The Robert Wood Johnson Foundation has released a fascinating glimpse into data suggesting that childhood obesity may be declining in several US cities and counties.
While sugar-sweetened beverages (SSBs) have garnered much attention in the US given their associations with obesity and diabetes in the Nurses Health Study and a number of other assessments, a key question is whether this effect also translates to low- and middle-income countries where both domestic and imported beverages are becoming increasingly popular. In an article just published in the American Journal of Public Health, we looked at this question using the soft drink industry’s own statistics, merged with comparative survey data on weight status and diabetes across the globe.
In today’s edition of the journal PLoS One, we published an “open access” study on the relationship between sugars and type 2 diabetes. The study was an international analysis applying statistical techniques from the field of econometrics to public health data in order to understand the relationship between sugar availability and diabetes prevalence. It was peer-reviewed by five independent statisticians and diabetes experts. The study can be easily misinterpreted—for example, one doctor made the silly comment: “Well this is just like correlating the number of cups someone owns to their risk of diabetes, which is confounded by obesity”—which reflects that the doctor did not read the study or didn’t understand the statistical methods involved; obviously, as professors who teach statistics all day, we controlled for obesity and dealt with these kinds of issues up front. The study is not a typical simple “correlation study” that is far too common in the medical literature. There are, however, very important caveats to the findings, and some context that’s pretty critical to understand. So we wanted to re-iterate the very careful wording in the study and make sure that the actual study findings made it somewhere into the melodramatic discourse on this subject…
Given the extensive interest these days about how public health decision-makers are being influenced by the soda industry, we decided to take a more systematic look at what institutions and people have close ties to the industry, and what sorts of relationships they have. It is no longer a secret that the Pan American Health Organization, a regional office of World Health Organization, accepts money from the Coca- Cola Company, PepsiCo, Kraft, Nestle, and Unilever. Similarly, some members of the WHO’s Nutrition Guidance Expert Advisory Group have food industry ties, particularly in the form of receiving funding. But who else in the public sphere of governance is linked to “Big Soda”, and how?
Ever since the observation in 1995 that hunger and obesity co-existed among children, a flurry of research has sought to answer the question of whether those who are more “food insecure” are most likely to also become (ironically) obese. Many studies have now correlated participation in food stamp programs (since renamed the Supplemental Nutrition Assistance Program, or SNAP) with obesity. One in seven Americans are now on food stamps after the recession, so this finding may have important implications for the overall obesity epidemic. It may also seem like obvious selection bias to correlate food stamps to obesity; those who are poor are more likely to eat calorie-dense and cheap food, becoming both stuffed and starved. But a new study comparing food stamp users to eligible non-users found that the stamp users were disproportionately more likely to eat unhealthy foods. What’s going on here, and what should we do about it, if anything?
In 2003, 168 countries signed the world’s first public health treaty: the Framework Convention on Tobacco Control (FCTC). The FCTC legally bound countries to enforce major tobacco control measures, ranging from tobacco taxes to regulations on public smoking. Through a massive international effort, the FCTC has assisted countries to improve their tobacco prevention programs, and the treaty continues to be a basis for many new programs that are implementing evidence-based tobacco control strategies.
In an article in today’s PLoS Medicine, we publish new data showing that the food and beverage industry’s activities in low- and middle-income countries parallel that of the tobacco industry in years past; moreover, as cardiovascular disease and diabetes rates rise in poor nations, junk food, soda, and alcohol are statistically the major factors giving rise to deaths among working-age populations, and the newest evidence suggests that educational programs alone aren’t effective when markets are drowned by imports of cheap, unhealthy food and readily-accessible booze. So should the public health community push for a nutritional treaty or governance structure that parallels the successful introduction of the FCTC, but addresses “unhealthy commodities” like junk food? If so, what would such a structure look like?
Last year, we wrote about the increasing attention garnered by research on “food deserts“–regions of America where people lack easy access to nutritious foods. Like many folks, we were lulled into the idea that life in such deserts would contribute to obesity–by leaving people without other options to eat healthy produce rather than pre-packaged junk food. But recent research has led to us to ask: were we wrong?