by Marion Nestle

Currently browsing posts about: Obesity

May 22 2017

WHO resources for ending the double burden of malnutrition (under- and overnutrition)

The World Health Organization (WHO) has just published a series of papers on “double-duty” actions needed to end world malnutrition.  By this, it means addressing not only classic undernutrition and its consequences (stunting and wasting of children, nutrient deficiencies and starvation in adults) but also obesity and its risks for chronic disease.

In a commentary on the WHO site and in The Lancet, Fracesco Branca, Alessandro Demaio, and Corinna Hawkes say:

This is the potential of “double-duty actions”—interventions, programmes, and policies that have the ability to simultaneously reduce the risk or burden of both undernutrition and overweight, obesity, or diet-related NCDs (noncommunicable diseases). Double-duty actions offer an integrated approach to addressing malnutrition. WHO proposes three levels for increasing the efficiency of nutrition actions through a double-duty approach.

The three levels are:

  1.  Ensure that current interventions, policies, and programmes designed to address one form of malnutrition do not inadvertently increase the risk of another.
  2. Leverage existing actions designed to address one type of malnutrition to simultaneously reduce other types.
  3. identify the shared drivers between different forms of malnutrition to proactively identify de novo actions for reducing all forms of malnutrition.

 

The WHO expands on these ideas in a policy brief.

They describe the interventions that can and should be taken in an action policy brief.

These are useful resources for anyone interested in and concerned about doing something about the double burden of malnutrition.

Dec 8 2016

Food Politics Alaska style: Supermarket prices

I visited the AC supermarket in Utqiagvik, the town formerly known as Barrow.

It could be anywhere USA, with anything you could possibly want, including fresh blueberries from Argentina.  How’s that for food miles?

Remember: all of this, no exceptions, comes in by cargo plane.

The produce section was lovely, with remarkably fresh foods at equally remarkable prices.

Would you believe the green leaf lettuce is $3.50, the baby carrots $7.29, and the romaine $4.69?  New York prices on steroids.

How about white potatoes at $3.29, red ones at $2.79, and baking potatoes at $18.99 for 10 pounds.

Or the reason I was so concerned about the tossed out school lunch milk cartons: $7.11 on sale.

How about bread on sale for $5.98 a loaf?

Just to make me feel at home, here are the sugary drinks down one entire aisle.  The 12-packs were on sale for $10.98, which must not be enough to discourage sales.

Are soft drinks a problem in Utqiagvik/Barrow?

Yes, they are.

The prevalence of obesity and diabetes is low, but rising steadily, and the Indian Health Service dentists told me that they see plenty of little kids with rotted teeth from drinking sodas and sweet juices in baby bottles.

The nutrition transition is taking place in America too, and for the same reasons that obesity and diabetes are becoming problems in the developing world.

Sep 7 2016

The well deserved fuss over the UK’s childhood obesity plan

The much delayed UK government’s plan for dealing with childhood obesity has finally been released to virtually universal dismay over the missed opportunity.

The strategy is now a Plan, and says it is “the start of a conversation.” It reconfirms the government’s intentions to implement a soft drink tax, subject to consultation, but does not include a range of measures recommended by its own Public Health England and by last year’s House of Commons Health Committee, such as reduce food marketing and controls on retail promotions. It relies on voluntary sugar reduction by the food industry and encouraging parents to help increase children’s physical activity to meet the recommended 1 hour per day.

It’s fun to read the criticisms: nobody minces words.

An editorial in The Lancet

The UK Government’s long-anticipated response to the childhood obesity crisis disappointed everyone. From doctors, health charities, and celebrities to the very industry it seeks to propitiate, the Childhood Obesity Plan, published with as little noise as possible in the summer recess, has met with resounding criticism. As a Comment in today’s Lancet highlights, the strategy has been delayed for a year, and in that time it has been watered down to a vague Plan with no teeth.  Reading the report from start to finish gives the impression that its authors haven’t.

The Lancet editorial continues

The absence of curbs on industry practices that contribute to childhood obesity—promotions of unhealthy food in supermarkets and restaurants; advertising of junk food through family TV programmes and social media—seems like a gift to industry.

The Lancet is especially miffed because it ran a series on obesity last year that made it clear what kinds of policies needed to be enacted.

Also in The Lancet, World Obesity’s Tim Lobstein and Klim McPherson say

What we read in the government’s Plan is nothing particularly new, nothing bold, and very little that can actually be measured to assess the Plan’s success. It is a document that is not only a disappointment to public health professionals, but also evidence of a government walking away from its moral duty to protect the health of children, and its fiscal duty to protect the NHS from the consequent costs.

The Association for the Study of Obesity (ASO) issued a statement:

the plan is a lost opportunity to provide leadership and commitment in tackling childhood obesity as part of a whole systems approach. It lacks bold actions that are needed to reverse the current high levels of child obesity such as: a ban on junk food advertising before the 9pm watershed; reduction in portion sizes; reformulation targets for industry that address high energy density foods; curbing the promotion of unhealthy foods in supermarket; investment to increase and extend evidence-based child weight management services. All of these would be robust, evidence-based actions and would start to tackle the root causes of obesity in this country.

Again in The Lancet, Yoni Freedhoff and Kevin Hall point out the need for more sensible weight loss studies:

Over the past several decades, dozens of randomised controlled trials have compared various diets for the treatment of obesity. Ideally, such studies should have provided strong evidence for clear clinical recommendations and also put a stop to society’s endless parade of fad diets. Unfortunately, the evidence base remains contested and the “diet wars” continue unabated…What is especially striking is the similarity of the long-term pattern of mean bodyweight change, irrespective of diet prescription.5 …Fewer resources should be invested in studying whether or not a low-carbohydrate diet is marginally better than a low-fat diet, or whether intermittent fasting provides marginally better short-term outcomes than a so-called Paleo diet.

Their study provides further evidence why we need stronger policies for preventing obesity.  It’s too bad the UK couldn’t do better.

And if you think things are any better in New Zealand

The food industry has hit out at claims in a leading journal that New Zealand’s childhood obesity plan was flawed and that the government valued corporate profit over public good. The Food and Grocery Council said that an editorial in the New Zealand Medical Journal, which claimed that the government’s strategy did not address excess sugar intake, was “flawed on many fronts.  Moreover, the FGC complained that its response to the article, solicited by Fairfax Media, was not run.

Addition, September 14

Nov 27 2015

Weekend Reading: Kima Cargill on Food Psychology

Kima Cargill.  The Psychology of Overeating: Food and the Culture of Consumerism.  Bloomsbury, 2015.

Capture

I did a blurb for this one:

Psychologist Kima Cargill takes a tough, critical look at today’s consumerist culture from the perspective of research as well as of observations drawn from her clinical experience with patients struggling with weight issues. To stop overeating in today’s food environment means finding effective ways to counter the many moral, political, economic, and social imperatives to consume. The ideas in this book should inspire readers to think of obesity in an entirely different way—more as the result of a consumerist society than of individual weakness.

Nov 10 2015

Two reports: Who is Obese? How to Curb Global Sugar?

The first report is from the UK.   Fat Chance? Exploring the Evidence on Who Becomes Obese is a curious example of what happens when a sugar company (AB Sugar) partners with a health organization (2020 Health) to produce a policy document.

The report examines the role of age, gender, socioeconomic factors, the built environment, mental health and disability, sleep, bullying and child abuse, smoking, ethnicity, and religion as factors in obesity—everything except diet and activity levels.

The press release for the report gives key findings, among them:

  • Obesity rates are rising rapidly among the poor as well as other groups who experience social instability.
  • Uncertainty seems to be a significant factor for weight gain.
  • Fast food outlets near working environments have a significant impact on the BMI of men; the lack of green space has an impact on obesity rates particularly among girls.
  • Half of all people suffering with psychosis are obese.
  • Parental obesity, especially in mothers, is a far more predictive factor in childhood obesity than is ethnicity.

Its authors write:

What is particularly highlighted in recent research, though rarely explicitly stated, is that obesity rates seem to be deeply influenced by social change (not just influences within static social categories). The studies we have compiled for this review show a subtle trend that has become increasingly evident over the last decade. It is highlighted in economic mobility, rising rates of mental illness, technological habits and engagements, and rapidly shifting urban ground. Argued here, broadly speaking, is that many of these categories strongly hint to a meta-structure that remains profoundly under-researched and largely ignored. This is the structure of uncertainty, a type of habitus that influences the terms of emotional engagement between an individual and their daily life. Insidiously, it undermines health seeking behaviour by making daily decision processes cognitively intolerable and emotionally taxing.

They conclude:

…approaches to obesity that recognise and incorporate complexity might impact a host of rising health problems that affect communities across Britain. The same interventions that encourage healthy BMI may improve energy levels through metabolic process and sleeping habits, while reducing risk of mental health problems, diabetes and a range of other comorbidities not discussed in this report.

But they don’t say what those interventions might be.

Could they possibly have something to do with removing sugary drinks and foods from local environments?

For doing just that, the World Cancer Research Fund International has produced Curbing Global Sugar Consumption: Effective Food Policy Actions to Help Promote Healthy Diets & Tackle Obesity.

Examples of actions which have had these effects include school nutrition standards in Queensland, Australia; a vending machine ban in France; a front-of-package symbol that led to product reformulation in the Netherlands; soda taxes in France and Mexico; a programme targeting retail environments in New York City, USA; a programme promoting increased water consumption in schools in Hungary; school fruit and vegetable programmes in Netherlands and Norway; a healthy marketing campaign in Los Angeles County, USA and a comprehensive nutrition and health programme in France.

The first report asks us to solve problems of poverty, instability, and mental health before taking action to prevent obesity, even when actions are known to be effective.  The second calls for such actions now.

Could AB Sugar’s sponsorship possibly have something to do with this difference?

Oct 2 2015

Weekend Reading: Emily Yates-Doerr’s “The Weight of Obesity”

Emily Yates-Doerr.  The Weight of Obesity: Hunger and Global Health in Postwar Guatemala. University of California Press, 2015.

Emily was a student in NYU’s anthropology department and I’ve admired her work for a long time.  Her book is based on her remarkable dissertation work, and I was happy to be asked to blurb it:

Emily Yates-Doerr gives us an anthropologist’s tough analysis of how one resource-poor Guatemalan population responds to an increasingly globalized food supply as it transitions rapidly from widespread hunger and malnutrition to the increasing prevalence of obesity and its health consequences.  The Weight of Obesity views this “nutrition transition” from the unusually revealing perspective of an insider who experienced it personally with eyes wide open.

For me, the most riveting parts of her book are the transcribed conversations between clinic nutritionists and patients newly diagnosed with type 2 diabetes—a case study in the cultural gap between nutrient-based advice (“nutritionism”) and the way people actually eat.  The effects of the rapid influx of “ultra-processed” products on the health of the populations studied here are also painfully clear.  This is an ethnography of the nutrition transition caught just as these cultural and dietary shifts were occurring.

Aug 14 2015

Let’s Ask Marion: Can Exercise Balance Out Soda Drinking?

This is the latest in a series of Q & A’s written by .   It appeared on Civil Eats, August 12, 2015.  And please note references added at the end.

Civil Eats: Your next book, Soda Politics: Taking on Big Soda (and Winning), documents the history of how this sugary beverage gave rise to some of our most powerful corporations and has lately become Public Enemy Number One in the war on obesity.

With sales on the decline, the New York Times recently reported that Coca-Cola is pouring millions of dollars into a ‘science-based’ campaign to convince the public that the secret to achieving and maintaining a healthy weight is not avoiding excess calories, but getting more exercise. What’s the science on more exercise versus fewer calories?

Marion Nestle: When it comes to studies about the health effects of sugary drinks, the science, alas, depends on who pays for it. Studies paid for by government or private health foundations show that if you want to prevent obesity, [a combination of] eating less and moving more works every time.

You can lose weight by eating less on its own. But you will have a much harder time doing that by increasing physical activity. This is because it takes lots of effort to compensate for excess calories. Eat two little Oreo cookies—100 calories—and you have to walk a mile to work them off. Drink a 20-ounce soda and you need to cover nearly three miles. This was the point of the New York City health department’s subway current poster campaign, which shows that you need to walk from Union Square in Manhattan to downtown Brooklyn to burn off 275 calories.

The soda industry would love you to believe that the principal cause of obesity is lack of physical activity, and they put tons of money into research to discourage other ideas. They much prefer you to believe that all of their products can be part of an active, healthy lifestyle that includes balanced diets, proper hydration, and regular physical activity. I call the idea the “physical activity diversion.” It deflects attention from what really counts in obesity prevention: not eating huge amounts of junk foods, snack foods, and sodas.

Mind you, I’m greatly in favor of physical activity for its many benefits: physiological, social, psychological, and health. But there is a good reason for the outraged reaction to Coca-Cola’s video seemingly suggesting that all you have to do to burn off the 140 “happy calories” in a 12-ounce soft drink is to laugh out loud for 75 seconds. This is so far from the reality of calorie balance that several countries actually banned the commercial [in 2013].

Soda companies promote the primacy of physical activity in other clever ways. The Coca-Cola Foundation says that about one-third of its philanthropic contributions go to organizations working to counter obesity, especially through promotion of physical activity.

Both Coca-Cola and PepsiCo invest heavily in sponsorship of international sports teams. They put fortunes into recruiting sports celebrities as spokespersons. These investments accomplish two purposes: they influence fans to buy the products and shift the focus to physical activity. Obesity, these imply, is about what you do, not what you eat or drink. Public health advocates complain about how frequently young people—especially those of color or in low-income families—are exposed to advertising by professional athletes. The sponsored programs and celebrities never suggest that drinking less soda might be a useful health-promotion strategy.

As a nutritionist and co-author of a book titled Why Calories Count, I thoroughly agree that balance, variety, and moderation are fundamental principles of healthful diets, and that weight gain is a result of calorie imbalance.

But soda companies distort these principles to distract from their marketing of sugary drinks and how overconsumption of these drinks overrides normal physiological controls of hunger and satiety. Independently funded research makes it abundantly clear that avoiding sodas is one of the best things you can do for your health.

Sponsorship of research or research investigators by Coca-Cola or the American Beverage Association is reason alone for skepticism.

References: I am grateful to Richard Cooper for forwarding his paper on the relative contributions to obesity of diet and exercise.  From his review of the literature, you must reduce calories to lose weight.

He also pointed me to rebuttals by  Blair and Hill, the investigators featured in the New York Times article cited above.

The rebuttal by Steven Blair and colleagues.

  • Funding: Drs. Blair, Archer, and Hand are funded via unrestricted research grants from The Coca-Cola Company for analyses of dietary trends and for an energy balance study.
  • Conflict of interest: None declared [Evidently, these investigators do not perceive funding by Coca-Cola as a conflict]

The rebuttal from James Hill and John Peters:

  • Conflict of interest: J.H. receives research grants from the American Beverage Association and serves on advisory boards for McDonalds, General Mills and McCormicks. J.P. receives research funding from the American Beverage Association.

 

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Jun 9 2015

The Lancet series on obesity policy (in case you missed it)

Some time ago, I posted the terrific Lancet infographic on obesity policy.

Here are the series articles (or at least the abstracts) that go with it.

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