Archive for August, 2012

Federal Priorities: Twinkies over Apples

August 31st, 2012

A report from the Oregon Student Public Interest Research Group found that, “In the seventeen years between 1995 and 2011, taxpayers spent $18.2 billion subsidizing junk food ingredients; they spent $637 million on subsidies for apples. On average, every year, that’s $1.07 billion for junk food, and $37.4 million for apples.” See OSPIRG: Apples to Twinkies

 

Republican Party Platform Guts Obesity Policies

August 30th, 2012

Among the provisions in the Republican Party Platform adopted this week in Tampa, Florida are these affecting obesity:

Food stamps and other nutrition programs be sent in block grants to the states.

On Medicare and Medicaid, the platform states,  “The problem (with these programs) goes beyond finances. Poor quality healthcare is the most expensive type of care because it prolongs afflictions and leads to ever more complications. Even expensive prevention is preferable to more costly treatment later on. When approximately 80 percent of healthcare costs are related to lifestyle – smoking, obesity, substance abuse – far greater emphasis has to be put upon personal responsibility for health maintenance. Our goal for both Medicare and Medicaid must be to assure that every participant receives the amount of care they need at the time they need it, whether for the expectant mother and her baby or for someone in the last moments of life.”

Editor’s note: This paragraph is rather hard to discern. On the one hand, it seems to be an blank check for prevention programs which are, overwhelmingly, governmental programs. Yet, then it shifts to personal responsibility. Then, a neck-whipsawing shift to Medicare and Medicaid participants getting every service they need when they need it. So, what exactly does this mean? Do you get bariatric surgery, for example, when you need it? Or is it denied because you did not take “personal responsibility?”

Regarding Medicare, the platform calls for making the program into a “premium support” program for those age 55 and younger. For these individuals, Medicare would provide a voucher to go out and purchase private health insurance coverage. Currently, Medicare covers bariatric surgery and intensive behavioral counseling for both those over age 65 and those disabled and receiving Social Security disability. Frankly, I am skeptical that private insurance companies (which did not insure elderly persons before Medicare was enacted) would cover such persons and such services without prohibitively high premiums.

For Medicaid, the platform proposes “alternatives to hospitalization for chronic health problems. Patients should be rewarded for participating in disease prevention activities. Excessive mandates on coverage should be eliminated. Patients with long-term care needs might fare better in a separately designed program.”

Editor’s note: The platform does not describe what an “alternative to hospitalization” would be. The reference to “patients with long-term care needs” refers to millions of elderly Americans whose nursing home costs are paid for by Medicaid, after their own assets are exhausted. It has been a politically charged issue to make the spouse’s assets at risk for the patient’s nursing home costs. This was proposed in the Ryan Budget. What a “separately-designed” program would be was not specified.

Of course, the platform calls for  the repeal Obamacare or the Affordable Care Act “in its entirety.” This would include free intensive behavioral  counseling for adults with obesity under plans which were not grandfathered, grants for healthier communities, access to breastfeeding sites at work, access to health insurance by persons whose obesity has prevented them from getting insurance due to a “pre-existing condition, and greater rights for individuals to fight denials of claims.

Of course, also repealed would be the regressive provisions for “workplace wellness” programs which penalize overweight workers for not meeting weight targets set by their employers.

In 2008, The Republican Party Platform, adopted in St. Paul, Minnesota, provided:

“Prevent Disease and End the “Sick Care” System. Chronic diseases – in many cases, preventable conditions – are driving health care costs, consuming three of every four health care dollars. We can reduce demand for medical care by fostering personal responsibility within a culture of wellness, while increasing access to preventive services, including improved nutrition and breakthrough medications that keep people healthy and out of the hospital.  To reduce the incidence of diabetes, cancer, heart disease and stroke we call for a national grassroots campaign against obesity, especially among children”.

 

Food Deserts Questioned…Again

August 25th, 2012

Is there a robust relationship between neighborhood food environments and childhood obesity? That is the question Roland Sturm and colleagues Victoria Shier and Ruopeng An set out to answer in a new paper in the journal, Public Health. Using standard definitions and a large database of 5th and 8th graders, they found “no consistent evidence across (counts of a particular type of food outlets per population, food environment indices and indicators for the presence of specific combinations of types of food stores) and outcomes to support the hypothesis that improved access to large supermarkets results in lower youth BMI, or greater exposure to fast food restaurants, convenience stores, and small food stores increases BMI.” See PubMed: Is There a Robust Relationship between Neighborhood food environment

Don’t tell Health and Human Secretary Kathleen Sebelius. In May, at the Weight of the Nation Conference, she declared that food deserts were a cause of obesity stating, “Obesity can be caused by any combination of factors. For some, it is an addiction like smoking. For others, it’s a lack of fresh fruits and vegetables near their home.” HHS_Secretary Speeches_Weight of the Nation

This may be just a case of sloppy thinking or poor staff work. More likely, it was an effort to buttress First Lady’s Michelle Obama’s major $400 million initiative to bring supermarkets to underserved areas. Let’sMove: Food desert programs. Sturm’s earlier paper had already questioned this policy. PubMed: School and residential food environment California

 

Maternal Employment and Childhood Obesity

August 24th, 2012

Of the putative causes of obesity, one of the strongest and most consistent is maternal obesity. But maternal employment has also been implicated in a number of studies over the last few years. While not proving causation, the dramatic increase in childhood obesity since the 1970’s, coincides with an equally dramatic rise in female participation in the workforce who had children under the age of 18. This rate rose from 47.4% to 71.2%.

Are these two phenomenon related? It’s a good question. Putting two graphs next to each other doesn’t prove one affected the other. Recent studies have shows an increased likelihood that children of working mothers are more likely to be overweight than those of non-working mothers. A systemic review of OECD countries found evidence indicating the working mothers were somewhat more likely to have overweight children. PubMed: Maternal Employment Childhood Health Effects in OECD countries. A large study in the United Kingdom found that any maternal employment after birth contributed to the likelihood the child would be overweight. PubMed: Maternal Employment and early childhood obesity UK Millenium Study.

Moms are not likely to be surprised that the evidence shows that Dad’s employment or hours worked do not correlate to a child overweight, presumably because they spend less time in cooking, food preparation, and child care to begin with.

But the question still remained, does maternal employment result in less time spent in activities directly related to a child’s diet and physical activity or a reduction in other activities. So John Cawly and Feng Liu undertook to research this question, utilizing an extensive database, the American Time Use Study (ATUS).

They found that, on average, working mothers spent 277 minutes a day with children; 410 minutes for non-working mothers. Working mothers were less likely to spend any time grocery shopping, cooking, eating with children, child care and supervising children. Among women who spent any time in these activities, the average number of minutes spent was consistently lower for working than for-non-working mothers. According to the authors, “The one exception to this general pattern is that working mothers are significantly more likely to report spending any time purchasing prepared food.” Roughly 20% of both working and non-working women with children spend 0 minutes with children a day.

More specifically, 8 hours of employment is associated with women spending 7 fewer minutes grocery shopping, 23 fewer minutes cooking, 18 fewer minutes eating with children, 14 minutes fewer minutes playing with children, 51 fewer minutes caring for children, and, 5 fewer minutes supervising children. The time deficits are roughly twice as large for women with a husband or partner than for single mothers. There was no significant difference in the time spent with children by husbands whose spouse worked or did not work. Overall, fathers appear to offset less than 15% of the decrease in time that working mothers spend with their children. Even non-working men pick up only about 1/3 of the slack.

Other research in this field indicate that children of working mothers have fewer formal  meals, more food consumed grazing, more prepared foods, more time spent watching television, and more time unsupervised.

Moms are not having a picnic either. The Cawley study found that, compared to non-working mothers, working mothers spent 48 fewer minutes per day watching TV, 31 fewer minutes sleeping, 17 fewer minutes at leisure and 16 fewer minutes socializing.

As I write this, the airwaves have political ads calling for tougher restrictions on welfare payments (which go to mothers with children), specifically more rigorous work requirements. This study may indicate that there are long term consequences for such policies in terms of maternal and child health. Other policies, including those affecting food labeling and school physical activity should be re-evaluated.

Back in the 1970s, there was a lot of debate over whether mothers should work at all. This was seen as some discretionary. We are a long way away from that time. For the vast majority of working mothers, have the additional income is essential to the whole family survival.

Just a word about the American Time Use Study: This database, maintained by the Department of Labor, Bureau of Labor Statistics (http://www.bls.gov/tus/) is, in my opinion, underutilized in obesity. Predictably, we hear recommendations that people should just change their lifestyle, spend more time, like 30-60 minutes a day in physical activity, more time buying fresh foods, cooking wholesome foods, turning off the TV to do some activity, etc….Well, the ATUS provides some average time usage by adults. For weekdays: Personal care activity 9.24 hours, eating and drinking 1.19 hours, household activities 1.63 hours,  purchasing goods and services, .69 hours, caring for household members .54, comparing for non-household members .20 hours, working and work related activities 4.49 hours, educational activities .60 hours, organizational, civic and religious activities 0.25 hours, leisure and sports 4.73, telephone calls, email, .16 hours. The point is, when asking people to make changes in their diets and physical activity, we have to ask “where is this time going to come from?” It has come from other activities? Taking care of Grandma? Volunteering at church? What? Just giving ‘good advice’ is not enough when so many Americans are living such stressful lives when free time is in short supply, especially for working moms.

Read Cawley and Liu’s research at PubMed:Maternal Employment and Childhood Obesity

Illustration from www.itsnitelife.com.

Our Genes Are Changing: New Evidence

August 23rd, 2012

As readers of these pages know, I always react when people, in discussing obesity, dismiss genetics as a cause with the statement to the effect, ‘our genes just don’t change.’ On other pages, I recite evidence that this just isn’t true. Our genes do change. I also notice that you never hear a genetics expert make this claim. And for a good reason, our knowledge of genetics changes every week.

Now comes a new study using genomic databases from Iceland. The study of 78 trios of mother, father and child, looking for mutations in the child’s genes which were not present in either parent and therefore must have arisen spontaneously in the egg, sperm or embryo. Fathers passed on nearly four times as many new mutations as mothers, 55 v. 14. The older the father, the greater the number of mutations. Most of the mutations may be harmless but some are linked to conditions like autism and schizophrenia. NatureNews:Fathers bequeath more mutations as they age

Maternal obesity and metabolic conditions have been linked to autism in their offspring PubMed: Maternal Metabolic Conditions and risk of autism. Likewise, schizophrenia has been linked to obesity, diabetes and inflammation PubMed: Schizophrenia, metabolic syndrrome and inflammation

Bottom line: while the increasing age of the father may be relevant for autism research, the point for obesity genetics may be that both mothers and fathers pass on spontaneous mutations to their child. Our genes are changing.

 

Another cause?

August 22nd, 2012

Another putative cause of obesity was just published…the use of antibiotics in children. How many does that make? PubMed: Antibiotic use in children and obesity

 

Studies on the Built Environment and Obesity Challenged

August 22nd, 2012

Researchers at the University of Alabama at Birmingham Department of Health Care Organization and Policy have made some interesting findings regarding the literature around the built environment (parks, trails, sidewalks) and physical activity and obesity. Of the 169 articles they looked at, 89% reported beneficial relationships but virtually all utilized simple observational designs. Studies utilizing objective measures of obesity, such as pedometers, were 18 % less likely to find a positive relationship. Articles focusing on children in community settings, those with direct measures of obesity or those with an academic first author were less likely to find a beneficial relationship. Conclusion: policy makers should require more rigorous scientific research, which, by the way, is the same conclusion Chris Still and I came to in our recent article.

See PubMed: Relationship between Built Environment and Physical Activity

 

What’s the Cause of Obesity?

August 22nd, 2012

A new study indicates that grilled foods may contribute to obesity and type 2 diabetes. OK. I’m sure it’s a good piece of research. See Medical Daily: Grilled Foods Obesity Diabetes.  I intend to add it to my list of putative causes of obesity. How many causes can you name?

Here’s my list (so far): high fat diets, trans fats, large portion sizes, sugar-sweetened beverages, food insecurity, low socioeconomic status, high fructose corn syrup, television viewing, low levels of physical activity, maternal obesity, gestational diabetes, vending machines, competitive food sales in schools, food deserts, intrauterine influences, eating away from home, costs of eating healthy foods, endocrine disruptors, sleep deficits, assortative mating, air conditioning, air pollution, weight gain inducing drugs, living in the suburbs, international trade policies, decline in occupational physical activity, maternal smoking, no or short term breastfeeding, food marketing to  children, high-capacity beverage containers, child maltreatment, driving children to school, transportation policies, farm subsidies, food overproduction, respiratory problems, mental disabilities, physical disabilities, heavy alcohol consumption, smoking cessation, stress, lack of self-control, low parental education, your friends, gut microbial, a virus, television in the bedroom, home labor saving devices, skipping breakfast, snacking, lack of family meals, maternal employment, irregular working hours of mother or father or both,  having tonsils removed, ambient light at night, pre-natal exposure to natural disasters, pureed fed babies, meat-fat diets, high consumption of seaweed (in S. Korea), menopause, the market economy, economic development, depression, being a female prisoner in the United States, being born by C-section, poor emotional coping, arcea nut chewing, living with a single mother, delayed prenatal care, thyroid dysfunction, family conflict, consumption of pastries and chocolate (in Burkina Faso), and inflammation.

In India, compared to normal weight persons, obese individuals consumed more phlkas, chapatis/parathas/naan, plain dosa,mutton/chicken pulao/biryani, chicken fried and grilled, rasam , mixed vegetable sagu, vegetable raitha, honey, beetroot and bottlegourd. Consumption of plain milk was higher among normal weight than obese individuals. PubMed: Differences in consumption of food items.

To be fair, the researchers almost always note that these are observational studies, showing an association which is statistically significant. However, by the time the article gets to the university or hospital press office or out of the journal’s PR shop and into a journalist’s hands, the disclaimer that causation has not been established usually falls aside.