the problem of obesity in perspective: dealing with the modern food world paul rozin buenos aires...
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The problem of obesity in perspective: Dealing with the
modern food world
Paul RozinBuenos Aires
September, 2014:
Flegal et al., 2005Main Outcome Measures Number of excess
deaths in 2000 associated with given BMI
levels
http://www.surgeongeneral.gov/news/testimony/obesity07162003.htmStatement of Richard H. Carmona, M.D., M.P.H., F.A.C.S.Surgeon GeneralU.S. Public Health ServiceWednesday, July 16, 2003
•“Nearly two out of every three Americans are overweight or obese. •“One out of every eight deaths in America is caused by an illness directly related to overweight and obesity.
“But the fact is that we have an epidemic of childhood obesity. “
World obesity 2010• http://www.who.int/mediacentre/factsheets/
fs311/en/
• In the world, over 200 million men and nearly 300 million women are obese
World Obesity (CIA, 2008)Obesity BMI>=30 as % of all adults• https://www.cia.gov/library/publications/the-world-
factbook/rankorder/2228rank.html
• 1. American Samoa 74.6%
• 18. USA 33.0%
• 23. Mexico 32.1%
• 29. Argentina 29.7%
• 102. Brazil 18.8%
• 108. France 18.2%
• 157. Japan 5.0%
• 184. India 1.9%
World Malnutrition
• http://www.wfp.org/hunger/stats
• Hunger kills more people every year than AIDS, malaria and tuberculosis combined
• 842,000,000 don’t get enough to eat in world
• Poor nutrition causes nearly half (45%) of deaths in children under five - 3.1 million children each year.
• The Paleolithic human in the modern, developed world
• Old heuristics, e.g., “the image equals the object”
Late 20th Century developed world
• Epidemiological revolution: longer life and death from degenerative diseases: shift to long-term consequences
• food surplus• extraordinary range of food choices• development of super-foods (e.g. chocolate)• no work needed to attain choices• Old heuristics not applicable: bias to eating• massive amounts of risk information• no training in dealing with risks/benefits or nutrition
Feature Heaven Hell
Love Italians Swiss
Banks Swiss Italians
Universities British French
Food French
Feature Heaven Hell
Love Italians Swiss
Banks Swiss Italians
Universities British French
Food French British
The developed world
• Western Europe vs India
• 60% of all people live in Asia
• 50% of total expenditures on food in developing world
Rating scale
• 1. strongly disagree
• 2. disagree
• 3. neither agree nor disagree
• 4. agree
• 5. strongly agree
Eating is a religious experience; My diet must adhere to strict moral/religious principles
Mea
n A
gree
men
t
“Concerned about being overweight”
• % responding “often“ or “almost always”
• 57% females, 21% males
• US college students from 6 universities across the country
Rozin, Bauer & Catanese, 2003
“I am embarrassed to buy a chocolate bar in the store”
• American college students from six campuses across the USA
• % Females: 13.5
• % Males: 4
Obesity:France vs USA
• % BMI >= 30• France: 16%• USA: 32%
• 2008 http://www.who.int/gho/countries
Life expectancy at birth(data from 2008-2010: www.who.int/gho/countries)
rank country years rank country years
1 Japan 83 10 Norway 81
4.5 Australia 82 10 Sweden 81
4.5 Israel 82 14 Austria 80
4.5 Italy 82 14 Belgium 80
4.5 Singapore 82 14 Finland 80
4.5 Spain 82 14 Germany 80
4.5 Switzerland 82 14 Greece 80
10 Canada 81 14 Korea 80
10 France 81 14 U.K. 80
10 Netherlands 81 19.5 U.S.A. 79
Age-standardized annual mortality from
CHD and related risk factors (males 35-64)
WHO/MONICA Renaud & de Logeril, 1992
Location Mortality / 100,000
Serum chol-
esterol (mg/dl)
Toulouse, France 78 230
Lille, France 105 252
Stanford, USA 182 209
Percent of subjects preferring a week at a luxury (vs. gourmet) hotel at same price
Females Males
Paris, France 13 8
USA 83 70
Percent of subjects selecting “unhealthy” for choice:
What do you think of when you think of HEAVY CREAM?: whipped or unhealthy
Females Males
France 28 23
USA 68 48
Percent of subjects agreeing that they eat a “healthy diet”
Females Males
France 76% 72%
USA 28% 38%
Attitudes regarding food and meat among American, French, Argentinean
and Brazilian college students
• Marle S. Alvarenga
• Paul Rozin
• Matthew B. Ruby
• Guillermina Rutszein
• Eve Richter
• Teri Kirby
If there was an inexpensive pill to safely satisfy nutritional needs and
hunger without having to eat, I would take it
% > = very true of me
Argentina 15.8%
Brazil 11.3%
France 5.9%
USA 14.3%
Enjoying food is one of the most important pleasures in my life
% > = very true of me
Argentina 52.8%
Brazil 56.1%
France 66.2%
USA 53.1%
In general, I am more concerned with the caloric content of food
than the taste
% > = very true of me
Argentina 5.3%
Brazil 4.4%
France 2.5%
USA 34.6%
Eating alone does not bother me
% > = very true of me
Argentina 54.8%
Brazil 51.5%
France 41.7%
USA 51.8%
Beef consumption by country (2007 or 2008): kg/capita/year
• France 13.3
• USA 28.5
• Brazil 37.6
• Argentina 71.8
Free Assoc to BEEF: most common words
Argentina Brazil France USA
FEMALE FEMALE FEMALE FEMALE
Asado 36 saborosa 66 viande 130 Cow 52
Rojo 31 churrasco 59 steak 23 Meat 24
sabroso 29 sangue 43 rouge 22 Hamburger 22
Comida 19 Gordura; succulente 18 vache 20 Disgusting 19
Jugoso 17 Animal 13 Red 18
MALE MALE MALE MALE
Asado 17 churrasco 39 viande 68 Cow 27
Sabroso, delcicioso, rico, 10
saborosa 31 Steak 26 Steak 18
Vaca, sabrosos, grosso sangue 25 vache 17 Meat 15
Jugoso. milanesa 3 Proteina 17 sang 8 Hamburger, red 7
Boi/vaca 15 rouge 5
Sample free associations to “beef” USA (with valence)
Word 1- Word 2 Word 3 SumValence
Ambiv-alence
Cow (0) Burger (1) Baseball (1)
+2 No
Fat (-1) Unhealthy (-1)_
Cholesterol (-1)
-3 No
Fat (-1) Protein (1) Meat (1) +1 Yes
Percent of reduced fat foods indifferent categories, in supermarkets
Item France USA
Yogurt 22 96
Milk 36 56
Ice cream 00 25
About 2001
Restaurant portion size
Restaurant France USA
McDonald’s (7) 189g 256g
Quick/Bking(5) 207g 322g
Chinese (6) 244g 418g
Supermarket food portions
ITEM Carrefour Acme
Y ogurt (modal) 125g 227g
Fresh fruit (mean,4 types)
431g 553g
Coca cola (modal)
330ml 500ml
Supermarket non-food portions
ITEM Carre-four
Acme
toothpaste (modal, ml)
75 170
toilet paper (mean, sq cm)
121 117
Cat food (modal, g)
100 85
Obesity: Changing the person
• Dieting
• Nutrition information and education Education about science, risks, benefits
• Changing preferences and intake
• Failure of obesity treatments and dieting
• Only bariatric surgery
• Think about height
Changing the food environment
• Accessibility
• Small accumulated value
• 1-3 standard coca cola cans a week
Salad bar
• Reaching over to the middle (about 5% reduction in calories)
• Spoon versus tongs (about 5% reduction in calories)
Environment Changes
• Glass size
• Plate size: Brian Wansink
• Very large serving amounts (Wansink: soda)
Diliberti, Rolls et al., 2004
In a student cafeteria, when students are served a 50% largerportion of macaroni and cheese (right) they eat more, and don’tcompensate by eating less of the rest of the meal
Cultural norms: Unit bias(Geier and Rozin, 2006)
• Free access in lobby to bowl of M&Ms, with either teaspoon or tablespoon
• Amount taken with tablespoon is 70% greater
• Similar effects with large or small tootsie rolls or pretzels
Cumulating increments
• James Hill, David Levitsky,Barbara Rolls, Marion Nestle, Paul Rozin et al.
• Some evidence that portion change effects may endure, and are not fully compensated for over at least 2 weeks (Rolls, Levitsky)
Lay’s stacked potato chips
Geier, Wansink and Rozin
Segmentation and consumption interruptsAbout 50% reduction
Government versus Industry initiation
• Let the free market do it (organic, fat free, calorie free)
• Smaller portion sizes
Energy Expenditure
• Suburban Life
• Malls
• The car culture
• Small but continuing increments
• Role for government: e.g., better and cheaper public transportation
Some French-American differences
• Portion size• Eating time• Eating sociality/ conversation (conviviality)• Freshness and taste (vs shelf life) priority in foods• Degree of snacking and snacking opportunities• Differences in actual foods consumed (e.g., wine)• Differences in variety of food consumed
(Drewnowski et al.)• Walk/bicycle vs car orientation
We can learn from the French in this domain (not all domains)
• Focus on the environment to try to reduce food intake and waist lines
• Don’t reduce the pleasure of eating
• Make small changes that encourage more exercise and less eating
• Let the effects of those small changes accumulate, and…..