Tag: Skinny on Obesity

Reigning in Sugar with Regulation – “The Skinny on Obesity” Series Finale

This week we wrap up “The Skinny on Obesity” series with an argument for why obesity is a public health and economic threat that’s worthy of the same treatment as other public health problems like smoking and drug abuse. For our experts, nothing short of wholesale change in what we expect from the food industry will make a dent in America’s obesity problem.

Some might call Dr. Lustig’s argument for the regulation of sugar as the creation of a “nanny state,” but he insists that food manufacturers already benefit tremendously from government subsidies and have limited  consumer choice to predominantly high-sugar foods– precisely how we got so fat in the first place. It’s a provocative argument and one worth hearing out. Watch “The Skinny on Obesity: Drugs, Cigarettes, Alcohol..and Sugar?”

But don’t stop there. We’ve made plenty of resources available, including an editorial by UCSF Public Health Professor Laura Schmidt, who backs up the argument for sugar regulation, as well as an overview of the research that supports such interventions.

We hope you’ve gotten as much out “The Skinny on Obesity” as we have working on it. I know many of us here at UCTV have already made changes in how we eat and think about food. While we still have the ocassional birthday cake in the office, you can be darn sure that we’re calculating the toll it takes on our bodies, brains and society at large. It still tastes pretty good though.

Stay tuned in June for the next UCTV Prime series, “Our Digital Life.” The three-part series premieres June 15 and explores how researchers at UC Merced are using digital technology to inform and influence our lives.

VN:F [1.9.3_1094]
Rating: 9.3/10 (12 votes cast)
VN:F [1.9.3_1094]
Rating: +13 (from 13 votes)

Regulation of Sugar – Strategies That Work

As suggested by the experts in “The Skinny on Obesity: Drugs, Cigarettes, Alcohol..and Sugar?” public policy intervention is one possible tactic to put the brakes on America’s obesity epidemic. Whether you consider the regulation of sugar-enriched food products regrettable or a revelation, it helps to know what the research says. Lucky for us, UCSF Health Policy Professor Laura Schmidt offered up an overview.

 

WHAT DOESN’T WORK

So far, evidence shows that individually focused approaches, such as school-based interventions and warning labels on product packaging, demonstrate only salutary efficacy. Conversely, for both alcohol and tobacco, there is robust evidence that “supply side” control strategies —taxation, distribution controls, age limits –- lower both consumption of the product and accompanying health harms.

WHAT DOES WORK

Taxation
Successful interventions for alcohol, tobacco and sugar all share a common end-point: curbing availability. Taxation — in the form of special excise duties, value added taxes, and sales taxes — are the most popular and effective ways to reduce the overall volume of drinking, and in turn, substance abuse and related harms.

Taxes are easy to collect and cause little market distortion. We have robust evidence of their beneficial effects on both acute (e.g., injuries) and chronic (e.g., cirrhosis) alcohol-related health conditions. Moreover, alcohol taxes disproportionately impact youth – a group at particularly high risk for alcohol-related harms.

Soda taxation will likely prove an efficient, effective public health strategy. European experience with sugar taxation thus far strongly supports this conclusion.  However, one problem is that the current U.S. soda tax debate centers on adding one penny per ounce, which would raise the price of a can of soda by only 10-12 cents. Statistical modeling suggests the price should double to significantly impact soda consumption. Another question is whether juice consumption would be similarly taxed, as it contains an even higher average fructose load than does soft drinks (1.8 vs. 1.7 gm/ounce).

Controls at the Point of Sales
Other successful tobacco and alcohol control strategies target limits on product availability through distribution controls on opening hours or days for retail sales, the controlled placement and location of retail markets, and density of sales outlets, as well as limits on who can legally purchase the products. Reducing the density of retail alcohol outlets, through stricter state licensing and local zoning ordinances, especially in lower income communities, has been shown to reduce alcohol-related problems in controlled studies.

A reasonable parallel for sugar would tighten licensing requirements on vending machines and snack bars that sell sugary products in schools and workplaces. States could apply zoning ordinances to control the number of fast food outlets and convenience stores in low-income communities, and especially around schools, while providing incentives for the establishment of grocery stores and farmer’s markets. Another option would be to limit sales during the time intervals of school operation, or to raise the age limit for purchase of soft drinks.  Indeed, parents in South Philadelphia recently took this upon themselves by blocking children from entering convenience stores after school. Why couldn’t a public health directive do the same?

Controls on Advertising and Marketing
Advertising shapes children’s perceptions about alcohol and tobacco, encouraging pro-drinking attitudes and greater consumption. Voluntary agreements among manufacturers and distributors have rarely been enforced or monitored, and, naturally, sugar vendors favor voluntary policing.

In contrast, government-imposed regulations on the marketing and promotion of alcohol to youth have been quite effective. Thus far, the U.S. government has not imposed a ban or careful monitoring of the marketing of high-sugar content products to children. Some communities, such as Santa Clara and San Francisco, CA, have however instituted toy bans on Happy Meals.

Subsidization
Reduced fructose consumption could also be fostered through subsidization — by limiting access to soft drinks and promoting access and consumption of healthy alternatives in low-fructose, high-fiber foods. Promotion of such foods in U.S. low-income programs such as Women, Infants, and Children, and Food Stamps is an obvious place to start.  Unfortunately, the petition by New York City to stop subsidization of soft drinks within the Food Stamp program was denied by the U.S. Dept. of Agriculture.

Recommended Actions for the FDA
Ultimately, food producers and distributors must reduce the amount of sugar added to foods. But sugar is cheap, sugar tastes good, and sugar sells, so companies have little incentive to change. The U.S. Food and Drug Administration already has the power to instigate change at every step in the production pipeline: from farmers, to food processors, to marketers, to suppliers, and ultimately, consumers. Although one institution alone can’t turn this juggernaut around, the FDA could “set the table” for change.

Since fructose acts as a chronic, dose-dependent liver toxin analogous to alcohol, the FDA should consider removing fructose from the Generally Regarded as Safe (GRAS) list, which currently allows food manufacturers to add unlimited amounts to any food.  Opponents will argue that other nutrients on the GRAS list, such as iron and vitamins A and D, can also be toxic when over-consumed. However, these substances have no abuse potential, as does sugar. Removal from the GRAS list would send a powerful signal to the European Food Safety Administration and the rest of the world, now facing the same crisis of obesity-related illness that America has been struggling with for the past 30 years.
REFERENCES

Babor, T., Caetano, R., Casswell, S., Edwards, G. & Giesbreacht, N. Alcohol: no ordinary commodity: research and public policy. Oxford University Press (2003).

International Regulation of Alcohol: Room, R., Schmidt, L.A., Rehm, J. & Mäkela P. Br. Med. J. 337, a2364 (2008)

Soda Taxes, Soft Drink Consumption, and Children’s Body Mass Index: Sturm, R., Powell L.M., Chriqui, J.F. & Chaloupka, F.J. Health Aff.  29, 1052-1058 (2010).

 

 

VN:F [1.9.3_1094]
Rating: 7.6/10 (8 votes cast)
VN:F [1.9.3_1094]
Rating: +7 (from 9 votes)

Regulating Sugar: It’s All About the Nudge

UCSF health policy Professor Laura Schmidt has plenty to say when it comes to the availability of sugar in the American diet. She agrees with the assement made by her UCSF colleagues in “The Skinny on Obesity: Drugs, Cigarettes, Alcohol..and Sugar?” that there is a definitive public health demand for regulation of the food industry in response to the obesity epidemic. Her research focuses on what works and what doesn’t when it comes to regulations and she made her case in  U.S. News & World Report editorial published on March 30, 2012. What follows is the unedited version:

“Regulating Sugar: It’s All About the Nudge,” by Laura A. Schmidt, PhD
Professor, UCSF School of Medicine

The overabundance of sugar in the American diet isn’t just making us fat.  It’s hurting our health.  We were all raised to think of sugar as benign “empty calories.”  But science shows that too much sugar—i.e., the amount consumed by the average American—leads to high blood pressure, dyslipidemia, fatty liver, insulin resistance and pancreatitis.  Excessive sugar consumption leads to metabolic disease, which leads to the main chronic illnesses that will eventually kill most of us: heart disease, stroke, cancer, as well as diabetes.  Sugar overload also creates a cascade of chemical changes in the body, turning off the hormones that tell us when we’ve eaten enough, and affecting brain neurotransmitters that leave us craving more sugar.   

The point is that too much sugar has all of these harmful effects on health in addition to its role in America’s obesity epidemic.   This growing awareness has led to a trenchant public debate about whether it isn’t time to regulate sugar.

The debate about regulating sugar is, however, based on a false assumption: If we regulate the stuff, we will wind up with government bureaucrats telling us what we can and can’t eat.  Fortunately, there are alternatives that lie somewhere between political extremes — in gentle, market-based alterations that improve health while actually increasing choice.

For decades, America’s main strategy to prevent obesity and metabolic disease has been education: nutrition labels, public service announcements, and mainly, school-based health education.  There is now solid evidence that health education doesn’t work to change behavior, especially for substances with abuse potential.  It can change attitudes and knowledge, but it doesn’t have lasting effects on what people actually do.

Most of us intuitively understand why health education doesn’t work. We may try for a while to eat healthy by limiting added sugar.  But we quickly find that it actually takes a lot of planning, money, and effort to not eat sugar, and that many of us crave the stuff due to effects on the brain’s “reward center.”

The fundamental problem is that we live in what addiction researchers call a saturated environment.  You know you live in a sugar-saturated environment when you have to go out of your way to find a drinking fountain or a fresh apple.  But junk food counters and vending machines line the walls of workplaces, airports, shopping centers and even schools.  Our saturated environment doesn’t just make sugar-laden products easy to get.  It makes them hard to avoid.

In their New York Times bestseller, Nudge, two professors from the University of Chicago School of Economics (a bastion of conservative politics) point out what public health researchers have known for years:  Most of the time, most of us tend to eat and drink what’s in front of us.  The best way to promote healthy weight and metabolism is to make the healthy stuff cheaper and easier to get than the unhealthy stuff.  These authors describe a simple experiment that vividly illustrates the point. A school cafeteria lady put the low-fat milk on the front shelf while the sugary drinks went up high and in back.  Guess what?  The lunch lady increased milk consumption while helping kids get off the sweet stuff throughout the school.

Effective public health regulation is all about the nudge.  It’s about making healthier options easier and cheaper to get, and asking people to reach a little farther for products harmful to health.  More importantly, it’s about nudging producers and distributors to increase the availability of healthier alternatives through market incentives: by ending subsidies and pro-rating taxes based on how much sugar has been added to the product.  There is now a vast body of international research showing that such simple strategies are easy to implement and tangibly affect population health.

But one question remains: How is it possible that regulating sugar will actually increase personal choice?  Well, we all know that junk food companies have massive marketing departments working 24/7 to figure out ways to nudge us towards their products.  That’s why candy in the supermarket checkout aisle is at eye level for a child, and why the milk is at the back end of the store.  That’s why 80% of the foods in America are laced with added sugar—to make us want to buy these more and more of these products. What we need is a nudge back.  At a minimum, there should be a level playing field for consumers to choose.

There is one assumption that lies at the heart of these new public health regulatory solutions — that, at the end of the day, most Americans want to live long, healthy lives and would prefer a smorgasbord of options for what they choose to drink and eat.  We don’t want anybody—government or corporations—telling us we can or can’t have a soda.  But we do want choosing health to be an easy option, if not the default.  This assumption, unlike others framing the current sugar debate, seems like a reasonable one to make.

Of course nobody wants a government bureaucrat telling us what we can eat and drink.  But neither should we want to live in an environment where powerful corporations tell us what to eat and drink, by continuously nudging us toward products that undermine our chances for a long, healthy life.

VN:F [1.9.3_1094]
Rating: 10.0/10 (14 votes cast)
VN:F [1.9.3_1094]
Rating: +14 (from 14 votes)

How Sweet is Sweet? An Overview of Sweeteners

The helpful folks at UCSF’s Center for Obesity Assessment, Study and Treatment (COAST), whose experts are featured in UCTV Prime’s “The Skinny on Obesity” series, offer an overview of sweeteners to help you figure out what fits in your diet.

How Sweet is Sweet?

It all comes down to the amount of fructose you consume, not necessarily the type of sweetener it’s found in.

For example: A can of soda has 39 grams of high fructose corn-syrup (equivalent of 10 sugar cubes) at 42-65% fructose. But look at the chart below and notice that Agave syrup has even more fructose than high fructose corn syrup! Does that make HFCS better for you?

Well, it’s complicated. But really it comes down to the amount of sweetener you are consuming.  Since you use remarkably less Agave to sweeten your beverages or baked goods as you would compared to sugar or HFCS, you have decreased the amount of fructose you are consuming, even though it’s inherently high in fructose.

It’s all about proportion and amounts. So next time you sweeten, ask yourself, what is the quantity of sweetener and what is the “fructose load” of your sweetening choice? If your load is high, you want to consume items with low % fructose. If your load is low, having a sweetener that is higher in fructose may not make that much of a difference. (Interestingly, Brown Rice Syrup contains 0% fructose.)

 

VN:F [1.9.3_1094]
Rating: 7.0/10 (11 votes cast)
VN:F [1.9.3_1094]
Rating: +6 (from 8 votes)

Stress Beefs Up the Waistline — How Stressed Are You?

The latest “Skinny on Obesity” episode, “A Fast-Paced, Fast Food Life,” focuses not just on what we put in our mouths, but how we live our lives. UCSF experts Elissa Epel and Barbara Laraia explain the connection between stress and obesity and offer practical, effective solutions that don’t involve dieting and exercise.

How do researchers even measure stress? One way is the Perceived Stress Scale, developed by Sheldon Cohen and his colleagues in 1983. The Perceived Stress Scale aims to measure the degree in which situations in one’s life are appraised as stressful. It was developed to address the link between the occurrence of stressful events and the perception by the respondent regarding how threatening or demanding such an event was. This scale can provide an index of chronic stress or strain, and coping with these stresses.

So… how stressed are you? Take the stress quiz and find out. Just answer the ten simple questions, then follow the instructions to calculate your score and gauge where you fall on the scale.

Scores around 13 are considered average. Researchers at UCSF’s Center for Obesity Assessment, Study and Treatment (COAST) have found that high stress groups usually have a stress score of around 20 points. Scores of 20 or higher are considered high stress, and if you are in this range, you might consider learning new stress reduction techniques as well as increasing your exercise to at least three times a week. High psychological stress is associated with high blood pressure, higher BMI, larger waist to hip ratio, shorter telomere length, higher cortisol levels, suppressed immune function, decreased sleep, and increased alcohol consumption. These are all important risk factors for cardiovascular disease.

If you find yourself in the high range, you might consider looking into some of these suggested stress reduction resources from UCTV and the folks at COAST:

UCTV videos on Managing Stress

Stress Less: The New Science That Shows Women How to Rejuvenate the Body and the Mind (2010) by Thea Singer (Hudson Street Press)

The Healthy Mind, Healthy Body Handbook (1996) by David Sobell & Robert Orenstein (Time Life Medical, Patient Education Media Corporation)

The Relaxation & Stress Reduction Workbook, 5th ed. (2000) by Martha Davis, Elizabeth Robbins Eshelman and Matthew McKay

Why Zebras Don’t Get Ulcers: An updated guide to stress, stress-related diseases, and coping (1998) by Robert M. Sapolsky (New York: Freeman and Co., educational only)

Stress: Portrait of a Killer, Dr. Robert Sapolsky’s website

Full Catastrophe Living: Using the wisdom of your body and mind to face stress, pain, and illness (1990) by Jon Kabat-Zinn. (Dell/Bantam Publishing Co.)

Mayo Clinic Stress Center

VN:F [1.9.3_1094]
Rating: 0.0/10 (0 votes cast)
VN:F [1.9.3_1094]
Rating: 0 (from 0 votes)