reducing obesity carolyn l. engelhard, mpa assistant professor & health policy analyst...

REDUCING OBESITY

Carolyn L. Engelhard, MPAAssistant Professor & Health Policy Analyst

University of Virginia School of MedicineFebruary 1, 2011

Policy Strategies from the Tobacco Wars

The growing prevalence of obesity over time

Obesity Trends* Among U.S. AdultsBRFSS, 1986

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14

Source: CDC Behavioral Risk Factor Surveillance Summary; http://aps.nccd.cdc.gov/brfss



No Data <10% 10%–14




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


F as in Fat, 2009 http://healthyamericans.org/reports/obesity2009/Obesity2009Summary.pdf; National Center for Health Statistics, 2008

More than 1 in 3 adults in the U.S.

were obese by 2008

http://healthyamericans.org/reports/obesity2009/Obesity2009Summary.pdf

U.S. most obese country in the world

https://www.mckinseyquarterly.com/PDFDownload.aspx?ar=2687

45% of U.S. adults are projected to be obese this year

Consequences of Obesity - Adults

Obesity is related to 20 chronic illnesses and results in 112,000 deaths/year in U.S. (2.6M globally)

U.S. spends $147 billion/year to treat obesity

In the U.S., every point of BMI >30 adds $300 in per capita HC costs

U.S. would save $200 billion/year if we weighed what we did in 1987

50% of obesity-related treatments paid for by Medicare or Medicaid

For the first time since the Civil War, average life span

may shrink because of obesity-related conditions

Consequences of Obesity - Kids

• 10 million children and adolescents are obese

• The average 10 year old weighed 77 lbs in 1963; today 88 lbs

• 25% of all vegetables eaten in U.S. are french fries or chips

• One out of four kids eat fast food at least once a day

• Overweight adolescents have a 70% chance of becoming an obese adult

Source: National Center for Health Statistics, 2006; Obesity in childhood is defined as BMI at 95th percentile or above

http://graphics8.nytimes.com/images/2010/02/14/weekinreview/14bittmann-grfk/14bittmann-grfk-popup.jpg

Sugared beverages are the No. 1 source of calories in the American diet, representing 7% for adults and 10% for children and teenagers

190 cal/day/capita come from sugared beverages -- 120 calories more than in late 1970s

Risk of becoming obese increases by 60% for pre-teens for every additional serving of sugar-sweetened beverage per day

Consequences of Obesity – Kids and Sugared Drinks

History of the success of tobacco control

Past 45 yrs, smoking rates have fallen -- 42.4% to 19.8% in 2007

In 1964, Surgeon General Luther Terry appointed committee: Cigarette smoking is a health hazard of sufficient importance in the US to

warrant appropriate remedial action.

What worked? Most important, according to WHO: excise taxes Broadcast bans Public information campaigns Banned smoking in mainly indoor places Encouraged treatment modalities such as nicotine patches Measures to prevent youth from accessing tobacco

Graphic, front-of-package labels cut Canadian tobacco use by 5% in one year, the largest one year drop in a

decade

Lessons from other countries

Similarities of tobacco and obesity

Chronic disease and premature death

Significant health care costs

History of aggressive marketing

Disproportionately represented in lower socio-economic strata

Social stigma

Same neurological pathways involved in addiction

Difficult to treat

Difference #1: Exercising can compensate for overeating , somewhat

• 82% of obesity from excess calories

• 18% by lack of exercise

• Adolescent physical activity stable over time

• Obesity the result of overeating rather than too little exercise

Difference #2: Only some food is unhealthy

Researchers at Oxford University in UK developed a numerical nutrient “score” balancing a 100 gram serving of a food’s risky elements – calories,

saturated fat, salt, and sugar – against the food’s nutritional benefits – fruit and vegetable content, fiber, and protein

Used in UK, Australia, and New Zealand to ban advertising

Policy Interventions from the “Tobacco Wars” #1 : Advertising Bans

A study of 22 OECD countries found that comprehensive bans on tobacco advertising results in a 5-7% reduction in tobacco use

Food industry spends more on advertising than any other industry -- $30 Billion ($10B on kids)

Children and youth view 12-21 commercials/day for snack foods More than 85% are for fattening food 1/7th to 1/3rd of obesity in kids linked to food ads

Banning fast food advertising would reduce the number of overweight children by 18% and teenagers by 14%

Policy Interventions from the “Tobacco Wars” #2 : Clear and simple labeling

Half of American food budget spent on meals/snacks outside home 33% of calories are from fast food restaurants Restaurant fast food consumption = 800 more calories per day Fast food patrons underestimate calories by half

In restaurant chains above a certain size, calories are required on menus and menu boards in Philadelphia, NYC, California, Maine, Massachusetts, and Oregon (nationwide beginning in 2011)

Policy Interventions from the “Tobacco Wars” #3: Front-of-package “signpost” labeling

Current nutrition “fact box” on foods can be confusing to consumers

Other countries use front of package signpost labels

Australia consumers 5x as likely to identify healthy foods w/ traffic light labels

Tesco stores (UK) showed a 41% drop in unhealthy food purchases after implementing “Front of Package” signpost system

The FDA is considering moving to a green, yellow, red “dot” system on foods

Policy Interventions from the “Tobacco Wars” #4: Taxing fattening food

Sugar, rum and tobacco are commodities which are nowhere necessities of life, which are

become objects of almost universal consumption , and which are therefore extremely proper subjects of taxation.

Adam Smith, Wealth of Nations, 1776

The UK has a 17.5% tax on sugared and high-fat foods, France 19.6%, and Canada 5%

Reasons to tax unhealthy foods like sugared beverages

Reduce consumption – 10% (11 gal) w/ penny per ounce

Raise revenue – same penny = $10B/yr; $150B/10 yrs

Send message about dangers of fattening food

Correct market failure of externalities – costs borne by taxpayers

Enact personal responsibility – accountability for extra costs

Reasons against taxing unhealthy foods

Disadvantages low income households Inherent regressivity of the tax

Lack of access to affordable healthy food in some low-income communities; 5% of Americans have no car and live > ½ mile away from supermarket

Price – the big factor– Fattening food is cheaper, per calorie. $10 will buy 2 pkg of

organic blueberries or a week’s worth of Mac and cheese

Tax subsidies for healthy foods

Taxes could be targeted to: Increase food stamp allotment for fruits and vegetables Support community-based initiatives to bring healthy,

affordable food to low-income communities

Studies suggest that lower-priced fruits and vegetables will increase consumption of healthy foods and lower BMI for low-income kids

Revenues could subsidize health coverage for low-income people who lack health insurance

Are food taxes politically viable? 40 states have modest taxes on sugared beverages and snacks

Although anti-tax, Americans may support taxes for specific reasons

53% favored tax on sugary drinks to finance reform, but increased to 83% support with “raise money for health care

reform while also tackling the health problems that

stem from being overweight”KFF Tracking Poll, June 2009

* According to the UK “Rayner” model, 33% of foods would be subject to taxation based on their score of “less healthy”; we derived a 0.931 “own price elasticity” (the % by which consumption decreases in response to a 1% increase in price of the food) when calculating consumption post-tax

What we proposed in our study: new taxes

10% tax on Fattening Foods* as classified by the UK model

What we proposed in our study: food subsidies

For even more progress* reducing obesity, we combined the tax with a 10% subsidy to lower the cost of fruits and vegetables

*Research from the UK suggests that a combination of taxes on unhealthy foods plus subsidies for healthy foods results in healthy eating consumption behavior

After one year, red items decreased 5.3%, yellow

increased 30.7%, and green rose 16.5%

What we proposed in our study: food labeling

http://cityroom.blogs.nytimes.com/2009/08/31/new-salvo-in-citys-war-on-sugary-drinks/?scp=1&sq=soda%20fat%20sewell&st=cse

What we proposed in our study: marketing changes

50 countries regulate and/or ban unhealthy food advertising aimed at children

In the U.S., a comprehensive ban would confront a constitutional challenge, but restricting ads would help

Some cities have used pro-active marketing campaigns to educate the public about the dangers of unhealthy foods

Conclusion: policy and politics

Recent decades’ increase in obesity was not caused by a change in human nature; it resulted from a change in the environment in which people make food choices

Just like with smoking, policy makers will need to change that environment

As with tobacco, the belief in individual liberty and the battle against the industries that benefit from the sale of unhealthy foods will make changing the environment difficult

Aggressive public policy interventions used to reduce tobacco use could be used in fighting obesity

Imposing excise or sales taxes on fattening foods of little nutritional value

Putting graphic, simple labels on the front of packaged foods showing nutritional value

Requiring restaurant chains to put simple nutrition information on the menu next to item (enacted in PPACA; compliance required by end of 2011)

Restricting advertising and limiting the marketing of fattening food

http://www.coloradohealth.org/uploadedImages/Images/Health_Elevations/Winter_2010/public_policy_graphic.jpg

How to Influence Public Policy

Influencing public

policy in order to

reduce obesity will

require multiple

legislative, regulatory,

and community-based

strategies

National coverage of our study

Public reactions to our study

Fabulous idea! As a Registered Dietitian, I work with people every day that talk about how they "have to" drink soda and eat fast food because it is the only thing that fills them up and they can afford. There is a ton of evidence that shows you can eat healthy foods and spend very little money. A tax on the unhealthy foods would help motivate people to find healthier foods to spend their money on.

This is tyranny. Plain and simple. Who decides what is a “fatty” food?...My friends, we need to say enough is enough! If we don’t stop this we will be living in the United Socialist States of America.

http://www.urban.org/UploadedPDF/411926_reducing_obesity.pdf

Questions?Questions?

reducing obesity carolyn l. engelhard, mpa assistant professor & health policy analyst...

Documents

obesity trends

obesity carolyn

time slide

growing prevalence of

tobacco wars slide

policy strategies

adults brfss