Issues concerning obesity exist at the nexus of civil liberty and collective responsibility. We claim freedom to eat anything despite the consequences - to our health or our finances. But the costs are not solely ours.

Obesity's consequences include heart disease, type 2 diabetes, stroke and osteoarthritis. Heart disease, stroke and diabetes are the first, fourth and seventh leading U.S. causes of death. Annual obesity-related medical costs are estimated at $150 billion to $190 billion.

Balancing liberty and collective responsibility for health, then, is a primary challenge of public health. The Obama administration's efforts have focused on the primary drivers of obesity: unhealthy eating and a lack of physical activity. The fight against obesity depends on such efforts but it also depends on reforming another expression of civil liberty: lobbying.

In 2010, the Obama administration initiated a National Task Force on Childhood Obesity, the first such Cabinet-level effort. Examples of outcomes include a campaign to increase physical activity, production incentives to increase availability of healthier foods, revised food labeling, physical activity and nutritional standards, monitoring food marketing to children and increasing access to healthy food retailers in underserved communities.

An example of positive change in these areas is a shift in the national children's nutrition effort to support the purchase of fresh fruits and vegetables, including providing vouchers for farmers markets throughout the country.

First lady Michelle Obama has encouraged conversation about healthy eating and exercise. She has brought school children to the White House Kitchen Garden and has spoken about the challenge of feeding her family in the face of the overwhelming junk-food marketing campaign aimed at children. She has kept up a dialog with industry and engages communities to increase physical activity with the "Let's Move!" campaign.

Efforts appear to be paying off. The Centers for Disease Control and Prevention recently reported that obesity rates dropped in most states between 2008 and 2011. This is an encouraging sign.

While we see glimpses of improvement, there are miles yet to go. We weigh more than we did 30 years ago, our portion sizes are astronomical, we walk half as much and many communities are reducing physical activity in schools. To truly make a lasting impact on obesity we need to engage in lobbying reform.

The administration's efforts are bold and could be more so, but they have been met with tremendous industry resistance.

Recent analyses by Reuters described a threefold increase in lobbying efforts and resources directed toward this administration by the food and beverage industry. This began in 2009 as Congress was considering a soda tax and continued, focusing on nutrition, labeling and junk-food marketing.

It is no surprise that in 2011 Congress rejected proposed USDA school lunch standards while assuring us that tomato paste continued to have four times the "extra vegetable serving credit" than it actually has.

Such outcomes are reinforced by the revolving door between Congress and lobbying firms. This year, the Center for Responsive Politics reported that 57.2 percent of food and beverage industry lobbyists are "revolvers" - rotating between government and roles as consultants and strategists on K Street.

Changing the trajectory of the obesity epidemic requires vision and courage. We, as citizens, need to "step it up" - in the words of Michelle Obama - not just to eat well and increase physical activity, but to call for lobbying reform in the name of the public interest.

Without it, we essentially tie one hand behind our backs in the fight against obesity. The growth of lobbying is a problem that goes beyond the obesity-policy arena. It is a structural challenge to democracy that must be addressed for the public good.

Beth Meyerson is an assistant professor at the Indiana University School of Public Health. Readers can email her at bmeyerso@indiana.edu.

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