Clemente Botelho

Changing the Obesity Landscape

Drive through town. It appears yet again, now in the form of fast-food restaurants that promise you a quick fix to your hunger, thirst or boredom.  

“It” is everywhere—at the mall, in the workplace, on TV and the Internet. We’re surrounded by an intoxicating surfeit of food that is cheap, calorie-laden and easy to prepare or obtain. Our “obesogenic environment” promotes a single theme: Eat. Drink. Consume.  

The effects are obvious: Two-thirds of American adults are overweight or obese. Obesity among American children has more than tripled in the past 30 years. And chronic diseases associated with obesity are rising. 

In response to this health crisis, Bloomberg School researchers are pursuing a broad range of strategies aimed at changing our social, cultural and physical landscape. Their goal: Paint a new canvas that encourages healthy eating and physical activity.

Change the food system

Try this: Walk into a grocery store with $20. With half your money, purchase packaged foods and snacks (macaroni and cheese in a box, cookies, chips). With the other half, buy fruits and vegetables. Then calculate the calories in each set of purchases.  

Chances are, your processed food dollars will buy you many times more calories, and far more of them will come in the form of fat and sugar, says Robert Lawrence, who credits Hopkins anthropologist Sid Mintz for the idea behind this thought experiment. 

Our agriculture system makes producing fat and sugar relatively inexpensive, notes Lawrence, MD, director of the School’s Center for a Livable Future (CLF). “We have a food industry that is scientifically designed to addict us to a combination of fat, sugar and sodium as high as it can be in calories,” he says. 

The solution: Change the system. Admittedly no small task, says Lawrence, the Center for a Livable Future Professor. He says he’d start with the Farm Bill. Many of his colleagues in health policy and nutrition agree. 

The omnibus bill governing much of the nation’s agriculture and food policy is currently at $284 billion, and large portions of that funding support select agriculture sectors. In 2009, corn producers received $3.9 billion, soybean producers $1.7 billion, and wheat producers $2.2 billion.  

Such funding may indirectly fuel the obesity epidemic, says Roni Neff, CLF research and policy director. Corn, for example, is cheap to produce, and therefore so is high-fructose corn syrup, the sweetener in most sodas. And increased soda consumption is a leading suspect in the search for culprits fueling the obesity epidemic. 

In addition, farm policy encourages overproduction, notes Neff, PhD ’06, MSc. American farmers produce almost 4,000 calories per person per day. “So there are profits to be made from convincing us to eat as much as possible of this surfeit,” she says. 

She and Lawrence say they’d like to shift that balance, so that more financial incentives go toward producing a healthy food supply, including support for farms that grow a mix of foods, such as grains, fruits and vegetables. Farm policies might also address the overproduction issue by promoting conservation and assuring farmers a more stable living, thus reducing their need to maximize production. 

Neff and others at the CLF are dissecting the different streams of funding in the Farm Bill to see where each goes—toward fruit and vegetable production, meat production, sustainable agriculture, etc. They are also developing a set of policy briefs describing how various parts of the bill affect public health and are working to develop farm policies that would better support public health. Preliminary hearings have begun on the current round of the Farm Bill, which is expected to come up for a vote in 2012. “There is more public health interest in the Farm Bill than ever before,” says Neff. 

Adds Lawrence, “We are starting to demonstrate a connection between a universal health problem and our food supply.”

Share the power to change 

On a steamy hot August afternoon, several thirsty teenagers walk into a West Baltimore corner store and head to the refrigerators, where cold soda, juice drinks and water await. As they open the refrigerator doors, they may—or may not—notice the fluorescent sign above: DID YOU KNOW THAT WORKING OFF A BOTTLE OF SODA OR FRUIT JUICE TAKES 50 MINUTES OF RUNNING? 

Many people apparently do not know, says Sara Bleich, an assistant professor in Health Policy and Management. But she is testing the idea that such nutritional information can persuade consumers, specifically teenagers, to cut down on the number of empty calories they consume. 

Bleich, PhD, admits that changing people’s behavior is a huge challenge, one made especially difficult given the marketing competition. Of the many billions of dollars spent on food advertising, almost 70 percent goes toward promoting convenience foods, candy, snacks, soft drinks, alcoholic beverages and desserts, according to one assessment, while ads for fruits and vegetables, grains or beans account for only 2 percent. Plus, in corner stores a can of soda costs as little as 60 cents, while a bottle of water is usually a dollar or more. 

Studies examining the persuasive power of information on food choices have shown mixed results. For instance, a report on a two-year-old New York City law requiring that franchise restaurants post calorie counts of their foods concluded that the law had no effect on the number of calories consumers purchased. A second study, however, showed that calories purchased did decline at one specific category of restaurants: coffee shops. 

In her study, Bleich and graduate student Desmond Flagg are targeting teenagers in a largely African-American neighborhood. Obesity among African-American teens is 25 percent. The success of her information campaign could depend upon the type of information conveyed. In their study, Bleich and Flagg are comparing different messages about sweetened drinks. 

In addition to the poster about running, other signs point out how many calories a bottle of soda or fruit juice has or what percentage of one’s daily recommended calories it contains. Flagg, a C. Sylvia and Eddie C. Brown Community Health Scholar, posts a sign and then records the beverages that teenagers purchase. At the end of the study, he and Bleich will compare the results for the different signs. 

Targeting sweet drinks is a tactical choice, says Bleich. These beverages are laden with sugar and calories. A 12-ounce bottle of cola, for instance, contains the equivalent of about 10 teaspoons of sugar. And sweetened drinks (mainly soda) make up 16 percent of the calories teens consume, says Bleich. “So if you can pull that out of the diet, it can have a big impact.”