Www.YaleRuddCenter.org Dealing With Obesity Do We Have The Courage?

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Dealing With Obesity

Do We Have The Courage?


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1985

No Data <10% 10%-14% 15-19% 20%

BRFSS, BMI > 30

2005

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

A Global Crisis?

EU Trends1980-2005

Females

Females 1980-1984

© International Obesity TaskForce 2005

% Obesity

< 5 %

5-9.9%

10-14.9%

15-19.9%

20-24.9%

≥ 25%

Females 1985-1989


% Obesity

< 5 %

5-9.9%

10-14.9%

15-19.9%

20-24.9%

≥ 25%

Females 1990-1994


% Obesity

< 5 %

5-9.9%

10-14.9%

15-19.9%

20-24.9%

≥ 25%

Self Reported

data

Females 1995-1999


% Obesity

< 5 %

5-9.9%

10-14.9%

15-19.9%

20-24.9%

≥ 25%

Self Reported

data

Females 2000-2005


% Obesity

< 5 %

5-9.9%

10-14.9%

15-19.9%

20-24.9%

≥ 25%

Self Reported

data

Projected % Increase in Diabetes, 2000 - 2030

Yach, Stuckler, BrownellNature Medicine, 2006

0

25

50

75

100

125

150

U.S. China India

36.5%

75.5%

134%

% Increase in Diabetes, 2000 - 2030

Yach, Stuckler, BrownellNature Medicine, 2006

0

25

50

75

100

125

150

DevelopedCountries

DevelopingCountries

19.8%

124%

What Won’t Work

Treatment

Diets

Self-help

Commercial

Lifestyle change

Medication

Surgery

EfficacyPublic Health

Impact

??

??

Modest

Modest

Modest

High

Low

Low

Low

Low

Low

Low

What Might Work

Two Solid Contributors

One Possible Contributor

- Economics- Marketing

- Addiction

Economics

• Price

• Access

Link of Poverty With Obesity

Drewnowski & SpecterAm J Clin Nutr, 2004

The Cost of Calories

Drewnowski & SpecterAm J Clin Nutr, 2004

Relative Changes in Costs(using Consumer Price Index)

From 1980 - 2000

3.8% average increase in inflation rate

Food prices rose less (3.4%)

This is 14% drop in relative price of food

Council of Economic Advisors2004 Report

% Increase in Costs from 1985-2000

Putnam et al.Food Rev, 2002

0

25

50

75

100

125

Soft Drinks Sugar &Sweets

Fruits &Vegetables

20%

46%

117%

Tale of Three Cities

Detroit, MI

Branford, CT

Chapel Hill, NC

0 300,000 600,000 900,000

Population

Detroit

Branford

ChapelHill

29,000

52,440

800,000

0 20,000 40,000 60,000 80,000 100,000

Median Family Income

Detroit

Branford

ChapelHill

$33,853

$69,510

$88,200

Number of LargeFull Service Markets

Branford 2

Chapel Hill 6

Detroit 2

0.0 1.0 2.0 3.0 4.0 5.0 6.0

Markets Per 50,000 People

Detroit .125

Branford 3.4

ChapelHill

5.7

Improving Access

More SupermarketsZoningEnterprise zonesTax incentives

Use of Existing MarketsDistributionStoragePrice

The Perfect

Economic Storm

Healthy FoodCosts More

Availability

PricingIncentives

Food Marketing

Food Marketing

Amount

Impact

Types

Massive

Multiple

Profound

Traditional Marketing

+

Guerilla MarketingViral Marketing

Stealth Marketing

New Frontiers

• Virtual ads – sporting events

• Virtual ads – TV & Movies

• Cell phones

• A viral cohort

Tax FreedomDay

United States April 30

New Zealand June 1

Germany July 5

RWJF $100million/yr

vs.Child

Marketing

January 4!

Legal Challenges

Limiting commercial speech

Preemption

Enhancing compelled speech

Food and

Addiction

Food and Addiction

Biological (evolutionary) plausibility

Clinical plausibility

Research plausibility

Yale Meeting on Food & AddictionCo-chairs

Kelly Brownell YaleMark Gold Univ of Florida

KeynoteNora Volkow NIDA

Partial Participant ListLouis Aronne CornellClaude Bouchard PenningtonSam Klein Wash UnivBart Hoebel PrincetonMark Gold Univ of Florida

Shelley Greenfield HarvardBarbara Mason ScrippsGene-Jack Wang Brookhaven

Nora Volkow NIMH

Excellent Reviews and Conceptual Papers

• Bart Hoebel animal neuroscience

• Nora Volkow human neuroscience

• Mark Gold human studies

• Elissa Epel food reward

What Might Be Addictive?

Macronutrients (sugar, fat)

Chemical additives

Ingredients (e.g., HFCS)

What to Do?

It Begins With

A Story

Knowledge

TheIndividual

Motivation

How Best to Make Change?

Educate

Implore

Medicate

Operate

LessObesity?

CDC, BRFSS

% of US Population GettingRecommended Physical Activity (1986-2000)

Knowledge

TheIndividual

Motivation


Educate

Implore

Medicate

Operate

LessObesity?

Knowledge

TheIndividual

Motivation


Educate

Implore

Medicate

Operate

LessObesity

TheIndividual

OptimalDefaults

Economics

Legislation

Environment

Regulation

LessObesity

One Example – Pension Plans

Automatic enrollment

Employee must enroll

near 100%

< 50% in 1st yr

Choi, Laibson et al, 2002In Poterba (Ed). Tax Policy and the Economy

Another Example – Organ Donation

Johnson & Goldstein, Science, 2003“Do defaults save lives?”

Dr. Thomas FriedenNYC Commissioner of Health

Michael BloombergMayor

Optimal LegalDefaults

The Importance ofLocal Victories

Deputize a massive potential force

Mobilization more likely for local issues

More opportunities for ingenuity

But What Is Needed

An evaluation SWAT Team

National organizing resource body

Funding

Www.YaleRuddCenter.org Dealing With Obesity Do We Have The Courage?

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