ANAHEIM, CA—According to federal public health agencies, obesity is now officially an epidemic. And a curious epidemic it is. Unlike the infectious scourges that plagued humankind for millennia, obesity is almost exclusively behavioral in origin, and directly reflects abundance rather than scarcity.
According to the National Center for Health Statistics’ most recent data, roughly 65% of US adults are overweight (defined as body mass index over 25), and half of them are frankly obese (BMI greater than 30). Fifteen percent of all children aged 6–11 are overweight, a doubling of the 1980 figure. Fifteen percent of all 12–19 year olds are likewise overweight, a tripling since 1980.
A study by the RAND corporation showed that obesity results in greater increases in utilization and cost of medical services than do smoking, problem drinking or even aging. Based on data from the Healthcare for Communities telephone survey of more than 10,000 US households, RAND showed that obese individuals have a 36% greater utilization of inpatient and outpatient services, and a 77% percent increase in medication costs compared with normal weight adults. In comparison, smokers showed only a 21% increase in medical services and a 28% increase in medication use over non-smokers.
Medicine’s best efforts to address obesity on a population basis are likely to fail unless the medical community somehow reckons with one of the prime pathogenic factors: food industry economics, said Marion Nestle, PhD, at NutraCon, an annual conference on nutrition science and natural products development sponsored by New Hope Natural Media.
Leaving aside the rare cases of obesity attributable to endocrine or genetic disorders, obesity in America is largely a result of increased caloric input. Helping the process along is the practice of “supersizing” by the food industry and the “eat more” messages that pervade food marketing strategies, said Dr. Nestle, professor of nutrition science at New York University, and author of the recent book, Food Politics.
Physical inactivity certainly contributes, but Dr. Nestle contends that it is not the main driver. “People are just as sedentary now as 15 years ago, and yet we’ve seen a marked increase in obesity over the last 15 years. It must be that people are eating more.” On average, Americans now consume 3,800 calories daily, roughly twice what we need to meet basic physiologic requirements.
Food is big business, $1.3 trillion dollars annually, to be exact. And more than 50% of the nation’s total food expenditure is for food consumed outside the home. Roughly 80% of the total food dollar goes to manufacturers of food products: the processors, packagers, transporters, marketers and restaurants. “There’s a pretty big incentive to produce processed foods.”
An overabundance of cheap food commodities—fats, starches, and sweeteners—along with the introduction of 10,000 to 15,000 new processed food products into the US market each year make the food industry competitive to the extreme. “You have to either get people to choose your product over your competition’s, or you have to convince everyone to simply eat more in general.”
The latter is the most widely used marketing strategy. The best way to increase revenue, it seems, is to increase portion size. Thus, “Big Gulp” soft drinks, “Happy Meals,” free extra toppings, and All-You-Can-Eat specials.
Many people fail to understand how supersizing impacts health, said Dr. Nestle. “There’s just no intuitive understanding that larger portions contain more calories. Many people don’t seem to get that a 64 oz soft drink contains 800 calories, or that a 7 oz hot pretzel is basically your bread serving for the day.” This cognitive disconnect is reinforced by food and beverage industry marketing efforts, to the tune of $30 billion annually. Roughly $10 billion is spent on direct-to-consumer advertising, most of which promotes an “eat more” mentality.
McDonald’s spends approximately $1 billion each year on direct marketing in the US alone. Dr. Nestle noted that the company manufacturing the popular Altoids mints—a nutritionally worthless product—spends about $10 million on direct-to-consumer advertising. “That’s five times higher than the maximum amount the federal government ever spent on the ‘Five-a-Day’ campaign aimed at increasing fruit and vegetable consumption.”
The constant encouragement to eat more is easily fulfilled by a seemingly endless supply of high fat, high calorie, nutritionally questionable “convenience” foods, dispensed everywhere from fast food restaurants to public school vending machines, and sadly even in hospital lobbies and cafeterias. Add in a general lack of physical exercise and the obesity epidemic is easily understood.
Dr. Nestle urged health care providers to become more aware and active on this issue. The American Academy of Pediatrics’ recent statement opposing soft-drink concessions in schools is a positive step, though it is sad that obesity in teens had to hit crisis levels before the pediatric community took a stand.
Unfortunately, there has been far too much complicity between medicine and the food industry, Dr. Nestle said. As an example, she cited a highly sugared cereal whose package bears the American Medical Association “Red Check” for heart health, despite the fact that more than 50% of the total calories per serving are from sweeteners. “The message here is that this cereal is good for your heart, good for your health. In reality, it is good for the cereal business.”
Steven Grover, a spokesman for the National Restaurant Association, said Dr. Nestle’s analysis is overly simplistic and he charged her with joining into the widely popular “blame game.” While he acknowledged that convenience foods do contribute to the obesity problem, he believes the Quick Service industry (the preferred industry term for fast food restaurants) are being saddled with an undue onus.
“Much of the media attention has been negatively-focused. It is not so much promoting positive messages as finger-pointing,” he said at a conference on obesity sponsored by the Food and Drug Law Institute. He contended that Quick Service restaurants represent only 20% of the nation’s 858,000 restaurant locations, and just 20% of the total restaurant revenue. Most individual chain restaurants operate at a profit margin of just 5%–8%. “If restaurants relied exclusively on supersizing to generate revenue, they would be out of business.”
Mr. Grover stressed that the fast food business has repeatedly tried to introduce healthier food, to very mixed results. “As much as 20 years ago, many fast food restaurants started offering healthier fare, based on market research showing people wanted it. The problem was, people were telling the market researchers the “correct” answers. But when it came down to putting their money on the counter, they were buying the bacon burgers, not the salads. There were quite a few huge failures.”
This has begun to change. “There has been a big change over the last 2–3 years. Some of the new healthy lifestyle products are really starting to be accepted.” With the popularity of the Atkins diet and other low-carb regimens, restaurants are being hit with repeated requests for low-carb items, and they are responding in kind. A family dining chain is soon expected to offer customers a carb counter at the point of purchase. He added that 8 states now require some type of menu labeling, and many quick-serves are already voluntarily including calorie information on their menus and tray liners.
The National Restaurant Association is involved in a joint project with the US Department of Agriculture to distribute brochures and posters outlining, “Three Steps to a Healthy Lifestyle.” The text and diagrams focus on balance in the diet, physical activity, and moderation. The Association has already printed 300,000 posters and tray liners, to be used by member restaurants.
Dr. Nestle believes it will take far more than that to control obesity. She called for federal mandates to regulate food advertising, particularly ads aimed at children; elimination of soft drinks and junk food from public school vending machines, adjustments of farm subsidies to bolster production of fruits and vegetables rather than beef and dairy, and development of truly educational, health-oriented media campaigns.
Addressing the charge that her focus on fast food restaurants and processed food producers sidesteps the issue of freedom of choice and personal responsibility, Dr. Nestle said, “I’m not opposed to personal responsibility. People simply need to learn to eat less and move more.” However, one cannot ignore the powerful economic interests that drive the current obesity crisis. “What industry would benefit if people were eating more healthfully?”