One of the most detailed investigations ever carried out into obesity in the US today proposed increased taxes on junk food and heavily-sweetened soft drinks, a move that will be aggressively resisted by the multibillion-dollar beverage industry.
New state and local government taxes are among a range of proposals aimed at tackling a problem that has become a major drain on health spending.
The report, Local Government Actions to Prevent Childhood Obesity, written jointly by the Institute of Medicine and the National Research Council, says: "In the United States, 16.3% of children and adolescents between the ages of two and 19 are obese. This epidemic has exploded over just three decades ... The prevalence of obesity is so high that it may reduce the life expectancy of today's generation of children and diminish the overall quality of their lives."
It suggests state legislators, governors, mayors, community leaders and others take action rather than waiting for a lead from the federal government.
These actions include offering tax credits as an incentive for grocery stores to open up in poor neighbourhoods, building pavements to encourage walking, creating more bike trails, and reducing video games and other sedentary pursuits in preschool and afterschool clubs.
"Childhood obesity poses a serious threat to health in the United States," the report says.
Congress, while drawing up a bill before the summer as part of President Barack Obama's drive for health reform, proposed a federal tax on soft drinks.
The Congressional Budget Office, set up to provide members of the House and Senate with independent advice, estimates that a three-cent tax would generate $24bn (£14.8bn) over the next four years, which would help pay for health reform.
But it appears to be backing down in the face of an intensive advertising campaign backed by the American Beverage Association, which includes Coca Cola. The association in July set up a new lobbying group, Americans Against Food Taxes. The group says: "Discriminatory and punitive taxes on soda and juice drinks do not teach our children to have a healthy lifestyle and have no meaningful impact on child obesity or public health."
The group has been running an aggressive advertising campaign over the summer that shows a family enjoying soft drinks on a camping holiday, with a voice-over saying "this is no time for Congress to be adding taxes on the simple pleasures we all enjoy."
The soft drinks market in the US is worth an estimated $115bn a year.
The new obesity report says that even if Congress was to act, obesity would still need to be confronted by state and local communities who can impose the kind of measures needed, just as they have in, for example, enforcing regulations requiring the wearing of bike helmets to protect children.
The report identifies tackling poor neighbourhoods as being as important as the need for advice on health nutrition and exercise. "For example, many communities lack ready sources of healthy food choices, such as supermarkets and grocery stores. Or they may not provide safe places for children to walk or play. In such communities, even the most motivated child or adolescent may find it difficult to act in healthy ways," the report says.
It calls on measures to increase access to healthy food and to encourage physical activity. These include: a call for restaurants to list calorie counts on their menus; opening school playgrounds and athletic fields to the local communities; realigning bus routes or other transportation to increase access to supermarkets and grocery stores; and increasing access to free, safe drinking water in public places as an alternative to sugar-sweetened drinks.
Some communities could divert money designated for crime, if that would be politically easier, the report says. "For example, afterschool recreation programmes implemented to increase physical activity with obesity prevention in mind can help meet crime prevention goals by reducing opportunities for youth to be victims or perpetrators of crime," it says.
The American Heart Association last week published research that identified highly-sweetened soft drinks as being the No 1 source of added sugars in the US diet.
The American Beverage Association, in a press statement, responding to the heart association, said: "Like many foods, soft drinks and other sugar-sweetened beverages are a source of calories, but in and of themselves, they are not a unique risk factor for obesity or other negative health outcomes - including heart disease."
Obesity in the US
More than 26% of Americans are obese.
US obesity rates rose 37% between 1998 and 2006.
Obese children and adolescents are more likely than their lower-weight counterparts to develop hypertension, high cholesterol and type 2 diabetes.
Obesity-related health spending has grown to $147bn a year, double what it was nearly a decade ago, according to a study published by the journal Health Affairs.
Obesity-related health problems account for 9.1% of the total US health budget, up from 6.5% in 1998. Obese people spend 40% more - or $1,429 more per year -- in healthcare costs than people of normal weight.
