Obesity-US will try anything to fight obesity and boost health

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US will try anything to fight obesity and boost health


03 April 2013 by Jessica Hamzelou





IT'S no secret that the US has a weight problem, but the numbers are staggering: over one-third of US adults are obese. Cases of heart disease, type 2 diabetes and strokes – which kill hundreds of thousands each year and are linked to obesity – are set to multiply tenfold between 2010 and 2020. By 2030, the annual medical bill for the nation's bad eating habits could top $66 billion.

Statistics will not scare people into better health, though. "The big question is: how do you encourage folks to eat better?" says Steven Carlson at the US Department of Agriculture.

Carlson and his colleagues at the USDA and the Massachusetts Department of Transitional Assistance are trying to answer that question. Through a programme called the Healthy Incentives Pilot (HIP), they have put themselves at the forefront of a growing war on obesity that involves elements of federal, state and local governments, researchers, and even private industry. No one knows what strategy will ultimately work, so everything is being tried. The initial results are encouraging.

The idea behind HIP is simple: make healthy foods more affordable. Over 14 months, from November 2011 to December last year, 7500 residents of Hampden, Massachusetts, who get government assistance when buying groceries, received 30 cents of food-buying credit for every dollar of their allowance that they spent on fruit and vegetables.

Carlson and his colleagues are still in the process of evaluating the impact of the HIP scheme, but he says: "We have some pretty strong indications that this investment did increase the amount of fruit and vegetables consumed by these low-income families."

Elsewhere, health insurance company Humana is offering broad incentives through its Vitality initiative. Clients who sign on have their health assessed and then collect points for healthy activities. Each time a member visits the gym, for example, they can swipe a card to receive points. "You can use those reward points for an Amazon gift card or a pedometer, or to book a vacation," says Stuart Slutsky, who oversees product development at Humana Vitality.

Humana has started offering the Vitality scheme as a standalone product, without insurance, to other companies. Car manufacturer Toyota, which employs about 30,000 people in the US, has enrolled its employees in the scheme. Some signed-up companies have even taken things a step further, imposing financial penalties on employees who fail to make the most of the scheme.

Chew on this

Plans like Vitality have been in place in South Africa and the UK since the late 1990s, and members have already reaped rewards. Within a year of enrolling, for example, companies in South Africa saw employees shedding excess weight and rates of high blood cholesterol also fell.

Clients signed to the insurance programme are also encouraged to buy healthier foods at Wal-Mart, the largest food-seller in the US. Last October the company began labelling fruits, vegetables and low-fat, low-sodium food items with a "Great for You" icon. Members of the Humana Vitality scheme get a 5 per cent discount on these items. "So far we've seen very strong shopping trends for our members as they're activating the benefit," says Slutsky.

Another obvious approach is to make unhealthy foods more expensive. But fat taxes don't go down well in the US or elsewhere. A recent attempt to impose a tax of 16 Kroner (then about £1.50) per kilogram of saturated fat in food products in Denmark failed, as Danes started heading over national borders to buy their fix of cheap, fatty foods. Sugar-sweetened beverages, on the other hand, represent a clear-cut target, says Roberta Friedman at Yale University's Rudd Center for Food Policy and Obesity.

"We've got such solid science that shows there is a relationship between consumption of sugar-sweetened beverages and type 2 diabetes, cardiovascular disease, gout and tooth decay," she says. It is thought that sodas contribute about 7 per cent of the caloric intake of the average US citizen. "They don't offer any nutrition... and there's proof they're damaging to your health."

The prevailing sentiment among health researchers is that a penny-per-ounce tax on sugar-sweetened drinks would significantly reduce their consumption and improve public health. Such a tax would increase the cost of a 20-oz (568-millilitre) soda by about 20 per cent.

"A 20 per cent rise will have a bit of an impact, but it may not be enough," worries neuroendocrinologist Robert Lustig at the University of California, San Francisco, who treats children with obesity-related illnesses. But a study published last year offers hope. It concluded that a nationwide penny-per-ounce tax would decrease overall consumption of sugar-sweetened beverages by 15 per cent among 25 to 64-year-olds. Over 10 years, such a reduction would avert 95,000 coronary heart events, 8000 strokes, and save more than $17 billion in medical costs alone, the study's authors claim (Health Affairs, doi.org/fxmjjq).

A bill introduced in the California legislature by Democrat senator Bill Monning aims to do exactly that. "Senate Bill 662 would place a 1 cent per fluid ounce excise tax on sugar-sweetened beverages, and the money collected would go to a California children's health promotion fund," Monning says.

Attempts to put such a tax in place in other states have so far proved unsuccessful. "There have been huge amounts of money and lobbying from industry," says Kelly Brownell at the Rudd Center. He likens the beverage industry's strategy to that of tobacco companies in the 1950s. "They've gone right with the tobacco playbook," he says. "But people are becoming highly sceptical of the companies. They're probably not going to be able to lobby their way out of this for much longer."

Public health researchers are pinning their hopes on Monning's bill. "California leads the country; we're a laboratory of democracy," says Lustig. "It will happen here before it happens anywhere else. But is California ready for a soda tax?"

It might just be. A recent survey by Field Poll suggests that 68 per cent of Californians favour the bill. "California has always been a pioneer and an innovator," says Monning. "We don't underestimate the uphill nature of this fight... but we see a growing public sentiment that is supportive and that will hopefully move legislators forward on this issue."


Eating with your eyes

Tweaking food prices may be the best way to alter eating habits, but playing tricks on our eyes works, too.

All it takes for schoolchildren to choose a carton of milk over a chocolate drink, for example, is moving the chocolate drink to the shelf's back row. "The consumption of chocolate milk goes down because people like to pick up what they see first," says Kelly Brownell at Yale University's Rudd Center for Food Policy and Obesity.

Similar tactics could be employed to prevent people from overeating. After the age of 3, we tend to stop regulating our food intake by when we feel full, and instead finish what's in front of us.

But people do tend to regulate their intake when a serving is partitioned. Individuals ate fewer Pringles, for example, when they encountered a red-coloured crisp after every seven they consume (Health Psychology, doi.org/kzr). Elongating a packet of crisps can also lead a person to think they are eating more than they are. The same goes for the shape of a vessel a person drinks out of: taller, thinner glasses can trick a person into thinking they have consumed more than if they had drunk the same amount from a shorter, wider vessel.



Source: www.newscientist.com