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Are fast food ads killing us?

By Sujit Sharma

(CNN) - The war on tobacco began more than 50 years ago. And though it was followed by a set of
bans on smoking in public places, it took until the 1990s for smoking to begin to decrease

Why did it take so long to embrace what scientists had known for years? Because changing society
requires changing culture -- and that is a slow process.

Cultural norms are best represented by the advertising that directly influences what we choose to
consume and how we choose to consume it. Using imagery of aspirational lifestyles and attitudes
(picture young adults, all holding cigarettes, having fun on a beach or "Joe Camel" wearing a leather
jacket while sitting on a motorcycle), cigarette marketers effectively convinced Americans to buy
tobacco en masse.

And for several decades, the same methods have been used to promote a style of consumption for
something that seems less innocuous but can be life threatening: food. Food advertising and
marketing has helped convince the average American that it's OK to eat lower quality foods more
often and in larger portion sizes.

In other words, our culture has unwittingly accepted a marketing scheme which promotes a lifestyle
that is literally killing us.

On average, we consume more calories than we did just 30 years ago, without a corresponding
biological need for more calories. Between 1971 and 1974, the average American adult consumed
almost exactly 2,000 calories per day. Thirty years later, that number increased to more than 2,200
calories. This seemingly small increase of just more than 200 more calories in daily food intake is the
driving force behind the obesity problems we see today.

As a full-time pediatric emergency room doctor, the effects of childhood obesity are increasingly
obvious in the work I do. More and more, I am seeing children, often toddlers, who are already
obese and may be plagued by chronic disease and shortened life spans.

But it's so difficult to treat these children knowing that advertisers will only to continue to encourage
them to Just as in the case of tobacco, connecting the dots between the marketing of food and
obesity is complex and aggressively fought by industries that profit from our national appetite. The
argument offered by defenders of the industry is that food advertising only seeks to promote one
brand over another (brand choice) and doesn't influence overall consumption.

However, in 2016, two of the most extensive meta-analyses to date, published in the American
Journal of Clinical Nutrition and Obesity Reviews, reported that food advertising does indeed
influence individual eating behavior, especially in children, leading to weight gain.

Let's take a closer look at food advertising in practice.

An average adult person should eat somewhere in the range of 2,000 calories per day. Calories are
fuel for our cells, like gasoline for your car. Calories come from three sources: carbohydrates, lipids
(or fats) and protein. We need all three of these as fuel, including fats and carbs. Limits for each of
these calorie sources have been established by medical science to help define the parameters of a
basic healthy diet.

And yet an ad for a $4 "deal" from Hardee's, which includes a cheeseburger, fried chicken sandwich,
soda and fries, clocks in at 1,420 calories -- comprised of 61 grams of fat, 43 grams of protein and
187 grams of carbohydrates. With close to 3,000 mg of sodium, this one meal surpasses the
American Heart Association's recommended sodium limit of 1,500 milligrams per day. And, worse
yet, it has more than half the calories a person should consume in one day in only one meal.

But how many wince at the sight of the $4 deal ad? All of us, adults and children alike, are constantly
bombarded with messages that consciously and unconsciously influence our decision-making. We
think people in the ad seem happy, so why not follow suit?

Enter example two. "Larry the Cable Guy" appears sleeveless and grinning in ad for Prilosec, a
heartburn medication. The caption above his head reads, "Suffering from heartburn day after day is
as unnecessary as wearing sleeves."

Now this ad might not raise any eyebrows on its own, but Larry appears in a second ad for spicy
chicken batter, endorsing the very food that leads to heartburn. In an almost identical outfit, Larry
poses beside a plate of chicken nuggets and fries, and says, "You gotta try it!"

Only in America would we have the celebrity who promotes poor eating habits also endorse the
medication that treats the health complications that may result from those habits!

Unfortunately, we cannot wait to address this food marketing issue.

Projections for health care costs will be unsustainable unless we make drastic changes now. In 2015,
we spent approximately $3.2 trillion (17.8% of our GDP) on health care, and that number has
steadily been rising. Notably, obesity-related illnesses now make up about 21% of these costs.

And based on current trends, a New England Journal of Medicine study published in 2005reported
that children today may be the first generation predicted to likely not live longer than their parents.
This is largely because of health problems related to obesity.

So how do we begin to address this advertising issue? As anyone experienced in addiction will tell
you, the first step in treating the problem is admitting you have one. So we need to acknowledge
that we are a culture in love with excess.

Next, we can learn from the war on tobacco. As scientific evidence mounted, legislators began to
make widespread changes to the rules of marketing cigarettes. Similarly, research around obesity
must influence the making and marketing of food.

And, as consumers, we have to open our eyes to the fact that food ads today promote and
encourage irrational decisions. The companies defending these ads are doing so at the expense of a
sustainable way of life.

Employing behavioral economic research, we can also be more innovative in our approach to
convincing consumers to eat healthier. Things like the positioning of healthier products in cafeterias,
the names the products are given and celebrity endorsement of healthy eating habits can all help
drive us toward a future where food promotes wellness rather than disease.

Years from now, we will undoubtedly look back at how we approve of food advertising today as
illogical -- and possibly immoral. The sooner we can change the rules of the game for food
advertising and realize that we are nurturing poor eating habits, the sooner we can make an impact.

Overeating is the new smoking, but it doesn't have to be.