Currently browsing posts about: Obesity

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. 

Here’s my once a month on the first Sunday Food Matters column for the San Francisco Chronicle, out today:

Nutrition and public policy expert Marion Nestle answers readers’ questions in this column written exclusively for The Chronicle. E-mail your questions to food@sfchronicle.com, with “Marion Nestle” in the subject line.

Q: I’m confused about calories. If I cut calories to lose weight, does it matter what foods I eat? Or are all calories the same?

A: As the co-author of “Why Calories Count: From Science to Politics,” I hear this question all the time.

The short answer: Calories matter for weight. The choice of foods that provide the calories matters a lot for health and may make it easier for you to diet successfully.

To lose weight, reducing calorie intake below expenditure works every time.

To prove this point, a professor at Kansas State University lost 27 pounds in 10 weeks on the Twinkies diet – one Twinkies every three hours with occasional snacks of chips, sugary cereals and cookies. Even so, he cut his usual calorie intake by 800 a day. Anyone would lose weight doing that.

Only four dietary components provide calories: fat (9 per gram), carbohydrate and protein (4 per gram each) – and alcohol (7 per gram).

Does the particular mix of these components make any difference to weight loss? Yes, say proponents of diets low in carbohydrate, especially rapidly absorbable sugars and refined starches.

Low-carbohydrate diets are necessarily high in fat, and somewhat higher in protein. Do people lose weight on them because of the effects of carbohydrates on insulin levels or because low-carbohydrate diets help reduce calories?

This question does not have an easy answer, but not for lack of trying. Weight-loss studies are hard to do. Estimating calorie intake is notoriously inaccurate, and measuring calories is difficult and expensive.

The first measurement study I know of took place in 1964. Investigators from the Oakland Institute for Medical Research studied weight loss in five obese patients in a hospital metabolic ward. They calculated the number of calories needed to induce rapid weight loss in each patient, and fed each of them a liquid formula diet containing that number every day. Every few weeks, they changed the formula to vary the proportions of protein (ranging from 14 percent to 36 percent of calories), fat (12 percent to 83 percent), and carbohydrate (3 percent to 64 percent).

Regardless of the proportions, all patients lost weight at a constant rate. The investigators titled their study “Calories Do Count.”

This study was conducted under rigidly controlled conditions of hospitalization and involved actual measurements – not estimations – of calorie intake and body weight.

But what about weight-loss studies involving people who are not incarcerated? Since the early 2000s, numerous clinical trials have shown low-carbohydrate diets to produce greater weight loss than low-fat diets. Some also have observed improvements in blood pressure, blood glucose levels and blood lipids.

But it is so inaccurate to estimate calorie intake in such studies that most didn’t bother to try. This means they can’t say whether the weight loss was due to composition of the diet or to calorie reduction.

It’s possible that low-carbohydrate, high-fat diets make people less hungry, but the evidence for this is mixed. Most studies of extreme diets of any type report high dropout rates or failure to stick to the diet for more than six months or so. And even though initial weight loss is rapid on low-carbohydrate diets because of water loss, these diets are low in fiber and some vitamins.

One problem with losing weight is that it takes fewer calories to maintain smaller bodies. Dieting also reduces energy expenditure.

One recent study of that problem involved taking detailed measurements for several years, and illustrates the difficulties of obtaining definitive answers to questions about diet composition and energy balance.

The researchers wanted to know whether diet composition affected energy expenditure in very obese people who had just dieted off up to 15 percent of their weight. They found that a low-carbohydrate diet did not slow down energy expenditure nearly as much as a low-fat diet, meaning that low-carbohydrate diets might make it easier for people to maintain weight loss.

On this basis, the investigators said, “The results of our study challenge the notion that a calorie is a calorie from a metabolic perspective.”

Perhaps, but study subjects were fed prepared calorie-controlled diets for only four weeks, and lost and maintained weight under highly controlled conditions. Does diet composition matter for weight maintenance in the real world? Longer-term studies by other investigators show that diet composition makes little difference in the ability to maintain weight loss.

Most reviews of the subject conclude that any diet will lead to weight loss if it cuts calories sufficiently.

Obviously, some diets are better for health than others.

Face it. The greatest challenge in dieting is to figure out how to eat less – and to eat healthfully on a regular basis – in the midst of today’s “eat more” food environment. And that’s a much more important research problem than whether low-carbohydrate or low-fat diets work better for weight loss.

Marion Nestle is an author and a professor in the nutrition, food studies and public health department at New York University. She blogs at foodpolitics.com. E-mail: food@sfchronicle.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?

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.”