Tag Archives: obesity
One issue I don’t think gets enough attention as a political challenge is prioritizing. We like to think of social progress as a series of repairs to be made, but really it’s a series of tradeoffs.
I was listening to a podcast the other day on the debate between obesity advocates and eating disorder advocates. Both groups want kids to be in a healthy weight range, but each attacks from a different end of the spectrum.
In the podcast they mention BMI report cards. Schools have apparently been experimenting with reports for parents that include health info alongside educational info. Johnny has an A in math, a B in science and a C in weight control.
Obesity advocates like BMI report cards because they give parents and students information they can use to address warning signs before they become problems. Eating disorder advocates hate BMI report cards because they give parents and students ammunition for bullying. What if one of those report cards falls out of your backpack and the other kids see it?
If you’re a school principal, you can’t win. You don’t institute the report cards, you get a call from the the obesity folks. You institute them, you get a call from the eating disorder folks.
The podcast frames it like eating disorders and obesity are equally severe problems. In reality, 5 percent of 13-18 year olds will suffer from an eating disorder at some point in their lives (the number currently suffering from one would be much smaller). Meanwhile, 18 percent of children 12-19 are obese.
No politician would ever say ‘Dropping the obesity rate by 5 percent means increasing the rate of eating disorders by 1 percent, and we’re prepared to do that.’ But that may very well be part of the calculus.
This is where everyone goes ‘Can’t we just reduce one without increasing the other?!’
Maybe. But no matter what, there are going to be consequences. Making sports mandatory in elementary schools would probably reduce obesity, but it would also probably result in further marginalization of disabled or otherwise un-sporty kids. Improving school lunches might draw attention to the kids who can’t afford them.
And so on. I’m not arguing that we should say ‘Fuck the anorexics, full speed ahead!’ or anything, just that there’s no such thing as social change that doesn’t have consequences.
Luckily, it sounds from this podcast like BMI report cards aren’t such a great idea anyway. Most parents already know if their kids are overweight, and telling them that in writing doesn’t magically give them the skills or inclination to do anything about it. But someday, we’re going to find a solution to this. And right afterwards, every principal’s phone is going to start ringing.
If you pay careful attention to the way Ikarians have lived their lives, it appears that a dozen subtly powerful, mutually enhancing and pervasive factors are at work. It’s easy to get enough rest if no one else wakes up early and the village goes dead during afternoon naptime. It helps that the cheapest, most accessible foods are also the most healthful — and that your ancestors have spent centuries developing ways to make them taste good. It’s hard to get through the day in Ikaria without walking up 20 hills. [...]
Every one of these factors can be tied to longevity. That’s what the $70 billion diet industry and $20 billion health-club industry do in their efforts to persuade us that if we eat the right food or do the right workout, we’ll be healthier, lose weight and live longer. But these strategies rarely work. Not because they’re wrong-minded: it’s a good idea for people to do any of these healthful activities. The problem is, it’s difficult to change individual behaviors when community behaviors stay the same.
In the United States, you can’t go to a movie, walk through the airport or buy cough medicine without being routed through a gantlet of candy bars, salty snacks and sugar-sweetened beverages. The processed-food industry spends more than $4 billion a year tempting us to eat. How do you combat that? Discipline is a good thing, but discipline is a muscle that fatigues. Sooner or later, most people cave in to relentless temptation. [...]
The big aha for me, having studied populations of the long-lived for nearly a decade, is how the factors that encourage longevity reinforce one another over the long term. For people to adopt a healthful lifestyle, I have become convinced, they need to live in an ecosystem, so to speak, that makes it possible. As soon as you take culture, belonging, purpose or religion out of the picture, the foundation for long healthy lives collapses. The power of such an environment lies in the mutually reinforcing relationships among lots of small nudges and default choices. There’s no silver bullet to keep death and the diseases of old age at bay. If there’s anything close to a secret, it’s silver buckshot.
Exactly this! People on this little Greek island aren’t morally or genetically superior, they’re just surrounded by an environment that systematically, comprehensively, ubiquitously encourages healthy behaviors. In the rest of the west, our environment does the exact opposite.
I just finished Lizzie Collingham’s The Taste of War: World War Two and the Battle for Food. It perfectly combines my two current obsessions: 1) Food and 2) Everything I Know About WWII is Wrong.
The book follows the food policies of all the major combatants in WWII: Axis, Allies and colonies alike. Each chapter demonstrates, in its own microcosmic way, how recent a phenomenon our current abundance of food is. Nixon famously told his secretary of agriculture that he didn’t want food to be an election issue ever again, and after reading The Taste of War, you kind of sympathize with him.
Food shortages were a common occurrence before WWII, and even more so during and immediately after. People in countries rich (Britain) and poor (China) faced empty shelves, malnutrition and, in extreme cases (Russia) resorted to boiling leather shoes because they yielded a few calories of gelatin.
This anecdote from Japan is illustrative of how food shortages trickle down through all corners of the economy:
Arakawa Hiroyo and her husband owned a bakery shop in Tokyo. They made katsutera, a sort of sponge cake made with flour, eggs and sugar. The decline of their business reflected the dwindling food supply in Japan. At first, as a food business, they were supplied with flour and sugar, and customers would bring them vegetables in exchange for katsutera.
Eventually the supply of their ingredients declined and they were only able to bake every two or three days. Then the police would drop by.
‘Oh, today you’re baking?’ they would comment innocently. ‘This house sure smells good.’And then Arakawa would have to give them some cakes.The grocers in her street suffered from the same problem. Police and soldiers would simply pocket the food and refuse to pay.
Eggs were the first of their ingredients to disappear altogether. For a while they had a supply of powdered egg from Shanghai but eventually this became unavailable, as did sugar. Arakawa changed the business to making sandwiches, but even those they had to fill with whale ham because there was no pork to be had.
Then bread and whale ham became unavailable. Undaunted, they changed to making ‘cut bread’ for the army, which meant that supplies of the necessary ingredients were guaranteed. [...]
Then the military laid claim to their bread-making machine for the iron and they had to close their business.
The sheer foreignness of this experience demonstrates both the novelty of food shortages as a non-issue, and how unprepared we are for our current infinity of food products.
I want to agree with this study because it confirms my pre-existing biases, but am I really supposed to ignore this paragraph?
The study’s 21 participants, 18 to 40 years old, initially lost 10% to 15% of their body weight during a three-month diet that contained about 45% of total calories from carbohydrates, 30% from fat and 25% from protein.
… So this experiment basically took three groups of seven people, put them on a diet, and recorded what happened. I know that controlled laboratory studies on weight loss are difficult and expensive, but an n this small isn’t science, it’s a reality show.
Bloomberg is doing a good thing by banning servings of soda above 16 ounces.
Is it perfect? No. Will it singularly solve America’s obesity crisis? No. But it’s a step.
Now everyone just quiet down for a minute so we can wait for it to come into effect, root for it and see what happens.
1. This is not a consumer choice issue
Banning servings of soda above 16 ounces does not prevent you from drinking large amounts of soda. If you want more than 16 ounces, buy two. All this policy does is create a (slight) disincentive to overconsume diabetes-juice at every meal. It’s not a panacea, and it’s not pretending to be.
2. This effort does not preclude others.
Yes, America should deal with its farm subsidies. And bring PE back into schools. And educate parents. And stop playing video games. And cook more. And jog in barefoot-shoes. Fine, whatever. Those are not arguments against this particular policy, and efforts to make them reality are helped, not hindered, by it. This is what cultural change looks like: Dozens of initiatives in dozens of jurisdictions, until a new consensus forms.
3. Political actors need to freedom to experiment
Fundamentally, this policy represents an elected official doing what is within his power to reduce the negative impacts of obesity. I hope that mayors, governors, principals, civil servants and bureaucrat across the country are watching what Bloomberg did with his authority today, and thinking about what they can do with theirs.
Now that I’m not eating sugar, peanut butter is one of the hardest foods to find. All of the major brands contain significant amounts of sugar (usually disguised as dextrose or some syrup), even the organic brands. This got me thinking about the peanut butter I used to eat when I lived in the states, so I went to the Jif homepage to look up the nutritional information on their Reduced Fat Creamy Peanut Butter, which was a staple of my breakfast from about 10 years old to 19.
I’ve been out of the US food environment for quite awhile, and Germany and Denmark, say what you want about them, don’t have deceptive labeling or choice-overload the way the US does. Still, a few things surprised me about the spreadable options back in my homeland:
- All of Jif’s peanut butters have exactly the same calories per serving: 190. As a kid, I would have been better off just eating the full-fat version rather than the ‘reduced fat’, which just makes up for the lost fat with extra sugar.
- Even the ‘natural’ peanut butter has a shitload of sugar in it, and basically the same nutrition info and ingredients as the standard peanut butter. If you want proof that the term ‘natural’ is pure marketing, look no further.
- The Jif Omega-3 Peanut Butter is a joke. It’s still laden with sugar, and the nutrition label admits that it contains ‘less than 2%’ of the ingredients that contain omega-3s.
- All of Jif’s peanut butters contain sugar, even the ‘natural’ and ‘simply’ versions.
It’s becoming increasingly clear that American consumers should just ignore what is on the front of the label and go straight to the nutrition facts on the back. What does it say about America’s political culture that consumers have to maintain constant, hawklike vigilance just to avoid eating products that are demonstrably unhealthy? I’d like to see a survey of how many Jif consumers know that their peanut butter is up to 30% sugar.
Jif obviously has the right to make peanut butter with the nutritional profile of cake frosting. What’s less obvious is why it is allowed to market such cake frosting as ‘natural’, ‘simple’ and containing health-promoting ingredients without any regulation by the government. It’s one thing to make an unhealthy product. It’s another to hide behind a cloak of nutrition and trick consumers into feeding that product to their children.
On the Seoul-Berlin flight I read Peter Pringle’s Cornered: Big Tobacco at The Bar of Justice. I’m interested in tobacco as a model of how the US could apply responsibility for obesity onto food companies, and it reads like the world’s longest, unfunniest bar joke: How many lawyers does it take for a government to hold its own evilest companies to account for their impacts?
These events [an FDA inquiry, a high-profile ABC News piece on Big Tobacco and a shitload of leaked internal documents] had created a new anti-smoking era and set off an explosion of lawsuits that became known as the Third Wave of tobacco litigation.
The first, from 1954 to 1973, came after the big lung cancer scare of the early ‘50s, when laboratory research linking smoking to cancer in mice was first published. Sick smokers went to court, but proving their cancer was caused by cigarettes was much more difficult than their lawyers had imagined; the companies had little problem creating a doubt in the mind of juries.
In the Second Wave, from 1983 to 1992, the scientific evidence was more firmly established. But the industry still successfully beat back and claims for damages by persuading juries that a smoker chooses to smoke knowing the risks. By this time, the industry had built up the most sophisticated legal defences of any US commercial enterprise and wore down its opponents by outspending and outlasting them.
A tobacco lawyer had once boasted, paraphrasing General Patton, that he won cases not by spending his company’s money, but by ‘making the other son-of-a-bitch spend all of his.’
In other words, it wasn’t enough that cigarettes caused undeniable harm. Before liability could be proven, lawyers had to establish that cigarettes were singularly harmful: They alone caused lung cancer in their users.
The book then proceeds to tell the story of the Third Wave of tobacco litigation, the one that won. The reason it was finally successful wasn’t the leaks or the media or the activist head of the FDA (David Kessler, whose book I’m reading next). The Third Wave succeeded because of two things: 1) Cigarettes were demonstrated to be addictive, and 2) The Mississippi Attorney General came up with the strategy of suing Big Tobacco not for its harm to smokers, but for its cost to the state to treat them all.
Ultimately, the $368 billion tobacco settlement wasn’t punitive damages against their public health effects. It was a reimbursement for all the Medicare and Medicaid money the states had spent treating lung cancer and emphysema, and a hedge against their future costs. In exchange, the states agreed to stop suing.
The reasons the Third Wave lawsuits won are precisely why lawsuits against food companies won’t.
Cigarettes are a class of product in a way that food isn’t. While you can demonstrate that McDonald’s and Coca-Cola produce products that cause undeniable harm, it’s a lot harder to show that they cause singular harm. Fast food and soda contribute to America’s obesity problem, but they’re not the only ones that do. You could just as easily blame General Motors, Monsanto and Playstation for our national calorie surplus and activity deficit.
Addiction is similarly difficult to show. While it’s pretty well established that some foods have the hallmarks of addiction (compulsiveness, tolerance, withdrawal, etc), there’s no evidence that food companies deliberately modify the levels of sugar and fat in their products to trap their users.
And then there’s reimbursement of medical costs. Obesity is related to everything from joint pain to dementia, and estimates of the ‘cost’ of obesity are usually just a finger in the wind. Everybody has to eat; lots of people who eat junk food aren’t fat, and lots of fat people don’t eat junk food. Tying obesity-related morbidity to a particular product (Big Macs), company (McDonald’s) or sector (drive-in fast food) would require a class of monogamous users that probably don’t exist in large numbers.
If the food environment in the US is going to improve, it probably won’t be through legislation, at least without a few more failed waves of litigation and whistleblowing.
More generally, I know we’re supposed to think of the Big Tobacco lawsuits as a victory for public health and a triumph of little victims over big corporates, but it actually demonstrates the opposite. The tobacco settlement represents the culmination of decades of work by personal-injury lawyers to get tobacco companies to fork over astronomical punitive damages, of which they were entitled to a cut.
Pringle blithely notes that in the big-time asbestos lawsuits of the ‘80s and early ‘90s, lawyers took home up to 65 percent of the billion-dollar damages, and the victims of lifelong respiratory illnesses, on whose behalf the lawsuits were filed, received as little as $40,000 each. The tobacco settlements ultimately went to the states, not the victims of smoking-related illnesses.
I suppose it’s nice that lawyers, like the press, represent an informal check-and-balance in the US political system, but the Big Tobacco settlements don’t demonstrate a victory for the ‘little guy’. They’re just one set of big guys winning against another in the third round.
1. Make prevention the only objective
If you’re already fat, you’re screwed. Diets and exercise are so unlikely to work in the long run that you might as well say they don’t. Habits are hard to break, the food environment is a persistent siren and keeping weight off basically means you’re hungry for the rest of your life. Government investment in weight-loss programs for adults are unlikely to have large effects.
Which is why the government should aim its entire obesity effort at preventing childhood obesity. Food industry arguments about personal responsibility, consumer choice and free speech break down when it comes to minors. Children cannot meaningfully understand marketing messages or give consent. They are profoundly subject to their environment and significantly less capable of long-term thinking than adults.
As obesity researcher Yoni Freedhof puts it:
Try to imagine childhood obesity as a flooding river with no end in sight. While teaching children how to swim might help temporarily in keeping them afloat, given that the flood isn’t abating, chances are, even with the best swimming instructions, the kids are going to get tired and sink. So while swimming lessons certainly can’t hurt, what we really need to be shouting about doing is actually changing their environment and building them a levee.
Big Government is perfectly placed to take drastic efforts to prevent childhood obesity. You can’t accuse the government of being a ‘nanny state’ when it comes to children: Protecting children is what nannies do. The government has a clear responsibility–and a profound obligation– to manipulate the economy, environment, infrastructure and legal framework to protect children from companies that lie to them and an environment that manipulates them.
The government needs to lay it out for food companies: When Americans turn 18, you can have them. Until then, they’re ours.
2. Hold companies responsible for obesity outcomes
One of the best ideas I heard on the Rudd Center podcasts was a dude who said that food companies should be given responsibility for quantitative indicators of children’s well-being. So Coca-Cola wants to control all the vending machines in a school district? Fine, but over the next five years the obesity of children in all of those schools has to go down by 5 percent. If obesity goes up during that time, you lose access to them.
This principle could be applied at a city, state or nationwide scale. The best program the government could undertake would be to gather together the major associations of food manufacturers, beverage companies and restaurants and tell them the following:
‘Look, 30 percent of the kids in this country are overweight or obese. We will reduce that to 15 percent, and we’ll do whatever it takes to get there. You can either help us in this goal voluntarily or we will force you through legislation. For the next five years, we’ll work with you to develop voluntary marketing codes, reduce the fat and sugar in your products and promote physical activity. If childhood obesity hasn’t gone down in five years, we’ll legally restrict your ability to sell food in schools. If it hasn’t gone down in 10 years, we’ll ban all marketing to children nationwide. If it hasn’t gone down in 15 years, we’ll tax the shit out of any product that has added sugar.’ And so on.
The food industry always argues that voluntary marketing standards and product guidelines are preferable to legislation. If those standards don’t have any impact on the rise in childhood obesity, however, they’re as useless as day-old French fries.
Holding companies responsible for outcomes instead of processes gives them the freedom to develop their own approaches and an incentive to police each other. Under this plan, industry confederations like the American Grocery Manufacturers and the American Restaurant Association could set industry-wide standards for, say, portion sizes or added sugar that all their members would have to abide by. An objective benchmark allows the government to say ‘you guys figure it out. Or we’ll do it for you’.
Other government agencies already take this approach. The Fed, for example, has committed to keeping inflation around 2 percent, and has said it will do whatever it takes to hit that target (including allowing unemployment to spike above 10 percent). It’s time the rest of the government took the same approach.
Every OECD country has committed to a free-market model that provides food companies unlimited access to consumers, and fuels a cycle of overconsumption, obesity and morbidity. I wonder if any of them will commit to ending it.
By now everyone knows about the studies showing that how much you eat is significantly affected by how food is presented to you. You eat 28 percent more from a 12-oz. plate than from a 10-oz. plate. You consider a serving of cereal to be about 2/3 of a bowl, regardless of how big the bowl is.
The guy who’s responsible for a lot of this research, Brian Wansink, gives good interview:
“Most of us don’t overeat because we’re hungry. We overeat because of family and friends, packages and plates, names and numbers, labels and lights, colors and candles, shapes and smells, distractions and distances, cupboards and containers.” […]
“What I find most surprising is that across the hundreds of studies we’ve done across thousands of people, almost nobody is willing to believe that they are influenced by their environment,” Wansink said. “We all want to believe we are too smart to be influenced by the lighting in a room, or what the person across the table is doing. That’s why these cues are so dangerous to our diet.”
This is both remarkable and unsurprising. More than 90 percent of the population believes they’re an ‘above-average’ driver. Everyone else is affected by marketing ploys, social cues and environmental triggers. Me, I eat exclusively when I’m hungry and stop the moment I reach satiety.
One of the most powerful drivers of human behaviour is that we like to be told what to do. One of Francis Fukuyama’s core insights in The Origins of Political Order is that there is basically no such thing as a pre-rules society. From the first hunter-gatherer tribes, humans developed norms and structures to guide individual behaviour.
Humans have a strong desire to do the right thing, but it’s not as strong as the desire to do what you’re ‘supposed’ to. Religion, parenting and politics are just near and far ways of giving you guidance for how to behave in a given situation. You say ‘excuse me’ when you bump into someone on the bus because you’ve been told that’s the appropriate thing to do. You shake hands with people when you meet them because someone somewhere told you that’s what one does.
The anxiety we feel in unfamiliar situations doesn’t come from the situations themselves but from the ambiguity about which rules apply. This is why we talk about each other all the time: Someone else didn’t follow a rule. No other species, to my knowledge, writes or reads advice columns.
When you eat, the size of a bowl is the world’s way of telling you how much cereal you’re ‘supposed’ to have. The cakes next to the cash register are telling you that it’s appropriate to have dessert with your meal. All of these cues are permission slips to consume more. And about 30 years ago, we started following rules from companies that want to sell us food rather than signals from our own bodies.
It’s great that Wansink is working with elementary schools to make sure the environment is encouraging better choices. I shudder to think, however, of all the other areas of our lives where it isn’t.