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David Wallinga, M.D.

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Challenging the Obesity System

Posted: 04/09/10 03:50 PM ET

Last month, to great fanfare, First Lady Michelle Obama announced her Let's Move initiative to combat childhood obesity.

Tuesday's signing of the historic health reform bill assures that more children, once obese, will actually be able to get treatment for it. The bad news is how ineffective and expensive most obesity treatment actually is. America currently spends $147 billion a year on obesity-related illness.

What's been missing historically is any recognition that the biggest bang for our taxpayer dollars is to prevent kids from getting overweight and obese in the first place. And that's why the White House initiative is so important. It starts the process of making kids' food in schools and communities healthier.

But ultimately, we need to put a spotlight on the fact that our national obesity epidemic is but a single symptom of a more serious illness: our unhealthy food system.

In order to prescribe healthier food, we must rethink the entire system, from the farm to our children's mouths. We wrote about the need for this healthier food system in this month's Health Affairs, which was devoted to child obesity.

Researchers now link obesity with diets rich in added sugars, fats, and refined grains, and of course in the snacks, sweets, beverages and fast foods in which they are so prominent. According to U.S. Department of Agriculture data, in 2007 Americans' average daily calorie intake was 400 calories higher than in 1985, and 600 calories higher than in 1970.

Suprising to many is that the ultimate source of so many of these added calories in the American food supply can be traced to two crops: corn (sweeteners) and soybeans (fats and oils).

But it shouldn't be surprising. For the past 35 years, U.S. farm policy has incentivized the production of a few commodity crops (like corn and soybeans), and the calories that come from them.

In the early 20th century through the 1950s, production of these crops was seen as essential to addressing under-nutrition in the U.S., and throughout the world. U.S. farmers responded by dramatically increasing yields -- up to 600 times higher now than in 1920.

At the same time, depression-era farm programs recognized that overproduction of these crops risked the prices for them plunging below what farmers needed to make a living, or rising above what consumers could afford. As a result, these programs managed supply of these commodities, to keep prices relatively stable, and to keep farmers in business and making money.

But from 1965 through 1996, these supply management programs were gradually dismantled. U.S. farm policy today is designed instead to encourage farmers to grow as much as possible of these few commodity crops, utilizing several different types of subsidies, crop insurance and taxpayer-supported research. Quite rationally, farmers have followed these policy signals, making significant capital investments (new combines, irrigation systems, etc.) to produce these crops.

As a cheap calorie policy, U.S. farm policy has been a success. Foods high in fats, sugars and calories, such as cooking oils, snacks, fast foods and sugared sodas, are some of the cheapest foods in the American diet. But for public health, U.S. farm policy's focus on a few commodities is outdated.

We know, for example, that diets rich in fruits and vegetables can help manage weight and lower risks for cancer and other chronic diseases, especially when they replace calorie-dense, nutrient-poor foods. Yet fewer than one in 10 Americans meet the levels of fruits and vegetable consumption recommended under the latest calorie-specific, healthy eating guidelines. And farm policy historically has overlooked incentives for fruit and vegetable production.

So how do we get farm policy and public health on the same page?

As a start, the executive branch needs to pull together disparate health and agriculture communities around food policy. There needs to be a Healthy Foods Commission -- and it has to be independent. Such a commission, comprised of non-governmental public health, agriculture and food system experts, could work closely with the Administration's Task Force on Childhood Obesity to ensure upstream and downstream food system goals are mutually reinforcing.

Second, America's farmers have got to be key partners in this healthier food system. If the nation is serious about making fruits, vegetables and other healthy foods more accessible, policymakers need to offer at least as much research, financial and other support to growers of these foods as has been offered for decades to growers of commodity crops.

Specific policies to accomplish this might include: reinstating programs to manage oversupply of commodity crops and calories; support for current farmers transitioning from commodity to other crop production; new farmer recruitment, financing and training; an agriculture research agenda that includes a more diverse mix of crops and farming methods; and allowing farmers growing fruit and vegetable to participate in commodity programs of the farm bill.

Third, we need to raise the standards for the National School Lunch and Breakfast programs. These programs should be required to meet the USDA's healthy eating guidelines and this should be codified in the Child Nutrition Act, expected to be voted on soon by Congress.

Today, the quality of the calories produced by U.S. agriculture may be at least as important as their quantity. For us to make long-lasting progress on obesity, we must heal the symptom's source: an unhealthy food system. Let's move!

 

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Last month, to great fanfare, First Lady Michelle Obama announced her Let's Move initiative to combat childhood obesity. Tuesday's signing of the historic health reform bill assures that more childre...
Last month, to great fanfare, First Lady Michelle Obama announced her Let's Move initiative to combat childhood obesity. Tuesday's signing of the historic health reform bill assures that more childre...
 
 
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04:22 PM on 04/12/2010
Bring back ephedra the best weight loss supplement. Just because a few people overused this herb and died isn't sufficient reason to ban it. It would go a long way towards reducing our obesity epdemic as would banning high fructose corn syurp.
12:46 AM on 04/13/2010
I Agree. The medical evidence showing that ephedrine/caffeine is safe and effective is so strong that obesity scientists organized an international symposium to encourage the medical industry to use it to treat obesity. Scientists from all over the world published papers from this symposium in Supplement 1 of the Feb 1993 issue of the International Journal of Obesity and Related Metabolic Disorders.

The problem with ephedra based diet products is that the Pharma cartel can't patent them and make a fortune by selling them as prescription diet pills. Every product is used improperly by a small percentage of people. The FDA took advantage of this and banned ephedra. They will, no doubt, be rewarded by the well known revolving door employment (payoff) between the pharmaceutical industry and well behaved FDA bureaucrats.

And obese people will suffer the loss of this well researched, state-of-the-art weight loss combination.
02:31 PM on 04/12/2010
"But ultimately, we need to put a spotlight on the fact that our national obesity epidemic is but a single symptom of a more serious illness: our unhealthy food system."

Now if we could agree on what is a healthy diet and fix our unhealthy food system...
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Leslie Robinson Goldberg
Writer
12:01 AM on 04/12/2010
Please, let's get nutrition guidelines for school kids and the food pyramid out of the hands of the US Department of Agriculture and give it to the National Institutes of Health. The USDA was set up to promote farming not health. I read an article that clearly demonstrated how you could eat junk food all day (sugary, salty, greasy processed food) and still follow the Food Pyramid. I think a lot of people are doing just that!
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JScott
John Galt's last name is McGuffin-Smithee
12:42 PM on 04/11/2010
Let's remember that fruits and vegs don't get these kinds of subsidies BUT oftern
the water to irrigate them is-all of the federal water projects in Calif. and the western US.
11:09 AM on 04/11/2010
Parents feed their children. Blame the parents. If you are ignorant and indifferent and you raise a fat kid, that's your problem, not mine. I'm not giving away tax money that could go to help feed genuinely hungry children.
11:08 AM on 04/12/2010
Recently, at a hotel breakfast buffet in DC, that was filled with fresh fruit and all kinds of other healthy options, we observed a young girl fill a cereal bowl up with bacon three times and wash it all down with huge colas. Her family members made similar choices. If you do not hold individuals to account for their choices you are missing 2/3rd's (at least) of the solution. Put the blame where it belongs and maybe we can start getting somewhere with this problem.
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Pooja R. Mottl
06:01 PM on 04/10/2010
Hi David - fantastic post and nice seeing you and IATP here! Partnering with America's farmers is definitely a key piece in reforming our system - an area that needs to be investigated in much greater detail for sure... -- Pooja
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bthechangeyouseek
03:58 PM on 04/10/2010
"But ultimately, we need to put a spotlight on the fact that our national obesity epidemic is but a single symptom of a more serious illness: our unhealthy food system. In order to prescribe healthier food, we must rethink the entire system, from the farm to our children's mouths."

As many posters have said it starts with a change in national policies, and I would add, rethinking our relationship with food.
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katmeyster
We don't have a spending problem.
02:37 PM on 04/10/2010
The food pyramid and suggestions for what Americans should eat are political policies that have nothing to do with making us healthy.

The government subsidizes corn, wheat, and soy -- the very foods that are creating the obesity and diabetes epidemic in this country. The USDA wants products to contain as much high fructose corn syrup as possible as this is a cheap way to make food last longer and exportable. Politicians want the money from large agri-business to get re-elected. And if you really want a conspiracy (although I think it just worked out this way), the medical and pharmaceutical industry is getting wealthy off of our preventable illnesses. There is no upside for corporations (who donate to campaigns) for us to be healthy.

It is imperative that we un-tie the USDA from the food pyramid. Can you imagine a government organization that promotes the use of subsidized crops that are essentially poisoning us to be in charge of recommending what we eat?

I wish the Obamas were more attuned to current scientific and medical research about the dangers of the food the government was promoting -- we definitely need a change.
11:01 AM on 04/10/2010
I grew up on one of those now-almost-extinct small family farms. My parents raised almost all the food we ate--vegetable gardens, seasonal berries and apples, beef, chicken, eggs and dairy. My mother churned our own butter in one of those old-fashioned butter churns. We separated our raw milk morning and evening. The grain we cultivated was sold to the local mills from which we purchased our flours, out of which my mother handmade our whole grain bread. (No, I didn't live in the 1800's. This was the 1970's). We were green and sustainable and organic long before this became a politically correct agenda.

Fast forward to the 2000's. I'm living in the suburbs of a large American metropolis, raising two kids on a budget. I'm appalled by the things I'm giving my kids to eat--milk and dairy products laced with antibiotics and hormones, produced on factory farms that confine their dairy cows to inhabitable quarters. Meat and chicken--ditto. Mass produced vegetables and fruit with who knows what kind of pesticides infecting the skins. Everything that comes in a package, from pasta sauce to mustard, laced with high fructose corn syrup, sugar, and highly processed foods made from refined flour. This is child abuse, along with animal cruelty.

Is this really progress?
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bthechangeyouseek
03:52 PM on 04/10/2010
Sounds like you are a label reader, so you choose what you feed to your kids. Help them get involved, through patio/kitchen gardening, cooking meals from basic raw foods. The fast food nation is definitely not progress, as slow food can also be cooked fast.
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JScott
John Galt's last name is McGuffin-Smithee
12:40 PM on 04/11/2010
Is this really progress?

Big corporate ag would like you to think so.
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medicontheedge
big loud broad
02:18 AM on 04/10/2010
we have been getting larger, as a people, since neandrethal times... is it our food source? or is it inherent that we will eat what is easily available because it is easily available?

discuss.
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Ozark Homesteader
http://ozarkhomesteader.wordpress.com
10:05 AM on 04/11/2010
Hmmmmmm. I think it's a combination of inactivity and overeating coupled with "food" that cannot meet our nutritional needs. Americans could afford to eat a few thousand calories a day a few generations ago because they had no cars. Today we don't need to eat so much, but we do need to eat higher quality food, food that will meet our basic nutritional needs with fewer calories. Too many people don't do that.

http://ozarkhomesteader.wordpress.com/
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Ozark Homesteader
http://ozarkhomesteader.wordpress.com
11:03 PM on 04/09/2010
President Obama's choice of an Ag chief with ties to industrial agriculture was one of two huge disappointments I had with his first year in office. I had dreams of Obama's appointing Michael Pollan or Alice Waters. The only reason why bad foods are cheap today is our tax dollars' subsidizing their production. We should be subsidizing fruits and vegetables, not corn and soy. While I'm all for the showy things like the White House vegetable garden, we need more direction from the President to Congress, and we need to remove people like Blanche Lincoln from power on key Congressional ag committees.

FYI: Lincoln's Democratic opponent in the upcoming primary is Bill Halter. He raised a record amount of cash in March, but she had a few years' head start, so he still very much needs donations to be competitive. Polling indicates he could defeat a Republican opponent in November, while she could not.

http://ozarkhomesteader.wordpress.com/
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bthechangeyouseek
03:54 PM on 04/10/2010
nice post. Not sure if Alice or Michael were available, but I think there are probably a number of people that support the slow food movement that would be willing to step in.
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Ozark Homesteader
http://ozarkhomesteader.wordpress.com
10:01 AM on 04/11/2010
Thanks for the kind words. Both knew that they were the popular favorites of slow-food and anti-obesity enthusiasts, and neither denied their availability, so . . . something tells me they would have said yes if asked. I could be wrong of course, not knowing either one personally.

http://ozarkhomesteader.wordpress.com/
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08:12 PM on 04/09/2010
I am all for reducing or even removing the sugar, starches, grains, and frankenfoods, from our children's food, but the problem is in lumping fat in with the culprits. Good fats (mono unsaturates and some saturated fats from healthy sources) are essential to a good diet. They provide a much needed "satiety factor" eliminating cravings,helping to regulate insulin, and helping to reduce the overall calories ingested. Much of Obesity, barring some exceptions is all about the insulin. A "good" diet of healthy proteins and low glycemic indexed carbohydrates from vegetables and a small amount of fruit, but without much needed fat to provide a satiety factor/cut cravings is very difficult and in the long run almost impossible to stay with. I am tired of people blaming the obese, and putting out the party line by providing only half truths and "solutions" doomed to fail in the long run.
The truth is out there, I would encourage anyone reading this comment to look into it.
10:54 AM on 04/10/2010
You are right-on, singermuse. Well put.
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katmeyster
We don't have a spending problem.
02:27 PM on 04/10/2010
Good post. This is exactly right, and I am glad you made the point. I want to increase the fat in my diet (have already eliminated all sugar and grain) as that is how I have been losing weight, vastly improving my lipid profiles and, I believe, reducing my chances for cancer. But I do worry about all the antibiotics and other toxins that are contained in animal fat and dairy products. Wal-Mart sells chicken that says "100% natural" because it doesn't have added hormones -- yet fails to mention how the animal was raised or how many antibiotics it was given (this practice should is deceptive and should be illegal). I am now using virgin, unprocessed, organic coconut oil and want to only consume organic veggies and grass-fed, organic, beef products. All of this is very difficult to do in this society and on a budget.
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06:14 PM on 04/10/2010
I do my best to get my fats from healthier sources and try to keep the rest of my food choices to 10% or less fat.

A small handful ot nuts, a veggie sandwich with avocado instead of butter or mayo each day or every other day and grilled salmon a couple times per week does the job.