If you happen to be the 1-in-3 Americans who is neither obese nor overweight (and, thus, considered at risk of becoming obese), you might well conclude that the habits of the remaining two-thirds of Americans are costing you, big time. U.S. life expectancies are expected to slide backward, after years of marching upward. (But that's their statistical problem: Yours is how to make them stop costing you all that extra money because they are presumably making poor choices in their food consumption.)

In the debate over healthcare reform, the added cost of caring for patients with obesity-related diseases has become a common refrain: most recent is the cost-of-obesity study, also released today by the Centers for Disease Control and Prevention . It finds that as obesity rates increased from 18.3% of Americans in 1998 to 25% in 2006, the cost of providing treatment for those patients' weight-driven problems increased healthcare spending by $40 billion a year.

As evidence of this new "get-tough" strategy on obesity, they may well cite a study released today by the Urban Institute titled " Reducing Obesity: Policy Strategies From the Tobacco Wars ."

When historians look back to identify the pivotal moments in the nation's struggle against obesity, they might point to the current period as the moment when those who influenced opinion and made public policy decided it was time to take the gloves off.

"Facing the serious consequences of an uncontrolled obesity epidemic, America's state and federal policy makers may need to consider interventions every bit as forceful as those that succeeded in cutting adult tobacco use by more than 50%," the Urban Institute report says. It took awhile -- almost 50 years from the first surgeon general's report on tobacco in 1964 -- to drive smoking down. But in many ways, the drumbeat of scientific evidence and the growing cultural stigma against obesity already are well underway -- as any parent who has tried to bring birthday cupcakes into her child's classroom certainly knows.

Key among the "interventions" the report weighs is that of imposing an excise or sales tax on fattening foods. That, says the report, could be expected to lower consumption of those foods. But it would also generate revenues that could be used to extend health insurance coverage to the uninsured and under-insured, and perhaps to fund campaigns intended to make healthy foods more widely available to, say, low-income Americans and to encourage exercise and healthy eating habits.

If anti-tobacco campaigns are to be the model, those sales taxes could be hefty: The World Health Organization has recommended that tobacco taxes should represent between two-thirds and three-quarters of the cost of, say, a package of cigarettes; a 2004 report prepared for the Department of Agriculture suggested that, for "sinful-food" taxes to change the way people eat, they may need to equal at least 10% to 30% of the cost of the food.

And although 40 U.S. states now impose modest extra sales taxes on soft drinks and a few snack items, the Urban Institute report suggests that a truly forceful "intervention" -- one that would drive down the consumption of fattening foods and, presumably, prevent or reverse obesity -- would have to target pretty much all the fattening and nutritionally empty stuff we eat: "With a more narrowly targeted tax, consumers could simply substitute one fattening food or beverage for another," the reports says.

Of course, the United States also would have to adopt extensive menu- and food-labeling changes that would make "good foods" easily distinguishable from the bad ones subject to added taxes. Not to worry though: Several European countries, most notably Great Britain, have led the way in this area.

And here's the payoff: Conservatively estimated, a 10% tax levied on foods that would be defined as "less healthy" by a national standard adopted recently in Great Britain could yield $240 billion in its first five years and $522 billion over 10 years of implementation -- if it were to begin in October 2010. If lawmakers instituted a program of tax subsidies to encourage the purchase of fresh and processed fruits and vegetables, the added revenue would still be $356 billion over 10 years.

That would pay for a lot of healthcare reform, which some have estimated will cost as much as $1 trillion to implement over the next ten years.

There can be little doubt that lobbyists for the food, restaurant and grocery industries would come out swinging on any of these proposals. But the report cites evidence of a turning political tide for proposals that would hold the obese and other consumers of nutritionally suspect food accountable for their choices. A recent national poll found that 53% of Americans said they favored an increased tax on sodas and sugary soft drinks to help pay for healthcare reform. And even among those who opposed such an idea, 63% switched and said they'd favor such a tax if it "would raise money for health-care reform while also tackling the problems that stem from being overweight."

-- Melissa Healy