Currently browsing posts about: Obesity-policy

JAMA Internal Medicine has just published an editorial I wrote: Preventing Obesity—It Is Time for Multiple Policy Strategies

As it explains, it is a commentary on a research article by Joshua Petimar, et al, Assessment of Calories Purchased After Calorie Labeling of Prepared Foods in a Large Supermarket Chain  

Both papers are behind paywalls, but here are the key points of the supermarket article:

Question  Was calorie labeling of prepared foods in supermarkets associated with changes in calories purchased from prepared foods and potential packaged substitutes?

Findings  In this longitudinal study of 173 supermarkets followed from 2015 to 2017, calories purchased from prepared bakery items declined by 5.1% after labeling, and calories purchased from prepared deli items declined by 11.0% after labeling, adjusted for prelabeling trends and changes in control foods; no changes were observed among prepared entrées and sides. Calories purchased from similar packaged items did not increase after labeling.

Meaning  Calorie labeling of prepared supermarket foods was associated with overall small declines in calorie content of prepared foods without substitution to similar packaged foods.

I was really interested in this study because the “large supermarket chain” that supplied reams of data was so obviously Hannaford, which has long been ahead of the curve in trying to encourage customers to make healthier food choices.

In 2005, Hannaford initiated a Guiding Stars program that ranked–and still ranks–products by giving them zero to three stars depending on what they contain.

I wrote about the first-year evaluation of this program way back in 2006.  It did help customers to make better choices.

Now, all these years later, the FDA is contemplating doing some kind of front-of-package label.  As I said, Hannaford is way ahead.

But the point of my editorial is that single interventions rarely do better than what this study found.

I argue here for trying multiple strategies at once:

My interpretation of the current status of obesity prevention research is that any single policy intervention is unlikely to show anything but small improvements.

Pessimists will say such interventions are futile and should no longer be attempted.

Optimist that I am, I disagree.  We cannot expect single interventions to prevent population-basedweight gain ontheirown,but they might help some people—and might help even more people if combined simultaneously with other interventions.

….Widespread policy efforts to reduce intake of ultraprocessed foods through a combination of taxes, warning labels, marketing and portion-size restrictions, dietary guidelines, and media education campaigns, along with policies for subsidizing healthier foods and promoting greater physical activity, should be tried; they may produce meaningful effects.

Politically difficult? Of course. Politically impossible? I do not think so.

Unless we keep trying to intervene—and continue to examine the results of our attempts—we will be settling for the normalization of overweight and the personal and societal costs of its health consequences.

Here’s Ted Kyle’s commentary on my commentary on ConscienHealth.

I was struck by headlines last week stating that a CDC study found that 78% of people hospitalized with Covid-19 were overweight or obese.

78%?  That is an enormous percentage.

I looked up the study: Body “Mass Index and Risk for COVID-19–Related Hospitalization, Intensive Care Unit Admission, Invasive Mechanical Ventilation, and Death — United States, March–December 2020.”

Summary

What is already known about this topic?

Obesity increases the risk for severe COVID-19–associated illness.

What is added by this report?

Among 148,494 U.S. adults with COVID-19, a nonlinear relationship was found between body mass index (BMI) and COVID-19 severity, with lowest risks at BMIs near the threshold between healthy weight and overweight in most instances, then increasing with higher BMI. Overweight and obesity were risk factors for invasive mechanical ventilation. Obesity was a risk factor for hospitalization and death, particularly among adults aged <65 years.

What are the implications for public health practice?

These findings highlight clinical and public health implications of higher BMIs, including the need for intensive management of COVID-19–associated illness, continued vaccine prioritization and masking, and policies to support healthy behaviors.

The data supporting the headline are found in Table 1 in the paper.  This shows that overweight and obesity do indeed account for 78% of hospitalizations, but also close to that percentage for ICU visits and mechanical ventilation, but “only” 73% of deaths.

Overweight and obesity were especially risky for people under age 65, although they caused plenty of problems for people over age 65 too.

Why do they make Covid-19 worse?  The best guesses have to do with inflammation and mechanical pressure on lungs.

I found these figures shockingly high.

Shouldn’t we be doing all we can to reduce the risks for overweight and obesity?  Yes we should.

And what are those risks?

• Poverty
• Racial discrimination
• Inadequate schools
• Unemployment
• Lack of adequate health care
• Air pollution
• And, of course, poor diets

If Covid-19 has taught us anything, it is that to prevent its bad effects, we need vaccinations and masking for sure, but we also need to change society.

Trust for America’s Health has just issued its annual report on obesity in America.

The full report is here.

The results are truly alarming, especially because obesity—and the conditions for which it increases risk—also increase the risk of poor Covid-19 outcome.

The U.S. adult obesity rate stands at 42.4 percent, the first time the national rate has passed the 40 percent mark, and further evidence of the country’s obesity crisis. The national adult obesity rate has increased by 26 percent since 2008…Rates of childhood obesity are also increasing with the latest data showing that 19.3 percent of U.S. young people, ages 2 to 19, have obesity. In the mid-1970s, 5.5 percent of young people had obesity.

The report has a special section on the link between food insecurity and obesity.

Food insecurity and obesity have many of the same risk factors (e.g., income or race/ethnicity) and often coexist in populations. Researchers have hypothesized several mechanisms for how food insecurity might lead to obesity. These include the direct limitations to a healthy diet that come from inadequate food affordability and/or availability; stress and anxiety about food insecurity
that generate higher levels of stress hormones, which heighten appetite; and a physiological response in which the body stores higher fat amounts in response to reduced food availability.

As always, this is a terrific source of current information about America’s increasingly prevalent health problem and what’s being done—and needs to be done—to solve it.

The Mexican state of Oaxaca became the first to ban the sales of junk foods to children under the age of 18.

The state of Tabasco did the same.

A dozen other Mexican states are considering similar actions.  The rationale is clear: the health consequences of obesity in general and with Covid-19 in particular.

One-third of Mexicans aged 6 to 19 are overweight or obese, according to UNICEF. They may not be disproportionately affected by COVID-19 now, but they can suffer myriad health issues, especially in adulthood.

And Mexico’s new warning labels are now in effect and will be required for all packaged foods by the end of the year.

Mexico has been able to implement these measures despite overwhelming food industry opposition.

How?  I credit the outstanding advocacy work of the Mexico’s National Institute of Public Health and the consumer coalition, Alianza por la Salud Alimentaria.

Boris Johnson, the UK’s admittedly overweight prime minister, has suddenly become a champion of anti-obesity policy, following his bout with Covid-19.

As the Washington Post puts it, “Boris Johnson says ‘I was too fat’ as he launches anti-obesity campaign.”

The campaign is based on two reports, one detailing the high and growing prevalence of obesity in Great Britain and its links to Covid-19 susceptibility.

The second is a government policy report, which says it is

• introducing a new campaign – a call to action for everyone who is overweight to take steps to move towards a healthier weight, with evidence-based tools and apps with advice on how to lose weight and keep it off
• working to expand weight management services available through the NHS [National Health Service], so more people get the support they need to lose weight
• publishing a 4-nation public consultation to gather views and evidence on our current ‘traffic light’ label to help people make healthy food choices
• introducing legislation to require large out-of-home food businesses, including restaurants, cafes and takeaways with more than 250 employees, to add calorie labels to the food they sell
• consulting on our intention to make companies provide calorie labelling on alcohol
• legislating to end the promotion of foods high in fat, sugar or salt (HFSS) by restricting volume promotions such as buy one get one free, and the placement of these foods in prominent locations intended to encourage purchasing, both online and in physical stores in England
• banning the advertising of HFSS products being shown on TV and online before 9pm and holding a short consultation as soon as possible on how we introduce a total HFSS advertising restriction online

The UK food industry does not like this.  It insists that this campaign is “a terrible missed opportunity.”

I was interested to see Hank Cardello’s comment on this (Cardello is with the conservative Hudson Institute in the US): “How A Libertarian Is Tackling Obesity And Why Big Food Should Worry.”  Cardello thinks that Johnson’s efforts are the wave of the future.  The food industry should stop fighting public health measures, he says.  Instead, it should:

• Get ahead of imposed regulations instead of resisting change. Instead of fighting public health initiatives, they can lead the way with research that defines workable steps to reverse the obesity crisis.
• Educate with public service ads. It’s time that food and restaurant corporations air public service announcements (PSAs) about healthy eating and the impact of high sugar, salt and fat on health and obesity.
• Commit to a BHAG (”Big Hairy Audacious Goal”). They can decide, for instance, that at least 50% of the products they sell will be healthier versions or in smaller portions.

Wouldn’t that be terrific, and it’s great that he’s saying so (I keep telling him that he sounds more like me every day).

But can food companies follow his advice?  Not as long as they put profits to shareholders, first, alas.

That’s what really needs to change.

I learned about this from a tweet.

I recognized the clip.  It was from an interview I did in January in Toronto: TVO’s The Agenda: Battling bias in nutrition research (slso on YouTube, and in transcript).  Nam was the terrific interviewer.

But do not miss Minhaj’s last Patriot Act episode of 2019, “How America is Causing Global Obesity.”  This is a brilliantly researched account of obesity politics, from food industry influence to trade policy.

I couldn’t have done better myself and dearly wish I had his production team (and his performance ability).

On World Obesity Day, I posted links to three recent reports.

An editorial in The Lancet made me realize that I had not read this one nearly carefully enough.  It deserves careful reading.

It comes from Sallie Davies, who just stepped down as Britain’s Chief Medical Officer.  In another Lancet piece, she and her colleagues insist that children have a right to live in a healthy environment:

Today, government legislation is necessary not simply because we have an obligation to protect vulnerable children, but because children have rights. The UN Convention on the Rights of the Child (UNCRC), the most widely ratified international human rights treaty, sets out children’s rights to protection, education, health and health care, shelter, and good nutrition…a child rights approach requires us to recognise childhood obesity as the responsibility of the state and as an issue that must be addressed across society…It is time to address childhood obesity as a rights issue.

In her report, she insists that government should enact legislation to ensure a healthy food environment; Annex A lists recommendations:

• Increase taxes on sugary drinks
• Require product reformulation to reduce sugar and calories
• Tax unhealthy foods
• Label calories
• Provide free drinking water
• Remove tax exemptions for advertising
• Phase out marketing of unhealthy products
• Ban eating and drinking on public transport
• Only permit healthy options at sports facilities
• Promote smaller portion sizes

Her report also suggests ways to promote physical activity.

Worth a try?  I think so.

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.