Currently browsing posts about: Obesity

I don’t usually take estimates of the cost of bad diets and obesity too seriously because they are necessarily based on multiple assumptions, none of them verifiable.  But I do like to collect them.  Here are two papers from the American Journal of Health Promotion estimating such costs.  One estimates the health benefits and savings in medical costs from diets reduced in saturated fat, sodium, and calories (a savings of $60-120 billion), and the other estimates cost savings and productivity increases for reduction in calories and sodium ($109-256 billion).  Whatever the real savings are, they are likely to be enormous.  And that’s just money.  It’s harder to put a value on quality of life.  Maybe that’s all we need to know at this point.

Yale’s Rudd Center for Food Policy has invented a Revenue Calculator for Soft Drink Taxes for estimating the amounts of money states and cities could raise from taxes on soft drinks.  You type in the state or city, estimate the size of the tax, decide what kinds of drinks it’s for, and push the  button.  Bingo.  California could raise about $1.8 billion a year from a 1 cent tax.

And the Department of Health and Human Service has hooked up with the Advertising Council for a new kids’ activity campaign on the Internet, this one using Maurice Sendak’s Wild Things tied in to a movie coming out in October.  I wasn’t so happy about the last such campaign, which featured Shrek and is still up on the site.  Shrek also advertises junk foods.  Maybe this one will work better?

Reports about what to do about obesity in adults and children are coming out one after another.

The HSC Foundation has produced Fighting Obesity: What Works, What’s Promising? (click on Fighting Obesity Report).  Based on interviews, it reviews model programs that are having some success, such as The Food Trust, a Philadelphia-based nonprofit organization; The Consortium to Lower Obesity in Chicago Children (CLOCC); and The Coordinated Approach to Child Health (CATCH) Program.  Its main conclusion: a focus on pregnant women and children will have the biggest payoff.

NIH has New Tools to Promote Healthy Habits, one of which is “We Can!  Ways to Enhance Children’s Activities and Nutrition.”  The online program tells families how to improve food choices, increase physical activity, and reduce screen time.  [Question: do online programs do any good at all?  I’d really like to know.]

Finally (for now), the Institute of Medicine and Robert Wood Johnson Foundation have produced Local Government Action to Prevent Childhood Obesity, with a mind-numbing 58 steps that governments could take to do some good .  They also published a brief summary. Fortunately, the authors select the 12 actions most likely to succeed:

1. Create incentive programs to attract supermarkets and grocery stores to underserved neighborhoods
2. Require menu labeling in chain restaurants to provide consumers with calorie information on in-store menus and menu boards
3. Mandate and implement strong nutrition standards for foods and beverages available in government-run or regulated after-school programs, recreation centers, parks, and child-care facilities, including limiting access to unhealthy foods and beverages
4. Adopt building codes to require access to, and maintenance of, fresh drinking water fountains (e.g. public restrooms)
5. Implement a tax strategy to discourage consumption of foods and beverages that have minimal nutritional value, such as sugar sweetened beverages
6. Develop media campaigns, utilizing multiple channels (print, radio, internet, television, social networking, and other promotional materials) to promote healthy eating (and active living) using consistent messages
7. Plan, build and maintain a network of sidewalks and street crossings that connects to schools, parks and other destinations and create a safe and comfortable walking environment
8. Adopt community policing strategies that improve safety and security of streets and park use, especially in higher-crime neighborhoods
9. Collaborate with schools to implement a Safe Routes to Schools program
10. Build and maintain parks and playgrounds that are safe and attractive for playing, and in close proximity to residential areas
11. Collaborate with school districts and other organizations to establish agreements that would allow playing fields, playgrounds, and recreation centers to be used by community residents when schools are closed (joint-use agreements)
12. Institute regulatory policies mandating minimum play space, physical equipment and duration of play in preschool, afterschool and child-care programs

A 12-step program for preventing childhood obesity!  These are good ideas.  What will it take to get them put into practice?

The ever intrepid New York City Health Department launches a new campaign today: Stop drinking soft drinks or else you are “Pouring on the Pounds.”

It explains the rationale for the campaign in a bulletin.  In short, as described in the press release:

“On average, Americans now consume 200 to 300 more calories each day than we did 30 years ago. Nearly half of these extra calories come from sugar-sweetened drinks. When Health Department researchers surveyed adult New Yorkers about their consumption of soda and other sweetened drinks, the findings showed that more than 2 million drink at least one sugar-sweetened soda or other sweetened beverage each day – at as much as 250 calories a pop…. The Health Department advises parents not to serve their kids punch, fruit-flavored drinks or “sports” and “energy” drinks…. If you order a sugar-sweetened beverage, ask for a “small.”….if you enjoy sugar-sweetened beverages, make them an occasional treat and not a daily staple.”

What?  Soft drinks add empty calories that nobody needs? These sound like fighting words!  I can’t wait to hear the response of the Beverage Associations and will post them as soon as they come in.  Stay tuned!

Good news (sort of): Overall obesity rates in children seem to be stabilizing.  Rates rose from 1998-2003 but did not change much from 2003-2007, with one exception: rates are still rising among American Indian/Alaskan Native children.  Here’s a map of childhood obesity rates by state (thanks to the Wall Street Journal).  Rates are decreasing in a few states!  Oregon has the lowest rates (less than 10%).  Mississippi has the highest (21%).

Overweight children are more influenced by advertisements for branded products than are average weight children, according to a pilot (preliminary) study in Appetite.  Evidence for restrictions on advertising?  I think so.

The CDC has produced a policy-wonkish list of 22 Recommended Community Strategies and Measurements to Prevent Obesity in the United States.  These are suggestions for what communities should do to make it easier for people to eat less (or better) and move more.  Examples: “Communities Should Provide Incentives to Food Retailers to Locate in and/or Offer Healthier Food and Beverage Choices in Underserved Areas,” and “Communities Should Improve Availability of Mechanisms for Purchasing Foods from Farms.”  These are all good “shoulds.”   The report gives ideas for measuring the success of such initiatives but does not discuss how to implement them, alas.

[Posted from New Delhi]

The latest estimate from CDC on the annual cost of obesity: $147 billion.  Ordinarily, I don’t take such numbers too seriously because they are based on assumptions that may or may not  be correct.  But this number has been challenged by so personal an attack on the new head of the CDC, Tom Friedan, that I’m thinking it should be taken seriously.

The attacker is the supposedly independent – but thoroughly industry-sponsored –  American Council on Science and Health (ACSH).  Here’s the quote from its latest online newsletter:

Frieden’s Crusade Moves to Washington

A study presented on Monday at a CDC obesity meeting determined that obesity-related diseases account for nearly 10 percent of all medical spending in the United States – an estimated $147 billion per year. The study was sanctioned by CDC director Dr. Thomas Frieden, whose partiality to government-interventionist responses to public health concerns is epitomized by his quote: “Reversing obesity is not going to be done successfully with individual effort. It will be done successfully as a society.”

“The reason he hyped this study was to promote more proactive government interventions, including a three cent soda tax,” says ACSH’s Jeff Stier. Dr. Ross adds, “Whenever I see numbers like this – especially when they are being promoted by someone we know is a fan of big government – I suspect that they have been altered or manipulated. Obesity is definitely a health threat, and it will definitely be a burden on our health care system. How much of a burden, we don’t know. But I don’t trust these numbers.”

Well, I don’t trust ACSH.  For one thing, just try to figure out who funds them.  For another, note the way ACSH invokes science to make its political agenda seem authoritative.

Whatever the real cost of obesity, its consequences will place a considerable burden on our health care system.    And it will take societal responsibility as much as – or more than – individual responsibility to deal with the problem.

[Posted from London]

I am always indebted to Joel Moskowitz of the University of California School of Public Health’s Center for Family and Community Health for his almost daily forwarding of research on obesity.  His recent postings include data from the Centers for Disease Control (CDC).  The CDC has just released preliminary results of the 2008 National Health Interview Survey.  These include, among other measures, data charts and tables on obesity (rates still rising steadily since 1997), physical activity (no measurable change), and diabetes (rising in parallel with obesity).

Interpretation: if physical activity rates have not changed, then the reason obesity rates are going up is because people are eating more calories.

Plenty of evidence backs up this idea.  All you need to do to see why people are eating more is to take a look at Time magazine’s discussion of the implications of calorie labeling: “Would you like 1,000 calories with that?”

I’ve just received the latest cancer statistics from CA–A Cancer Journal for Clinicians. The good news is that overall cancer death rates are down from their peak in the 1990s and rates of specific cancers are stable or decreasing.  None seems to be increasing.

Look at what is happening with heart disease (page 15).   Its rates have fallen by half since the mid-1970s for people under age 85.  Even for people over 85, heart disease death rates are falling rapidly.

Obesity is a risk factor for both cancer and heart disease.  So ideas about its effects on health need to take these statistics into consideration.  But before dismissing obesity as a risk factor, note that both heart disease and cancer remain leading causes of death, and both disproportionately affect low-income groups.   Groups with low income and education tend to have many risk factors for these diseases, among them high rates of obesity.

Public health still has plenty of work to do.

Investigators at the Harvard School of Public Health estimated the toll of behavioral contributors to early mortality.  Obesity, they say, is the #3 cause of death after cigarette smoking and high blood pressure.

Dutch researchers say smoking is what kills people.  Obesity just leads to disability.

The Robert Wood Johnson Foundation says schools could do something to help prevent obesity if they got their act together.  It provides a guide to doing so.

Adam Drewnowski, my colleague and friend at the University of Washington, says: if you want to understand obesity, take a look at what poverty makes people eat.

And Jeffrey Friedman, an obesity researcher at Rockfeller University tells Nature that obesity is neither an epidemic nor a disease of lifestyle.  It’s all in the genes and in evolution.

I say (see What to Eat): eat less, move more, eat plenty of fruits and vegetables, and don’t eat too much junk food!