Two Duke Global Health Institute (DGHI) faculty members—Mary Story and Eric Finkelstein—have articles in the November issue of Health Affairs, which is devoted entirely to the subject of food and health, marking the first time the publication has covered this subject in this way.
Finkelstein and colleagues look at the connection between the consumption of specific food and beverages and weight gain among children and adolescents. Story and colleagues examine the complex relationship between food and health and provide policy recommendations designed to clear the way for people to eat better.
Finkelstein: Certain Foods Promote Obesity
Finkelstein looked at a set of data from the Avon Longitudinal Study of Parents and Children in the United Kingdom, which showed the level of consumption of 27 foods and beverages by a group of 4,646 young people age 7-13, in addition to their physical activity and weight. Children completed a food diary and had their height and weight measured at ages seven, 10 and 13 years. Their activity levels were measured with a device that calculates the duration and intensity of physical activity.
“Potato chips are one of the most obesity-promoting foods for young people,” Finkelstein said. He and his co-authors found that other problematic foods included butter and margarine, breaded or coated chicken or fish, French fries, processed meats, refined grains such as white bread, desserts and sweets, and milk and soda.
The characteristics or cooking processes of certain foods appear to be responsible for some of the negative effects. For instance, liquid calories have been shown to be more obesity-promoting than calories from solid foods, perhaps because beverages are typically less satiating than food. Despite the fact that both potato chips and French fries are on the “bad” list, potatoes themselves, when boiled or mashed without using oil, are highly satiating and contain a number of essential nutrients. Similarly, uncoated chicken and fish are not associated with weight gain.
At least 30 minutes of physical activity each day was associated with healthy weight levels.
“Don’t Super-size It” among Recommendations
“Our findings support policies that aim to reduce the intake of specific food items and efforts to change methods of cooking and processing food,” Finkelstein said.
He also said the findings of this study support policy efforts underway in several countries around healthier school meals, limiting sales of super-sized sugar-sweetened beverages, and school- or community-based physical activity opportunities.
Story: Many Factors Feed into Consumer Dietary Choices
Story and colleagues present a broad overview of the connection between food and health and suggest policies that alter the environment to promote healthy eating.
According to Story, the American diet has improved slightly over the decade 1999-2010, but it is still poor. The data her team examined showed that educational levels contribute to better dietary quality, which exposes an important disparity in diet based on level of education. The data also showed that the diet of children and young people is generally short of healthy items such as fruits, vegetables and whole grains and long on added sugars, sodium and saturated fats.
Alongside these worrisome trends are increases in obesity, diabetes, hypertension and food allergies. The data exposed significant disparities between whites and populations of color in disease prevalence.
How individuals choose, procure and eat food is governed by a complex set of variables, according to Story. Those variables include macro systems like agricultural policy and food manufacturing and social and cultural norms, to local factors like food availability in a particular neighborhood, family financial resources and personal taste.
In 2009, more than 19,000 new food and beverage products were introduced in the U.S., many of which came about because of advances in food science and food processing. “Unfortunately, many of those new products are high in calories and contain unhealthy fats and sweeteners,” said Story. “But because they’re cheap, tasty and easy to prepare, they continue to make up more and more of the American diet.”
Recommendations Address Food Labeling, Marketing and Taxes
Story and colleagues seek to attack the obesity epidemic with set of policy recommendations that mirror the influences that contribute to it. Starting at the macro level, they recommend labeling of trans fat on packaged goods and posting of calories in chain restaurants.
They recommend changes in food marketing to young people, so that kids under 12 are exposed to healthy diet and lifestyle options. So far, 17 companies have voluntarily agreed to abide by this recommendation.
According to Story, changes to federal programs that are implemented locally (such as the WIC program, SNAP and the school lunch program) can make healthy food and beverage options more widely available, resulting in individuals and families making healthier choices.
At the individual level, increasing taxes on items such as sugary beverages has shown to be an effective strategy. In addition, providing additional money to SNAP users when they purchase fresh produce reduces this well-documented price barrier.
“There is no magic bullet when it comes to addressing broad cultural, societal and biological factors that contribute to the obesity epidemic,” said Story. “It will take a broad, comprehensive commitment at many levels to tackle the formidable environmental factors that contribute to unhealthy eating.”
