Currently browsing posts about: Obesity

The Times’ obituary for Dr. Albert J. (“Mickey”) Stunkard, who died last week at the age of 92, describes his work on the genetics of obesity and quotes Dr. Walter Willett’s comment that genetics accounts for only a small part of the “legions of the obese.”

Stunkard was writing about the lifestyle and environmental determinants of weight gain, long before most of us had a clue.

I learned this in 2000 when Michael Jacobson and I were writing a paper on public health policy approaches to obesity prevention.[i]   We were arguing that policies aimed at preventing weight gain focused almost entirely on personal behavior but needed to focus on fixing the environment of food choice.

A peer reviewer scolded us for missing Stunkard’s work.

At last, we discovered Stunkard’s groundbreaking work.  In the published paper, we wrote:

The most notable exception [to the focus on personal responsibility] was the report of a 1977 conference organized by the National Institutes of Health (NIH) to review research and develop recommendations for obesity prevention and management.

In one paper, A.J. Stunkard thoroughly reviewed social and environmental influences on obesity.[ii]  As a result, the conference report included an extraordinarily broad list of proposals for federal, community, and private actions to foster dietary improvements and more active lifestyles.

These ranged from coordinated health education and model school programs to changes in regulations for grades of meat, advertising, taxes, and insurance premiums. Some of the proposals cut right to the core of the matter: “Propose that any national health insurance program…recognize obesity as a disease and include within its benefits coverage for the treatment of it.” “Make nutrition counseling reimbursable under Medicare.” And “Fund demonstration projects at the worksite.”[iii]

He was far ahead of his time and will be greatly missed.

References

[i] Nestle M, Jacobson MF.  Halting the obesity epidemic: A public health policy approach.  Public Health Reports 2000;115:12-24.

[ii] Stunkard AJ. Obesity and the social environment: current status, future

prospects. In: Bray GA, editor. Obesity in America. Washington:

Department of Health, Education, and Welfare (US); 1979. NIH Pub.

No.: 79-359.

[iii] Stunkard A. The social environment and the control of obesity. In:

Stunkard AJ, editor. Obesity. Philadelphia: WB Saunders; 1980. p. 438-

The biggest story—front page, right column—in the New York Times today is CDC’s report of a 43% drop in obesity among children ages 2 to 5 in the last decade.

• 2003-2004: 14%
• 2011-2012:   8%

A change this large is highly unusual.

The data come from a report in JAMA which found no change in overall obesity prevalence in that decade among infants and toddlers, youth ages 2 to 19, or adults.  When looking at the data for subgroups, however, the authors found two exceptions:

• The big decline in obesity among children ages 2 to 5
• A big increase in obesity among women ages 60 and older (oops)

What to make of this?

The decline in obesity among young children is consistent with previous reports, although these showed a smaller change.

To examine what the data show, it helps to look at an illustration.  The JAMA paper does not provide one, but a reporter sent me this:

The lower curve is for children ages 2 to 5.  It shows a sharp uptick in 2003-2004 (what was that about?), followed by a decline in 2007-2008.  The new data extend the decline a little further.

Any decline in the rising prevalence of obesity is cause for celebration.  So is the no change in a decade among almost everyone else.

The reasons?  I can only speculate but the “eat less junk food and move more” message must be getting out.

I received an e-mail message from Dr. Justine Davies, the editor of The Lancet Diabetes & Endocrinology, announcing a series of review articles on bariatric surgery for treatment of obesity.

Bariatric surgery, she says,

is the most effective treatment for both obesity and type 2 diabetes. In many people with type 2 diabetes, bariatric surgery not only limits disease progression, but also reverses complications.

She asks: So why is this procedure not being used more often to treat
patients with obesity?

Bariatric surgery has substantial benefits in terms of weight loss, metabolic status, and quality of life. It is safe and effective, and the future savings made through prevention of comorbid diseases could counterbalance its high cost. The surgery should, therefore, be available as an option to use when appropriate, and not only when all other options have been eliminated. Bariatric surgery offers a real opportunity for preventing comorbid diseases and complications of obesity. If it is only used as a final resort, this opportunity will be missed.

I can think of several good reasons: pain and suffering, treatment complications, questionable long-term prognosis, and cost, for starters.

Prevention is a better option.

If only we knew how….

Here are the papers:

• Editorial: Bariatric surgery: why only a last resort?
• Comment: Is bariatric surgery safe?
• Comment: Quality of life after bariatric surgery
• Series 1: Reversal of organ damage after bariatric surgery
• Series 2: Mechanisms of bariatric surgery
• Series 3: Bone loss after bariatric surgery
• Series 4: Are criteria for bariatric surgery fit for purpose?

Deborah A. Cohen.  A Big Fat Crisis: The Hidden Forces Behind the Obesity Epidemic—And How We Can End It.  Nation Books, 2013.

Here’s my blurb:

Deborah Cohen gives us a physician’s  view of how to deal with today’s Big Fat Crisis.  In today’s “eat more” food environment, Individuals can’t avoid overweight on their own.   This extraordinarily well researched book presents a convincing argument for the need to change the food environment to make it easier for every citizen to eat more healthfully.

And from the review on the website of the Rand Corporation, where Deborah Cohen works:

The conventional wisdom is that overeating is the expression of individual weakness and a lack of self-control. But that would mean that people in this country had more willpower thirty years ago, when the rate of obesity was half of what it is today. Our capacity for self-control has not shrunk; instead, the changing conditions of our modern world have pushed our limits to such an extent that more and more of us are simply no longer up to the challenge.

The Food and Agriculture Organization of the United Nations (FAO) has organized a series of Perspectives on World Food Day.

Mine is titled “A Push for Sustainable Food Systems.”  It’s illustrated with cartoons from Eat, Drink, Vote.

In Mexico, you can get most kinds of sodas in 3 liter bottles.  At 17 pesos ($1.33) for 3 liters, Pepsi is cheaper than water.

Note the 3-peso penalty if you buy two 1.5-liter bottles.  

It’s hardly a coincidence that Mexico has high soda consumption and high rates of obesity.  Taxing sodas seems like a particularly good idea in this situation.

Policy wonk types: try this one!

Melvin Delgado.  Social Justice and the Urban Obesity Crisis: Implications for Social Work.  Columbia University Press, 2013.

This is an academic’s analysis of the social causes of obesity, especially among the urban poor, and what to do about it.  Although the book is aimed at social workers, it works for public health as well.  Delgado calls for community-based participatory health promotion principles and interventions.  These are clearly needed.

If only they weren’t so hard to do…

The NYC Health Department goes to court at noon today for a hearing on the 16-ounce soda cap (I’ll be there).

Yesterday, it released alarming data on diabetes deaths, now at an all-time high.

The press release notes that although NYC’s overall deaths are going down,  diabetes-related deaths are going up.

The deaths are highest in low-income communities.

In April, the Health Department reported that nearly 650,000 New York adults have diabetes, an increase of 200,000 in a decade.   Most of these are due to type 2 diabetes, the “adult” kind.

Why?  Obesity.

Although a small percentage of overweight people develop type 2 diabetes, most people with type 2 diabetes are overweight.

Losing weight is the first thing to do to prevent or treat type 2 diabetes.

Reducing intake of sugary sodas is the first thing to do to lose weight.

That is why the health department wants to reduce the portion sizes of sugary drinks at food service establishments.

Today’s court hearing should be interesting. Stay tuned.