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I spend a lot of my time working on issues related to chronic disease and the first things one learns about chronic diseases is that they are incredibly common, have a massive impact on individuals, families and the broader society and that the probability of becoming chronically diseased is profoundly influenced by smoking, drinking, diet and exercise. I don’t much care for tabloid language like “obesity epidemic” but it’s pretty clear that, at a population level, more people are fatter than in the recent past and that this is a factor in the increased incidence of a broad range of diseases.
Now, one of the more immediate consequences of the current economic crisis is that the profits of fast food and confectionery companies are rising. This makes me wonder about what the long term impact of the recession will be but also causes me to observe that here is proof positive that lifestyle “choices” are not made in a social or economic vacuum. This is crucial because at the moment the principal public health intervention related to obesity is the generation of vast numbers of preachy messages.
This is really annoying and stupid because everyone concerned with public health and the determinants of health knows that preaching is spectacularly ineffective. Not only is it ineffective as a public health intervention it causes people to get very defensive which is understandable but not helpful. The classic case study on just how ineffective preaching is is smoking (or as we insiders call it, tobacco cessation strategy). Warning messages just give politicians the warm fuzzies. They have no impact at all on smoking behaviour. We have decades of evidence to prove this. We also know what does work; economic incentives (1) and changing environments.
Now it strikes me that “obesity strategy” today is very much where tobacco strategy was fifty years ago. Back then, everyone who cared to look at the science knew there was a problem but nothing was done about. Producer lobbies (tobacco farmers, cigarette companies, the hospitality industry) had government by the short hairs and by a combination of economic FUD and spurious civil rights arguments ensured that governments restricted themselves to utterly ineffective propaganda campaigns. Smoking began to decline sharply only when it became more difficult and expensive to smoke.
Fifty years on we are in the same boat with obesity. We know that it would be of societal benefit if people ate better and exercised more. We also know how to make that happen. It’s not rocket science. The diet piece is probably easier than the exercise one. Direct and indirect subsidies to agri-business need to be realigned to promote healthy eating. Right now they have exactly the opposite effect. In fact, where I live, virtually every component of a cheeseburger is massively subsidized(2). The exercise piece is more complex and, perhaps, more interesting. Recent research in Canada shows that people who live in the inner city exercise more and are lighter and healthier than people who live in the suburbs. Going down a level shows that this is largely a function of people walking or biking to do things that suburbanites use cars for (this is a good example that shows that lifestyle choices are very much not made in some sort of environmental vacuum). So we can see that a really effective public health intervention would be to make it easier for people to live in cities without a car.(3) Where does government stand on this? Governments at all levels in Canada continue to subsidize the suburban lifestyle by direct subsidies to the auto and lumber industries and by building roads and other infrastructure that, together, make the suburbs profitable to develop and artificially affordable to live in. Obviously there are other useful exercise related initiatives that governments could take and they don’t include pumping out pro exercise propaganda while closing school swimming pools. The whole situation is not helped by a political system that is systematically gerrymandered to reduce the influence of large cities.
Why then do governments pursue policies that cost the economy billions and curtail millions of lives? It’s essentially the same story as with tobacco fifty years ago. Again we have a producer coalition that desperately wants to rubbish the public health agenda. This time the producers are even more powerful. They include farmers (4), processed food companies, the auto industry and the property development industry. All of these groups are politically incredibly influential. Property developers pretty much own local government in Ontario for example.
What will it take to break the cycle? I don’t know. I’m not sure that the research has been done on what finally tipped the balance of forces against the tobacco lobby. I suspect that we could learn a lot from such a study.
(1) A very distinguished public health physician once pointed out to me that raising the price of a pack of smokes by $1 had more impact on mortality than all the advances in cancer treatment of the last 30 years.
(2) I remember a senior executive of McCain’s back when NAFTA was first signed complaining that his US pizza competitors who got export subsidized Canadian wheat flour, tomatoes and cheese would now be able to re-export them back to Canada, tariff free, as frozen pizza.
(3) This would probably be the most effective way of reducing carbon emissions too.
(4) Why are farmers so powerful? They are a small group of corporate welfare bums but the public loves them. I don’t get it.
Now, one of the more immediate consequences of the current economic crisis is that the profits of fast food and confectionery companies are rising. This makes me wonder about what the long term impact of the recession will be but also causes me to observe that here is proof positive that lifestyle “choices” are not made in a social or economic vacuum. This is crucial because at the moment the principal public health intervention related to obesity is the generation of vast numbers of preachy messages.
This is really annoying and stupid because everyone concerned with public health and the determinants of health knows that preaching is spectacularly ineffective. Not only is it ineffective as a public health intervention it causes people to get very defensive which is understandable but not helpful. The classic case study on just how ineffective preaching is is smoking (or as we insiders call it, tobacco cessation strategy). Warning messages just give politicians the warm fuzzies. They have no impact at all on smoking behaviour. We have decades of evidence to prove this. We also know what does work; economic incentives (1) and changing environments.
Now it strikes me that “obesity strategy” today is very much where tobacco strategy was fifty years ago. Back then, everyone who cared to look at the science knew there was a problem but nothing was done about. Producer lobbies (tobacco farmers, cigarette companies, the hospitality industry) had government by the short hairs and by a combination of economic FUD and spurious civil rights arguments ensured that governments restricted themselves to utterly ineffective propaganda campaigns. Smoking began to decline sharply only when it became more difficult and expensive to smoke.
Fifty years on we are in the same boat with obesity. We know that it would be of societal benefit if people ate better and exercised more. We also know how to make that happen. It’s not rocket science. The diet piece is probably easier than the exercise one. Direct and indirect subsidies to agri-business need to be realigned to promote healthy eating. Right now they have exactly the opposite effect. In fact, where I live, virtually every component of a cheeseburger is massively subsidized(2). The exercise piece is more complex and, perhaps, more interesting. Recent research in Canada shows that people who live in the inner city exercise more and are lighter and healthier than people who live in the suburbs. Going down a level shows that this is largely a function of people walking or biking to do things that suburbanites use cars for (this is a good example that shows that lifestyle choices are very much not made in some sort of environmental vacuum). So we can see that a really effective public health intervention would be to make it easier for people to live in cities without a car.(3) Where does government stand on this? Governments at all levels in Canada continue to subsidize the suburban lifestyle by direct subsidies to the auto and lumber industries and by building roads and other infrastructure that, together, make the suburbs profitable to develop and artificially affordable to live in. Obviously there are other useful exercise related initiatives that governments could take and they don’t include pumping out pro exercise propaganda while closing school swimming pools. The whole situation is not helped by a political system that is systematically gerrymandered to reduce the influence of large cities.
Why then do governments pursue policies that cost the economy billions and curtail millions of lives? It’s essentially the same story as with tobacco fifty years ago. Again we have a producer coalition that desperately wants to rubbish the public health agenda. This time the producers are even more powerful. They include farmers (4), processed food companies, the auto industry and the property development industry. All of these groups are politically incredibly influential. Property developers pretty much own local government in Ontario for example.
What will it take to break the cycle? I don’t know. I’m not sure that the research has been done on what finally tipped the balance of forces against the tobacco lobby. I suspect that we could learn a lot from such a study.
(1) A very distinguished public health physician once pointed out to me that raising the price of a pack of smokes by $1 had more impact on mortality than all the advances in cancer treatment of the last 30 years.
(2) I remember a senior executive of McCain’s back when NAFTA was first signed complaining that his US pizza competitors who got export subsidized Canadian wheat flour, tomatoes and cheese would now be able to re-export them back to Canada, tariff free, as frozen pizza.
(3) This would probably be the most effective way of reducing carbon emissions too.
(4) Why are farmers so powerful? They are a small group of corporate welfare bums but the public loves them. I don’t get it.
no subject
Date: 2009-02-25 07:15 pm (UTC)no subject
Date: 2009-02-25 07:17 pm (UTC)no subject
Date: 2009-02-26 01:50 pm (UTC)It's not hugely different as a public health issue, though, and a measure of size is much easier to use than trying to work out how active a person is. The new thing in Australia (http://www.measureup.gov.au/internet/abhi/publishing.nsf/Content/How+do+I+measure+myself-lp) is to use waist size rather than BMI. It's been talked about since 2005 but I haven't seen much about it elsewhere
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Date: 2009-02-25 07:26 pm (UTC)no subject
Date: 2009-02-25 07:29 pm (UTC)(no subject)
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Date: 2009-02-25 07:36 pm (UTC)no subject
Date: 2009-02-25 07:27 pm (UTC)There's less evidence than you might think that ordinary levels of fatness are dangerous. If you go by the BMI and longevity numbers from the NIH, "overweight" people live a little longer than "healthy" weight people, and low-end obese people have intermediate lifespans.
Admittedly, BMI isn't the same thing as fatness, but it's probably got a loose correlation.
no subject
Date: 2009-02-25 07:31 pm (UTC)BMI is such bullshit. I'm a curvy girl but pretty healthy, yet my BMI says I'm obese. Which doesn't exactly motivate me to lose weight!
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Date: 2009-02-25 07:42 pm (UTC)(no subject)
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Date: 2009-02-25 07:34 pm (UTC)1) Regarding food, I suppose one could make the argument that no one has to smoke, but we all need to put food/drink in our mouths at some point. And the food that's worst for you tends to be designed to appeal to the greatest number of tastebuds, whether through the salt, sugar, or fat content. Wasn't the original point of high-fructose corn syrup the fact that it's (a) cheaper to use and (b) exponentially sweeter than sugar, so the manufacturers got more intense taste for less price? It's hard to imagine someone loving the taste or smell of tobacco as a young child -- most smokers would probably admit that their first cigarette made them feel sick -- but what about the taste or smell of a cheap cheeseburger?
2) I've chatted with my mother about food trends, mostly about how tinned food and TV dinners were so trendy when she was a child because they were new and modern and available at any time. Nowadays, tinned green beans are just a convenience item, and many consider them not as good as 'fresh' beans simply because they're packaged. And there's a lot of hidden salt and sugar in those foods because it helps preserve them and conceal the tinned taste. And yet my mother still has more tinned food and frozen dinners than I think I ever will, because that's how she was raised and how she's most comfortable cooking. Do you think habits will change as the generations change?
no subject
Date: 2009-02-25 07:47 pm (UTC)On e of the reasons HFCS is cheaper to use is because it's heavily subsidized! In the EU manufactureres tend to use sugar instead because that's heavily subsidized. Truly you get what you pay for even if you don't know you are paying for it.
no subject
Date: 2009-02-25 07:43 pm (UTC)See forthcoming post about commodification, food, power, and ethics. (Which I was just about to start but now I have office hours so I have to go.)
*love*
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Date: 2009-02-25 07:58 pm (UTC)(no subject)
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Date: 2009-02-25 08:31 pm (UTC)no subject
Date: 2009-02-25 08:38 pm (UTC)no subject
Date: 2009-02-25 08:44 pm (UTC)My old new job was in the immediate suburbs, and required my driving there (or facing three Métro changes.) New new job is within the Vélib catchment area (and a reasonable distance), and I can take buses or the métro when it rains. I no longer use my car and now bike or walk without even thinking of it distances I did not use to consider walkable. (The Vélibs put me back on a bike after close on 25 years. It's perfectly true, you don't forget.)
None if this is proper exercise, but it does make a difference, including the sheer feel-good factor induced by even a very modest rise in endorphin levels.
no subject
Date: 2009-02-25 08:51 pm (UTC)But also, we need to think about convenience. You're working 40+ hours a week, who wants to soak their dried beans and clean their greens etc etc etc. I spend 2-3 hours each weekend cooking my food for the next week, so I can just pull out a tupperware and snarf something down b/c I'm so busy. If I forget my lunch, I tend to just have a coke and 2 bags of Doritos.
Mmmmm.... Doritos...
(Speaking of which, we need to remember the chemicals in these foods-- those french fries smell good b/c of the chemicals! Doritos are so addicting because of the MSG! C'mon, chemicals!)
*runs off to get Doritos*
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Date: 2009-02-25 09:06 pm (UTC)(no subject)
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Date: 2009-02-25 09:04 pm (UTC)I'm kind of fat myself. I'm not averse to fatness in an aesthetic sense. But it's stupid not to be cognizant of the health risk. So we need to find a way of separating out the health issue from the moralising and from the aesthetic.
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Date: 2009-02-25 09:08 pm (UTC)(no subject)
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Date: 2009-02-25 10:37 pm (UTC)Now, one of the more immediate consequences of the current economic crisis is that the profits of fast food and confectionery companies are rising. - I was discussing this with a friend the other day and I must confess I find this, if not strange, at least comment-worthy. It is, I would contend, relatively easy to eat a nutritionally balanced diet on little money, if you just know a few basics of cooking. So I suppose giving people access to fresh vegetables and teaching them to cook and stuff might also be useful, but that's as far as my suggestions went.
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Date: 2009-02-25 10:51 pm (UTC)(no subject)
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Date: 2009-02-25 10:37 pm (UTC)And despite recently upping my exercise (a 1 mile bike commute is now a 4.5 mile bike commute, and I still do it every day) I'm still not only putting on weight but getting fatter.
I do see the points you are making though. Interestingly we now live in a village rather than in the middle of town, but instead of taking up driving we get some food delivered and buy the rest in the village. Perhaps instead of encouraging people to move from the suburbs to the city you need to make sure that there are shopping and leisure opportunities in the suburbs. With such a small city I'm still pretty close to the town centre though, probably much the equivalent of many of your city dwellers!
I know I could lose weight if I was willing to diet, but I'm not currently willing to diet forever to keep it off. I wonder if I'll change my mind if I actually do start having high blood pressure or diabetes? But you're absolutely right that preaching doesn't work one bit. Not even when you're preaching to yourself.
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Date: 2009-02-25 10:47 pm (UTC)I realise that the city/suburb thing as I framed it in this article is a very North American perspective. The nature of north American suburbs is such that it really isn't viable to provide walking distance shopping and leisure opportunities. The population density is too low. People move to the suburbs because they want a big house on a large lot. The price of that is low density. Also, the developers aren't interested in that kind of livability. They want the shopping concentrated in large box stores which are more profitable for them and their tenants.
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Date: 2009-02-25 11:00 pm (UTC)And if you are a woman my age, the range for healthy is about 23%-35%. That's a big range. For a woman 20-40, you can still be considered healthy with 33% body fat.
So I'm sorry. If you are carrying more than a third of your weight in body fat, I don't care how much exercise you get. It's just not healthy. And it's not something to write off by saying that fat is a feminist issue. Yes, a fat person who exercises is likely to be healthier than a thin person who drinks and smokes a lot, but that's not actually the point, is it?
Sorry. This hits a real button for me.
no subject
Date: 2009-02-25 11:11 pm (UTC)Interesting, except that in Winnipeg, the trend seems to be reversed, not because inner city dwellers don't walk or take the bus, but because there are substantial food deserts within the inner city. There are few grocers or markets to begin with, and even the supermarkets like Safeway don't stock enough fresh and healthy food. So inner city dwellers end up buying crap which is also conveniently cheaper.
And also um...
Why are farmers so powerful?
Whoa, slow down there, Big City Dweller. I don't know which farmers you're talking to, but the farmers around here that I know and buy food from are not corporate welfare bums. Is this a comment on the Wheat Board? I;m not sure where this ire is coming from, so please elaborate.
no subject
Date: 2009-02-25 11:24 pm (UTC)The farm sector in Canada, like most industrialised countries is highly subsidised. It also accounts for about 2% of employment so its small. I'm sure there are farmers who don't rake in huge subsidies but many do. Milk quota wouldn't be a valuable traded commodity if it weren't for supply management, which is a form of subsidy. Find me another economic sector where 2% of the workforce gets its own cabinet minister.
no subject
Date: 2009-02-26 12:35 am (UTC)I kind of feel like many other people have wound up in the opposite camp: they never learned anything about food: they don't know how to cook, no one ever taught them how, they watch those ridiculous shows on the Food Network (maybe), which mostly tell them that it's hopeless anyhow, and then they open a can or a frozen something. (As an aside, I watched the US Food Network last weekend with my mom, and boy are the ads for total shit food!)
And yes yes yes to fixing food subsidies to actually produce food, not chemicals. I remember when I learned that Iowa had once had the tastiest peaches in the US, until subsidies and refrigeration killed that. If we subsidized fruits and vegetables, not corn and soy, I do wonder how much better everyone's health would be. (I also kind of would like it if the patty on that cheeseburger cost more than the cheese.)
Gym-phobia
Date: 2009-02-26 01:54 am (UTC)My boyfriend doesn't know how to cook at all, despite coming from a very well-off family. He was never allowed in the kitchen as a kid so just didn't pick up the basic skills of how to handle meat, chop vegetables, saute an onion etc. So he lives off processed cheese and biscuits, salty snacks and microwaveable meals - and yes, I do worry about his health! I think it's irresponsible parenting not to teach your children about food - where it comes from, how to tell if it's fresh, what's in season, and how to cook and prepare it. A few basics go a very long way.
no subject
Date: 2009-02-26 03:18 am (UTC)Perhaps we should have a sugar tax? Or rather, on processed foods (actually, I think our GST targets processed "ready to eat" foods, but not basic ingredients, or fruit, meat, and veges). It always seems wrong to me when, for example, frozen chips are cheaper than plain potatoes.
The subsidizing of agriculture in first world countries is ridiculous. I believe that in North America, many sweet things are made with corn syrup, which is made because corn farmers are subsidized and they need to use up all that maize somehow.
Subsidized agriculture in the first world directly corresponds to poverty in the developing world, and is one of the key issues that the Fair Trade movement seeks to address (some bullet points on teh matter here).
no subject
Date: 2009-02-26 04:09 am (UTC)North Americans have a thing about farmers. Hardly anoybody farms anymore, or even knows anyone who does, so we have subsituted a nice myth about the rugged individualist working 16 hour days and barely getting by so he can live free in the open air and produce pure healthy food for the hedonistic rich living in cities. We don't seem to have realized that farming has now become agribusiness; the work is done by slaves and the profits are collected by people who little, if any, real work on their land. One line from Pollan's last book stays in my head: "Goerge Naylor [corn farmer] works his fields fifty-seven days a year."
Since there are so few people in the agribusiness industry, and there is so much money in it, those people wield inordinate amounts of power. There are 300 million eaters in this country and a few thousand agribusinessmen - guess which group has a Cabinet office. Guess which group writes bigger checks.
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Date: 2009-02-26 01:40 pm (UTC)In Australia of those four we only have the property developers at a local level and the farmers on a state or national level. The farmers don't have the same level of subsidies or protection, either. The property developer leads to places without public transport in this state, although that's helped a fair amount by the government being appallingly bad at managing public transport. The benefit of public transport over cars in this case is that there's more temptation to walk. On the other hand the developers want to build denser suburbs closer to the centre of the city.
So perhaps we're well positioned in Australia for the sort of policy you're thinking of. It wouldn't be unprecedented policy here but there's plenty of room for something more coherent and comprehensive.
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Date: 2009-02-26 01:49 pm (UTC)The problem with the farmers is that the way subsidies tend to be structured they are incented to produce unhealthy food. Since the farmers are locked in a symbiotic relationship with government around subsidy policy I see them as part of the problem.