And it means turning healthy foods into "picker" foods: "If you think about the difference between unhealthy foods and healthy foods, one of the [distinctions] is that you can pick up unhealthy foods a lot more easily than you can pick up healthy foods—with the possible exception of carrot sticks, and you can't only have carrot sticks," he said.
Decreasing exposure to unhealthy foods—like decreasing exposure to tobacco—is another avenue, albeit a tricky one. At schools, for instance, many kids are exposed to these foods through vending machines, which help in part to finance school activities. "Principals face a devil's dilemma of whether they get revenues for very important programs in incredibly strained fiscal times or whether they try to have a commercial-free environment for children to learn in through graduation."
Image is the third key area. "Food ads for children are extensive," Frieden said. "I think when we look back 20 to 30 years from now, we'll say 'what in the world were they thinking'?—allowing the kind of advertising that occurs today still to exist in the midst of an epidemic of childhood obesity."
In the future, the ads on TV and Internet today "will look as anachronistic to us then as the tobacco ads from a generation or two ago looked to us now," he said. But the reality is that today, children continue to be exposed to extensive marketing and promotion.
One way to approach this is counter advertising—much like was done with tobacco ads. "Counter advertising works to change the image. What works unfortunately are not positive ads about smoke-free living. Those have limited or no impact." he said.
Instead, the ads should show that "human impact of a product but should never attract the victim. It should show only the reality of what the product causes in terms of illness, disability, and death," he said. "Counter advertising is essentially untested in obesity prevention and control. It is, in my personal opinion, very likely to be effective. It is certain to be very controversial."
Overall, as a society, "I do not think that we can wait for perfect evidence" to tackle obesity now, he said. "The question, I think before us—and what we have to weigh as a group as we consider the 'Weight of the Nation'—is whether we as a society are willing to take the actions necessary to reverse the epidemic of obesity."