Posts Tagged ‘food’

FTC Proposes Voluntary Food Marketing Guidelines

May 6th, 2011

The Federal Trade Commission released its long-awaited voluntary guidelines for industry regarding how they market foods to children. Interagency Working Group Seeks Input on Proposed Voluntary Principles for Marketing Food to Children  The agency is proposing that there be more good foods and fewer bad foods marketed to children. (ED: No doubt this will be very controversial.)

 A forum for stakeholders will take place on May 24, 2011.  Public comment is being sought. They must be submitted by June 13, 2011. But early reaction was largely negative Junk Food ‘Guidelines’ Won’t Help – NYTimes.com

Links to Blogs

September 27th, 2009

Blogs of the STOP Obesity Alliance, George Washington University: Former Surgeon General Richard Carmona, Christine Ferguson http://www.stopobesityalliance.org/blog

Blogs of the Rudd Center on Food and Health Policy, Yale University: Rebecca Puhl http://ruddsoundbites.typepad.com/rudd_sound_bites/rebecca_puhl

The Message or the Messenger, Part 2

September 27th, 2009

July 30, 2009 :: By Morgan Downey

The debate over President Obama’s selection of Dr. Regina Benjamin as the next Surgeon General has focused on whether someone who appears to be somewhat overweight can carry the messages of the public health community to eat better food and less of it and exercise more to achieve a healthy weight.

While the debate ranges over the BMI range of the top government spokesperson, no one, it seems, is looking at the message itself.

One can well question whether the educational messages are working. One recent study showed that adherence to the federal government’s five recommendations for healthy living has decreased from 15% to 8%. Adherence to healthy lifestyle habits in US adults…[Am J Med. 2009] – PubMed Result This has occurred during an extensive educational campaigns about obesity during this period.

Given the investment in getting out the message of the values of living a healthy lifestyle, there are some disconcerting findings. For example, a new, small study indicated that messages to exercise may lead to greater food intake. Immediate increase in food intake following exerci…[Obesity (Silver Spring). 2009] – PubMed Result This experiment showed that when subjects were receiving information on exercise from actual campaigns, their consumption of available foods increased over the control group which did not get the messages.

As much as I am wary of anecdotal messages, I am reminded of a recent meeting of persons wanting to lose weight. One woman said she was the mother of five children and they had a family gathering (Thanksgiving, Christmas, Easter, Passover, weddings, graduation, christenings, bar mitzvahs, bat mitzvahs, etc. ..fill in the blanks.) One daughter told the mother she needed to eat better. The mother was resentful. But when another daughter talked to her about changing her food choices, she was receptive. The second daughter was overweight and struggling with it; the first daughter was always lean.

We have assumed that the best messenger was one who walked the walk. But does that mean only a lean person can be the messenger? OR would we rather have a leader who is like us…strugglingsometimes failing and trying to get back into the saddle?

A Diet for the New Administration

September 27th, 2009

December 30, 2008

By Morgan Downey

At this time of year, millions of Americans are hoping the new Administration will solve our seemingly intractable problems at home and abroad. Millions are also hoping to lose weight in the New Year. The two are not unrelated.

Over the past three decades, obesity has increased among all segments of the population, in the United States and abroad. Obesity is now recognized as the fuel behind many major health problems from cancer to diabetes to heart disease, and a significant cause of increasing health care utilization and health care costs.

While this recognition has increased among both Republicans and Democrats (for the first time, both parties recognized obesity in their 2008 party platforms), changing public policy has not caught up with the problem. Under President George W. Bush, Medicare did undo its policy that obesity was not a disease and did expand coverage of surgery for the treatment of obesity. There have been modest increases in the research and prevention budgets at the National Institutes of Health and the Centers for Disease Control and Prevention. But by and large, the efforts of the last eight years have been largely educational: tell people they should lose weight, eat more nutritiously, and exercise more.

Duh! We get it. And it doesn’t work. Frankly, other than bariatric surgery, nothing works very well to lose significant amounts for a long period of time. There simply is not one ‘fix’ that will reverse this disturbing trend.

So here is some advice to the incoming Administration. It should be noted that many appointees named so far have a solid exposure to obesity from a public policy perspective, including former Senator Tom Daschle, nominee for Secretary of Health and Human Services, Peter Orszag, named to head the Office of Management and Budget, Governor Bill Richardson, nominated for Secretary of Commerce, and Melody Barnes, incoming chief of domestic policy at the White House.

Universal health insurance is often put forward as the panacea for all ills. However, Democrats may have to learn that expanding health insurance coverage alone does not translate to a healthier population, especially if obesity continues to increase among children and adolescents. Truth be told, we do not have adequate medical interventions to affect the rates of obesity and its effects. So, if we do not know how to truly prevent obesity or create a long term treatment, what should a new Administration do? Basically, it should focus on how to create the conditions where it is more likely than not that we will find effective strategies for prevention and treatment in the future.

  1. Being a role model is not enough. It’s been noted that George Bush and Barack Obama share a passion for physical activity. Unfortunately, the habits of the chief executive do not translate to population changes. And then there is the smoking thing. Being a role model is not an excuse for inadequate policies.
  2. Make someone responsible for obesity policy development. Right now there is no one tasked at the upper levels of the U.S. Government with dealing with obesity. True, periodically the heads of different agencies give a speech, start a new website or create a new task force but little happens because so many do so little with scant coordination.
  3. Prepare to spend some money. For one of the most significant health problems in the country, the federal government spends vastly less than on obesity than other conditions. Research, prevention and treatment costs for diabetes and heart disease, to name but two, swamp comparable figures for obesity. The federal government is spending more on getting TV converters boxes in US homes than the entire NIH research budget on obesity.
  4. Do not just focus on childhood obesity. While childhood obesity is critical, remember that the population between 7 and 16 spans only 9 years out of a lifetime. Look at obesity over the lifetime and look for relevant interventions. Support childhood prevention programs but require that they have a competent evaluation method so we will know what is working and what is not.
  5. Do focus on research. Perhaps 90% of what we know about obesity has been learned since the discovery of leptin in 1994. Too many people believe that we know everything we need to know about obesity and do not need any more research. That’s not true. A great deal is known but there are many more questions than answers. Scientific credibility on issues around body weight is sorely needed. Every hour on television another weight loss program or product is hyped as being based on doctor’s advice or scientific study. What can help on both fronts is for the Administration to create a National Institute of Obesity Research at the National Institutes of Health. A new entity like this can reenergize researchers on obesity, can more closely coordinate the many disparate programs across NIH, provide leadership to other federal agencies, states and local governments and provide much needed focus on the social and economic impacts of obesity. Furthermore, a director who is articulate can help lead policymakers and the public away from harmful and dangerous products and keep a focus on developing effective interventions. The NIH bureaucracy will oppose “disease specific” research but their interests should not trump the public health needs and the best use of taxpayer dollars.
  6. As part of your health care reform package, remove the bias against drugs for weight loss in the Medicaid statute and change the exclusion of these drugs under Medicare Part D. Then have the Food and Drug Administration revisit its risk/benefit views of drugs to treat obesity. There are few fans of pharmaceutical companies in a Democratic Congress and Administration and there are even fewer who favor drugs to treat obesity. Nonetheless, there is a huge treatment gap. We have more and more effective surgical options, one over-the-counter FDA approved pill, a couple of tried medicines, commercial plans and self-help. What we do not have are the drug treatment options we have for high cholesterol, hypertension or diabetes. Recently, major pharmaceutical companies such as Merck, Pfizer, Solvay and Sanofi-Aventis have dropped or cut back on their programs to develop drugs for obesity. There are two reasons. First, insurance companies will not reimburse for most obesity treatments, including counseling, drugs and surgery. For the pharmaceutical industry, it just did not make economic sense to invest in drugs which were not going to be reimbursed. This is where leadership by Medicaid and Medicare is critical. If these programs support obesity products, private insurance may follow. This is in the government’s long term interest because insurers can avoid treating or preventing obesity knowing that the big effects, like diabetes and heart disease will not be seen until later in life, when Medicare will become the payor. Second, many involved in obesity drug development feel, rightly or wrongly, that the Food and Drug Administration is so risk-averse that they simply cannot afford the long and expensive trials necessary to meet the rising bar of safety. A National Institute of Obesity Research can help shape clinical trials needed by the FDA and speed the process along.
  7. Look to multiply your opportunities. For example, you can use the public works part of the economic stimulus package to construct new gyms in schools, sidewalks, playgrounds, green spaces and biking/walking trails to encourage more physical activity.
  8. Let the states experiment with taxes and proposals like displaying caloric content in restaurants. Vending machines, non-diet soft drinks, high-fat foods have all come under fire in recent years for contributing to the obesity epidemic. The problem is that these products still only contribute a fraction to an individual’s total caloric intake. But no one is sure that they won’t be replaced by other calories. Likewise, there will be voices to restrict food advertising to children through the federal government’s regulatory powers. Use your National Institute of Obesity Research to design evaluation studies so that there is an objective review to see if these policies will work.
  9. Take some leadership internationally. The United States has a long history of involvement in global health issues, such as HIV/AIDs. However, very little is done on the federal level to learn from other countries’ experiences and to help shape global patterns of eating and physical activity.
  10. Avoid the single fix ideas. The obesity field is full of good advice and scant evidence. Focusing on a single fix, such a TV advertising, agricultural subsidies or sweetened beverage may consume a great amount of political resources without producing the outcome you seek.

The obesity epidemic is more likely than not to continue to grow over the next four to eight years. However, the new Administration can position the United States for meaningful change if it takes its time and devotes attention to organizing the effort. With any luck, we can make future New Year’s resolutions more likely to be successful.

Dietary Intervention

September 27th, 2009

                                                                                                                                                                

Portion control The influence of food portion size and energy dens…[Am J Clin Nutr. 2005] – PubMed Result

Diets are not the answerMedicare’s search for effective obesity treatments…[Am Psychol. 2007] – PubMed Result

Low-carbohydrate diets, obesity, and metabolic ris…[Curr Atheroscler Rep. 2007] – PubMed Result

Comparison of a very low-carbohydrate and low-fat …[J Am Coll Nutr. 2004] – PubMed Result

Efficacy and safety of low-carbohydrate diets: a s…[JAMA. 2003] – PubMed Result

The role of dietary fat in body fatness: evidence …[Br J Nutr. 2000] – PubMed Result

Low-fat diets and energy balance: how does the evi…[Proc Nutr Soc. 2002] – PubMed Result

NIH: Very low calorie diets WIN – Publication – Very-Low-Calorie Diets

Health benefits of dietary fiber. [Nutr Rev. 2009] – PubMed Result

Position of the American Dietetic Association: hea…[J Am Diet Assoc. 2008] – PubMed Result

The Mediterranean Diet is widely promoted for its healthful outcomes which is supported in this review article Adherence to Mediterranean diet and health status:…[BMJ. 2008] – PubMed Result

Information on portion sizes Smallstep Adult and Teen; NHLBI-Portion Distortion Quiz

Routes to obesity Routes to obesity: phenotypes, food choices and ac…[Br J Nutr. 2000] – PubMed Result

High-fat and low-fat (behavioural) phenotypes: bio…[Proc Nutr Soc. 1999] – PubMed Result

Popular diets: correlation to health, nutrition, a…[J Am Diet Assoc. 2001] – PubMed Result

Dietary approaches that delay age-related diseases. [Clin Interv Aging. 2006] – PubMed Result

What are the long-term benefits of weight reducing…[J Hum Nutr Diet. 2004] – PubMed Result

Total calories available: http://www.cnpp.usda.gov/Publications/FENR/V16N2/fenrv16n2.pdf

Diets of Americans need improvement: http://www.cnpp.usda.gov/Publications/FENR/V16N1/FENRV16N1.pdf

Want to see what folks eat? This is not for weaklings! This is why you’re fat.

Heard of the DASH diet? Here it is: Lowering Your Blood Pressure With DASH, NHLBI

Need Help with portion control? See: http://hp2010.nhlbihin.net/portion/servingcard7.pdf

Take the portion distortion test: NHLBI-Portion Distortion Quiz

Volume Substitutions: Fruits & Veggies More Matters » Volume Comparisons

What Fruits and Vegetables are in Season and how to prepare them: Fruits & Veggies More Matters » What’s In Season? Winter

Type of vegetarian diet, body weight, and prevalen…[Diabetes Care. 2009] – PubMed Result

Vegetarian diets and weight status. [Nutr Rev. 2006] – PubMed Result

Downey Fact Sheet 1 – About Obesity

September 27th, 2009

pdficon_small Printable PDF

Obesity is a global epidemic and a major health concern because of its premature mortality and extensive comorbidities. Obesity is a common, complex, multifactorial disease with a high degree of heritability. Between 25 and 40% of person with obesity have a parent who is obese. There are several significant facts to bear in mind when discussing obesity:

By Julie Snider for the Downey Obesity Report

By Julie Snider for the Downey Obesity Report

Every individual inherits a certain number of fat cells or adipose tissue. Obesity requires (a) a large number of fat cells or (b) a large volume in each fat cell or (c) both. Adipose tissue continues throughout the lifespan. Weight loss, including surgically-induced weight loss, does not remove fat cells. This is why weight regain is so common. Individuals with obesity have significantly more fat cells than the non-obese, 23-65 billion compared to 37-237 billion for persons with obesity . Early onset obesity is associated with increase adipose cell number while adult obesity is associated with normal cell number. There are two phases of life in which growth of adipose cells are likely to develop: very early, within the first few years of life and between the ages of 9-13 years of age. Those who become very obese early in life are the ones who have nearly normal cell size but have the greatest increase in cell number; whereas those with onset of obesity between 9-13 have more change in cell size than cell number. Salans LB, Cushman SW, Weisman RE, Studies of human adipose tissue. Adipose cell size and number in non0bese and obese patients. J. Clin Invest. 1973 Apr’ 52(4): 929-41)

Extremely obese individuals may have four times the number of fat cells as lean counterparts. http://www.jpp.krakow.pl/journal/archive/1205_s6/pdf/5_1205_s6_article.pdf

Human food intake and energy expenditure are controlled by complex, redundant and distributed neural systems that reflect fundamental biological reaction to food supply and energy balance. The hypothalamus and caudal brainstem play a critical role. The limbic system is important for processing information regarding previous experience with food, reward and emotion. The predisposition to store considerable amounts of energy as fat for later use is now a major health risk. Brain, appetite and obesity – PubMed Results

Extensive research over the past 10 years has shown that appetite is regulated by a complex system of central and peripheral signals which interact in order to modulate the individual response to nutrient ingestion. Satiety signals include cholecystokinin, glucagon-like peptide and peptide YY which originate from the gastrointestinal tract during a meal and through the vagus nerve reach the caudal brainstem. Here the signals move to the arcuate nucleus where satiety signals are integrated with adiposity signals, namely leptin and insulin, and with several other inputs create a neural circuit which controls the individual’s response to a meal, i.e. keep eating or stop. Neuro-hormonal control of food intake: basic mecha…[J Physiol Pharmacol. 2005] – PubMed Result

Adipose tissue, rather than some inert, jello-like, substance is an active hormonal tissue, secreting many hormones which are involved in creating signals from the gut to the brain, indicating hunger or satiety. These hormones include insulin, leptin, ghrelin, PYY-33-6, adiponctin, resistin and visfatin as well as cytokines and chemokines, such as tumor necrosis factor-alpha, interleukin-6 and others. These can lead to a chronic sub-inflammatory state which plays a critical role in the development of insulin resistance, type 2 diabetes, increased risk of cardiovascular disease associated with obesity. Adipokines: the missing link between insulin resis…[Diabetes Metab. 2008] – PubMed Result

Downey Fact Sheet 2 – Quick Facts

September 27th, 2009
The Downey Obesity Report

The Downey Obesity Report

Printable PDF

ADULT OBESITY

The adult obesity rates have risen dramatically from 1960 to today; rates of overweight (BMI >30) have doubled, rates of obesity (BMI 30-39.9) have nearly tripled and rates of extreme or morbid obesity (BMI >40) have nearly increased seven fold.

ADULT (age 20-74) Prevalence 1

Overweight (BMI 25-30) Percentage

1960-1962 31.5%

2005-2006 33%

Obese (BMI>30)

1960-1962 13.4%

2005-2006 35.1%

Extreme or Morbid Obese( BMI>40)

1960-1962 0.9%

2005-2006 6.2%

The rates of obesity only tell half the story. During this period, the total US population has also increased. Therefore, the raw numbers of Americans affected have also increased. Looking at the numbers of people affected, the overweight population has doubled, the obese population has increased 5 fold and the population with extreme or morbid obesity as increased by a factor of nearly 12!

Number of Americans Overweight in 1960: 56.5 million

Number of Americans Overweight in 2006: 94.5 million

Number of Americans Obese in 1960: 24 million

Number of Americans Obese in 2006:
40 million

Number of American with extreme or morbid obesity in 1960:
1.6 million

Number of Americans with extreme or morbid obesity in 2006: 18.6 million

Since 1960-61 to 2006, the number of American adults who became obese or extremely obese*: 61.1 million

Average number per year: 1.3 million

Average number per month: 110,779

Average number per day: 3,693

Average number per hour: 153

Average increase per minute: 2.5

Since 1960-61 to 2006, the number of American adults who became  extremely obese*: 11 million

Average number per year: 240,217

Average number per month: 20,018

Average number per day: 667

Average number per hour: 27

Adolescents Obesity age 12-19 3

Percent overweight/obese 2005-2006 18%

Young adult Obesity
Ages 18-29

Percent obese 1971-1974 8%

Percent obese 2005 24%

Childhood 2

Ages 6-11 15%

Ages 2-5 11%

Year at which each group will reach 80% obesity 4

All 2072

Men 2077

Women
2058

African American Women 2035

African American Men 2079

Mexican American Women 2073

Mexican American Men 20 91

White Women 2082

White Men
2073

Adipose Tissue (Fat Cells) 5

Age at which typical body has acquired its full number of fat cells: 13

Number of fat cells in average American Adult: 23-65 billion

Number of fat cells in persons with morbid obesity: 37-237 billion

Number of fat cells lost in weight-loss efforts: 0

By Julie Snider for the Downey Obesity Report

By Julie Snider for the Downey Obesity Report

 

Daily Calories Needed and Available 6

Recommended calories per day by typical American adult:

Men 2,400 to 2,800

Women 2,000 to 2,200

Mean (meaning half were above and half below) adult daily calorie intake per day 7 :

Men

1971 2,450

2001-2004 2,593

Women

1971 1,542

2001-2004 1,886

Percent increase in food available for consumption per person from
1970 to 2003: 16%

Amount of food available for each person increase from
1.67 pounds in 1970 to 1.95 pounds in 2003

Daily caloric intake has grown by 523 calories from 1970 to 2003. Leading the way were fats, oils, grains, vegetables and sugars and sweeteners.

U.S. Government Biomedical Research 8

2008 Budget of National Institutes of Health $29.6 billion

NIH Spending 2008 on selected diseases:

Cancer
$5.6 billion

HIV/AIDS funding $2.9 billion

Cardiovascular Disease
$2.0 billion

Heart Disease $1.2 billion

Obesity
$664 million

U. S. Government Infrastructure on Combating Obesity

Name of coordinator of U.S. global anti-obesity efforts:

(Trick question: no such position exists)

Name of White House coordinator of federal anti-obesity efforts:

(Another trick question: no such position exists)

Name of coordinator of Department of Health and Human Services***anti-obesity efforts:

(No such position exists)

*Calculations were made by taking the CDC prevalence figures for 1960-1962 and 2005-2006and multiplying them against US census data for 1960 and census data for 2006,respectively. See Census Bureau Home Page

**Available in this context means the total US calories available for consumption, less spoilage and waste. See ERS/USDA Data – Food Availability (Per Capita) Data System)

*** Department of Health and Human Services includes the National Institutes of Health, the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, the Food and Drug Administration, Office of the Surgeon General, the Agency for Healthcare Research and Quality among others.)

Notes

1. N C H S – Health E Stats – Prevalence of overweight, obesity and exreme obesity among adults: United States, trends 1960-62 through 2005-2006

2. FASTSTATS – Overweight Prevalence

3. http://www.cdc.gov/nchs/data/hus/hus08.pdf

4. Studies of human adipose tissue. Adipose cell size…[J Clin Invest. 1973] – PubMed Result

5. Will all Americans become overweight or obese? est…[Obesity (Silver Spring). 2008] – PubMed Result. In this estimate, by 2030, 86.3% of adults will be overweight or obese and 51% obese; black women at a level of 96.9% will be the most effected, followed by Mexican-American men (91.1%). By 2048, all American adults would be overweight or obese but black women would reach that milestone by 2034. In children, the authors estimate, rates will nearly double by 2030.

6. http://www.usdaplate.com/

7. http://www.ers.usda.gov/AmberWaves/November05/pdf/FindingsDHNovember2005.pdf

8. NIH Research Portfolio Online Reporting Tool (RePORT) – Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC)

By Julie Snider for the Downey Obesity Report

By Julie Snider for the Downey Obesity Report

Schools and Children

September 27th, 2009

As concern about childhood obesity has increased, the school environment has received increased attention.

Retooling school food offerings can help. The Somerville MA experiment Retooling food service for early elementary school…[Prev Chronic Dis. 2009] – PubMed Result

A very positive study on the value of nutrition education in the schools Effectiveness of school programs in preventing chi…[Am J Public Health. 2005] – PubMed Result

Effect of the school food environment Association between school food environment and pr…[J Am Diet Assoc. 2009] – PubMed Result

School food environments and practices affect diet…[J Am Diet Assoc. 2009] – PubMed Result

Schools are making progress in addressing obesity. Schools and obesity prevention: creating school en…[Milbank Q. 2009] – PubMed Result

International Journal of Obesity – Abstract of article: Childhood overweight and elementary school outcomes

Overweight affect school performance in girls but not boys. See: http://www.rand.org/pubs/reprints/2008/RAND_RP1315.pdf

Impact of removing low nutrition foods in schools. The Impact of Removing Snacks of Low Nutritional V…[Health Educ Behav. 2009] – PubMed Result

Food use in middle and high school fundraising: do…[J Am Diet Assoc. 2009] – PubMed Result

School Environment gets worse with higher grades. School food environments and policies in US public…[Pediatrics. 2008] – PubMed Result

BMI measurement in schools Body mass index measurement in schools. [J Sch Health. 2007] – PubMed Result

Journal of Public Health Policy – Disparities in Physical Activity and Sedentary Behaviors Among US Children and Adolescents: Prevalence, Correlates, and Intervention Implications

Journal of Public Health Policy – Arkansas Act 1220 of 2003 to Reduce Childhood Obesity: Its Implementation and Impact on Child and Adolescent Body Mass Index

Journal of Public Health Policy – Early Impact of the Federally Mandated Local Wellness Policy on Physical Activity in Rural, Low-Income Elementary Schools in Colorado

Journal of Public Health Policy – Preventing Childhood Obesity through State Policy: Qualitative Assessment of Enablers and Barriers

Journal of Public Health Policy – Correlates of Walking to School and Implications for Public Policies: Survey Results from Parents of Elementary School Children in Austin, Texas

Journal of Public Health Policy – Sociodemographic, Family, and Environmental Factors Associated with Active Commuting to School among US Adolescents

Journal of Public Health Policy – Implementation of Texas Senate Bill 19 to Increase Physical Activity in Elementary Schools