The problem of obesity in perspective: Dealing with the

modern food world

Paul RozinBuenos Aires

September, 2014:

Definition

• BMI = weight (kg)/height (m) 2

• Obesity BMI >= 30

• Overweight BMI >=25, <30

Patagonia69,853 kg40 mBMI 43.7

Obesity in perspective

• The risk: overweight and obesity

Flegal et al., 2005Main Outcome Measures Number of excess

deaths in 2000 associated with given BMI

levels

The obesity “epidemic”

1.4 pounds gained/year in USA over last 20 years

http://www.surgeongeneral.gov/news/testimony/obesity07162003.htmStatement of Richard H. Carmona, M.D., M.P.H., F.A.C.S.Surgeon GeneralU.S. Public Health ServiceWednesday, July 16, 2003

•“Nearly two out of every three Americans are overweight or obese. •“One out of every eight deaths in America is caused by an illness directly related to overweight and obesity.

“But the fact is that we have an epidemic of childhood obesity. “

Epidemic versus “Slow crawl”

Medicalresearch

Foodindustry

Govern-ment

Media

Public

Obesity and Malnutrition

World obesity 2010• http://www.who.int/mediacentre/factsheets/

fs311/en/

• In the world, over 200 million men and nearly 300 million women are obese

World Obesity (CIA, 2008)Obesity BMI>=30 as % of all adults• https://www.cia.gov/library/publications/the-world-

factbook/rankorder/2228rank.html

• 1. American Samoa 74.6%

• 18. USA 33.0%

• 23. Mexico 32.1%

• 29. Argentina 29.7%

• 102. Brazil 18.8%

• 108. France 18.2%

• 157. Japan 5.0%

• 184. India 1.9%

Obesity in USA over time

Obesity in USA 2009-2012

Marasmus: energy deficiency

Kwashiorkor: proteindeficiency

World Malnutrition

• http://www.wfp.org/hunger/stats

• Hunger kills more people every year than AIDS, malaria and tuberculosis combined

• 842,000,000 don’t get enough to eat in world

• Poor nutrition causes nearly half (45%) of deaths in children under five - 3.1 million children each year.

• The Paleolithic human in the modern, developed world

• Old heuristics, e.g., “the image equals the object”

Late 20th Century developed world

• Epidemiological revolution: longer life and death from degenerative diseases: shift to long-term consequences

• food surplus• extraordinary range of food choices• development of super-foods (e.g. chocolate)• no work needed to attain choices• Old heuristics not applicable: bias to eating• massive amounts of risk information• no training in dealing with risks/benefits or nutrition

Feature Heaven Hell

Love Italians

Banks Swiss

Universities British

Food French

Feature Heaven Hell

Love Italians Swiss

Banks Swiss

Universities British

Food French

Feature Heaven Hell

Love Italians Swiss

Banks Swiss Italians

Universities British

Food French

Feature Heaven Hell

Love Italians Swiss

Banks Swiss Italians

Universities British French

Food French

Feature Heaven Hell

Love Italians Swiss

Banks Swiss Italians

Universities British French

Food French British

The developed world

• Western Europe vs India

• 60% of all people live in Asia

• 50% of total expenditures on food in developing world

Rating scale

• 1. strongly disagree

• 2. disagree

• 3. neither agree nor disagree

• 4. agree

• 5. strongly agree

Eating is a religious experience; My diet must adhere to strict moral/religious principles

Mea

n A

gree

men

t

The combination of health and beauty norms

“Concerned about being overweight”

• % responding “often“ or “almost always”

• 57% females, 21% males

• US college students from 6 universities across the country

Rozin, Bauer & Catanese, 2003

“I am embarrassed to buy a chocolate bar in the store”

• American college students from six campuses across the USA

• % Females: 13.5

• % Males: 4

Cultural solutions

France

With Claude Fischler

Obesity:France vs USA

• % BMI >= 30• France: 16%• USA: 32%

• 2008 http://www.who.int/gho/countries

Life expectancy at birth(data from 2008-2010: www.who.int/gho/countries)

rank country years rank country years

1 Japan 83 10 Norway 81

4.5 Australia 82 10 Sweden 81

4.5 Israel 82 14 Austria 80

4.5 Italy 82 14 Belgium 80

4.5 Singapore 82 14 Finland 80

4.5 Spain 82 14 Germany 80

4.5 Switzerland 82 14 Greece 80

10 Canada 81 14 Korea 80

10 France 81 14 U.K. 80

10 Netherlands 81 19.5 U.S.A. 79

Age-standardized annual mortality from

CHD and related risk factors (males 35-64)

WHO/MONICA Renaud & de Logeril, 1992

Location Mortality / 100,000

Serum chol-

esterol (mg/dl)

Toulouse, France 78 230

Lille, France 105 252

Stanford, USA 182 209

Percent of subjects preferring a week at a luxury (vs. gourmet) hotel at same price

Females Males

Paris, France 13 8

USA 83 70

Percent of subjects selecting “unhealthy” for choice:

What do you think of when you think of HEAVY CREAM?: whipped or unhealthy

Females Males

France 28 23

USA 68 48

Percent of subjects agreeing that they eat a “healthy diet”

Females Males

France 76% 72%

USA 28% 38%

Attitudes regarding food and meat among American, French, Argentinean

and Brazilian college students

• Marle S. Alvarenga

• Paul Rozin

• Matthew B. Ruby

• Guillermina Rutszein

• Eve Richter

• Teri Kirby

If there was an inexpensive pill to safely satisfy nutritional needs and

hunger without having to eat, I would take it

% > = very true of me

Argentina 15.8%

Brazil 11.3%

France 5.9%

USA 14.3%

Enjoying food is one of the most important pleasures in my life

% > = very true of me

Argentina 52.8%

Brazil 56.1%

France 66.2%

USA 53.1%

In general, I am more concerned with the caloric content of food

than the taste

% > = very true of me

Argentina 5.3%

Brazil 4.4%

France 2.5%

USA 34.6%

Eating alone does not bother me

% > = very true of me

Argentina 54.8%

Brazil 51.5%

France 41.7%

USA 51.8%

Argentina P I C

Brazil P I C

France P I C

USA P I C

C=current I= idealP=peer ideal

Argentina PI C ??

Brazil ICP

France CPI

USA ICP

C=current I= idealP=peer ideal

Beef consumption by country (2007 or 2008): kg/capita/year

• France 13.3

• USA 28.5

• Brazil 37.6

• Argentina 71.8

Liking for beef (-100 to +100)M

ean

Lik

ing

Free Assoc to BEEF: most common words

Argentina Brazil France USA

FEMALE FEMALE FEMALE FEMALE

Asado 36 saborosa 66 viande 130 Cow 52

Rojo 31 churrasco 59 steak 23 Meat 24

sabroso 29 sangue 43 rouge 22 Hamburger 22

Comida 19 Gordura; succulente 18 vache 20 Disgusting 19

Jugoso 17 Animal 13 Red 18

MALE MALE MALE MALE

Asado 17 churrasco 39 viande 68 Cow 27

Sabroso, delcicioso, rico, 10

saborosa 31 Steak 26 Steak 18

Vaca, sabrosos, grosso sangue 25 vache 17 Meat 15

Jugoso. milanesa 3 Proteina 17 sang 8 Hamburger, red 7

Boi/vaca 15 rouge 5

Sample free associations to “beef” USA (with valence)

Word 1- Word 2 Word 3 SumValence

Ambiv-alence

Cow (0) Burger (1) Baseball (1)

+2 No

Fat (-1) Unhealthy (-1)_

Cholesterol (-1)

-3 No

Fat (-1) Protein (1) Meat (1) +1 Yes

Valence of 3 beef free associations (-3 to +3)

Val

ence

The food environment

• With Claude Fischler, Kim Kabnick and Erin Pete

Percent of reduced fat foods indifferent categories, in supermarkets

Item France USA

Yogurt 22 96

Milk 36 56

Ice cream 00 25

About 2001

Restaurant portion size

Restaurant France USA

McDonald’s (7) 189g 256g

Quick/Bking(5) 207g 322g

Chinese (6) 244g 418g

Supermarket food portions

ITEM Carrefour Acme

Y ogurt (modal) 125g 227g

Fresh fruit (mean,4 types)

431g 553g

Coca cola (modal)

330ml 500ml

Supermarket non-food portions

ITEM Carre-four

Acme

toothpaste (modal, ml)

75 170

toilet paper (mean, sq cm)

121 117

Cat food (modal, g)

100 85

Mean own portion size (chicken) (1 to 8 half card decks)

Mea

n P

orti

on s

ize

Mean own portion size (coca cola) (8 levels)

Mea

n P

orti

on s

ize

Mean own portion size (ice cream) (scoop size: 10-110)

Mea

n P

orti

on s

ize

Obesity: Changing the person

• Dieting

• Nutrition information and education Education about science, risks, benefits

• Changing preferences and intake

• Failure of obesity treatments and dieting

• Only bariatric surgery

• Think about height

Changing the food environment

• Accessibility

• Small accumulated value

• 1-3 standard coca cola cans a week

Salad bar

• Reaching over to the middle (about 5% reduction in calories)

• Spoon versus tongs (about 5% reduction in calories)

Portion size

• Amnesia study: Availability

Environment Changes

• Glass size

• Plate size: Brian Wansink

• Very large serving amounts (Wansink: soda)

Diliberti, Rolls et al., 2004

In a student cafeteria, when students are served a 50% largerportion of macaroni and cheese (right) they eat more, and don’tcompensate by eating less of the rest of the meal

Cultural norms: Unit bias(Geier and Rozin, 2006)

• Free access in lobby to bowl of M&Ms, with either teaspoon or tablespoon

• Amount taken with tablespoon is 70% greater

• Similar effects with large or small tootsie rolls or pretzels

Cumulating increments

• James Hill, David Levitsky,Barbara Rolls, Marion Nestle, Paul Rozin et al.

• Some evidence that portion change effects may endure, and are not fully compensated for over at least 2 weeks (Rolls, Levitsky)

Lay’s stacked potato chips

Geier, Wansink and Rozin

Segmentation and consumption interruptsAbout 50% reduction

35 calories/wedge

Government versus Industry initiation

• Let the free market do it (organic, fat free, calorie free)

• Smaller portion sizes

Energy Expenditure

• Suburban Life

• Malls

• The car culture

• Small but continuing increments

• Role for government: e.g., better and cheaper public transportation

Learning from the French

Some French-American differences

• Portion size• Eating time• Eating sociality/ conversation (conviviality)• Freshness and taste (vs shelf life) priority in foods• Degree of snacking and snacking opportunities• Differences in actual foods consumed (e.g., wine)• Differences in variety of food consumed

(Drewnowski et al.)• Walk/bicycle vs car orientation

We can learn from the French in this domain (not all domains)

• Focus on the environment to try to reduce food intake and waist lines

• Don’t reduce the pleasure of eating

• Make small changes that encourage more exercise and less eating

• Let the effects of those small changes accumulate, and…..

Vetri Foundation Charter School Lunch: Feb, 2013

Vetri Foundation Charter School Lunch: Feb 2013

$1.50

Yes, eating can be bad for health

But NOT EATING is much worse for health

Adios