Dealing With Obesity Do We Have The Courage?

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

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

A Global Crisis?

EU Trends Females

Females © International Obesity TaskForce 2005 % Obesity < 5 % 5-9.9% % % % ≥ 25%

Females © International Obesity TaskForce 2005 % Obesity < 5 % 5-9.9% % % % ≥ 25%

Females © International Obesity TaskForce 2005 % Obesity < 5 % 5-9.9% % % % ≥ 25% Self Reported data

Females © International Obesity TaskForce 2005 % Obesity < 5 % 5-9.9% % % % ≥ 25% Self Reported data

Females © International Obesity TaskForce 2005 % Obesity < 5 % 5-9.9% % % % ≥ 25% Self Reported data

Projected % Increase in Diabetes, Yach, Stuckler, Brownell Nature Medicine, % 75.5% 134%

% Increase in Diabetes, Yach, Stuckler, Brownell Nature Medicine, % 124%

What Won’t Work

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

What Might Work

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

Economics Price Access

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

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

Relative Changes in Costs (using Consumer Price Index) From % 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

% Increase in Costs from Putnam et al. Food Rev, % 46% 117%

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

Population Detroit Branford Chapel Hill 29,000 52, ,000

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

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

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

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

The Perfect Economic Storm

Healthy Food Costs More Availability Pricing Incentives

Food Marketing

Amount Impact Types Massive Multiple Profound

Traditional Marketing + Guerilla Marketing Viral Marketing Stealth Marketing

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

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

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

Legal Challenges Limiting commercial speech Preemption Enhancing compelled speech

Food and Addiction

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

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

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

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

What to Do? It Begins With A Story

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

CDC, BRFSS % of US Population Getting Recommended Physical Activity ( )

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

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

The Individual Optimal Defaults Economics Legislation Environment Regulation Less Obesity

The Individual Optimal Defaults Economics Legislation Environment Regulation Less Obesity

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

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

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

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

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