Currently browsing posts about: Obesity-policy

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.”

I’m catching up on some reading over the long weekend.  Here are some selections from the latest issue of Childhood Obesity (Click here for the complete Table of Contents).

I’ve been asked to comment on the HBO series, Weight of the Nation and everything that comes with it: the accompanying book, the auxiliary videos, the distribution plan to schools and other institutions, and the Institute of Medicine’s report, Accelerating Progress in Obesity Prevention.

Because I wanted to look at all of it before commenting, plenty of others have beaten me to it, among them FoodandTechConnect’s infographic summary,   Kerry Trueman on AlterNet and Michele Simon on Grist.

I don’t have HBO but got sent the press kit, the Weight of the Nation book, the disks, and the IOM report.  I watched all four hours of the HBO series, plus the “Rethinkers” video of kids working on a school lunch project in New Orleans (air dates), plus the IOM and HBO books, plus the website.

Overall, Weight of the Nation makes the size, scope, causes, and consequences of obesity alarmingly clear.

The talking heads—many of them my friends, colleagues, and former students—all had plenty to say about what obesity means on a day-to-day basis for individuals and its personal and economic cost to society.

The programs ought to convince anyone that obesity is a big problem and that something big needs to be done to prevent it.

But doing something big, the series makes clear, will be very difficult.

This may be realistic, but it is not inspiring.

We need inspiration.   That’s why I wish the programs had focused as much on social responsibility as they did on personal responsibility.

I wanted to see the programs take leadership on how government can help citizens reduce the social, economic, and business drivers of obesity.

That kind of leadership exists.  To see it in action, watch the video of the New Orleans school “rethinkers.”  Those kids wanted to improve their school lunches.  They got busy, dealt with setbacks, and learned how to make the system work for them.  They “spoke truth to power” and “held feet to the fire.”

Why aren’t adults doing the same?   Politics, the IOM report explains.  Although one of its principal recommendations is critical—Create food and beverage environments that ensure that healthy food and beverage options are the routine, easy choice—its recommendations speak some truth to power but do little to hold feet to the fire.

The IOM report explains the political realities:

The committee’s vision takes into account the need for strategies to be realistic, as well as consistent with fundamental values and principles.  At the same time, however, having a diversity of values and priorities among them is itself a principle of U.S. society.

Potentially competing values and principles must be reconciled, for example, in considering protections needed for individuals versus the community at large or for the public versus the private sector.

Vigilance regarding unintended adverse effects of changes undertaken to address the obesity epidemic is also needed.

“Americans,” the report says, are accustomed to the current obesogenic environment, one “driven by powerful economic and social forces that cannot easily be redirected.”

It may not be easy to redirect such forces, but shouldn’t we be trying?

In 1968 the CBS documentary Hunger in America galvanized the nation to take action to reduce poverty and malnutrition.

The HBO series was equally shocking but I wish it had focused more on how we—as a society—could mobilize public distress about the poor quality of food in schools and the relentless and misleading marketing of sodas and junk foods that it so well documented.

But dealing with the need to address the social and economic forces that promote obesity would, I’m told, be considered lobbying, which the private-public sponsors of the series are not permitted to do.

Mobilizing public support for health is considered lobbying.  Food industry marketing is not.

FoodNavigator-USA.com columnist Caroline Scott-Thomas wrote about the HBO series:

As an industry journalist, I’ll be among the first to admit that industry is stuck in a very hard position here: On the one hand, it wants to be seen to be doing the right things – but on the other, what people say they want to eat, and what they actually do eat are often very different, and after all, food companies are in the business of making money.

But honestly, could industry do more to make healthy choices routine, easy choices? I think so.

Yes it could, but won’t unless forced to.

Without leadership, we are stuck doing what the food industry needs, not what the public needs.

Weight of the Nation did an impressive and compelling job of defining the problem and its causes and consequences.  I wish it—and the IOM—could have risen above the politics and pressed harder for strategies that might help people make healthier choices.

But—if the HBO programs really do help mobilize viewers to become a political force for obesity prevention, they will have been well worth the effort that went into making and watching them.

I’m getting caught up on my journal reading and didn’t want to miss this one.

The journal Childhood Obesity has a special issue of articles related to Michelle Obama’s Let’s Move! campaign.  Mrs. Obama wrote the foreword.

Here are some selections:

Let’s Move! Raising a Healthier Generation of Kids
First Lady Michelle Obama
Childhood Obesity. February 2012, 8(1): 1-1.
First Page | Full Text PDF|

Let’s Move! Progress, Promise, and the Miles Left To Go
David L. Katz
Childhood Obesity. February 2012, 8(1): 2-3.
First Page | Full Text PDF |

The latest obesity statistics from the Centers for Disease Control and Prevention show no change over the last several years in either adults or children.  No change is good news.

For adults in 2009-2010 the prevalence of obesity was 35.5% among men and 35.8% among women.  Obesity, in these surveys is defined as a Body Mass Index (BMI) at or greater than 30.

This represents no significant overall change compared to rates in 2003-2008.  

Going back to 1999, however, obesity rates increased significantly among men in general, and among black (non-Hispanic) and Mexican-American women in particular.  In more recent years, the rates among these groups leveled off.

 For children and adolescents in 2009-2010 the prevalence of obesity was 16.9%.  For this group, obesity is defined as a BMI at or greater than the 95th percentile of weight for height.

This represents no significant change compared to rates in 2007-2008, but with one exception: the rate of obesity among adolescent males aged 12 through 19 increased.

For decades, rates of overweight and obesity in the United States stayed about the same. But in the early 1980s, rates increased sharply and continued to increase through the 1990s.

The increases correlated closely with deregulatory policies that encouraged greater farm production and loosened restrictions on food marketing.  These led to an increase in the number of calories available in the food supply, pressures on food companies to sell those calories, a proliferation of fast food places, and marketing strategies that made it normal to drink sodas all day long, and to eat everywhere, at all times of day, and in larger portions.

Why are obesity rates leveling off now except among boys?  Nobody seems to know.

I can make up several reasons, all speculative (and I have my doubts about most of them).

• People have gained all the weight they can and are in equilibrium
• People are more careful about what they are eating
• The poor economy is encouraging people to eat less
• Junk food marketing is targeted more to boys
• Girls are more careful about their weight
• Boys are particularly susceptible to “eat more” marketing pressures
• Boys are under greater psychological tension and eat to relieve it

Anyone have any better ideas?  It would be good to figure out the reason(s) as a basis for more sensible public policy.

The amazing New York City Health Department, almost unique in its interest in public health and willingness to do what it can to improve the health of New Yorkers, adds another campaign to its collection of hard hitters.  This one is on the need to reduce portion sizes.

The subway campaign posters in Spanish and English.  Here’s an example in Spanish.

I especially like this campaign because much of the work on increasing portion sizes in the food supply was launched by my former doctoral student, now Dr. Lisa Young.  See:

• Young LR, Nestle M, The contribution of expanding portion sizes to the US obesity epidemic. American Journal of Public Health, 2002. 92(2): p. 246-9.
• Young LR, Nestle M, Expanding portion sizes in the US marketplace: implications for nutrition counseling. Journal of the American Dietetic Association, 2003. 103(2): p. 231-4.

Larger portions do three things:

• They have more calories, obviously.
• They induce people to eat more calories
• They induce people to underestimate the number of calories they are eating

All of these induce people to eat more than they need or should.

The expansion of portion sizes alone is sufficient to explain rising rates of obesity.

The Health Department’s campaign makes sense.  Let’s hope it helps.

Update, January 10: The American Beverage Association doesn’t like the ads much, according to Crain’s:

Portion control is indeed an important piece of the solution to obesity,” said said Stefan Friedman, New York spokesman for the American Beverage Association, in a statement. “But instead of utilizing scare tactics, the beverage industry is offering real solutions like smaller portioned containers and calorie labels that show the number of calories in the full container, right up front, to help people chose products and sizes that are right for them and their families.

And if you think the New York City ads are tough and hard-hitting, try these “Strong4Life ads from the state of Georgia.  Shocking people out of complacency?  Or just shocking?

Update, January 25: The New York Times reports that the shocking photograph of an overweight man with a leg amputation was “photoshopped” from a stock photo.

This is unfortunate, as it opens the Health Department up to unnecessary criticism:

The American Beverage Association, which opposes the city’s efforts against sodas and fast food, called the advertisement overwrought. “This is another example of the ‘What can we get away with?’ approach that shapes these taxpayer-funded ad campaigns,” Chris Gindlesperger, the association’s director of communications, said in a statement.

I subscribe to The Lancet, and always enjoy reading its editor’s weekly Offline column.  In October, editor Richard Horton wrote about how  government obesity policy needs to be based firmly on scientific evidence.

And what is that evidence?

On this question, the evidence is utterly clear.  Thanks to the work of the best scientific minds in obesity research, the most reliable evidence shows that the government’s plan should include taxes on unhealthy foods and beverages, front-of-pack traffic-light nutrition labeling, reductions of junk food and drink advertising to children, and school-based programmes to reduce television viewing and sugar-sweetened beverage consumption (Lancet, 2011;378:1451).

If you care about public health evidence, that’s what it shows.  But doing these things goes against the business interests of food companies and they are doing everything they can to oppose such science-based measures.

In the U.S., the Sunlight Foundation has just released a report detailing the amounts of money food companies have spent on lobbying to block federal attempts to set nutritional standards for marketing foods to children (see previous posts).

Big companies such as Nestle, Kellogg, Viacom, McDonalds, General Mills, and Time Warner have indicated on official reports that they have lobbied on the controversial proposed guidelines; all together such companies have reported spending more than $37 million on lobbying this year.

The Sunlight report lists reported lobbying expenses (for example, Coca-Cola $4.7 million, General Mills $660,000).  It also points out that

…Over all public relations were handled by Anita Dunn, formerly communications director at the Obama White House, at the firm SKDKnickerbocker Consulting.

Anita Dunn is of special interest because of her previous position at the White House.  Now she’s working for the not-so-loyal opposition.  Marian Burros reported on this switch for Politico:

Dunn, who served as White House communications director, is a senior partner at SKDKnickerbocker Consulting, which is handling public relations for the food industry’s campaign. Switching sides isn’t uncommon in the incestuous world of Washington consulting and lobbying, and the food industry coalition seeking to scuttle the voluntary guidelines argues that they are actually enforceable regulations in disguise that could lead to billions in lost sales.

Dr. Horton’s comments in Lancet imply that the British government isn’t doing much better.

As for the European Union (EU),  Food Chemical News reported on December 8 that major food companies— McDonald’s, Burger King, Coca-Cola, Danone, Kellogg, Mars, Nestlé, PepsiCo, Procter & Gamble and Unilever, as well as the European Snacks Associations—have just pledged to promote only healthful products on their websites aimed at children under age 12.

By “healthful,” they mean products that meet “better-for-you” criteria.  Food Chemical News cites a study suggesting that European children now see 79% less advertising of really bad junk foods on kids’ TV than they did in 2005, and 29% less across all TV programs.

The study did not say whether sales of those products were down too. If not, this could explain the willingness of companies to extend the voluntary restriction to websites aimed at very young children.

All of this would be much simpler for parents if governments paid attention to the research.  If they did, they would:

• Tax unhealthy foods and beverages
• Require traffic-light front-of-pack labels
• Stop junk food and drink advertising to children
• Institute programs to reduce television viewing
• Institute programs to reduce sugar-sweetened beverage consumption

Taken together, these might actually make some progress in reducing childhood obesity.

The UK Government has “quietly disbanded” its independent advisory group on obesity.  Apparently, it didn’t like the advice it was getting.

The firing is quite understandable.  The group was appointed by the previous government as a result of recommendations in what is known as the Foresight report: Tackling Obesities: Future Choices.   This report advised mapping out strategies for obesity interventions that went way beyond education about personal food choices.

The expert group followed this advice and recommended public health programs to change the food environment and counter food industry marketing.

The new government, however, prefers a “nudge” strategy.  Derived from behavioral economics, “nudge” involves no compulsion (e.g., taxes on junk foods).  Instead, people are free to follow advice to eat better but don’t have to.

Thus, the government’s Call to Action on Obesity in England focuses on individual responsibility and says nothing about the influence of food and drink marketing on food choices.

Two members of the expert committee, Goeffrey Rayner and Tim Lang, have publicly criticized “nudge” as “a smokescreen for inaction.”

No wonder the group was fired.

But as Professor Lang explains:

The closure of the expert advisory group is bad news all round: bad politics, bad policy, and bad science. It shuts the door on an important attempt by the state to recognise the systemic nature of what drives obesity…It’s plain as a pikestaff that obesity requires systems change, not a tweak here and there, yet that is what is being offered.

Doing something about obesity requires eating less and eating better, both very bad for business.   For this UK government, business interests trump those of public health.