Currently browsing posts about: Obesity-policy

Apr 4 2014

Government policies to reduce obesity: suggestions for action

Thanks to all who commented on my April 1 (not a joke) post on inadvertant government policies that promote obesity.

Thanks in particular to Joshua De Voto who forwarded a link to the Sean Faircloth article that kicked off this discussion.

What’s remarkable about the list of items is that they constitute a policy agenda for health promotion.  Just turn them around:

  • Subsidize development of trails and sidewalks in cities and communities.
  • Pass zoning laws that encourage foot and bicycle traffic.
  • Provide nutrition information in fast food and other restaurants (fingers crossed that the FDA will eventually get on this).
  • Require physical education, nutrition, and cooking classes in schools.
  • Ban marketing of junk foods to children.
  • Ban marketing of junk foods in schools (USDA is trying to do this).
  • Subsidize production of fresh fruits and vegetables.
  • Subsidize healthy foods in programs for poor people.
  • Eliminate corporate tax deductions for marketing.
  • Permit lawsuits against food companies.

I can think of other policies well worth promoting.

Please add to the list!

Apr 1 2014

Call for ideas: Do government policies promote obesity? How?

Nicholas Kristof of the New York Times recently devoted a column to an analysis of who really gets welfare in the United States.  He listed policies that favor not only the wealthy, but the fabulously wealthy:

  • Subsidies for private airplanes via tax write-offs and deductions
  • Tax deductions for private yachts
  • Tax deductions for hedge funds and private equity
  • Bank rescues
  • Incentives to operate locally

His column reminded me of one written in 2005 by Sean Faircloth, then a Maine State representative, “Six ways government promotes obesity and what to do about it.”

No government, Faircloth said, could have devised more effective policies for reducing physical activity and promoting junk food.  Taxpayers, he pointed out:

  • Subsidize oil companies and cars to the detriment of trails and sidewalks.
  • Make it impractical to get basic information in foods and restaurants (menu labeling regulations: where are you?).
  • Give large corporations free reign to market to children.
  • Allow soda and snack-food companies to market products in schools (USDA is trying to change this).
  • Direct billions in subsidies toward processed foods while neglecting fresh produce.
  • Promote high-calorie foods in programs for poor people.

I thought this was an interesting way of thinking about obesity policy and over the years have added these:

  • Allowing marketing costs to be deducted from taxes as business expenses
  • Bans on lawsuits against food companies
  • Ambiguous and obfuscating dietary guidelines (e.g. SoFAS in the 2010 edition)

No doubt there are others.

Can you think of any others?  Thanks.

Dec 13 2012

Good news: cities report declines in childhood obesity

I don’t get many fan letters (as you can tell from reading the comments to posts).  When I do, they mean a lot.  Here’s an especially lovely one from a reader this week:

I cannot help but think of you and the work that you do having a great impact on the first signs of child/youth obesity declining.  Although the “researchers” indicate they are not sure of the reasons for the decline, I think many within the food / food politics community know that the work you do, the awareness you spread and the advertising you expose, greatly affects the way we feed our children.  As a real food advocate and parent, thank you for the work you do.

Thanks but I can take no credit (much as I would love to).

The writer is referring to a front-page, right-hand column story—the most important of the day—in the December 11 New York Times.   The article said that several cities are reporting drops in childhood obesity rates.

The drops may be small, just 3% to 5%, but any reversal in obesity trends is excellent news.

Last September, the Robert Wood Johnson Foundation first reported such drops.

It noted that the declines were occurring in places that had taken comprehensive action to address childhood obesity.

New York City, for example, has engaged in major efforts to make healthy dietary choices the easy choices.  Health Commissioner Tom Farley recently reported a 5.5% decline in childhood obesity.

The Foundation says that Philadelphia:

has undertaken a broad assault on childhood obesity for years. Sugary drinks like sweetened iced tea, fruit punch and sports drinks started to disappear from school vending machines in 2004. A year later, new snack guidelines set calorie and fat limits, which reduced the size of snack foods like potato chips to single servings. By 2009, deep fryers were gone from cafeterias and whole milk had been replaced by one percent and skim.

Broad policies like these are exactly what the Institute of Medicine recommends (me too).

And now, it seems, these actions are actually having the intended effect.

That’s the best news ever.

And I don’t care who gets credit for it.

 

Sep 24 2012

Do sugar-sweetened beverages promote obesity? Yes, say papers in the New England Journal.

 The New England Journal of Medicine has just published a series of articles on sugar-sweetened beverages to  coincide with presentations at The Obesity Society’s annual meeting.  Here are links to the articles.  I’ve extracted brief quotes from some of them.  And here’s a summary in the New York Times.

Perspective: J.L. Pomeranz and K.D. Brownell, Portion Sizes and Beyond — Government’s Legal Authority to Regulate Food-Industry Practices.

Regulations that affect “ordinary commercial transactions” (such as the sale of a product) are presumed to be constitutional if they have a rational basis and if the government body enacting them has the appropriate knowledge and experience to do so.

In the case of New York City’s portion-size restrictions, for example, the health department is an expert public health body that reviewed relevant scientific evidence on the health hazards associated with consumption of sugar-sweetened beverages and the effect of portion sizes on consumption patterns. The proposed policy thus has a rational basis….

Original Article: Q. Qi and Others, Sugar-Sweetened Beverages and Genetic Risk of Obesity

The study concludes: “the genetic association with adiposity appeared to be more pronounced with greater intake of sugar-sweetened beverages.”

Original Article: J.C. de Ruyter and Others,  A Trial of Sugar-free or Sugar-Sweetened Beverages and Body Weight in Children

We conducted an 18-month trial involving 641 primarily normal-weight children from 4 years 10 months to 11 years 11 months of age. Participants were randomly assigned to receive 250 ml (8 oz) per day of a sugar-free, artificially sweetened beverage (sugar-free group) or a similar sugar-containing beverage that provided 104 kcal (sugar group). Beverages were distributed through schools….Masked replacement of sugar-containing beverages with noncaloric beverages reduced weight gain and fat accumulation in normal-weight children.

Original Article: C.B. Ebbeling and Others, A Randomized Trial of Sugar-Sweetened Beverages and Adolescent Body Weight

We randomly assigned 224 overweight and obese adolescents who regularly consumed sugar-sweetened beverages to experimental and control groups. The experimental group received a 1-year intervention designed to decrease consumption of sugar-sweetened beverages, with follow-up for an additional year without intervention….Among overweight and obese adolescents, the increase in BMI was smaller in the experimental group than in the control group after a 1-year intervention designed to reduce consumption of sugar-sweetened beverages, but not at the 2-year follow-up

Editorial: S. Caprio, Calories from Soft Drinks — Do They Matter?

These randomized, controlled studies — in particular, the study by de Ruyter et al. — provide a strong impetus to develop recommendations and policy decisions to limit consumption of sugar-sweetened beverages, especially those served at low cost and in excessive portions, to attempt to reverse the increase in childhood obesity.

Clinical Decisions: T. Farley, D.R. Just, and B. Wansink, Regulation of Sugar-Sweetened Beverages

This one is a point/counterpoint.  On the basis of the evidence just presented, should government regulate sugary drinks?

New York City Health Commissioner Tom Farley says yes:

If a harmful chemical in schools were causing our children to get sick, people would demand government regulation to protect them. It is therefore difficult to argue against a government response to an epidemic of obesity that kills more than 100,000 persons a year in the United States and has an environmental origin.7

Federal, state, and local governments already regulate the food system, from farm to retail, in many ways and for many purposes, ranging from support of agriculture to prevention of foodborne illness. The question is not whether we should regulate food, but rather whether we should update food regulations to address this new epidemic.

David Just and Brian Wansink say no:

We must also recognize that the universe of foods that contribute to childhood obesity is much larger than sugar-sweetened beverages. Such a narrowly defined approach would have minimal chance for overall success. Rather, we must consider approaches that will involve parents, schools, and pediatricians in leading children toward more healthful eating habits and increased physical activity. In truth, we cannot hope to create regulations that restrict behavior holistically.

I’d say we now have plenty of evidence that habitual use of soft drinks raises risks for obesity, and plenty of evidence for the need for regulation.

Yes, it would be nice if “leading children to eat better” worked, but parents, teachers, and everyone else needs lots of help in coping with today’s food environment.

The New England Journal has done a great public service in publishing these papers as a series, and the authors all deserve much praise for taking on these difficult research projects.

OK city agencies: get to work!

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:


Viewpoint

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

Editorial

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 18 2012

Today’s debate: The Wall Street Journal asks who’s responsible for preventing obesity?

Betsy McKay of The Wall Street Journal organized and moderated a debate on this question.  I was a participant along with Brian Wansink , the John S. Dyson professor of marketing at Cornell University and Michael D. Tanner, senior fellow at the Cato Institute.

The debate is lengthy—you can read all of it online—but here are my initial responses to the two questions asked of me.

WSJ: What role should government play in addressing the obesity epidemic?  

DR. NESTLE: The government is up to its ears in policies that promote obesity. To name only a handful: supporting production of food commodities, but not of fruits and vegetables; permitting food and beverage companies to deduct marketing expenses from taxes; permitting SNAP benefits [food stamps] to be used on any food, thereby encouraging food companies to market directly to low-income groups.

Research on the prevalence of obesity shows that after decades of remaining at the same level, it began to increase sharply in the early 1980s. Our sense of personal responsibility did not change then. What did change was the food environment, transformed by food industry imperatives to increase sales, to one that increasingly urged people to “eat more” by making it socially acceptable to eat anywhere, anytime, and in very large amounts. In this kind of food environment, all but the most mindful eaters overeat. Few of us are in that category.

The food, beverage and restaurant industries collectively spend roughly $16 billion a year to promote sales through advertising agencies, perhaps $2 billion of that targeted at children. Marketing to children is well established to encourage kids to want advertised products, pester their parents for them, and believe that those products are what they are supposed to be eating. The “I am responsible” argument does not work for children (I’m not aware of evidence that it works well for adults either). Because regular consumption of junk foods and sugary drinks is linked to obesity in children, marketing these products to them is overtly unethical.

To expect food and beverage companies, whose sole purpose is to increase sales and report growth in sales every quarter, to voluntarily stop marketing to children makes no sense. On ethical grounds alone, government intervention is essential.

Given the personal and economic costs of obesity—currently estimated at $190 billion a year—governments have many reasons to promote the health of their populations. Just ask the military.

WSJ: Let’s talk about some specific initiatives. Will Mayor Bloomberg’s cap on soda sizes reduce soda consumption? What about the proposed municipal tax of a penny an ounce on sugary drinks in Richmond, Calif.?

DR. NESTLE: If only education and personal responsibility worked to improve eating behavior. Brian Wansink’s research clearly shows that his own students, diligently educated to understand the effect of large food portions on eating behavior, will still eat more when given more food—and, more seriously, they will underestimate the amount they have eaten.

Education must be backed up by a supportive environment. So why not create a food environment that makes it easier for people to eat less? Mayor Bloomberg’s idea of capping soda sizes at 16 ounces is an interesting approach to doing just that. A 16-ounce soda is not exactly abstemious. It is two standard servings, 50 grams of sugar and 200 calories.

To suggest that food laws will not change behavior makes little sense. For one thing, anti-obesity initiatives have scarcely been tried. For another, the history of anti-smoking interventions suggests quite the opposite. Attempts to get smokers to quit by invoking personal responsibility made little headway. Smokers quit when the government made smoking so inconvenient and expensive that it became easier to stop than to continue.

The intense response of soda companies to Mayor Bloomberg’s cap on soda size is testimony to the effectiveness of regulatory approaches. The companies would not be putting this kind of effort or spending millions to oppose an action they expected to fail.

Aug 27 2012

How much does obesity cost American society?

The costs of obesity are personal, but also societal.

Economists love trying to figure out how to quantify such things.

The most widely used estimate for the United States is from Cawley and Meyerhoefer’s 2012 article in the Journal of Health Economics: $190 billion annually for health care and lost productivity (their 2010 working paper may be easier to access at the National Bureau of Economic Research site).

Now the Campaign to End Obesity has published its own analysis of these costs.

  • $44.7 billion, for inpatient services.
  • $45.2 billion, for non-inpatient services.
  • $69.3 billion, for pharmaceutical services.
  • $146.6 billion, across all services.

As the Campaign puts it:

the total economic cost of overweight and obesity in the United States and Canada caused by medical costs, excess mortality and disability is approximately $300 billion per year. The portion of this total due to overweight is approximately $80 billion, and approximately $220 billion is due to obesity. The portion of the total in the United States is approximately 90 percent of the total for the United States and Canada.

I don’t know what to make of such estimates.  They are always based on assumptions that may or may not be valid. 

One thing is clear: obesity is expensive, personally, economically, and politically.

That’s why it’s a good idea to support public health initiatives to make it easier for people to maintain a healthy weight.

Providing healthier food in schools, getting junk food out of schools, soda taxes, soda caps, and restrictions on marketing to kids are the kinds of ideas that are worth supporting.  

Now. 

Aug 18 2012

Guest post: Paul Ryan’s Views on Food Politics

Daniel Green, a student at Cornell, asked whether I intended to write about Paul Ryan’s views on food politics.  He volunteered to put something together with his colleague, Dr. Margaret Yufera-Leitch.  Here are their thoughts:

Few Americans had heard of Paul Ryan (R-Wisconsin) until last week when he was announced as Presidential-hopeful Mitt Romney’s November running mate. A Janesville, Wisconsin native, former personal trainer and Oscar Mayer Weinermobile driver during his college days, Ryan is a strong advocate on the Hill for the P90x exercise routine and avoids eating fried foods and desserts (yes, even on the campaign trail).

But how do Mr. Ryan’s personal beliefs impact his voting on food politics related matters?

Obesity prevention

In the case of obesity, prevention has been shown repeatedly to be the best medicine. Of the $2.6 trillion spent on US health care in 2010, 95% went for disease treatment leaving only $421 per American per year for prevention—not even enough money for a 1-year gym membership in most states.

In an interview with Politico, Mr. Ryan admitted to maintaining 6-8% body fat with a healthy BMI of 21, admirable for any working professional. But Mr. Ryan, who has voted against every Affordable Care Act related bill, takes the stance that what you eat and what you weigh are both matters of personal responsibility. In 2005, he voted for H.R. 554 “The Personal Responsibility in Food Consumption Act” also known as the cheeseburger bill, which aimed to ‘prohibit weight gain-related or obesity-related lawsuits from being brought in federal or state courts against the food industry.’ The bill was passed by the House but failed to even go up for vote in the Senate. The legislation was featured in the 2004 Morgan Spurlock documentary Super Size Me, where Marion Nestle also made her on-screen debut.

According to a recent report by the Bipartisan Policy Center, by 2020 Obesity will cost America $4.6 trillion dollars annually and healthcare costs related to obesity will consume 19.8% of U.S. GDP. The sudden rise of obesity is a clear sign that, as a country, we have fostered an obesogenic environment that will require commitments from both the public and private sectors to reform.

Given that 70% of Americans are overweight and obese, we have collectively demonstrated that public service announcements alone have not yet resulted in the significant population-wide behavior changes needed to reverse obesity and more importantly alleviate a strained U.S. Health Care system.

SNAP Benefits

One of the most important programs available to lower income Americans is the Supplemental Nutritional Assistance Program (SNAP), commonly referred to as Food Stamps, which provides access to fresh foods for low-income families. Given that increased fruit and vegetable consumption are cornerstone habits of the Preventative Medicine conversation, why has Mr. Ryan argued to cut SNAP by $33 billion over the next ten years?

Affordable Care Act

Paul Ryan’s choices to repeal $6.2 trillion dollars of support from the Affordable Care Act and obesity-related provisions, demonstrates a lesser degree of support for preventative care than his widely publicized exercise regime suggests.  Perhaps with unemployment still high and unsure economy, America has bigger fish to fry than fixing the food system and reversing obesity but at least for now, Paul Ryan will take his fish broiled.

 Paul Ryan Food Politics Fact Sheet

Favorite Exercise Program: P90x
BMI: 21 (Healthy)
Dietary Restrictions: Doesn’t eat desserts or fried foods
View on cause of Obesity Personal Responsibility
Country of Origin Labeling (COOL) For
Farm Bill Against
Food Safety Modernization Act Against
Healthcare Reform (Affordable Care Act/Obamacare) Strongly against
Menu Labeling No direct comment- but against Obamacare which includes it
Repealing the Prevention and Public Health Fund For
School Lunch Reform and Child Nutrition Reauthorization For
Soda Taxes No direct comment

 

References and source materials are available from the authors:

  • Daniel Green studies Applied Nutrition and Psychology at Cornell University.  dpg64@cornell.edu. You can follow him on Twitter at www.Twitter.com/dgrreen.
  • Margaret Yufera-Leitch received her PhD in experimental psychology with a focus in eating behavior from the University of Sussex. She is currently a visiting assistant professor at the University of Calgary.   dr.leitch@impulsive-eating.com.  Her website is www.impulsive-eating.com.
Page 1 of 41234