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11/2/2010
1
Eating, Obesity, and Food Choice in Americans and Others
Or Eating in the 21st Century
Developed WorldDeveloped World
Paul Rozin, PhDProfessor of Psychology
University of PennsylvaniaSeptember 20, 2010
Two questions
How much do people eat?What do they eat?
The obesity epidemic
• Since 2000• Not an epidemic• Not contagious• Not contagious• Not a growth curve like an epidemic• For Americans in last 20 years
– About 1.5 pound gain per year
Selling obesity as public health disaster # 1
• Switch from obesity to overweight (BMI>=25)
• Attributing all negatives associated with g gobesity to obesity
• Cost estimates for USA per year vary from from 48,000,000,000 to 1,000,000,000,000
• Biggest effect may be on female self-esteem and quality of life
Body Mass Index (BMI)
• BMI = (weight in kg)/(height in m2)• BMI >18.5, < 25 is “normal• BMI >=25 < 30 is “overweight”• BMI >=25, < 30 is “overweight”• BMI >= 30 is “obese”
http://www.surgeongeneral.gov/news/testimony/obesity07162003.htmOffice of surgeon generalStatement of Richard H. Carmona, M.D., M.P.H., F.A.C.S.Surgeon GeneralU.S. Public Health ServiceWednesday, July 16, 2003y, y ,“The crisis is obesity. It’s the fastest-growing cause of disease and death in America. And it’s completely preventable.
•Nearly two out of every three Americans are overweight or obese. •One out of every eight deaths in America is caused by an illness directly related to overweight and obesity.
But the fact is that we have an epidemic of childhood obesity.
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2
Flegal et al., 2005Main Outcome Measures Number of excess deaths
in 2000 associated with given BMI levels
100
150
S (1
000S
)
-100
-50
0
50
BMI<18.5 BMI >=18.5,<25
BMI >=25, <30 BMI>=30
EX
CES
S D
EATH
S
BMI
• (weight[kg]) /(height[meters])2
• Obesity BMI>=30• The gold standard• The gold standard
Take out your piece of paper and pencil
• Write your discipline or major– (e.g., Nutrition, Psychology, Marketing)
• BMI = (weight[kg]) /(height[meters])2• BMI (weight[kg]) /(height[meters])• Why is HEIGHT SQUARED in the
denominator?
BMI: Why is height squared?Quetelet: 19 century
Hgt 1.3mDiam 1mH/D = 1.3
Assume 1 square meter = 100kg
Hgt 2.0mDiam 1.54mH/D = 1.3
Volume = hgt * (pi*r2)
Vol = .785 m2
Wgt = 102kgBMI = 60.35Bm3 = 46.4
Vol = 3.71 m2
Wgt = 371kgBMI = 92.7Bm3 = 46.4
Adaptations to our ancestral environment that don’t work now
• 1. Eating predisposition
2. The magical law of similarity
• Appearance = reality• The image = the object
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3
• 3. The univariate mind
A
Height4 ft 11 in
3
Height5 ft 9 in
3
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• 4. The monotonic mind
A diet totally free of salt is healthier than a diet of the same number of calories that
includes a pinch of salt every dayGroup % Agree
College students 19
National Sample 27
Physical Plant workers 37
Overall 28
Adaptations to our ancestral environment that don’t work now
• 5. The categorical/dichotomous mind
A pint of cottage cheese has more calories than one teaspoon of ice cream.
Group % Disagree
College students 30
National Sample 25
Physical Plant workers 38
Overall 31
6. Optimal foraging
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Mismatch: Health information and lay ability to interpret it
• 7. Lack of understanding of the scientific enterpriseenterprise
Medicalh
Foodindustry
Govern- Mediaresearchment
Public
Late 20th Century developed world
1. Epidemiological revolution: longer life and death from degenerative diseases
2. Food surplus3. Development of super-foods (hi sugar, hi fat)4. Extraordinary variety5. No work needed to attain choices6. Massive amounts of risk information7. No training in dealing with risks/benefits
The combination of health and beauty normsy
“Concerned about being overweight”
• % responding “often“ or “almost always”• 57% females 21% males• 57% females, 21% males• US college students from 6 universities
across the country
Rozin, Bauer & Catanese, 2003
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6
“I am embarrassed to buy a chocolate bar in the store”
• American college students from six campuses across the USAp
• % Females: 13.5
• % Males: 4
Weighing sensitivityMean (s.d) (Discomfort 0-100)
FemaleN=285-287
MaleN = 183
Alone 19.4 (30.0) 12.5 (29.9)( ) ( )
Male acquaint
59.8 (35.0) 21.1 (31.1)
FemaleAcquaint
53.7 (33.1) 26.5 (31.8)
Geier and Rozin
What is your current figure?____What is your ideal figure?_____What is the ideal female figure selected by
American women? ______
slide body Image USA StudentsLate 1980s
A CI OA2004
General female ideal: pink = female estimate, blue = male
Late 1980s
2004C I=COA
Little change from 1980s
A
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7
France versus USA
• Claude Fischler• Rebecca Bauer, Dana Catanese, Kim
Kabnick Estelle Masson Erin PeteKabnick, Estelle Masson, Erin Pete,• Alison Sarubin, Christy Shields, • Amy Wrzesniewski
Life expectancy at birthUN Demographic Yearbook (1993
u country years rank country years1 Japan 79.2 9/10 Israel,Italy 76.82 Sweden 78.1 11 Canada 76.43 Switzerland 77.8 12 U. K. 76.24 Australia 77.4 13 Austria 76.15/6 Norway,
Netherlands77.2 14 Belgium 75.8
7 France 77.0 15 USA 75.48 Spain 76.9 16 WGermany 75.1
Overweight:France vs USA (late 1990s)
• % BMI >= 25• % BMI >= 25• France: 39%• USA: 61%
Age-standardized annual mortality from CHD and related risk factors
(males 35-64)WHO/MONICA Renaud & de Logeril, 1992
Location Mortality / 100,000
Serum chol-esterol (mg/dl)( g )
Toulouse, France 78 230
Lille, France 105 252
Stanford, USA 182 209
Attitudes to food and eatingPercent of subjects preferring luxury
hotel to gourmet hotel at the same price
Female students Male students
France 13% 8%
USA 83% 71%
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8
Percent of subjects saying “unhealthy” for choice:
Heavy cream: whipped or unhealthy
Female students Male students
France 28% 23%
USA 67% 48%
Percent of subjects agreeing that they eat a “healthy diet”
Females Males
France 76% 72%
USA 28% 38%
Factors in four country study• Concern about healthiness of food• Worry about weight/fat• Pleasure/Importance• Culinary associations• Fat/salt reduced diet• Healthy eater
Rozin, P., Fischler, C., Imada, S., Sarubin, A., & Wrzesniewski, A. (1999). Attitudes to food and the role offood in life: Comparisons of Flemish Belgium, France, Japanand the United States. Appetite, 33, 163-180.
Chernoff Faces
Metaphor: Food and the body are like:
USA France
Tree 26 66
Car or factory 43 26
Temple 32 10
Representative national samplesFischler, Rozin et al., 2004
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9
The food environment
Restaurant portion sizeRestaurant France USA
McDonald’s (7) 189g 256g
Quick/Bking(5) 207g 322g Quick/Bking(5) 207g 322g
Chinese (6) 244g 418g
Rozin, P., Kabnick, K., Pete, E., Fischler, C., & Shields, C. (2003). The ecology of eating: Part of the French paradox results from lower food intake in French than Americans, because of smaller portion sizes. Psychological Science, 14, 450-454.
Supermarket food portions
ITEM Carrefour Acme
Yogurt (modal) 125g 227g g ( ) g g
Fresh fruit (mean,4 types)
431g 553g
Coca cola (modal)
330ml 500ml
Supermarket non-food portions
ITEM Carre-four
Acme
toothpaste 75 170 toothpaste (modal, ml)
75 170
toilet paper (mean, sq cm)
121 117
Cat food (modal, g)
100 85
Social norms and eating
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10
Unit Bias
• Norm for eating one entity• M&Ms free in bowl• Small spoon or 4X spoonSmall spoon or 4X spoon• 70% more consumed with 4X spoon• 60% more with double vs single pretzels
• Geier, A. B., Rozin, P., & Doros, G. (2006). Unit bias: A new heuristic that helps explain the effect of portion size on food intake. Psychological Science, 17, 521-525.
EnergyIntake
EnergyExpenditure
EnergyStorage
Energy
EnergyExpenditure
Intake
EnergyStorage
car
The French Garage
street
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11
MANHATTAN
NEW YORKSUBURB
PARIS
French vs American differences(with Abigail Remick & Claude Fischler)
1. Quality vs quantity2. Moderation vs abundance3 Collective values vs individualization3. Collective values vs individualization4. Joys vs comforts5. Food more associated with conviviality6. Environment limits modest amounts of
food to mealtimes and smaller portions
Obesity as individual responsibility
• Dieting looks easy: less food, lower weight• It rarely works for the long term
Incremental changes
• One apple day less, all else equal: loss of 8 pounds
• About one regular coke switched to dietAbout one regular coke switched to diet coke a WEEK: eliminate obesity epidemic
• ALL ELSE EQUAL
Working on the environment
Summing small differences ideaKelly Brownell, James Hill, David Levitsky, Marion Nestle, Barbara
Rolls, Andrew Geier and Paul Rozin
11/2/2010
12
Working on the environment
Cafeteria StudiesWith Sydney Scott, Megan Dingley,
Andrew Geier, Jenn Rineer, Ian Schwartz, Hong Jiang, Kalina
Urbanek, Mark Kaltenbach.Also work by Barbara Rolls
12 vs 16 oz plastic cups2 soda machines, no charge
4 beverages with highest intake
1
1.2
1.4
rson
0
0.2
0.4
0.6
0.8
Diet Pepsi Pepsi Fruit Punch Ginger Ale
Oun
ces/
per
12 oz16 oz
Net .48 oz less in the meal, or for one such meal a day, annualWeight loss of 0.6 pounds
Soup
Sushi
Sandwiches/Coffee
Exit
Salad Bar
Entrance
Salad Bar ArrangementsABRAMSON’S SALAD BAR (Chicken in the middle: Mon, Wed, Fri)
GG
CKE
N
TOFU
SSI
NG
BR
EAD
C
RO
UTO
NS
WR
S N
DRY
RE
D
PEPP
ER
BREA
D
CRU
MB
S
BA
NZO
BE
ANS
OLI
VES
KID
NEY
BE
ENS
CH
OK
E
O P
EP
PE
R
A F
ISH
AR C
UBE
S
CA
RR
OT
LETT
UC
E LE
TTU
CE
MIX
OU
TS
OU
TS
SE
AFO
OD
SLD
BLA
CK
OLI
VE
S
PEPP
ER
CA
RR
OT
MU
SH
RO
OM
MU
SH
RO
OM
SO
Y B
EA
NS
ION
S
PEPP
ER
OR
N
KID
NEY
BE
ENS
EG
CH
IC
DR
ES
FLA
X
SEED
S
PUM
P-K
IN
SEED
S
SUN
-FL
OW
SEED
S
CR
AN
B
ER-
RIE
S
RED
BE
ETS
RED
BE
ETS
TAN
GER
INES
CU
CU
MBE
RS
CU
CU
MBE
RS
AR
TIC
JALA
PE
N
TUN
A
BLA
CK
BEA
NS
FETA
CH
EE
SE
PRO
VOLO
NE
CH
ED
DA
OLI
VES
GR
EEN
PEP
PER
CA
ULI
FLO
WER
SPIN
ACH
LETT
UC
E
SP
RO
SP
RO
OLI
VE
OIL
/ V
INE-
GA
R
PO
TATO
E S
LD
GR
EEN
PEP
PER
PAST
A SL
D
RED
P
ON
I
RED
P
CO
TO
MAT
OE
S
TO
MAT
OE
S
BLU
E C
HE
ES
E
SHR
ED
. CH
EDD
AR
BR
OC
OLL
I
BR
OC
CO
LI
Access by ease of serving
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13
Schematics: Spoons/Tongs, Manipulation A
Dressing and T
Oranges Artichoke
Dressing and Condiments Lettuces
• Isolates edge v. middle
Tomato
Cheddar
Schematics: Spoons/Tongs, Manipulation B
Dressing and T
Oranges Artichoke
Dressing and Condiments Lettuces
• Isolates edge v. middle
Tomato
Cheddar
Utensil Study Results (% of Total Intake)
10%
12%
14%
16%
ood
In
take
SpoonTongs
0%
2%
4%
6%
8%
Artichoke Oranges Cheddar TomatosIngredient
% o
f Tota
l Fo
Net difference of 5.53 g/day, or 1,476 g/year or 0.43 pounds/yr
Salad Bar Position. Study 3. Middle versus Single Edge
Dressing and
C
Dressing and Condiments GreensB
• Isolates edge v. middle
A
Edge v. Middle
0.0150
0.0200
0.0250
0.0300
0.0350
0.0400
EdgeMiddle
0.0000
0.0050
0.0100
Chick
en Egg
Salm
onTu
na
Tomatoe
s
Carro
ts
Broc
coli
Mushr
ooms
IngredientNet difference of 5.6 g/day, or 1,899 g/year or 0.54 pounds/yr
• Accessibility in terms of height: eye or floor level. Alternated once a week
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14
Soda Cabinets, Manipulation A
Sobe Lifewater
Pepsi
Aquafina Flavored Water
Mountain Dew
Soda Cabinets, Manipulation B
Aquafina Flavored WaterMountain Dew
Sobe Lifewater
Pepsi
Soda Purchases by Display Level
6.00
8.00
10.00
12.00
ag
e #
Ite
ms
ase
d P
er
Da
y
Eye-LevelBottom
0.00
2.00
4.00
Pepsi Mtn Dew FlavoredAq
Sobe
Soda
Av
era
Pu
rch
a
Average reduction of 19.1% when soda is on bottom level
Segmentation cues or consumption interruptsp p
Geier, Wansink & Rozin
Lay’s stacked potato chipsAd lib potato chips for each student while watching a 35
minute movie
• Controls: All Lay’s Original• Lo Segment: All Lay’s original except• Lo Segment: All Lay s original except
every 10th chip is Red Basil/tomato chip• Hi Segment: All Lay’s original except every
5th chip is Red Basil/tomato chip
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15
Mean # chips eaten as a function of segmentation cues
P<.001 in both studies.: Study 1 at Cornell, Study 2 at Penn
Compensation problemsAll else equal: ceteris parebis
1. Increase calories at subsequent meals– Via regulation of weight system– Via personal food rewards for weight loss orVia personal food rewards for weight loss or
healthy eating2. Metabolic adaptation3. Increase in energy output
David Levitsky
• One of few studies controlling for compensation
• 18 young adults with ad-lib feeding except18 young adults, with ad lib feeding except for daily (weekday) lunch restriction to 250 calories
• All intake monitored and weighed
Figure 7
-0.2-0.10.00.10.20.30.40.50.60.7
Meal Replacement
ght C
hang
e (k
g)
Normal Lunch
-1.2-1.1-1.0-0.9-0.8-0.7-0.6-0.5-0.4-0.3
Wei
g
Levitsky, 2010. Weight change over 2 weeks by replacing anormal lunch (500-600 kcal) with a lunch of 250 kcal for 10 week days
Doctors and lay people:The power of culture
• 50-70 doctors and 50-70 lay people from each of five countries
• France, Germany, Italy, U.K., U.S.A• 20 items relating diet and eating to health
– Value of vitamin pills– Healthiness of dairy products, wine, meat– Importance of food, exercise, moderation for health– (Leeman, Fischler & Rozin, 2006)
11/2/2010
16
Sample of correlation technique
0 5
1
1.5
2
2.5
e A
-2
-1.5
-1
-0.5
0
0.5
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
z sc
ore A
BC
Lay-Doctor similarities on food-health (Pearson rs across 20 variables)
• France doctor with – France Lay .45– US doctor -.53US doctor .53
• US doctor with– US Lay .48
Lay-Doctor similarities on food-health (Pearson rs across 20 variables)
• France doctor with – France Lay .45– German doctor -.38German doctor .38
• German doctor with– German Lay .69
-0 1
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
Cor
rela
tion
-0.7
-0.6
-0.5
-0.4
-0.3
-0.2
-0.1
Mea
n C
Physicians--Lay Same Country
Physicians--Physicans Different
Countries
Physicians--Lay Dif ferent Countries
Lay--Lay Different Countries
Categories of Comparison
END