studies prove that people’s choices are heavily influenced by the setting, context, framing, and characteristics of the environment in which they make food purchasing decisions.
In the early 1980s, manufacturers discovered that how their products were marketed in stores was among the most important factors in influencing the buying habits of consumers. That fueled an acceleration in the practice of buying supermarket shelf space, a deal in which retailers give preferred placement to the products of wholesalers who pay for it. The ends of aisles, near the check out lines and stand-alone floor displays are choice product locations. This is how that Santa cutout ends up hawking candy canes in the middle of the produce section. People are very sensitive to such displays. As a consequence, purchases from these locations are between two and five times higher than when the same items are placed elsewhere. The products displayed in this way comprise an estimated 30 percent of all supermarket sales and provide the largest profits for manufacturers.
During the holiday season it’s more important than ever that consumers consider the fundamental force driving the obesity epidemic in America: the tsunami of novel strategies used to market food. When shopping for holiday food, keep in mind that the treats being proffered by that smiling, life-sized Santa cutout in the aisle of your favorite supermarket may not be the healthiest gift for you and your waistline.
During the holiday season, a time when overindulgence is a tradition for many, food marketing creates especially serious challenges for people trying to limit their intake and make careful decisions about healthier eating. Walk through any supermarket or big box store this time of year and it’s impossible not to be confronted with promotions for fatty appetizers and snacks, processed cookies and cakes, holiday themed sugary drinks and cereals and super-sized chocolates and candy canes.
To be sure, it is ultimately up to individuals whether to reach for that highly processed treat that is all but devoid of nutritional value. Yet the common belief that everyone has the capacity to consciously and independently control what they buy or how much and what they eat is challenged by studies that have proven that people’s choices are heavily influenced by the setting, context, framing, and characteristics of the environment in which they make these decisions. This is a problem all year, of course, but it becomes even more difficult to resist in-store temptation when it is bathed in images of holiday good cheer.
Food purchasing environments are controlled by the food industry, whose goal, like all other businesses, is to increase profits. And the food industry is free to craft a seasonal marketing environment that portrays poor nutritional choices as cherished holiday traditions without regard for the consequences on consumers’ health.
In the early 1980s, manufacturers discovered that how their products were marketed in stores was among the most important factors in influencing the buying habits of consumers. That fueled an acceleration in the practice of buying supermarket shelf space, a deal in which retailers give preferred placement to the products of wholesalers who pay for it. The ends of aisles, near the check out lines and stand-alone floor displays are choice product locations. This is how that Santa cutout ends up hawking candy canes in the middle of the produce section.
People are very sensitive to such displays. As a consequence, purchases from these locations are between two and five times higher than when the same items are placed elsewhere. The products displayed in this way comprise an estimated 30 percent of all supermarket sales and provide the largest profits for manufacturers. They also disproportionately feature highly processed, low-nutrient, “value added” products — the worst for your health. People typically do not recognize that placement figures in their selection of such products, and instead, tend to blame themselves when their holiday shopping trip yields enough fat and sugar to swell even Santa’s ample waistline.
With increasing demand from manufacturers for this premium shelf space, supermarkets have grown larger and larger. The growing variety of products, especially when the holidays are here, can lead people to resort to a type of cognitive processing that relies on mental shortcuts instead of thoughtful decisions. This can lead to impulsive, poor choices based upon superficial characteristics like appearance, pricing, and salience. Thus, the modern supermarket is an environment that increases the risk of chronic diseases all year, but especially now.
Unless we grow our own food, we humans have a limited capacity to avoid exposure to these risk factors. The burden on individuals to keep up their guard, to be wary, and to actively resist an overwhelming food environment has become more than most of us can bear. If we really want to help consumers achieve their long-term goals of controlling their weight and eating a diet that won’t lead to heart disease or diabetes, we need solutions that won’t force people to work so hard.
So how do we make it easier? We need very specific consumer research on how to place products in stores so they don’t overwhelm consumers. Maybe we should segregate all the foods known to increase the risk of chronic diseases from the foods that don’t. Then people who want to limit their exposure can do so, and those who don’t will still be able to choose what they want. Maybe we should set limits on which products can be placed in salient promotional displays. Would consumers feel that their rights had been abridged if they had to travel to the back of the store to get candy and soda, but could find skim milk right up front?
Ordinarily our society does not tolerate flawed designs or business practices that increase the risk of illness or injury. We should no longer accept food marketing practices that undermine our health. As the most important consumer season gets underway, we need to start mitigating these factors if we want better health in 2014.
Deborah A. Cohen, M.D., is a senior natural scientist at the RAND Corporation and the author of the forthcoming book, A Big Fat Crisis: The Hidden Influences Behind the Obesity Epidemic — and How We Can End It.
This commentary appeared on The RAND Blog on December 23, 2013.
It’s all happening anyway. Eventually, the tide will surge and the wall will burst.
Already, an explosion of monitoring, testing, and sensing devices are coming on the market, providing consumers with instant analysis of their fitness, blood chemistry, sleep patterns and food intake. It’s only a matter of time before regulators feel compelled by consumer demand to find a way to accommodate better and cheaper innovations, and for slowly changing industries to dramatically restructure themselves in the face of overwhelming new opportunities. The long-term potential of vast databases of genomic data to improve health outcomes, reduce costs, and reorient the debate on medical priorities is too valuable to be held back for long — and arguably the biggest transformation for the healthcare industry since the discovery of antibiotics in the early 20th century.
Market disruptions often occur — or not — as the direct result of unintended collisions between breakthrough technologies and their more incremental regulators. In the latest dust-up, the U.S. Food and Drug Administration (FDA) last month ordered startup 23andMe to stop marketing its $99 genetic analysis kit, just before the Christmas shopping season kicked into high gear.
To date, over half a million customers have taken the swab in return for detailed ancestry data and personalized information on 248 genetic traits and health conditions. The company, which launched in 2007 with substantial backing from Google, has been working closely — albeit more slowly than the FDA would have liked — with the FDA to ensure it complies with federal health and safety regulations. But the agency concluded in its recent warning letter that 23andMe was marketing a “device” that was “intended for use in the diagnosis of diseases or other conditions,” and as such, its marketing materials required pre-approval from the FDA, which includes extensive research studies.
23andMe is an example of what we call a “Big Bang Disruption” — a product or service innovation that undermines existing markets and industries seemingly overnight by being simultaneously better andcheaper than the competition. What’s happening in genomic testing (and healthcare in general) is consistent with our research in over 30 different industry segments, from manufacturing to financial services to consumer products.
When technologies improve exponentially, many industry incumbents — and the regulators who oversee them — are kept constantly off-balance. That’s because incumbents have been indoctrinated by a generation of academic literature and MBA training to ignore disruptive products until they had a chance to mature in the market, assuming they would first appear as cheaper but inferior substitutes that would only appeal to niche market segments.
Doctors — who are also incumbents in this situation — are struggling to respond to disruptive medical technologies that change the power dynamic in the patient relationship. Several 23andMe users have reported taking the FDA’s advice of reviewing their genetic results with their physicians, only to find the doctors unprepared, unwilling, or downright hostile to helping interpret the data.
Often, incumbents’ only competitive response — or the only one they can think of — is to run to the regulators. That’s what’s has been happening to car-sharing services such as Uber, Lyft, and Sidecar; to private drone makers; and casual accommodation services such as Airbnb, to name just a few examples. And now it’s happening to 23andMe, one of hundreds of new startups aimed at giving healthcare consumers more and better information about their own bodies — information that has long been under the exclusive and increasingly expensive control of medical professionals.
Absent any real law on the subject, the agency has strained credulity to categorize 23andMe’s product as a diagnostic “device” — making it subject to its most stringent oversight. The FDA’s letter focuses intently on the potential that consumers will both under- and over-react to the genetic information revealed. The agency fears that users will pressure their doctors for potentially unnecessary surgery or medication to treat conditions for which they are genetically pre-disposed, for example. And it assumes that the costs of such information abuse outweigh any benefits — none of which are mentioned in the agency’s analysis.
The company, of course, has agreed to comply with the FDA’s stern warning, and has ceased providing its customers with anything other than hereditary data. For now. Perhaps it will reach some accommodation with the agency, or perhaps the FDA’s ire will prove untamable, an end to the innovative startup and whatever value its technology might have delivered.
But as with every Big Bang Disruptor in our study, winning the battle and winning the war are two very different things.
The FDA is applying a least common denominator standard to 23andMe, and applying it arbitrarily. Already, an explosion of monitoring, testing, and sensing devices are coming on the market, providing consumers with instant analysis of their fitness, blood chemistry, sleep patterns and food intake. It’s only a matter of time before regulators feel compelled by consumer demand to find a way to accommodate better and cheaper innovations, and for slowly changing industries to dramatically restructure themselves in the face of overwhelming new opportunities. The long-term potential of vast databases of genomic data to improve health outcomes, reduce costs, and reorient the debate on medical priorities is too valuable to be held back for long — and arguably the biggest transformation for the healthcare industry since the discovery of antibiotics in the early 20th century.
The information flood is coming. If not this Christmas season, then one in the near future. Before long, $100 will get you sequencing of not just the million genes 23andMe currently examines, but all of them. Regulators and medical practitioners must focus their attention not on raising temporary obstacles, but on figuring out how they can make the best use of this inevitable tidal wave of information.
Whatever the outcome for 23andMe, this is a losing battle for industry incumbents who believe they can hold back the future forever.
Larry Downes & Paul Nunes
Larry Downes and Paul Nunes are co-authors of Big Bang Disruption: Strategy in the Age of Devastating Innovation (Penguin Portfolio 2014). Downes is Research Fellow with the Accenture Institute for High Performance, where Nunes serves as its Global Managing Director of Research. Their book has been selected as a 2014 book of the year by the Consumer Electronics Association.
Danebo Elementary in Eugene, Ore., is one of 50 schools receiving money to teach classes while integrating something called the “Good Behavior Game.” Teacher Cami Railey sits at a small table, surrounded by four kids. She’s about to teach them the “s” sound and the “a” sound. But first, as she does every day, she goes over the rules.
“You’re going to earn your stars today by sitting in the learning position,” she says. “That means your bottom is on your seat, backs on the back of your seat. Excellent job, just like that.”
For good learning behavior, like sitting quietly, keeping their eyes on the teacher and working hard, kids get a star and some stickers.
Railey says the game keeps the kids plugged in and therefore learning more. That in turn makes them better educated teens and adults who’re less likely to pick up a dangerous habit, like smoking.
The Washington, D.C., nonprofit Coalition for Evidence Based Policy says it works. It did a studythat found that by age 13, the game had reduced the number of kids who had started to smoke by 26 percent — and reduced the number of kids who had started to take hard drugs by more than half.
The fact that a teacher is playing the Good Behavior Game isn’t unusual. What is unusual is that Trillium is paying for it. Part of the Affordable Care Act involves the federal government giving money to states to figure out new ways to prevent people from getting sick in the first place.
So Trillium is setting aside nearly $900,000 a year for disease prevention strategies, like this one. Jennifer Webster is the disease prevention coordinator for Trillium Community Health, and she thinks it’s a good investment.
“The Good Behavior Game is more than just a game that you play in the classroom. It’s actually been called a behavioral vaccine,” she says. “This is really what needs to be done. What we really need to focus on is prevention.”
Trillium is paying the poorer schools of Eugene’s Bethel School District to adopt the strategy in 50 classrooms.
Trillium CEO Terry Coplin says changes to Oregon and federal law mean that instead of paying for each Medicaid recipient to get treatment, Trillium gets a fixed amount of money for each of its 56,000 Medicaid recipients. That way Trillium can pay for disease prevention efforts that benefit the whole Medicaid population, not just person by person as they need it.
“I think the return on investment for the Good Behavior Game is going to be somewhere in the neighborhood of 10 to one,” Coplin says.
So, for each dollar spent on playing the game, the health agency expects to save $10 by not having to pay to treat these kids later in life for lung cancer because they took up smoking.
Coplin concedes that some of Trillium’s Medicaid recipients will leave the system each year. But he says prevention still makes medical and financial sense.
“All the incentives are really aligned in the right direction. The healthier that we can make the population, the bigger the financial reward,” he says.
The Oregon Health Authority estimates that each pack of cigarettes smoked costs Oregonians about $13 in medical expenses and productivity losses.
Not all the money Trillium is spending goes for the Good Behavior Game. Some of it is earmarked to pay pregnant smokers cold, hard cash to give up the habit. There’s also a plan to have kids try to buy cigarettes at local stores, then give money to store owners who refuse to sell.
This story is part of a reporting partnership with NPR, Oregon Public Broadcasting and Kaiser Health News.
If our negotiators buckle under the pressure applied by third parties, the price of a new trade agreement will be very high.
Illustration: Jim Pavlidis.
Two-thirds of Indonesian men smoke and more than half of Chinese men smoke. Even more disturbing is that 40 per cent of 13-15-year-old Indonesian boys smoke. How have these levels been reached while the world has known for more than 50 years that tobacco is such a deadly habit?
In China, it is now estimated that 114 million people have diabetes. South Africa has one of the highest per capita alcohol consumption rates in the world, with more than 30 per cent of the population struggling with an alcohol problem or on the verge of having one.
Tobacco, alcohol, and diabetes related to overweight and obesity all have one feature in common. They are each largely driven, and in the case of tobacco completely caused, by powerful commercial interests in the form of transnational corporations. It has been said that China’s booming economy has brought with it a medical problem that could bankrupt the health system.
We now face a major dilemma: unrestrained commercial development is pitted against the health and wellbeing of populations. This dilemma is not new – opponents of the abolition of slavery complained it would ruin the economy – but it is manifesting in more obvious ways in the 21st century.
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The tobacco, alcohol and ultra-processed (”junk”) food and drink industries have been rapidly expanding in low and middle-income countries. In the past decade, tobacco retail sales growth in these countries was 20 times that of the developed world. For alcohol consumption it was three times; sugar-sweetened beverages it was twice. But it isn’t only Indonesia, China and South Africa where we find this dilemma; it is alive and well in Australia.
For years we have known that the tobacco industry promotes and funds biased research findings, co-opts policy makers and health professionals, lobbies politicians and officials to oppose public regulation, and influences voters to oppose public health measures through expensive public relations campaigns. This success has been noticed and over the past decade alcohol and ultra-processed food and drink companies have been emulating these very same tactics.
This is of little surprise given the flow of people, funds and activities across the industries. For example Philip Morris owned both Kraft and Miller Brewing; the board of SAB Miller (the second largest alcohol manufacturer) includes at least five past or present tobacco company executives and board members; and the Diageo executive director responsible for public affairs spent 17 years in a similar role at Philip Morris.
Economic development plays an important role in the health and wellbeing of populations. Income, employment and education levels are all major determinants of good health. Businesses create wealth, provide jobs and pay taxes (but as we have seen, not all of them). One of the best ways to protect and promote health is to ensure people have safe, meaningful jobs. The more evenly wealth and opportunity are distributed, the better the overall health and wellbeing of a population.
But clearly not all businesses are good or healthy – yet we see some of them expanding their markets and influence across the globe – seemingly with no capacity to diminish or mitigate the harm they do. It is astonishing that an industry such as tobacco, which is so harmful to human health, can wield so much power. In Indonesia, Philip Morris and its affiliate, Sampoerna, will invest $US174 million to improve production capacities so, as Sampoerna’s president has said, ”Indonesia would be the centre of the Marlboro brand production to cater [for] demands in the Asia-Pacific region”.
Why do they need to expand their activities? Aren’t the existing 700 million smokers in the region enough? Especially when we know that more than half of them will die prematurely, losing about 20 years of life to tobacco.
The major tobacco, food, and alcohol companies have assets that are greater than many countries and can wield this power in parliament, law courts and the media, against the interests of the public’s health.
A new battlefront in this power play is the Trans Pacific Partnership Agreement (TPP). This trade agreement among 12 countries (including Australia, Japan and the US) represents about 40 per cent of the global economy.
The Australian government aims to ”pursue a TPP outcome that eliminates, or at least substantially reduces, barriers to trade and investment” and that will ”also deal with behind-the-border impediments to trade and investment”.
It is highly complex, has 29 chapters, is being negotiated in secret and is provoking considerable criticism on the basis that it could greatly strengthen the hand of some industries to sue national governments for their domestic policies and also greatly weaken the capacity of governments to buy cheaper generic drugs. The Nobel prize-winning humanitarian group Medicins sans Frontieres says the TPP ”could restrict access to generic medicines, making life-saving treatments unaffordable to millions”.
If our trade negotiators buckle under the pressure from other governments, which are, in turn, highly influenced by transnational companies, then Australia will have to confront some major problems. These include delayed availability of cheaper generic drugs and increased cost of medicines; interference with our Pharmaceutical Benefits Scheme; enshrining of rights to foreign corporations, such as tobacco companies, to sue our government; interference with our capacity to introduce health warnings on alcohol packaging, and the limiting of future options for food labelling.
Surely we must find a balance between unrestrained commercialism and maximising health and wellbeing. We need business for our individual and collective wellbeing. However, the benefits unhealthy businesses bring are outweighed by the costs – in terms of premature death, chronic illness, limited healthcare finances, overcrowding of hospitals and loss of productivity from unhealthy employees.
This is why we have governments – to ensure a balance among the rights of individuals, consumers, businesses and society as a whole. If, as Prime Minister Abbott has said, Australia is open for business, then we need to make sure it’s open for good business. If we can’t control the vested interests of unhealthy industries in trade agreements or in our domestic regulations, unhealthy business will come back to bite us all.
Rob Moodie is professor of public health at the University of Melbourne
rich american’s die earlier than rich people in other countries
Having a sicker population, Woolf points out, means a sicker economy and a sicker future for the U.S.
“Anyone that lives on mac and cheese, a lot of this packaged food, probably will grow up in one way or another addicted to this type of food. It’s well-known that there is very clear evidence that packaged foods are designed to be addictive,” he says. “Do you know anyone who is addicted to chicken or fish or celery? That doesn’t exist.”
We were standing at Target in an aisle we’d never walked down before, looking at things we didn’t understand. Pill splitters, multivitamins, supplements, and the thing we were here to buy: a long blue pill box—the kind with seven little doors labeled “S M T W T F S “ for each day of the week, the kind that old people cram their pills into when they have too many to remember what they’ve already taken.
My husband, Joe Preston, shook his head. “Do I really need this?”
I grabbed it off the shelf and threw it in our basket. And when we got home, Joe—then a fit and fairly spry 30-year-old man with a boss-level beard—stood at the kitchen counter, dropping each of his prescriptions with a plink into the container.
I guess it’s true that life is full of surprises, but for the three years since Joe’s crippling pain was diagnosed as the result of an autoimmune disease called Ankylosing Spondylitis, our life has been full of surprises like this one. Pill boxes, trips to the emergency room, early returns from vacation. Terms like “flare-up” have dropped into our vocabulary. We’ve sat in waiting rooms where Joe was the only person without a walker or a cane. Most of our tears have been over the fact that these aren’t the kind of surprises either of us thought we’d be encountering at such a young age.
But here’s the thing: We recently realized we weren’t alone. Almost all of our friends are sick, too. When we met our friend Missy Narrance, Joe found solace in talking to her about his health. She’s 29 and has been battling lupus and fibromyalgia for the past 10 years. She’s been through chemotherapy twice, and her daily symptoms are so extreme that she was granted federal disability status when she was just 23 years old. In our close group of friends—who range from 25 to 35 years old—we know people with everything from tumors to chronic pain. Sometimes our conversations over beers on a Friday night turn to discussions of long-term care and miscommunication between doctors.
I thought this would be the time when we’d be preparing for the rest of our lives: earning money, going on fun vacations, having families, building our careers. And we are, but at the same time, we’re doing it while we’re trying to manage pain symptoms, chase down prescriptions, and secure stable health insurance. When I was in college, I remember being prepared to survive in the workforce, but I don’t remember a class that told me how to do that if half of your household is in so much pain on some days that they can’t get to work. I’m barely over 30. I thought I had so much more time before I had to think about this stuff.
I wondered if this was normal. Do we know so many people who are dealing with pain because people are just getting sicker in general?
I found out that they kind of are. It turns out that chronic conditions like what Joe and my friends are dealing with are one of America’s biggest health emergencies. And it’s one that many people say we’re not prepared to deal with.
Not surprisingly, the CDC says cancer is still the second leading cause of death for Americans. But not only do chronic conditions—a category that includes everything from autoimmune diseases like arthritis and lupus, to obesity, heart disease, and diabetes—claim the number one spot, they’re compromising Americans’ quality of life and disabling people for long periods of time. Take arthritis for example: Right now, the CDC says it affects 1 in 5 adults, and is the most common cause of disability in America. “As the U.S. population ages, the number of adults with doctor-diagnosed arthritis is projected to increase from 46 million to 67 million by 2030, and 25 million of these individuals will have limited activity as a result,” the CDC report reads.
But it’s not just that Americans are getting sicker—it’s that young Americans are getting sicker. A 2013 report by the National Research Council and Institute of Medicine (NAC/IOM) echoes the shock of that fact. “The panel was struck by the gravity of its findings,” it reads. “For many years, Americans have been dying at younger ages than people in almost all other high income countries.”
Steven Woolf, director of the Center on Society and Health at Virginia Commonwealth University, helped prepare the NAC/IOM report and brought the findings before the U.S. Senate last month during a discussion on what is ailing Americans. In particular, Woolf points at how data is painting a bleak future for American women.
“Women are less likely to live to age 50 if they’re born in the United States than other high income countries,” he says. “I have a chart where we show this pattern going back to 1980. Back then if you looked at the survival of women to age 50, the U.S. was in the middle of the pack. Over time, not only has the U.S. fallen down in the ranking, they’ve fallen off the chart. That’s something we’re trying to understand.”
And don’t be mistaken, Woolf says: The United States’ outlook isn’t skewed from other countries’ because of its diverse people and massive disparities in socioeconomic status. “We analyzed the data by a variety of social classes and have found that the problem is pervasive. Rich Americans die earlier than rich people in other countries. College-educated people die earlier than college-educated people in other countries,” he says. “It’s misguided for people who are better off and doing well to think that this is someone else’s problem.”
“It’s very concerning,” Woolf says. “We are living shorter lives than people in other countries. We’re sicker than people in other countries.”
In fact, a recent report by the University of Washington’s Institute for Health Metrics and Evaluation, says that “in some U.S. counties… life expectancies are on par with countries in North Africa and Southeast Asia.”
Having a sicker population, Woolf points out, means a sicker economy and a sicker future for the U.S.
“In terms of the economy… this means that American businesses are at a competitive disadvantage with other countries because their workforce is sicker. This doesn’t bode well [for] the next generation’s well-being in terms of health and life expectancy.”
It’s noon on a Thursday, and my friend Missy is sitting in her pajamas. For the past six years since she was put on disability, this is what her day-to-day life has looked like. She draws and paints compulsively, holed up in the tiny room she shares with her boyfriend in a house with four other people. She watches a lot of documentaries, and she sleeps constantly.
For her, discovering she had lupus and fibromyalgia was a weight lifted off her shoulders. Ever since she was in junior high and discovered swollen lymph nodes under her arms, she ping-ponged between doctors and different diagnoses. Being sick meant that she missed her last semester in high school. She watched her friends fall away as they worried about prom, and she worried about chemotherapy. She told any guy that wanted to date her that if they wanted to leave because she was sick, she understood.
She grappled with constant guilt, thinking that maybe she wasn’t really sick—that she could bite the bullet and be a productive member of society if she tried hard enough. So when she found out that her condition had a name, it was a relief.
“That’s the thing that a lot of people with chronic illness go through. When they finally are diagnosed … it is so relieving,” she says. “Because you have likely been questioned by people about your health and about your symptoms, therefore you’ve questioned yourself about your symptoms and [felt] some sense of guilt. Or [thought], ‘Maybe I’m wrong. Maybe I’m not really experiencing what I’m experiencing.’”
“And so when someone else finally comes in, who knows what they’re talking about, and is like ‘You’ve had these illnesses and you’ve been dealing with these symptoms,’ it’s so relieving. It’s like, ‘God. Thank you. Finally. Thank you.’”
Dr. Enrique Jacoby, regional advisor for healthy eating and active living for the World Health Organization (WHO), says people like Missy and my husband Joe might just be victims of the American lifestyle.
“We’re sicker for a number of reasons. Not one single factor is to be blamed for the problem,” Jacoby says. “One of the reasons is we are eating bad. We are being excessively exposed to junk food… We have more pollution because of biofuels that are really, really bad for you.”
He points to the way American cities have grown so large that people are almost required to drive everywhere instead of walking, which means most people aren’t getting anywhere near the right amount of exercise. Jacoby says that 100 years ago the most popular public spaces were parks and plazas—places that encouraged exercise and social interaction. Today, they’re roadways.
I ask Jacoby: Are my friends sick, by chance, because they grew up eating Spaghetti-O’s and Kraft macaroni and cheese like every other kid in the 1980s? Are they victims of an era driven by convenience foods and sugary drinks? (Joe’s father was a Pepsi salesman.)
“Anyone that lives on mac and cheese, a lot of this packaged food, probably will grow up in one way or another addicted to this type of food. It’s well-known that there is very clear evidence that packaged foods are designed to be addictive,” he says. “Do you know anyone who is addicted to chicken or fish or celery? That doesn’t exist.”
While Missy and Joe both possess certain genes that allow them to have these diseases, Jacoby says dependence on processed food as children might have been what brought them to the surface. And it might be the story behind what’s happening to so many Americans.
So, according to this theory, our genes aren’t really changing, but they’re confused. “It’s not going to be an immediate genetic change in society, but what we’re experiencing is that our genes’ expression is being, in a way, modified,” Jacoby says.
It might be that our lifestyle is why Americans are so sick. Another theory, according to Dr. Frederick Miller of the National Institute of Environmental Health Sciences, might be that humans are being weeded out in different ways than in the past, as more communicable diseases have been eliminated.
“If you do away with the infectious disease risks that perhaps killed off a number of individuals early in life [in the past], people who may have altered immune systems, who perhaps couldn’t have handled [those infections, then] go on in adulthood to develop these diseases,” he says.
He points to the “hygiene hypothesis”: As humans have eliminated infections and led cleaner early lives, allergies and autoimmune disease incidences have increased because of our underdeveloped immune systems. “It’s not completely proven, it’s a hypothesis,” Miller says, “But it is consistent with some of the data out there.”
“There may not be too many free rides in this world,” he says. “As we move away from one disease, we may be moving toward other diseases.”
My husband says he’s lucky. Not because he’s sick, but because it could be so much worse. Joe still holds down a full-time job as a creative director at an advertising agency. He’s still able to play drums in his band.
And, in some ways, he’s just started dealing with his disease. For a long time, he didn’t even want to go to do the doctor to see if something was wrong with him. He’d been diagnosed with Juvenile Rheumatoid Arthritis when he was in elementary school, but that went away when he got older. He figured this pain might just be a new version of that.
“But then at some point I complained enough when I wasn’t paying attention,” he said to me one night as we sat on our couch with a tape recorder rolling. “I complained enough times, [then] you said something enough times, to where I finally decided to go back.”
He says he remembers thinking “if I go and it does turn out to be something, then it’s something I have to deal with.” He was young, after all. Could there really be a problem?
Since he’s been diagnosed, he says he’s done a lot of thinking about how he never expected he’d be dealing with a disease at this point in his life, and how that’s become a polarizing factor with other people our age that aren’t sick.
“It’s, like, I’m still only 33. I probably am still considered in a lot of people’s eyes [to be] youthful enough that I shouldn’t have to deal with thinking about this kind of stuff,” he says. “I feel like my parents were still partying and drinking beers [at 33]. This is the age my Dad was when they had me. I don’t think [he] was worrying about what fucking pills he was going to take or not take, you know what I mean? They were like ‘We’re out of Budweiser.’”
Miller says that when young people are dealing with chronic conditions, it can have a huge impact on the economy, health care system, and the formation of future generations.
“One of the unique things about autoimmune diseases, as opposed to cancer, is that these are more likely to be long-term,” he says. “You’re not just dealing with the immediate problems, but the entire lifelong implications of that.”
It’s a fact that the Institute for Health Metrics and Evaluation noted in its report: “Diseases of poverty, such as communicable, maternal, nutritional and newborn causes, have decreased universally while non-communicable conditions traditionally associated with wealthier countries have risen,” it reads. “As people live longer and die at lower rates, the number of years spent living with disability… has increased.”
Woolf says there is still much research to be done into what’s causing Americans to be so sick. But he says this future we’re headed toward is preventable.
“We’ve known for many years what needs to be done about this,” he says. “The problem is not a lack of knowledge about what to do, but a lack of resolve and resources for how to do it… For each [issue], there are major blue ribbon reports that have outlined precisely what needs to be done about it.”
So why hasn’t it happened?
Woolf says that legislation to create a healthier America—from improved nutritional quality of food to taxes on soda—is seen as an affront to personal liberty. “A willingness to implement public policies … often involves higher taxes that American taxpayers don’t want to spend, or a willingness to change personal freedoms.”
“We can still have a free society but accept some limits on what we do to try to promote good health,” he continues. “There’s such a visceral reaction to what is perceived as a nanny state … or what people think of socialized welfare states, that any semblance of that tends to get rejected.”
Right now, he says that so much research about American health—particularly women’s health—is very new.
“I just think it’s something that hasn’t been widely disseminated,” he says, pointing to the NRC/IOM report “Shorter Lives, Poorer Health.” “The general media … haven’t been briefed about this sufficiently.”
And because of that, people aren’t ready to make healthy, infrastructural changes.
“It might be that we as a society make an informed decision that, yeah, we may pay the price for it in terms of poor health, but we get to live our lives the way we want to,” he says. “I feel that that’s okay, as long as we are making that choice as informed citizens. The problem is that I don’t think that the American public knows that that’s happening, or that American parents know that their kids will live shorter lives than in other countries.”
Jacoby, of the WHO, agrees, saying chronic conditions have become a top priority for his organization. “Chronic conditions are really, really stealing lives.”
Back at our house, Joe and I have been talking for hours about his condition and how it affects his daily life. I’ve been crying for most of the conversation, especially when we talk about the future. We talk about how our friend, Missy, can’t leave her house much. Catching someone’s cold could sideline her for weeks. Even fluorescent lights in grocery stores start to make her sick to her stomach.
We talk about how we hope that Joe never has to stop doing the things he loves because of his condition.
“I’m just sad for other people that they can’t do more. That would be the tougher thing. At least, I have very little that I can complain about,” he says. “But in the same breath, the thing that worries me about it, is that it would be one thing if I was 50 or 60. But I’ve got a long time to get worse. Time can be a friend and an enemy, I suppose. That’s just life, I guess.”
Artificial sweeteners are safe and effective tools for weight management, says obesity specialist
By Elaine WATSON, 26-Nov-2013
Related topics: Sweeteners (intense, bulk, polyols), R&D, Food safety, The obesity problem, Health & Wellness, Beverage, Healthy Foods
While consumer concerns over artificial sweeteners have been blamed – in part – for the funk the diet soda market currently finds itself in (click here ), the fact remains that they are safe and effective tools for weight management, according to one obesity specialist.
Suzanne Phelan, PhD, associate professor in the kinesiology department at California Polytechnic State University and adjunct associate professor in the department of psychiatry, Brown Medical School, is an expert in the application of behavioral methods to prevent and treat obesity.
She is also co-principal investigator of the National Weight Control Registry, an ongoing longitudinal study evaluating 5,000+ successful weight losers.
People trying to manage their weight need to spend their calories wisely
Speaking to FoodNavigator-USA after contributing to a myth-busting session on low- and no-calorie sweeteners at the recent ObesityWeek conference in Atlanta, Georgia, Dr Phelan said that in an ideal world, we’d all just drink water to stay hydrated.
However, if people want something sweet, beverages using high intensity sweeteners can quench thirst without adding empty calories, she said, noting that people that successfully lose weight – and keep it off – are less likely to consume sugar sweetened beverages.
Long term successful weight losers consume smaller proportions of sugary drinks
No one food is to blame for obesity, and soft drinks companies are right that balancing calories consumed with calories expended is a key factor in weight management, she said.
However, achieving this balance is a lot harder if you regularly consume large amounts of empty calories from sugar sweetened beverages, she added.
On the firm’s latest earnings call, PepsiCo CEO Indra Nooyi said: “In the last 6-9 months, there has been an accelerated decline in diet drinks as people say they don’t want artificial sweeteners, they want more natural sweeteners, they don’t mind some calories. We are seeing a fundamental shift in consumer habits and behaviors.”
“People trying to manage their weight need to spend their calories wisely andif you want to save calories, cutting out sugar-sweetened beverages and replacing them with water or beverages sweetened with low or no calorie sweeteners is a good way to do this.
“If you look at long term successful weight losers, they are consuming smaller proportions of sugary drinks – they are minimizing their consumption of sugary drinks and juices.”
(Click here to read about a recent Harvard meta-analysis showing that sugar-sweetened beverage consumption promotes weight gain in children and adults.)
No evidence that diet sodas make people crave sweeter foods or serve as an appetite stimulant
Asked if she thought former NYC mayor Michael Bloomberg’s attempts to cap sizes of sugary drinks sold in certain outlets at 16oz were helpful, she said: “We should give initiatives like this a try. I’m in favor of government efforts to make it easier for people to consume fewer calories.”
As for the oft-quoted hypothesis that diet soda and other artificially sweetened products make people crave sweeter foods or serve as an appetite stimulant, there is “no evidence” to support this claim, she said.
(Click here to read a 2010 review in the British Journal of Nutrition which found that “there is no consistent evidence that low-energy sweeteners increase appetite or subsequent food intake, cause insulin release or affect blood pressure in normal subjects”. A more recent study –click here – published in the American Journal of Clinical Nutrition in Feb 2013 came to the same conclusion.)
Correlation, not causation
Meanwhile, a 2012 study also published in the American Journal of Clinical Nutrition (click here ) showed that replacing caloric beverages with non-caloric beverages was an effective weight-loss strategy, while a 2009 study co-authored by Dr Phelan in 2009 and published in the International Journal of Obesity (click here ) showed that those who have lost weight and successfully kept it off adopt a number of strategies, including drinking more artificially sweetened beverages, she said.
Dr Suzanne Phelan: People trying to manage their weight need to spend their calories wisely
So why do some commentators still insist that diet soda is responsible for all manner of problems?
For example, a recent opinion article published in the journal Trends in Endocrinology and Metabolism by behavioral neuroscientist Dr Susan Swithers alleged that regular consumption of diet sodas induced “metabolic derangements”putting users at “increased risk of excessive weight gain, metabolic syndrome, type 2 diabetes, and cardiovascular disease.”.
In the literature, there are some large scale epidemiological studies showing a correlation between consumption of low and no calorie sweeteners and increased risk of some of these health problems, said Dr Phelan, “so that has created a natural state of confusion.”
But this is correlation not causation, she said, and randomized controlled trials do not show similar results.
Meanwhile, a study by Harvard researchers published in the journal Circulation in 2012 (click here ) analyzing the Health Professionals Follow-Up Study, a prospective cohort study including 42,883 men, found that artificially sweetened beverage intake was not associated with increased risk of coronary heart disease risk.
The authors also said their results “highlight the need for cautious interpretation of studies reporting positive associations between diet drinks and cardiometabolic and cardiovascular outcomes”.
Artificial sweeteners and safety
As for safety, aspartame and sucralose are among the most thoroughly tested ingredients in the food supply and have been deemed safe by all major scientific and regulatory bodies from Health Canada to the FDA, the Joint Expert Committee on Food Additives (JECFA) of the World Health Organization (WHO) and Food and Agriculture Organization (FAO); and the European Food Safety Authority, added Dr Phelan.
Glucose management ingredient gets UAE distribution, ‘needs to be in food supply,’ founder says
By Maggie Hennessy, 25-Oct-2013
Related topics: Suppliers, Markets
Sometimes the best way to build a new market is to step back.
This is the case for ATM Metabolics, whose cofounders Dr. Daryl Thompson and Dr. Joseph Ahrens created Emulin, a patented blend of plant-sourced chlorogenic acid, myricetin and quercetin that claims to help maintain healthy blood sugar levels and facilitate weight loss in diabetics.
Facing hesitation from American corporations about incorporating Emulin into foods, the company has signed a licensing deal with United Arab Emirates development company Mubadala to distribute Emulin as both a medical food and as an additive to fortify diabetically sensitive food products. The firm hopes the distribution and resulting“dramatic improvement in glycemic management for type 2 diabetics,” who make up a growing percentage of the population in the UAE, will be a springboard to deploying Emulin as a medical food in the US.
“We need this to be in the food supply,” Thompson told FoodNavigator-USA. Emulin is currently available in the US as Diabetix, a dietary supplement supplied by VREV.
Blocks GI of the ‘whole meal’
Developed by ATM Metabolics cofounders Dr. Daryl Thompson and Dr. Joseph Ahrens, Emulin works by interrupting the metabolic pathways of carbohydrate metabolism. It claims to reduce glucose synthesis in the liver, enhance glucose uptake from the bloodstream, and increase the sensitivity of insulin receptors in the signaling pathways—thereby making insulin more efficient, according to Thompson.
What makes it so important for Emulin to be incorporated into food, he added, is it will not only block the glycemic impact of what you’re eating and drinking, but the whole meal. In other words, it addresses the glycemic impact of both the milkshake you’re drinking and the cheeseburger you’re having with it.
“Emulin when added to foods had the ability to reduce the entire glycemic impact and caloric impact of a whole meal by up to 30%,” he said. “This is because Emulin actually inhibits or ‘puts to sleep’ the enzymes in the body that are responsible for breaking down, transporting and storing sugars while inducing activity in metabolically useful enzymatics such as those in muscle tissue. Emulin reduces the amount of sugars that the body absorbs and at the same time enhances the body’s ability to utilize the sugars instead of storing them as fat.
“The good thing about this is that it is a ‘chaperone’ process that was developed by nature to properly regulate sugar transportation and usage in the human body. Our research team was lucky enough to identify this process and learn how to adapt it to our processed foods to make them safer glycemically.”
Thompson claims that Emulin works at both the acute and chronic level, meaning “the longer you take it, the less diabetic you become.”
Reeducating corporate America on ‘disruptive technology’
The primary motivators for taking Emulin to the UAE were twofold: the growing incidence of diabetes in the UAE and the hesitance of American food companies to embrace new, disruptive technology in the diabetes realm.
The UAE has experienced remarkable economic growth in a relatively short period of time, which has raised the prosperity of its population. But this new-found wealth has also brought with it a growing incidence of metabolic syndrome and diabetes. According to the World Health Organization and International Diabetes Federation, 32% of the adult UAE population (age 20-79) may have diabetes or pre-diabetes, with other data indicating that the adult UAE population (ages 18 and above) has already reached a diabetes or pre-diabetes rate of 44%.
“The UAE is rife with diabetes and metabolic syndrome, but it also has a very forward-thinking healthcare system. And they’ve shown they really want to address this growing problem,” Thompson said. “We’re developing a plan there to get this distributed throughout the country and use it as model of how we will model foods here.”
The second reason for crossing the pond is the resistance of American food companies to embrace “We’ve met with every American food company out there and the story is the same: they’ve gotten too big to be able to properly handle new disruptive technology,” he said. Thus, by spearheading the effort in the UAE, ATM Metabolics can demonstrate the practical approaches to dealing with metabolic diseases like diabetes with physical evidence. The product will be rolled out in the next six months, and Thompson expects to bring it back to the US within a year.
“We are working diligently to use UAE as a showcase to show how diabetes can be rapidly treated using Emulin in the food supply,” he said. “We’re hoping that this will serve as a blueprint for reeducating corporations here in the US.”
Consumption of sugar sweetened beverages may be associated with an increased risk of developing endometrial cancer in postmenopausal women, according to new data.
Related topics: Carbohydrates and fibers (sugar, starches), R&D, HFCS, Beverage
Consumption of sugar sweetened beverages may be associated with an increased risk of developing endometrial cancer in postmenopausal women, according to new data.
The study, published in Cancer Epidemiology, Biomarkers & Prevention, revealed that postmenopausal women who consumed sugar-sweetened beverages were more likely to develop the most common type of endometrial cancer compared with women who did not drink sugar-sweetened beverages.
Led by Dr Maki Inoue-Choi from the University of Minnesota School of Public Health, the team found postmenopausal women who reported the highest intake of sugar-sweetened beverages had a 78% increased risk for oestrogen-dependent type I endometrial cancer (the most common type of this disease).
This association was found in a dose-dependent manner: the more sugar-sweetened beverages a woman drank, the higher her risk, the team said.
“Although ours is the first study to show this relationship, it is not surprising to see that women who drank more sugar-sweetened beverages had a higher risk of oestrogen-dependent type I endometrial cancer but not oestrogen-independent type II endometrial cancer,” said Inoue-Choi.
“Other studies have shown increasing consumption of sugar-sweetened beverages has paralleled the increase in obesity,” she added. “Obese women tend to have higher levels of estrogens and insulin than women of normal weight. Increased levels of estrogens and insulin are established risk factors for endometrial cancer.”
However, because the new study is the first to show an association between high sugar-sweetened beverage consumption and endometrial cancer, the findings need replication in other studies, Inoue-Choi explained.
Sugar Nutrition UK: This type of study has a number of significant limitations
Commenting on the study findings Dr Glenys Jones of Sugar Nutrition UK noted that the findings only appear to hold true for sugar-sweetened drinks, and not for glucose, fructose or for sweets/baked goods.
“As the authors mention in the discussion, this type of study has a number of significant limitations and is unable to show any cause and effect relationships,” she added.
“A single questionnaire at the beginning of a study cannot account for any changes in dietary habits, reformulation or body weight during the subsequent 24 years of the study, all of which could be confounding factors in the statistical analysis.”
The American Beverage Association added: “This study does not show that sugar-sweetened beverage consumption causes endometrial cancer. In fact, its findings conflict with the results of several other published studies that showed no association between consumption of sugar and risk for endometrial cancer.
“The Mayo Clinic states common risk factors as changes in female hormones, older age, obesity, and inherited genetic conditions – not sugar or beverage consumption. Moreover, the study only measured dietary behaviors at the very beginning of the study, yet makes conclusions about health outcomes over 12 years.”
Study details
Inoue-Choi and colleagues analysed data from 23,039 postmenopausal women who reported dietary intake, demographic information, and medical history in 1986, prior to the cancer diagnosis, as part of the Iowa Women’s Health Study. Dietary intake was assessed using the Harvard Food Frequency Questionnaire (FFQ), which asked study participants to report intake frequency of 127 food items in the previous 12 months.
The team explained that the FFQ included four questions asking usual intake frequency of sugar-sweetened beverages, including 1) Coke, Pepsi, or other colas with sugar; 2) caffeine-free Coke, Pepsi, or other colas with sugar; 3) other carbonated beverages with sugar, such as 7-Up; and 4) Hawaiian Punch, lemonade, or other non-carbonated fruit drinks.
‘Sugar-free soft drinks’ included low-calorie caffeinated and caffeine-free cola (for example Pepsi-Free), and other low-calorie carbonated beverages such as Fresca, Diet 7-Up, and Diet Ginger Ale, said the authors.
The ‘sweets and baked goods’ category comprised 13 items in the FFQ, including chocolate, candy bars, candy without chocolate, cookies (home-baked and ready-made), brownies, doughnuts, cakes (home-baked and ready-made), sweet rolls, coffeecakes or other pastries (home-baked and ready-made), and pies (home-baked and ready-made).
Inoue-Choi and the research team then categorised the sugar-sweetened beverage consumption patterns of these women into quintiles, ranging from no intake (the lowest quintile) to between 1.7 and 60.5 servings a week (the highest quintile).
Between 1986 and 2010, 506 type I and 89 type II endometrial cancers were recorded among the women studied.
The team did not find any association between type I or type II endometrial cancers and consumption of sugar-free soft drinks, sweets/baked goods, and starch, but did find an association with sugar-sweetened beverage consumption after controlling for other lifestyle and risk factors.
“Too much added sugar can boost a person’s overall calorie intake and may increase the risk of health conditions such as obesity, diabetes, heart disease, and cancer,” Inoue-Choi commented.
Source: Cancer Epidemiology, Biomarkers & Prevention Published online ahead of print, doi: 10.1158/1055-9965.EPI-13-0636 “Sugar-Sweetened Beverage Intake and the Risk of Type I and Type II Endometrial Cancer among Postmenopausal Women” Authors: M. Inoue-Choi, K. Robien, A. Mariani, et al
Illustration: Jim Pavlidis.
