The real cost of obesity - University of Washingtondepts.washington.edu/uwcphn/news/presentations/... · 2010-08-12 · A comment about rising prices ... The paradox – it is possible

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The real cost of obesity:The real cost of obesity:Disparities in diet quality and healthDisparities in diet quality and health

Adam Drewnowski, PhDAdam Drewnowski, PhDDirector, Center for Public Health NutritionDirector, Center for Public Health Nutrition

Director, NIH Roadmap Center for Obesity ResearchDirector, NIH Roadmap Center for Obesity ResearchProfessor of Epidemiology and MedicineProfessor of Epidemiology and Medicine

School of Public Health and Community MedicineSchool of Public Health and Community MedicineUniversity of WashingtonUniversity of Washington

Fruit and vegetables and the prevention of obesity and its assocFruit and vegetables and the prevention of obesity and its associated diseasesiated diseases..EGEA International Conference, 17EGEA International Conference, 17--19 April 2007, Brussels, Belgium19 April 2007, Brussels, Belgium

Disparities in obesity rates Disparities in obesity rates can be seen at local levelcan be seen at local level

“All politics is local”“All politics is local”

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Disparities by county in the USDisparities by county in the US

A necessary question:A necessary question:Is obesity an economic issue?Is obesity an economic issue?

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How do people make food choices

Food choices

Energy density

Health

Taste

Cost

Variety

Time/Con-venience

Obesity

Grains,Sugar/fat

Sugar/fatGrains,Sugar/fat

Grains,Sugar/fat

A disconnect between the ideal A disconnect between the ideal diet…..diet…..

The Harvard SPH Food Pyramid

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……and reality for most consumersand reality for most consumers

First questionFirst question

Do energyDo energy--dense foods cost less?dense foods cost less?

•• Energy density defined as kcal/100gEnergy density defined as kcal/100g•• Energy cost defined as Energy cost defined as €€/1000 kcal, /1000 kcal,

edible portionedible portion•• Added sugars and fats cost lessAdded sugars and fats cost less•• The recommended healthier foods The recommended healthier foods

cost more (note log scale)cost more (note log scale)

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Energy density (kcal/100g) and energy cost (Euros/1000kcal) – INCA study

spreads

Log scale!

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Energy density (kcal/100g) and energy cost ($/1000kcal) –Seattle 2006 Supermarket prices

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A comment about rising pricesA comment about rising prices•• Seattle food prices collected in 2004 and 2006Seattle food prices collected in 2004 and 2006•• Same supermarkets, same foods, same packagesSame supermarkets, same foods, same packages•• The foods were split by energy densityThe foods were split by energy density

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Fats and sweetsFats and sweets

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Second questionSecond question

Are energyAre energy--dense foods nutrientdense foods nutrient--poor?poor?

•• EnergyEnergy--dense taste better and cost lessdense taste better and cost less•• But are they lacking in key nutrients?But are they lacking in key nutrients?•• We need nutrient profiling and a nutrient We need nutrient profiling and a nutrient

density scoredensity score•• Then we can look at nutrients per calorie Then we can look at nutrients per calorie

and nutrients per unit cost and nutrients per unit cost

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Examples of nutrient profiling:Creating a nutrient density score for foods

• Nutrient Density Score is the ratio between the amount of nutrients in a food and the energy that the food provides

NDS = (NAS/ED) * 100• Nutrient Adequacy Score is based on percent DVs

for N key nutrients as provided by 100 g of food

NAS = (Σ (Nutrienti/DVi) * 100)/N• Nutrient-to-price ratio NPR = NAS/price per 100g

Maillot et al. 2007 (submitted for publication)Maillot et al. 2007 (submitted for publication)

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Fruit and vegetables have low energy density and high nutrient density

Fats/oils

Darmon, Darmon, Maillot, Drewnowski JADA 2005

F+V

sugar

beverages

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Higher nutrient-density (per 100g) usually means higher cost (also per 100g)

Darmon, Darmon, Maillot, Drewnowski JADA 2005

Third questionThird question

Do energyDo energy--dense diets cost less?dense diets cost less?

•• INCA I is a nationally representative study of 1,985 French adults, based on 7-day diet records.

• Mean national food prices for >650 foods supplied by the French government (INSEE); by market research agencies (SECODIP), and by industry websites

• Diet costs estimated by multiplying unit price for each item by portion size and summing over all foods consumed by that person

• That is the estimated cost of the diet – assuming that all foods are purchased and prepared at home

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At each intake quintile, At each intake quintile, higher energy density = lower cost higher energy density = lower cost ((€€/wk)/wk)

DrewnowskiDrewnowski et al. 2007et al. 2007

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As dietary ED increases As dietary ED increases ––so do total energy intakesso do total energy intakes

INCA dataINCA data

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Last question:Last question:

What happens when you stratify What happens when you stratify diets by energy diets by energy costcost??

Food expenditures can be a proxy for SESFood expenditures can be a proxy for SES

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Q1 Q2 Q3 Q4

% o

f Q

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Energy Intake

Vitamin C

Vitamin Dß CaroteneFolates

4.9 €/10MJ 5.9 €/10MJ 6.9 €/10MJ 9.0 €/10MJ4.5 €/d 5.3 €/d 6.0 €/d 7.4 €/d

Energy Density

Vit E

Low-cost diets: more energy, fewer nutrients

Referent diet

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What do we know about What do we know about food, health, and income?food, health, and income?

40%40% 33%33% 25%25%

Engel’s Law (1867) Engel’s Law (1867)

As incomes rise, food costs As incomes rise, food costs account for lower share of account for lower share of incomesincomes

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Total foodFood at homeFood away from home

USDA’s Economic Research Service Food Review, 23, 2000Boyd Orr: UK 1937

Share of income spent on food in the US keeps declining

19371937

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Consumption by income: Consumption by income: Boyd Orr 1937Boyd Orr 1937

FruitFruit

FishFish

VegetablesVegetables PotatoesPotatoes

SugarSugar

BreadBread

Lard, suetLard, suetMeatMeat

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oilshortening

margarine

sugar cheese

koolAid

beans

mayonnaise lettuce

potatoes

fresh tomatoescrackers

ground beef

white bread

milk

eggs

zucchini squash

green peppers

What can you get for $100/week for a family of 4. The USDA Thrifty Food Plan: 1999

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Access to healthy foodsAccess to healthy foods

•• AffordabilityAffordability•• EnergyEnergy--dense foods are cheaperdense foods are cheaper

•• AccessibiityAccessibiity•• EnergyEnergy--dense foods are closerdense foods are closer

•• ConvenienceConvenience•• Fast foods take less time to prepareFast foods take less time to prepare

A challenge for public health nutritionA challenge for public health nutritionLess expensive More expensive

• If a meal of grilled chicken, broccoli and fresh fruit costs more and is less convenient than a burger and fries, the battle against obesity will be lost •Editorial, The Lancet January 31, 2004

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Spend less = Eat moreSpend less = Eat moreAre obesity and poverty linked by the low cost of energyAre obesity and poverty linked by the low cost of energy--

dense foods that are both palatable and convenient? dense foods that are both palatable and convenient?

Drewnowski & Specter, Am J Drewnowski & Specter, Am J ClinClin NutrNutr 2004;79:62004;79:6--1616

The Energy Density curve Drewnowski and Specter AJCN 2004:79:6-16

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Sugar fat

Energydensity

Food energyrequirement

Food energy

Low quality High quality

The paradox – it is possible to spend less and get moreBut the calories will be refined grains, added sugar and fat

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Conclusions:Conclusions:

The real cost of obesity lies in the The real cost of obesity lies in the current hierarchy of food prices current hierarchy of food prices and the promotion of low cost and the promotion of low cost

energyenergy--dense foods dense foods

Obesity is an economic issueObesity is an economic issue

Documents

The real cost of obesity - University of Washingtondepts.washington.edu/uwcphn/news/presentations/... · 2010-08-12 · A comment about rising prices ... The paradox – it is possible