Tag: obesity

We’re not any fatter?

Obesity rates have flat-lined according to the most recent analyses of National Health and Nutrition Examination Survey data. But what does that mean to you?

These numbers could be interpreted positively: Public health interventions and health communication could have curtailed the expansion of the American waistline, and we might even be headed for a reduction in obesity rates in the coming decades.

They could be interpreted neutrally: Public health and food industry interests have negated the effects of the opposition group.

Or the numbers could be interpreted negatively: We have reached a saturation point and all Americans who are capable of becoming obese are now obese, and no amount of health messaging and education prevented the unhealthy weight gain.

It’s the health communicator’s job to figure out what to do with national statistics, how to interpret the data for the American public. And that’s a lot of power–it could increase or decrease funding for obesity interventions and prevention work currently underway; it could change the public and private response to requests for greater regulation over the food industry, better school food and physical activity, city and regional planning, and so much more. So how should health communicators treat this important but ambiguous information about a plateau in obesity rates? I’m not sure.

My own research would benefit from increased resources and interest, but that interest might be generated from groups that believe we should build on previous success OR from groups who feel that we have to try something radically new. And I think both are right. It may be in our best interests for health communicators to openly debate the importance of these data to generate dialogue among disparate groups.

What do you think? Is there one best way to present this story?

Photo courtesy of Danillo Rizzuti

Big, bigger, biggest apple

NYC does it again!

New York City’s Health Department just released new ads (in English and Spanish) with stunning visuals of supersized drinks and fast food over backgrounds bulging with fat bodies (some missing limbs from diabetes-related amputations). The goal of this new campaign: to get New Yorkers to shrink their portion sizes and hopefully their waistlines and chronic disease.

I like the message of reducing intake, but I’m not convinced that the average American compares what they are confronted with at McD’s today with what they would have gotten there 50 years ago, and I am even less convinced that this ad campaign will result in positive change. Elsewhere on this blog we have talked about positive messaging, and I still believe that telling people to eat MORE fruits and vegetables can lead to more sustainable change than telling them to eat FEWER french fries, especially when the industry continues to offer “more for your money.”

I could not find any peer-reviewed journal articles about the city’s last obesity-related media campaign. I would like to see data on effectiveness, as hard as it is to collect and analyze, because without it we don’t know if health communication resources should be spent elsewhere. New York City and Georgia‘s attempts to reach a broad audience certainly meant well…I just don’t think this latest campaign is going to have anything to show for all the time and money that went into it.

What is your gut reaction to this focus on portion size and reducing consumption? Are there other ways to get the public to trim excess calories from its diet?

Burger photo courtesy of Grant Cochrane.

Other images available from the NYC Health Department website: http://www.nyc.gov/html/doh/html/cdp/cdp-healthy-portions.shtml




Fat acceptance: good or bad?

I am fascinated by the Fat Acceptance movement because I can’t quite figure out if it’s a good thing or not. The Fat Acceptance movement is basically what it sounds like – a movement to advance the social, medical and personal acceptance of overweight and obese individuals. There’s even an organization: The National Association to Advance Fat Acceptance (NAAFA) (http://www.naafaonline.com/dev2/). Fat Acceptance activists are prolific in the blog-o-sphere: Kate Harding’s Shapely Prose (http://kateharding.net/), Joy Nash’s Fat Rant Blog (http://fatrantblog.wordpress.com/), and The Big Fat Blog (http://bigfatblog.com/) are just a few examples. A Google search for “fat acceptance” returns thousands of results.

For those who don’t know, here is a brief rundown of the beliefs of the Fat Acceptance movement:
1. Overweight and obese designations are arbitrary and not scientifically sound. Every one has a set point in his/her weight. Some people were genetically meant to be much bigger than others and trying to achieve a weight less than the set point is dangerous and impossible.
2. Diets don’t work. Most every one who diets will gain the weight back. This also applies to lifestyle changes made in an effort to lose weight (not applicable to changes made to become healthier).
3. Intuitive eating, where you listen to your body’s needs and eat accordingly, should be practiced.
4. An individual can be healthy at any size.
5. Fat by itself is not linked to morbidity and mortality.

For sure there is a social stigma about being fat. Most media images portray overweight and obese (even though the movement doesn’t support use of these terms, I’ll still use them as they are medically defined) individuals as being lazy, unhealthy, unattractive, and dumb. I like that the movement promotes positive images of overweight and obese individuals by showing that they are capable of being active, eating right, and living a happy and fulfilled life. In short, fat individuals can lead healthy lives. Too often we equate thinness with health when that may not necessarily be the case. Activists in the movement rightly point out that naturally thin individuals who don’t eat healthfully or exercise regularly aren’t seen as failures or told that they need to make changes. However, overweight and obese individuals who do eat and exercise right are told that they’re not successful until they lose weight, despite having made healthy choices. By focusing on health, individuals can see themselves as being successful because the end goal – health – has been achieved. If the goal is weight loss, then the individual may not achieve it, see herself/himself as a failure, and revert back to unhealthy behaviors. This focus on health would hopefully encourage people to adopt and maintain healthier behaviors.

My main issues with the movement, however, center on the concept of intuitive eating, the futility of trying to lose weight, and the refutation of scientific evidence that links obesity and overweight with morbidity and mortality. Intuitive eating seems good in theory, but I wonder if it may be used as an excuse to eat unhealthy foods. The futility of trying to lose weight is also fatalistic and may deter some individuals, who do need to lose weight for health reasons, from even trying, which would result in poorer health outcomes. Finally, activists in the movement refute the scientific consensus that overweight and obesity are linked to morbidity and mortality. This is done by using a handful of studies that don’t demonstrate these relationships. Scientific consensus is a powerful thing and shouldn’t be ignored. Basically, if scientists can agree on something, then it’s probably valid. The fact that the movement ignores this because it doesn’t support its agenda is disconcerting.

I’m really interested in hearing what others think of the Fat Acceptance movement! Is this an example of good or bad health communication? Is this a helpful or harmful movement?

Image credit: Tobyotter via Flickr

And the biggest winner is…

Who, exactly, is the winner here?

A friend of mine, knowing how much I love reality television, diet and exercise fads, and human torture, pointed me to a clip from NBC’s The Biggest Loser.

I’ve had a lot of experience as a personal trainer, and I understand that some people get their motivation in different ways. I’ve tended to lean more towards a positive, empathetic strategy with my clients, but for some people the tough love approach works quite well. However, what I saw in this clip goes beyond tough love. What happened in this episode was not about helping these contestants deal with barriers they might experience in their struggle to lose weight–this was mean, manipulative, and transparently about “good” television:


To summarize, the contestants basically are put in to a room filled with plates of thanksgiving goodies such as pumpkin pie, turkey and gravy, and cranberry sauce. Underneath each plate is a number, but contestants have to eat what’s on the plate in order to see what’s underneath. The person with the lowest number wins a set of prizes. Ironically, one of the “prizes” is a 3-lb advantage on their next “weigh-offs.”

What is the lesson here? There are a host of reasons why this show could give people the wrong idea about healthy living and healthy weight maintenance. It depicts people losing weight through unrealistic means at an unrealistic pace in an unrealistic setting. The show also perpetuates the idea that it is only the responsibility of the individual and does not demand that we change any aspect of our society or culture to combat this epidemic.  To top it off, the contestants are exploited and abused, and their struggle is shown to the world.

Admittedly, they signed up, and I imagine they are being compensated, but I still wonder:

Who are the biggest winners in this situation? The audience? The contestants? What about the producers?


Safe homes lead to healthy people

“You can predict the life expectancy of a child by the zip code in which they grow up.  This is wrong,” said U.S. Department of Housing and Urban Development (HUD) Secretary Shaun Donovan is quoted in several places today, including the Robert Wood Johnson Foundation’s website.  According to Donovan, women who grow up in more affluent neighborhoods–which were also found to be safer places–had lower rates of obesity, diabetes, psychological distress, and major depression than women who lived in poorer, more dangerous places.

The information came to light as the result of a HUD demonstration project that moved poor women into better neighborhoods.  What they found was that health care, school performance, job attachment all were closely linked to how well people were housed. So it is true; where and how you live directly affect how healthy you are likely to be, how well you (or your kids) do in school and how happy you are at work.

Hooray! MSNBC reports that people who eat candy are skinnier!

MSNBC posted a story earlier this spring titled, Sweet! Candy eaters surprisingly slimmer, reporting on a study done by actual scientists that showed that people in their study who ate candy were more likely to have smaller waists and weigh less.

For anyone who loves candy (who doesn’t, really?) that’s great news! So we can eat candy without fearing weight gain and poor health outcomes?

Not exactly. A section about halfway through the article reads thus:

The results suggest these foods are not associated with overweight or disease when consumed in moderation, said study researcher Carol O’Neil, of Louisiana State University Agricultural Center. Indeed, participants in the study did not eat very much candy, only about 1.3 ounces a day on average.

So in other words, it’s not candy by itself that causes weight gain. Eating too much of it does. That is a riveting assessment, and certainly newsworthy. Newsworthy enough to produce a news story with a headline that could certainly be considered misleading.

By the same logic, butter, soda, bacon and chocolate mousse do not make you fat, which is entirely true. No food, if eaten in moderation, is going to make a person fat by itself. So why the study?

The answer may lie at the end of the original article, and have to do with an interesting aspect of this study that MSNBC failed to disclose: The study was partially funded by the National Confectioners Association.

Is it responsible for popular media outlets to report on studies that have a clear conflict of interest, in a way that could confuse consumers about what is healthy and what is not? Do you think that the average reader would understand that this study is simply saying something that most health and nutrition researchers already know–that certain foods should be eaten in moderation?

How often do you think studies like this get reported on, and how do you think those news stories get interpreted by the general public?


FAT: What no one is telling you

A few years back, Twin Cities Public Television produced a nationally-aired documentary titled: Fat: What no one is telling you. The film approached the obesity epidemic in a comprehensive and personal way that had not been attempted before, and has not been replicated since.

Here’s a preview of the film, which can be viewed on TPT’s website:

When asked about what he had learned while making this film, producer Tom Spain had this to say:

The big surprise, and the big dilemma, is the complexity. One researcher told me early on: If you’re going to deal with the subject, you have to honor the complexity…I’ve since learned this is a social phenomenon, an emotional phenomenon, a genetic phenomenon, it’s a food supply phenomena. It’s such a vast subject that’s way beyond the reach of medicine or weight loss programs…it’s just huge.

That’s something that was a surprise and a dilemma because the job of a filmmaker is to take an issue and make it clear and simple. And our message is that this is not clear and this is not simple.

Mr. Spain hit on an issue that perhaps is the reason why four years later, the conversation about obesity still has not changed much: Obesity is not simple, yet we as a media-consuming public demand simplicity. We still try to pin the blame on one thing or another, and when complex solutions are proposed, they are dismissed because they alone will not fix the problem.

The problem with any solution to the epidemic is that we will not be able to prove that any one potential solution will work, just as it is impossible to prove just how responsible any one determinant is for obesity’s development.

Most importantly, this film describes the human aspect of the condition. Whatever its causes, people who suffer from obesity are people just like everyone else. This documentary does a great job of letting us hear from them, on their terms.

If you get a chance, watch this documentary, then try to start paying attention to how obesity—its  causes and remedies—is portrayed in the popular media.

Does the conversation still need to change?

Obesity: It’s all your fault!

Or is it?

An NPR story this week describes the problems both doctors and patients encounter  in discussing patients’ growing waistlines. Some of those problems stem from the stigma associated with obesity that has been blogged about here at Upstream. Because obesity is so often seen as an individual moral failing, doctors understandably don’t want to feel like they are accusing their patients of being lazy or overindulgent. Conversly, patients can feel like they’ve failed their doctors if they have been unable to lose weight since a previous visit.

The truth is, gaining weight is pretty easy in this country, and geting rid of it is extremely difficult. Individual responsibility is certainly a necessary component of weight management, but one of the many external barriers to weight loss is the the way it is talked about. The focus tends to be on the individual and not the environment: the choice of dinner at McDonald’s versus the number of McDonald’s in a neighborhood; the choice to not exercise versus the number of parks in a city or the safety of the streets; the choice to not cook fresh foods when one was never taught how to cook vegetables and grew up eating chicken nuggets.

Obesity is such a difficult issue because in spite of the vast numbers of environmental and structural barriers, it still often comes down to the choices people make. However, those choices can be a lot easier if patients believe that their doctors are on their side. Many doctors may not even be aware of the vast difficulties facing individuals who are struggling with a weight problem. The NPR story points out that few doctors are taught about obesity in medical school, even though it may soon become the number-one health burden on our society.

The rise of obesity is indeed a moral failing. It comes from a failure in our society to value the things that will promote health and happiness. It comes from our failure to fund healthy school lunches; our failure to keep all neighborhoods safe and attractive; a failure to provide comprehensive, skill-building, life-long health education; a failure to reign in a commercial media machine that creates a religion out of mass consumption; and finally, it comes from our failure in blaming the people who are victims of a society that has failed them in so many ways.

In a country that valued those things, a doctor and a patient might not have to skirt around such a serious health issue.

Photo credit: http://cgiraldez.deviantart.com/

“How do you eat an elephant?”…

“One bite at a time.” These are the words of a very important mentor, Rob Roberts, that echo in my head whenever I feel like the health problems we face, as a nation and a world, are too great. It’s a strange, yet apt, reminder that change happens slowly, with planning and preferably a whole lot of help.

To that end, health communication should be about not just raising awareness of health challenges, but also raising awareness about solutions! If Food Day got you riled up and you’re looking for where you and your community can direct that new energy, here are a few ideas to explore and support beyond your own kitchen (see last week’s post about simple solutions for individuals):

  • Farm-to-School: Find out what your community is doing to feed its kids right!
  • FoodCorps: Young leaders partner with limited-resource communities to deliver hands-on nutrition education, build and tend school gardens, and bring high-quality local food into public school cafeterias.
  • FoodFight: Using schools as a platform to give students the tools, knowledge and resources needed to take responsibility for their eating and buying habits and ownership over their health and life chances.
  • HealthCorps®: Founded by heart surgeon Dr. Mehmet Oz and Lisa Oz to fight obesity and build mental resilience in American youth. Young leaders are educating the student body, creating a FitTown and advocating for healthier communities, states and nation.
  • Let’s Move: Michelle Obama’s initiative has many ways that you can get involved, whether you’re a student, teacher, parent, chef or other community member.
  • The 10% Campaign: Challenging North Carolinians to Buy Local Food. (Also, see Katie’s post about CSAs.)

This is just the tip of the iceberg (lettuce?). What other organizational, regional or national groups are working to improve how we eat? Share here!


I am more than a little excited that my country has decided to devote a whole day to food, from farm to fork. I believe in the power of real food, to nourish, to heal, to improve our economy and the environment, and to bring people together. I challenge a politician or popular figure to say they are against good food.

Last week, my post sparked a discussion about heuristics (basically, a decision-making process that uses our experiences and ‘rules of thumb’ to make quick decisions). Food Labels are in some ways the ultimate heuristic tool that government, industry and health advocates have yet to master. Current labels are complicated. (Should I care that a product has 400 versus 600 grams of sodium per serving?) Proposed revisions to the Food Label probably oversimplify the matter, although they might facilitate smarter snap-judgments.

“Food” has taken on a whole new meaning in modern America– too often foods require explanation. Think about the ingredients in a Twinkie, for example – do you know what Polysorbate 60 is, or what it does for your body? Exactly. We like to make things complicated, but I hope that Food Day highlights for everyone that real, simple foods are uncomplicated to prepare and enjoy, and that even growing them could be less complicated if positive policy change could be achieved.

In the end, the best foods have no labels…Broccoli, Carrots, Pears, Avocados, Garlic, Spinach, Sweet Peas, Peaches…these guys need no explanation. They’re GRRRRRREAT!

In honor of FOOD DAY on October 24, and in deference to our need for simplification in a complicated food world, here are my 5 suggestions for a healthier relationship to food.

  1. 5 ingredients or less – if the food label is longer, it’s probably not worth consuming on a daily basis (who wants to read all those ingredients anyway?!).
  2. Support local farmers – it’s one of the easiest ways to access real, affordable food.
  3. It’s not a meal unless it has a fruit and/or vegetable – really. (And a corollary – “Eat the rainbow, and I don’t mean Skittles.”)
  4. Eat with your family (or friends or neighbors) – it’s more enjoyable, and you know it.
  5. Be your own Food Network – 1 pot, 1 baking dish, 1 pan…go! Cooking can be simple, quick and delicious without the flames and crazy knife skills of professional chefs. Don’t doubt your own abilities.

And finally, if 5 tips are still too many, I suggest you follow Michael Pollan’s even simpler solution: Eat Food. Not Too Much. Mostly Plants.

If you have a simple set of Food Rule to live by, feel free to share (Pollan has a great collection here). And if you have a novel solution to our country’s “food” problems (industrial, highly-processed, inhumane, polluting food products), share that too! Happy FOOD Day!

Photo courtesy of Piyachok Thawornmat