Currently browsing posts about: Obesity-policy

The British journal, The Lancet, has a special series of papers on obesity and obesity policy, just out.

Don’t miss the Body Weight Simulator! It’s great fun to play with while waiting out a hurricane.

You type in your age, weight, and height (you can change the metrics to pounds and inches), and indicate your activity level.  It tells you how many calories you can eat every day to maintain that weight (Yikes!  That’s all? No wonder I have so much trouble).

It also tells you how many calories you need to reduce in order to lose weight over whatever time period you specify.

And here are the papers, reviews, and commentaries (you will need to log in to read more than the summary):

The future challenge of obesity
David King
Full Text | PDF

Reversing the tide of obesity
William H Dietz
Full Text | PDF

Where next for obesity
Harry Rutter
Full Text | PDF

The global obesity pandemic: shaped by global drivers and local environments
Boyd A Swinburn, Gary Sacks, Kevin D Hall, Klim McPherson, Diane T Finegood, Marjory L Moodie, Steven L Gortmaker
Summary | Full Text | PDF

Health and economic burden of the projected obesity trends in the USA and the UK
Y Claire Wang, Klim McPherson, Tim Marsh, Steven L Gortmaker, Martin Brown
Summary | Full Text | PDF

Quantification of the effect of energy imbalance on bodyweight
Kevin D Hall, Gary Sacks, Dhruva Chandramohan, Carson C Chow, Y Claire Wang, Steven L Gortmaker, Boyd A Swinburn
Summary | Full Text | PDF

Changing the future of obesity: science, policy, and action
Steven L Gortmaker, Boyd A Swinburn, David Levy, Rob Carter, Patricia L Mabry, Diane T Finegood, Terry Huang, Tim Marsh, Marjory L Moodie
Summary | Full Text | PDF

To my pleasant surprise, editorial writers in the conservative press defended Michelle Obama’s Let’s Move campaign against attacks by even more conservative critics (I’m still catching up with what I missed on vacation).

December 26 Washington Post: Op-ed: “How did obesity become a partisan fight?, by Fred Hiatt , editorial page editor:

Well, yes, if Michelle Obama is for it, someone will be against it. Someone like Glenn Beck, for example, who was moved to rail against carrot sticks, or Sarah Palin, who warned that Obama wants to deprive us all of dessert.

And when you look a little deeper, it’s not surprising that a crusade seemingly beyond questioning would become a political battle.

Interests that might feel threatened by Let’s Move include the fast-food industry, agribusiness, soft-drink manufacturers, real estate developers (because suburban sprawl is implicated), broadcasters and their advertisers (of sugary cereals and the like), and the oil-and-gas and automotive sectors (because people ought to walk more and drive less).

Throw in connections to the health-care debate (because preventive services will be key to controlling the epidemic), race (because of differential patterns of obesity) and red state-blue state hostilities (the reddest states tend to be the fattest), and it turns out there are few landmines that Michelle Obama didn’t trip by asking us all to shed a few pounds.

Hiatt’s piece ends with “It’s not going to be easy,” Michelle Obama says. She’s right – but also right to keep pushing.”

December 27 Wall Street Journal: Editorial: “Palin’s Food Fight.”

President Obama’s indiscriminate expansion of federal power has inspired a healthy populist rebellion, but his opponents sometimes seem to lose their sense of proportion. Take Sarah Palin’s mockery of Michelle Obama’s childhood antiobesity campaign.

The first lady has emphasized more nutritious school lunches but mostly encourages parents to make sure their kids eat healthy and exercise. Mrs. Palin sees a big government plot.

…No one hates the nanny state more than we do, but Mrs. Obama isn’t exactly ordering up Lenin’s Young Pioneers. Adults do have an obligation to teach children how to live, and that includes adults who are role models by dint of their national prominence….Telling kids to eat their vegetables and run around the block is merely instructing them to take responsibility for their own choices.

With this kind of support, real progress is possible.  How’s that for an optimistic note on which to start the new year?

The World Health Organization (WHO) has a new, tough report out: “Set of recommendations on the marketing of foods and non-alcoholic beverages to children.”

It’s policy aim: to reduce the impact on children of marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt.

Here are some of its recommendations (edited):

• Given that the effectiveness of marketing is a function of exposure and power, the overall policy objective should be to reduce both the exposure of children to, and power of, marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt.
• To achieve the policy aim and objective, Member States should consider different approaches, i.e. stepwise or comprehensive, to  reduce marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt, to children.
• Settings where children gather should be free from all forms of marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt.
• Governments should be the key stakeholders in the development of policy and provide leadership, through a multistakeholder platform, for implementation, monitoring and evaluation. In setting the national policy framework, governments may choose to allocate defined roles to other stakeholders, while protecting the public interest and avoiding conflict of interest.
• Considering resources, benefits and burdens of all stakeholders involved, Member States should consider the most effective approach to reduce marketing to children of foods high in saturated fats, trans-fatty acids, free sugars, or salt.
• Member States should cooperate to put in place the means necessary to reduce the impact of crossborder marketing (in-flowing and out-flowing) of foods high in saturated fats, trans-fatty acids, free sugars, or salt to children.

The Rudd Center at Yale has just released Fast Food F.A.C.T.S., a thoroughly comprehensive report on the marketing of fast food to children and adolescents.

The report lavishly illustrates and extensively documents the ways in which fast food companies market to kids, the strategies they use, and the effects of these efforts on kids’ diets.

Readers: add it to your library!  FDA and FTC: get busy!

Addition: Advertising Age reports on the fast food industry’s response to the Rudd Center report.  All the industry can come up with, says Advertising Age, is a “canned response.”  Looks like the Rudd Center got it right.

OECD (the Organization for Economic Cooperation and Development), a group of 33 countries “committed to democracy and the market economy,” has just released a major report on obesity.

Its main conclusion?  The United States population has the highest percentage of overweight and obesity in the democratic, market-economy world.

The report’s conclusion?

Individual interventions have a relatively limited impact; therefore, comprehensive strategies involving multiple interventions to address a range of determinants are required to reach a “critical mass” – one that can have a meaningful impact on the obesity epidemic by generating fundamental changes in social norms. The development of comprehensive prevention strategies against obesity needs to focus on how social norms are defined and how they change; on the influence of education and information on obesity but also on the potential for government regulation to affect behaviours; and on the role of individual choice and values. A sensible prevention strategy against obesity would combine population and individual (high-risk) approaches.

Buried in this paragraph are some important concepts: societies need to change social norms as well as individual behavior, and governments need to intervene to make the social environment more conducive to healthier practices.

Nancy Hellmich of USA Today attempted a translation of some of the recommendations for individuals:

• Individual lifestyle counseling by family doctors and dietitians may be the most effective to increase the life expectancy and quality of life for people who are obese or at risk of becoming so.
• Individual counseling should be supplemented with health-promotion campaigns, compulsory food labeling and cooperation between industry and government in the regulation of food advertising to kids.

The report breaks down data by country.  Here are ours.

Harvard pediatrician David Ludwig and Tufts professor Alice Lichtenstein team up in a JAMA commentary with a novel idea.  How about re-introducing home economics into the school curriculum!

Girls and boys should be taught the basic principles they will need to feed themselves and their families within the current food environment: a version of hunting and gathering for the 21st century. Through a combination of pragmatic instruction, field trips, and demonstrations, this curriculum would aim to transform meal preparation from an intimidating chore into a manageable and rewarding pursuit.

…Obesity presently costs society almost $150 billion annually in increased health care expenditures. The personal and economic toll of this epidemic will only increase as this generation of adolescents develops weight-related complications such as type 2 diabetes earlier in life than ever before. From this perspective, providing a mandatory food preparation curriculum to students throughout the country may be among the best investments society could make.

It’s almost impossible to keep up with what’s being written about childhood obesity.  The papers and commentary pour in.  Much of this is well worth reading.  If you want to keep up on the latest thinking about the issue, here are some places to start:

1.  Health Affairs: Thanks to Matt Gruenberg for alerting me to the issue of Health Affairs devoted entirely to obesity topics.  Here’s the Table of  Contents.

The Robert Wood Johnson Foundation had a hand in this and discusses some of the papers on its website.

Even better, Health Affairs has produced a series of “issue briefs” to go with the journal articles.  These are available on the Health Affairs blog. They cover:

• Overview: The State Of Childhood Obesity In America
• The Role Of Agriculture Policy In Reducing Childhood Obesity
• Food Marketing And Distribution’s Role In The Fight Against Childhood Obesity
• Speeding Up Progress In Fighting Obesity In Schools
• Lessons From States On Fighting Childhood Obesity
• The Pervasive Effects Of Environments On Childhood Obesity

2.  FoodNavigator.com has a “special issue” on childhood obesity from the business standpoint:

Giving children the best nutritional start: With childhood obesity rates apparently sky rocketing around the world, celebrity chefs redesigning school meals, and international initiatives to influence what our children eat, now is an interesting time for child nutrition.

Kids’ food trends in the spotlight: Some major trends in children’s eating habits could change as the economy recovers – but foods marketed as natural and healthful are here to stay, according to a senior analyst at Mintel. 

How characters can help children eat healthily: From Disney to Tony the Tiger, consumer groups have been campaigning hard to break the links between childhood icons and unhealthy foods. But furry friends and super-heroes are now putting in more of an appearance on healthy products.

Kids’ TV food commercials down, but cross-promotions soar: Cross-promotions on food packaging targeted at children increased by 78 percent between 2006 and 2008, according to a study from Yale’s Rudd Center for Food Policy.

3.  Michelle Obama’s campaign:USA Today reports on Mrs. Obama’s talk to the school nutrition association, the organization of people who work in school lunchrooms – those who Jamie Oliver refers to as “lunch ladies.”  Check out the coverage and see the video.

What is one to make of all this?  Childhood obesity is a huge public health issue and deserves the attention it is getting.  Let’s hope some of it works.

Reports about what to do about obesity in adults and children are coming out one after another.

The HSC Foundation has produced Fighting Obesity: What Works, What’s Promising? (click on Fighting Obesity Report).  Based on interviews, it reviews model programs that are having some success, such as The Food Trust, a Philadelphia-based nonprofit organization; The Consortium to Lower Obesity in Chicago Children (CLOCC); and The Coordinated Approach to Child Health (CATCH) Program.  Its main conclusion: a focus on pregnant women and children will have the biggest payoff.

NIH has New Tools to Promote Healthy Habits, one of which is “We Can!  Ways to Enhance Children’s Activities and Nutrition.”  The online program tells families how to improve food choices, increase physical activity, and reduce screen time.  [Question: do online programs do any good at all?  I’d really like to know.]

Finally (for now), the Institute of Medicine and Robert Wood Johnson Foundation have produced Local Government Action to Prevent Childhood Obesity, with a mind-numbing 58 steps that governments could take to do some good .  They also published a brief summary. Fortunately, the authors select the 12 actions most likely to succeed:

1. Create incentive programs to attract supermarkets and grocery stores to underserved neighborhoods
2. Require menu labeling in chain restaurants to provide consumers with calorie information on in-store menus and menu boards
3. Mandate and implement strong nutrition standards for foods and beverages available in government-run or regulated after-school programs, recreation centers, parks, and child-care facilities, including limiting access to unhealthy foods and beverages
4. Adopt building codes to require access to, and maintenance of, fresh drinking water fountains (e.g. public restrooms)
5. Implement a tax strategy to discourage consumption of foods and beverages that have minimal nutritional value, such as sugar sweetened beverages
6. Develop media campaigns, utilizing multiple channels (print, radio, internet, television, social networking, and other promotional materials) to promote healthy eating (and active living) using consistent messages
7. Plan, build and maintain a network of sidewalks and street crossings that connects to schools, parks and other destinations and create a safe and comfortable walking environment
8. Adopt community policing strategies that improve safety and security of streets and park use, especially in higher-crime neighborhoods
9. Collaborate with schools to implement a Safe Routes to Schools program
10. Build and maintain parks and playgrounds that are safe and attractive for playing, and in close proximity to residential areas
11. Collaborate with school districts and other organizations to establish agreements that would allow playing fields, playgrounds, and recreation centers to be used by community residents when schools are closed (joint-use agreements)
12. Institute regulatory policies mandating minimum play space, physical equipment and duration of play in preschool, afterschool and child-care programs

A 12-step program for preventing childhood obesity!  These are good ideas.  What will it take to get them put into practice?

My latest interview with Eating Liberally is about the policy implications of the “F is for Fat” study (see earlier post).