Supersize America: Whose job to fight obesity?

New York Mayor Michael Bloomberg is the latest elected official to seek to use the power of government to slim down Americans' waistlines. But he's hardly the first.

Before he raised eyebrows by proposing to ban the sale of sugary sodas bigger than 16 ounces at New York's restaurants, delis, cinemas, and stadiums, officials elsewhere have tried other strategies for fighting the obesity war. They've enforced moratoriums on new fast-food outlets in certain neighborhoods. They've required eateries to print calorie counts of menu items, and they've kicked sodas and snack foods out of public schools.

The sharp rise in obesity rates that marked the 1980s and '90s has flattened in recent years, but researchers disagree over how much difference such government interventions have made. The result is that policy proposals like Mr. Bloomberg's tend to be greeted by equal parts cheers and jeers – with many public-health activists giving them the benefit of the doubt, and many restaurateurs and food purveyors slamming such intercessions as "nanny state" limits on individual choice.

In between is the US public, collectively heavier than ever, trying to sort out for themselves whether public-health liabilities that officials attribute to obesity warrant intrusion into a behavior as private as eating and drinking.

One is Angela Hutchinson, a casting director and, on this day, a patron at McDonald's in Sherman Oaks, Calif. Here, calories are printed on the menu for all to see, courtesy of a state law that since 2010 has applied to restaurant chains. Ms. Hutchinson says she routinely checks the calorie count when she eats out, but not here.

"Gimme a break. This is fast food," she says, ordering a Big Mac and fries. "But when I'm sitting down, I really do use them and appreciate them."

Those who say obesity is the public's business note that it has a greater effect on the prevalence of chronic illness and on rising medical expenditures than does heavy smoking or problem drinking. In 2008, obesity-related conditions accounted for nearly 10 percent of total US medical costs, or $147 billion, with taxpayer-borne Medicare and Medicaid assuming a large part of the burden. Indeed, the medical costs paid by third-party payers for people who are obese were $1,429 higher that year than for people of normal weight, according to the US Centers for Disease Control and Prevention (CDC), which tracks public-health issues.

Rising rates of obesity in the United States have been documented for at least 20 years now. Almost 38 percent of today's adults and about 17 percent of kids ages 2 to 19 are considered obese, meaning excess body fat has accumulated to the extent that health could be adversely affected, according to the CDC.

Few quibble over the scope of the problem or its possible consequences – only over how best to tackle it. Most see public education as an appropriate role for government, akin to first lady Michelle Obama's "Let's Move" campaign that urges kids to exercise and to choose fewer "empty-calorie" foods. But some draw the line at regulations or specific prescriptions from officialdom.

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