Thursday, December 4, 2008

Lead A Horse To Water; It May Drown Itself

CDC trends in obesity 1985 2001
The human genome did not change drastically in The United States over the past thirty years; yet, the American waistline has. In fact, as seen in the video above, fat has been engulfing the American map. How can one explain the 300,000 deaths a year related to obesity and overweight-related conditions? Here, American culture will be examined in the new indictment that obesity, despite its lack of direct biological vectors, might actually be a ‘communicable disease.’

Obesity as a societal problem; obesity as an epidemic.

In 1998, scientist James O. Hill, director of the Colorado Clinical Nutrition Research Unit at the University of Colorado Health Sciences Center, published a new look upon obesity in America. Dr. Hill surmised that largely an environment that promotes excessive food intake and discourages physical activity has caused the current epidemic of obesity. Despite the best efforts of Natural Selection and the other components of evolution that have awarded humans physiological mechanisms to defend against body weight loss, they have only weak physiological mechanisms to defend against body weight gain when food is abundant. Hill continues, that control of portion size, consumption of a diet low in fat and energy density, and regular physical activity are behaviors that protect against obesity, but it is becoming difficult to adopt and maintain these behaviors in the current environment.1

These are words that shook the world. His paper was so convincing that obesity could no longer be blamed on ‘the media,’ fast food, the 'government', ‘fat genes,’ or anything else for that matter. The problem of bigness now encompassed the biggest monster of them all, American culture as a whole. Certainly, all of the elements listed above contributed to the problems: The media, as a whole was missing the point; The government doing little in the name of health care; There are, in fact, ‘fat genes,’ as many as 400,2 but, they are polygenic and heterogeneous (nearly all of us have some genetic ‘predisposition' to obesity;3 And so and so forth, however, what academics are now beginning to understand, from historians and sociologists to biologists and health professionalsobesity as epidemic, not necessarily as disorder is largely the resulting nexus of contemporary culture.

Astounding results; extraordinary numbers. Such a cultural nexus has led to the following: Today Americans are the fattest people on the face of the earth…About 61 percent of Americans are overweight overweight enough to begin experiencing health problems as a direct result of that weight. About 20 percent of us are obese so fat that our lives will likely be cut short by excess fat. More than five million Americans now meet the definition of morbid obesity; they are so obese that they qualify for a radical surgical technique known as gastroplasty, wherein the stomach is surgically altered so as to keep food from being digested. In fact, The American Bariatric Society, the people performing these surgeries, report that its doctors’ waiting lists are months long and that they “can’t keep up.” 4,5 The crisis continues and deepens. Obesity seems to be on the rise in all segments of the population. There is a suggestion that the increases are a little greater in middle-aged men than in other groups, but beyond that the increase is similar for men and women, for nonsmokers and smokers, for people of all educational levels and for people of all ages including children.6,7 Are parents to blame? Well, a recent study suggests that parents who display high levels of dis-inhibited eating, especially when coupled with high dietary restraint, may foster the development of excess body fat in their children.8

Summation: the current surge in the global prevalence of obesity reflects the failure of mechanisms that regulate body weight to cope with environments that promote overeating and discourage physical activity. Yet, within any obesity-promoting environment there is considerable variation among individuals regarding their susceptibility to weight gain.9 What else would we expect? In a society where serving sizes are gargantuan, attractive foods are ubiquitous, bargains are abundant and variety is overwhelming ad nauseum, it comes as little surprise that waistlines are expanding. Dr. Kelly D. Brownell, a professor of psychology at Yale and an expert on eating disorders, has gone so far as to label American society a "toxic environment" in terms of food.10

The questions rise endlessly from this sea of fat. First, how did we get to this point and how did it happen so quickly? Second, can anything be done about obesity as an epidemic today and in the future?

Politics as usual; 1970s as formative.

By early 1973, with food price inflation at unprecedented levels, the unrest of the public had transformed into an all-out ‘silent majority’ protest.11 Across the nation, food fear took hold at a trail-blazing pace. Stores selling horse meat opened in Portland and Chicago.12,13 Nixon needed to control food prices, ‘or else.’ Nixon placed Earl Butz, his lively Secretary of Agriculture, in charge of finding and implementing a solution. Butz, nearly single-handedly, deregulated the American farm system, ended mandatory siloing, and abandoned export approvals or large shipments.14,15 In addition, Butz, single-handedly, may have forever changed American agriculture in larger ways. In 1976, as with the rest of his career, Butz reversed old conservative notions about American agriculture. He proved that free trade truly was the best system for the farmland of America and for underwriting democracy abroad by visiting, and defending, open trade for Malaysian palm oil.16 He thereby may have been one of the largest single contributors to American consumption of saturated fat. By the conclusion of Butz’s career as Secretary, he had transformed American agriculture and the American consumer; his policies laid the groundwork for cheap, plentiful, and, as will be seen, sweet calories.

Productive farmland; Market hungry farmers.

Meanwhile sugar prices were erratic. Instability in production, an embargo on Cuba, and other factors made it difficult to forecast sugar prices for business purposes. Where to sell all of the surplus production that Butz's plan was creating was the question to be answered. In 1971 the solution was invented and by the later 70s ubiquitous. This was the year when scientists in Japan discovered a way to instantaneously halt market advances in the sugar cane and sugar beet growing developing world. These scientists developed a sweetener six times as sweet as cane sugar, and made from a crop far cheaper than sugar canes or beets that increased product stability, maintained a caramelized state if desired, and more. They invented High Fructose Corn Syrup (HFCS) while forever providing a market, and expanding for, corn.

Earlier this year, we saw $7.50 corn, an unprecedented price, triple that of the $2.50 that corn hovered near for years. The results of this, along with some technological innovations in production are as follows: According to the latest figures from the U.S. Department of Agriculture (USDA), consumption of various sweeteners, often in calorie-dense food and drink, from fruit-flavored drinks to energy bars, has risen in the United States from an estimated 113 pounds per person in 1966 to 147 pounds in 2001. Also from the USDA, in 1966, refined sugar, also known as sucrose, mainly grown in the third world, and highly susceptible to price change, held the premier slot, accounting for 86 percent of sweeteners used. Today, sweeteners made from corn are the leader, racking up $ 4.5 billion in annual sales and accounting for 55 percent of the sweetener market. That switch largely reflects the steady growth of high-fructose corn syrup, which climbed from zero consumption in 1966 to 62.6 pounds per person in 2001.17,18

Cheap sweeteners; Cheap cola; High profit margins.

It is know well known that the profit margins on cola are enormous, but how did we get to drinking so much of it? Much of the current trend in sizing, especially in fast food, can be traced to a man by the name of David Wallerstein. In the early 1960s, Wallerstein had realized that the movie business was a truly margin based industry while working at the Balaban Theaters chain. He saw that it was not the minuscule markup on ticket sales where the theaters actually profited, but on the sale of popcorn, soda, and the like. In an attempt to expand profits, he began to sell larger sized popcorn servings for only slightly more money. Sales began to steadily climb, not only of pop-corn, but of high profit cola as well. Later, this theater experience translated into fat dividends at McDonald’s. Wallerstein was asked to solve the dilemma of a la carte style dining at McDonalds. With the profit margins on burgers being slim, and the opposite being true for French fries and soda, his challenge was to find a way to get consumers to buy more of the latter. The birth of super-sizing ensued.19 The value meal, however, can be attributed to two other men, Max Cooper, a McDonald’s franchisee, and John Martin, the savior of Taco Bell. 20,21 The bottom line was this, people perceived value, and perceived value heavily influenced demand. Scientific evidence garnered by recent sociological work has bolstered this concept. As a result, marketplace food portions have increased in size and now exceed federal standards. Portion sizes began to grow in the 1970s, rose sharply in the 1980s, and have continued in parallel with increasing body weights.22

Nominal and Inflation Adjusted Corn Prices (1973-2008)

Chart Via>

You can lead a horse to water; It may just drown itself.

In a recent study, researchers compiled information from two surveys involving 1,000 adults each. One was conducted in 2000 and the other in 2003. In 2000, 7 percent of those surveyed said they ate their entire meal all the time when dining at full-service restaurants. That number rose to 37 percent in 2003. Scientific studies show that people can and do unconsciously consume more calories, as much as 56 percent more, when served larger portions. In these studies, volunteers all reporting equal levels of hunger were served lunch four times over four weeks. Each day, the meal was consecutively increased in size from 500 to 625 to 750 to 1000 grams of food. As the results were analyzed, the researchers were astounded.

As the portion sizes increased for each individual, so too did the consumption by each participantdespite their initial equality in self-remarked hunger levels.23 Essentially, the researchers found you can make someone eat more, almost certainly, simply by putting more food in front of them. Unfortunately, this debate is largely academic at the moment. Dr. Barbara Rolls of Pennsylvania State University recently told a news conference, "In a country where 64 percent of us are overweight or obese, there is an alarming tendency to overlook the sheer amount of food we're eating."24

Leading a horse to water in a puddle; leading a horse to water in a pond; leading a horse straight into Marianas Trench.

Now that it has been established that to make an adult eat more, simply place more food in front of them, we must ask ourselves, how much food has been being placed in front of them? As of 1996, nearly 25 percent of the $97 billion spent on fast food came from items promoted by size. A serving of McDonald’s French fries had expanded from 200 calories in 1960 to 320 calories in the late 1970s to 450 calories in the mid-1990s to 540 calories in the 1ate ‘90s to the current energy for your ‘half-an acre of potatoes’ at 610 calories. The one time 590 McDonald’s meal is now 1550 calories on average.25,26

Conclusions drawn; solutions suggested.

It is now clear that people will eat more if you put more in front of them, and will buy more if you make the items appear slightly cheaper, so the ballooning of the average American plate positively correlates to the ballooning of the average American. American grandeur is eating itself to death. Child obesity, diabetes, coronary heart disease, 300,000 deaths a year, and on, and on, as our waists grow larger, and our lives grow shorter. Unfortunately for many, the problems of their girth are unlike the other fights of the seventies; they cannot be blamed on others or on ‘human nature’ or on ‘your mom’s thighs.’

Although the poor are disproportionately affected, no single group has been able to successfully escape the wrath of the scale. Moreover, the nastiness of public diversion, with various forms of dieting, the fight against fat, proteins, carbohydrates, or pick your nutrient of the week, to all of the various blames, etc. have led to a population with an overwhelming majority overweight and at risk for significant maladies, but where obesity is not confronted boldly nor systemically, especially in childhood, due to fears of ‘self-esteem’ issues. The one universal truth, despite all other attempts, culture or region, race, or class, is portion size. People simply eat too much in a nation of plenty with few boundaries or borders.

The solution I propose here is a progressive tax. Not a ‘fat-tax’ as some have proposed, or a ‘junk-food’ tax as others have, for it is clear that these things are not necessarily causal to obesity. Instead, I propose a progressive portion scale tax. For example, a ‘standard’ 8 ounce can of soda is taxed at the standard sales tax rate of X percent. For any size over this amount, up to double, in this case 15.9 ounces, there is an additional X percent tax. For sizes greater than double, 20 ounce soda bottles for example, the tax rate gets to sin tax levels. Wholesale is exempt, as the intent is not to disrupt business, but to modify consumption. This is justified by the enormous cost to society of obesity, much like the justification for sin taxation on cigarettes, alcohol, and gaming cards.

1 Hill, James O., John C. Peters. Environmental Contributions to the Obesity Epidemic. Science; 280, 1371-1373 (29 May 1998).

2 Ashrafi, Kaveh, et al. Genome-wide RNAi analysis of Caenorhabditis elegans fat regulatory genes. Nature; 421, 268-272 (16 Jan 2003).

3 Mokdad, A.H. et al. The Spread of the Obesity Epidemic in the United States, 1991-1998. Journal of the American Medical Association; 282, 1519-1522 (27 October 1999).

4 Satcher, David (Assistant Secretary for Health and Surgeon General). The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity. U.S. Department of Health and Human Services; 1-5 (2001).

5 Gawande, Atul. The Man Who Couldn’t Stop Eating. The New Yorker, 78 (9 July 2001).

6 Taubes, Gary. DEMOGRAPHICS: As Obesity Rates Rise, Experts Struggle to Explain Why. Science Magazine; 280, 5368, 1367-1368 (May 1998).

7 Strauss, Richard and Harold Pollack. Epidemic increase in childhood overweight, 1986-1998. Journal of the American Medical Association; 286, 2845-2848 (2001).

8 Hood, MY et al. Parental eating attitudes and the development of obesity in children: The Framingham Children's Study. International Journal of Obesity; 24, 1319-1325 (2000).

9 Dullo, Abdul G. A Sympathetic Defense Against Obesity. Science; 297, 780-781 (2 August 2002).

10 Goode, Erica. The Gorge-Yourself Environment. The New York Times, Health, 22 July 2003.

11 As Food Supplies Dwindle…Prices Go Soaring. U.S. News & World Report; 75, 16 (16 July 1973).

12 A Threat of Food Shortage. Time; 55, (9 July 1973).

13 The Great Meat Furor. Newsweek; 81, 19 (9 April 1973).

14 Duscha, Julius. Up, Up, Up Butz Makes Hay Down on the Farm. New York Times Magazine; 73 (16 April 1972).

15 Why a Food Scare in a Lande of Plenty?. U.S. News & World Report; 75, 15-20 (16 July 1973).

16 Andelman, David A. Business in Malaysia. The New York Times; D1 (6 August 1976).

17 Squires, Sally. Sweet but Not So Innocent?; High-Fructose Corn Syrup, Ubiquitous in the American Diet, May Act More Like Fat Than Sugar in the Body. Some Researchers Are Starting to Suspect It's Feeding the Obesity Epidemic. The Washington Post; Health, F01 (11 March 2003).

18 King, Patricia. Blaming it on Corn Syrup. The Los Angeles Times, Health, (24 March 2003).

19 Love, John F. McDonald’s: Behind the Arches. Bantam: New York; 242-246, 296-297 (1986).

20 Kroc, Ray. Grinding it Out: The Making of McDonald’s. Contemporary Books: Chicago; 173-175 (1977).

21 Carson, Teresa. Taco Bell Wants to Take a Bite Out of Burgers. BusinessWeek; 63 (4 August 1986).

22 Lisa R. Young and Marion Nestle. The Contribution of Expanding Portion Sizes to the US Obesity Epidemic. American Journal of Public Health; 92, 2, 246-249 (February 2002).

23 Morris et al. Portion size of food influences energy intake in adults. FASEB Journal; 15, A890 (8 March 2001).

24 Survey: Americans clean their plates, no matter how full. Reuters,

Friday, July 18, 2003.

25 Horovitz, Bruce. Portion sizes and fat content out of control. USA Today; 1 (20 February 1996).

26 Brody, Jane. Fighting the lessons that schools teach. New York Times, D5 (16 April 2002).


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