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T here is a growing public health crisis that is global in scope, and it isn't another emerging infectious disease. It concerns being overweight and the adverse health consequences of obesity, which include diabetes, heart disease, and cancer. To sketch the extent of this problem, we begin with the United States, an appropriate starting point because U.S. dietary styles and food habits have been exported so widely around the world. In 1998, the National Institutes of Health (NIH) in the United States found that 97 million U.S. adults (55% of the U.S. population) were considered obese or overweight. The Surgeon General issued a "Call to Action" on the obesity problem, but it drew a lackluster response from the responsible federal agencies, and Americans continued to consume an average of 3800 calories per person per day, or about twice the daily requirement. It is now estimated that over two-thirds of U.S. adults are overweight. Last year, NIH Director Elias Zerhouni appointed an agency-wide task force to develop recommendations for coping with the epidemic, and perhaps that gives room for some encouragement. But this is an exploding health issue in Europe as well as the United States. Nor is it limited to the developed world: Mayans in Guatemala, South Africans, aboriginal Australians, and Pacific Islanders also show patterns of emerging obesity. The World Health Organization (WHO) is deeply concerned about the issue, recognizing that nearly 1 billion adults are overweight and at least 300 million are obese. It has developed a plan that nations might use to deal with this health crisis. After more than 2 years of intensive debate among world countries, WHO formally approved a Global Strategy on Diet, Physical Activity and Health in May 2004 that recommends that people limit their intake of fats, salt, and sugar. This strategy had been heavily criticized by officials of the U.S. Department of Health and Human Services (HHS), despite Secretary Tommy Thompson's high-profile obesity initiative that even included his own weight-loss program! The HHS critique supported an effort by the U.S. delegation to force major revisions in the WHO plan related to advertising and food pricing. An HHS official, who apparently believes that economic incentives don't matter, said that WHO should stick to "sound science." In this space over a year ago (Science, 7 Feb. 2003, p. 781), Marion Nestle of New York University was critical of the food industry for its political influence over U.S. food policy and for its aggressive marketing of foods that are high in energy but low in nutritional value. Every once in a while, a representative for that industry says something that is unconsciously revealing. In responding to reporters' queries about the WHO plan, a spokesperson suggested that more attention be given "to the issue of individual responsibility." That neatly displaced a burden from manufacturers, advertisers, and government, and put it on the sufferer. Well, behavioral modification may be the solution for some, but for others the...

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