After years of near total neglect, the problem of childhood obesity is now in the limelight. Terms like “epidemic,” “crisis,” and “emergency” are used frequently when describing the trend. Progress is defined with strong language and fueled by statistics such as the observation that this generation of children will be the first to live shorter lives than their parents. Multi-disciplinary journals such as the Journal of Law, Medicine & Ethics have dedicated symposiums to the issue, and conferences have been convened (...) not only by health professionals but by government agencies, the food industry, and even professionals who market to children. The seriousness of childhood obesity is no longer in doubt, and finally attention has turned to the more complex question – what must be done? (shrink)

No provision of the Patient Protection and Affordable Care Act (PPACA) has been more contentious than the so-called “individual mandate,” the constitutionality of which is now before several appellate courts. Critics claim that the mandate represents an unprecedented attempt by the federal government to compel individual action. Yet, states frequently employ similar mandates to protect the public's health. These public health mandates have also often aroused deep opposition. This essay situates PPACA's mandate, and the opposition to it, in that broader (...) context. The article reviews the arguments that public health's population perspective provides in support of mandates, as well as the reasons why mandates often ignite intense legal and political opposition. Most importantly, by holding individuals accountable for population-based problems, mandates may undercut the public health arguments that justify them. The article concludes by arguing that public health policymakers need to know more about the unintended political and legal costs of mandates. (shrink)

No provision of the Patient Protection and Affordable Care Act has proven to be more contentious than the so-called “individual mandate.” Starting in 2014, the mandate will impose a penalty on non-exempt individuals who lack health insurance. According to Congress, the mandate is essential to ensuring near universal coverage. Without it, PPACA’s insurance reforms will lead healthy individuals to delay purchasing health insurance until they require medical care, resulting in risk pools with a disproportionate share of high-risk people. The price (...) of insurance will then climb, causing more and more not-so-sick people to forego health insurance. The resulting “death spiral” will make insurance unaffordable to many more Americans. (shrink)

Childhood obesity is a serious problem for increasing numbers of children around the world. According to the International Obesity Task Force, 1 of 10 schoolaged children worldwide is overweight or obese, a number totaling 155 million; of these, 2-3% are obese. Prevalence is highest in the Americas and Europe, followed by the Near/Middle East, with smaller but growing numbers in the Asia-Pacific and Sub-Saharan regions of the world.In the United States, which provides the data for much of this report, prevalence (...) continues to rise. The most recent nationally representative data indicate that 33.6% of individuals aged 2-19 years were overweight and 17.1% were at risk for overweight in 2003-2004, compared to 28.2% and 13.9% in 1999-2000, respectively. In this age group, the prevalence of overweight or at risk for overweight was highest among Mexican Americans, followed by Non-Hispanic blacks and Non-Hispanic whites, and a higher percentage of males were overweight compared to females. (shrink)