Currently browsing posts about: Obesity

My email inbox was flooded last week with The Obesity Society’s call for more research on the value of taxes on sugar-sweetened beverages.

“Although taxing SSBs might generate revenue that can be used to promote other healthy food items, the net outcome may not necessarily decrease overweight and obesity rates in the United States or worldwide,” said Steven B. Heymsfield, MD, FTOS, President-Elect of The Obesity Society (TOS) and professor and director of the Body Composition-Metabolism Laboratory at the Pennington Biomedical Research Center at Louisiana State University in Baton Rouge.

Why would a professional society that represents people who ostensibly care about obesity science, treatment, and prevention issue a statement aimed at casting doubt on a demonstrably effective public health measure?  (Soda companies know the taxes are effective; that’s why they fight them so hard).

The Obesity Society (TOS), alas, often appears far more favorable to the interests of food and beverage companies than those of public health.  Could funding of the society and its members have anything to do with this?

Here is the TOS position on corporate funding:

TOS recognizes the value in providing any donor that wishes to support our mission to find solutions to the obesity epidemic the opportunity to provide financial support.

The current TOS policy expressly eliminates all forms of evaluation or judgment of the funding source (other than the stipulation that funding is reasonably assumed not to be derived from activities deemed ‘illegal’).

TOS chooses instead to focus its ethical mission on transparency in disclosing the sources of funding, clear stipulations outlining our commitment to the ethical use of funds, and a commitment to non-influence of the funding sources over the scientific aspects of funded projects and TOS as a whole.

Translation: We will take money from any company, regardless of the effects of its products on public health.

The TOS rationale is that disclosure takes care of the problem and that funding won’t influence the science.  Unfortunately for this view, research demonstrates that disclosure does not eliminate the influence of funding, and the influence of funding is considerable—though often unrecognized, as is apparent in this case.

TOS has a disclosure policy, and discloses its officers’ conflicts of interest.  These are considerable.

• The TOS president’s university, Louisiana State, has received more funding from Coca-Cola than any other in recent years.  Researchers there have been funded generously by Coca-Cola.
• An elected president of TOS had to resign over charges that he had been paid by the restaurant industry to file an affidavit opposing New York City’s calorie-labeling proposal.

In 2013, Dr. Yoni Freedhoff resigned his TOS membership over the society’s sponsorship policies.  In his comment on the current TOS statement, Freedhoff points out that “sugar-sweetened beverage taxes decrease sugar-sweetened beverage consumption and increase healthier beverage consumption while providing the greatest potential health benefits to low income consumers.”

TOS members who care about creating a healthier food environment should consider joining Dr. Freedhoff.  lf not, they should insist that TOS leadership take vigorous pro-public health stances on matters affecting their patients’ health.

Additional comments, October 31, 2018

Yesterday I received a message from Liz Szabo, a reporter for Kaiser Health News, who is writing a piece on TOS’s relationships with food companies.  She questioned Steve Heymsfield, the group’s current president, who responded at length with a message that included this paragraph:

Marion Nestle, on the other hand, is professor “emeritus” and our understanding is that she no longer reports directly to a dean at New York University. That created a hurdle for us when trying to manage Dr. Nestle’se false and misleading blog related to this matter on her website. Even after learning her comments were misleading from Dr. Popkin, and unlike Popkin who has a high ethical standard, she failed to take down that post.

This surprised me, because nobody from TOS or anywhere else had written me to correct the post, Dr. Popkin’s corrections were to something he—not I—had written, and my ongoing relationship with NYU is readily evident from the information posted under About on this site.

I pointed this out to Dr. Heymsfield, who replied with annotations to my post.  Most of these deal with opinion and interpretation rather than fact.  The one thing I got “completely false” is my interpretation that TOS lacks standards for deciding which donors are acceptable.  Dr. Heymsfield says it does.  I am happy to hear that and stand corrected on that point.

Since September, the New York Times has been investigating how the food industry markets its products in the developing world, and how this marketing is encouraging a rising prevalence of obesity and its health consequences. The series is called Planet Fat.   This is the complete set to date, in reverse chronological order.

If you haven’t read them, this week is a good time to catch up.  Enjoy!

One Man’s Stand Against Junk Food as Diabetes Climbs Across India

India is “sitting on a volcano” of diabetes. A father’s effort to ban junk food sales in and near schools aims to change what children eat.

By GEETA ANAND

Dec. 26, 2017

 

Dec. 23, 2017

 

Dec. 11, 2017

 

Nov. 13, 2017

 

Oct. 2, 2017

 

Oct. 2, 2017

 

Sept. 16, 2017

 

Sept. 17, 2017

 

HLPE [High Level Panel of Experts on Food Security and Nutrition]. Nutrition and food systems. A report by the High Level Panel of Experts on Food Security and Nutrition of the Committee on World Food Security, Rome, 2017.

This report takes a food systems approach to recommendations for reducing the double burden of malnutrition—obesity in the presence of widespread hunger and its consequences.

This report aims to analyse how food systems influence diets and nutrition. It offers three significant additions to previous frameworks. First, it emphasizes the role of diets as a core link between food systems and their health and nutrition outcomes. Second, it highlights the central role of the food environment in facilitating healthy and sustainable consumer food choices. Third, it takes into account the impacts of agriculture and food systems on sustainability in its three dimensions (economic, social and environmental). 2. A food system gathers all the elements (environment, people, inputs, processes, infrastructures, institutions, etc.) and activities that relate to the production, processing, distribution, preparation and consumption of food, and the outputs of these activities, including socio-economic and environmental outcomes. This report pays specific attention to nutrition and health outcomes of food systems. It identifies three constituent elements of food systems, as entry and exit points for nutrition: food supply chains; food environments; and consumer behaviour.

Where are we in obesity prevalence?  The Robert Wood Johnson Foundation (RWJF) and Trust for America’s Health (TFAH), are keeping score for us.   Their report gives figures state by state.  Since I live in New York, I’m highlighting its figures.

ADULT OBESITY PREVALENCE

This looks like good news.  The increase is slowing down and maybe trends are leveling off at long last.

 

CHILDREN’S PREVALENCE OF OVERWEIGHT AND OBESITY

 

This also looks hopeful.  The prevalence is level or declining in most states.

But, as Richard Besser of the Robert Wood Johnson Foundation and John Auerbach of Trust For America’s Health explain in an editorial in The Hill,

One of the best ways to bring down those adult obesity rates in every state is to prevent children from becoming overweight or obese in the first place…Unfortunately, there are signs that we are moving in the wrong direction—and not just on school meals…These kinds of threats put at grave risk the progress our nation has achieved. To accelerate progress in addressing obesity, we urge policymakers to support proven programs like school meals and SNAP that put kids on a healthier track for their entire lives, and maintain full funding for agencies like the Centers for Disease Control and Prevention that are responsible for protecting the health of kids and adults nationwide.

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.

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.

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

• Jamie Oliver weighs in—The Guardian

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

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.