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

2. www.YaleRuddCenter.org PodcastseNewsletter Slide PresentationsResources Galore

3. 1985 No Data <10% 10%-14% 15-19%  20% BRFSS, BMI > 30

4. 1986

5. 1987

6. 1988

7. 1989

8. 1990

9. 1991

10. 1992

11. 1993

12. 1994

13. 1995

14. 1996

15. 1997

16. 1998

17. 1999

18. 2000

19. 2001

20. 2002

21. 2003

22. 2004

23. 2005 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

24. A Global Crisis?

25. EU Trends 1980-2005 Females

26. Females 1980-1984 © International Obesity TaskForce 2005 % Obesity < 5 % 5-9.9% 10-14.9% 15-19.9% 20-24.9% ≥ 25%

27. Females 1985-1989 © International Obesity TaskForce 2005 % Obesity < 5 % 5-9.9% 10-14.9% 15-19.9% 20-24.9% ≥ 25%

28. Females 1990-1994 © International Obesity TaskForce 2005 % Obesity < 5 % 5-9.9% 10-14.9% 15-19.9% 20-24.9% ≥ 25% Self Reported data

29. Females 1995-1999 © International Obesity TaskForce 2005 % Obesity < 5 % 5-9.9% 10-14.9% 15-19.9% 20-24.9% ≥ 25% Self Reported data

30. Females 2000-2005 © International Obesity TaskForce 2005 % Obesity < 5 % 5-9.9% 10-14.9% 15-19.9% 20-24.9% ≥ 25% Self Reported data

31. Projected % Increase in Diabetes, 2000 - 2030 Yach, Stuckler, Brownell Nature Medicine, 2006 36.5% 75.5% 134%

32. % Increase in Diabetes, 2000 - 2030 Yach, Stuckler, Brownell Nature Medicine, 2006 19.8% 124%

33. What Won’t Work

34. Treatment Diets Self-help Commercial Lifestyle change Medication Surgery Efficacy Public Health Impact ?? Modest High Low

35. What Might Work

36. Two Solid Contributors One Possible Contributor - Economics - Marketing - Addiction

37. Economics Price Access

38. Link of Poverty With Obesity Drewnowski & Specter Am J Clin Nutr, 2004

39. The Cost of Calories Drewnowski & Specter Am J Clin Nutr, 2004

40. 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 Advisors 2004 Report

41. % Increase in Costs from 1985-2000 Putnam et al. Food Rev, 2002 20% 46% 117%

42. Tale of Three Cities Detroit, MI Branford, CT Chapel Hill, NC

43. Population Detroit Branford Chapel Hill 29,000 52,440 800,000

44. Median Family Income Detroit Branford Chapel Hill $33,853 $69,510 $88,200

45. Number of Large Full Service Markets Branford 2 Chapel Hill 6 Detroit 2

46. Markets Per 50,000 People Detroit.125 Branford 3.4 Chapel Hill 5.7

47. Improving Access More Supermarkets Zoning Enterprise zones Tax incentives Use of Existing Markets Distribution Storage Price

48. The Perfect Economic Storm

49. Healthy Food Costs More Availability Pricing Incentives

50. Food Marketing

51. Amount Impact Types Massive Multiple Profound

52. Traditional Marketing + Guerilla Marketing Viral Marketing Stealth Marketing

60. New Frontiers Virtual ads – sporting events Virtual ads – TV & Movies Cell phones A viral cohort

61. Tax Freedom Day United States April 30 New Zealand June 1 Germany July 5

62. RWJF $100 million/yr vs. Child Marketing January 4!

63. Legal Challenges Limiting commercial speech Preemption Enhancing compelled speech

64. Food and Addiction

65. Food and Addiction Biological (evolutionary) plausibility Clinical plausibility Research plausibility

66. Yale Meeting on Food & Addiction Co-chairs Kelly BrownellYale Mark GoldUniv of Florida Keynote Nora VolkowNIDA Partial Participant List Louis AronneCornell Claude BouchardPennington Sam KleinWash Univ Bart HoebelPrinceton Mark GoldUniv of Florida Shelley GreenfieldHarvard Barbara MasonScripps Gene-Jack WangBrookhaven Nora VolkowNIMH

67. Excellent Reviews and Conceptual Papers Bart Hoebel animal neuroscience Nora Volkow human neuroscience Mark Gold human studies Elissa Epel food reward

68. What Might Be Addictive? Macronutrients (sugar, fat) Chemical additives Ingredients (e.g., HFCS)

73. What to Do? It Begins With A Story

74. Knowledge The Individual Motivation How Best to Make Change? Educate Implore Medicate Operate Less Obesity?

75. CDC, BRFSS % of US Population Getting Recommended Physical Activity (1986-2000)

76. Knowledge The Individual Motivation How Best to Make Change? Educate Implore Medicate Operate Less Obesity?

77. Knowledge The Individual Motivation How Best to Make Change? Educate Implore Medicate Operate Less Obesity

78. The Individual Optimal Defaults Economics Legislation Environment Regulation Less Obesity

79. The Individual Optimal Defaults Economics Legislation Environment Regulation Less Obesity

80. One Example – Pension Plans Automatic enrollment Employee must enroll near 100% < 50% in 1 st yr Choi, Laibson et al, 2002 In Poterba (Ed). Tax Policy and the Economy

81. Another Example – Organ Donation Johnson & Goldstein, Science, 2003 “Do defaults save lives?”

82. Dr. Thomas Frieden NYC Commissioner of Health Michael Bloomberg Mayor Optimal Legal Defaults

83. The Importance of Local Victories Deputize a massive potential force Mobilization more likely for local issues More opportunities for ingenuity

84. But What Is Needed An evaluation SWAT Team National organizing resource body Funding

85. www.YaleRuddCenter.org