Currently browsing posts about: Obesity

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.

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.

I subscribe to a weekly or so news feed from the International Association for the Study of Obesity (IASO) in the U.K.  (to sign up, contact newsnet@iaso.org).

Here are some of the items from the October 27 feed:

• US: Consumer groups complain over ‘stealth’ PepsiCo ads
• US: Tell McDonalds to stop hyping unhealthy fast food to kids
• Ireland: Why tax on sugar is a sweet idea for health
• US: Global Sports and Energy Drinks market could hit $52bn by 2016
• US: Researchers question link between sugary drinks and health risk
• US: Researchers find link between sugary drinks and aggression

It’s a good way to keep up on the sugary drinks controversy, if nothing else.

Here are some of the latest reports on how food marketing influences eating patterns and obesity.

American University’s Kogod School of Business publishes a business magazine, Kogod Now.  It latest CoverStory takes a tough look at at how targeted marketing of foods and beverages contributes to the obesity crisis, especially among minority children and adolescents.

Cornell University’s Pierre Chandon and Brian Wansink ask the question, “is food marketing making us fat?”  Their review of the research leads them to conclude that a “small steps” approach ought to help reverse obesity.   Recent analyses, however, suggest that reversing overweight is likely to take a lot more than small steps, but it’s worth reading what they have to say about marketing practices.

Two reports from Canada indicate that industry self regulation has little effect on actual food industry marketing practices.  Instead, banning the marketing of junk foods, as has been accomplished in Quebec, works somewhat better.

The American Academy of Pediatrics takes a look at how television watching affects obesity in children.  If kids watch a lot of TV–and they have a TV set in their bedrooms—they are at high risk of becoming obese.  The obvious conclusion?  Get rid of the TV!

It is heartening that so much of the research on obesity these days focuses on changing the food marketing environment.  Now if policymakers would just pay some attention!

My mailbox is overflowing with new reports and commentary about obesity.  Here are some examples:

State medical expenses: The journal, Obesity, has an analysis of the cost of obesity to states.  Obesity costs states an additional 7 to 11% in medical expenses. Between 22% (Virginia) and 55% (Rhode Island) of state costs of obesity are paid by taxpayers through Medicare and Medicaid.

Robert Wood Johnson Foundation series on preventing childhood obesity: 

• Food marketing to children: U.S. Businesses Show Mixed Progress on Marketing a Healthy Diet to Children and Adolescents
• Industry self-regulation: Self-Regulation by Food and Beverage Industry Does Little to Reduce Kids’ Exposure to Unhealthy TV Ads
• New York City’s menu labeling regulation: Customers Who Use Menu-Labeling Information Order Fewer Calories
• The ban on sugar-sweetened drinks in Boston schools: Boston High School Students Drinking Fewer Sugary Beverages

From the Campaign to End Obesity:

Obesity Rates Projected to Soar, ABC News, 8.25.11: Will half the U.S. population be obese by 2030? The current trajectory would see 65 million more obese adults, raising the national total to 164 million. Roughly one-third of the U.S. population is currently obese.

In U.S., Obesity Rates Remain Higher Than 20% in All States, Gallup, 8.25.11: Colorado continues to be the state with the lowest obesity rate in the country, at 20.1% in the first half of 2011. West Virginia has the highest obesity rate in January through June 2011, at 34.3%, which is also the highest Gallup has measured for any state since it began tracking obesity rates in 2008.

Reversing the obesity epidemic will take time, LA Times, 8.26.11: The old rule that cutting out or burning 500 calories a day will result in a steady, 1-pound-per-week weight loss doesn’t reflect real people, researchers say. For the typical overweight adult, every 10-calorie-per-day reduction will result in the loss of about 1 pound over three years.

I’ve commented on some of these in previous posts.  If you find the avalanche of studies overwhelming, you are in good company.  I do too, but will summarize my take on the literature in my forthcoming book with Malden Nesheim, Why Calories Count: From Science to Politics, due out from University of California Press in March 2012.  Stay tuned.

The British journal, The Lancet, has a special series of papers on obesity and obesity policy, just out.

Don’t miss the Body Weight Simulator! It’s great fun to play with while waiting out a hurricane.

You type in your age, weight, and height (you can change the metrics to pounds and inches), and indicate your activity level.  It tells you how many calories you can eat every day to maintain that weight (Yikes!  That’s all? No wonder I have so much trouble).

It also tells you how many calories you need to reduce in order to lose weight over whatever time period you specify.

And here are the papers, reviews, and commentaries (you will need to log in to read more than the summary):

The future challenge of obesity
David King
Full Text | PDF

Reversing the tide of obesity
William H Dietz
Full Text | PDF

Where next for obesity
Harry Rutter
Full Text | PDF

The global obesity pandemic: shaped by global drivers and local environments
Boyd A Swinburn, Gary Sacks, Kevin D Hall, Klim McPherson, Diane T Finegood, Marjory L Moodie, Steven L Gortmaker
Summary | Full Text | PDF

Health and economic burden of the projected obesity trends in the USA and the UK
Y Claire Wang, Klim McPherson, Tim Marsh, Steven L Gortmaker, Martin Brown
Summary | Full Text | PDF

Quantification of the effect of energy imbalance on bodyweight
Kevin D Hall, Gary Sacks, Dhruva Chandramohan, Carson C Chow, Y Claire Wang, Steven L Gortmaker, Boyd A Swinburn
Summary | Full Text | PDF

Changing the future of obesity: science, policy, and action
Steven L Gortmaker, Boyd A Swinburn, David Levy, Rob Carter, Patricia L Mabry, Diane T Finegood, Terry Huang, Tim Marsh, Marjory L Moodie
Summary | Full Text | PDF

It used to be that the “soda wars” referred to Coke vs. Pepsi.  No more.  Today’s soda wars are fought on the health front, as more and more evidence links sugary drinks to obesity and other health problems.

The current issue of the New Yorker has an article by John Seabrook (in which I am briefly quoted) about Pepsi’s attempt to “health up” its snacks and drinks.

Seabrook’s article, “Snacks for a fat planet,” describes the extraordinary amount of money and effort Pepsi is spending to try to tweak its products to make them seem healthier.  His article doesn’t exactly give Pepsi a pass (as some of my readers have complained), but it does not really come to grips with how sugary drinks and snacks affect health or how Pepsi is marketing its products in developing countries.

That, no doubt, is why Pepsi has sent out a press release to reports that enclosed the complete article and suggested that reporters might be “interested in the company’s focus on its innovative approach to:”

• Reduce salt, fat and sugar across the portfolio – the New Yorker feature explains PepsiCo’s effort to re-shape natural salt so that it has more surface area, and, in turn, is perceived as “saltier” on the tongue – meaning they can maintain all the salty flavor in Lay’s but reduce overall sodium content
• Scale more drinks and snacks made with whole grains, fruit, vegetables and dairy to new markets – e.g. bringing vegetable-based gazpacho (perhaps with an edible whole grain spoon) to the U.S.
• Test new ingredients brought back from “treks” around the world – e.g. using a state-of-the-art robot in PepsiCo’s new Hawthorne, NY research lab to test botanicals and other natural ingredients from near and far – e.g. even secluded villages in the far East – to determine their impact on taste and viability for use in PepsiCo snacks and drinks (Do they intensify sweetness? Can they be a substitute for sugar? Do they have a particular healthful function?)

Score this one as a win for Pepsi.

Along with such pledges, Pepsi is aggressively marketing sodas to teenagers.  The San Francisco Chronicle reports on Pepsi’s new “social marketing” vending machines.

At a trade show in Chicago this week, PepsiCo rolled out a prototype interactive soda machine that lets you send a drink as a gift to a friend or a random stranger.

“Our vision is to use innovative technology to empower consumers and create new ways for them to engage with our brands, their social networks and each other at the point of purchase,” Mikel Durham, PepsiCo Foodservice’s chief innovation officer, said in a press release.

“Social Vending extends our consumers’ social networks beyond the confines of their own devices and transforms a static, transaction-oriented experience into something fun and exciting they’ll want to return to, again and again.”

But these kinds of marketing pushes are not confined to Pepsi.   Advertising Age reports that Joe Tripodi, Coke’s chief marketing officer of Coca-Cola explains the company’s growth strategy: focus on teenagers:

The company sees huge opportunities to grow colas, and the business as a whole, around the world in the next decade. Teen recruitment will be particularly important, as the company follows demographic trends.

“There was a time [a decade ago] when we walked away from teen recruitment and probably lost a generation of drinkers,” Mr. Tripodi said. “Parts of the world lost confidence in cola as the engine of growth. We’ve gotten that back in a big way. …When you look at the massive opportunity in so many huge countries in the world, that’s what energizes us and why we believe cola is still at its very early stages.”

And then there are partnership strategies. The latest is Sonic drive-ins’ campaign for Limeades for Learning. The campaign encourages eaters to vote for school projects like those that support physical activity.  Sonic promises to fund the projects with the most votes. The Limeades, by the way, are 620 calories (for a medium) or 950 calories (for a large).

Finally, for now, the Boston Globe reports that most Massachusetts voters support a sales tax on sodas if the money is used for some useful purpose.  But:

The American Beverage Association has been aggressively fighting taxes on soda, as cities and states across the country look for new tools to counter an obesity epidemic and raise revenue amid squeezed budgets. It has spent millions fighting initiatives that impose product-specific excise taxes on sugar-sweetened beverages and has been successful in nearly every attempt.

Expect more such public relations efforts superimposed on fundamental marketing techniques aimed at kids and fighting back on taxes and other attempts to limit soda intake.

How does this comport with the spanking new advertising guidelines to children or any of the previous pledges? Is sending a soda to a friend an activity or marketing? Or both?

http://www.sfgate.com/cgi-bin/blogs/techchron/detail?entry_id=87904

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.