How Our Government Incentivizes the Overproduction of Junk Food

Lauren Servin, Next New Deal, May 30, 2012

Americans need their tax dollars spent on providing food that will make us healthy, not food that's tied to the obesity epidemic.

While Michelle Obama has been working hard to reduce childhood obesity through her "Let’s Move" campaign, she has done little to advocate for change in the Farm Bill, which is set to expire on September 30th. This is the main piece of agricultural legislation, and some believe it is the root cause of the obesity problem. Our country spends far too much of taxpayer money subsidizing the very foods that may be making us unhealthy.

Over the past five years, the Farm Bill has distributed $42 billion of our tax dollars to farmers, mainly in the form of direct payments or subsidized crop insurance. Those that qualify for these payments are mostly big commodity firms that grow such crops as corn, wheat, soy, and cotton, and they are paid regardless of crop prices. A majority of these firms are large enough that with the recent rise in commodity prices and without a regulatory limit on how much they can produce, much of the government subsidy gets banked as extra profits. The subsidies not only add to the national debt, but incentivize the overproduction of crops that are the major ingredients in unhealthy foods.

The Environmental Working Group reported that from 1995 to 2010, 75 percent of farm subsidies went to firms with incomes in the top 10 percent. Such payments are also further concentrated in the states that grow the largest amounts of corn and soy. In the same period, $167.3 billion was spent on commodity crops, of which $77.1 billion went to corn subsidies, with $14.2 billion spent in Iowa alone. All 50 states engage in some sort of agriculture, yet 8.5 percent of subsidies are concentrated in Iowa, spent mostly on corn that is inedible to humans. This corn is either fed to animals, used as fuel in the form of ethanol, or undergoes heavy processing to become an ingredient in sodas, candy, and other food.

And these food items have been linked to high rates of obesity. The real cost of foods containing unhealthy, commodity-related ingredients has consistently declined since 1985, while the consumption of such unhealthy foods has gone up correspondingly. From 1986 to 2000, the prevalence of obesity quadrupled from one in 200 Americans to one in 50.

Why did our government initially subsidize these commodity crops? Subsidies were a way to manage surplus food resulting from increased production needed to fuel WWII and to feed Europe, whose agricultural land had been destroyed. They offset and controlled the overproduction of these crops so as to prevent them from flooding the market. The government began paying farmers not to grow commodities, and they purchased surpluses to be placed in large government stores. By controlling production, they helped keep commodity prices stable. In the 1980s and 1990s, big food processers lobbied to get rid of these regulatory subsidies to maximize the amount of crops produced. Increased production was believed to promote economic growth through expansion into foreign markets. The overproduction caused prices to fall dramatically, yet farmers continued to produce more and more to try to make up for their losses.

Instead of trying to fix this issue through regulating commodity production, the 1996 farm bill, otherwise known as the “Freedom to Farm” bill, got rid of all subsidy programs that incentivized farmers to control their production and let the market provide payment to farmers. However, farmers became incredibly vulnerable to market fluctuation and many went bankrupt. To avoid an all-out disaster, the government enacted emergency subsidy payments to farmers, which were then made permanent by congress in 2002. This toxic combination of deregulation and perpetual subsidy has led to the overproduction and overuse of crops that we find in junk food.

But some of these payments may change in the near future. In a rush to impact the deficit, the “super committee” attempted to slash the Farm Bill by $23 billion over the next 10 years. A majority of these cuts, about $15 billion, will come from these direct payments to commodity farmers. But $6.5 billion will come from conservation programs and $4 billion from food stamps. While the commodity cuts look big, structurally the bill remains the same, with incentives still in place for farmers to grow large quantities of commodity crops. 

Programs that tend to promote healthier food under conservation, such as converting conventional farms to organics and capital for new farmers, will likely be cut. During the final hearings, some senators did voice concern over crop diversity, opportunities for new farmers, and conserving soil and water resources. However, there was no comprehensive proposal offered to address these issues, meaning they will likely be forgotten.

While some researchers deny the relation between subsides and obesity, there is no question that there are more cheap junk foods on supermarket shelves than ever before and that obesity rates are at a record high. It is also hard to ignore that the main ingredients in these cheap, unhealthy foods are the subsidized commodity crops that have flourished due to policies enacted during the ‘80s and ‘90s. While some subsidies for commodity crops are likely to be cut, the government needs to once again play a regulatory role in agricultural markets. Because of the unpredictability of agricultural production, farmers will continue to lean on the side of planting more as they take advantage of high commodity prices. Until there is regulation of such crops and incentives for the production of healthier options, the cheap price of unhealthy foods will continue to win out over healthier options that are less appealing to some both in taste and in price. We need our tax dollars or our debt invested in food that we actually eat, that will keep us healthy, and that is accessible to Americans of all income levels. 

Lauren Servin is a Roosevelt Institute | Pipeline Fellow focusing on agriculture policy and food security.

New York Plans to Ban Sale of Big Sizes of Sugary Drinks

Michael M. Grynbaum, the New York Times, May 31, 2012

New York City plans to enact a far-reaching ban on the sale of large sodas and other sugary drinks at restaurants, movie theaters and street carts, in the most ambitious effort yet by the Bloomberg administration to combat rising obesity. 

The proposed ban would affect virtually the entire menu of popular sugary drinks found in delis, fast-food franchises and even sports arenas, from energy drinks to pre-sweetened iced teas. The sale of any cup or bottle of sweetened drink larger than 16 fluid ounces — about the size of a medium coffee, and smaller than a common soda bottle — would be prohibited under the first-in-the-nation plan, which could take effect as soon as next March. 

The measure would not apply to diet sodas, fruit juices, dairy-based drinks like milkshakes, or alcoholic beverages; it would not extend to beverages sold in grocery or convenience stores.

“Obesity is a nationwide problem, and all over the United States, public health officials are wringing their hands saying, ‘Oh, this is terrible,’ ” Mr. Bloomberg said in an interview on Wednesday in the Governor’s Room at City Hall. 

“New York City is not about wringing your hands; it’s about doing something,” he said. “I think that’s what the public wants the mayor to do.” 

A spokesman for the New York City Beverage Association, an arm of the soda industry’s national trade group, criticized the city’s proposal on Wednesday. The industry has clashed repeatedly with the city’s health department, saying it has unfairly singled out soda; industry groups have bought subway advertisements promoting their cause. 

“The New York City health department’s unhealthy obsession with attacking soft drinks is again pushing them over the top,” the industry spokesman, Stefan Friedman, said. “It’s time for serious health professionals to move on and seek solutions that are going to actually curb obesity. These zealous proposals just distract from the hard work that needs to be done on this front.” 

Mr. Bloomberg’s proposal requires the approval of the Board of Health, a step that is considered likely because the members are all appointed by him, and the board’s chairman is the city’s health commissioner, who joined the mayor in supporting the measure on Wednesday. 

Mr. Bloomberg has made public health one of the top priorities of his lengthy tenure, and has championed a series of aggressive regulations, including bans on smoking in restaurants and parks, a prohibition against artificial trans fat in restaurant food and a requirement for health inspection grades to be posted in restaurant windows. 

The measures have led to occasional derision of the mayor as Nanny Bloomberg, by those who view the restrictions as infringements on personal freedom. But many of the measures adopted in New York have become models for other cities, including restrictions on smoking and trans fats, as well as the use of graphic advertising to combat smoking and soda consumption, and the demand that chain restaurants post calorie contents next to prices.

In recent years, soda has emerged as a battleground in efforts to counter obesity. Across the nation, some school districts have banned the sale of soda in schools, and some cities have banned the sale of soda in public buildings. 

In New York City, where more than half of adults are obese or overweight, Dr. Thomas Farley, the health commissioner, blames sweetened drinks for up to half of the increase in city obesity rates over the last 30 years. About a third of New Yorkers drink one or more sugary drinks a day, according to the city. Dr. Farley said the city had seen higher obesity rates in neighborhoods where soda consumption was more common. 

The ban would not apply to drinks with fewer than 25 calories per 8-ounce serving, like zero-calorie Vitamin Waters and unsweetened iced teas, as well as diet sodas.

Restaurants, delis, movie theater and ballpark concessions would be affected, because they are regulated by the health department. Carts on sidewalks and in Central Park would also be included, but not vending machines or newsstands that serve only a smattering of fresh food items. 

At fast-food chains, where sodas are often dispersed at self-serve fountains, restaurants would be required to hand out cup sizes of 16 ounces or less, regardless of whether a customer opts for a diet drink. But free refills — and additional drink purchases — would be allowed. 

Corner stores and bodegas would be affected if they are defined by the city as “food service establishments.” Those stores can most easily be identified by the health department letter grades they are required to display in their windows. 

The mayor, who said he occasionally drank a diet soda “on a hot day,” contested the idea that the plan would limit consumers’ choices, saying the option to buy more soda would always be available. 

“Your argument, I guess, could be that it’s a little less convenient to have to carry two 16-ounce drinks to your seat in the movie theater rather than one 32 ounce,” Mr. Bloomberg said in a sarcastic tone. “I don’t think you can make the case that we’re taking things away.”

He also said he foresaw no adverse effect on local businesses, and he suggested that restaurants could simply charge more for smaller drinks if their sales were to drop.

The Bloomberg administration had made previous, unsuccessful efforts to make soda consumption less appealing. The mayor supported a state tax on sodas, but the measure died in Albany, and he tried to restrict the use of food stamps to buy sodas, but the idea was rejected by federal regulators. 

With the new proposal, City Hall is now trying to see how much it can accomplish without requiring outside approval. Mayoral aides say they are confident that they have the legal authority to restrict soda sales, based on the city’s jurisdiction over local eating establishments, the same oversight that allows for the health department’s letter-grade cleanliness rating system for restaurants. 

In interviews at the AMC Loews Village, in the East Village in Manhattan, some filmgoers said restricting large soda sales made sense to them. 

“I think it’s a good idea,” said Sara Gochenauer, 21, a personal assistant from the Upper West Side. Soda, she said, “rots your teeth.” 

But others said consumers should be free to choose. 

“If people want to drink 24 ounces, it’s their decision,” said Zara Atal, 20, a college student from the Upper East Side. 

Lawrence Goins, 50, a postal worker who lives in Newark, took a more pragmatic approach.

“Some of those movies are three, three and a half hours long,” Mr. Goins said. “You got to quench your thirst.” 

Colin Moynihan contributed reporting.

Getting America on a Diet That Works

The Editors, Bloomberg,  May 20, 2012

Obesity has become a danger far greater than hunger. Yet amid the alarming stories about its harm to America’s health and economy, one bit of information has been drowned out: The percentage of U.S. adults who are obese appears to have plateaued. 

According to data from the National Health and Nutrition Examination Survey, which measures the heights and weights of a representative sample of almost 6,000 Americans, the prevalence of obesity in 2009-2010 was essentially the same as in 2003- 2008. Given that the rate had doubled from 1980 to 2000, this is positive news. 

It should not, however, be reason to give up the fight. Rather, the findings lead us to twin conclusions: We can make gains against obesity, and we should find ways to accelerate that progress. 

The U.S. prevalence remains disastrously high: Thirty-six percent of adults (78 million) and almost 17 percent of children (12.5 million) weigh enough in relation to their height to be considered obese. For Hispanic and Mexican-American women, the prevalence is more than 40 percent, and for black women, it’s over 58 percent. 

The health risks are unambiguous: diabetes, heart disease, stroke, breast and colon cancer, liver and gallbladder disease, sleep apnea, osteoarthritis and infertility. Treating these and other problems costs $190 billion a year, more than a fifth of the nation’s medical bill. 

Why We’re Heavy

Many causes have been clearly identified: Our plates bulge with dense, starchy, high-calorie foods, but hold fewer fruits and vegetables than nutrition guidelines recommend. We eat out and order in more than ever, as both parents work outside the home. Our office jobs are sedentary. Kids sit around indoors too much. We spend a great deal of time watching TV, moving little and absorbing ads for all sorts of cheap, sugary, salty foods. 

As a species, we lack biological mechanisms to block our appetites at the point when we’ve eaten enough or, having overeaten, to hunger less for the next meal. To the contrary, our bodies are naturally adept at gaining fat. 

Conquering obesity will require changing our “obesogenic” culture in such a way as to steer people, en masse, away from fattening habits and lead all of us to choose healthy foods in modest portions, and become more active. 

This cannot be accomplished with one sweeping national policy, although the federal government can push for some useful changes. The 2010 health-care reform law, for example, requires restaurants and vending-machine operators with at least 20 locations to list the calorie content of their standard menu items. The Food and Drug Administration is working out the rules to make this happen. 

The FDA is also working to update its labeling requirements for packaged food, aiming in part to make calorie information more prominent, on the front of the package. Britain has created a model for this, with its voluntary front-of-package labels in traffic-light colors: Fat, saturated fat, sugar and salt content are given with rankings of green for low, amber for medium and red for high. 

We’d also like to see national agriculture policy changed to refocus crop and insurance subsidies away from corn, soybeans, wheat and cotton and toward vegetables.

But state and city policy makers can push for changes, too, and can arguably have the greater effect. Foods and eating habits have local qualities, after all. Obesity rates vary by state -- from 20 percent in Colorado (in 2010) to 34 percent in West Virginia. And each city and state has its own tolerance for government interference. 

Local Preferences

Not all county officials would be willing to demand, for example, that kids’ meals containing toys adhere to limits on calories and salt, as supervisors in San Francisco and Santa Clara, California, have done. But some cities might follow New York’s example and ban artificial trans fats in restaurants. 

States can experiment with modifying the food environment in other ways. Iowa, for instance, has enhanced vending machines at highway rest stops by adding healthy snacks and providing traffic-light-colored nutritional labels. 

Some cities might want to try putting pressure on restaurants to limit portion sizes, aiming for a weight- conscious 700 calories per meal, as has been proposed by scientists at the RAND Corp. Many local governments would no doubt resist such a step as “nannying,” but state and local health officials set various other standards for food and water, to prevent food-borne illness and contamination. Now that one in three adults are obese, it’s clear that calorie count is also an aspect of food safety. 

Local officials can provide tax breaks and streamlined permitting processes to encourage fresh-food grocers and farmers’ markets to set up shop in neighborhoods that need them. They can zone neighborhoods to get housing developers to provide safe and convenient sidewalks. 

We would especially like to see some cities follow the recommendation of many obesity experts -- including, most recently, the Institute of Medicine -- and put a penny-an-ounce tax on sugar-sweetened beverages. A study published this year suggested this could reduce per capita consumption by 15 percent. But it would be nice to find out for sure whether people would choose less fattening beverages if sodas cost more. 

Although no one knows how well each strategy will work, there is good reason to think that the prevalence of obesity can be reduced in adults. As for children, a prime target for obesity prevention, they will be the subject of the next editorial on the subject.

Dieting for Dollars (or Maybe a Movie Ticket)

Nicole LaPorte, The New York Times, May 12, 2012

BACK in 1999, Michael Paolini, an inventor at I.B.M. in Austin, Tex., was having lunch at a Ruby Tuesday’s with some fellow engineers when the group decided that too many burgers and fries were translating into thicker waistlines. It was time to lose weight. 

But, being engineers, they weren’t just going to hit the StairMaster. They decided to build a computer program to make shedding pounds as geekily fun as playing Xbox, but with an added incentive: the opportunity to win cash. 

The idea for this program, which recently won patent approval, was simple: participants would be rewarded for eating well and discouraged from eating poorly. So a salad for lunch could mean winning 50 cents. Pecan pie? Forget it. 

The invention is an example of how gamification — applying game techniques and psychology to influence behavior in the real world — is affecting the health arena. Eventually, I.B.M. hopes to license the system to companies or insurers as they seek to improve employees’ well-being. 

Already, a cornucopia of mobile apps on the market — like Lose It and Weight Watchers Mobile — try to make the arduous process of losing weight more fun. Weight Watchers gives dieters a specific number of daily points so they can stay within a caloric limit, and lets them see how many points they’d use by adding, say, blue cheese dressing instead of balsamic vinaigrette to greens. 

I.B.M.’s program, which like these apps relies on users to report their consumption truthfully, is a more customizable model. It can be used by anyone from kosher eaters to moms trying to get their children to eat peas. 

The nature of rewards is also flexible. Mr. Paolini noted that “everyone understands cash,” which is why the initial version employs it, but that users could also earn movie tickets or even FarmVille animals for use in the online game. 

Mr. Paolini and his colleagues were inspired by the Honda Insight, a hybrid car that gives drivers immediate feedback on how their driving is affecting the car’s gas mileage. Seeing that feedback immediately, they reasoned, motivated people to change how they drove. 

The dashboard “shows gas mileage in really big letters,” Mr. Paolini said. “It has the current average and the lifetime average. Everyone can see it. So if you get in the car and it has 50 miles to a gallon, and you’ve been driving in stop-and-go traffic and are down to 25 miles a gallon, what does that say about you and your driving technique? 

“It’s that mechanism that empowers the driver to make choices. He could still put on the gas and go, but he could also change his technique,” say, by braking gently and taking his foot off the gas when he sees a car. “That’s the same kind of thing we’re doing here.” 

It’s possible to imagine health insurance companies supporting the I.B.M. program as a way to lower employees’ medical bills and, eventually, their monthly premiums. But this may raise privacy issues of the sort that Facebook has been battling. Should a health insurance company or an employer be privy to a 3 a.m. Snickers bar binge? 

“The patent drives good behavior, but, like anything, it has the possibility of abuse,” said Paul Hebert, managing director of I2I, a marketing company that works with companies on incentive and rewards programs. “Health insurance providers could theoretically start to use the program as leverage” with a company, he said. “In other words, ‘Use the program with your employees or pay a higher premium.’ ” 

There is also a potential perception issue in an organization, he said. “If I have half my employees opting in, and half not,” he asked, will the people who don’t participate be judged negatively? 

Responding to the idea that the program might be used in an Orwellian way, Mr. Paolini said it was up to those who put it into effect to decide how much information is collected and how that data will be used. 

He added that applying social media tools to weight loss has become increasingly popular. “People post their daily weight or eating habits to online social groups,” he said. “What they get from this is sometimes encouragement, sometimes suggestions, and sometimes a swift boot to the butt to help put them back on the right path.” 

Mr. Paolini acknowledged that there is no guarantee that people will be honest about what they do or don’t consume when they use the I.B.M. program. “You could strap an ankle bracelet on people if you really cared to, but I don’t think people would do that voluntarily,” he joked. 

Ultimately, he said, the program is built around trust — that the overseer isn’t exploiting data, and that participants aren’t cheating, say, by failing to record that Snickers binge.

Ethical debates aside, is the program effective? Mr. Paolini says he thinks it is. After using it, he says, he succeeded in losing 18 pounds.

Virtual World Takes on Childhood Obesity

A startup blends activity tracking with online incentives in hopes of getting kids into shape. 

Mya Frazier, Technology Review, MIT, May 16, 2012

Malica Astin, 11, never paid much attention to how much physical activity she got. But one day she played basketball while wearing a small activity tracker called a Zamzee on her waist. Later, she plugged it into a computer's USB port and uploaded the data captured by the device's accelerometers. Unlike a FitBit, a popular pedometer geared to adults, Malica's Zamzee didn't tell her how many steps she took or calories she burned. Instead, it gave her points for the movements she made. 

Even months later, she recalls the details of that first windfall: 758 points. And why not? The points are a currency that she can spend in the virtual world of Zamzee.com, where she created an avatar and outfitted it with braces, a necklace, and a hula skirt. 

Malica has since earned 3,612 "Zamz," and could eventually save enough to get real items like an iPod Nano (16,000 Zamz) or Wii console (18,000 Zamz). "At first, I didn't know what it was all about," she says. "Then I really started liking it."

Malica's experience illustrates the goals of Zamzee, a startup that is testing the notion that the addictiveness of games can be harnessed to solve a seemingly intractable social ill—in this case, childhood obesity. Rather than focusing on weight loss or diet, Zamzee hopes to reward movement of any kind in children 11 to 14, the ages when, according to research, physical activity drops precipitously. 

Zamzee is a for-profit venture started by Hope Lab, the nonprofit foundation begun by eBay founder Pierre Omidyar and his wife, Pam. (Hope Lab has also created the Re-Mission video game to increase medication compliance among kids with cancer.) Although Zamzee formally launches this fall, it has been in pilot programs in schools and community centers in Atlanta, Chicago, and the San Francisco Bay Area.

Malica is one of 20 middle-school girls who has been trying Zamzee at a Boys & Girls Club in Atlanta. It's a daunting proving ground. Georgia ranks second in the nation for childhood obesity, and 52 percent of middle-school students fail to meet the CDC's recommendations for daily activity. The situation is so dire that Children's Healthcare of Atlanta, a system of pediatric centers, recently launched a hard-edged ad campaign aimed at overweight children.

In contrast, Zamzee is about carrots rather than sticks. Parents put money into an account to fund the rewards that their children can try to earn with their Zamz (though some donors, such as the Mayo Clinic, are providing funding for poor families during the pilot tests).  

Neuroscientist Sandra Aamodt, the author of Welcome to Your Child's Brain, praises Zamzee's focus on physical activity instead of weight. But she cautions that a substantial body of research has found that intrinsic motivation outlasts extrinsic rewards: "There's this funny tendency to lose the focus on why you enjoyed something in the first place," Aamodt says.     

With that in mind, Zamzee's developers have been testing multiple methods for motivating children. Steve Cole, a biomedical scientist at UCLA who heads research and development for Hope Lab, says Zamzee has found that combining virtual and monetary rewards can be successful.

Even so, not all Zamzee users are as motivated as Malica. Emani Welch, 13, an Atlanta seventh-grader, isn't racking up enough points for rewards. She's yet to create an avatar or even log on to Zamzee.com. "I just sit still most of the time because there's not much to do," she says. "I go play tennis every now and then."

Copyright Technology Review 2012.

A Mathematical Challenge to Obesity

Claudia Dreifus, The New York Times, May 15, 2012

Carson C. Chow deploys mathematics to solve the everyday problems of real life. As an investigator at the National Institute of Diabetes and Digestive and Kidney Diseases, he tries to figure out why 1 in 3 Americans are overweight. 

We spoke at the recent annual meeting of the American Association for the Advancement of Science, where Dr. Chow, 49, gave a presentation on “Illuminating the Obesity Epidemic With Mathematics,” and then later by telephone; a condensed and edited version of the interviews follows. 

You are an M.I.T.-trained mathematician and physicist. How did you come to work on obesity?

 

In 2004, while on the faculty of the math department at the University of Pittsburgh, I married. My wife is a Johns Hopkins ophthalmologist, and she would not move. So I began looking for work in the Beltway area. Through the grapevine, I heard that the N.I.D.D.K., a branch of the National Institutes of Health, was building up its mathematics laboratory to study obesity. At the time, I knew almost nothing of obesity. 

I didn’t even know what a calorie was. I quickly read every scientific paper I could get my hands on. 

I could see the facts on the epidemic were quite astounding. Between 1975 and 2005, the average weight of Americans had increased by about 20 pounds. Since the 1970s, the national obesity rate had jumped from around 20 percent to over 30 percent. 

The interesting question posed to me when I was hired was, “Why is this happening?” 

Why would mathematics have the answer?

 

Because to do this experimentally would take years. You could find out much more quickly if you did the math. 

Now, prior to my coming on staff, the institute had hired a mathematical physiologist, Kevin Hall. Kevin developed a model that could predict how your body composition changed in response to what you ate. He created a math model of a human being and then plugged in all the variables — height, weight, food intake, exercise. The model could predict what a person will weigh, given their body size and what they take in. 

However, the model was complicated: hundreds of equations. Kevin and I began working together to boil it down to one simple equation. That’s what applied mathematicians do. We make things simple. Once we had it, the slimmed-down equation proved to be a useful platform for answering a host of questions. 

What new information did your equation render?

 

That the conventional wisdom of 3,500 calories less is what it takes to lose a pound of weight is wrong. The body changes as you lose. Interestingly, we also found that the fatter you get, the easier it is to gain weight. An extra 10 calories a day puts more weight onto an obese person than on a thinner one. 

Also, there’s a time constant that’s an important factor in weight loss. That’s because if you reduce your caloric intake, after a while, your body reaches equilibrium. It actually takes about three years for a dieter to reach their new “steady state.” Our model predicts that if you eat 100 calories fewer a day, in three years you will, on average, lose 10 pounds — if you don’t cheat. 

Another finding: Huge variations in your daily food intake will not cause variations in weight, as long as your average food intake over a year is about the same. This is because a person’s body will respond slowly to the food intake. 

Did you ever solve the question posed to you when you were first hired — what caused the obesity epidemic?

 

We think so. And it’s something very simple, very obvious, something that few want to hear: The epidemic was caused by the overproduction of food in the United States. 

Beginning in the 1970s, there was a change in national agricultural policy. Instead of the government paying farmers not to engage in full production, as was the practice, they were encouraged to grow as much food as they could. At the same time, technological changes and the “green revolution” made our farms much more productive. The price of food plummeted, while the number of calories available to the average American grew by about 1,000 a day. 

Well, what do people do when there is extra food around? They eat it! This, of course, is a tremendously controversial idea. However, the model shows that increase in food more than explains the increase in weight.

In the 1950s, when I was growing up, people rarely ate out. Today, Americans dine out — with these large restaurant portions and oil-saturated foods — about five times a week.

Right. Society has changed a lot. With such a huge food supply, food marketing got better and restaurants got cheaper. The low cost of food fueled the growth of the fast-food industry. If food were expensive, you couldn’t have fast food. 

People think that the epidemic has to be caused by genetics or that physical activity has gone down. Yet levels of physical activity have not really changed in the past 30 years. As for the genetic argument, yes, there are people who are genetically disposed to obesity, but if they live in societies where there isn’t a lot of food, they don’t get obese. For them, and for us, it’s supply that’s the issue.

Interestingly, we saw that Americans are wasting food at a progressively increasing rate. If Americans were to eat all the food that’s available, we’d be even more obese. 

Any practical advice from your number crunching?

One of the things the numbers have shown us is that weight change, up or down, takes a very, very long time. All diets work. But the reaction time is really slow: on the order of a year.

People don’t wait long enough to see what they are going to stabilize at. So if you drop weight and return to your old eating habits, the time it takes to crawl back to your old weight is something like three years. To help people understand this better, we’ve posted an interactive version of our model at bwsimulator.niddk.nih.gov. People can plug in their information and learn how much they’ll need to reduce their intake and increase their activity to lose. It will also give them a rough sense of how much time it will take to reach the goal. Applied mathematics in action! 

What can Americans do to stem the obesity epidemic?

One thing I have concluded, and this is just a personal view, is that we should stop marketing food to children. I think childhood obesity is a major problem. And when you’re obese, it’s not like we can suddenly cut your food off and you’ll go back to not being obese. You’ve been programmed to eat more. It’s a hardship to eat less. Michelle Obama’s initiative is helpful. And childhood obesity rates seem to be stabilizing in the developed world, at least. The obesity epidemic may have peaked because of the recession. It’s made food more expensive. 

You said earlier that nobody wants to hear your message. Why?

I think the food industry doesn’t want to know it. And ordinary people don’t particularly want to hear this, either. It’s so easy for someone to go out and eat 6,000 calories a day. There’s no magic bullet on this. You simply have to cut calories and be vigilant for the rest of your life.

Public Health Experts Make Recommendations For Obesity Prevention

John Reichard, CQ HealthBeat Editor, Reuters, May 11, 2012

An optimist might say America is about to turn the corner in its battle against obesity. It isn't because things are getting markedly better. It's that there may be a growing realization that the obesity epidemic could easily get worse. With that recognition, action may follow.

An intense round of meetings and briefings on obesity in recent days and new reports appeared to heighten that awareness. The experts involved said that nothing less than a culture change is required to counter the health threat. And every level of society must be involved.

The message to Congress: Do not shirk your role in addressing the many influences that foster obesity. Schools, employers, health care providers, insurers, families and individuals cannot afford to do so either.

Anchoring a week's worth of events was the May 8 release of a 478-page report by the Institute of Medicine. It predicted that people will act when they know the facts. "Once awareness of the catastrophic nature of the obesity problem is understood and felt and the need for diverse and numerous leaders is recognized, all will share the moment of saying to themselves, 'I can do something about this, and I want to play a role.' "

Americans have slowly but surely modified their behavior to cope with other public health threats. They have significantly reduced their use of tobacco, for example. But the Institute of Medicine report's prediction may be based more on faith than reality, judging from the difficulty of turning back the tide of obesity.

A Bad Neighborhood

The institute report described the powerful influences that promote obesity by talking about "environments" relating to physical activity, food, beverages and messages. It says in effect that Americans live in a bad neighborhood when it comes to avoiding obesity. Adults and children have ready access to cheap, high-calorie foods that come in super-sized portions and are heavily promoted on TV. Physical education classes, once the norm in schools, are no longer offered or have been curtailed. Children play computer games by the hour. In inner cities, where obesity rates are highest, the "built environment" conspires against activity with limited access to exercise areas and high concentrations of fast-food outlets.

"People have a very tough time achieving healthy weights when inactive lifestyles are the norm and inexpensive high-calorie foods and drinks are readily available 24 hours a day," said Dan Glickman, who chaired the institute panel that produced the report. Glickman, a former Kansas congressman, was Agriculture secretary in the Bill Clinton administration.

Without successful anti-obesity efforts, the percentage of obese adults will reach 42 percent in 2030, up from 33 percent now, according to projections released by the Centers for Disease Control and Prevention at a "Weight of the Nation" conference the agency sponsored in Washington May 7 to 9. That will add $550 billion over the next two decades to the nation's health care tab. Treating illnesses related to people being obese or overweight costs $190 billion a year, the institute report said. Two-thirds of adults and a third of children are either obese or overweight.

Experts worry especially about the young. Type 2 "adult-onset" diabetes brought on by obesity and inactivity now accounts for half of new diabetes cases in adolescents, compared with 3 percent a few decades ago.

"We are learning that type 2 diabetes is a more aggressive disease in youth than in adults and progresses more rapidly," said Philip Zeitler, a researcher at Children's Hospital in Aurora, Colo. The longer a person has type 2, the greater the chances that blindness, stroke, heart and kidney failure will occur.

Widespread media coverage of these and other alarming findings adds to the drumbeat of press reports in recent years on obesity. The institute suggests that awareness eventually will reach a point where the "bold, widespread and sustained action" called for by the study begins to occur. "Funding for implementation is likely to become available as the seriousness of the obesity threat is understood," the report says.

To help coordinate action the report offers dozens of recommendations to reach five goals: make schools the heart of anti-obesity efforts; make physical activity a daily part of everyone's lives; offer healthy foods and beverages in all settings; change food marketing; and involve employers, doctors and hospitals in the effort. Congress, it says, should consider taxing soft drinks. And within two years it should legislate marketing standards if industry does not act voluntarily before then to promote healthier nutrition.

But the going will be slow before any tipping point is reached. A major finding calls for 60 minutes a day of physical education through grade 12 — tough to achieve given tight budgets and school testing demands. Industry blocked a soda tax during the health law debate and has resisted federal marketing guidelines. Lawmakers are raiding the multibillion dollar health law fund created to prevent obesity and other costly conditions.

That's "not a very good priority choice when health care is the fastest growing part of our national budget and the whole focus is on debt reduction," Glickman said.

Source: CQ Online News

Same-day coverage of the people and events shaping health care policy from Washington.

© 2012 CQ Roll Call All Rights Reserved.

WSJ: The Tax Code Diet

The Institute for Medicine gets political on obesity.

The Wall Street Journal, May 11, 2012

Beware of scientists who moonlight as politicians. A case in point is this week's Institute of Medicine obesity report that endorses far more regulation of food, business, real estate, health care, transportation, the works. 

"The Weight of the Nation" is one of those prestige doorstops—at some 462 pages it's obese itself—that certain folks will herald as a landmark but deserves some skepticism before it comes to dominate elite opinion. The report even arrives with an epigraph from Goethe ("Knowing is not enough . . . we must do") and a companion HBO documentary.

No question the bulging U.S. waistline is a public health problem. Two-thirds of Americans are now overweight or obese, a trend that began in earnest only over the last 25 or 30 years. For the first time in history, more Americans are obese than smoke. The report estimates 20.6% of annual medical spending is attributable to obesity, much of it absorbed by taxpayers via Medicare and Medicaid.

The institute's panelists don't come out for entitlement reform or new incentives for individuals to maintain a healthy weight through diet and exercise, however. Instead they conclude that America is bombarded by "obesogenic environmental forces" that encourage us to be fat, such as marketing and the availability of low-cost, calorie-rich foods and drinks. Therefore they envision a government-led transformation "across all levels and sectors of society."

It's never a good omen when planners use such language. Some of the policy suggestions are by now obligatory, like potato-chip warning labels and retiring Mayor McCheese to the same glue factory as Joe Camel. Others are more novel—zoning rules that encourage bike paths, parks and grocery stores (but not gyms and health clubs). Some are even sensible: more insurance plan benefit designs that modestly reward healthy habits, for example.

But the most dangerous idea is the call to turn over a large part of fiscal policy to a scientific committee. The panelists want to expand farm subsidies—entitlements for plants and animals—to include fruits and vegetables. They would have done far better to endorse an end to subsidies for row crops like corn, which become low-quality calories via refined starches and high-fructose corn syrup.

"The Weight of the Nation" also comes out for using the tax code to promote social policy via "substantial and specific excise taxes on sugar-sweetened beverages," aka a soda tax. This option will grow more appealing to the political class as federal and state balance sheets continue to deteriorate, but one thing it won't do is improve public health. 

A 2007 paper out of Yale found that each 1% increase on soft drink prices could reduce body mass indexes by 0.0115% on average. Playing off that finding, George Mason economists calculate the price of a can of soda would need to rise 1,200%—to $9.75—to have an effect on obesity trends. That's about what a liter of gasoline costs in carbon-tax Europe. 

The cries for more regulation of consumer choice and picking winners and restaurants will only grow after the institute's report. But new and many more government anti-obesity programs are likely to follow the historic pattern and end up making people fatter.

A version of this article appeared May 11, 2012, on page A12 in some U.S. editions of The Wall Street Journal, with the headline: The Tax Code Diet.

Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation

National Research Council. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. Washington, DC: The National Academies Press, 2012.

Two-thirds of adults and one-third of children are overweight or obese. Left unchecked, obesity's effects on health, health care costs, and our productivity as a nation could become catastrophic. The staggering human toll of obesity-related chronic disease and disability and an annual cost of $190.2 billion for treating obesity-related illness underscore the urgent need to strengthen obesity prevention efforts in the United States. The IOM evaluated prior obesity-prevention strategies and identified recommendations to accelerate progress. The IOM's recommendations, when implemented together, could profoundly reshape the environments where people live, learn, work, and play.

Accelerating Progress in Obesity Prevention is the basis of Weight of the Nation, a multipronged project, which will shed new light on the facts and myths of this urgent public health issue and explore how obesity is impacting our nation and the health care system. This project will feature a series of four documentary films, a three-part HBO Family series, 14 bonus short films, a social media campaign, a companion book, and a nationwide community-based outreach campaign. The four-part documentary series - which will air May 14 and 15 - and other facets of the initiative were developed with expert input from IOM as well as CDC and NIH.

Click the link below for more information about the project provided by the IOM.

Weight of the Nation: Project Page

Check out the HBO trailer for a sneak peak at the documentary series airing May 14th and 15th.

Watch the Weight of the Nation HBO Trailer

Stay tuned for the full length documentaries, which will be free to view even without an HBO subscription.

Learn more about the Weight of the Nation book, which was co-authored by IOM Executive Officer, Judith Salerno.

Want to read the book? Purchase Weight of the Nation here.

School Breakfast, the New Food Fight

Mark Bittman, The New York Times, May 1, 2012

My father — who turned 89 this past Sunday, bless him — grew up what’s now called “food insecure.” Like many immigrants, the Bittman family ate whatever they could get their hands on. This served them well when dinner was a boiled potato with sour cream.

It served them less well after World War II, when every male in the family was making $60 a week or more, which wasn’t bad when $60 paid the rent. Soon thereafter, my paternal grandparents and their sons — my father had three brothers — were way overweight, even obese. All developed diabetes and heart disease.[1]

My father is the only survivor. Both those grandparents and two of my three uncles were dead by the time they were the (tender) age I am now.

Of the two edges of the sword of America’s malnutrition — hunger and obesity — the latter is by far the more prevalent and deadly. In New York City perhaps 2 percent of children have “very low food security,” which might mean vitamin deficiencies, a day without food, a loss of weight, a month of being hungry[2]. Meanwhile, 40 percent of New York’s public school students are overweight or obese, and 2,000 New Yorkers die each year from obesity or overweight-related conditions. All of those deaths are preventable.

No one should belittle even a little hunger, but this why-do-we-even-have-to-talk-about-it comparison of it and obesity is germane because the city’s Health Department recently suspended expansion of the Breakfast in the Classroom (BIC) program, which serves free breakfast in the classrooms of 381 of 1,750 public schools. The program is ostensibly meant to ensure that hungry kids start the day with something to eat.

But the school system already offers every kid, all 1.1 million of them, regardless of income, the opportunity to have free breakfast in the school cafeteria. BIC simply puts that breakfast on every kid’s desk.

The Health Department reined in BIC after finding that roughly 20 percent of all kids might be eating two breakfasts: one before arriving at school and another at their desks, adding on average about 90 unneeded calories to their daily intake. Linda Gibbs, deputy mayor for Health and Human Services, explained that the city wants to make “sure that that no child goes hungry and that every child has access to a healthy breakfast,” but at the same time “wants to be cautious that our good intentions don’t inadvertently exacerbate the obesity issue,” noting the 40 percent figure cited above.

The move’s critics, including some anti-hunger groups, believe that measures to prevent obesity cannot be taken at the expense of addressing hunger and that it’s unconscionable not to act to prevent kids from going hungry.[3] (Ironically enough, some research suggests that hunger may lead to obesity. That was my family’s story.)

But at this point our moral aversion to hunger must be matched by our distress about kids eating themselves sick. Not only does obesity lead to increased rates of Type 2 diabetes, but a study published in The New England Journal of Medicine also found that the heaviest kids were nearly twice as likely as the thinnest to die before age 55.

Still: instead of arguing who needs help more — hungry kids or obese ones — we should help both, starting by recognizing that combating poverty and fighting the dominance of the food “system” that promotes junk at the expense of real food are the ways to conquer both obesity and hunger.

The ostensible rationale for BIC is not to provide free school breakfasts to food-insecure kids, since such a program already exists, but to reduce the stigma of going to claim breakfast in the cafeteria. There are indeed issues of making it to the cafeteria before the bell rings (what if the bus is late?), but if my memory serves me, the stigma of being an overweight 8-year-old is at least as bad as having skipped breakfast at home and having to get it at school. [4]

A serious program for healthy kids might offer occasional snacks of apples, carrots and celery instead of boxed cereal or a cheese stick, both common BIC options. Part of why that doesn’t happen is because perversely named “specialty crops” (you call them “fruits and vegetables”) aren’t supported by the Department of Agriculture in the same way as commodity crops like corn. [5]

Fruits and vegetables should and could be overflowing in classrooms, but that would benefit only kids. The people who really benefit from BIC are, as usual, the companies that market that food and that stand to increase their sales by billions of dollars if BIC were to become a national mandate.

And though the work of anti-hunger organizations like Food Research and Action Center (FRAC) is essential, some of their financing comes from the likes of ConAgra, Kraft, Tyson and the National Dairy Council. And it doesn’t take a cynic to imagine why Kraft or the Dairy Council might like to see kids starting the day with cereal or cheese. Nor is it difficult to imagine them influencing FRAC, in the same way that Big Food’s lobbying and campaign contributions[6] 

might affect the farm bill. Similarly, when the C.E.O. of Weight Watchers International is a co-author of an op-ed criticizing the city’s Health Department for making obesity a greater priority than hunger, I can’t help thinking about just how much Weight Watchers would profit if yet another generation of Americans got fat. Shame on me, I know.

This is complicated, and many of the critics of the Health Department’s actions are allies on other issues. But the vast majority of kids do not need more calories (simply put, more calories to more kids means more obesity), and the real battles should be to subsidize healthy food, discourage junk, eradicate junk food advertising to children, preserve and expand beneficial food assistance programs, and have food policy determined by experts and citizens rather than by corporations and the elected officials who are in their pockets. At the same time, let’s all — parents, teachers, administrators and concerned citizens — encourage those kids who need a free breakfast to make their way to the cafeteria, where it awaits them.

[1] All. Both.

[2]  “Hunger” can be defined, if you have the patience to read this: http://www.ers.usda.gov/amberwaves/june07/features/struggling.htm#box3.

[3] It’s unconscionable for what remains the richest country in the world to have hungry kids at all.

[4] Other secondary issues: having the classroom become the locale for food fights; turning teachers into lunch monitors and bussers; lost teaching time; the conversion of the classroom into a dining room. Etc.

[5] Further evidence, if needed, that the Department of Agriculture is far better at the half of its job that mandates support of industrial agriculture than the half that promotes the health of all Americans. The new farm bill could fix this, but it’s not going to.

[6] If you are going to read one long piece about the war over food this month, the Reuters report linked to here should be it. Mind-blowing.