Addressing Obesity By Changing Environments Kelly D. Brownell Yale University
Nutrition in schools Sugared beverages & taxes Food marketing and children Examples of Major Initiatives Food labeling
A Conceptual Scheme
Knowledge Motivation How Best to Make Change? Educate Implore Medicate Operate The Individual Less Obesity?
CDC, BRFSS % of US Population Getting Recommended Physical Activity ( )
NHANES % of US Adults Getting Recommended Fruit & Vegetable Servings
Youth Risk Behav Survey % of US Children Getting Recommended Fruit & Vegetable Servings
What Are We Doing Now? Knowledge Motivation Educate Implore The Individual Less Obesity?
Knowledge Motivation How Best to Make Change? Educate Implore Medicate Operate The Individual Less Obesity?
Optimal Defaults Economics Legislation Environment Regulation The Individual Less Obesity?
Another Example – Organ Donation Johnson & Goldstein, Science, 2003 “Do defaults save lives?”
Disastrous Defaults (examples) The economics of food Food marketing Portions Too much access Too little access
Food Marketing
Powerful Relentless Exploitative
TV Advertising Adver- gaming Other Youth Websites Bunnies Life Hannah Montana Clifford Crunch Mighty Bites Honey Sunshine Puffins Cheerios Kix EnviroKids Organic Mini Wheats Organic Wild Puffs The Best Dozen None
TV Advertising Adver- gaming Other Youth Websites xxx x xxx xxx xxx xxx xxx xx Reese’s Puffs Cap’n Crunch Count Chocula Trix Froot Loops Smorz Lucky Charms Golden Grahams Cinnamon Toast Crunch Corn Pops Cocoa Puffs Fruity/Cocoa Pebbles xxx The Worst Dozen
RWJF $100 million/yr vs. Child Marketing January 4!
The Special Case of Sugar-Sweetened Beverages
The World’s Most Valuable Brand?
% Calories Per Day From 2 Beverages Nielsen & Popkin. Am J Prev Med, Milk Soft Drinks
Single greatest source of added sugar Poor calorie compensation Targeting of vulnerable populations Sugar may be addictive Gratuitous addition of caffeine Completely empty calories Why Soda? Rock solid proof of harm
SSBs: How Much? Average intake = 50 gallons/yr (189 liters) Average child = 175 calories/day
Children Ages 2-18 Empty calories = 40% of total intake Largest contributor to overall intake SSBs + Juice Drinks, 173 kcal/day Reedy & Krebs-Smith J Amer Dieteitic Assn, 2010
Brownell et al. New Engl J Med, 2019
How Worried is Industry?
Millions Spent Lobbying Coke & Pepsi + ABA Los Angeles Times Feb 7, 2010
Household Budget Surveys Expenditure records (all beverages) Household income & number of residents Industry Reports Market volume & market value Sugared Beverages in Latin America Underestimates Captures about 50% of intake
Data: Datamonitor 2009, Euromonitor 2009, Andreyeva et al 2011
Consumption Trends Peru, Data: Peru, Encuesta Nacional de Hogares
Consumption Trends Mexico, Data: Mexico, Encuesta Nacional de Ingresos y Gastos de Hogares
Consumption Trends & Income Data: Mexico, Encuesta Nacional de Ingresos y Gastos de Hogares
Consumption Trends & Income Data: Mexico, Encuesta Nacional de Ingresos y Gastos de Hogares
Estimated Revenue (20% tax) $2.66 billion $256 million $857 million $2.37 billion Brazil Chile Colombia Mexico Peru$191 million Revenue (US Dollars) Calculations based on Datamonitor 2010, Euromonitor 2010, World Bank 2009
Who Are The Change Agents?
Legislators federal, state, local Legal Authorities e.g., state attorney’s general The Press Litigators
Dr. Thomas Frieden NYC Commissioner of Health Michael Bloomberg Mayor Legal Defaults
Game Changing Developments NYC trans fat ban in restaurants Menu labeling White House Announcements Soda tax proposals Conn. Attorney General – Smart Choices