Should government put America on a diet to solve the obesity crisis? Or would that be a form of force-feeding?

Two out of three U.S. adults — and 16 percent of children 6 to 19 — are overweight or obese.

The numbers aren’t much better in South Carolina, where more than three in five adults are overweight or obese.

Surgeon General Richard Carmona says regulation isn’t the answer to stemming that epidemic.

“It has to start with the individual,” said Dr. Carmona, who will speak Wednesday at a forum on obesity and public policy, hosted by the USC School of Law. “Do you really want the government to tell you what to eat?”

Government regulation should be the last resort except in cases where people promote their business dishonestly or in ways that could harm the public, Carmona said. Even then, regulation might not be necessary if the public is well-informed and asks the right questions.

Appropriate state and local government roles include raising health literacy, providing technical and funding assistance for various programs, and providing role models and mentors, Carmona said.

“I would hope that the average person, armed with the right information, would make the right decision for their health, for their safety,” Carmona said.

While in South Carolina for USC’s annual Johnson & Johnson Healthcare Lecture, Carmona plans to visit an elementary school as part of his 50 Schools in 50 States initiative through which he talks with students nationwide about risky behaviors and healthy choices. He already has visited 26 schools.

Hopes for a lifestyle revolution rest in educating today’s children, Carmona said. “It’s not going to be done in one generation. It will be an inter-generational transfer of culture.”

Carmona’s message on obesity is part of a bigger debate on how much of the responsibility of addressing the epidemic rests on individuals, and how much the government should intervene.

For example, classifying obesity as a disease could clear the way for insurance companies to pay for preventive measures, said Dr. Phyllis Speiser, a member of the Obesity Consensus Working Group, an international consortium of 65 physicians and other health professionals.

Under today’s health system, few preventive services — such as counseling — are paid for by insurers, said Speiser, who also is a pediatric endocrinologist at Schneider Children’s Hospital in New York.

“There certainly has to be personal responsibility, but people have to be educated,” she said. “Part of that education process is the provision of preventative health services.”

Carmona sees obesity as part of a larger group of preventable, behavior-related problems such as smoking and wearing a seat belt. Despite prevention efforts, many people continue to choose to put themselves at risk.

Other experts say those behaviors might not be entirely under the person’s control.

“Some people might classify obesity as a voluntary health risk, but it’s part of a much larger group of behaviors that may or may not be voluntary,” said Robert Veatch, professor of medical ethics and former director of the Kennedy Institute of Ethics at Georgetown University.

Nonvoluntary factors include genetics, psychological and other conditions that affect behavior, and decisions made for children by adults.

If, in fact, obesity is mainly a result of voluntary actions, deciding how obese you want to be is a value judgment, Veatch said, and the government should not be involved in that directly — except when personal choices saddle the public with additional expenses.

“The government has a legitimate role in letting people know the cost to themselves and to others,” Veatch said. “I don’t know what else they ought to be doing.”

The Centers for Disease Control and Prevention reports that in 1998, overweight- and obesity-related medical expenses accounted for 9.1 percent of U.S. medical expenditures, then costing as much as $78.5 billion.

South Carolina ranks among the top 10 states in terms of obesity-related medical expenses. From 1998 to 2000, annual obesity-related costs in South Carolina were an estimated $1.1 billion — more than 6 percent of adult medical expenses.

“Even if you’re willing to sacrifice your own life, society pays for your indiscretion,” Carmona said. “We pay in the loss of a life and the value of a person, but we also pay economically at a time when we really can’t afford that.”

Reach Reid at (803) 771-8378 or czreid@thestate.com.