The problem of obesity in perspective: Dealing with the modern food world

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The problem of obesity in perspective Dealing
with the modern food world

• Paul Rozin
• Buenos Aires
• September, 2014

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Definition

• BMI weight (kg)/height (m) 2
• Obesity BMI gt 30
• Overweight BMI gt25, lt30

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Patagonia 69,853 kg 40 m BMI 43.7
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Obesity in perspective

• The risk overweight and obesity

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Flegal et al., 2005Main Outcome Measures Number
of excess deaths in 2000 associated with given
BMI levels
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The obesity epidemic

• 1.4 pounds gained/year in USA over last 20 years

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• http//www.surgeongeneral.gov/news/testimony/obesi
  ty07162003.htm
• Statement 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.

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Epidemic versus Slow crawl
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Food industry
Media
Medical research
Govern- ment
Public
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Obesity and Malnutrition
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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

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World Obesity (CIA, 2008)Obesity BMIgt30 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

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Obesity in USA over time
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Obesity in USA 2009-2012
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Kwashiorkor protein deficiency
Marasmus energy deficiency
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World Malnutrition

• http//www.wfp.org/hunger/stats
• Hunger kills more people every year than AIDS,
  malaria and tuberculosis combined
• 842,000,000 dont get enough to eat in world
• Poor nutrition causes nearly half (45) of
  deaths in children under five - 3.1 million
  children each year.

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• The Paleolithic human in the modern, developed
  world
• Old heuristics, e.g., the image equals the
  object

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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

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Feature Heaven Hell
Love Italians
Banks Swiss
Universities British
Food French
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Feature Heaven Hell
Love Italians Swiss
Banks Swiss
Universities British
Food French
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Feature Heaven Hell
Love Italians Swiss
Banks Swiss Italians
Universities British
Food French
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Feature Heaven Hell
Love Italians Swiss
Banks Swiss Italians
Universities British French
Food French
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Feature Heaven Hell
Love Italians Swiss
Banks Swiss Italians
Universities British French
Food French British
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The developed world

• Western Europe vs India
• 60 of all people live in Asia
• 50 of total expenditures on food in developing
  world

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Rating scale

• 1. strongly disagree
• 2. disagree
• 3. neither agree nor disagree
• 4. agree
• 5. strongly agree

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Eating is a religious experience My diet must
adhere to strict moral/religious principles
Mean Agreement
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The combination of health and beauty norms
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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
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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

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Cultural solutions

• France
• With Claude Fischler

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ObesityFrance vs USA

• BMI gt 30
• France 16
• USA 32
• 2008 http//www.who.int/gho/countries

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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
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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
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Percent of subjects preferring a week at a luxury
(vs. gourmet) hotel at same price
Females Males
Paris, France 13 8
USA 83 70
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Percent of subjects selecting unhealthy for
choiceWhat do you think of when you think of
HEAVY CREAM? whipped or unhealthy
Females Males
France 28 23
USA 68 48
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Percent of subjects agreeing that they eat a
healthy diet
Females Males
France 76 72
USA 28 38
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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

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If there was an inexpensive pill to safely
satisfy nutritional needs and hunger without
having to eat, I would take it
gt very true of me
Argentina 15.8
Brazil 11.3
France 5.9
USA 14.3
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Enjoying food is one of the most important
pleasures in my life
gt very true of me
Argentina 52.8
Brazil 56.1
France 66.2
USA 53.1
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In general, I am more concerned with the caloric
content of food than the taste
gt very true of me
Argentina 5.3
Brazil 4.4
France 2.5
USA 34.6
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Eating alone does not bother me
gt very true of me
Argentina 54.8
Brazil 51.5
France 41.7
USA 51.8
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Argentina P I
C Brazil P I
C France P I
C USA
P I C
Ccurrent I ideal Ppeer ideal
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Argentina PI C
?? Brazil ICP France
CPI USA
ICP
Ccurrent I ideal Ppeer ideal
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Beef consumption by country (2007 or 2008)
kg/capita/year

• France 13.3
• USA 28.5
• Brazil 37.6
• Argentina 71.8

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Liking for beef (-100 to 100)
Mean Liking
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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
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Sample free associations to beef USA (with
valence)
Word 1- Word 2 Word 3 Sum Valence 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
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Valence of 3 beef free associations (-3 to 3)
Valence
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The food environment

• With Claude Fischler, Kim Kabnick and Erin Pete

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About 2001
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Restaurant portion size
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Supermarket food portions
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Supermarket non-food portions
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Mean own portion size (chicken) (1 to 8 half
card decks)
Mean Portion size
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Mean own portion size (coca cola) (8 levels)
Mean Portion size
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Mean own portion size (ice cream) (scoop size
10-110)
Mean Portion size
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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

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Changing the food environment

• Accessibility
• Small accumulated value
• 1-3 standard coca cola cans a week

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Salad bar

• Reaching over to the middle (about 5 reduction
  in calories)
• Spoon versus tongs (about 5 reduction in
  calories)

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Portion size

• Amnesia study Availability

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Environment Changes

• Glass size
• Plate size Brian Wansink
• Very large serving amounts (Wansink soda)

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In a student cafeteria, when students are served
a 50 larger portion of macaroni and cheese
(right) they eat more, and dont compensate by
eating less of the rest of the meal
Diliberti, Rolls et al., 2004
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Cultural norms Unit bias(Geier and Rozin, 2006)

• Free access in lobby to bowl of MMs, with either
  teaspoon or tablespoon
• Amount taken with tablespoon is 70 greater
• Similar effects with large or small tootsie rolls
  or pretzels

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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)

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Lays stacked potato chips
Segmentation and consumption interrupts About 50
reduction
Geier, Wansink and Rozin
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35 calories/wedge
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Government versus Industry initiation

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

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Energy Expenditure

• Suburban Life
• Malls
• The car culture
• Small but continuing increments
• Role for government e.g., better and cheaper
  public transportation

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Learning from the French
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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

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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
• Dont reduce the pleasure of eating
• Make small changes that encourage more exercise
  and less eating
• Let the effects of those small changes
  accumulate, and..

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Vetri Foundation Charter School Lunch Feb, 2013
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1.50
Vetri Foundation Charter School Lunch Feb 2013
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Yes, eating can be bad for health
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But NOT EATING is much worse for health

• Adios