Geography, income, fast food, and whole food: Super-sizing of

AmericaSusan J. Massad, HSD, RD, CHES

ProfessorFramingham State Collegesmassad@framingham.edu

Obesity rate in the United States has increased to an alarming

degree• Defined Body Mass Index (BMI), > 30• BMI = weight in kilograms divided by

height in meters squared. (BMI=kg/m2). • National Institutes of Health

classifications for BMI:– Underweight <18.5 kg/m2– Normal weight 18.5–24.9 kg/m2– Overweight 25–29.9 kg/m2– Obesity (Class 1) 30–34.9 kg/m2– Obesity (Class 2) 35–39.9 kg/m2– Extreme obesity (Class 3) ≥40 kg/m2

Data• US population: 304,059,724 (US Census

Bureau, 2009). • With approximately 72 million obese

Americans, the obesity rate is approximately 23.6%.

• US Surgeon General report:– number of overweight children in the US

has doubled– number of overweight adolescents tripled,

since 1980. • Rise in obesity does not appear to

correlate with food abundance

Rate of obesity has serious health implications:

• ↑ risk of coronary heart disease• ↑ type II diabetes• ↑ colon and breast cancer• ↑ hypertension• ↑ cholesterol and triglycerides• ↑ sleep apnea• ↑ stroke• ↑ liver and gallbladder diseases• ↑ osteoarthritis• ↑ infertility

Obesity risks, cont.

• Abdominal obesity → excess fat around the “trunk” → caused by excess caloric intake, ↑ consumption of refined carbohydrates, and physical inactivity.

• Abdominal fat, measured by waist circumference and waist: hip ratio, → highly correlated with insulin resistance, inflammation, hypertension, elevated blood lipids, and hyperglycemia.

• Abdominal obesity has tripled in U.S. during the past 4 decades, currently affecting half of all adults (Blaha et. al., 2008).

Mapping obesity trends

• The U.S. Centers for Disease Control and Prevention provides data on the state-by-state and nationwide obesity rates. Over the last 20 years, the rates have steadily risen.

• See:http://www.cdc.gov/obesity/data/trends.html

http://www.cdc.gov/obesity/data/trends.html

http://www.cdc.gov/obesity/data/trends.html

http://www.cdc.gov/obesity/data/trends.html

http://www.cdc.gov/obesity/data/trends.html

Rise in obesity can be attributed to:

• Greater reliance on fast food and convenience foods

• Dramatic reduction in physical activity• Increased TV viewing and computer

use• Aggressive marketing of calorie dense

foods of low nutritional quality• Portion “distortion”

• SUPERSIZING

Changes in serving size• USDA's National Nutrient Database - nutritional

information for thousands of common foods; includes calories and nutrients in common (recommended) portion sizes.

• Portion sizes, on which this data is based, varies from portion sizes sold in food establishments. Ex: USDA database:1 bagel 3 inch diameter, 2 oz., 146 calories. Most bagels bagel delis: double the portion size and calories.

• Hamburger cooked at home from 80% lean 20% fat ground beef ~ 230 caloriesA “quarter pounder” from a fast food restaurant (meat only, no bun): ~ 400 calories.

Food Politics• Early 1980s, food companies lobbied US

Congress to require commodity producers (e.g. beef, dairy, eggs, peanuts) to deduct or “check-off” a fee from sales to be used for generic advertising/promotion.

• Federally sanctioned; benefit certain food commodities.

• Most check-off funds: designated for research and advertising, but most ends up being used to promote particular commodity → e.g. meat/beef boards design campaigns promoting beef consumption as a “wholesome” food high in iron and protein, de-emphasizing high fat and cholesterol content.

• Dairy board heavily promotes, milk, cheese, ice cream primary sources of calcium, also de-emphasizing high fat and cholesterol content

• (Nestle, 2003).

Socioeconomic trends and food selection

• Although overweight and obesity have increased across almost all racial, ethnic and socioeconomic levels, higher BMIs are associated with socioeconomic disadvantage and non-white race and ethnicity.

• Affluent neighborhoods have more chain grocery stores and supermarkets, while the less affluent neighborhoods have more convenience stores that sell lower quality foods at higher (convenience) prices

Differences in adolescents' eating habits, perceptions, and dietary

intakes by “food security” status

• Compared with food-secure youths, food-insecure youths - more likely to perceive that eating healthfully was inconvenient and that healthy food did not taste good.

• Food-insecure youths reported eating more fast food, fewer family meals and fewer breakfastsweek than food secure youths.

• Food-insecure youths had higher fat intakes (P<0.01), than food-secure.

• Food-insecure more likely to have BMI > 95th percentile. (Widome, Neumark-Sztainer, Hannan, Haines & Story, 2009)

Relationship between fast-food restaurants located near schools &

obesity among middle & high school students

• Davis & Carpenter (2008) found that students with fast-food restaurants near (within one half mile of) their schools:(1) consumed fewer servings of fruits &

vegetables(2) consumed more servings of soda(3) were more likely to be overweight than

were youths whose schools were not near fast-food restaurants

Number of fast-food establishments rose steadily over

last 2 decades• Leading global foodservice retailer,

McDonald's: ~ 31,000 restaurants serving more than 58 million people in 118 countries each day.

• Most common high-fat, calorie-dense menu items: French Fries, the “Quarter Pounders,” the “Big Mac,” “Chicken McNuggets” and the “Egg McMuffin”

Success of McDonald’s: appeal to CHILDREN

• Corporation owns and operates > 400 playgrounds

• McDonald’s “Happy Meals” made for young children come with toys from top toy manufacturers – e.g. “beanie babies,” “Aladdin” figures, “cabbage patch kids.”

• Other fast food retailers have followed suit, including rivals Burger King, Pizza Hut, and Taco Bell.

• Children get caught up in “consumer frenzy” of owning these toys that are popular amongst their friends; pressure their parents to take them to restaurants that offer the toys.

Availability of “Whole Foods” Markets

• Largest food retailer of "natural" and organic products, including produce, seafood, grocery, meat and poultry, bakery, prepared foods, special foods for those with allergies (e.g. gluten free, wheat free, milk-free, egg-free), cheese, specialty coffee, natural cosmetics, and nutritional supplements.

• Meat & dairy: generally hormone-free and organic. • All foods - free of synthetic additives/preservatives. • Average price of most items - higher than that

purchased in traditional, “mainstream” grocery stores.

• Whole Foods stores tend to be located in more affluent communities.

Kids and Whole Foods• Big difference in prices of kid’s meals for on-the-go

parents• McDonald’s Chicken McNugget “Happy Meal” with

toy:~ $2.99 plus tax• Whole Foods an “Ian’s all-natural, organic Chicken

Nugget” meal: ~ $5.99. • Whole Foods only offers “wholesome” foods; don’t

sell many foods that are heavily marketed to children (e.g. high-sugar breakfast cereals, high fat, high-sodium, processed snacks & chips, candy).

• Whole Foods snacks aimed at children (cookies & crackers made with all-natural ingredients, all-natural 100% fruit juices, all-natural peanut butter, 100% fruit preserves, flavored organic yogurt): more expensive than their traditional, less-healthy counterparts sold at ordinary grocery stores.

McDonald’s Happy Meal vs. Ian’s all-natural organic

chicken meal:$2.99 $5.99

Snack price comparison

Organic Apple & Sultana Fruit Bar

• Price: $1.33• Size: 1.33 oz.• 280 calories

Skittles candy• Price: $0.79• Size: 2.17

ounces • 311 calories

This research examines the relationships between state-by-state obesity rates and per capita income, fast food establishments, and “Whole Foods” markets.

Four hypotheses:

1. There is a relationship between per capita income and obesity rates

2. There is a relationship between the number of “McDonalds” fast-food restaurants per capita and obesity rates

3. There is a relationship between McDonalds restaurants per capita and per capita income

4. There is a relationship between per capita income and the number of “Whole Foods” markets per capita.

Methods:

• Data was collected on state-by-state population from the U.S. Census Bureau. Obesity rates and ranks were obtained from the U.S. Centers for Disease Control and are shown in Figure 1 and Table 2.

• Information on number of McDonald’s restaurants per state was purchased from “Aggregate Data, LLC” (2009). Information on the number of Whole Foods markets per state was obtained from the Whole Foods web page.

Continued

Methods, cont.

• After all data was collected correlation coefficients computed for: 1) Relationship between per capita income

and obesity rate by state2) McDonald’s restaurants per capita and

obesity rates3) McDonald’s restaurants per capita and per

capita income4) number of “Whole Foods” markets per

capita and per capita income. Data is presented in Tables 4 and 5.

Results

• Statistically significant relationships:– Obesity rates and number of McDonalds

per capita; the two were positively correlated (there were more McDonald’s in the states with higher obesity rates).

– Per capita income and obesity rates; the two were negatively correlated (the lower the per capita income, the greater the obesity rate)

Results, cont.

• Significant positive correlation between:– Number of “Whole Foods” grocery

stores and per capita income (more Whole Foods stores in states with higher per capita income).

• No significant correlation between:– McDonald’s restaurants per capita and

per capita income

Discussion/implications Relationship between SES & obesity

• Negative correlation between states’ per capita incomes & obesity rates consistent with other studies (Beydoun and Wang, 2008; Ford & Dzewaltowski, 2008; Widome, Neumark-Sztainer, Hannan, Haines & Story, 2009).

• Lower SES:– more expensive and often healthier foods less accessible– seems to lead to greater consumption of foods higher in fat,

sodium and simple sugars– less affluent neighborhoods lower accessibility to healthy

foods

• Block & Kouba (2006): affluent neighborhoods in Chicago area had more chain grocery stores and supermarkets than less affluent neighborhoods, and that the produce in the less affluent neighborhood markets had lower quality produce.

Discussion/implications: Significant and positive correlation between

per capita income and the number of “Whole Foods” markets per state.

• Consistent with findings of Horowitz, Colson, Hebert, & Lancaster (2004).

• Store patrons have more access to “natural” brands and wider variety of wholesome foods from which to choose then they would have at the more traditionally grocery store chains.

• Typically pay about 10-15% more on their “whole foods” groceries.

• Concept of “whole foods/healthy diet” does not appear to have caught on with all classes.

• Instead natural foods grocery stores often perceived as places for trendier, elitist shoppers, rather than for everyone.

Until such retail food establishments become more widely available with more

affordable prices likely to be little change in eating practices of lower income families

• Widome, Neumark-Sztainer, Hannan, Haines & Story (2009) study confirmed that youths from lower income families reported eating more fast food but fewer family meals and they had higher fat intakes.

• Beydoun and Wang (2008) study stressed importance of making healthy foods more accessible to poorer segments of population by lowering their price while increasing price of the unhealthy foods.

• Increasing SES, which in some cases works through lowering perceived barrier of food price, can also improve diet quality.

Food and SES, cont.

• Also, many people have mistaken perception that it’s expensive to eat nutrient dense diet, adequate in calories, and does not exceed the recommendations for fat, cholesterol, and sodium.

• Individuals that receive federal food assistance can still eat a balanced diet given some parameters.

8 leader nutrients: protein, vitamins B1, B2, B3 ,A & C, minerals iron & calcium.Least expensive nutritious foods/group and the nutrients they provide:

Food group Food sources Nutrients

Meat/protein group eggs, canned tuna, peanut butter, dried beans/legumes (e.g. kidney beans, chick peas, black beans, lentils),

protein, and iron

Dairy group low fat or non-fat milk or reconstituted non-fat milk powder, low /non-fat yogurt

protein, calcium, vitamins A, D, and riboflavin

Vegetable group carrots, broccoli, and yams beta carotene, (converts to vitamin A; broccoli is also high in calcium

Fruit group apples, bananas, strawberries in-season, melons in-season, oranges in season

Note: strawberries, melon, and oranges are high in vitamin C, apples and bananas are not

Grain group Brown/white rice, rolled oats, store brand whole grain breads

thiamin, riboflavin, and niacin

Fats and oils store brand canola or olive oil

vitamin E

Food and SES cont.• Ironically, as obesity has increased over last 2

decades, need for federal food assistance increased.

• Congressional Budget Office (CBO) projection: cost of Supplemental Nutrition Assistance Program - $50 billion in 2009 ( of 27% from 2008).

• ~ 31 million Americans receive SNAP; approximately 72 million are obese.

• In 2007, leanest state was Colorado; (18.4% obesity rate), followed by Hawaii (20.7%), Connecticut (20.8%), and Massachusetts (20.9%). The fattest states were Mississippi (31.7% obesity rate), followed by West Virginia (34.6), Alabama (30.1), and Louisiana (29.5%).

• “Fattest” states all had lower per capita incomes (mean: $31,385), than the leaner states (mean: $45,870).

Conclusion:• The 20-year span of increased obesity

rates is an alarming trend. • In 1987, 15 states had obesity rates <

10%; 15 had rates of 10-14%. • In 1997, no state had obesity rate <

10%; 16 had rates of 10-14%; 31 had rates of 15-19%; and 3 had rates of 20-24%.

• In 2007, no state had rates < 10%, none had rates of 10-14%, only one had a rate of 15-19%, 20 had rates of 20-24%; 26 had rates of 25-29%, and 3 had rates of 30% or greater.

Conclusion, cont.

• Of the many factors that contribute to obesity, lower incomes, greater availability of fast food restaurants, and less availability of “whole foods” markets have at least some role.

• In this study, higher per capita income and greater availability of “whole foods” type grocery stores were negatively correlated with the obesity rates, while lower per capita incomes and greater availability of “whole foods” type grocery stores were negatively correlated with the obesity rates, while lower per capita incomes and availability of McDonald’s restaurants were positively correlated with obesity.

The economic recession has had influence on the obesity rates

• Positive correlation between obesity rates and number of McDonald’s restaurants and negative correlation between per capita income and number of McDonald’s - worth further speculation.

• Why is the chain so successful? Playgrounds allure to parents who may be seeking low-cost recreation and inexpensive meals at same time.

• Part of the current success of McDonald's Corp., which has been thriving during the economic downturn lower cost (less-expensive alternatives to sit-down restaurants).

• Additionally, they’ve added espresso beverages to their menu; may appeal to the parents who would typically buy specialty coffee drinks at cafes like Starbuck’s or Peet’s.

Final recommendations:• Until the system that has created the obesity

epidemic changes radically, there will be little change in the nation’s health and its high obesity rate.

• Cities and towns should examine the impact of any new fast food restaurants on its locality.

• At same time, local governments should explore the benefits of allowing healthier food chains like the “whole foods” –type grocers to come in.

• If there is empty retail space may make sense for a local government to offer tax-incentives to companies that are offering children and their parents more affordable, healthy foods.

Final recommendations, cont:

• Local school boards need more oversight of the physical education mandates and cities and towns need to offer playgrounds and other low-cost recreational facilities to deter parents from taking their children to those offered at fast food restaurants.

• Federal government and USDA need to provide more assistance to school lunch programs so that they can offer healthier, reduced-fat, and reduced-calorie options to the students.

Correspondence:

Susan Massad, HSD, RD, CHES ProfessorDepartment of Consumer SciencesFramingham State College100 State St.Framingham, MA 01701smassad@framingham.edu