1) The usual measure of obesity is BMI. This is dumb. While people with high BMI's are usually fatter than people with low BMI's, when a fat person becomes healthy through exercise and diet changes, they often do not lose weight. I've gone from zero regular exercise to working out a minimum of eight times/week and have not lost a single pound, intentionally. While I'm not obese, even according to the CDC, I'm certainly considered overweight. So, measurement is a problem, and using BMI to determine obesity and to impose consequences on obesity just sets fat people up for failure when they try to become healthier through exercise and diet changes.
2) Why is this the gov't's business again? Yeah, I know there are all kinds of justifications. But seriously, why is this the gov't's business?
3) One gov't program has taken some positive steps: WIC now offers $16/month for fresh produce and provides less juice and less or no full-fat milk than they used to. They also offer breastfeeding support. The quality varies between local programs, but in some areas it is very good. A friend of mine does peer support for her local WIC office. Breastfeeding tends to reduce obesity.
4) Food stamps should designate a proportion of each family's allowance to be used for fresh produce. Many states have implemented programs that enable food stamp users to buy stuff at farmers' markets. That is a step in the right direction.
5) Local charities and community organizations of very kinds should help people get physical exercise. Many YMCA's offer reduced cost memberships for low-income people; that's a good start. Senior centers should focus on exercise more, with walking groups, age- and mobility-appropriate lending libraries of video workouts. Ditto for community mental health organizations and county health departments. You don't find out about low-cost YMCA memberships unless you go to a YMCA. If you are poor, you probably don't go to a YMCA. My YMCA hits their fund-raising goal every year. I am confident that with more outreach and more charity, they could come up with the money to do more. If the problem is facilities becoming overburdened, then they could partner with local schools to offer classes off-site. This would also address the problems of transportation for seniors and for low-income people.
6) medical providers should emphasize the importance of exercise more. I've never been encourage by a medical professional to exercise. This is pretty dumb, considering that I have recurrent problems with depression and there is substantial evidence that exercise is at least as effective as some medications in treating depression. Similarly, after hanging around on running forums, I've learned that there are whole lots of people out there not taking expensive drugs every day simply because they run. I'm one of them, to the tune of about $400/month.
7) Insurance companies should take of the above.
8) Ultimately it is usually a personal choice. I'm against obesity penalties either privately or publicly imposed for two reasons: the above-detailed problem of measurement and effectiveness and fact that living is a grossly oversized body is punishment enough, and incentive enouh to address the problem. Most people who don't have other problems. Why give them more problems?