Map of life expectancy at birth from Global Education Project.

Tuesday, August 30, 2005

I couldn't have said it better myself. . .

. . . or nearly as well. A great rant by Marion Nestle in the new American Journal of Public Health. Subscription only (of course), and as I get tired of saying, they could put the public into public health by making it open access. Well, the rest of the issue is about as entertaining as Seinfeld alumni marathon. Here are some of the good parts. (I've clipped out the footnotes.)

Unless current trends reverse, it seems likely that one third of all children born today—and even higher proportions of Hispanic and Black children —will develop type 2 diabetes during their lifetimes and can expect a shortened life expectancy because of it. Such alarming estimates are based on the demonstrated connection between overweight and the type 2 form of diabetes, which comprises as much as 95% of diabetes cases. Among adults with diabetes, about 85% are overweight and 55% obese (as defined by body mass index cutpoints of 25.0 and 30.0 kg/m2, respectively). . .

Obesity is causally related to type 2 diabetes, and this disease is not something you would wish on any child. It not only raises risks for heart disease, stroke, kidney failure, blindness, and neurological problems but also requires management of insulin resistance through medication, diet, and physical activity—not easy to accomplish in adults, let alone children. . .

As grammar school students in post–World War II Manhattan, my friends and I had the run of the city. We walked to school, went to after-school lessons, biked, roller-skated, played ball, and took subways on our own. In that pretelevision and precomputer era, we were too busy playing to be overweight. Today, a parent allowing that kind of freedom to a young child would risk arrest for child abuse. Working families, unsafe neighborhoods, and lack of after-school supervision do not allow children to play freely. Schools cannot be expected to fill the gap. Most lack funding for supervised in-or after-school games, and some forbid children to play at school at all in fear of lawsuit-generating injuries. On the food side of energy balance, children of my era did not have access to large amounts of high-calorie foods with minimal nutritional value ( junk foods), which are now considered normal fare. It is now normal for children to spend their free time at home watching televised commercials for such foods or using computers to view clever food advertisements disguised as games. It is now normal for children to expect to eat foods marketed in these ways. . . .

In 1980, the US food supply (production plus imports minus exports) provided 3300 kcal (13.8 MJ) per day per capita; by 2000 the supply had grown to 3900 kcal (16.3 MJ) per day. Even with wastage, this amount greatly exceeds the caloric needs of most adults and virtually all children. One effect of caloric overabundance is fierce industry competition to sell those calories. Wall Street requires companies to demonstrate growth every quarter. In this investment environment, food companies have 2 choices: they can entice people to buy their products instead of anyone else’s, or they can encourage people to buy more food in general. In an economy of overabundance, obesity and diabetes are just collateral damage.

From a business perspective, social norms that encourage people to eat more food make perfect sense. If you are in the food business, you want people to snack instead of eating regular meals. You are happy to serve larger portions: food is cheap, relative to labor costs, and customers love bargains. You want people to eat frequently throughout the day, drink sodas instead of water, and eat in formerly food-free places (e.g., clothing stores, bookstores, and libraries). You want it to be socially acceptable for children to bring snacks to school, have access to vending machines, and eat branded drinks, snacks, and fast foods during school hours.

Marketing to children also makes good business sense. It establishes brand loyalty early in life, encourages children to pester their parents to buy specific products, and undermines parental authority about food issues. It teaches children to believe that they are supposed to eat packaged foods designed especially for them. Food marketers want children to demand food that is sweet, candied, oddly shaped, amusingly colored, and in packages illustrated with cartoons. They want children to influence family food purchases, which is why McDonald’s spent more than $1.2 billion on US media advertising, PepsiCo spent $211 million on advertising soft drinks, and Kraft Foods spent $20 million on Kool-Aid ads and $25 million on Lunchables ads in 2004.. . .
But advice focused on individuals has not succeeded in reversing current health trends. Food companies cannot be expected to take actions contrary to their own economic interests. Government agencies cannot easily act in the public interest if doing so runs contrary to the interests of food companies. Public health approaches to preventing diabetes must address the societal changes that have led to the current predicament. As the Institute of Medicine eloquently argues, prevention of obesity in children must become a national priority for government, the food industry, and health professionals, and pursuit of this goal must involve strong leadership with accountability for an action plan that involves the industry, schools, and communities.


I trust this constitutes fair use. In any event, I am pretty sure Dr. Nestle would want you to read this.

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