Food Availability and the “Obesity Epidemic”

I’m taking some nutrition courses these days, and as part of my coursework, I’ve been learning about food availability or food disappearance data. These are data that reflect a country’s total annual food production, imports, and initial stock of food, subtracting out exports, non-food uses of these items, and end-point stockpiles. As such, they overestimate what people eat (because they include in the total food that was spoiled and thrown out, for example), but give a rough idea of people’s food consumption and trends over time. These data have been reliably collected in the U.S. for more than a century (although not necessarily for all foods), so they provide an interesting snapshot of what we are eating. The below information I collected for a class assignment, but I thought it was so interesting it deserved a wider audience and am sharing it here as well.

Since food availability data are available for many foods going back decades, we can observe whether changes in food consumption in the U.S. over time map onto changes in other health indicators. My interest here of course is in obesity, and what people breathlessly call the “obesity epidemic.”

Take a look at this image, which is from the National Institute of Diabetes and Kidney Disease’s page on Overweight and Obesity Statistics (http://www.niddk.nih.gov/health-information/health-statistics/Pages/overweight-obesity-statistics.aspx):

The green-gray area at the bottom of the graph is the percentage of U.S. adults who were classified as overweight in that year; the dark green is the percentage obese, and the gray at the top is the percentage of extremely obese people. I’m a little confused by the graph in that BMI definitions for overweight, obese, etc., changed in the mid-1990s, and I don’t know whether this graph adjusts for that or uses the earlier or later definitions. But for now let’s just assume that the definition of these categories remained constant over time.

What’s interesting about this graph is first of all that there is no epidemic of overweight. The percentage of people in the overweight category has stayed roughly steady over time. (That is interesting in and of itself. Why don’t *both* overweight and obesity increase during this time?) But they don’t: Only obesity and extreme obesity have increased. It’s also interesting to observe that that change happened suddenly. Somewhere between the late 1970s and 2000 is when essentially all of the change occurred, and then it leveled off.

If you believe diet causes obesity (and I’m far from convinced on this point, but many people do believe this), then you should be interested in what on earth might have dramatically changed in Americans’ diets between 1970 and 2000 to explain the change. The change — whatever it was — should have happened at or just before that time, and then leveled off to produce a pattern similar to what we see on the graph.

Food disappearance data should be one of the best sources to examine this question.

Before we look at the data, though: Take a guess. What do you think has changed in Americans’ diets since 1970 that explains the increase in obesity during that time? Really, write it down. Keep yourself honest. Now, let’s take a look:

This article (http://ajcn.nutrition.org/content/91/5/1530S.full; Barnard, 2010) provides some useful tables summarizing food availability data since 1909. If you want to explain the “obesity epidemic” using diet, you should be looking for foods that saw big increases or decreases between 1970 and 2007.
Here’s one relevant table from that article:

TABLE 1

Availability of major food commodities in the United States, 1909–2007¹

	1909	1935	1970	2007
Meats (kg/y)
Meat, total2	56.3	44.6	80.7 (48.3)3	91.2 (54.4)
Red meat	46.2	35.0	60.0 (37.3)	50.3 (31.2)
Poultry	5.1	4.9	15.4 (9.1)	33.5 (19.8)
Fish and shellfish	5.0	4.8	5.3 (1.9)	7.4 (3.4)
Eggs (individual eggs/y)
Eggs, fresh and processed	284.0	270.9	302.2 (238.9)	245.1 (189.6)
Dairy products (kg/y)
Fluid milk, total	133.7	129.1	122.3 (86.2)	81.0 (57.0)
Whole milk (plain and flavored)	105.0	109.5	99.6 (70.1)	25.0 (17.5)
Low-fat and skim milk	28.7	19.7	22.7 (13.3)	56.0 (35.0)
Cream	5.6	5.7	1.8 (2.3)	3.8 (0.0)
Butter	8.1	8.0	2.5 (2.0)	2.1 (1.7)
Cheese, whole and part-skim milk	1.7	2.4	5.2 (4.0)	14.9 (11.2)
Cheese, cottage	0.3	0.6	2.3 (1.6)	1.2 (0.8)
Frozen dairy products	0.7	3.8	13.0 (9.1)	11.5 (8.0)
Evaporated and condensed milk	2.8	8.5	5.5 (3.8)	3.5 (2.5)
Dry milk	NA	0.8	2.6 (2.5)	1.5 (1.4)
Added fats and oils (kg/y)
Added fats and oils, total	16.1	21.8	25.3 (17.5)	39.4 (25.9)
Butter	8.1	8.0	2.5 (2.0)	2.1 (1.7)
Margarine	0.6	1.4	4.9 (3.9)	2.0 (1.6)
Lard	3.1	4.4	2.0 (1.0)	0.7 (0.4)
Edible tallow	NA	NA	0.2 (0.1)4	1.3 (0.7)
Shortening	3.6	5.5	7.9 (5.3)	9.5 (6.4)
Salad and cooking oils	NA	NA	7.0 (4.4)	22.8 (14.5)
Other fats and oils	0.7	2.7	1.0 (1.0)	0.8 (0.7)
Peanuts and tree nuts (kg/y)
Peanuts	NA	NA	2.5 (2.1)	2.9 (2.4)
Tree nuts	NA	NA	0.8 (0.7)	1.5 (1.3)
Fruit and fruit juices (kg/y)
Fruit and fruit juices, total	NA	NA	79.3 (49.3)	96.8 (60.2)
Fresh fruit	NA	NA	43.7 (19.2)	54.4 (24.5)
Fruit juice	NA	NA	22.0 (18.5)	32.5 (27.5)
Other processed fruit5
Canned	NA	NA	10.6 (9.0)	6.4 (5.4)
Frozen	NA	NA	1.5 (1.3)	2.1 (1.8)
Dried	NA	NA	1.2 (1.0)	1.0 (0.8)
Other process	NA	NA	0.3 (0.2)	0.4 (0.3)
Vegetables (kg/y)
Vegetables, total	NA	NA	103.4 (67.7)	130.0 (80.3)
Fresh	NA	NA	65.6 (37.3)	85.0 (45.1)
Canned	NA	NA	22.9 (19.3)	21.3 (18.0)
Frozen	NA	NA	9.8 (6.8)	17.7 (12.0)
Grains (kg/y)
Flour and cereal products	136.4	92.7	62.0 (43.2)	89.5 (62.6)
Caloric sweeteners (kg/y)
Total caloric sweeteners	NA	NA	54.1 (38.5)	62.0 (44.1)
Cane and beet sugar	NA	NA	46.3 (33.0)	28.2 (20.0)
Corn-based sweeteners	NA	NA	7.2 (5.1)	33.1 (23.6)
Syrups and honey	NA	NA	0.7 (0.5)	0.6 (0.5)

 

Here’s another:

TABLE 2

United States per capita beverage availability, 1970–2007¹

	1970	2007
	L/y	L/y
Milk	118.3	78.2
Whole milk	96.5	24.2
Other milk	21.9	54.0
Carbonated soft drinks	127.32	184.8
Fruit juice	20.9	31.0
Bottled water	6.23	110.0
Beer	70.0	82.5
Wine	5.0	9.3
Distilled spirits	6.9	5.4

 

In looking at the table, there were reasonably big increases in the following foods between 1970 and 2007: poultry, low fat and skim milk, cheese, salad and cooking oils, whole fruit and fruit juices, vegetables (mainly fresh and frozen), grains, corn syrup, and non-milk beverages, especially soda, water, and beer and wine. (The article notes something the table doesn’t — most of that increase in soda is an increase in diet soda, NOT sweetened soda).

Big decreases happened with milk, red meat, eggs, and sugar.

So, what do you make of that? Which of those changes do you think most plausibly relate to the change in obesity, and why? (Or do you think none of these factors explain it, and why?)

My own take is that either these changes do not explain the increase in obesity at all (they seem to be mostly relatively small changes), or if a change is partially responsible, then these are my votes for which foods are plausible:

• The increase in poultry might be responsible, if antibiotic residues in poultry are causing changes in the human gut microbiome (e.g., see Riley, Raphael & Faerstein, 2013)
• Perhaps high fructose corn syrup
• Perhaps diet soda, particularly since diet soda consumption may be a marker for dietary restriction, which may lead to weight gain
• Maybe the increase in grains or cooking oils?

I’d be curious to hear your take…..

(And here are the references for this post:

Barnard, N. D. (2010). Trends in food availability, 1909–2007. The American journal of clinical nutrition, 91(5), 1530S-1536S.

Riley, L. W., Raphael, E., & Faerstein, E. (2013). Obesity in the United States–dysbiosis from exposure to low-dose antibiotics?. Frontiers in public health, 1.)

 

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Why Does Health At Every Size Work?

We know that non-weight-loss, body acceptance approaches to health (sometimes called Health At Every Size) can work in terms of helping people at a range of weights achieve better markers of physical health. For example, several randomized controlled trials have shown improvements in cholesterol and blood pressure in “overweight” and “obese” women using these approaches. But how?

Generally these approaches don’t cause weight loss — they’re not designed to cause weight loss, and the focus is on body and self acceptance. One answer may lie in the lifestyle improvements women in these studies made. Various studies found that they became more active, and/or ate a higher quality diet, and/or engaged in less binge eating. So maybe it’s simply those positive changes that caused the physical improvements.

For hypertension especially, though, I wonder if some improvement was due to the effect of body acceptance interventions on either self-esteem, body image, or experiences of anti-fat bias and discrimination. The link between exposure to racial discrimination and hypertension among African-Americans (who are at relatively higher risk for hypertension) is well known, and researchers have learned some interesting things about that relationship. For example, internalized negative attitudes towards African-Americans are even more strongly predictive of poor heart health among African Americans than perceived discrimination. In addition, perceived ethnic density — that is, reporting that you live in a community with lots of other people of your ethnicity — may buffer some of the effects of racism on health in general among minority communities.

Perhaps connecting to a community of other higher-weight folks who are practicing body acceptance, standing up to size-based discrimination, and challenging their internalized anti-fat bias is what leads to some of these improvements, not just better eating and exercise.

People Dancing (Part 1 of a series)

In case you need some models for some aspect of your own life that feels impossible to you now, I’m starting a People Doing Things series on this blog to help you visualize or locate people who look like you doing things you’d like to be doing. I’m aiming to illustrate human diversity, but each post — of course — will not be comprehensive. Pingbacks are permitted on this blog, so feel free to link here if you have an example on your own blog of People Doing Things, and I will update the post to show your suggestions!

To begin with, let’s look at photos, videos, and blogs of people dancing!

That’s Ragen Chastain dancing, by the way. You can read her dance blog here.

Listen to Big Moves’ NPR Interview

Visit Big Moves dance studio for classes, shows, etc.

Trailer for the movie Everyday Dancers

The UK’s Ballet Black:

PSA for the scholarship program of the City Ballet of Los Angeles:

Trailer for a show by the UK’s StopGap Dance

The Prometheus Dance Company’s Elders Ensemble

That’s Kim Tanri, artistic director of the Japanese-Malaysian performing arts group Taihen, which I think is pictured here:

Cuba’s Danza Voluminosa:

(Hat tip to Body Impolitic for the pointer both to Danza Voluminosa and Taihen)

The Black Swan Diaries

Wheelchair Dancer:

Los Hermanos Macana do tango:

Tango with three dancers

A lone dancer practicing in hir studio:

Research Round Up Part 3: Weight, Shape, and Mortality

So, you’re with me thus far: Diets don’t work to help people lose weight. “Healthy lifestyle change” doesn’t help people lose weight (nor is it clear that it helps people get healthy, actually, but more on that later). Your failure to feel better by changing your body shape or size may be beginning to make sense in context: You can’t do it, because apparently it can’t be done.

But what about your health? No less an authority than the Centers for Disease Control is standing ready to persuade you that obesity is a terrible public health epidemic. One would think that getting or staying thin must be a prerequisite to a long, healthy life.

Let’s look at that idea a bit more closely. To do that, we start with your BMI, your Body Mass Index. The BMI is a measure of body size that is less crude than a simple weight measurement in that it corrects for expected variation in weight due to height. (I said it was less crude. I did not say it was elegant.) Research done on obesity often uses BMI as its outcome measure.

Here, let’s calculate your BMI.

Mine comes out at about 27, which puts me in the “overweight” category. If you run the widget, you’ll see it places you into one of four categories.

• underweight (BMI < 18.5)
• normal weight (BMI 18.5-24.9)
• overweight (BMI 25-29.9)
• obese (BMI >= 30)

Researchers usually also distinguish between

• mildly obese (BMI 30-34.9) and
• moderately/extremely obese (BMI >= 35)

Click here to see if you can put these categories in order by risk of mortality. Which category has the highest mortality risk? Which has the lowest?

Are you surprised by the correct answers? All of the large, epidemiological studies of which I am aware on this topic have ALL come up with this same rank ordering of mortality risk.

So if “longevity “is a decent proxy for “better health,” then the fabulous “mildly obese” Kate Harding

is “healthier” and can expect to live longer than the apparently “normal-weight” Beyonce:

And the “moderately/extremely obese” fashion icon Lesley Kinzel

is in better health and can expect to outlive apparently”underweight” Angelina Jolie:

A quick note: In looking at these photos, I encourage you to check your body policing urges at the door. I am not claiming that any of these prominent women is or is not healthy, or does or does not lead a “healthy lifestyle” (whatever that means), as I don’t have any data to address those questions and am not inclined to police the private, personal behavior of individuals even if I did. I set these pictures side-by-side as vivid illustrations to encourage you to challenge your stereotypes about body shape and health and marvel about the inaccuracy of the messages you might have received about that. They’re not here so you can trade one set of unrealistic expectation about what is “healthy” for another.

Does “Healthy Eating” Lead to Body Change? Research Roundup, Part 2

Of course, even Weight Watchers claims that “diets don’t work; weight watchers does.” Diets may not work, you might be thinking, but what about “healthy eating” or “healthy lifestyle change”? Surely if you eat right you will lose weight, right?

Not so fast. The Women’s Health Initiative Dietary Modification Study was the largest, most extensive, experimental study of “healthy eating” ever conducted. More than 48,000 older women (ages 50-79) were randomly assigned to either eat their usual diet, or eat a low-fat, high fiber, diet with lots of vegetables, fruits, and whole grains — the essence of what most people think of as “healthy eating.”(They chose older women because they wanted to be sure there would be enough incidence of disease among the participants to detect differences between the groups after several years of follow up.)

The women in the intervention group had intensive, state-of-the-art support to maintain their diets  — an intensive initial group treatment led by nutritionists, followed by a long-term maintenance intervention group that met regularly over the course of the study, individual counseling, and personalized feedback on their dietary targets and progress.  They ate this diet and continued in the intervention program (and were compared to their control-group counterparts) for an average of 8 years of follow up.

They weren’t perfect at maintaining their target diets, of course, but they were pretty good: As Sandy Szwarc notes, “The women in the healthy eating intervention group cut their total fat intakes down to 24% of their calories and 8% saturated fat the first year — well below the control group eating about 38% total fat and nearly 40% more saturated fats. By the end of the study, the “healthy eaters” were still averaging 29% fat, compared to 37% in the control group. The “healthy” dieters also ate about 25% more fruits and vegetables, grains and fiber than the typical American diet of the control group.”

So, what do you suppose were the benefits of the healthy diet these women maintained faithfully for 8 years?

• There was no advantage in terms of cardiovascular disease, including heart disease and stroke, for the healthy eating women.
• There was no advantage in terms of breast cancer, colorectal cancer, or any of 30 other cancers, except possibly ovarian cancer, and the researchers note that this one, modest, effect, may be due only to chance.
• And despite maintaining a restricted diet for 8 years — at follow up, they were eating an average of 361.4 kcal/day less than they had been eating at baseline — these women lost a total of about one pound, on average, compared to the women who ate as they pleased.

These women successfully changed their eating lifestyles for 8 years: more fruits and vegetables, more whole grains, less fat, less calories. Classes, nutrition groups, hearing feedback about how they were doing. (“Couldn’t you cut out the chocolate, Ann-Marie?”) Yet they didn’t do better in terms of cardiovascular health, or cancer. They lost only a pound, for 8 years of effort. Would that be worth it to you?

(Sandy Szwarc has an excellent series on this study if you’d like to read more about it.)

It’s Not Just You: A Research Round Up, Part 1

If you feel like a failure in your efforts to change your body, lose weight, and achieve happiness, you’re not alone.

Efforts at weight loss and body change, especially through dieting, are common: nearly 50% of men and 75% of women report dieting at some point. Americans spend about $35 billion — more than $100 for every man, woman, child, and infant — every year on weight loss products, according to this article from CBS news. Researchers have also gotten in on the act: The National Institutes of Health spent $147 million on obesity research in 2010, more than it spent on breast cancer, lung cancer, and stroke combined.

But all that scientific, entrepreneurial, and ordinary human effort expended hasn’t achieved much more than your own efforts have. If you’ve tried, and failed, to lose weight, it isn’t your fault.

There is little evidence that any weight loss diet — even the state-of-the-art scientifically supported diets that are generally studied in randomized controlled trials — is effective over the long term. In fact, as many as two thirds of dieters in clinical trials regain more weight than they lost on their diets. Also, weight loss research is biased toward showing successful results, so clinical research on weight loss probably underestimates the extent to which dieting is counterproductive.

The news may be worse in non-laboratory, real-world situations. Among adolescent girls, self-reported dieting, exercise for weight control, and dietary restraint actually predicted weight gain and the onset of obesity over long-term follow up, a finding that’s been replicated in several studies.

As Kate Harding said, diets don’t work. (And no, “lifestyle change” doesn’t work as a weight loss tactic, either. That’s part 2. Coming attractions.)

Happy Anorexics

So, did you figure out why? What are the reasons you have engaged in a struggle with your body? Do you want to feel better about yourself? Do you hope to feel more confident, less self-conscious, sexier, more accomplished, more energetic, more optimistic, happier?

So: How’s that working for you? How far have your efforts brought you to these positive feelings? Maybe you already know that they have not in fact brought you closer either to solving the problem or achieving happiness — that in fact your problem has become larger and your self-hatred and unhappiness more intense.

But that’s only because these strategies haven’t worked, right?

If only you could have the body you dream of…

If only you were thin…

Then, then you would be happy.

You may not know how to get there, but you know that if somehow you could, your life would begin.

But consider the situation of people with anorexia. People with anorexia, by definition, have been successful at achieving thinness. One stringent definition of Anorexia Nervosa requires sufferers to have a BMI of 17.5 or less.

A BMI of 17.5 or less is not necessarily what you may think of as “emaciated.”

Toronto model Caroline Savage has a BMI of 17.5:

Puerto Rican model Ana Delia D has a BMI of 17.5

Toronto model Sara Balint has a BMI of 17.5

U.S. model Kelli Kickham has a BMI of 17.5:

People with anorexia often look like supermodels. They’ve achieved what you may be imagining. And yet, despite having achieved a supermodel-like ideal of thinness, they are not happy. In fact, people with anorexia are more likely to die by suicide than people with any other DSM-IV mental disorder, including depression and schizophrenia. If being thin and having a model’s figure worked to bring self-confidence, happiness, and self-esteem, eating disorders treatment centers should be filled with happy anorexics.

This is a new, and lovely, eating disorders treatment hospital. Does it look like a place of happiness to you?

Achieving thinness doesn’t bring happiness. Indeed, the evidence suggests it may bring misery.

Cinderella Ate My Daughter!

Fantastic review of Peggy Orenstein’s new book and an interesting historical overview of how children got color-coded at About-Face.

If It Hasn’t Worked, Why Do It?

If the strategies you’re using to feel better about your body haven’t worked, why are you still using them?

More than 60% of American women ages 25-45 say that they are currently trying to lose weight.  75% have disordered eating patterns. (Note that the second link is to a popular press article that describes the study in the first link.)

Is dieting a strategy you have tried? Have you engaged in other strategies to change your body to make it more appealing or acceptable?

• Eating disordered behaviors?
• Fasting?
• Exercise?
• Surgery?

Even if you realized a long time ago that none of these strategies worked in a long-term way, you may have continued to engage in them. Even if these strategies don’t change your body, they may offer other benefits.

It’s interesting that the reasons people give for dieting are similar whether they are:

• normal weight adolescent girls on their first diets,
• underweight women with Anorexia Nervosa,
• or fat men or women seeking medical treatment for weight loss.

Losing weight “for health reasons” is sometimes given as a reason for dieting, especially among fat people seeking weight loss treatment. But health isn’t the only reason people give. For many people, the most important reasons to diet have to do with pleasing others, looking better (in order to feel better about themselves), and improving unhappy moods. Teenage girls beginning their first diets say they did it “because I was depressed” or “unhappy with myself.” Women with Anorexia say that the eating disorder “makes me feel good about myself” or “makes me feel accomplished.” 15% of overweight or obese people seeking weight loss treatment in one study reported that the major reason they sought to lose weight was not health or appearance, but to improve their mood.

Is your mood state linked to your body shape? Why?

What motivated your first efforts to change your body?

• Was it being teased by peers?
• Negative body comments by the people you loved about themselves?
• Negative body comments by the people you loved about you?
• Being told to lose weight, by a parent, a peer, a lover, a doctor?
• Noticing that your body looked different from someone else?
• Or is the link between “feeling bad” and “feeling fat” less obvious to you?

What are your reasons for engaging in strategies to change your body and eating?

The Solution To Your Problem

If you made a list of all the strategies you’ve tried to solve your body problem last week, I left you with a cliffhanger. You evaluated all of the strategies you have already tried, so now that you’ve considered them, I have some questions for you.

• How old were you when your problem with weight, shape, food, or body image came into your life?
• How old are you now?
• How many years have passed since this problem entered your life?
• And since the problem entered into your life, has the problem gotten better, gotten worse, or stayed about the same?

So what does that mean?

I don’t even know you, but I have a guess about the pattern you have just described here. Does this sound familiar?

• You have worked hard, for many years, trying to solve your problem with weight, shape, body image, and food by every logical means.
• You have put in a good-faith effort. You have tried unbelievably hard.
• Nevertheless, despite all your efforts, here you sit, years later, with a bigger problem than you had when you started, or at least a problem that is no smaller or easier to solve.

Is that the case for you? How does that feel?

Does it feel hopeless?

Or are you reading this blog with one last hope? Maybe this stranger on the Internet really has it, the solution, that once-and-for-all magic that will fix this problem in a way none of your previous efforts ever have. One more try. Maybe this time will be the charm.

Well. I have some terrible news for you. I don’t have the solution. You’ve done everything I can think of, and probably many things I could never think of, to solve your problem with weight, shape, food, and body image, and yet the problem is still here, big as life and twice as distressing. I don’t have any magic wand to control something that you, with all your best efforts, have been unable to control.

All I can offer you are some images:

When you go into a casino, go up to a slot machine, and insert a coin, what do you hope will happen?

If you take a roll of coins to this slot machine and play, it is likely that you will win: a little bit, here and there, just enough that you may feel tempted to keep playing. Not only that, if you look around, you will see evidence – flashing lights and clinking coins — that some people win big.

But what happens if you keep playing, roll after roll of quarters, for days, weeks, months on end?

You lose money. And the longer and harder and more faithfully you play, the more you lose, even though — as gambling addicts can tell you — from time to time you may be ahead, you may be winning. Why is this? Why is it that gambling addicts always lose money — entire fortunes! — despite dedicated effort, over many years, in a place expressly designed to address their hopes to win big?

The reason is very simple: Because the game is rigged.

Could it be that the same is true for your game? Your dieting, weight loss, self-hatred game?

Look back over your list and see if this is true: Did your problem ultimately get worse every time you tried to make it better? (Don’t be like the gambler, who brags about the small wins without admitting to the much bigger losses – look at the net change for you over time.)

If the problem got worse every time you tried to make it better,  is it possible that the solutions may be part of the problem?