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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 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 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 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 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 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” 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 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 o o o o