Posts Tagged ‘vending machines’

The TechnoPhysio Evolution

June 8th, 2011

Book Review:    The Technophysio Evolution    

The Changing Body, Health, Nutrition, and Human Development in the Western World since 1700

by Roderick Floud, Robert W. Fogel, Bernard Harris and Sok Chul Hong, (Cambridge Press, 2011)

The authors are distinguished economists (Fogel has a Nobel Prize in Economics). With dizzying detail, it traces the changes in the human body over the last 300 years in Britain, France and the United States. During this period, humans have become much taller and heavier than ever before. The book charts the “technophysio evolution,” a complex interplay between increasing technological changes and improved standards of living, resulting in improved nutrition. The improved nutrition is passed from mother to child to child with improvements in height and weight in successive generations. This is not a straight line but the trends are unmistakable – improved mortality with tall and heavier adults.

The Technophysio Evolution hypothesis has five elements:

  1. The nutritional status of a generation – shown by the size and shape of their bodies – determines how long that generation will live and how much work its members will be able to do.
  2. The work of a generation, measured both in hours, days, and weeks of work and in work intensity, when combined with the available technology, determines the output of that generation in terms of goods and services.
  3. The output of a generation is partly determined by its inheritance from past generations; it also determines its standard of living and its distribution of income and wealth, together with the investment it makes in technology.
  4. The standard of living of a generation determines, through its fertility and distribution of income and wealth, the nutritional status of the next generation.
  5. And so on, ad infinitum.

In other words, increasing body weight is a by-product of advances in wealth and income, producing healthier, i.e. larger children, who, in turn, produce better nourished, i.e., larger,  children.

The “techno” part of this evolution include everything from American colonists moving from a wooden plow to an iron one; improvements in food production and distribution, refrigeration, canning, changes in water, sanitation and public health which reduced mortality from infectious diseases while improving nutrition for more and more people.

The “physio” part incorporates research on the fetal origins of adult disease and will support the attention to epigenetics as an important aspect in the development of obesity. This is not purely genetics or genetic determinism but the process of transition of improvements in nutrition to the health of the mother and her survival as well as to the survival of more children for longer periods of time. Epigenetic changes is coming into focus as a critical stages for the development of obesity and will certainly receive more attention in the future. Epigenetic changes in early life and future risk o… [Int J Obes (Lond). 2010] – PubMed result

Is there an end to the process or is there a natural limit to this growth? Well, we don’t really know but none appears so far. (It seems to me, at least, that evolution has not felt it necessary to provide unlimited height of the species since there does not appear any survival value to being taller. On the other hand, nature has felt that there was a distinct survival value to being able to store energy (read fat) on our bodies and there does not seem to be a particular limit to this.)

by permission, Cambridge University Press

 

Interestingly, the authors find that, for American white males ages 40-59, the increase in BMI from 1870 to 1980 is less closely related to food consumption than to reduction of contaminated environments and work hours. “Not only have working hours,” they write, “declined substantially throughout the twentieth century, but the type of work became more sedentary, and so required less energy.” However, “The recent large increase of BMI in 1980-2000 (6 percent) is highly connected to increased food intake during the period (22 percent). (At p. 336) Further, they note the average BMI of American white males has increased by 15.7% throughout the 20th Century, half during the last two decades of the twentieth century. “This means that American body size is rapidly moving toward overweight and obesity.This would seem compatible with a new finding from Tim Church and colleagues at the Pennington Biomedical Research Center that in the 1960’s about half of jobs in private industry required at least moderate physical activity. That figure is now less than 20%. Over the last 50 years, occupational daily energy expenditure decreased from by 142 calories in men and a similar amount in women.  Trends over 5 Decades in U.S. Occupation-Related P… [PLoS One. 2011] – PubMed result

What are the policy implications of this Technophysio Evolution?

First, increases in body size are a product of 300 years improvement in technology, productivity and standards of living. This evolution began long before television, fast food, vending machines, sugar-sweetened beverages and other would-be villans in the obesity epidemic.

Second, the very same nutritional improvements which led to larger bodies in Europe and the United States are being actively pursued in undernourished parts of developed nations and throughout the developing world. This indicates greater and greater levels of obesity in the developing world with obesity related diseases.

Third, epigenetics needs to receive more attention as a point of intervention in the development of obesity.

Fourth, simplistic views that blame individuals and proclaim that just cutting back food  or going to the gym will fix the obesity epidemic.  Strategies which just repeat the ELEM mantra (Eat Less Exercise More) have to be questioned if those strategies are likely to affect this profound historical trend.

A few years ago, Gina Kolata, in her book, Rethinking Thin (Farrar,Straus and Giroux, 2007)  discussed the views of some obesity researchers that we are looking at a new stage in the evolution of the species. This tome adds significant evidence that our obesity strategies need to be re-thought to take this 300 year trend into account.

FDA Proposes Restaurant, Vending Calorie Labeling

May 6th, 2011

The Food and Drug Administration released two  proposed regulations, part of the Obama Health Care Reform Act, to require disclosure of calories on restaurant menus and vending machines. See Labeling & Nutrition > Overview of FDA Proposed Labeling Requirements for Restaurants, Similar Retail Food Establishments and Vending Machines. Comments are due by June 6, 2011.

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.