by Marion Nestle

Currently browsing posts about: Obesity-policy

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.

Oct 16 2020

Good news #5: Mexico’s public health nutrition actions

The Mexican state of Oaxaca became the first to ban the sales of junk foods to children under the age of 18.

The state of Tabasco did the same.

A dozen other Mexican states are considering similar actions.  The rationale is clear: the health consequences of obesity in general and with Covid-19 in particular.

One-third of Mexicans aged 6 to 19 are overweight or obeseaccording to UNICEF. They may not be disproportionately affected by COVID-19 now, but they can suffer myriad health issues, especially in adulthood.

And Mexico’s new warning labels are now in effect and will be required for all packaged foods by the end of the year.

Mexico has been able to implement these measures despite overwhelming food industry opposition.

How?  I credit the outstanding advocacy work of the Mexico’s National Institute of Public Health and the consumer coalition, Alianza por la Salud Alimentaria.

Aug 18 2020

The UK takes on obesity: a new campaign

Boris Johnson, the UK’s admittedly overweight prime minister, has suddenly become a champion of anti-obesity policy, following his bout with Covid-19.

As the Washington Post puts it, “Boris Johnson says ‘I was too fat’ as he launches anti-obesity campaign.”

The campaign is based on two reports, one detailing the high and growing prevalence of obesity in Great Britain and its links to Covid-19 susceptibility.

The second is a government policy report, which says it is

  • introducing a new campaign – a call to action for everyone who is overweight to take steps to move towards a healthier weight, with evidence-based tools and apps with advice on how to lose weight and keep it off
  • working to expand weight management services available through the NHS [National Health Service], so more people get the support they need to lose weight
  • publishing a 4-nation public consultation to gather views and evidence on our current ‘traffic light’ label to help people make healthy food choices
  • introducing legislation to require large out-of-home food businesses, including restaurants, cafes and takeaways with more than 250 employees, to add calorie labels to the food they sell
  • consulting on our intention to make companies provide calorie labelling on alcohol
  • legislating to end the promotion of foods high in fat, sugar or salt (HFSS) by restricting volume promotions such as buy one get one free, and the placement of these foods in prominent locations intended to encourage purchasing, both online and in physical stores in England
  • banning the advertising of HFSS products being shown on TV and online before 9pm and holding a short consultation as soon as possible on how we introduce a total HFSS advertising restriction online

The UK food industry does not like this.  It insists that this campaign is “a terrible missed opportunity.”

I was interested to see Hank Cardello’s comment on this (Cardello is with the conservative Hudson Institute in the US): “How A Libertarian Is Tackling Obesity And Why Big Food Should Worry.”  Cardello thinks that Johnson’s efforts are the wave of the future.  The food industry should stop fighting public health measures, he says.  Instead, it should:

  • Get ahead of imposed regulations instead of resisting change. Instead of fighting public health initiatives, they can lead the way with research that defines workable steps to reverse the obesity crisis.
  • Educate with public service ads. It’s time that food and restaurant corporations air public service announcements (PSAs) about healthy eating and the impact of high sugar, salt and fat on health and obesity.
  • Commit to a BHAG (”Big Hairy Audacious Goal”). They can decide, for instance, that at least 50% of the products they sell will be healthier versions or in smaller portions.

Wouldn’t that be terrific, and it’s great that he’s saying so (I keep telling him that he sounds more like me every day).

But can food companies follow his advice?  Not as long as they put profits to shareholders, first, alas.

That’s what really needs to change.

Jan 10 2020

Weekend viewing: Hasan Minhaj on obesity politics

I learned about this from a tweet.

I recognized the clip.  It was from an interview I did in January in Toronto: TVO’s The Agenda: Battling bias in nutrition research (slso on YouTube, and in transcript).  Nam was the terrific interviewer.

But do not miss Minhaj’s last Patriot Act episode of 2019, “How America is Causing Global Obesity.”  This is a brilliantly researched account of obesity politics, from food industry influence to trade policy.

I couldn’t have done better myself and dearly wish I had his production team (and his performance ability).