Transcript The hungry, worried, and irrational consumer

The problem of obesity in
perspective: Dealing with the
modern food world
Paul Rozin
Buenos Aires
September, 2014:
Definition
• BMI = weight (kg)/height (m) 2
• Obesity BMI >= 30
• Overweight BMI >=25, <30
Patagonia
69,853 kg
40 m
BMI 43.7
Obesity in perspective
• The risk: overweight and obesity
Flegal et al., 2005
Main Outcome Measures Number of excess deaths
in 2000 associated with given BMI levels
The obesity “epidemic”
1.4 pounds gained/year in
USA over last 20 years
http://www.surgeongeneral.gov/news/test
imony/obesity07162003.htm
Statement of
Richard H. Carmona, M.D., M.P.H., F.A.C.S.
Surgeon General
U.S. Public Health Service
Wednesday, July 16, 2003
•“Nearly two out of every three Americans are
overweight or obese.
•“One out of every eight deaths in America is caused by
an illness directly related to overweight and obesity.
“But the fact is that we have an epidemic of
childhood obesity. “
Epidemic versus “Slow crawl”
Food
industry
Government
Medical
research
Media
Public
Obesity and Malnutrition
World obesity 2010
• http://www.who.int/mediacentre/factsheets/
fs311/en/
• In the world, over 200 million men and
nearly 300 million women are obese
World Obesity (CIA, 2008)
Obesity BMI>=30 as % of all adults
• https://www.cia.gov/library/publications/the
-world-factbook/rankorder/2228rank.html
• 1. American Samoa
74.6%
• 18. USA
33.0%
• 23. Mexico
32.1%
• 29. Argentina
29.7%
• 102. Brazil
18.8%
• 108. France
18.2%
• 157. Japan
5.0%
• 184. India
1.9%
Obesity in USA over time
Obesity in USA 2009-2012
Marasmus: energy
deficiency
Kwashiorkor: protein
deficiency
World Malnutrition
• http://www.wfp.org/hunger/stats
• Hunger kills more people every year than
AIDS, malaria and tuberculosis combined
• 842,000,000 don’t get enough to eat in
world
• Poor nutrition causes nearly half (45%) of
deaths in children under five - 3.1 million
children each year.
• The Paleolithic human in the
modern, developed world
• Old heuristics, e.g., “the image
equals the object”
Late 20th Century developed
world
• Epidemiological revolution: longer life and death
from degenerative diseases: shift to long-term
consequences
• food surplus
• extraordinary range of food choices
• development of super-foods (e.g. chocolate)
• no work needed to attain choices
• Old heuristics not applicable: bias to eating
• massive amounts of risk information
• no training in dealing with risks/benefits or
nutrition
Feature
Heaven
Love
Italians
Banks
Swiss
Universities
British
Food
French
Hell
Feature
Heaven
Hell
Love
Italians
Swiss
Banks
Swiss
Universities
British
Food
French
Feature
Heaven
Hell
Love
Italians
Swiss
Banks
Swiss
Italians
Universities
British
Food
French
Feature
Heaven
Hell
Love
Italians
Swiss
Banks
Swiss
Italians
Universities
British
French
Food
French
Feature
Heaven
Hell
Love
Italians
Swiss
Banks
Swiss
Italians
Universities
British
French
Food
French
British
The developed world
• Western Europe vs India
• 60% of all people live in Asia
• 50% of total expenditures on food in
developing world
Rating scale
•
•
•
•
•
1. strongly disagree
2. disagree
3. neither agree nor disagree
4. agree
5. strongly agree
Mean Agreement
Eating is a religious experience; My diet must
adhere to strict moral/religious principles
The combination of health and
beauty norms
“Concerned about being
overweight”
• % responding “often“ or “almost always”
• 57% females, 21% males
• US college students from 6 universities
across the country
Rozin, Bauer & Catanese, 2003
“I am embarrassed to buy a
chocolate bar in the store”
• American college students from six
campuses across the USA
• % Females:
13.5
• % Males:
4
Cultural solutions
France
With Claude Fischler
Obesity:
France vs USA
• % BMI
>= 30
• France: 16%
• USA:
32%
•
2008
http://www.who.int/gho/countries
Life expectancy at birth
(data from 2008-2010: www.who.int/gho/countries)
rank country
years
rank country
years
1
Japan
83
10
Norway
81
4.5
Australia
82
10
Sweden
81
4.5
Israel
82
14
Austria
80
4.5
Italy
82
14
Belgium
80
4.5
Singapore
82
14
Finland
80
4.5
Spain
82
14
Germany
80
4.5
Switzerland
82
14
Greece
80
10
Canada
81
14
Korea
80
10
10
France
Netherlands
81
81
14
U.K.
19.5 U.S.A.
80
79
Age-standardized annual mortality from
CHD and related risk factors
(males 35-64)
WHO/MONICA Renaud & de Logeril, 1992
Location
Mortality /
100,000
Toulouse, France
78
Serum cholesterol (mg/dl)
230
Lille, France
105
252
Stanford, USA
182
209
Percent of subjects preferring a week at a
luxury (vs. gourmet) hotel at same price
Females
Males
Paris, France
13
8
USA
83
70
Percent of subjects selecting “unhealthy” for
choice:
What do you think of when you think of
HEAVY CREAM?: whipped or unhealthy
Females
Males
France
28
23
USA
68
48
Percent of subjects agreeing that
they eat a “healthy diet”
Females
Males
France
76%
72%
USA
28%
38%
Attitudes regarding food and meat
among American, French, Argentinean
and Brazilian college students
•
•
•
•
•
•
Marle S. Alvarenga
Paul Rozin
Matthew B. Ruby
Guillermina Rutszein
Eve Richter
Teri Kirby
If there was an inexpensive pill to
safely satisfy nutritional needs and
hunger without having to eat, I would
take it
% > = very true of me
Argentina
15.8%
Brazil
11.3%
France
5.9%
USA
14.3%
Enjoying food is one of the most
important pleasures in my life
% > = very true of me
Argentina
52.8%
Brazil
56.1%
France
66.2%
USA
53.1%
In general, I am more concerned
with the caloric content of food
than the taste
% > = very true of me
Argentina
5.3%
Brazil
4.4%
France
2.5%
USA
34.6%
Eating alone does not bother me
% > = very true of me
Argentina
54.8%
Brazil
51.5%
France
41.7%
USA
51.8%
P
Argentina
Brazil
France
USA
C=current
I= ideal
P=peer ideal
I
P
P
P
I
I
I
C
C
C
C
Argentina
PI
Brazil
ICP
France
CPI
USA
ICP
C=current
I= ideal
P=peer ideal
C
??
Beef consumption by country
(2007 or 2008): kg/capita/year
•
•
•
•
France
13.3
USA
28.5
Brazil
37.6
Argentina 71.8
Mean Liking
Liking for beef (-100 to +100)
Free Assoc to BEEF: most
common words
Argentina
Brazil
France
USA
FEMALE
FEMALE
FEMALE
FEMALE
Asado 36
saborosa 66
viande 130
Cow 52
Rojo 31
churrasco 59
steak 23
Meat 24
sabroso 29
sangue 43
rouge 22
Hamburger 22
Comida 19
Gordura; succulente 18
vache 20
Disgusting 19
Animal 13
Red 18
MALE
Jugoso 17
MALE
MALE
MALE
Asado 17
churrasco 39
viande
68
Cow 27
Sabroso, delcicioso, rico, saborosa 31
10
Steak 26
Steak 18
Vaca, sabrosos, grosso
sangue 25
vache 17
Meat 15
Jugoso. milanesa 3
Proteina 17
sang 8
Hamburger, red 7
Boi/vaca 15
rouge 5
Sample free associations to “beef” USA
(with valence)
Word 1-
Word 2
Cow (0)
Word 3
Sum
Valence
Ambivalence
Burger (1) Baseball
(1)
+2
No
Fat (-1)
Unhealthy Cholesterol
(-1)_
(-1)
-3
No
Fat (-1)
Protein (1) Meat (1)
+1
Yes
Valence
Valence of 3 beef free
associations (-3 to +3)
The food environment
• With Claude Fischler, Kim Kabnick and
Erin Pete
P ercen t of red uced fa t food s in
d ifferen t ca teg ories, in su p erma rkets
Item
F rance
U SA
Y ogurt
22
96
M ilk
36
56
Ice cream
00
25
About 2001
Restaurant portion size
R e s t a u ra n t
F ra n c e
USA
M c D o n a ld ’s (7 ) 1 8 9 g
256g
Q u ic k /B k in g (5 ) 2 0 7 g
322g
C h in e s e (6 )
418g
244g
Supermarket food portions
IT E M
C a r r e fo u r A c m e
Y o g u r t (m o d a l) 1 2 5 g
227g
F r e s h fr u it
431g
553g
330m l
500m l
(m e a n ,4 t y p e s )
C o c a c o la
(m o d a l)
Supermarket non-food portions
IT E M
C a rre -
Acm e
fo u r
to o th p a s te
75
170
121
117
100
85
(m o d a l, m l)
t o ile t p a p e r
(m e a n , s q c m )
C a t fo o d
(m o d a l, g )
Mean Portion size
Mean own portion size (chicken)
(1 to 8 half card decks)
Mean Portion size
Mean own portion size (coca cola)
(8 levels)
Mean Portion size
Mean own portion size (ice cream)
(scoop size: 10-110)
Obesity: Changing the person
• Dieting
• Nutrition information and education
Education about science, risks, benefits
• Changing preferences and intake
• Failure of obesity treatments and
dieting
• Only bariatric surgery
• Think about height
Changing the food environment
• Accessibility
• Small accumulated value
• 1-3 standard coca cola cans a week
Salad bar
• Reaching over to the middle (about 5%
reduction in calories)
• Spoon versus tongs (about 5% reduction in
calories)
Portion size
• Amnesia study: Availability
Environment Changes
• Glass size
• Plate size: Brian Wansink
• Very large serving amounts (Wansink:
soda)
In a student cafeteria, when students are served a 50% larger
portion of macaroni and cheese (right) they eat more, and don’t
compensate by eating less of the rest of the meal
Diliberti, Rolls et al., 2004
Cultural norms: Unit bias
(Geier and Rozin, 2006)
• Free access in lobby to bowl of M&Ms,
with either teaspoon or tablespoon
• Amount taken with tablespoon is 70%
greater
• Similar effects with large or small tootsie
rolls or pretzels
Cumulating increments
• James Hill, David Levitsky,Barbara Rolls,
Marion Nestle, Paul Rozin et al.
• Some evidence that portion change effects
may endure, and are not fully compensated
for over at least 2 weeks (Rolls, Levitsky)
Segmentation and consumption interrupts
About 50% reduction
Lay’s stacked potato chips
Geier, Wansink and Rozin
35 calories/wedge
Government versus Industry
initiation
• Let the free market do it (organic, fat free,
calorie free)
• Smaller portion sizes
Energy Expenditure
•
•
•
•
•
Suburban Life
Malls
The car culture
Small but continuing increments
Role for government: e.g., better and
cheaper public transportation
Learning from the French
Some French-American
differences
•
•
•
•
•
•
•
Portion size
Eating time
Eating sociality/ conversation (conviviality)
Freshness and taste (vs shelf life) priority in foods
Degree of snacking and snacking opportunities
Differences in actual foods consumed (e.g., wine)
Differences in variety of food consumed
(Drewnowski et al.)
• Walk/bicycle vs car orientation
We can learn from the French in
this domain (not all domains)
• Focus on the environment to try to reduce
food intake and waist lines
• Don’t reduce the pleasure of eating
• Make small changes that encourage more
exercise and less eating
• Let the effects of those small changes
accumulate, and…..
Vetri Foundation Charter School Lunch: Feb, 2013
$1.50
Vetri Foundation Charter School Lunch: Feb 2013
Yes, eating can be bad for
health
But NOT EATING is
much worse for health
Adios