Why is obesity a Why is obesity a political political problem?problem?

Cheap food? Corporate Cheap food? Corporate profits? profits?

Health care costs?Health care costs?

The debate over obesity, it turns out, is The debate over obesity, it turns out, is a lot like the debate over global a lot like the debate over global warming. In both cases, major warming. In both cases, major companies protect their profits not only companies protect their profits not only by lobbying against policies they don't by lobbying against policies they don't like, but also by financing advocacy like, but also by financing advocacy groups devoted to debunking research groups devoted to debunking research whose conclusions they don't like. - whose conclusions they don't like. - Paul Krugman Paul Krugman

NY Times, “Girth of a Nation” July 5, 2005NY Times, “Girth of a Nation” July 5, 2005

Economics +/vs. education= Economics +/vs. education= PoliticsPolitics

Obesity is a disease of Obesity is a disease of poverty of mind and poverty of mind and pocketbook.pocketbook.

Education

Economics

Politics

Gersham’s Law: bad Gersham’s Law: bad drives out the gooddrives out the good

Cheap high fat/high calorie food is driving Cheap high fat/high calorie food is driving out healthier choices out healthier choices

The organic market has emerged in The organic market has emerged in response to the consumer perception that response to the consumer perception that cheap industry food is bad for you but it is cheap industry food is bad for you but it is not cheapnot cheap

The food industry outspends public health The food industry outspends public health education efforts by more than education efforts by more than 500 to 1500 to 1

The leading causes of The leading causes of death death

Actual causes of death 1990 Actual causes of death 1990 and 2000and 2000

The Economic Burden of The Economic Burden of CVDCVD

Heart disease CAD Stroke HTN CHF Total CVD

$0

$50

$100

$150

$200

$250

$300

$350

Bill

ions

$368

$239

$133

$54 $56 $29

CAD, coronary artery disease; CHF, congestive heart failure; CVD, cardiovascular disease; HTN, hypertension. Heart Disease and Stroke Statistical 2004 Update. American Heart Association.

CAD, coronary artery disease; CHF, congestive heart failure; CVD, cardiovascular disease; HTN, hypertension. Heart Disease and Stroke Statistical 2004 Update. American Heart Association.

Prevalence of Diagnosed Diabetes Among US Adults,1991-2001

Cost of Diabetes in the US, Cost of Diabetes in the US, 20022002

Total (direct and indirect): 

$132 billion Direct medical

costs: $92 billion Indirect costs:  $40 billion

(disability, work loss, premature mortality)

(*BMI 30, or about 30 lbs overweight for 5’4” person)

1995

200

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. AdultsBRFSS, 1991, 1996, 2003

2005

Source: Behavior Risk Factor Surveillance System, CDC

Prevalence of the Metabolic Prevalence of the Metabolic Syndrome in the USSyndrome in the US

Ford ES, et al. JAMA 2002;287:356-9

0102030

405060

20-2930-39

40-4950-59

60-69> 69

Age (years)

Pre

va

len

ce

(%

)

Men Women

Metabolic Syndrome CostsG

enet

ics

Enviro

nmen

t Dyslipidemia

HDL-C

TG

Hyp

erte

nsio

n

IGT

IFG Ear

ly D

M

Obe

sity

Late

DM

Fertility

drugs

Aspirin

Herbal

supplements

OTC

Phentermine

Orlistat

Sibutramine

Resins

Fibrates

Statins

Niacin

OTC

Ezetimibe

Diuretics

Ace inhibitors

Beta blockers

Alpha agonists

ARBs

Other

Insulin

Glitizones

Sulfonylureas

Biguanides

Others

Fluoride

Pesticides

Antibiotics

Fertilizers

Sunblocks

Antireflux

Gen

etic

s

Enviro

nmen

t Dyslipidemia

HDL

Trig

Hyp

erte

nsio

n

IGT

IFG Ear

ly D

M

Obe

sity

Late

DM

Fertility

drugs

Aspirin

Fluoride

Pesticides

Antibiotics

Fertilizers

Sunblocks

Antireflux

Herbal

supplements

OTC

Phentermine

Orlistat

Sibutramine

Resins

Fibrates

Statins

Niacin

OTC

Ezetimibe

Diuretics

Ace inhibitors

Beta blockers

Alpha agonists

ARBs

Other

3.99 + $80.00 + $29.99 + $138.29 + $9.99 + $61.99 + $79.95 + $89.79 =

InsulinGlitizonesSulfonylureasBiguanidesOthers

$493.99 per month

The yearly cost for The yearly cost for this sample this sample individual?individual?

$5927.88$5927.88

All diseases are like a All diseases are like a costly game of Russian costly game of Russian

roulette roulette

“Genetics loads the gun;

the environment pulls the trigger.” -George Bray

What are leading theories in What are leading theories in our environment making our environment making

obesity worse?obesity worse? Diet Diet Lack of exercise Lack of exercise Inadequate sleep. (Average sleep amounts have fallen, and many studies Inadequate sleep. (Average sleep amounts have fallen, and many studies

tie sleep deprivation to weight gain.) Increases ghrelin. tie sleep deprivation to weight gain.) Increases ghrelin. Endocrine disruptors, which are substances in some foods that may alter Endocrine disruptors, which are substances in some foods that may alter

fats in the body. (HFCS)fats in the body. (HFCS) Nice temperatures. (Air conditioning and heating limit calories burned Nice temperatures. (Air conditioning and heating limit calories burned

from sweating and shivering.)from sweating and shivering.) Fewer people smoking. (Less appetite supression.)Fewer people smoking. (Less appetite supression.) Medicines that cause weight gain.Medicines that cause weight gain. Population changes. (More middle-agers and Hispanics, who have higher Population changes. (More middle-agers and Hispanics, who have higher

obesity rates.)obesity rates.) Older birth moms. (That correlates with heavier children). Older birth moms. (That correlates with heavier children).

Genetic influences during pregnancy. Genetic influences during pregnancy. Darwinian natural selection. (Fat people outsurvive skinny ones). Darwinian natural selection. (Fat people outsurvive skinny ones). Assortative mating, or "like mating with like," as Allison puts it. Assortative mating, or "like mating with like," as Allison puts it.

Translation: fat people procreating with others of the same body type, Translation: fat people procreating with others of the same body type, gradually skewing the population toward the heavy end. gradually skewing the population toward the heavy end.

And possible bacteria in the gut! (Did the bacteria or obesity come And possible bacteria in the gut! (Did the bacteria or obesity come first?)first?)

Are you fat? It Could Be the Air ConditionerBy MARILYNN MARCHIONE, AP Medical Writer

Anything but…Anything but…

Cheap high calorie/high Cheap high calorie/high fat food and a lack of fat food and a lack of exerciseexercise

This is the sacred This is the sacred cow of dietary cow of dietary

advice advice

And I am sad to say I have to kill And I am sad to say I have to kill this poor cow.this poor cow.

homework.uoregon.edu:8080/dchat/images/cow.gif

What if our losing weight What if our losing weight battle is a combination of battle is a combination of

things (like a system)?things (like a system)?

Add nobody is completely to blame nor Add nobody is completely to blame nor blamelessblameless

Everyone is responsible because Everyone is responsible because everybody bears some sort of burden from everybody bears some sort of burden from the cost of health care due to obesity the cost of health care due to obesity

What has changed?What has changed?

Our politics has become more Our politics has become more polarized polarized

Our economy has become more Our economy has become more centralized and profit driven centralized and profit driven

Our educational and public health Our educational and public health systems need to focus on systems need to focus on sustainable long-term needs for sustainable long-term needs for both individual and social growthboth individual and social growth

What is in our food What is in our food supply?supply?

0

10

20

30

40

50

60

70

80

90

Year

Gra

ms

Added fats

Added sugars

We add 77.2 grams of fat and 29.7 grams of caloric sweeteners per capita into our food supply. This makes high calorie food very cheap!

Source: USDA (2006)

The simple carbohydrate The simple carbohydrate breakdownbreakdown

0.0

20.0

40.0

60.0

80.0

100.0

120.0

Refined sugar

HFCS

Early in 2005 a pound of beet sugar cost 24 cents but high fructose corn syrup cost about half as much 13 cents a pound.HFCS has become a very common and cheap sweetener.

There is a new There is a new scientific paradigm scientific paradigm

emerging…emerging… The problem is neither fat The problem is neither fat nor carbohydrates nor carbohydrates

The real problem is we are The real problem is we are eating too much of the wrong eating too much of the wrong type of fat and type of fat and carbohydrates with very little carbohydrates with very little fiber in our dietfiber in our diet

The fiber trend… since The fiber trend… since 19071907

Dietary fiber in grams

0

5

10

15

20

25

30

35

1909

1917

1925

1933

1941

1949

1957

1965

1973

1981

1989

1997

Year

Gra

ms

Dietary fiber in grams

We took out the fiber then put it back in

Refined breads and cereals are designed to taste better. Some people kept eating the bread and cereal without the fiber. The greater the refinement the worse it is for you.

There is little difference in the There is little difference in the science behind these 3 science behind these 3

leading diet books…leading diet books…

The big difference is the The big difference is the writing style and health writing style and health

education education

          

 

                       

              

 

Dietary advice has not Dietary advice has not changed much-changed much-

In thirty years, the USDA has not In thirty years, the USDA has not significantly changed dietary advicesignificantly changed dietary advice ..

What do we eat?What do we eat?

49

32.8

17.9

Carbs

Fat

Protein

51.6

32.8

20.3

Carbs

Fat

Protein

Males Females

The calories we consume come from49 %(males) to 52% (females) from carbohydrates {half that from sweeteners}32.8% from fat 17.9 (males) 20.3 (females) from protein

How many calories do we How many calories do we eat?eat?

The average male consumes 2618 calories daily.The average female consumes 1877 calories daily.

0

500

1000

1500

2000

2500

3000

Male ageadjusted

40 59years

Femaleage

adjusted

40 59years

Kcal

Kcal

How many calories make a How many calories make a pound of fat? pound of fat?

About 3600 calories (above your About 3600 calories (above your resting metabolic rate) is a resting metabolic rate) is a pound of fat (for the average pound of fat (for the average person).person).

Cutting through the fat…Cutting through the fat…There are good fats, bad fats and There are good fats, bad fats and very ugly fats in our nation’s food supply :very ugly fats in our nation’s food supply :a) the good fats are Omega 3 fatty acids, a) the good fats are Omega 3 fatty acids,

monounsaturated fats and polyunsaturated fats monounsaturated fats and polyunsaturated fats c) the bad fats are saturated fatsc) the bad fats are saturated fatsd) the ugly fats are trans-fat acidsd) the ugly fats are trans-fat acids

In the human body our liver turns these fats into the good (HDL), the bad (LDL and triglycerides) and the ugly (VLDL).

In 5 seconds, what do these In 5 seconds, what do these labels say?labels say?

Slow down and digest the food information you Slow down and digest the food information you need because your health depends on itneed because your health depends on it

The 3 stories about The 3 stories about High Fructose Corn High Fructose Corn

SyrupSyrup

It is liquid candy. It has no It is liquid candy. It has no nutrients and will leave you nutrients and will leave you hungry. - my Nutrition hungry. - my Nutrition instructor at WIU.instructor at WIU.

Beverages are less satiating than solid Beverages are less satiating than solid food. When consuming beverages, food. When consuming beverages, people don’t compensate by eating people don’t compensate by eating less food later simply because liquid less food later simply because liquid calories do not register with appetite calories do not register with appetite control.control.

Cindy Goode, Hy Vee dietitian quoted Cindy Goode, Hy Vee dietitian quoted in the Iowa City Press Citizen in in the Iowa City Press Citizen in December 2006.December 2006.

High fructose corn syrup inhibits High fructose corn syrup inhibits leptin (the satiety controlling leptin (the satiety controlling hormone) and raises triglycerides in hormone) and raises triglycerides in blood blood

K. Neff, S.Elliot, M. Tschop, Dietary Fructose Reduce Circulating Insulin and Leptin Attenuates Postprandial Suppression of Ghrelin and increases Triglycerides in Women (2004) Journal of Clinical Endocrinology & Metabolism

All three say pretty the All three say pretty the same thing:same thing:

Empty calories you Empty calories you consume in soda pop will consume in soda pop will make you fat and more make you fat and more hungryhungry

Why don’t get rid of Why don’t get rid of HFCS? HFCS?

High fructose corn syrup is the cheapest thing in the food market. The profit margin is HUGE.

Every restaurant in country sells it. We might have a recession without it. Maybe even a famine…

Making moral choices in a Making moral choices in a system of systemic violence is system of systemic violence is no easy task but being part of no easy task but being part of the problem not an answer to the problem not an answer to systemic violence. systemic violence.