by Marion Nestle

Currently browsing posts about: Obesity

Oct 15 2019

World Obesity: Three More Reports

Friday October 11 was World Obesity Day, which explains why so many groups are issuing reports on obesity prevalence, risks, costs, and prevention strategies.

I wrote about the one from the Trust for America’s Health, The State of Obesity, a few weeks ago.

Here are three more, just in.

1.  The Heavy Burden of Obesity: The Economics of Prevention.

This one was produced by the OECD (Organisation for Economic Co-operation and Development).  It finds: “Almost one in four people in OECD countries is currently obese. This epidemic has far-reaching consequences for individuals, society and the economy. Using microsimulation modelling, this book analyses the burden of obesity and overweight in 52 countries (including OECD, European Union and G20 countries), showing how overweight reduces life expectancy, increases healthcare costs, decreases workers’ productivity and lowers GDP.”

2.  Time to Solve Childhood Obesity   This is “An Independent Report by the Chief Medical Officer, 2019, Professor Dame Sally Davies in the U.K.  The cover deals with both cause and effect:

3.  State of Childhood Obesity: Helping All Children Grow Up Healthy.  The Robert Wood Johnson produced this one.

Its key findings:

  • Obesity rates for youth ages 10 to 17 did not change much from 2016 (15%-16%).
  • Racial and ethnic disparities persist as do disparities by income.
  • Mississippi had the highest overall youth obesity rate (25.4%); Utah had the lowest (8.7%).

Comment:  Obesity is a global problem, not just one for the U.S.  Plenty of policies exist that could help make healthier food choices easier and less expensive.  But as the Lancet Global Syndemic report so clearly explained, doing something about obesity is hampered by weak (corporate-captured) government, food industry opposition, and weak civil society.  The first two are difficult to do anything about without attention to the third.  The clear need: strengthen civil society.  Let’s get to work on that.

Sep 20 2019

Weekend reading: the state of obesity

Trust for America’s Health has just published its annual report on obesity, state by state.

As the home page puts it, “U.S. Obesity Rates Reach Historic Highs – Racial, Ethnic, Gender and Geographic Discrepancies Continue to Persist.”

The press release has an even more pointed headline: “U.S. Obesity Rates at Historic Highs – Nine States Reach Adult Obesity Rates of 35 Percent or More.”

The report highlights that obesity levels are closely tied to social and economic conditions and that individuals with lower incomes are more at risk. People of color, who are more likely to live in neighborhoods with few options for healthy foods and physical activity, and, are the target of widespread marketing of unhealthy foods, are at elevated risk.

What to do?

The report calls for sugary drink taxes, expanded SNAP and WIC Nutrition support programs and a built environment that encourages physical activity.

Buried in the report are suggestions for curbing food-industry marketing and other efforts to undermine public health initiatives.

  • Keep industry out of dietary guidelines.
  • Consider regulating food-industry marketing.
  • Stop industry from preempting state public health laws.
  • Reduce unhealthy food marketing to children.

Lots of good stuff here and well worth a read.

Aug 5 2019

Industry-funded study of the week: “probiotic” weight-loss supplement

I spotted some tweets about this study from Washington Post writer Tamar Haspel, who has a sharp eye for this sort of thing.  Her first tweet said:

Her second tweet explained the problem:

So of course I had to look up the study.  It’s not one I would ordinarily have noticed because its title does not use the word “probiotic,” which typically refers to the live bacteria (in yogurt, for example).  The evidence for benefits of probiotics is iffy, so this study raises lots of questions.

Let’s take a look at it:

The Study:  Supplementation with Akkermansia muciniphila in overweight and obese human volunteers: a proof-of-concept exploratory study. Depommier C, et al.  Nature Medicine (2019

Conclusion: I’ve left out the statistics to make this easier to read:  “Compared to placebo, pasteurized A. muciniphila improved insulin sensitivity…, and reduced insulinemia…and plasma total cholesterol…. Pasteurized A. muciniphila supplementation slightly decreased body weight…compared to the placebo group, and fat mass…and hip circumference…compared to baseline….In conclusion, this proof-of-concept study…shows that the intervention was safe and well tolerated and that supplementation with A. muciniphila improves several metabolic parameters.”

Competing interests:  Five of the authors “are inventors of patent applications…filed with [patent offices in at least 12 countries]…dealing with the use of A. muciniphila and its components in the context of obesity and related disorders.” Two of the authors are cofounders of A-Mansia Biotech S.A., a Belgian company that sells A. muciniphila supplements, presumably as weight-loss supplements.

Comment: As Haspel points out, the subjects in this study were given either (a) live bacteria, (b) Pasteurized (and, therefore, mostly dead) bacteria, or (c) a placebo.  The Pasteurized ones were associated with metabolic benefits and weight loss.  Pasteurization is what gets done to milk to kill most—not all—of the living bacteria it contains.  In this study, Pasteurized bacteria had the same effect on the microbiome as the unpasteurized.  The point of the study was to show that the Pasteurized supplement would induce weight loss; the observed loss, however, was not statistically significant.   Nature Medicine‘s editors should know better.  So should the New York Times’ editors.  Haspel points out that the New York Times account of the study accepted its conclusion uncritically, headlining it “A Probiotic for Obesity?”  At least the headline included a question mark.  The article did not mention the authors’ patents or conflicts of interest; it should have.

Bottom line: If you want to keep your microbiome healthy, eat a healthy diet.

May 21 2019

Obesity explained: Ultra-processed foods –> Calories –> Weight Gain

Kevin Hall at NIH has done a controlled diet study demonstrating that people who consume ultra-processed foods eat more calories—500 more a day (!)—and, therefore, gain weight.

Carlos Monteiro at the University of São Paulo and his colleagues explain how to identify ultra-processed foods.  

They also demonstrate that ultra-processed foods comprise nearly 60 percent of calorie intake.

No surprise.  Calories matter, as Mal Nesheim and I explained in our book Why Calories Count: From Science to Politics (and thanks Kevin for confirming what we wrote in that book).

The clear conclusions of this study have elicited a lot of attention.  Here’s my favorite from Francis Collins, the head of NIH and Kevin Hall’s boss, who also did a blog post:

Examples of media accounts (there were lots more)

Jan 28 2019

New Lancet report: The Global Syndemic: Uniting Actions to Address Obesity, Undernutrition, and Climate Change

The Lancet has been busy.  Last week, it published a blockbuster report on the need for worldwide dietary changes to improve human health and that of the environment.  I posted about this EAT-Forum report on Friday.

Now, The Lancet releases yet another report, this one taking a unified approach to dealing with the three most important nutrition issues facing the world: Malnutrition (undernutrition), obesity, and the effects of our food production and consumption system on the environment and climate change—for which this report coins a new term: The Global Syndemic.

This report breaks new ground in identifying the food industry as one of three main barriers to ending this “Syndemic.”  I’ve added the numbers for emphasis.

  • Powerful opposition by [1] commercial vested interests, [2] lack of political leadership, and [3] insufficient societal demand for change are preventing action on The Global Syndemic, with rising rates of obesity and greenhouse gas emissions, and stagnating rates of undernutrition.
  • New social movement for change and radical rethink of the relationship between policymakers, business, governance and civil society is urgently needed.
  • The Commission calls for a global treaty to limit the political influence of Big Food (a proposed Framework Convention on Food Systems – modelled on global conventions on tobacco and climate change); redirection of US$5 trillion in government subsidies away from harmful products and towards sustainable alternatives; and advocacy from civil society to break decades of policy inertia.

Wow.  This is telling it like it is—at long last.  From the press release:

  • A key recommendation from the Commission is the call to establish a new global treaty on food systems to limit the political influence of Big Food.
  • The food industry’s obstructive power is further enhanced by governance arrangements that legitimise industry participation in public policy development, and the power that big corporations have to punish or reward governments by relocating investment and jobs.
  • Regulatory approaches to product reformulation (eg. salt and sugar reduction), labelling and marketing to children are needed because industry-led, voluntary approaches have not been effective.

Yes!

The documents

The press

▪ The Guardian
The Times (London)
Irish Farmers Journal

Additional press, posted January 30

Newswires (syndicated in international outlets):

UK:

US:

Rest of world:

Jan 16 2019

Bad news on world hunger and obesity: they are getting worse

United Nations agencies have just released their annual report on world food insecurity.

Its main unhappy conclusion:

Food insecurity has increased since 2014:

So has worldwide obesity:

What is to be done?

Alas, that’s not what this report is about.

Dec 7 2018

Weekend reading: the 2018 Global Nutrition Report

If you want an overview of the current status of nutrition problems in the world, what is being done about them, and what needs to be done about them, this report is required reading (to get to the download button for the entire report, scroll to the end of the page).

The report is chock full of useful facts, figures, case studies, and recommendations.  A massive undertaking, it

was produced by the Independent Expert Group of the Global Nutrition Report, supported by the Global Nutrition Report Stakeholder Group and the Secretariat at Development Initiatives. The writing was led by the co-chairs Jessica Fanzo and Corinna Hawkes, supported by group members and supplemented by additional analysts and contributors.

For a quick overview, go right to the slide deck and then to the graphics in the executive summary.

The report deals both with problems of malnutrition (undernutrition) and obesity (overnutrition), especially in children.

It also deals with adult obesity:

It identifies measurable nutrition indicators that can be used to track progress:

It recommends actions to reduce the prevalence of malnutrition and obesity.

What stands in the way of implementing these steps?  Political will, alas.

These reports have come out annually since 2014.  Let’s hope this one gets the attention it deserves.

Jul 24 2018

The Obesity Society should support public health, not corporate health

My email inbox was flooded last week with The Obesity Society’s call for more research on the value of taxes on sugar-sweetened beverages.

“Although taxing SSBs might generate revenue that can be used to promote other healthy food items, the net outcome may not necessarily decrease overweight and obesity rates in the United States or worldwide,” said Steven B. Heymsfield, MD, FTOS, President-Elect of The Obesity Society (TOS) and professor and director of the Body Composition-Metabolism Laboratory at the Pennington Biomedical Research Center at Louisiana State University in Baton Rouge.

Why would a professional society that represents people who ostensibly care about obesity science, treatment, and prevention issue a statement aimed at casting doubt on a demonstrably effective public health measure?  (Soda companies know the taxes are effective; that’s why they fight them so hard).

The Obesity Society (TOS), alas, often appears far more favorable to the interests of food and beverage companies than those of public health.  Could funding of the society and its members have anything to do with this?

Here is the TOS position on corporate funding:

TOS recognizes the value in providing any donor that wishes to support our mission to find solutions to the obesity epidemic the opportunity to provide financial support.

The current TOS policy expressly eliminates all forms of evaluation or judgment of the funding source (other than the stipulation that funding is reasonably assumed not to be derived from activities deemed ‘illegal’).

TOS chooses instead to focus its ethical mission on transparency in disclosing the sources of funding, clear stipulations outlining our commitment to the ethical use of funds, and a commitment to non-influence of the funding sources over the scientific aspects of funded projects and TOS as a whole.

Translation: We will take money from any company, regardless of the effects of its products on public health.

The TOS rationale is that disclosure takes care of the problem and that funding won’t influence the science.  Unfortunately for this view, research demonstrates that disclosure does not eliminate the influence of funding, and the influence of funding is considerable—though often unrecognized, as is apparent in this case.

TOS has a disclosure policy, and discloses its officers’ conflicts of interest.  These are considerable.

In 2013, Dr. Yoni Freedhoff resigned his TOS membership over the society’s sponsorship policies.  In his comment on the current TOS statement, Freedhoff points out that “sugar-sweetened beverage taxes decrease sugar-sweetened beverage consumption and increase healthier beverage consumption while providing the greatest potential health benefits to low income consumers.”

TOS members who care about creating a healthier food environment should consider joining Dr. Freedhoff.  lf not, they should insist that TOS leadership take vigorous pro-public health stances on matters affecting their patients’ health.

Additional comments, October 31, 2018

Yesterday I received a message from Liz Szabo, a reporter for Kaiser Health News, who is writing a piece on TOS’s relationships with food companies.  She questioned Steve Heymsfield, the group’s current president, who responded at length with a message that included this paragraph:

Marion Nestle, on the other hand, is professor “emeritus” and our understanding is that she no longer reports directly to a dean at New York University. That created a hurdle for us when trying to manage Dr. Nestle’se false and misleading blog related to this matter on her website. Even after learning her comments were misleading from Dr. Popkin, and unlike Popkin who has a high ethical standard, she failed to take down that post.

This surprised me, because nobody from TOS or anywhere else had written me to correct the post, Dr. Popkin’s corrections were to something he—not I—had written, and my ongoing relationship with NYU is readily evident from the information posted under About on this site.

I pointed this out to Dr. Heymsfield, who replied with annotations to my post.  Most of these deal with opinion and interpretation rather than fact.  The one thing I got “completely false” is my interpretation that TOS lacks standards for deciding which donors are acceptable.  Dr. Heymsfield says it does.  I am happy to hear that and stand corrected on that point.