Download Sara Chaffee Olivia St Martin Reading Summaries Moving Nutrition

Sara Chaffee
Olivia St Martin
Reading Summaries
Moving Nutrition Upstream: The Case for Reframing Obesity
 Abstract
o Right now, nutrition is viewed as individual responsibility
o Public health officials need to “reframe” the issue, or change the
debate so that the social, economic and political context surrounding
individuals becomes clear
 Introduction
o The greatest return on investments will be from creating policies that
improve environment conditions for the public, not just trying to get
individuals to eat better
o Key metaphor in public health: The upstream/downstream theory
 Most people working to better public health are so
preoccupied by rescuing people already with the condition
(downstream), that they don’t realize/don’t have time to figure
out what is causing the problem in the first place (upstream)
 Prevention vs. treatment
 The wrong frame for obesity
o While awareness and discussion about obesity have grown
tremendously in recent years, the way obesity is considered limits
understanding of the issue as well as the ability of the public to
address it successfully
 Current frames on obesity evoke individual willpower and character
o Current popular frames on obesity: appearance and health (bad) –
comes with the assumption that obesity is caused by overeating and
lack of willpower
o Lack of willpower/bad character framing of obesity are popular
because they coincide with leading values in American culture –
“rugged individualism”
o Because environmental contributors are missing from the “lack of
willpower” frame, solutions that improve environments are less likely
to be understood by public, and less likely to get support from
policymakers
 Current frames on obesity obscure a public health approach
o Current individualistic approaches conceal the idea that environment
can be a useful place for intervention; the term “obesity” keeps debate
focused “downstream”
 “Obesity” narrows the problem inappropriately
o Term “obesity” equates thinness with health, and minimizes other risk
factors such as diabetes and heart disease
 Obesity is stigmatizing
o Stigma associated with obesity can directly lead to poor health
Cultural norms for healthy weight can lead to eating disorders
Obese people may be too ashamed to exercise, and in some
cases avoid/postpone seeking medical care because of
stigmatization
A narrow focus on “obesity” favors the food, beverage, pharmaceutical
and diet industries
o Food industry: can blame peoples’ inability to control themselves, and
problem “users”, not problem promotions or products
o Pharmaceutical industry: benefit from individualized focus because it
medicalizes the problem (surgery/drugs= solution)
o Diet industry: obese people are the backbone of the diet plan market
“Obesity” moves the conversation downstream
o Obesity is viewed as a personal problem, not a social problem
A new frame needed
o The current view of obesity as a personal/behavior problem focuses
on a limited set of solutions that are likely to be unsuccessful
o “Health At Every Size” (HAES) – an approach trying to reframe obesity
 Suggest that public health interventions should look at physical
fitness, not weight as a key determinant of health
 Suggest in research and clinical practice to acknowledge that
people respond to treatment differently
o Many individuals need to take responsibility of their health, but,
society also has a responsibility to make an environment where good
choices are easier to make
o New frames - “Healthful eating” and “active living environments” are
examples of frames that visibly include the environment
A new frame can lead to new understanding
o Reframing the debate will create a new vocabulary for advocates to
use
 Shared vocabulary is important because it allows for
communication between groups, and will allow the problem to
move upstream, identifying the shared responsibility for
addressing the nutrition problem
o The discussion about obesity prevention needs to shift to realizing
that a variety of environmental influences are creating a serious
health problem
Implications for research and practice
o Next step: creating messages to make the case for the change, keeping
in mind that it will be contested
o Recent debate over selling soda in school to students
 Students should be instructed to make healthier choices, but,
students do not determine what is available to them at school
o Communities could demand that public institutions ensure healthful
food and activity environments for all residents
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Articulating public health values in frame requires a focus on strategy,
message, and tactics
o Public health practitioners and allies must pay close attention to how
they craft their arguments and then see those arguments get a fair
hearing in public discussion
o Framing can’t be the only thing that happens; media advocacy,
community organization, constituency building, learning about
political process are important
o Framing isn’t just a message it’s the values society holds
Beyond Counting Calories
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The problem of obesity has been defined in accordance to socially acceptable
solutions
o Especially in efforts to try to get people to eat more fruits and
vegetables
o This assumes that obesity caused by a lack of fruit and vegetable
consumption
Current assumptions of obesity have only enabled certain kinds of activism,
while shutting off others
o There is emphasis on stopping and reversing the trend of obesity,
instead of looking into the effects of obesity on biological functionality
o Current discourse has concealed other possible causes for obesity
 Such s environmental toxins, chronic stress, and capitalism
Studies that try to show relationships between neighborhood environments
and obesity have been inconclusive, inconsistent, and presumptuous
o Also ignored the roles of race and class in the creation of food deserts
 Food desert – obesogenic environment
o Thin real estate is expensive
 Concept of obesogenic environment shows unstated
preferences for places associated with urbane, privilege
environments
Is the calorie really an indicator of food’s weight producing qualities?
o Calorie is a measure derived from burning food, but does not exist as a
constituent molecule of any food
Increased recognition that the timing and pattern of food intake affects
weight gain/loss
o Eating earlier in the day leads to faster metabolism
Chronic stress is a factor in obesity through the release of cortisol
o Theories that long term exposure to stress and previous nutritional
deprivations could help explain the relationship between low
socioeconomic status and obesity prevalence
 Research that indicates the role of environmental toxins in adding to obesity
risings
o Experimentation has found that maternal exposure to a range of
chemicals can alter genetic pathways for fetuses in ways that
favor/generate obesity in life
o Research has found that exposure to chemicals permanently alters the
genes that direct fat distribution (in mice)
o Other studies show that certain chemicals stimulate growth of already
existing fat cells, and the development of fat cells from stem cells
o Scientists in NC found that children exposed to higher levels of PCBs
and DDE before birth had higher BMIs than those exposed to lower
levels
 Neoliberal capitalism also has a role in the obesity problem
o Tax rollbacks helped build what is associated with fast food/ chain
strips, box store malls, and even food deserts
o A key objective for both the Democratic and Republican parties have
long been to remove/disable regulations viewed as not good for
business
o Environmental Protection Agency slowed down on reviewing of
potentially toxic chemicals
o The Food and Drug Administration became a doormat in preventing
food substances of questionable safety and need from getting to the
market
 Current views on obesity equate thinness and beauty, and this is hugely
profitable
o Weight-loss industry makes more than a billion dollars per year
o From this, the pharmaceutical industry has a lot to gain from pushing
obesity as an epidemic, and makes receives a lot of funding to find the
“cure” for obesity
 Unfettered capitalism has generated many food qualities, created
environments, and chemical exposures related to obesogenesis, all while not
looking for any solutions to the problems it has created.
A Crisis in the Marketplace: How Food Marketing Contributes to Childhood Obesity
and What Can Be Done
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Abstract
o Reducing food marketing to children may be a means for addressing
global crisis of childhood obesity
 Many social, legal, financial, and public perception barriers
o Scientific literature says that food marketing to children is a) massive,
b) expanding in many venues, c) made up of mostly messages for
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calorie-dense, nutrient-poor foods, d) having harmful effects, and e)
increasingly global
o Article reviews knowledge of the impact of marketing and addresses
many approaches to change
CHILDHOOD OBESITY: A CRISIS IN THE MARKETPLACE
o Prevalence of childhood obesity in the US has more than tripled in just
three decades
o Global trends suggest overnutrition rivals undernutrition as the chief
food problem, even in developing countries
o It is common to claim that obesity results from combination of
genetics, family, and psychological variables as well as environmental
factors
 This stance discourages action because food industries and
governments think they are exempt from responsibility since
there are so many factors
 Essential to identify population-level factors
 Area of special concern: marketing of energy-dense foods and
beverages, esp. to children
WHY WORRY ABOUT FOOD MARKETING?
o The extent to which the food industry defines what is
acceptable/desirable to eat is essential
o Far less people raise/grow food in the modern environment, most
products are genetically modified and shipped thousands of miles
o Marketing is a contributing factor to the consumption of these foods
RESEARCH ON FOOD MARKETING TO CHILDREN
o Children and adolescents spend about $200 billion per year, much of
it on food products
o Food company invest heavily to increase sales and create brand
loyalty
o Television is a very prevalent form of food advertisements to children
but also promote products in other venues
 Schools, the internet, product placement in different forms of
entertainment/sports events
o More than 98% of television food ads seen by children are for
products high in fat, sugar, and/or sodium
 Promotes unhealthy eating habits and portrays positive
outcomes from consuming nutrient-poor foods
 Associates eating fast food with “fun, happiness, and being cool”
Effects of Food Marketing Exposure
o Food promotion has a causal and direct effect on children’s food
preferences, knowledge, and behavior
o Food advertisement increases children’s preferences and
consumption for those foods – both at the brand and category level
o Research shows that families in Quebec, where advertising to children
under 13 is banned, purchase fast food less often than families in
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Ontario, where there is no ban
o Although there is a positive correlation between watching more
television and increased food consumption, correlation does not
prove causation
o Food advertisement has a modest effect by comparison with other
factors such as parental diet, peer pressure, exercise, etc
Mechanisms of Food Marketing Effects
o Psychological assumptions, such as the belief that cognitive maturity
reduces the effects of marketing on children, limits researchers’
ability to understand full range of marketing effects
o Marketers create brand image or set of positive associations rather
than convince consumers of product superiority
o Newer forms of marketing are designed to deactivate skepticism and
other defenses against marketing
A Call for New Approaches to Study Marketing Effects
o Researchers starting to incorporate psychological/sociological
theories to understand impact of marketing
o Advertisers use “symbolic messages” in which they associate products
with child’s sense of identity
 Often portray products as oppositional/”anti-adult”
o Food marketing best understood by evaluating all levels of
influence/how they interact with exposure to food messages in media,
home, schools, and communities
POTENTIAL SOLUTIONS
o Calls for change in food marketing inhibited by series of “defensive
maneuvers” by commercial interests and inadequate attention to
public health consequences
The Dimensions of Possible Approaches
o Wide spectrum of possible approaches have been proposed to reduce
children’s exposure to commercial marketing
 1. The locus of responsibility can range from individual and
family level through corporation, trade association, federal,
and international control
 2. There are multiple marketing methods – non-broadcast
promotional, point of sale promotion, pricing incentives, etc
 3. Controls on marketing can be set as a general restriction or
more specific – issues with this because of question on
children’s rights to a commercial-free childhood
Involuntary Self-Regulation and Voluntary Pledges
o Private industry supports self-regulation on food marketing to
children
o Individual companies have made promises that start to address
consumers’ concerns – not to market in schools, remove internet
marketing to young children, etc
 More “appearance than substance”
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o Believed that certain conditions must be met in order for selfregulated industry pledges to be taken seriously
 Expected outcomes should be defined and must be linked to
the food consumption of children
 Benchmarks must be created, and assessment must be
objective
 Pledges should have a global scope, and research must be
comprehensive enough to test whether industry moves its
finances to other forms of marketing (not child marketing)
Actions of the World Health Organization and Nongovernment
Organizations
o May 2007 – World Health Assembly and UN resolved that the World
Health Organization should develop recommendations on marketing
of foods and non-alcoholic beverages to children
 Acts as benchmark to judge the promises and activities of the
industry in the future
BARRIERS TO CHANGE: Social Attitudes and Opinions
o Public and government perceptions are substantial barriers to change
o Previous bills that took the stance of obesity as a self-responsibility
problem failed
 Ironic that industry emphasizes personal responsibility, but
undermines consumers’ ability to be responsible
o Education is seen as the logical remedy for obesity, but has been
ineffective
Free Markets and Protected Speech
o Belief in free-market economies gives power to industry in policymaking, increases faith in industry self-regulation
o Raises issues of restricting free speech and violating First Amendment
Weak or Uncertain Regulatory Authority
o Global reach of marketing raises significant questions about
regulatory authority
 May be ban on commercialism to children in some countries,
but doesn’t mean they wont be able to view other countries’
channels/programs
 International agreements will be a necessity
o Weak regulatory authority within countries is also an issue
o Codes should be designed to encourage “healthy” and “better for you”
products – but industry needs to agree on nutrient profile standards
to define junk food across international boundaries
DISCUSSION AND CONCLUSIONS
o Progress on child nutrition is difficult to imagine unless food and
beverage marketing is reduced, if not eliminated
o Still considerable gaps in the science – will never be possible to study
the marketing of all products to all demographic groups in all forms
o Significant barriers to change, those alone require more study
o However, evidence shows powerful effects of food marketing and
justifies action now by organizations and governments
The Making of the Obesity Epidemic: How Food Activism Led Public Health Astray
 Introduction
o Weight control is a major public health problem – obesity is
“America’s #1 Health Problem”
o Three decades since 1952 – number of McDonalds rose from 1 to
8,000 in the world in nearly 32 countries
 However, obesity didn’t take off until 1990’s – by 1994 the
national rate was 23%
 2005 – 34% of all adults, 15% of all American children
 no consensus about what drove up the consumption of calories
and why obesity spiked so much after 1980
o Proliferation of fast, cheap, unhealthy foods had significant impact
o Can’t eradicate obesity, but rather we hope to be able to manage it
 Section 1
o 1950’s – obesity was viewed as personal responsibility problem
o 1980’s – public health experts described it as a disease along with risk
factor to other diseases
o 1990’s – became epidemic rather than just disease
o “Environment is the real cause of obesity” according to Kelly Brownell
at the time
o Also viewed as caused by profit-seeking corporations
o Compared to smoking crisis, in which companies were mandated to
put warning labels on cartons and smoking became less acceptable
social behavior
 Can’t do that with eating – no such thing as “second hand
eating” or anything like that
 Section 2
o Public health experts tried to universalize obesity risk by calling it an
“epidemic” – but no body count; epidemic usually referred to
deadly/infectious disease
o 2000 – CDC researchers concluded obesity as lethal – 350,000
premature deaths a year
o 2005 – only 111,909 deaths
 many problems with quantifying the health impacts of rising
obesity rates
 Effects aren’t as clear cut as with problems such as smoking,
which has direct causality relationship with lung cancer and
other problems
o Obesity is highly treatable, unlike some of the effects from smoking
 Section 3
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o Framed as a product of “involuntary risk” – innocent child who
doesn’t know better/how to choose healthy food, low income city
dweller without access to grocery stores, etc
o Anti-obesity campaigns promoted gardens in schools, taxes on soda
and junk food
o Public health experts saw poor areas as “food deserts” and that the
poor were more likely to be obese because healthy food was
unaffordable
 Created programs to change the marketplace and media
environments and improve access to affordable healthy foods
and opportunities for safe physical activity
Section 4
o Eventually found no relationship between children’s weight and
proximity to playgrounds or fast food restaurants
o No statistical relationship between the availability of healthy food and
lower risk of obesity development
o Found that healthier food wasn’t always more expensive, or that if it
was it was minimally so
 Poor chose foods because of “how they taste”
o Agricultural subsidies irrelevant – taking them away from unhealthy
food production places didn’t make the food more expensive
o Addition of gardens etc in poor neighborhoods just created negative
and misleading picture of the poor as passive victims of their food
environment
Section 5
o Smoking rates were shown to vary among education and income
levels – research showed that the more education people had been
through, the less they smoked (6.3% of people with post-grad degrees
in comparison with 29% among those with less than high school
degree)
o Opposite found with obesity – rich catching up and becoming heavier
than the poor overall
o Lifestyle factors cant explain the life expectancy gaps between the rich
and the poor
 Education and income remain the most salient factors
 Suggests that poor health outcomes associated with obesity
among low-income Americans has more to do with being poor
than being obese
o The poor have a lot of social capital to help change this, but public
health officials and philanthropies too often embrace obesity
strategies that reinforce notion of poor as victims of an environment
rigged against them
Section 6
o Fatness and diet are only two factors that shape health outcomes physical exercise important too
However, weight gain mostly explained by higher calorie
consumption
When it comes to the poor – obesity has less to do with “food deserts”
and more to do with “income, college degree, and quality health-care
deserts”
Suggests that junk food tax revenues would be better spent on giving
scholarships
Extending better health treatments to wider spectrum of public would
also greatly help poor
Continuing to frame obesity as personal problem won’t help in the
long run – people need to understand it on an environmental level as
well
 But still need to teach children how to manage desires/self
control as it can be applied to more than diet but also behavior
and decision making in general
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