Nutrition education is lacking in most health professions education — either isn’t incorporated, exists in the context of specific disease-related diets, or glosses over the concept of nutrition and diet. Honestly, it’s understandable considering how much knowledge needs to be conveyed and learned — especially in medical school, the only health profession I can speak to personally. But, just as I’ve written before about the need to incorporate more health policy education, it’s time to also offer more discussions about nutrition and the vast impact of society and policy on the “what” and “where” people eat. [Also just as important is proper education on eating disorders. This post from my friend Clare of Fitting it All In is a great overview about caring for individuals with eating disorders.]
Obesity is common, costly, and poses serious health risks. So let’s start with some numbers to get our bearings about why this topic warrants our attention:
- There are many obesity-related medical conditions, including heart disease, stroke, type 2 diabetes, and some cancers;
- In 2015-2016, the prevalence of obesity was 39.8% in adults and 18.9% in youth — this equates to about 93.3 million adults and 13.7 million children and adolescents;
- The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 dollars;
- Individuals with obesity have a medical cost $1,459 higher than individuals of normal weight;
- Obesity affects some groups more than others — among adults, Hispanics (47.0%) and non-Hispanic blacks (46.8%) have the highest rates of obesity, followed by non-Hispanic whites (37.9%) and non-Hispanic Asians (12.7%);
- This trend remains the same for youth — Hispanics (25.8%) and non-Hispanic blacks (22.0%) had a higher prevalence of obesity than non-Hispanic whites (14.1%) and non-Hispanic Asians (11.1%).
Obesity is a complex condition with biological, genetic, environmental, social, and cultural influences. Many factors that can contribute to obesity affect everyone at some point in their lives, but individuals who are food insecure or low-income face additional risks and challenges to maintaining healthy behaviors. These include everything from limited resources and lack of access to healthy, affordable food and high levels of stress, anxiety, and depression to limited access to health care (many low-income individuals are still uninsured in states that did not expand Medicaid) and greater exposure to advertisements for obesity-promoting products.
I remember reading this article about the impact of Mountain Dew on the oral health of West Virginia — it’s part of what spurred me to apply to MPH programs for public health nutrition and health policy. I wanted to gain a skill set that would enable me to help people make healthier choices for themselves and their children. [I guess that’s also how I ended up in medical school…] I ultimately focused on health policy in graduate school and wrote so many policy papers about sugar-sweetened beverage taxes as a means to reduce consumption. These types of drinks include soda, iced teas, sports drinks, lemonade…honestly, I would personally lump in most juices as they aren’t the most nutritious source of whatever vitamin they promote on the bottle — they’re usually just sugar.
According to a 2012 study by Yale’s Rudd Center for Food Policy and Obesity, the federal government is spending $1.7 billion to $2.1 billion on soda purchases through SNAP, the Supplemental Nutrition Assistance Program. Over the years, various states have attempted to pass legislation that would restrict the use of SNAP to purchase soda, sugary foods, and other unhealthy items. While this is one (albeit, controversial) method to reduce consumption of unhealthy foods, I think there is one area ripe for policy movement that is often overlooked — the impact of food advertising on obesity.
Once you’ve been made aware of this issue, you will start to notice it everywhere; it’s like the glass has been shattered. Next time you watch television, count the food and beverage advertisements each commercial break and record if they are for healthy or unhealthy products.
A recently published study from the Rudd Center for Food Policy and Obesity found that companies selling fast food, candy, sugary drinks and unhealthy snacks frequently target black and Hispanic youth in their advertising effort. Specifically, they found that these companies spent $1.1 BILLION in advertising in black-targeted and Spanish-language TV in 2017. The companies that spent the most on targeted advertising were fast food restaurants, including McDonald’s, Subway, Wendy’s and Taco Bell on Spanish-language TV; and Taco Bell, Domino’s, Burger King, Wendy’s and Arby’s on black-targeted TV. Even companies participating in the Children’s Food and Beverage Advertising Initiative — which aims to reduce calories and improve the nutritional quality of foods and drink consumed by children at fast-food restaurants — targeted black or Hispanic consumers. These companies include Campbell, General Mills, Kellogg, Kraft Heinz, PepsiCo and McDonald’s.
This all boils down to one thing — can and should corporations regulate themselves when the health of an entire young generation is at stake? What is the tipping point of obesity rates that states or the federal government are waiting for to get into this — pediatricians can’t just counsel all day if affordable, healthy options don’t exist or targeted advertising addicts young people to unhealthy foods for a lifetime. Parents with limited resources and time can only do so much when fast-food is ubiquitous and marketed directly at them — and when healthy foods are placed at too high a price point.
We cannot simply demand that people change their habits — their environment must change with them. Public policy must change to help them. This is the crux of public health and medicine — health policy can serve to support clinical and individual patient goals.