I Wish I Were Far From the Madding Crowd

April 28, 2010

Health Affairs special issue on child obesity (March 2010)

Health Affairs special issue on child obesity

http://content.healthaffairs.org/content/vol29/issue3/

Includes articles on obesity trends, prevention, connections with food and agriculture policy, effect of schools, lessons learned from states and localities, and more.

Note: Unfortunately it looks like you will have to pay to read the articles, but access to the abstracts (and the policy briefs listed below) is free.

From the Health Affairs blog

Child Obesity: Health Affairs Explores Strategies For Combating Epidemic

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April 27, 2010

Institute of Medicine report on “Bridging the Evidence Gap in Obesity Prevention” – is their framework comprehensive enough?

The Institute of Medicine is the health arm of the National Academy of Sciences.  On April 23, 2010, it released a report, “Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making.”

New Framework Recommended for Decision Making and Research on Obesity Prevention

http://www.nationalacademies.org/morenews/20100423.html

April 23, 2010 — To battle the obesity epidemic in America, health care professionals and policymakers need relevant, useful data on the effectiveness of obesity prevention policies and programs. A new report from the Institute of Medicine identifies a new approach to decision making and research that uses a systems perspective to gain a broader understanding of the context of obesity and the many factors that influence it.

http://www.iom.edu/obesityframework

Is the IOM systems approach missing what could be a large component of the system?

The Institute of Medicine states that it is adopting a systems approach to obesity prevention.  That sounds pretty comprehensive, right?

Well, maybe not.  Cutting to the chase, this report appears to be limited to looking at obesity prevention interventions and not all obesity causes.  The focus is entirely on caloric and energy balance.  But what if, as Dr. Robert Lustig and others have argued, what you eat and how it is metabolized are factors in the obesity epidemic?  Energy intake and energy expenditure might not reveal the whole picture.

And what about the possibility that environmental exposure to chemicals might be a factor?  Quickly skimming the report, I found Figure 4-5, “The obesity ‘system’: a broad causal map” (p. 4-12 (p.80) of the online version of the report) shows a blurry version of the diagram, but I was able to find the original on Slide 9 of the presentation, “System Dynamics Simulation in Support of Obesity Prevention Decision-Making.”

Bobby Milstein and Jack Homer, For Institute of Medicine Committee on an Evidence Framework for Obesity Prevention Decision-Making, Irvine, California, March 16, 2009
http://www.iom.edu/~/media/Files/Activity%20Files/PublicHealth/ObesFramework/IOMIrvine16Mar09v52MilsteinHomer.ashx

The “map” shows Prevalence of Overweight & Related Diseases being affected by two causes, Healthiness of Diet & Activity Habits and Genetic Metabolic Rate Disorders.

But what if metabolic rate disorders are not strictly genetic, but can be epigenetic or can be directly caused by chemical exposure?

That idea does not appear to have crossed their minds.  The framework and approach that are recommended look like they have merit, but I would argue that the authors are not looking at as large a system as they should be.

The environmental factors they do mention are along the lines of the “activity environment” and the food environment.”

Without acknowledging the effects exposure to chemicals might have on people’s propensity towards overweight and obesity the report is more limited than it should have been.  The focus is totally on social and behavioral interventions.  While diet and activity are probably the most important factors in obesity for most people, it appears that no thought has been given to the possibility that by reducing exposure to chemicals we might be able to prevent or at least reduce the rates and extent of overweight and obesity.

Links to Report Information

There are links to several different items here.  The links above are to a news release and the Institute of Medicine (IOM) Report web page (i.e. the page for the project/activity).  Links below are to the full text of the report online, the report recommendations, a four page report brief, as well as links to a webcast and podcast of the briefing on the release of the report, links to related resources (which duplicate some of the other links), and links to pages on the meetings that led to the creation of the report.

Full Report online

Report at a Glance

  • Recommendations (HTML)
  • Report Brief (4 pp.) (PDF, HTML)

Report: Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making

Released: April 23, 2010

http://www.iom.edu/Reports/2010/Bridging-the-Evidence-Gap-in-Obesity-Prevention-A-Framework-to-Inform-Decision-Making.aspx

A Framework for Decision-Making for Obesity Prevention: Integrating Action with Evidence

http://www.iom.edu/Activities/PublicHealth/ObesFramework.aspx

Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making

http://www.nap.edu/webcast/webcast_detail.php?webcast_id=420

April 23, 2010
Running Time: 00:58:04
Format: RealAudio (Requires free RealPlayer)  Podcast: (mp3)
To battle the obesity epidemic in America, health care professionals and policymakers need relevant, useful data on the effectiveness of obesity prevention policies and programs. A new report from the Institute of Medicine identifies a new approach to decision making and research that uses a systems perspective to gain a broader understanding of the context of obesity and the many factors that influence it.

Related Resources:

Report Briefs
Full Report
Project Website

Previous Meetings

April 23, 2010

An all consuming world?

Following the theme of yesterday’s post, I’ve included links to another video on waste and consumption (this one about McDonough’s & Braungart’s Cradle to Cradle concept), food consumption (includes a striking map), and creating green economies.

Rethinking how we make things

Waste = Food (Documentary on 49:23 min.)
http://video.google.com/videoplay?docid=-3058533428492266222#

An inspiring documentary on the Cradle to Cradle design concept of the chemist Michael Braungart and the architect William McDonough. Winner of the Silver Dragon at the Beijing International Science Film Festival 2006.

Sustainable consumption

Can Consumer Culture Be Transformed?

http://earthsky.org/human-world/state-of-the-world-2010-can-consumer-culture-be-transformed

Deborah Byrd of EarthSky looks at consumerism and its repercussions.  The quiz was interesting (I scored worse than she did). She also discusses the State of the World 2010 report on moving from a consumerist society to a sustainable one (see link below).

Quiz – Consumer Consequences: Find out if you are living a sustainable life
http://sustainability.publicradio.org/consumerconsequences/

State of the World 2010: From Madison Avenue to Mad Max? (Press Release) –  January 12, 2010
http://www.worldwatch.org/node/6359

Report websitehttp://www.worldwatch.org/sow10

Excerpt from press release (emphasis added):

The report examines the institutions that shape cultural systems. Business has played the leading role in shifting cultures to center on consumerism, making an array of resource-intensive products such as bottled water, fast food, cars, disposable paper goods, and even pets seem increasingly “natural.”

Government has also promoted consumerism as a lynchpin of policy, often making it synonymous with national well-being and job creation. As the global economic recession accelerated in 2009, wealthy countries primed national economies with $2.8 trillion of new government stimulus packages, only a small percentage of which focused on green initiatives.

Food consumption

Where The Buffalo Roamed
http://www.weathersealed.com/2009/09/22/where-the-buffalo-roamed/

Includes a map of the contiguous United States, visualized by distance to the nearest McDonald’s.

This site contains a number of other fascinating maps and graphics on a wide variety of subjects.

Food, Inc., the future of food, and waste = food
http://earthsky.org/agriculture/food-inc-the-future-of-food-and-waste-food

Transforming Cultures Blog – WorldWatch Institute

http://blogs.worldwatch.org/transformingcultures/retire-ronald/

Creating a sustainable economy

Green Economy Takes Centre Stage at UNEP 2010 Champions of the Earth Awards

http://www.eco-business.com/news/2010/apr/22/green-economy-takes-centre-stage-unep-2010-champio/

UNEP Green Economy Initiative

http://www.unep.org/greeneconomy/

The New Green Economy Conference Conversation

Part 1 – http://dirt.asla.org/2010/01/21/the-new-green-economy-part-1/
Part 2 – http://dirt.asla.org/2010/01/21/the-new-green-economy-part-2-what-d…
Part 3 – http://dirt.asla.org/2010/01/26/the-new-green-economy-part-3-what-i…

CleanSkies: EPA Administrator Lisa Jackson Calls For Green Revolution at NCSE Conference
http://greeneconomy.ning.com/video/lisa-jackson-calls-for-green

National Council for Science and the Environment (NCSE)

http://ncseonline.org/

NCSE Green Economy Blog

http://greeneconomy.ning.com

Note: While this looks like it might contain some good information, they seem to have a little problem with spam.

April 22, 2010

The Story of Stuff (in honor of Earth Day)

Since today is Earth Day, I thought The Story of Stuff would be an appropriate topic.  EPA is also celebrating its 40th anniversary.  More info on EPA events on its website:

The Story of Stuff is a 20-minute animated film narrated by Annie Leonard about the “materials economy” (that is, the traditional process of extracting materials, manufacturing products, distribution, consumption, and disposal) and how we need to move to a sustainable economy, which is the message behind Cradle to Cradle.

Stephen Colbert said that more than 10 million people have viewed the film.  (You can see a short interview he did with Leonard on the Story of Stuff website.)

If you can’t view the video there, it’s also posted on YouTube.
http://www.youtube.com/watch?v=gLBE5QAYXp8&feature=player_embedded#! (among others)

There’s also a short excerpt from the video in her interview with Stephen Colbert (5 min 30 sec) on the Story of Stuff website that discusses what we do with our leisure time and how that helps drive the cycle.

Consumption drives the whole cycle

One thing that really struck me was a quote Leonard provided from Victor Lebow, a 20th century economist and retail analyst.  (There’s more from this quote on the Wikipedia page on Lebow.)

Our enormously productive economy demands that we make consumption our way of life, that we convert the buying and use of goods into rituals, that we seek our spiritual satisfactions, our ego satisfactions, in consumption. The measure of social status, of social acceptance, of prestige, is now to be found in our consumptive patterns. The very meaning and significance of our lives today expressed in consumptive terms. The greater the pressures upon the individual to conform to safe and accepted social standards, the more does he tend to express his aspirations and his individuality in terms of what he wears, drives, eats—his home, his car, his pattern of food serving, his hobbies….

We need things consumed, burned up, worn out, replaced, and discarded at an ever increasing pace. We need to have people eat, drink, dress, ride, live, with ever more complicated and, therefore, constantly more expensive consumption.

According to Wikipedia, “Modern authors disagree as to whether Lebow was encouraging and prescribing conspicuous consumption or grimly acknowledging and critiquing its prevalence among American consumers.”

Still, it’s pretty scary!  (Could consumerism be viewed as one big Ponzi scheme?  After all, at the rate we’re going to run out of stuff to make stuff from.)

Leonard notes that after 9/11 George W. Bush didn’t advocate grieving, he said something along the lines of “Go shopping!”  (I’ll have to go reread Brave New World.  If I remember correctly, the society in that book is based on mass consumption.)

The Story of Stuff: The Book” provides more information about the effects of the traditional extraction and production process.

More info on the effects of resource extraction

For more information on how people’s health and the environment are affected by the extraction of coal, oil, natural gas, gold, and other  resources, see the EARTHWORKS website and blog.

April 18, 2010

Sugar is sugar … or not?

If you’ve followed any of the discussion about high fructose corn syrup (HFCS) vs. sucrose, you’ve probably heard representatives of the soft drink industry and HFCS refiners repeatedly say that fructose is no different than sucrose and that they’re metabolized the same (which, according to more and more research, is debatable).  I’ll get to that a little further on.

How much sugar we’re consuming

Amber Waves article “Behind the Data: Estimating Consumption of Caloric Sweeteners.” (April 2003)

Amount of HFCS and refined sugar delivered to food and beverage manufacturers in 2001

Intake levels represent the difference between total deliveries of calorie sweeteners for food and beverage use and estimated losses
Graphics from http://www.ers.usda.gov/AmberWaves/April03/Indicators/behinddata.htm

Make note of that 31.1 teaspoons per day figure for 2001.  (Daily intake in teaspoons = average annual intake in pounds / 365 days per year x 16 ounces per pound x 28.3495 grams per ounce / 4.2 grams per teaspoon.)

Think about the last item in that formula.  If the label on a box of cereal says 9 g of sugars, that means that a single serving contains 2 tsps of sugar.  A 12 oz. soda containing 39 g of sugars contains more than NINE teaspoons of sugar.  You get the idea.

According to Dietary Assessment of Major Trends in U.S. Food Consumption, 1970-2005 (see references), for 2005 it was down to 30 teaspoons per day.

What does this tell us?

Several points, one, representatives of the Corn Refiners Association and beverage manufacturers are right when they say that whether it’s fructose or sucrose doesn’t really matter.  If you’re consuming almost 4 times the amount of added sugars you should be, you are going to have problems!

Two, sucrose contained in beverages begins to undergo hydrolysis once it’s bottled and separates into its component parts (that is, fructose and glucose).  So in many cases when you’re drinking a sugar-sweetened soda you’re not drinking sucrose in solution, but sucrose, fructose, and glucose.  If enough time goes by most of the sucrose turns into free fructose and glucose.

A number of studies have shown that fructose is metabolized differently than glucose, but other studies seem to indicate that’s not as much of a concern, except possibly in two cases: one, when the ratio of fructose to glucose consumption is high, or in cases of high consumption of calories.  I would say that we have a combination of those, a relatively high ratio of fructose to glucose consumption (look at the relative amounts of HFCS to refined sugars used by beverage manufacturers!) together with consuming too many calories from sugar.  (And remember, that’s just the average amount.  Some people are consuming even larger amounts of sugar.)

Background on high fructose syrups

I recently came across a very interesting article, coauthored by John S. White, who is, or at least has been, a consultant to the Corn Refiners Association.

“Manufacturing, composition, and applications of fructose.”  L. Mark Hanover and John S. White.  American Journal of Clinical Nutrition, 1993, v.58(suppl.), 724S-732S.
http://www.ajcn.org/cgi/content/abstract/58/5/724S

The article describes the manufacturing and refining process of HFCS (or, as the authors call it, HFS), the composition of various grades of HFCS (as well as crystalline fructose and crystalline fructose syrup), functional properties and uses, and regulatory status.

What I found so fascinating about this particular article though, were these bits of information scattered throughout it.  According to the authors , HFS-42 (that is, HFCS that is 42% fructose) was the “first generation syrup of commerce.”  (p.726S)

They go on to note that :

Japanese and US manufacturers were producing HFS containing 55% fructose by the late 1970s.  HFS-55 was adopted by the carbonated-beverage industry and became the predominant sweetener in colas by late 1984. (p.726S)

On p. 727S, a table showing the typical composition of the various grades of fructose (ranging from 42% all the way up to 80% and 95%).

  • HFS-42 is 42% fructose, 53% dextrose (i.e. glucose), and 5% oligosaccharides
  • HFS-55 is 55% fructose, 42% glucose, and 3% oligosaccharides
  • HFS-80 is 80% fructose, 18% glucose, and 2% oligosaccharides
  • HFS-95 is 95% fructose, 4% glucose, and 1% oligosaccharides

One of the minor differences between HFS-80 and HFS-95 is that they, unlike the other two, contain less sulfated ash and no sulfur dioxide.  (Okay, the HFS-42 and -55 contain only 2 parts per million.)

The crystalline fructose and crystalline fructose syrup are both 99.5% or greater fructose.

What is interesting is that the authors note, p. 731S, that HFS-55 was being used in colas by late 1984, but that in 1988 the FDA had “proposed to recognize the long history of safety for fructose and reaffirm the GRAS status of HFS as a direct human food ingredient.” (FDA, 1992, 21 CFR 182.1866)  GRAS = “Generally Recognized As Safe” (for particular uses of a substance), CFR = Code of Federal Regulations

They go on to note: “The petition is specific for HFS-42, but may include HFS-55 on review of its additional processing steps.”

I’m not a lawyer, but to me that sounds like HFS-55 had not actually been approved for use as a direct human food ingredient at the time that cola manufacturers were starting to use it.  (I guess they must have just done that after the fact.)

HFS-55 vs. HFS-42

“The carbonated beverage industry is the largest user of HFS-42 and -55.” (p. 729S)  HFS-42 is primarily used in non-colas and HFS-55 in many colas, though colas can also be made using more HFS-42.  (See the graphic above about the use of sugar vs. HFCS by food vs. beverage manufacturers.)

In 1993 more than than 90% of energy-containing carbonated beverages produced in the U.S. were sweetened with HFS.

If I understand Hannover and White correctly, before 1984 most colas apparently were sweetened with HFS-42 and after 1984 with HFS-55.  In other words, the HFCS had approximately a 13% increase in the amount of fructose in it after the switch.

More importantly, the ratio of fructose to glucose changed from 42:53 to 55:42.  Why is that important?

Fructose malabsorption

Too much fructose in the diet can cause irritable bowel syndrome and other gastrointestinal problems.  However, studies have found that the problems are reduced when fructose is consumed with glucose.  (A certain percentage of the population is more prone to this, but it doesn’t seem to be an issue for most people.)

This is where you run into the problems of fructose metabolic products related to metabolic syndrome.   (The results of some studies also suggested that fructose malabsorption and metabolism problems were more likely to be associated with copper deficiency.)

Is HFCS the biggest problem?

I was going to say that HFCS is not the innocent player some portray it to be, then I realized that’s not really accurate.  The use of HFCS is not in and of itself the problem; the problem is food and beverage manufacturers putting it in almost every food and beverage they can.  It’s cheaper than refined sugar.  And most fast food places and restaurants reportedly make a higher profit margin off of soft drinks.  Once HFCS was introduced soft drink ingredients became so inexpensive that a lot of places started offering free refills.  I’m sure someone has brought that up before, but perhaps free refills are one of the main contributing factors to the increase in obesity (!?).   When people had to pay for a second glass of soda, they drank less.  Sorry, I don’t have a citation for that, but that seems obvious.  (Okay, I had to check.  I did a search on Google Scholar on +”obesity epidemic” +”free refills” and got 21 hits.   Google Scholar searches the scientific literature and books, as opposed to the entire Web.)

One example (with excerpt containing search terms):

Fructose, insulin resistance, and metabolic dyslipidemia

H Basciano, L Federico, K Adeli – Nutrition & Metabolism, 2005 – biomedcentral.com
in humans and animals, but the emphasis on fat reductions has had no significant benefits relative to the obesity epidemic. bombarded by huge million-dollar advertising campaigns for soft drinks, offered extra-extra-large serving sizes with free refills.

Apparently this is known as “portion distortion.”

Put that together with chronic overconsumption of sugar (regardless of whether they’re fructose or sucrose), unbalanced diets (deficiencies in vitamin D?), and not as much exercise as we should be getting.

Then throw in genetics, add a good dose of epigenetics in the form of gene-environment interactions, and you have all the conditions for development of metabolic syndrome and an obesity epidemic.

More on this in another post.

References

Dietary Assessment of Major Trends in U.S. Food Consumption, 1970-2005, by Hodan Farah Wells and Jean C. Buzby, Economic Information Bulletin No. (EIB-33) 27 pp, March 2008, http://www.ers.usda.gov/Publications/EIB33/

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