I Wish I Were Far From the Madding Crowd

July 21, 2010

Chemicals and the Obesity Epidemic: The Link

From the Safer Chemicals, Health Families website

http://www.saferchemicals.org/resources/obesity.html

Includes link to April 2010 report from the Washington Toxics Coalition.

http://www.saferchemicals.org/PDF/resources/obesity_factsheet.pdf

May 23, 2010

Food safety, marketing, and reducing childhood obesity

White House Task Force on Childhood Obesity Report

This report was released earlier this month. It discusses issues and offers recommendations relating to childhood obesity, including the usual regarding diet and lack of physical activity, but also notes the role that “obesogens” (endocrine disruptors and other chemicals thought to increase obesity by interfering with the body’s metabolic processes), food marketing, product formulation, access to healthier food, etc., play a part in the obesity epidemic.

Report: Solving the Problem of Childhood Obesity Within a Generation

http://www.letsmove.gov/taskforce_childhoodobesityrpt.html

Full reporthttp://www.letsmove.gov/tfco_table_of_contents.pdf (chapters also available as individual PDFs)

Contents
  • Early Childhood – A. Prenatal Care; B. Breastfeeding; C. Chemical Exposures; D. Screen Time; and E. Early Care and Education
  • Empowering parents and caregivers – A. Making Nutrition Information Useful; B. Food Marketing; and C. Health Care Services
  • Healthy Food in Schools – A. Quality School Meals; B. Other Foods in Schools; C. Food-Related Factors in the School Environment; and D. Food in Other Institutions
  • Access to Healthy, Affordable Food – A. Physical Access to Healthy Food; B. Food Pricing; C. Product Formulation; D. Hunger and Obesity
  • Increasing Physical Activity – A. School-Based Approaches; B. Expanded Day and Afterschool Activities; C. The “Built Environment”; and D. Community Recreation Venues

The role of marketing

The report notes:

Food marketing to children and adolescents is a big business. The Federal Trade Commission (FTC) estimates that, in 2006, food, beverage, and quick-serve restaurant companies spent more than $1.6 billion to promote their products to young people. Children and adolescents are an important demographic for marketers for several reasons: (1) they are customers themselves; (2) they influence purchases made by parents and caregivers; and (3) they are the future adult market.

The report says that the relationship between marketing and obesity isn’t firmly established, but that advertising does appear to have an effect on kids. Give me a break. Why would companies spend that kind of money if they weren’t getting the results they wanted?

Many books have been written about the ways in which companies try to market products to kids. A couple of note are Born to Buy: The Commercialized Child and the New Consumer Culture by Juliet Schor and Consuming Kids: The Hostile Takeover of Childhood by Susan Linn. Both books cover food marketing in a good amount of detail (and are well-documented).

One of the things that caught my attention in Born to Buy was Schor’s discussion of how marketing companies want to create a world in which consumers are constantly bombarded by 360-degree advertising (or what one agency refers to as “infinite consumer touchpoint possibilities”).

What are the effects of such marketing? Probably not just obesity. Overstimulation. Psychological effects. Increased materialism. And what are the eventual consequences? In an article, “Children, Commercialism, and Environmental Sustainability,” the authors (Tim Kasser, Tom Crompton, and Susan Linn) argue that “the same generation of children that is being encouraged to prioritize wealth, consumption, and possessions is the same generation that, if current trends continue, will need to drastically reduce its consumption patterns so as to prevent further global climate disruption, habitat loss, and species extinction.”

Food safety issues

The USDA Office of Inspector General issued a report in March 2010 (Audit Report 24601-08-KC) noting that:

One of the public food safety issues facing the United States is the contamination of meat with residual veterinary drugs, pesticides, and heavy metals. “Residue” of this sort finds its way into the food supply when producers bring animals to slaughter plants while they have these residual contaminants in their system. When the animals are slaughtered, traces of the drugs or pesticides contained in these animals’ meat is shipped to meat processors and retail supermarkets, and eventually purchased by consumers. In order to safeguard the Nation’s food supply from harmful residue, the U.S. Department of Agriculture’s (USDA) Food Safety and Inspection Service (FSIS) administers the national residue program.

The Inspector General found that “the national residue program is not accomplishing its mission of monitoring the food supply for harmful residues. Together, FSIS, FDA, and EPA have not established thresholds for many dangerous substances (e.g., copper or dioxin), which has resulted in meat with these substances being distributed in commerce. Additionally, FSIS does not attempt to recall meat, even when its tests have confirmed the excessive presence of veterinary drugs.”

So the food we eat might actually be a source of obesity in more than one way.  Does this bother anyone else?

May 5, 2010

PepsiCo CEO: “If all consumers exercised … obesity wouldn’t exist”

Pepsi CEO Indra Nooyi tells Fortune Magazine that obesity is all our fault

FORTUNE: You’ve said that Pepsi should be part of the solution, not the cause, of obesity. How are you and PepsiCo planning to go about that?

Nooyi: If all consumers exercised, did what they had to do, the problem of obesity wouldn’t exist….

(Thanks to Fooducate for finding that one!)

So there you have it.  It’s all our fault! (Since that’s the case, maybe we should just stop buying PepsiCo products.)

Based on the above, I would be willing to bet that Nooyi would disagree with the following article’s conclusions.  I would also be willing to bet that most major food and beverage companies spend a lot of money not just on advertising, but on marketing research, too.

Neurophysiological Pathways to Obesity: Below Awareness and Beyond Individual Control, Deborah A. Cohen, Diabetes July 2008 vol. 57 no. 7 1768-1773

doi: 10.2337/db08-0163

http://diabetes.diabetesjournals.org/content/57/7/1768.full

I think Cohen makes some very good arguments, but I would quibble with her on two points.

One, she says “the suppositions that a change in genetics and/or metabolism is responsible for the increase in obesity over the past three decades are implausible due to lack of evidence of mutations over this short period of time….” But if changes in metabolism are being caused epigenetically by exposure to chemicals in the environment, the rate of such changes could be much more accelerated than the rate of mutations one would expect from random mutations to people’s DNA.

Two, she says that arguments that it is totally the individuals’ fault that they are overweight or obese imply that 30 years ago people had more self-control.  Well, frankly, maybe they did!  That should not be discounted as a possibility.  But I would tend to go with the argument that most of the problem is caused by eating more and not being active enough.

Having said that,  I think her arguments about why people are eating more are quite valid and that food and beverage manufacturers are probably not going to make eating less any easier.

For the sake of argument let’s say that food and beverage manufacturers actually do want you to eat and drink less (well, at least as long as you keep eating and drinking their products).

So which companies are going to willingly cede market share to other companies?  Umm … none?  So what does that mean?  It means that they’re going to continue marketing their products as aggressively as they have in the past.  (It’s like a tragedy of the common food court!)  They’re just going to try to use different techniques to persuade people to but their products.  “Healthy. Organic. Natural.”  Most importantly, “Much better for you than that other company’s products….”

Or perhaps they figure that if their products are going to make us overweight or obese, then they’ll just sell us drugs to deal with metabolic syndrome and other health problems later.  (Huh, I wonder if any of the big food and beverage companies own any pharmaceutical firms.  Or have invested in them?)

Anyway, in the article Cohen identifies what she says are 10 neurophysiological pathways that can lead people to make food choices subconsciously or, in some cases, automatically.

These pathways include reflexive and uncontrollable neurohormonal responses to food images, cues, and smells; mirror neurons that cause people to imitate the eating behavior of others without awareness; and limited cognitive capacity to make informed decisions about food.

Given that people have limited ability to shape the food environment individually and no ability to control automatic responses to food-related cues that are unconsciously perceived, it is incumbent upon society as a whole to regulate the food environment, including the number and types of food-related cues, portion sizes, food availability, and food advertising.

There is a growing consensus that the global obesity epidemic is the result of increasing urbanization and globalization, coupled with significant changes in the food environment. Obesity was initially highest in developed countries, but developing countries are quickly catching up.

The dominant thinking about obesity is that prevention and treatment is a matter of self-control and individuals making wiser food choices.  However, if this is really the case, then it implies that 30 years ago, before obesity increased, the population had more self-control and made wiser choices, and since then, our collective capacity for self-control must have diminished. It also suggests that people who live in other countries with lower rates of obesity have more self-control than Americans.

Just as the suppositions that a change in genetics and/or metabolism is responsible for the increase in obesity over the past three decades are implausible due to lack of evidence of mutations over this short period of time, the idea that the levels of personal responsibility, knowledge, intelligence, or moral character of a majority of the population are rapidly declining is also not a credible explanation of this phenomenon. It is unlikely that the nature of people has changed so dramatically. What has changed dramatically, however, is the environment in which we now live.

The availability and affordability of food has increased, due to a combination of technological advances in food preservation and packaging, increased food production and crop yields, and decreases in food costs relative to total income. In many parts of the world, food is available to all socioeconomic classes 24 h/day, 7 days a week. Moreover, while food advertising is not new, greater sophistication in marketing—including the development of branding, expanded use of vending machines and other mechanisms for self-service, technologies like eye movement tracking, and the application of social psychology — are all widely used to increase impulse buying and sales of highly processed foods. The techniques are increasingly more sophisticated, customized, and targeted to increase their efficacy. (Emphasis added.)

Could the increases in food availability, food salience, and the sophistication of modern marketing explain the obesity epidemic? If so, there must be neurophysiological pathways within humans that facilitate consumption of readily available food. Further, these mechanisms should affect all population groups similarly, regardless of income or level of education.

Although individuals with a higher level of education have lower rates, the prevalence of overweight and obesity is increasing in well-educated individuals at roughly the same rate as in less educated individuals. It is not unusual to see doctors, nurses, and dietitians possessing expert knowledge about nutrition and weight control who are themselves overweight or obese. Thus, it is likely that the mechanisms affecting food intake are not a matter of conscious decision making based on knowledge but are operating below the level of individual awareness and beyond individual control.

This article will review the interaction between the food environment and human neurophysiology to provide some initial evidence that, to a large extent, obesity is the consequence of automatic and largely uncontrollable responses to an environment with excessive food availability and aggressive and unrelenting cues that cause people to eat too much. Ten possible neurophysiological pathways are proposed that, in conjunction with unprecedented increases in food availability and food marketing, might explain how and why people consume more calories than they expend, especially without their full awareness or control of their behavior. The mechanisms include 1) physiological reflexive response to food and images of food; 2) inborn preferences for sugar and fat; 3) hardwired survival strategies, including foraging behaviors in response to food variety and novelty, also without awareness; 4) inability to judge volume or calories either through visual perception or internal signals of satiety; 5) natural tendency to conserve energy; 6) mirror neurons that lead people to mimic the behavior of other humans, often without awareness; 7) automatic stereotype activation; 8) conditioned responses that result in desire for food when confronted with food-related cues; 9) automatic responses to priming; and 10) limited cognitive capacity and self-regulatory control. In addition, speculations on specific mechanisms that deserve further study and direction for obesity control are discussed.

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

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

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