Obesity: public health and food populism.

Summary On food issues, public health promoters and defenders of taste enjoyment ritually confront each other. This kind of staging overlooks the way in which consumers usually reconcile pleasure and health. By taking a close look at this arbitration, we want to put consumers back at the center of the public debate, as objects but also as actors of public policies on food and health. We have reached the end of a nutritional and dietary transition marked by a continuous increase in our intake of calories, fats and sugars, a growing demand for processed and cooked products, an increased recourse to out-of-home catering, and a weakening of the French food model among the younger generations. The entry into the era of food abundance is paid for by an explosion of overweight and obesity, with social inequalities that reveal the major determinants of the trade-off between pleasure and health. Technological progress in the agro-industry has favored the marketing of inexpensive products, rich in added fats, sugars and salt, providing easy satisfaction. Why give up these promises of "low cost" pleasure when we have a blocked life horizon and unhappy living conditions? The efforts we make to invest in our health and in our bodies, as the nutritional recommendation campaigns invite us to do, depend primarily on what we can hope to gain from them. However, the State must not abandon all regulatory ambitions in the area of food and health, on the pretext that the consumer is sovereign and that supply is content to satisfy demand. Because our trade-offs between pleasure and health are often imperfect and erroneous. Food marketing leads us to eat more than we would like. The consumption of fatty and sweet products distorts our taste and conditions our future choices, like an addiction. Our food environment ultimately tips the balance of pleasure far beyond what would be sufficient to satisfy our interests. A policy to regulate the food environment could be based on four pillars: 1) a nutritional label using the traffic light system (green-orange-red), depending on the nutritional profile of the food, affixed to the front of prepackaged products. 2) a reallocation of foodstuffs to different VAT rates according to their nutritional profiles, with a prominent VAT display. 3) a strict regulation of the commercial devices pushing to the increase of the consumed quantities (promotions, advertisements for children, etc.), and a regulation of the architecture of the choices in the places of purchase and restoration. 4) an agro-industrial policy favoring the production of foods with less added fat, sugar and salt. This package of measures is justified by the violations of consumer sovereignty observed in food markets. Such premises are debatable. The right of the state to regulate the environment in this way to influence our choices can also be questioned. The different policy options at stake ultimately involve values of freedom and public health protection, but also equity and economic efficiency. In order to decide, it is urgent to organize a debate in France on the future we want for our food. Since it is a question of their choices between pleasure and health, it is imperative that consumers be placed at the center of the deliberation process and the creation of public policies, so that a form of collective sovereignty over our food choices can be restored, if not individual sovereignty.