by Marion Nestle

Currently browsing posts about: Obesity-in-kids

Sep 19 2012

JAMA publishes theme issue on obesity

Yesterday, JAMA released a theme issue on obesity with several articles of particular interest, starting with New York City Health Commissioner Tom Farley’s Viewpoint.  About portion sizes, Dr. Farley notes:

As publicly traded companies responsive to the interests of their shareholders, food companies cannot make decisions that will lower profits, and larger portion sizes are more profitable because most costs of delivering food items to consumers are fixed….The sale of huge portions is driven by the food industry, not by consumer demand….The portion-size studies strongly suggest that, with a smaller default portion size, most consumers will consume fewer calories.  This change will not reverse the obesity epidemic, but it can have a substantial effect on it.

Lots of interesting food for thought here.  Take a look:


The Role of Government in Preventing Excess Calorie Consumption:  The Example of New York City
Thomas A. Farley, MD, MPH
JAMA. 2012;308(11):1093 doi:10.1001/2012.jama.11623

The Next Generation of Obesity Research:  No Time to Waste
Griffin P. Rodgers, MD; Francis S. Collins, MD, PhD
JAMA. 2012;308(11):1095 doi:10.1001/2012.jama.11853

FDA Approval of Obesity Drugs:  A Difference in Risk-Benefit Perceptions
Elaine H. Morrato, DrPH, MPH; David B. Allison, PhD
JAMA. 2012;308(11):1097 doi:10.1001/jama.2012.10007

Cardiovascular Risk Assessment in the Development of New Drugs for Obesity
William R. Hiatt, MD; Allison B. Goldfine, MD; Sanjay Kaul, MD
JAMA. 2012;308(11):1099 doi:10.1001/jama.2012.9931

Original Contribution

Exercise Dose and Diabetes Risk in Overweight and Obese Children:  A Randomized Controlled Trial
Catherine L. Davis, PhD; Norman K. Pollock, PhD; Jennifer L. Waller, PhD; Jerry D. Allison, PhD; B. Adam Dennis, MD; Reda Bassali, MD; Agustín Meléndez, PhD; Colleen A. Boyle, PhD; Barbara A. Gower, PhD
JAMA. 2012;308(11):1103 doi:10.1001/2012.jama.10762

Association Between Urinary Bisphenol A Concentration and Obesity Prevalence in Children and Adolescents
Leonardo Trasande, MD, MPP; Teresa M. Attina, MD, PhD, MPH; Jan Blustein, MD, PhD
JAMA. 2012;308(11):1113 doi:10.1001/2012.jama.11461

Health Benefits of Gastric Bypass Surgery After 6 Years
Ted D. Adams, PhD, MPH; Lance E. Davidson, PhD; Sheldon E. Litwin, MD; Ronette L. Kolotkin, PhD; Michael J. LaMonte, PhD; Robert C. Pendleton, MD; Michael B. Strong, MD; Russell Vinik, MD; Nathan A. Wanner, MD; Paul N. Hopkins, MD, MSPH; Richard E. Gress, MA; James M. Walker, MD; Tom V. Cloward, MD; R. Tom Nuttall, RRT; Ahmad Hammoud, MD; Jessica L. J. Greenwood, MD, MSPH; Ross D. Crosby, PhD; Rodrick McKinlay, MD; Steven C. Simper, MD; Sherman C. Smith, MD; Steven C. Hunt, PhD
JAMA. 2012;308(11):1122 doi:10.1001/2012.jama.11164

Health Care Use During 20 Years Following Bariatric Surgery
Martin Neovius, PhD; Kristina Narbro, PhD; Catherine Keating, MPH; Markku Peltonen, PhD; Kajsa Sjöholm, PhD; Göran Ågren, MD; Lars Sjöström, MD, PhD; Lena Carlsson, MD, PhD
JAMA. 2012;308(11):1132 doi:10.1001/2012.jama.11792

Surgical vs Conventional Therapy for Weight Loss Treatment of Obstructive Sleep Apnea:  A Randomized Controlled Trial
John B. Dixon, MBBS, PhD, FRACGP; Linda M. Schachter, MBBS, PhD; Paul E. O’Brien, MD, FRACS; Kay Jones, MT&D, PhD; Mariee Grima, BSc, MDiet; Gavin Lambert, PhD; Wendy Brown, MBBS, PhD, FRACS; Michael Bailey, PhD, MSc; Matthew T. Naughton, MD, FRACP
JAMA. 2012;308(11):1142 doi:10.1001/2012.jama.11580

Dysfunctional Adiposity and the Risk of Prediabetes and Type 2 Diabetes in Obese Adults
Ian J. Neeland, MD; Aslan T. Turer, MD, MHS; Colby R. Ayers, MS; Tiffany M. Powell-Wiley, MD, MPH; Gloria L. Vega, PhD; Ramin Farzaneh-Far, MD, MAS; Scott M. Grundy, MD, PhD; Amit Khera, MD, MS; Darren K. McGuire, MD, MHSc; James A. de Lemos, MD
JAMA. 2012;308(11):1150 doi:10.1001/2012.jama.11132


Progress in Filling the Gaps in Bariatric Surgery
Anita P. Courcoulas, MD, MPH
JAMA. 2012;308(11):1160 doi:10.1001/jama.2012.12337

Progress in Obesity Research:  Reasons for Optimism
Edward H. Livingston, MD; Jody W. Zylke, MD
JAMA. 2012;308(11):1162 doi:10.1001/2012.jama.12203

Sep 2 2012

Regulations do change eating behavior

My monthly, first Sunday column in the San Francisco Chronicle:

Q: I still don’t get it. Why would a city government think that a food regulation would promote health when any one of them is so easy to evade?

A: Quick answer: because they work.

As I explained in my July discussion of Richmond’s proposed soda tax, regulations make it easier for people to eat healthfully without having to think about it. They make the default choice the healthy choice. Most people choose the default, no matter what it is.

Telling people cigarettes cause cancer hardly ever got anyone to stop. But regulations did. Taxing cigarettes, banning advertising, setting age limits for purchases, and restricting smoking in airplanes, workplaces, bars and restaurants made it easier for smokers to stop.

Economists say, obesity and its consequences cost our society $190 billion annually in health care and lost productivity, so health officials increasingly want to find equally effective strategies to discourage people from over-consuming sugary drinks and fast food.

Research backs up regulatory approaches. We know what makes us overeat: billions of dollars in advertising messages, food sold everywhere – in gas stations, vending machines, libraries and stores that sell clothing, books, office supplies, cosmetics and drugs – and huge portions of food at bargain prices.

Research also shows what sells food to kids: cartoons, celebrities, commercials on their favorite television programs, and toys in Happy Meals. This kind of marketing induces kids to want the products, pester their parents for them, and throw tantrums if parents say no. Marketing makes kids think they are supposed to eat advertised foods, and so undermines parental authority.

Public health officials look for ways to intervene, given their particular legislated mandates and authority. But much as they might like to, they can’t do much about marketing to children. Food and beverage companies invoke the First Amendment to protect their “right” to market junk foods to kids. They lobby Congress on this issue so effectively that they even managed to block the Federal Trade Commission‘s proposed nonbinding, voluntary nutrition standards for marketing food to kids.

Short of marketing restrictions, city officials are trying other options. They pass laws to require menu labeling for fast food, ban trans fats, prohibit toys in fast-food kids’ meals and restrict junk foods sold in schools. They propose taxes on sodas and caps on soda sizes.

Research demonstrating the value of regulatory approaches is now pouring in.

Studies of the effects of menu labeling show that not everyone pays attention, but those who do are more likely to reduce their calorie purchases. Menu labels certainly change my behavior. Do I really want a 600-calorie breakfast muffin? Not today, thanks.

New York City’s 2008 ban on use of hydrogenated oils containing trans fats means that New Yorkers get less trans fat with their fast food, even in low-income neighborhoods. Whether this reduction accounts for the recent decline in the city’s rates of heart disease remains to be demonstrated, but getting rid of trans fats certainly hasn’t hurt.

Canadian researchers report that kids are three times more likely to choose healthier meals if those meals come with a toy and the regular ones do not. When it comes to kids’ food choices, the meal with the toy is invariably the default.

A recent study in Pediatrics compared obesity rates in kids living in states with and without restrictions on the kinds of foods sold in schools. Guess what – the kids living in states where schools don’t sell junk food are not as overweight.

Circulation has just published an American Heart Association review of “evidence-based population approaches” to improving diets. It concludes that evidence supports the value of intense media campaigns, on-site educational programs in stores, subsidies for fruits and vegetables, taxes, school gardens, worksite wellness programs and restrictions on marketing to children.

The benefits of the approaches shown in these studies may appear small, but together they offer hope that current trends can be reversed.

Researchers also suggest other approaches, not yet tried. The Yale Rudd Center has just shown that color-coded food labels (“traffic lights”) encourage healthier food choices.

And Rand Corp. researchers propose initiatives like those that worked for alcoholic beverages: Limit the density of fast-food outlets, ban sales in places that are not food stores, insist that supermarkets put junk foods and sodas where they are hard to see, ban drive-through sales, restrict portion sizes and use warning labels.

These regulatory approaches are worth trying. If research continues to demonstrate their value, cities will have even more reason to use them. If the research becomes compelling enough, the federal government might need to act.

In the meantime, cities are leading the way, Richmond among them. Their initiatives are well worth trying, testing and supporting.

**Marion Nestle is the author of “Why Calories Count: From Science to Politics,” as well as “Food Politics” and “What to Eat,” among other books. She is a professor in the nutrition, food studies and public health department at New York University, and blogs at E-mail:

Aug 28 2012

PepsiCo donates $100,000 to National Association of Hispanic Journalists

A blog post from Fernando Quintero on the Berkeley Media Studies Group’s site alerted me to PepsiCo’s latest example of corporate social responsibility: an additional $50,000 donation for scholarships and internships to the National Association of Hispanic Journalists bringing the total to $100,000.

Hispanic populations in the United States have higher than average rates of obesity, type 2 diabetes, and other chronic conditions associated with overconsumption of sodas and snacks.

Such generosity raises questions about what Pepsi is buying from this group.

The NAHJ says:

We are thrilled to have PepsiCo as a new partner committed to building a stronger Latino community,” said Ivan Roman, Executive Director for NAHJ. “The company’s support as we get more Hispanics into journalism to tell our stories is key to making sure our communities are represented fairly in the news media, while giving them a louder voice in the civic dialogue.

Why do I think that journalists in this Association are unlikely to be telling stories like these:

  • The relationship of soda and snack consumption to obesity and type 2 diabetes in Hispanic communities
  • The relationship of soda and snack consumption to Hispanic childhood obesity
  • How soda intake among Hispanic children leads to dental decay
  • Soda company marketing practices in Hispanic communities
  • The effects of soda and snack marketing on dietary practices and health in countries in Latin America

Pepsi says:

As part of La Promesa de PepsiCo, the company is building relationships with the community, strengthening its strategic partnerships, and sponsoring national Hispanic organizations like: CHCI (Congressional Hispanic Caucus Institute), HACR (Hispanic Association on Corporate Responsibility), LULAC (League of United Latin American Citizens), NAHJ (National Association of Hispanic Journalists), and NCLR (National Council of La Raza) among others.

A page from the tobacco-industry playbook, no?

Jun 4 2012

Weight of the Nation: the new “Hunger in America”?

My monthly Food Matters column for the San Francisco Chronicle:

Q: I forced myself to watch all four hours of HBO’s “Weight of the Nation.” I get it that obesity is a scary problem and I’m supposed to be eating less. What I don’t get is how I’m supposed to do that when food companies can do what they want and the government lets them.

A: I am with you on this one. I also looked at the website ( and a report from the Institute of Medicine, “Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation.” These all are components of a public-private partnership campaign to bring the personal and economic costs of obesity to national attention.

As The Chronicle’s David Wiegand put it in his Datebook review (see:, the show “pulls no punches, spares neither the multibillion-dollar food and advertising industries nor public officials for not only failing to fix the problem but actually making it worse.”

I thought the series focused too much on what you have to do on your own to manage your weight: take small steps, set realistic goals, focus on portion control, monitor your calorie intake.

I wish it had spent as much time on countering the actions of the food industry, called by Kelly Brownell of Yale’s Rudd Center as “powerful, pernicious and predatory.”

I also wish it had been more courageous in demanding that government help check the excesses of food industry marketing to make it easier for Americans to cope with the social, economic and business drivers of obesity that the series documented so well.

I saw that courage in an accompanying video for kids, which won’t be shown nationally until the fall. Watch for it. School kids in a Rethinkers club in New Orleans wanted to improve the lunches in their school. They went into action and figured out how to make the system work for them. They succeeded by learning to “speak truth to power” and “hold feet to the fire.”

Why aren’t adults doing the same? For an explanation, take a look at the institute’s report. Its recommendations do speak some truth to power. Although its No. 1 goal promotes physical activity (a thoroughly uncontroversial recommendation), its No. 2 is to fix the environment to make healthier food options routine and easy, especially by discouraging consumption of soft drinks.

As for holding feet to fire, the report warns that if companies don’t adopt nutrition standards for kids’ marketing within two years, policymakers should consider making them mandatory.

Consider? “Weight of the Nation” showed how the food industry reacted when the Federal Trade Commission tried to propose voluntary standards.

In two years? The institute already gave the food industry two years to act – six years ago. Its 2006 “Food Marketing to Children and Youth” report stated that if the industry didn’t stop advertising junk foods on children’s television programs within two years, Congress should legislate marketing standards.

In 1968, the CBS television documentary “Hunger in America” shocked the nation and galvanized Congress to pass legislation to reduce poverty and malnutrition.

“Weight of the Nation” is equally shocking. It impressively and compellingly defines the problem of obesity, its consequences and its causes, personal and societal.

But I wish the series – and the Institute of Medicine – had been able to rise above the politics and say more about how we as a society could do better to improve school food, limit the relentless marketing of sodas and junk foods, and make it easier for everyone to afford and have access to healthier foods.

Food companies are businesses. In today’s investment economy, they must not only make a profit but must increase the profit every 90 days. Business imperatives mean that they could help make healthier choices easier, but won’t unless forced to. That’s what New York Mayor Michael Bloomberg’s proposed ban on big sodas is trying to do (see:

At the very least, I’m hoping the HBO program will encourage viewers to press for political action to prevent obesity. If it does, history will judge this documentary to be as important a democratizing influence on our society as was “Hunger in America.”

May 28 2012

Childhood obesity: catching up on recent research

I’m catching up on some reading over the long weekend.  Here are some selections from the latest issue of Childhood Obesity (Click here for the complete Table of Contents).

Food Marketing to Youth: Current Threats and Opportunities
Marlene B. Schwartz, Amy Ustjanauskas
Childhood Obesity. April 2012, 8(2): 85-88.
First Page | Full Text PDF|
Revolution Foods: Equal Access for All
Interview with Revolution Foods Co-Founders Kristin Richmond and Kirsten Tobey
Childhood Obesity. April 2012, 8(2): 94-96 First Page | Full Text PDF|
Exploring Effectiveness of Messaging in Childhood Obesity Campaigns
David L. Katz, Mary Murimi, Robert A. Pretlow, William Sears
Childhood Obesity. April 2012, 8(2): 97-105.First Page | Full Text PDF|
Hard Truths and a New Strategy for Addressing Childhood Obesity
Eric A. Finkelstein, Marcel Bilger
Childhood Obesity. April 2012, 8(2): 106-109.First Page | Full Text PDF|
U.S. Government Initiatives
Childhood Obesity. April 2012, 8(2): 167-168.First Page | Full Text PDF |
May 17 2012

Pondering the Weight of the Nation

I’ve been asked to comment on the HBO series, Weight of the Nation and everything that comes with it: the accompanying book, the auxiliary videos, the distribution plan to schools and other institutions, and the Institute of Medicine’s report, Accelerating Progress in Obesity Prevention.

Because I wanted to look at all of it before commenting, plenty of others have beaten me to it, among them FoodandTechConnect’s infographic summary,   Kerry Trueman on AlterNet and Michele Simon on Grist.

I don’t have HBO but got sent the press kit, the Weight of the Nation book, the disks, and the IOM report.  I watched all four hours of the HBO series, plus the “Rethinkers” video of kids working on a school lunch project in New Orleans (air dates), plus the IOM and HBO books, plus the website.

Overall, Weight of the Nation makes the size, scope, causes, and consequences of obesity alarmingly clear.

The talking heads—many of them my friends, colleagues, and former students—all had plenty to say about what obesity means on a day-to-day basis for individuals and its personal and economic cost to society.

The programs ought to convince anyone that obesity is a big problem and that something big needs to be done to prevent it.

But doing something big, the series makes clear, will be very difficult.

This may be realistic, but it is not inspiring.

We need inspiration.   That’s why I wish the programs had focused as much on social responsibility as they did on personal responsibility.

I wanted to see the programs take leadership on how government can help citizens reduce the social, economic, and business drivers of obesity.

That kind of leadership exists.  To see it in action, watch the video of the New Orleans school “rethinkers.”  Those kids wanted to improve their school lunches.  They got busy, dealt with setbacks, and learned how to make the system work for them.  They “spoke truth to power” and “held feet to the fire.”

Why aren’t adults doing the same?   Politics, the IOM report explains.  Although one of its principal recommendations is critical—Create food and beverage environments that ensure that healthy food and beverage options are the routine, easy choice—its recommendations speak some truth to power but do little to hold feet to the fire.

The IOM report explains the political realities:

The committee’s vision takes into account the need for strategies to be realistic, as well as consistent with fundamental values and principles.  At the same time, however, having a diversity of values and priorities among them is itself a principle of U.S. society.

Potentially competing values and principles must be reconciled, for example, in considering protections needed for individuals versus the community at large or for the public versus the private sector.

Vigilance regarding unintended adverse effects of changes undertaken to address the obesity epidemic is also needed.

“Americans,” the report says, are accustomed to the current obesogenic environment, one “driven by powerful economic and social forces that cannot easily be redirected.”

It may not be easy to redirect such forces, but shouldn’t we be trying?

In 1968 the CBS documentary Hunger in America galvanized the nation to take action to reduce poverty and malnutrition.

The HBO series was equally shocking but I wish it had focused more on how we—as a society—could mobilize public distress about the poor quality of food in schools and the relentless and misleading marketing of sodas and junk foods that it so well documented.

But dealing with the need to address the social and economic forces that promote obesity would, I’m told, be considered lobbying, which the private-public sponsors of the series are not permitted to do.

Mobilizing public support for health is considered lobbying.  Food industry marketing is not. columnist Caroline Scott-Thomas wrote about the HBO series:

As an industry journalist, I’ll be among the first to admit that industry is stuck in a very hard position here: On the one hand, it wants to be seen to be doing the right things – but on the other, what people say they want to eat, and what they actually do eat are often very different, and after all, food companies are in the business of making money.

But honestly, could industry do more to make healthy choices routine, easy choices? I think so.

Yes it could, but won’t unless forced to.

Without leadership, we are stuck doing what the food industry needs, not what the public needs.

Weight of the Nation did an impressive and compelling job of defining the problem and its causes and consequences.  I wish it—and the IOM—could have risen above the politics and pressed harder for strategies that might help people make healthier choices.

But—if the HBO programs really do help mobilize viewers to become a political force for obesity prevention, they will have been well worth the effort that went into making and watching them.

Apr 28 2012

Reuters: How the White House wobbled on childhood obesity

I am in Brazil at meetings of World Nutrition Rio 2012 but was deluged yesterday by links to a lengthy Reuters’ Special Report: How Washington went soft on childhood obesity.

In an e-mail, Reuters explains that its report is about how food and beverage companies dominate policymaking in Washington, doubled lobbying expenditures during the past three years, and defeated government proposals aimed at changing the nation’s diet.

  • The White House, despite First Lady Michelle Obama’s child obesity campaign, kept silent as Congress killed a plan by four federal agencies to recommend reductions to sugar, salt and fat in food marketed to children.
  • Corporate lobbying last year led Congress to declare pizza a vegetable to protect it from a nutritional overhaul in the school lunch program.
  • The Center for Science in the Public Interest, widely regarded as the lead lobbying force for healthier food, spent about $70,000 lobbying– roughly what companies opposing stricter food guidelines spent every 13 hours.
  • The food and beverage industry has a near-perfect record in political battle even while health authorities link unhealthy food to the child obesity epidemic.
  • During the past two years, each of the 24 states and five cities that considered “soda taxes” has seen the efforts dropped or defeated.

Reuters Investigates also has a video about how the food industry fought back when the White House sought healthier school lunches and Congress directed federal agencies to set nutrition standards.

Readers of this blog may recall my post last December fretting about the White House pullback, and the vigorous denial the next day by White House senior food policy advisor Sam Kass.

I attributed White House caution to the upcoming election.  Reuters does too, apparently, and so does the New York Times

If the First Lady is to make real progress on Let’s Move, she needs all the support she can get.  This might be a good time to send a note to the White House strongly encouraging more vigorous action on methods to address childhood obesity.

Mar 26 2012

Childhood Obesity celebrates the second anniversary of Let’s Move!

I’m getting caught up on my journal reading and didn’t want to miss this one.

The journal Childhood Obesity has a special issue of articles related to Michelle Obama’s Let’s Move! campaign.  Mrs. Obama wrote the foreword.

Here are some selections:

Let’s Move! Raising a Healthier Generation of Kids
First Lady Michelle Obama
Childhood Obesity. February 2012, 8(1): 1-1.
First Page | Full Text PDF|

Let’s Move! Progress, Promise, and the Miles Left To Go
David L. Katz
Childhood Obesity. February 2012, 8(1): 2-3.
First Page | Full Text PDF |

The Healthy, Hunger-Free Kids Act— Building Healthier Schools
Thomas J. Vilsack, BA, JD, US Secretary of Agriculture, US Department of Agriculture
Childhood Obesity. February 2012, 8(1): 4-4.
First Page | Full Text PDF|

Motivating Kids To Move: The Role of Sports Stars in the Fight Against Childhood Obesity
Shellie Y. Pfohl, MS, President’s Council on Fitness, Sports & Nutrition (PCFSN), Drew Brees, Co-Chair, President’s Council on Fitness, Sports & Nutrition (PCFSN) and NFL Quarterback
Childhood Obesity. February 2012, 8(1): 5-6.

First Page | Full Text PDF|

Promoting Health at the Community Level: Thinking Globally, Acting Locally
Christina D. Economos, Alison Tovar
Childhood Obesity. February 2012, 8(1): 19-22.

First Page | Full Text PDF

Reestablishing Healthy Food Retail: Changing the Landscape of Food Deserts
Allison Karpyn, Candace Young, Stephanie Weiss
Childhood Obesity. February 2012, 8(1): 28-30.
First Page | Full Text PDF|

Children’s Meals in Restaurants: Families Need More Help To Make Healthy Choices
Margo G. Wootan
Childhood Obesity. February 2012, 8(1): 31-33.
First Page | Full Text PDF|

Stepping Up Across America: The Small Changes Approach
John C. Peters, Rachel C. Lindstrom, James O. Hill
Childhood Obesity. February 2012, 8(1): 76-78.
Making the Healthy Choice the Easy Choice
Jamie Devereaux
Childhood Obesity. February 2012, 8(1): 82-84.
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