Washington is gearing up for a complex and likely contentious debate about health care reform. Scrunched in among discussions about cost containment, universal coverage and public versus private competition may be a battle over diet-based illnesses.

The essence of the concern is not hard to find. U.S. obesity rates have more than doubled over the past 30 years, from 15% of the population in the late 1970s to roughly 35% today. Characterized as an "epidemic," this rising obesity is being linked to increasing incidence of type-2 (adult-onset) diabetes and heightened risks for heart disease and several cancers.

Nutrition experts will admit in general that focusing on diet alone is shaky science: "For any individual, the health effects of diets are modulated by genetics but also by education and income levels, job satisfaction, physical fitness, and use of cigarettes and alcohol," according to "Eating Made Simple," an article written by Marion Nestle that appeared in the September 2007 issue of Scientific American. In short, health is governed by a combination of inheritance, diet and lifestyle; no single factor explains disease.

They also will admit that singling out certain "bad foods" as causes of illnesses lacks research support: "Studies focusing on one nutrient in isolation have worked splendidly to explain symptoms caused by deficiencies of vitamins or minerals. But this approach is less useful for chronic conditions such as coronary heart disease and diabetes that are caused by the interaction of dietary, genetic, behavioral and social factors," Ms. Nestle wrote. Very simply, what’s bad for the goose may not be for the gander.

The lack of causal clarity between diet and disease is not stopping critics from targeting specific ingredients — like sweeteners and some fats — and specific food categories — like sweetened beverages, snack foods and calorie-dense foods such as meats, cheeses and dairy products. Correlations among such items, rising obesity and increased incidence of chronic diseases like diabetes are enough to put diet in the sights of health care reformers.

It’s a quick step from there to targeted interventions in the interests of health care cost control. Many of the reform ideas go well past such familiar prescriptions as food guidelines, nutrition labeling and ingredient lists. Taxing specific ingredients or banning them (or foods made from them) from children’s ads or schools are suggestions heard with growing frequency.

So, what is the food industry doing? Quite a lot, actually. It has long sponsored research to challenge or further elucidate studies linking food ingredients to certain diseases. It also is conducting studies to support health claims for some of its products (although the recent

Federal Trade Commission’s challenge of General Mills’ cholesterol claims for Cheerios creates some real uncertainties here). Though helpful, such work may be discounted by some as self-serving or short on credibility. It will remain a real challenge for industry to bring research-based evidence to bear on the debate.

It also is encouraging more active lifestyles and sponsoring activities designed to bring "calories out" more in line with "calories in." The beverage industry is collaborating with the Clinton Foundation’s Alliance for a Healthier Generation to change what is offered in school cafeterias and vending machines; similar efforts may soon be targeted on snack foods. These activities are more promising, as they engage industry and critics in more fruitful dialogues and helpful joint actions.

And there is much more going on or planned. The essential point is that diet-based disease is no longer an issue only in specialized journals. It is occurring with ever greater frequency in the popular press, and there is a significant risk that perceptions of causal links may harden, even though they are over-simplified and may lead to unintended adverse consequences.

Such perceptions then may become fodder for public debate and policy action. Increasing obesity, mounting costs of chronic diseases and a desire to contain rising health care costs as part of a broader reform initiative may coalesce, ensuring that targeted food taxes and dietary mandates will be on the minds and tongues of policymakers and the public alike. To avoid such outcomes will require a thoughtful, vigilant industry response.

This article can also be found in the digital edition of Milling and Baking News, June 2, 2009, starting on Page 41. Click