Currently browsing posts about: Obesity-policy

II.  The need for nutrition science leadership in promoting policies to prevent and treat disease

Three-quarters of American adults are overweight or obese and at increased chronic disease risk, yet nobody is screaming much about it (except for the MAHA people).

As the Government Accountability Office put it in 2021,  “federal strategy needed to coordinate diet-related efforts.”

Chronic health conditions (like heart disease, diabetes, cancer, and obesity) are costly and deadly—causing over half of U.S. deaths in 2018. They also exacerbated the pandemic: Americans with such conditions were 12 times more likely to die after contracting COVID, according to the CDC.

Yet chronic conditions are largely preventable with a healthy diet and other behaviors like exercise. The federal government leads 200 different efforts, spread across 21 agencies, to improve Americans’ diets. But agency efforts are fragmented and there are gaps in key scientific research, including for children. A strategy for working together could help.

In its recommendations, the GAO says:

Congress should consider identifying and directing a federal entity to lead development and implementation of a federal strategy for diet-related efforts aimed at reducing Americans’ risk of chronic health conditions.

The GAO comments:

The White House sponsored a conference on Hunger, Nutrition, and Health on September 28, 2022. In advance of that event, the White House released a national strategy aimed at ending hunger in America and increasing healthy eating and physical activity by 2030. [Note: I wrote about these events extensively.  For example, here]

However, we do not believe the White House strategy satisfies our matter because it does not contain the necessary information about outcomes and accountability, resources, and leadership. In particular, without designated leadership, it may be difficult to sustain the strategy over time. Therefore, as of March 2024, the matter remains open.

In October 2024, it still remains open.  I see this as an urgent priority.

Tomorrow: Personalized nutrition

Politics, as they say, makes strange bedfellows and I cannot get my head around the MAHA hearings last week.

Sen. Ron Johnson, R-Wis., has posted a video of the health and nutrition roundtable he held Monday with Robert F. Kennedy Jr., the former presidential candidate now supporting former President Trump, and others including Vani Hari, the “Food Babe.”  He listed participants in a press release.

Vani Hari posted her own video on Twitter (X): “American food companies are making a fool out of us. They are knowingly poisoning us. It’s time for this to stop. Our movement is growing like I have never seen before. It’s going to be historic! This is a clip from my Senate testimony in Washington DC yesterday, watch the whole thing.”

Another Tweet pointed to testimony by Jillian Michaels: “This is one of the best overviews I’ve ever witnessed on how the whole system has been rigged, in what is essentially a ‘bad health by design’ framework As Jillian Michaels says emphatically – People have been ‘sacrificed at the alter of corporate greed.”

This is amazing!

What I find most remarkable is the lack of mainstream nutrition science in this lineup.  The speakers are mainly influencers and not among the most recognized nutrition scientists.  Nearly all havie some decidedly non-mainstream interpretations of nutrition research and the history of federal nutrition policy.

BUT: They are calling for fixing the food system, doing something to coordinate and address diet-related chronic diseases, stopping corporate power, eliminating conflicts of interest between industry and government, getting toxic chemicals out of the food supply, and doing everything possible to refocus the food environment and dietary advice on health.

Try this: “Ultra-processed foods are the new cigarette for my generation,” said Grace Price, described as an 18-year-old social media influencer.

These are things I’ve been writing about here for years.  It’s hard to argue with any of this and I won’t.

But where are my nutrition scientist colleagues?

As Jerry Mande wrote to me, referring to the PCAST report I talked about yesterday:

How did it come to this? We have the nation’s top nutrition scientists afraid to demand action and Senators turning to nutrition influencers for advice. I must admit the influencers did a better job than the WH science advisors stating the urgency of the problem and demanding action.

In Food Fix, Helena Bottemiller Evich described the experience as “rather disorienting.”

I’ve been covering food policy in Washington for 15 years, and I would have never expected this cast of characters to be together in the Senate – and hosted by Republicans, no less. (It was hosted by Johnson, but Sen. Mike Crapo (R-Idaho) also attended. Both said they’d changed their diets to improve their health.)  As I noted recently, there is a political realignment happening here. Many of the concerns discussed during this roundtable – lack of food chemical regulation, metabolic dysfunction, pesticide exposure, lack of focus on nutrition in medical school, etc. – were previously common policy fare on the left. That’s all been shaken up by Johnson’s office.

Could it be that we are heading for bipartisan support for addressing epidemic obesity and diet-related chronic disease?

If so, it’s about time and I”m all for it.

But the mind boggles.

PCAST, the President’s Council of Advisors on Science and Technology, has released its REPORT TO THE PRESIDENT A Vision for Advancing Nutrition Science in the United States.

I learned about the report from a Tweet (X): 

I wrote about an earlier draft of the report in a previous post: The federal vision for chronic disease prevention: individual behavior, not the environment.  I called for the report to take on the need for fundamental improvements in the food environment aimed at preventing obesity-influenced chronic diseases.

If you read the fine print, the report has indeed done some of that.  It now mentions ultra-processed foods, for example,

people’s food selections are complex, influenced by various factors in a multifaceted U.S. (and global) food ecosystem, with many of these factors beyond an individual’s control, e.g., increased production and availability of ultraprocessed foods which are associated with overconsumption and obesity. In addition to widespread availability of inexpensive ultra-processed foods, the U.S. food environment has undergone huge changes in recent decades, including easy access to low-cost fast food and eating away-from-home becoming much more common…in the era of widespread internet and digital technology access and use, people’s food habits increasingly are influenced by advertising and social media, which are sources of both facts and misinformation. Acknowledging and understanding these factors and their intersections is critical to addressing nutrition-related health disparities.

It also says useful things like these:

• new emphasis must be placed on nutrition research that can equitably and effectively help all Americans achieve better health.
• [needed is an] equity focus that particularly considers those who are disproportionately affected—racially, ethnically, and socially minoritized groups—due to long-standing and structural inequities which make it hard for many people to eat healthy and be physically active.
• For such a highly developed nation, the U.S. has distressingly high rates of food insecurity, imbalanced nutrition, and inequities in food access, all further exacerbated by the pandemic.  With diet-related disease rates increasing, we have responded by focusing resources on costly medical treatments, further widening disparities and directing efforts away from prevention or addressing social determinants of health and a food environment that for too many Americans does not provide or promote good nutrition. The only way to reverse these trends and achieve robust health for our nation is to focus on prevention, which will require significant modifications of our overall food environment and must be informed by improved nutrition research.
• Preventing diet-related chronic diseases is among the most urgent public health challenges facing the nation.

Despite these statements, its two recommendations say nothing beyond the need for coordination aimed at addressing that challenge.

1. The Administration should implement a coordinated and sustained federal interagency effort, co-led by HHS and USDA, to strengthen the nutrition science base for current and future public and private sector actions to reduce the burden of diet-related chronic disease and maintain momentum toward the President’s 2030 goal.

2. To ensure equitable access to the benefits of nutrition research, federal agencies should prioritize equity in nutrition research, focus research on improving program delivery, continue efforts to diversify the nutrition science and dietetics workforce and engage the academic and private sectors in multisector research and intervention initiatives.

Yes, coordination would be a big help.  Nutrition research is all over the place at the federal level.  So would increased funding for nutrition research aimed at improving the food environment to prevent chronic disease.  Only a tiny fraction of the NIH budget goes for this purpose.  NIH’s main nutrition focus is “precision nutrition” aimed at individuals, not public health.  And much of the USDA’s nutrition funding goes to the kinds of industry-funded studies I post here on Mondays.

The report mentions what’s needed in theory; it ducks dealing with the tough politics of chronic disease prevention.

And alas, it did not cite my suggestions for what is needed (which I had sent to the committee).

So where is leadership for chronic disease prevention at the federal level?  It’s in an odd place at the moment, as I will discuss tomorrow.

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).

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.

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:

• The press release
• The World Obesity Atlas 2023  (this includes predictions for WHO member nations) 

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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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):

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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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

• Reduce the proportion of adults with obesity — NWS‑03
• Increase the proportion of women who had a healthy weight before pregnancy — MICH‑13

The objectives for Nutrition and Healthy Eating are here.

Of the objectives with data available, two showi improvement!