by Marion Nestle

Currently browsing posts about: Obesity-policy

Jan 12 2024

Weekend reading: UK report on industry’s role in poor health

I’m just getting around to reading this report from three groups in the UK: Action on Smoking and Health (ASH), the Obesity Health Alliance (OHA) and the Alcohol Health Alliance (AHA): Holding us back: tobacco, alcohol and unhealthy food and drink.

I learned about it from an article in The Guardian:

The report gives the health statistics: 13% of adults in England smoke, 21% drink above the recommended drinking guidelines, and 64% are overweight or living with obesity,.

NOTE: this report—unlike so many others—examines the political and economic causes of poor health.  It says practically nothing about personal choice or responsibility.  Instead, it focuses on industry profits and the costs of industry profiteering to society.

Big businesses are currently profiting from ill-health caused by smoking, drinking alcohol and eating unhealthy foods, while the public pay the price in poor health, higher taxes and an under-performing economy.

The wage penalty, unemployment and economic inactivity caused by tobacco, alcohol and obesity costs the UK economy an eye-watering £31bn and has led to an estimated 459,000 people out of work.

Meanwhile each year, the industries which sell these products make an estimated £53bn of combined industry revenue from sales at levels harmful to health.

The press release emphasizes the need to curb industry practices: More needs to be done to tackle the unhealthy products driving nearly half a million people out of work.

It recommends, among other things:

  • The Government should take a coherent policy approach to tobacco, alcohol and high fat, salt and/or sugar foods, with a focus on primary prevention.
  • Public health policymaking must be protected from the vested interest of health-harming industry stakeholders.

To do this, it suggests these actions to decrease sales of harmful products (my summary):

  • Restrict advertising
  • Set age limits  for purchase.
  • Do not allow prominent placement in shops.
  • Raise prices; tax.
  • Educate the public about risks (the one place where personal responsibility is considered).
Sep 29 2023

Weekend reading: rising prevalence of obesity in developing countries

The International Fund for Agricultural Development (IFAD), as part of its IFAD Research Series, released a report, Overweight and obesity in LMICs in rural development and food systems, along with a literature review.

The report finds obesity rates across developing countries to be approaching levels found in high-income countries.

The study attributes the rise to:

  • Food Prices: The price gap between healthy foods (expensive) and unhealthy foods (inexpensive) is greater in developing countries than in rich developed countries.
  • Diet: Sugar-sweetened beverage consumption is on the rise in developing countries and the global sales of highly processed foods rose from 67.7kg per capita in 2005 to 76.9kg in 2017.
  • Culture: In some developing countries, childhood fatness is associated with health and wealth and consumption of unhealthy foods carries prestige.
  • Gender: Women are more likely to be overweight or obese than men in nearly all developing countries.

One strength of this study is its consideration of the need for interventions across the entire food system:

The study results show that food system-related interventions are not overweight or obesity specific. Instead, they tap into the wider field of making diets more healthy and nutritious, and emerge as necessary strategies to set the scene for creating non-obesogenic food supply chains. The identified intervention strategies cut across different food system domains: there were production strategies for improved dietary diversity, strategies for processing (which involved food package labelling or price mechanisms), strategies for changing the food environment and strategies to address consumer behaviour.

Mar 10 2023

Weekend reading: stopping the rising prevalence of overweight and obesity

The World Obesity Atlas 2023, published by World Obesity Federation, predicts that unless preventive interventions succeed, by 2035:

  • The global economic impact of overweight and obesity will reach $4.32 trillion annually and constitute nearly 3% of global GDP.
  • The majority—51% or more than 4 billion people—will be living with overweight or obesity.
  • One in four people—nearly 2 billion—will have obesity.
  • The economic impact of overweight and obesity is estimated to be over $370 billion a year in low and lower-middle income countries alone.
  • Childhood obesity could more than double.

Here’s the prediction for the U.S.

In the report, the World Obesity Federation:

  • Notes that member states of WHO committed to halt the increase in obesity rates at 2010 levels by 2025. No country is on track to meet these targets.
  • Calls on governments to develop national action plans.
  • Calls on governments to improve health care.
  • Calls for building on the ROOTS framework for tackling obesity: Recognising the root causes, monitoring Obesity data, investing in Obesity prevention, ensuring access to Treatments, and adopting a Systems-based approach.

The documents:

Comment

This is a global problem requiring global solutions., and actions by every government, including ours.   We need a national obesity prevention plan focused on strategies like to work (reduction of food insecurity, improved health care, better education, restrictions on marketing junk food, etc).

Otherwise,  we are all headed to Wall-E, which will turn out to be prescient, rather than dystopian.

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Dec 20 2022

CDC revises growth charts for children: oh dear

It’s a sad sign of the times that the CDC has found it necessary to revise its standard growth charts for boys and girls in order to expand Body Mass Index ranges to include current weights.

The 2000 CDC BMI-for-age growth charts, based on data from 1963-1980 for most children, do not extend beyond the 97th percentile. So, CDC developed new percentiles to monitor very high BMI values. These extended percentiles are based on data for children and adolescents with obesity – including from 1988-2016 – thus increasing the data available in the reference population. See the report on alternative BMI metrics for more information.

Here’s what the comparison looks like (thanks to David Ludwig):Image

The comparison for girls extends to a BMI of 56.

What are we to make of this?  In revising the growth charts, the CDC is recognizing reality: children weigh more than they used to, and sometimes a lot more.

Why: the quick-and-dirty answer:  junk food (more calories consumed) and electronic media plus imprisonment (fewer calories expended).

The world has changed.  When I was a kid, and when my kids were kids, we didn’t eat a lot of junk food (more politely, ultra-processed), we weren’t allowed to snack all day, and we were free—required!—to walk to school and play outdoors unaccompanied.

Shouldn’t the CDC be engaging in campaigns to promote healthier eating and more activity among children?

One can wish.

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Dec 13 2022

Healthy People 2030 releases early progress report

Healthy People 2030 has released its latest set of tracking data.  This, you will recall, is the latest of the US Public Health Service’s 10-year plans for improving the health of Americans.  The agencies involved set specific, measurable objectives and track progress toward achieving them.

You can browse the full set of objectives here.

The objectives for overweight and obesity are here.  Three have tracking data available.  Of these,

One shows no change: Reduce the proportion of children and adolescents with obesity — NWS‑04

Two are getting worse

The objectives for Nutrition and Healthy Eating are here.

Of the objectives with data available, two showi improvement!

Three show no change:

Two (plus the obesity one above) are getting worse:

Aug 9 2022

My latest publication: Preventing Obesity

JAMA Internal Medicine has just published an editorial I wrote: Preventing Obesity—It Is Time for Multiple Policy Strategies

As it explains, it is a commentary on a research article by Joshua Petimar, et al, Assessment of Calories Purchased After Calorie Labeling of Prepared Foods in a Large Supermarket Chain  

Both papers are behind paywalls, but here are the key points of the supermarket article:

Question  Was calorie labeling of prepared foods in supermarkets associated with changes in calories purchased from prepared foods and potential packaged substitutes?

Findings  In this longitudinal study of 173 supermarkets followed from 2015 to 2017, calories purchased from prepared bakery items declined by 5.1% after labeling, and calories purchased from prepared deli items declined by 11.0% after labeling, adjusted for prelabeling trends and changes in control foods; no changes were observed among prepared entrées and sides. Calories purchased from similar packaged items did not increase after labeling.

Meaning  Calorie labeling of prepared supermarket foods was associated with overall small declines in calorie content of prepared foods without substitution to similar packaged foods.

I was really interested in this study because the “large supermarket chain” that supplied reams of data was so obviously Hannaford, which has long been ahead of the curve in trying to encourage customers to make healthier food choices.

In 2005, Hannaford initiated a Guiding Stars program that ranked–and still ranks–products by giving them zero to three stars depending on what they contain.

I wrote about the first-year evaluation of this program way back in 2006.  It did help customers to make better choices.

Now, all these years later, the FDA is contemplating doing some kind of front-of-package label.  As I said, Hannaford is way ahead.

But the point of my editorial is that single interventions rarely do better than what this study found.

I argue here for trying multiple strategies at once:

My interpretation of the current status of obesity prevention research is that any single policy intervention is unlikely to show anything but small improvements.

Pessimists will say such interventions are futile and should no longer be attempted.

Optimist that I am, I disagree.  We cannot expect single interventions to prevent population-basedweight gain ontheirown,but they might help some people—and might help even more people if combined simultaneously with other interventions.

….Widespread policy efforts to reduce intake of ultraprocessed foods through a combination of taxes, warning labels, marketing and portion-size restrictions, dietary guidelines, and media education campaigns, along with policies for subsidizing healthier foods and promoting greater physical activity, should be tried; they may produce meaningful effects.

Politically difficult? Of course. Politically impossible? I do not think so.

Unless we keep trying to intervene—and continue to examine the results of our attempts—we will be settling for the normalization of overweight and the personal and societal costs of its health consequences.

Here’s Ted Kyle’s commentary on my commentary on ConscienHealth.

Mar 17 2021

Overweight is a major risk factor for Covid-19 hospitalization and death

I was struck by headlines last week stating that a CDC study found that 78% of people hospitalized with Covid-19 were overweight or obese.

78%?  That is an enormous percentage.

I looked up the study: Body “Mass Index and Risk for COVID-19–Related Hospitalization, Intensive Care Unit Admission, Invasive Mechanical Ventilation, and Death — United States, March–December 2020.”

Summary

What is already known about this topic?

Obesity increases the risk for severe COVID-19–associated illness.

What is added by this report?

Among 148,494 U.S. adults with COVID-19, a nonlinear relationship was found between body mass index (BMI) and COVID-19 severity, with lowest risks at BMIs near the threshold between healthy weight and overweight in most instances, then increasing with higher BMI. Overweight and obesity were risk factors for invasive mechanical ventilation. Obesity was a risk factor for hospitalization and death, particularly among adults aged <65 years.

What are the implications for public health practice?

These findings highlight clinical and public health implications of higher BMIs, including the need for intensive management of COVID-19–associated illness, continued vaccine prioritization and masking, and policies to support healthy behaviors.

The data supporting the headline are found in Table 1 in the paper.  This shows that overweight and obesity do indeed account for 78% of hospitalizations, but also close to that percentage for ICU visits and mechanical ventilation, but “only” 73% of deaths.

Overweight and obesity were especially risky for people under age 65, although they caused plenty of problems for people over age 65 too.

Why do they make Covid-19 worse?  The best guesses have to do with inflammation and mechanical pressure on lungs.

I found these figures shockingly high.

Shouldn’t we be doing all we can to reduce the risks for overweight and obesity?  Yes we should.

And what are those risks?

  • Poverty
  • Racial discrimination
  • Inadequate schools
  • Unemployment
  • Lack of adequate health care
  • Air pollution
  • And, of course, poor diets

If Covid-19 has taught us anything, it is that to prevent its bad effects, we need vaccinations and masking for sure, but we also need to change society.

 

Nov 25 2020

The State of Obesity, 2020: no downturn in prevalence

Trust for America’s Health has just issued its annual report on obesity in America.

The full report is here.

The results are truly alarming, especially because obesity—and the conditions for which it increases risk—also increase the risk of poor Covid-19 outcome.

The U.S. adult obesity rate stands at 42.4 percent, the first time the national rate has passed the 40 percent mark, and further evidence of the country’s obesity crisis. The national adult obesity rate has increased by 26 percent since 2008…Rates of childhood obesity are also increasing with the latest data showing that 19.3 percent of U.S. young people, ages 2 to 19, have obesity. In the mid-1970s, 5.5 percent of young people had obesity.

The report has a special section on the link between food insecurity and obesity.

Food insecurity and obesity have many of the same risk factors (e.g., income or race/ethnicity) and often coexist in populations. Researchers have hypothesized several mechanisms for how food insecurity might lead to obesity. These include the direct limitations to a healthy diet that come from inadequate food affordability and/or availability; stress and anxiety about food insecurity
that generate higher levels of stress hormones, which heighten appetite; and a physiological response in which the body stores higher fat amounts in response to reduced food availability.

As always, this is a terrific source of current information about America’s increasingly prevalent health problem and what’s being done—and needs to be done—to solve it.