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.
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