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health, behavior, and the economy of obesity

Remember the post I opened about loving pizza? Yeah, well I guess my pepperonis are coming home to roost. It is becoming increasingly apparent our struggles with weight gain in this country, at least in terms of a health epidemic, is an economic problem. Eating healthy simply costs more than eating crap. As long as we subsidize corn, we are effectively enablers in an economic addiction to cheap food, poor health and death.

Last week I had the privilege to speak to executives and sales teams at a large financial company. The title of the talk is Innovation as a Requirement for Success in Healthcare. I have not put the slides online, it was mostly a "TED-style" talk and so the visuals do not stand too well on their own. I did share an interesting slide from a JAMA report on actual causes of death. We usually see reports on morbidity - heart attack, cancer, stroke, etc. This particular JAMA report attempted to determine the real root causes of death. For instance, was the lung cancer the direct result of a lifetime of smoking. The study concludes 40% - the bulk majority - of US deaths are due to behaviors. The top three causes are tobacco, obesity / sedentary lifestyle, and alcohol.

Thanks to Ben Miller for first alerting me to the JAMA study on his blog. If you have access, you can find the JAMA article on their site. 

In the talk, I used the JAMA slide as an example of how patient behavior contributes to challenges our healthcare system faces. I went on to talk about food choices in general - a mini soapbox opportunity. If you have seen Food, Inc or read The Omnivores Dilemma then you are already up to speed on how the price of food contributes to poor health.

Food, Inc. is available for free streaming on Amazon Prime as well as Netflix

In Pollan's Omnivores Dilemma, he looks at the price of corn as the most significant contributor to its ubiquity; and its ubiquity as a major cause of  obesity in America. Corn, largely thanks to advancements in genetic modifications as well as the innovation of nitrogen fertilizer, is a prolific crop. So prolific, as it turns out, we have so much excess the federal government pays farmers not to grow it. What do we do with all that corn? In addition to being broken down into many of the  multisyllabic, unidentifiable ingredients in processed food, we are now putting it in gasoline, plastics and more. Why? Because its cheap!

Want a primer? Read Polan's essay here

The artificially low price of corn enables Hostess to sell Twinkies for pennies. Cheap corn lets McDonlads sell you a supersized McWhatever for less than $5.00. Least I be labeled un-American for lambasting a buttered ear of corn at a cookout, it is worth noting we are talking about an entirely different species. For the record, I loved buttered ears of corn. Frankly I love anything buttered.

Last week the USDA in conjunction with the Economic Research Service published a report titled: The Effect of Food and Beverage Prices on Children’s Weights. In the report, researches conducted a longitudinal study of the body mass index of kindergarteners and the Quarterly Food-at-Home Price Database. The results are predictable. Cheap, low quality, highly caloric food contributes negatively to BMI.

In addition, lower prices for dark green vegetables and lowfat milk are associated with reduced BMI. The effect of subsidizing healthy food may be just as large as raising prices of less healthy foods.

From the report's Implications

There are three main implications of our findings. First, they support the idea that food prices have small, but statistically significant effects on children’s BMI. Lower prices for soda, starchy vegetables, and sweet snacks have likely led to increases in children’s BMI. The reverse is true for some healthier foods such as lowfat milk and dark green vegetables. Others have found that lower real prices for fruits and vegetables predict lower weight (Powell and Bao, 2009; Auld and Powell, 2009) or a smaller gain in BMI for young school-age children (Sturm and Datar, 2005, 2008). By separating the price of dark green vegetables from higher calorie starchy vegetables, we find that the price effect is not the same for all vegetables.

For the visual impact, consider the relative inflation of fresh fruits versus carbonated drinks.

While you'll never convince me drinking a liquid from another animal is normal (and yet I love cheese, I am paradox!) , check out the findings on drink consumption tends:

I would be the last person to admonish anyone's tastes or food preferences. As I write this, I'm looking at a plate which just a few scant minutes ago was throne to a wonderful slice of pepperoni and jalapeño pizza. Have I told you about my thing for Sour Patch Kids? OHMYGODTHEYAREAWESOME. However, we have a relative luxury in my household - we can afford leafy, healthy, full-of-summer-sun vegetables. We belong to a CSA farm.  We shop at Whole Foods and buy organic veggies. And non of that is cheap. While our personal choices may at times be poor, we have the ability to eat well and within our budget.  When a head of broccoli costs more than a whole meal at McDonalds how do we ever expect to address the behavioral causes of health problems and death in this country?