by Marion Nestle

Currently browsing posts about: Obesity

Nov 10 2015

Two reports: Who is Obese? How to Curb Global Sugar?

The first report is from the UK.   Fat Chance? Exploring the Evidence on Who Becomes Obese is a curious example of what happens when a sugar company (AB Sugar) partners with a health organization (2020 Health) to produce a policy document.

The report examines the role of age, gender, socioeconomic factors, the built environment, mental health and disability, sleep, bullying and child abuse, smoking, ethnicity, and religion as factors in obesity—everything except diet and activity levels.

The press release for the report gives key findings, among them:

  • Obesity rates are rising rapidly among the poor as well as other groups who experience social instability.
  • Uncertainty seems to be a significant factor for weight gain.
  • Fast food outlets near working environments have a significant impact on the BMI of men; the lack of green space has an impact on obesity rates particularly among girls.
  • Half of all people suffering with psychosis are obese.
  • Parental obesity, especially in mothers, is a far more predictive factor in childhood obesity than is ethnicity.

Its authors write:

What is particularly highlighted in recent research, though rarely explicitly stated, is that obesity rates seem to be deeply influenced by social change (not just influences within static social categories). The studies we have compiled for this review show a subtle trend that has become increasingly evident over the last decade. It is highlighted in economic mobility, rising rates of mental illness, technological habits and engagements, and rapidly shifting urban ground. Argued here, broadly speaking, is that many of these categories strongly hint to a meta-structure that remains profoundly under-researched and largely ignored. This is the structure of uncertainty, a type of habitus that influences the terms of emotional engagement between an individual and their daily life. Insidiously, it undermines health seeking behaviour by making daily decision processes cognitively intolerable and emotionally taxing.

They conclude:

…approaches to obesity that recognise and incorporate complexity might impact a host of rising health problems that affect communities across Britain. The same interventions that encourage healthy BMI may improve energy levels through metabolic process and sleeping habits, while reducing risk of mental health problems, diabetes and a range of other comorbidities not discussed in this report.

But they don’t say what those interventions might be.

Could they possibly have something to do with removing sugary drinks and foods from local environments?

For doing just that, the World Cancer Research Fund International has produced Curbing Global Sugar Consumption: Effective Food Policy Actions to Help Promote Healthy Diets & Tackle Obesity.

Examples of actions which have had these effects include school nutrition standards in Queensland, Australia; a vending machine ban in France; a front-of-package symbol that led to product reformulation in the Netherlands; soda taxes in France and Mexico; a programme targeting retail environments in New York City, USA; a programme promoting increased water consumption in schools in Hungary; school fruit and vegetable programmes in Netherlands and Norway; a healthy marketing campaign in Los Angeles County, USA and a comprehensive nutrition and health programme in France.

The first report asks us to solve problems of poverty, instability, and mental health before taking action to prevent obesity, even when actions are known to be effective.  The second calls for such actions now.

Could AB Sugar’s sponsorship possibly have something to do with this difference?

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Oct 2 2015

Weekend Reading: Emily Yates-Doerr’s “The Weight of Obesity”

Emily Yates-Doerr.  The Weight of Obesity: Hunger and Global Health in Postwar Guatemala. University of California Press, 2015.

Emily was a student in NYU’s anthropology department and I’ve admired her work for a long time.  Her book is based on her remarkable dissertation work, and I was happy to be asked to blurb it:

Emily Yates-Doerr gives us an anthropologist’s tough analysis of how one resource-poor Guatemalan population responds to an increasingly globalized food supply as it transitions rapidly from widespread hunger and malnutrition to the increasing prevalence of obesity and its health consequences.  The Weight of Obesity views this “nutrition transition” from the unusually revealing perspective of an insider who experienced it personally with eyes wide open.

For me, the most riveting parts of her book are the transcribed conversations between clinic nutritionists and patients newly diagnosed with type 2 diabetes—a case study in the cultural gap between nutrient-based advice (“nutritionism”) and the way people actually eat.  The effects of the rapid influx of “ultra-processed” products on the health of the populations studied here are also painfully clear.  This is an ethnography of the nutrition transition caught just as these cultural and dietary shifts were occurring.

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Aug 14 2015

Let’s Ask Marion: Can Exercise Balance Out Soda Drinking?

This is the latest in a series of Q & A’s written by .   It appeared on Civil Eats, August 12, 2015.  And please note references added at the end.

Civil Eats: Your next book, Soda Politics: Taking on Big Soda (and Winning), documents the history of how this sugary beverage gave rise to some of our most powerful corporations and has lately become Public Enemy Number One in the war on obesity.

With sales on the decline, the New York Times recently reported that Coca-Cola is pouring millions of dollars into a ‘science-based’ campaign to convince the public that the secret to achieving and maintaining a healthy weight is not avoiding excess calories, but getting more exercise. What’s the science on more exercise versus fewer calories?

Marion Nestle: When it comes to studies about the health effects of sugary drinks, the science, alas, depends on who pays for it. Studies paid for by government or private health foundations show that if you want to prevent obesity, [a combination of] eating less and moving more works every time.

You can lose weight by eating less on its own. But you will have a much harder time doing that by increasing physical activity. This is because it takes lots of effort to compensate for excess calories. Eat two little Oreo cookies—100 calories—and you have to walk a mile to work them off. Drink a 20-ounce soda and you need to cover nearly three miles. This was the point of the New York City health department’s subway current poster campaign, which shows that you need to walk from Union Square in Manhattan to downtown Brooklyn to burn off 275 calories.

The soda industry would love you to believe that the principal cause of obesity is lack of physical activity, and they put tons of money into research to discourage other ideas. They much prefer you to believe that all of their products can be part of an active, healthy lifestyle that includes balanced diets, proper hydration, and regular physical activity. I call the idea the “physical activity diversion.” It deflects attention from what really counts in obesity prevention: not eating huge amounts of junk foods, snack foods, and sodas.

Mind you, I’m greatly in favor of physical activity for its many benefits: physiological, social, psychological, and health. But there is a good reason for the outraged reaction to Coca-Cola’s video seemingly suggesting that all you have to do to burn off the 140 “happy calories” in a 12-ounce soft drink is to laugh out loud for 75 seconds. This is so far from the reality of calorie balance that several countries actually banned the commercial [in 2013].

Soda companies promote the primacy of physical activity in other clever ways. The Coca-Cola Foundation says that about one-third of its philanthropic contributions go to organizations working to counter obesity, especially through promotion of physical activity.

Both Coca-Cola and PepsiCo invest heavily in sponsorship of international sports teams. They put fortunes into recruiting sports celebrities as spokespersons. These investments accomplish two purposes: they influence fans to buy the products and shift the focus to physical activity. Obesity, these imply, is about what you do, not what you eat or drink. Public health advocates complain about how frequently young people—especially those of color or in low-income families—are exposed to advertising by professional athletes. The sponsored programs and celebrities never suggest that drinking less soda might be a useful health-promotion strategy.

As a nutritionist and co-author of a book titled Why Calories Count, I thoroughly agree that balance, variety, and moderation are fundamental principles of healthful diets, and that weight gain is a result of calorie imbalance.

But soda companies distort these principles to distract from their marketing of sugary drinks and how overconsumption of these drinks overrides normal physiological controls of hunger and satiety. Independently funded research makes it abundantly clear that avoiding sodas is one of the best things you can do for your health.

Sponsorship of research or research investigators by Coca-Cola or the American Beverage Association is reason alone for skepticism.

References: I am grateful to Richard Cooper for forwarding his paper on the relative contributions to obesity of diet and exercise.  From his review of the literature, you must reduce calories to lose weight.

He also pointed me to rebuttals by  Blair and Hill, the investigators featured in the New York Times article cited above.

The rebuttal by Steven Blair and colleagues.

  • Funding: Drs. Blair, Archer, and Hand are funded via unrestricted research grants from The Coca-Cola Company for analyses of dietary trends and for an energy balance study.
  • Conflict of interest: None declared [Evidently, these investigators do not perceive funding by Coca-Cola as a conflict]

The rebuttal from James Hill and John Peters:

  • Conflict of interest: J.H. receives research grants from the American Beverage Association and serves on advisory boards for McDonalds, General Mills and McCormicks. J.P. receives research funding from the American Beverage Association.

 

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Jun 9 2015

The Lancet series on obesity policy (in case you missed it)

Some time ago, I posted the terrific Lancet infographic on obesity policy.

Here are the series articles (or at least the abstracts) that go with it.

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Apr 1 2015

Interview with Columbia University Public Health Students

For tonight’s Grand Rounds at Columbia University, I did an interview with FPOP (Food Policy and Obesity Prevention).

Food Policy Expert Marion Nestle on the Heinz-Kraft Deal, GMOs, and the Secret Ingredients to Healthy School Lunches

March 31, 2014—Years before the Reagan Administration decreed that ketchup was a vegetable, Marion Nestle saw the connections between the dinner table and politics. Nestle, the nation’s leading advocate for good nutrition, will address the Mailman School in a Grand Rounds talk tomorrow and kick-off Public Health Fights Obesity, a month-long series of lectures and special events, including an April 16 symposium on preventing childhood obesity.

Nestle, a professor and founder of the department of Nutrition, Food Studies, and Public Health at New York University, is the author of acclaimed books, includingFood Politics: How the Food Industry Influences Nutrition and Health, and most recently, Why Calories Count: From Science to Politics.

In anticipation of her Grand Rounds talk, the student group Food Policy and Obesity Prevention interviewed Nestle about everything from attempts to regulate Big Soda, GMO labeling, to school lunches done right.

The federal Dietary Guideline Advisory Committee recently published recommendations that for the first time considered issues of food sustainability. There has been a lot of controversy.    

The guidelines have always been controversial, but never anything like this. I think this is an example of how worried the food industry is about the pushback about diet and health in America. Sustainability is the “S word” in Washington. The guidelines committee is trying to do is what I’ve been advocating for a very long time, which is to bring agricultural policy in line with health policy. Right now the policies are completely divorced.

At the same time you have Heinz and Kraft joining forces.  

The food industry is in a defensive position because food and health advocates have been enormously successful in changing the market and changing people’s views. The fastest growing segment of the food industry is organics. The makers of processed foods are in retreat.  Warren Buffett must think there’s plenty of money to be made in selling junk foods.  I hope he’s wrong.

Is Big Food increasingly eyeing opportunities overseas?

If you can’t sell it here, you sell it there. The best example of this is the soda industry, which is the subject of my next book. There has been a 10- to 15-year decline in sales of carbonated sweetened beverages in the United States. It’s one of the great successes of health advocacy. To compensate, Coke and Pepsi are increasingly focusing their efforts overseas. Expect obesity and its consequences to follow.

Speaking of global commerce, should we be concerned about trade agreements like the Transpacific Partnership?

Food and Water Watch called it “NAFTA on steroids.” It’s very hard to know what’s going on because the negotiations are being done in secret. People are worried that a lot of the protections we have against bad things in food will be taken away on the basis of violations of trade agreements.


Poster supporting a soda tax in Berkeley

Closer to home, here in New York we’ve heard a lot about attempts to legislate on soda with failed attempt to limit portion sizes. Other areas have had more luck—

Not luck—skill! The only place in the United States where a soda tax has been successful is Berkeley. They did everything about advocacy right. Instead of framing it as a health argument, they framed it as an argument against corporate power: Berkeley versus Big Soda. And there was an enormous grassroots effort to engage the entire community. Community organizing is classic public health. Nobody does it very often. But when it’s done, it works!

Another issue people have been talking about is GMO labeling. 

I was on the FDA food advisory committee in 1994 when they were in the process of approving GMOs. Those of us who were consumer representatives told the FDA that it had to require labeling. I’m surprised it’s taken this long for there to be a major national uproar. From the beginning, the question was: if they don’t want labels, what are companies like Monsanto trying to hide?

Speaking of Monsanto, there was news this week that a chemical in their Round Up herbicide is a likely a carcinogen.

RoundUp also induces weed resistance, which has become an enormous problem for the industry. And most of it is used on GMOs. It’s a plant poison! Why would anyone think it would be good for health?

Are GMOs always bad?

The papaya that’s engineered to resist ring spot seems like a reasonable use of biotechnology to me. It saved the Hawaiian papaya industry. That’s the only example I can think of that’s beneficial. Most of the technology has been applied to commodity crops.

What about food insecurity? Can GMOs help?

If you want to help food-insecure nations, you need to empower them to do their own agriculture. That agriculture needs to be sustainable. GMO crops are not sustainable.  They require seeds, fertilizer, and pesticides, every year.


President Obama signs the Healthy Hunger-Free Kids Act in 2010

According to a new Rudd Center study, more kids are eating fruit at school. At the same time, there’s a lot of pushback against healthy foods at school.

In 2010, Congress passed the Healthy Hunger-Free Kids Act. That was bipartisan. Today, bipartisan seems out of the question. The Republicans want to roll the Act back. There’s no question it’s working in most schools that have people committed to it. There are huge advances being made in school food that carry over to food outside school. Kids come home and they want different foods because they see that eating healthy foods is valued.

How much is this change tied to school leaders compared to funding?

More funding would help. But some of the poorest schools have cafeterias where you walk in and the food smells good. They’re making it happen by cooking onsite with USDA commodity foods, which are unprocessed and cheap. Someone who knows how to cook can turn USDA surpluses into good meals. But not every school does that. I’ve been in schools where the food was terrible, the kids weren’t eating it, and the plate-waste was astronomical.  If the food service workers know the names of the kids, it’s a good sign the food will be good too.

For students interested in food and health, what sectors offer the most opportunity? Government? Nonprofit?

It depends on what you like. We need good people in government. It’s really important to have public health professionals work from within to make agencies like the FDA and Department of Agriculture do useful work. Everybody loves NGOs. It doesn’t matter which. Just do it!

Attend Marion Nestle’s Grand Rounds talk on April 1, 4:00-5:30 p.m., at Alumni Auditorium, 650 West 168th Street, or watch it on LiveStream.

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Jul 22 2014

Rest in Peace Mickey Stunkard

The Times’ obituary for Dr. Albert J. (“Mickey”) Stunkard, who died last week at the age of 92, describes his work on the genetics of obesity and quotes Dr. Walter Willett’s comment that genetics accounts for only a small part of the “legions of the obese.”

Stunkard was writing about the lifestyle and environmental determinants of weight gain, long before most of us had a clue.

I learned this in 2000 when Michael Jacobson and I were writing a paper on public health policy approaches to obesity prevention.[i]   We were arguing that policies aimed at preventing weight gain focused almost entirely on personal behavior but needed to focus on fixing the environment of food choice.

A peer reviewer scolded us for missing Stunkard’s work.

At last, we discovered Stunkard’s groundbreaking work.  In the published paper, we wrote:

The most notable exception [to the focus on personal responsibility] was the report of a 1977 conference organized by the National Institutes of Health (NIH) to review research and develop recommendations for obesity prevention and management.

In one paper, A.J. Stunkard thoroughly reviewed social and environmental influences on obesity.[ii]  As a result, the conference report included an extraordinarily broad list of proposals for federal, community, and private actions to foster dietary improvements and more active lifestyles.

These ranged from coordinated health education and model school programs to changes in regulations for grades of meat, advertising, taxes, and insurance premiums. Some of the proposals cut right to the core of the matter: “Propose that any national health insurance program…recognize obesity as a disease and include within its benefits coverage for the treatment of it.” “Make nutrition counseling reimbursable under Medicare.” And “Fund demonstration projects at the worksite.”[iii]

He was far ahead of his time and will be greatly missed.

References

[i] Nestle M, Jacobson MF.  Halting the obesity epidemic: A public health policy approach.  Public Health Reports 2000;115:12-24.

[ii] Stunkard AJ. Obesity and the social environment: current status, future

prospects. In: Bray GA, editor. Obesity in America. Washington:

Department of Health, Education, and Welfare (US); 1979. NIH Pub.

No.: 79-359.

[iii] Stunkard A. The social environment and the control of obesity. In:

Stunkard AJ, editor. Obesity. Philadelphia: WB Saunders; 1980. p. 438-

 

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Feb 26 2014

Is obesity really leveling off? Yes, and falling in kids ages 2 to 5!

The biggest story—front page, right column—in the New York Times today is CDC’s report of a 43% drop in obesity among children ages 2 to 5 in the last decade.

  • 2003-2004: 14%
  • 2011-2012:   8%

A change this large is highly unusual.

The data come from a report in JAMA which found no change in overall obesity prevalence in that decade among infants and toddlers, youth ages 2 to 19, or adults.  When looking at the data for subgroups, however, the authors found two exceptions:

  • The big decline in obesity among children ages 2 to 5
  • A big increase in obesity among women ages 60 and older (oops)

What to make of this?

The decline in obesity among young children is consistent with previous reports, although these showed a smaller change.

To examine what the data show, it helps to look at an illustration.  The JAMA paper does not provide one, but a reporter sent me this:

Screenshot 2014-02-26 08.17.27

The lower curve is for children ages 2 to 5.  It shows a sharp uptick in 2003-2004 (what was that about?), followed by a decline in 2007-2008.  The new data extend the decline a little further.

Any decline in the rising prevalence of obesity is cause for celebration.  So is the no change in a decade among almost everyone else.

The reasons?  I can only speculate but the “eat less junk food and move more” message must be getting out.

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Feb 6 2014

Is surgery really the best way to deal with obesity?

I received an e-mail message from Dr. Justine Davies, the editor of The Lancet Diabetes & Endocrinology, announcing a series of review articles on bariatric surgery for treatment of obesity.

Bariatric surgery, she says,

is the most effective treatment for both obesity and type 2 diabetes. In many people with type 2 diabetes, bariatric surgery not only limits disease progression, but also reverses complications.

She asks: So why is this procedure not being used more often to treat
patients with obesity?

Bariatric surgery has substantial benefits in terms of weight loss, metabolic status, and quality of life. It is safe and effective, and the future savings made through prevention of comorbid diseases could counterbalance its high cost. The surgery should, therefore, be available as an option to use when appropriate, and not only when all other options have been eliminated. Bariatric surgery offers a real opportunity for preventing comorbid diseases and complications of obesity. If it is only used as a final resort, this opportunity will be missed.

I can think of several good reasons: pain and suffering, treatment complications, questionable long-term prognosis, and cost, for starters.

Prevention is a better option.

If only we knew how….

Here are the papers:

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