by Marion Nestle

Currently browsing posts about: Obesity-policy

Aug 27 2012

How much does obesity cost American society?

The costs of obesity are personal, but also societal.

Economists love trying to figure out how to quantify such things.

The most widely used estimate for the United States is from Cawley and Meyerhoefer’s 2012 article in the Journal of Health Economics: $190 billion annually for health care and lost productivity (their 2010 working paper may be easier to access at the National Bureau of Economic Research site).

Now the Campaign to End Obesity has published its own analysis of these costs.

  • $44.7 billion, for inpatient services.
  • $45.2 billion, for non-inpatient services.
  • $69.3 billion, for pharmaceutical services.
  • $146.6 billion, across all services.

As the Campaign puts it:

the total economic cost of overweight and obesity in the United States and Canada caused by medical costs, excess mortality and disability is approximately $300 billion per year. The portion of this total due to overweight is approximately $80 billion, and approximately $220 billion is due to obesity. The portion of the total in the United States is approximately 90 percent of the total for the United States and Canada.

I don’t know what to make of such estimates.  They are always based on assumptions that may or may not be valid. 

One thing is clear: obesity is expensive, personally, economically, and politically.

That’s why it’s a good idea to support public health initiatives to make it easier for people to maintain a healthy weight.

Providing healthier food in schools, getting junk food out of schools, soda taxes, soda caps, and restrictions on marketing to kids are the kinds of ideas that are worth supporting.  

Now. 

Aug 18 2012

Guest post: Paul Ryan’s Views on Food Politics

Daniel Green, a student at Cornell, asked whether I intended to write about Paul Ryan’s views on food politics.  He volunteered to put something together with his colleague, Dr. Margaret Yufera-Leitch.  Here are their thoughts:

Few Americans had heard of Paul Ryan (R-Wisconsin) until last week when he was announced as Presidential-hopeful Mitt Romney’s November running mate. A Janesville, Wisconsin native, former personal trainer and Oscar Mayer Weinermobile driver during his college days, Ryan is a strong advocate on the Hill for the P90x exercise routine and avoids eating fried foods and desserts (yes, even on the campaign trail).

But how do Mr. Ryan’s personal beliefs impact his voting on food politics related matters?

Obesity prevention

In the case of obesity, prevention has been shown repeatedly to be the best medicine. Of the $2.6 trillion spent on US health care in 2010, 95% went for disease treatment leaving only $421 per American per year for prevention—not even enough money for a 1-year gym membership in most states.

In an interview with Politico, Mr. Ryan admitted to maintaining 6-8% body fat with a healthy BMI of 21, admirable for any working professional. But Mr. Ryan, who has voted against every Affordable Care Act related bill, takes the stance that what you eat and what you weigh are both matters of personal responsibility. In 2005, he voted for H.R. 554 “The Personal Responsibility in Food Consumption Act” also known as the cheeseburger bill, which aimed to ‘prohibit weight gain-related or obesity-related lawsuits from being brought in federal or state courts against the food industry.’ The bill was passed by the House but failed to even go up for vote in the Senate. The legislation was featured in the 2004 Morgan Spurlock documentary Super Size Me, where Marion Nestle also made her on-screen debut.

According to a recent report by the Bipartisan Policy Center, by 2020 Obesity will cost America $4.6 trillion dollars annually and healthcare costs related to obesity will consume 19.8% of U.S. GDP. The sudden rise of obesity is a clear sign that, as a country, we have fostered an obesogenic environment that will require commitments from both the public and private sectors to reform.

Given that 70% of Americans are overweight and obese, we have collectively demonstrated that public service announcements alone have not yet resulted in the significant population-wide behavior changes needed to reverse obesity and more importantly alleviate a strained U.S. Health Care system.

SNAP Benefits

One of the most important programs available to lower income Americans is the Supplemental Nutritional Assistance Program (SNAP), commonly referred to as Food Stamps, which provides access to fresh foods for low-income families. Given that increased fruit and vegetable consumption are cornerstone habits of the Preventative Medicine conversation, why has Mr. Ryan argued to cut SNAP by $33 billion over the next ten years?

Affordable Care Act

Paul Ryan’s choices to repeal $6.2 trillion dollars of support from the Affordable Care Act and obesity-related provisions, demonstrates a lesser degree of support for preventative care than his widely publicized exercise regime suggests.  Perhaps with unemployment still high and unsure economy, America has bigger fish to fry than fixing the food system and reversing obesity but at least for now, Paul Ryan will take his fish broiled.

 Paul Ryan Food Politics Fact Sheet

Favorite Exercise Program: P90x
BMI: 21 (Healthy)
Dietary Restrictions: Doesn’t eat desserts or fried foods
View on cause of Obesity Personal Responsibility
Country of Origin Labeling (COOL) For
Farm Bill Against
Food Safety Modernization Act Against
Healthcare Reform (Affordable Care Act/Obamacare) Strongly against
Menu Labeling No direct comment- but against Obamacare which includes it
Repealing the Prevention and Public Health Fund For
School Lunch Reform and Child Nutrition Reauthorization For
Soda Taxes No direct comment

 

References and source materials are available from the authors:

  • Daniel Green studies Applied Nutrition and Psychology at Cornell University.  dpg64@cornell.edu. You can follow him on Twitter at www.Twitter.com/dgrreen.
  • Margaret Yufera-Leitch received her PhD in experimental psychology with a focus in eating behavior from the University of Sussex. She is currently a visiting assistant professor at the University of Calgary.   dr.leitch@impulsive-eating.com.  Her website is www.impulsive-eating.com.
Jul 31 2012

Obesity: global public health challenge or investment opportunity?

Worried about the potential personal and economic costs of obesity?  Never mind.  It’s time to view obesity as a business opportunity.

As the press release for a new research report from Bank of America Merrill Lynch, Globesity—The Global Fight Against Obesity, points out:

Increasing efforts to tackle obesity over the coming decades will form an important new investment theme for fund managers…Global obesity is a mega-investment theme for the next 25 years and beyond…The report…identifies that efforts to reduce obesity is a “megatrend” with a shelf-life of 25 to 50 years…BofA Merrill Lynch analysts across several sectors have collaborated to identify the sectors and companies developing long-term solutions.

Given the worldwide increase in obesity, its high prospective costs, and the ever-present threat of government regulation, the report identifies more than 50 global stocks that provide investment opportunities for fighting “globesity.”  These fall into four categories:

  • Pharmaceuticals and Health Care: companies taking advantage of the FDA’s increased support for obesity drug development; tackling related medical conditions and needs including diabetes, kidney failure, hip and knee implants; making equipment such as patient lifts, bigger beds and wider ambulance doors.
  • Food: companies accessing the $663 billion “health and wellness” market and reformulating portfolios to respond to increasing pressure such as “fat taxes” to reduce sugar and fat levels.
  • Commercial Weight Loss, Diet Management and Nutrition: companies pursuing dieting, nutrition and behavioral change—a $4 billion market in the U.S. and growing globally.
  • Sports Apparel and Equipment: “This is the longer-term play, but we believe that promoting physical activity will become a key priority for more government health policies.”

Well, that’s one way to look at it.  Public health, anyone?  

Jul 20 2012

SNAP to Health: A Fresh Approach to Strengthening SNAP

I’m on the advisory committee for SNAP to Health, a project of the Center for the Study of the Presidency and Congress, chaired by Dr. Susan Blumenthal.

The Commission released its report on Wednesday in Washington DC at a congressional briefing at which I (and several others) spoke.

The report, Snap to Health, is online at this link.  Its recommendations are here.

 

 

 

 

 

 

 

 

 

 

 

 

 

The major points made at the briefing:

  • SNAP funding must be preserved; the program is a lifeline for 46 million Americans, half of them children.
  • SNAP, as Rep. Ron Wyden (Dem-OR) put it, “is a conveyor belt for calories.”  It would be better if the calories came from healthier foods.
  • The prevalence of obesity is high among low-income Americans and some evidence suggests that rates may be higher among SNAP participants.
  • Buying healthier foods with SNAP benefits is not easy.  There are problems with access, cost, and relentless marketing of junk foods to low-income groups in general and to EBT users in particular.

As I discussed in my remarks (which are also supposed to be posted on SnapToHealth.org soon), food companies and retailers specifically target marketing efforts to low-income groups and to SNAP participants.  No such efforts market healthier foods to EBT users.

Michele Simon’s recent report documents the extensive lobbying efforts of food companies to make sure that SNAP recipients can use EBT cards to buy their products.

The Snap to Health report is meant to start a national conversation about helping this program to address twenty-first century health challenges.

Let the conversation begin!

Jul 17 2012

Summer reading: reports on diet and health

It’s the (relatively) quiet season and I’m getting caught up on reports coming in.   Here are two.

1.  The Bipartisan Policy Center, a group founded by former cabinet secretaries, has come up with a plan to improve the health of Americans: Lots to Lose: How America’s Health and Obesity Crisis Threatens our Economic Future.   The Executive Summary is online, but the website is difficult to navigate and you have to log into Facebook to read the entire report.

The report calls on the public and private sectors to collaborate in creating healthy families, schools, workplaces and communities. Some of the recommendations are aimed at the food environment, rather than individuals, which is good.  And they are addressed to families, schools, workplaces, communities, and farm policy.  But like most such reports this one does not explain how any of its recommendations might be achieved.

2.  The Rudd Center at Yale has produced Cereal Facts, a study showing that cereal companies:

Increased media spending on child-targeted cereals by 34% from 2008 to 2011, mainly on the least nutritious products.

  • More than doubled spending in Spanish-language media.
  • Improved overall nutritional quality of 13 of 14 brands advertised to children by 10 percent on average.
  • Sponsor TV ads that typically promote products containing one spoonful of sugar for every three spoonfuls of cereal.

Two more findings of interest:

  • In 2011, the average 6- to 11-year-old saw more than 700 TV ads for cereals.
  • Although General Mills and Kellogg do make nutritious products that are marketed to parents, they do not advertise those products to children.

Watch the video!

Jun 12 2012

More on Mayor Bloomberg’s controversial soda initiative

The controversy continues over Mayor Bloomberg’s proposal to limit the size of sodas to 16 ounces in certain places.

On the one hand, we have today’s account in the New York Times of Mayor Bloomberg’s visit to Montefiore in the Bronx, where obesity levels appear intractable:

Critics have described [Mayor Bloomberg’s] proposed soda rule as interfering with a matter of personal choice, calling instead for less intrusive means to address the obesity problem, through education and access to healthy foods. But the Bronx experience helps explain why Mr. Bloomberg and city health officials embraced the aggressive new regulatory tact after years of trying, and failing, to curb obesity through those types of measures.

…In defending his proposal, Mr. Bloomberg said at Montefiore that the ban was not intended to tread on anyone’s rights, and he noted that more than individual liberties were at stake. “We are absolutely committed to doing everything in our power to help you get on track and stay on track to maintain a healthy lifestyle,” he said. “Because this isn’t your crisis alone — it is a crisis for our city and our entire country.”

On the other hand, here’s the June 18 New Yorker–“soda noir.” 

 

 

 

 

 

 

 

 

 

The New York City Board of Health is meeting today to review the Mayor’s soda proposal.  Stay tuned!

Jun 7 2012

Are food companies part of the solution to obesity?

The June 2012 e-mailed newsletter from the International Association for the Study of Obesity (IASO) quotes from a speech by IASO’s Tim Lobstein at the recent Nordic Nutrition Conference. 

Dr Lobstein suggests that claims by large food companies to be an essential part of the solution  to obesity should be challenged.

These companies do not manufacture essential food items….They produce branded, mass-produced, processed snacks and beverages which are not necessary in a healthy diet.

Such companies should not be claiming a right to be included in policy decisions, and should not be displacing producers of healthier foods, such as fruit and vegetable growers, who are a legitimate part of the solution.

Think of that the next time you see ads from the American Beverage Association?

Jun 4 2012

Weight of the Nation: the new “Hunger in America”?

My monthly Food Matters column for the San Francisco Chronicle:

Q: I forced myself to watch all four hours of HBO’s “Weight of the Nation.” I get it that obesity is a scary problem and I’m supposed to be eating less. What I don’t get is how I’m supposed to do that when food companies can do what they want and the government lets them.

A: I am with you on this one. I also looked at the website (theweightofthenation.hbo.com) and a report from the Institute of Medicine, “Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation.” These all are components of a public-private partnership campaign to bring the personal and economic costs of obesity to national attention.

As The Chronicle’s David Wiegand put it in his Datebook review (see: sfg.ly/KO2vgI), the show “pulls no punches, spares neither the multibillion-dollar food and advertising industries nor public officials for not only failing to fix the problem but actually making it worse.”

I thought the series focused too much on what you have to do on your own to manage your weight: take small steps, set realistic goals, focus on portion control, monitor your calorie intake.

I wish it had spent as much time on countering the actions of the food industry, called by Kelly Brownell of Yale’s Rudd Center as “powerful, pernicious and predatory.”

I also wish it had been more courageous in demanding that government help check the excesses of food industry marketing to make it easier for Americans to cope with the social, economic and business drivers of obesity that the series documented so well.

I saw that courage in an accompanying video for kids, which won’t be shown nationally until the fall. Watch for it. School kids in a Rethinkers club in New Orleans wanted to improve the lunches in their school. They went into action and figured out how to make the system work for them. They succeeded by learning to “speak truth to power” and “hold feet to the fire.”

Why aren’t adults doing the same? For an explanation, take a look at the institute’s report. Its recommendations do speak some truth to power. Although its No. 1 goal promotes physical activity (a thoroughly uncontroversial recommendation), its No. 2 is to fix the environment to make healthier food options routine and easy, especially by discouraging consumption of soft drinks.

As for holding feet to fire, the report warns that if companies don’t adopt nutrition standards for kids’ marketing within two years, policymakers should consider making them mandatory.

Consider? “Weight of the Nation” showed how the food industry reacted when the Federal Trade Commission tried to propose voluntary standards.

In two years? The institute already gave the food industry two years to act – six years ago. Its 2006 “Food Marketing to Children and Youth” report stated that if the industry didn’t stop advertising junk foods on children’s television programs within two years, Congress should legislate marketing standards.

In 1968, the CBS television documentary “Hunger in America” shocked the nation and galvanized Congress to pass legislation to reduce poverty and malnutrition.

“Weight of the Nation” is equally shocking. It impressively and compellingly defines the problem of obesity, its consequences and its causes, personal and societal.

But I wish the series – and the Institute of Medicine – had been able to rise above the politics and say more about how we as a society could do better to improve school food, limit the relentless marketing of sodas and junk foods, and make it easier for everyone to afford and have access to healthier foods.

Food companies are businesses. In today’s investment economy, they must not only make a profit but must increase the profit every 90 days. Business imperatives mean that they could help make healthier choices easier, but won’t unless forced to. That’s what New York Mayor Michael Bloomberg’s proposed ban on big sodas is trying to do (see: sfg.ly/L45K0t).

At the very least, I’m hoping the HBO program will encourage viewers to press for political action to prevent obesity. If it does, history will judge this documentary to be as important a democratizing influence on our society as was “Hunger in America.”