Currently browsing posts about: Obesity-policy

Betsy McKay of The Wall Street Journal organized and moderated a debate on this question.  I was a participant along with Brian Wansink , the John S. Dyson professor of marketing at Cornell University and Michael D. Tanner, senior fellow at the Cato Institute.

The debate is lengthy—you can read all of it online—but here are my initial responses to the two questions asked of me.

WSJ: What role should government play in addressing the obesity epidemic?  

DR. NESTLE: The government is up to its ears in policies that promote obesity. To name only a handful: supporting production of food commodities, but not of fruits and vegetables; permitting food and beverage companies to deduct marketing expenses from taxes; permitting SNAP benefits [food stamps] to be used on any food, thereby encouraging food companies to market directly to low-income groups.

Research on the prevalence of obesity shows that after decades of remaining at the same level, it began to increase sharply in the early 1980s. Our sense of personal responsibility did not change then. What did change was the food environment, transformed by food industry imperatives to increase sales, to one that increasingly urged people to “eat more” by making it socially acceptable to eat anywhere, anytime, and in very large amounts. In this kind of food environment, all but the most mindful eaters overeat. Few of us are in that category.

The food, beverage and restaurant industries collectively spend roughly $16 billion a year to promote sales through advertising agencies, perhaps $2 billion of that targeted at children. Marketing to children is well established to encourage kids to want advertised products, pester their parents for them, and believe that those products are what they are supposed to be eating. The “I am responsible” argument does not work for children (I’m not aware of evidence that it works well for adults either). Because regular consumption of junk foods and sugary drinks is linked to obesity in children, marketing these products to them is overtly unethical.

To expect food and beverage companies, whose sole purpose is to increase sales and report growth in sales every quarter, to voluntarily stop marketing to children makes no sense. On ethical grounds alone, government intervention is essential.

Given the personal and economic costs of obesity—currently estimated at $190 billion a year—governments have many reasons to promote the health of their populations. Just ask the military.

WSJ: Let’s talk about some specific initiatives. Will Mayor Bloomberg’s cap on soda sizes reduce soda consumption? What about the proposed municipal tax of a penny an ounce on sugary drinks in Richmond, Calif.?

DR. NESTLE: If only education and personal responsibility worked to improve eating behavior. Brian Wansink’s research clearly shows that his own students, diligently educated to understand the effect of large food portions on eating behavior, will still eat more when given more food—and, more seriously, they will underestimate the amount they have eaten.

Education must be backed up by a supportive environment. So why not create a food environment that makes it easier for people to eat less? Mayor Bloomberg’s idea of capping soda sizes at 16 ounces is an interesting approach to doing just that. A 16-ounce soda is not exactly abstemious. It is two standard servings, 50 grams of sugar and 200 calories.

To suggest that food laws will not change behavior makes little sense. For one thing, anti-obesity initiatives have scarcely been tried. For another, the history of anti-smoking interventions suggests quite the opposite. Attempts to get smokers to quit by invoking personal responsibility made little headway. Smokers quit when the government made smoking so inconvenient and expensive that it became easier to stop than to continue.

The intense response of soda companies to Mayor Bloomberg’s cap on soda size is testimony to the effectiveness of regulatory approaches. The companies would not be putting this kind of effort or spending millions to oppose an action they expected to fail.

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. 

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

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.

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?  

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!

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!

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!

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?