Currently browsing posts about: Obesity

I recently received this request from Daniel posted to Feedback:

Would you mind writing a blog post on the new surgeon general’s obesity report? …Is there a food politic element to why this has gone under the radar? …I find it ironic that Michael Pollan’s Food Rules generated substantially more press than a report by the United States Surgeon General.

I’m not surprised.  Pollan’s book is a hot best seller (it’s #1 on Amazon books, and for good reason, in my opinion).   The need to prevent obesity and how to do it is not exactly front-page news.  And the new Surgeon General, Dr. Regina Benjamin, is still relatively unknown as a political force.

But let’s give Dr. Benjamin credit for taking on obesity in one of her first public actions: the release of “Vision for a Healthy and Fit Nation.”   The Vision, which comes with a press release and a fact sheet, recommends these actions to prevent obesity:

1. Reduce consumption of sodas and juices with added sugars.
2. Reduce consumption of energy dense foods that primarily contain added sugars or solid fats.
3. Eat more fruits, vegetables, whole grains, and lean proteins.
4. Control your portions.
5. Drink more water.
6. Choose low-fat or non-fat dairy products.
7. Limit television viewing time and consider keeping televisions out of children’s rooms.
8. Become more physically active throughout the day.
9. Breastfeed exclusively to 6 months.

These are all useful suggestions but we have heard them before.  The real issue is how to achieve them.  Here, the report disappoints.

The first two items should have grabbed attention: targeting soda reduction as as the first line of defense against obesity, and eating less junk food (my translation) as the second.

But Dr. Benjamin assigns parents the responsibility for feeding kids healthfully.  Fine, but what about about public health approaches to reducing soda consumption?  To pick a non-random example, soda  taxes are under intense debate right now.  Does Dr. Benjamin weigh in on such approaches?  Alas, no.  Only on the second-to-last page does she summarize suggestions from the Centers for Disease Control and Promotion (CDC), among them:

• Increase availability of healthy, affordable food and beverage choices in public service venues.
• Improve geographic availability of supermarkets in underserved areas.
• Improve access to fresh fruits and vegetables by providing incentives for the production, distribution, and procurement of foods from local farms.
• Limit advertisements of less-healthy foods and beverages.

I wish the report had focused on such ideas, instead of leaving them to an afterthought and personal responsibility. It’s great that the nation’s doctor cares about obesity but her Vision isn’t nearly as tough or realistic as it needs to be.  For that, we need the CDC or the report on food marketing to kids that the Institute of Medicine produced in 2005.

In 2001, Surgeon General David Satcher released the first government report on preventing obesity.  It got press. If this one didn’t, it could well be because it doesn’t break enough new ground.  Surely, it’s high time we got beyond blaming parents and instead started focusing on the need to create a food environment that makes it easier for parents and everyone else to make better food choices and be more active.

I hear that Michelle Obama will soon announce (tomorrow?) a new program to address childhood obesity.  I’m hoping that her program will take on some of the factors in the food environment that make it so difficult for everyone to eat healthfully.

Recent news reports encouraged me to take a quick look at the January 2010 American Journal of Clinical Nutrition where investigators have attempted to identify the proportion of human obesity accounted for by genetic variation.  Their conclusion: probably no more than 1% (we used to think it was 5%).  I don’t know why anyone would be surprised.  Obesity rates rose sharply in the early 1980s, with no possibility for so rapid a change in the genetic composition of the population.

I don’t think we need complicated genetic explanations for obesity.  We have so much evidence that people started consuming more calories at about that time and are continuing to do so.  Why more calories?  Portion sizes got bigger, and – hard as it may be to believe – larger portions have more calories!

In a commentary on the study, Claude Bouchard puts it this way:

The obesity epidemic we are facing today unfolded over the past few decades and can clearly not be explained by changes in the frequency of risk alleles. It is more likely due to a changing social and physical environment that encourages consumption and discourages expenditure of energy, behaviors that are poorly compatible with the genome that we have inherited.

Hence: eat less, move more!  And have an active weekend!

The research demonstrating the not-so-great effects of sodas just pours in, as it were.  The Robert Wood Johnson Foundation has two new research reports, one on justification for taxation of soft drinks, and the other on the negative effects of soft drinks on kids’ health.

David Ludwig writes in JAMA that artificially sweetened drinks are unlikely to help the situation.  They just make people want sweeter foods.

And the New York City Health Department has put its anti-soda campaign online.   This is its controversial “drinking fat” campaign designed to make the point that excess calories from sugary soft drinks will put on the pounds.  Why controversial?  Take a look at the cute guy demonstrating the drinking-fat point on the YouTube video.

What’s your take on this?

It’s post-Thanksgiving so I suppose I must say something about overeating.  Fad diets contribute to obesity, says the president of the British Society of Gastroenterology.  He singles out Atkins, Raw, Hallelujah (fruits and seeds mentioned in the Book of Genesis), and Grapefruit diets for particular scorn.  Why?  He doesn’t say.  His otherwise sensible conclusion: “The problem facing society is not the content of our diet but it’s the quantity we are consuming and the consequential impact of obesity.”

Ah yes, quantity.  Probably best not to mention it this week.  Enjoy the weekend!

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]