Why are so many Americans overweight or obese? The Institute of Medicine weighed in on the issue Tuesday with a comprehensive 478-page report that puts the blame on a social structure that promotes unhealthy choices. 

The document – intended as a roadmap for obesity prevention – says that willpower alone will not help people stay fit. What’s needed is a change in surroundings, including better access to sidewalks and parks and a greater availability of nutritious foods, according to IOM, the health arm of the National Academy of Sciences. 

“If a community has no safe placed to walk or play, lacks food outlets offering affordable healthy foods, and is bombarded by advertisements for unhealthy foods and beverages, its residents will have less opportunity to engage in physical activity and eating behaviors that allow them to achieve and maintain a healthy weight, ” says the report.


This healthy weight evades the 1/3 of adults and 17 percent of children in the United States who are obese. 

These numbers mark a huge jump from 1980, when only 15 percent of adults and 5 percent of children were obese. Between 1977 and 1978 children ages 2-18 consumed approximately 1,842 kcal per day. That average jumped to 2,022 kcal/day in the period between 2003 and 2006. 

Obesity-related illnesses such as diabetes and heart disease amount to $190.2 billion in health costs annually, according to a Medical Expenditure Panel Survey. Childhood obesity alone accounts for $14.1 billion in direct medical costs.

After examining 800 published strategies for reducing obesity, IOM produced 5 key recommendations that it says will accelerate obesity prevention. These include:

Making physical activity an integral and routine part of life

Making healthy foods available everywhere 

Promoting healthy foods and exercise through social marketing while limiting marketing of unhealthy foods

Expanding the role of healthcare providers and employers in promoting health

Strengthening obesity prevention in schools

Some of the suggestions IOM offers to achieve these goals involve bold policy changes, including a tax on sugar-sweetened beverages, which the authors say are a leading contributor to putting on pounds. 

According to one recent estimate, a 10 percent price increase for soft drinks would reduce consumption by 8-10 percent.  

The money levied from these taxes could then be invested in other obesity prevention measures, says the report.

“Consumption of sugar-sweetened beverages is the single largest contributor of calories and added sugars to the American diet,” note the authors.

For this reason it also recommends limiting the availability of these types of beverages and reducing  portion sizes of sugary drinks for children. 

The proposal to tax sugary beverages was met with heated industry criticism.

“A wide range of factors contribute to these health conditions and singling out one ingredient – or one set of products – in such an overly simplistic manner only undermines efforts to combat these diseases,” said the American Beverage Industry in a statement Tuesday.

The industry pointed out that it has voluntarily agreed not to market soft drinks to children under the age of 12 and has reduced average calories per serving by 23 percent from 1998 to 2010 with the introduction of lower-calorie options.

In another policy recommendation, the report recommends that the government review agricultural subsidies – now largely earmarked for commodity crops such as corn and cotton – to consider boosting incentives for healthy products such as vegetables, fruits and dairy.

Consumer advocates praised the IOM report, urging policymakers to put its recommendations into place. 

“The IOM report provides an excellent blueprint for solving America’s costly obesity problem,” said Michael Jacobsen, executive director of the Center for Science in the Public Interest. “But policy makers will have to invest both money and political capital to convert the advice into reality. Congress should fund a multi-billion-dollar, multi-year anti-obesity program that includes national and local community and social marketing campaigns.”

The report was released at the “Weight of the Nation” conference, a three-day event hosted by the Centers for Disease Control and Prevention.