultural subsidies and tariffs at the World Trade Organization meeting at Cancun, Mexico, do you expect US agricultural policy to change much in the immediate future? 7 Cheap food is here to stay! Do you want our free-enterprise capitalistic food system to change, given its overall net benefits? 8 Do you think we can prevent innovation in the supply chain like that which gave rise to fast-food restaurants?

What is the practical solution to our “lard” problem? I ask my students, but they don’t have any answers either, and this is discouraging because they are our human seed corn.

In Brief

Some compromises between business and public policy goals we can all live with

Author Information

James E. Tillotson, PhD, MBA, is currently Professor of Food Policy and International Business at Tufts University. Before returning to the academic world, Dr Tillotson worked in industry, holding various research and development positions in the food and chemical sectors.

Corresponding author: James E. Tillotson, PhD, MBA, PO Box Ten, Cohasset, MA 02025-0100 (e-mail:

© 2004 Lippincott Williams & Wilkins, Inc.