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Obesity is one of the leading causes of morbidity and mortality in the United States.1 Perhaps the most troubling aspect of this epidemic is the rising incidence of obesity among children and adolescents.2 With increasing rates of obesity, a growing number of adolescents are being diagnosed with type 2 diabetes, hypertension, and other obesity-related medical disorders.3-5 The problem of childhood obesity is now recognized as one of the leading medical problems among children and will likely lead to worsening general health among the adult population in the future.6 To gain some measure of control over this epidemic, I propose an “R-rating” for fast food that would require establishments to sell prepared foods with signifi cantly elevated calorie or fat content to a minor only if that minor is accompanied by a parent or adult guardian, analogous to the R-rating for movies. Such a system would include all vendors who sell prepared food including restaurants, grocery stores, and convenience stores.  The movie rating system, initially implemented in 1968, was adopted in an effort to assist parents in limiting their children’s access to fi lms that might be inappropriate for viewing by minors.7 The system was designed to give parents more control over what their children see, and allows parents to bring their child to movies with violence, sexual content, or other adult themes as they deem appropriate. The rating system thereby empowers parents and facilitates their ability to raise their children in the manner they choose.  Similarly, in 1996 the television industry voluntarily developed the T.V. Parental Guidelines.8 This rating system was designed to provide parents with greater information regarding programming. Further, because the F.C.C. now requires that all televisions sold in the United States with a 13-inch screen or larger be equipped with a V-Chip blocking device,9 and many cable boxes have built-in parental controls, parents are able to block content that they believe is inappropriate for their children. Like the R-Rating system for movies, parents may override these controls in instances when they believe that allowing their child or teen to view specifi c content is appropriate.  Many parents would presumably welcome a similar system for potentially unhealthy food. While some parents might occasionally choose to allow their child to eat a cheeseburger and fries, they would likely prefer some control over this behavior to ensure their child does not overindulge. Parents would therefore be free to expose their children to a wide variety of foods while permitting them some measure of control to promote their children’s health.  Such a system would appear to be a reasonable compromise between those who wish to promote healthy eating habits among children and those who wish to protect the free market. Indeed, it was because many theater owners recognized the need to give parents more control over what their children watch that they were active collaborators in the development and implementation of the movie rating system despite the potential for diminished ticket sales. Similarly, leaders in the fast food industry should be advocates and partners in the fast food rating system. Through collaboration between healthcare professional associations (like the American Medical Association, the American Academy of Pediatrics, the American Dietetic Association, the American Gastroenterological Association, etc.) and the fast food industry, with potential involvement of the federal government if needed, we could defi ne parameters for a fast food rating system and implement such safeguards for our children.  Because such a system has the potential to significantly improve the general health of adolescents without decimating corporate profi ts, and companies that agreed to such a system would surely gain signifi cantly in their public image, I believe that the fast food industry may be willing and active participants in such a system. Clearly, many restaurants have begun moving towards more healthy choices (e.g. McDonald’s restaurants now offer apple slices in place of french fries in their “Happy Meals”, although these “Apple Dippers” do come with sweetened dipping sauce). Leading the effort to create an R-rated system could greatly enhance corporate image and thereby potentially boost profi ts. For these reasons, many companies may enthusiastically participate in such a system. It is possible, however, that such a system would meet with signifi cant resistance. If so, it may be necessary for congress to become involved, as was necessary in the move to develop the V-Chip system for television programming.10  There are other precedents for limiting the sale of potentially harmful products to minors. While many believe that adults should be able to purchase alcohol, tobacco products, fi re arms, spray-paint, glue, and other potentially harmful or dangerous items, most would agree that the sale of such items to a minor would be inappropriate. While vendors clearly lose some revenue by adhering to regulations that limit sales to minors, we as a society believe that protecting minors from the adverse health effects of tobacco, alcohol, and other substances outweighs the limited loss of revenue and liberty. So too should we embrace an R-rating system for fast foods that would give parents greater control over what their children consume without limiting access for responsible adults.  While agreeing to defi nitions for what foods would fall under the R-rating might be challenging, we should not be dissuaded. It would seem that everyone would agree that facilitating parent’s control over what their children eat would be desirable. Determining how many grams of fat per serving, the precise caloric content of an item, or the grams of sugar per serving that would trigger an R-rating could be contentious, however certainly not insurmountable. If the common goal is to provide parents the ability to better care for their children, it would seem that we could develop and implement such a system quickly.  In today’s world where teens have easy access to many potentially harmful experiences, parents need as much help as possible. The R-rating for fast food is not intended to limit parent’s ability to raise their children as they choose; rather it is designed to give parents more control over one potentially unhealthy behavior. Furthermore, the R-rating might cause some parents to take pause before ordering these food items for themselves, their teens, or their young children. An R-rating system certainly would not be suffi cient to solve the adolescent obesity crisis, but it would give parents one more tool in helping their children grow up to be healthy adults who live long and happy lives.

Article Commentary: “R-Rating” for Fast Food: A Novel Weapon in Our Fight against the Expanding Teen Obesity Epidemic