Currently browsing posts about: Obesity

I am a member of the editorial board of the Journal of Public Health Policy, which publishes research and commentary on matters that affect international public health.  Dr. Anthony Robbins, one of its editors, and I are calling on authors to submit articles that consider ways to change behavior—not, as is all too common, of individuals but of the food industry.

The journal has published many papers on obesity policies aimed at improving the diet and exercise behavior of individuals.  These may be necessary, but they are not sufficient.  It is now time to deal with the behavior of the food industry.  Food industry profits are

generated by capturing increasingly larger shares of the market and by selling the population more food – and calories –than it needs. In this marketing environment, obesity is collateral damage.

The food industry’s ultimately anti-social behavior – whether conscious or inadvertent – is spreading globally. In higher income countries, it is ubiquitous, whereas in places where people have less disposable income, it is but the camel’s nose under the tent.

Thus, effective strategies to reduce obesity may vary depending on penetration by the industry – and less developed nations may still have more opportunities to avoid obesity, by getting ahead of the curve.

How are countries to do this?

Efforts to control obesity will have to enlist the public to focus on behavior, with a shift from a sole focus on citizens to a new one on the behavior of food corporations…We cannot eliminate the food industry to reverse the obesity epidemic, but we can constrain its anti-social behavior…We encourage authors to reach beyond the kind studies of policies on eating and activity that we receive so frequently.

We have come to believe that research studies concentrating on personal behavior and responsibility as causes of the obesity epidemic do little but offer cover to an industry seeking to downplay its own responsibility.

Instead, we urge authors to submit articles that consider how to understand and change the behavior of the food industry.

As a starting point for thinking about how to approach this topic, we ask: does the industry need to overfeed the population to remain profitable?

Have ideas?  Write them up and submit them to JPHP.  There is no deadline.  The journal will consider submissions whenever they arrive, but sooner is better than later.

I was interested to read Charles Blow’s comment in the New York Times (March 12) on the results of a recent Pew Research Center poll.  The question: Should the government should have a role in obesity prevention?

Nearly 60 percent said yes. Only about 40 percent said no.  Blow comments:

This is a remarkable change in public sentiment from 2005 when the Harvard School of Public Health asked a similar question and got almost the exact opposite result.

So what happened in the intervening years? One major occurrence has been the push by the president and first lady to combat the problem. Their initiatives promote commonsense approaches like increased breast-feeding, better diets and more exercise. Who could argue with that? The right, that’s who.

Blow presents the obesity statistics for states won by John McCain in 2008 (see below).  His conclusion:

This really shouldn’t be a partisan issue. This should be an all-hands-on-deck issue, including the hands of the government.

And red states, many of which are now the biggest losers in the fight against childhood obesity, have the most to gain.

To me, the interesting thing about this table is what we public health people call “tracking.”  Obesity tracks (correlates) with other measures of poor health—diet, activity, prenatal care, health care—all of which also correlate closely with poverty.

The curiosity here is why people who lack access to education, health care, and, for that matter, healthful diets would vote for candidates who don’t want them to have those things, but that’s American politics for you.

To my pleasant surprise, editorial writers in the conservative press defended Michelle Obama’s Let’s Move campaign against attacks by even more conservative critics (I’m still catching up with what I missed on vacation).

December 26 Washington Post: Op-ed: “How did obesity become a partisan fight?, by Fred Hiatt , editorial page editor:

Well, yes, if Michelle Obama is for it, someone will be against it. Someone like Glenn Beck, for example, who was moved to rail against carrot sticks, or Sarah Palin, who warned that Obama wants to deprive us all of dessert.

And when you look a little deeper, it’s not surprising that a crusade seemingly beyond questioning would become a political battle.

Interests that might feel threatened by Let’s Move include the fast-food industry, agribusiness, soft-drink manufacturers, real estate developers (because suburban sprawl is implicated), broadcasters and their advertisers (of sugary cereals and the like), and the oil-and-gas and automotive sectors (because people ought to walk more and drive less).

Throw in connections to the health-care debate (because preventive services will be key to controlling the epidemic), race (because of differential patterns of obesity) and red state-blue state hostilities (the reddest states tend to be the fattest), and it turns out there are few landmines that Michelle Obama didn’t trip by asking us all to shed a few pounds.

Hiatt’s piece ends with “It’s not going to be easy,” Michelle Obama says. She’s right – but also right to keep pushing.”

December 27 Wall Street Journal: Editorial: “Palin’s Food Fight.”

President Obama’s indiscriminate expansion of federal power has inspired a healthy populist rebellion, but his opponents sometimes seem to lose their sense of proportion. Take Sarah Palin’s mockery of Michelle Obama’s childhood antiobesity campaign.

The first lady has emphasized more nutritious school lunches but mostly encourages parents to make sure their kids eat healthy and exercise. Mrs. Palin sees a big government plot.

…No one hates the nanny state more than we do, but Mrs. Obama isn’t exactly ordering up Lenin’s Young Pioneers. Adults do have an obligation to teach children how to live, and that includes adults who are role models by dint of their national prominence….Telling kids to eat their vegetables and run around the block is merely instructing them to take responsibility for their own choices.

With this kind of support, real progress is possible.  How’s that for an optimistic note on which to start the new year?

Occasionally I write short pieces on request.  A couple have just been published.

The State Department’s Bureau of International Information Programs (who knew?) runs a website, America.gov, on which it provides answers to questions “YOU Asked!”   It invited me to respond to the question, “Why are so many Americans overweight.”

And the professional journal, Childhood Obesity, asked several people to contribute to its new “Industry Watch” column.  The question: “Will private sector companies “step up to the plate” to protect children’s health?

Enjoy!  I file links to these and other writings under Publications on this site.

FoodNavigator.com has a special issue on obesity research.  Its reports are based on single studies that may or may not agree with previous research and, therefore, require some interpretation.

Zero-calorie sweeteners do not prompt overeating, finds study: People do not compensate with extra calories after consuming foods and drinks sweetened with zero-calorie sweeteners, suggests a new study published in the journal Appetite…

Fruit flies help explain why diet success varies: A study on fruit flies has indicated that genetic interaction with diet has a greater impact on body weight than diet alone, which the researchers say can help explain different reactions to similar diets….

Sucralose does not promote weight gain: Human study: Consumption of sucralose and sucralose-sweetened products does not affect gut hormones linked to hunger, or detrimentally affect blood sugar levels, says a new study from Australia….

Food addiction: Fat may rewire brain like hard drugs: Overeating may be driven by a same neurobiological mechanism in the brain as drug addition, says a new study from the US that adds clout to the theory ‘food addiction’….

Overeating drives fat gain at the hips, says obesity-related study: Fat tissues in the upper and lower body may gain weight differently, says a new study which deepens our understanding of fat accumulation and obesity….

Two of these studies are about the effects of artificial sweeteners on hunger, satiety, calorie intake, and weight gain.  In contrast to previous studies, both of these find that sweeteners do not cause people to eat more to compensate for the reduced calories.

I’m guessing we will be hearing more about this topic, as new research results come in.  Stay tuned.

Jeffrey Koplan (Emory) and Kelly Brownell (Yale) have a commentary in JAMA (October 6) titled “Response of the food and beverage industry to the obesity threat.”   They describe how the food and beverage industries:

• Associate their products with health
• Frame the issues to emphasize balance or physical activity
• Pick and choose the science
• Reformulate products to make them appear healthier
• Defend themselves and attack critics

Sound familiar?  For details, see  Michele Simon’s excellent book, Appetite for Profit: How the Food Industry Undermines Our Health and How to Fight Back (Nation Books, 2006).

Addition, October 10: Lori Dorfman of the Berkeley Media Studies Group reminds me about its 2007 Framing Brief, “Reading between the lines: understanding food industry responses to concerns about nutrition.”  This group’s publications are always terrific resources for educating and taking action on food issues.

OECD (the Organization for Economic Cooperation and Development), a group of 33 countries “committed to democracy and the market economy,” has just released a major report on obesity.

Its main conclusion?  The United States population has the highest percentage of overweight and obesity in the democratic, market-economy world.

The report’s conclusion?

Individual interventions have a relatively limited impact; therefore, comprehensive strategies involving multiple interventions to address a range of determinants are required to reach a “critical mass” – one that can have a meaningful impact on the obesity epidemic by generating fundamental changes in social norms. The development of comprehensive prevention strategies against obesity needs to focus on how social norms are defined and how they change; on the influence of education and information on obesity but also on the potential for government regulation to affect behaviours; and on the role of individual choice and values. A sensible prevention strategy against obesity would combine population and individual (high-risk) approaches.

Buried in this paragraph are some important concepts: societies need to change social norms as well as individual behavior, and governments need to intervene to make the social environment more conducive to healthier practices.

Nancy Hellmich of USA Today attempted a translation of some of the recommendations for individuals:

• Individual lifestyle counseling by family doctors and dietitians may be the most effective to increase the life expectancy and quality of life for people who are obese or at risk of becoming so.
• Individual counseling should be supplemented with health-promotion campaigns, compulsory food labeling and cooperation between industry and government in the regulation of food advertising to kids.

The report breaks down data by country.  Here are ours.

Anti-tobacco advocates have been worried for years that concerns about obesity would draw funding away from anti-smoking initiatives (see previous posts).  Their fears are justified, as described in today’s New York Times and in a recent editorial in the New England Journal of Medicine.

Years of experience have taught anti-smoking advocates that countering the marketing efforts of cigarette companies required constant vigilance.  It also taught them that cigarette companies take immediate advantage of any weakening of resistance to their efforts.

Cigarettes remain the leading cause of preventable deaths among Americans.  Cigarette marketing aimed at children remains a national—and international—public health scandal.

Health should not be a zero-sum game.  Anti-obesity advocates have much to learn from anti-smoking advocates.  How about joining forces to improve the health of Americans?