The document discusses how obesity has become a political issue due to several factors, including cheap, high-calorie food promoted by corporate interests; the food industry outspending public health efforts on education; and health care costs associated with obesity-related diseases. It argues that both the food industry and advocates of public health are entrenched in their positions, similar to debates around global warming.

1. Why is obesity a political problem? Cheap food? Corporate profits? Health care costs?

2. The debate over obesity, it turns out, is a lot like the debate over global warming. In both cases, major companies protect their profits not only by lobbying against policies they don't like, but also by financing advocacy groups devoted to debunking research whose conclusions they don't like. - Paul Krugman NY Times, “Girth of a Nation” July 5, 2005

3. Economics +/vs. education= Politics Obesity is a disease of poverty of mind and pocketbook. Education Economics Politics

4. Gersham’s Law: bad drives out the good Cheap high fat/high calorie food is driving out healthier choices The organic market has emerged in response to the consumer perception that cheap industry food is bad for you but it is not cheap The food industry outspends public health education efforts by more than 500 to 1

5. The leading causes of death

6. Actual causes of death 1990 and 2000

7. The Economic Burden of CVD Heart disease CAD Stroke HTN CHF Total CVD $0 $50 $100 $150 $200 $250 $300 $350 Billions $368 $239 $133 $54 $56 $29 CAD, coronary artery disease; CHF, congestive heart failure; CVD, cardiovascular disease; HTN, hypertension. Heart Disease and Stroke Statistical 2004 Update. American Heart Association. CAD, coronary artery disease; CHF, congestive heart failure; CVD, cardiovascular disease; HTN, hypertension. Heart Disease and Stroke Statistical 2004 Update. American Heart Association.

8. Prevalence of Diagnosed Diabetes Among US Adults,1991-2001

9. Cost of Diabetes in the US, 2002 Total (direct and indirect): $132 billion Direct medical costs: $92 billion Indirect costs: $40 billion (disability, work loss, premature mortality)

10. (*BMI  30, or about 30 lbs overweight for 5’4” person) 1995 200 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Obesity Trends* Among U.S. Adults BRFSS, 1991, 1996, 2003 2005 Source: Behavior Risk Factor Surveillance System, CDC

11. Prevalence of the Metabolic Syndrome in the US Ford ES, et al. JAMA 2002;287:356-9

12. Metabolic Syndrome Costs Genetics Environment Hypertension IGT IFG Early DM Obesity Late DM Fertility drugs Aspirin Herbal supplements OTC Phentermine Orlistat Sibutramine Resins Fibrates Statins Niacin OTC Ezetimibe Diuretics Ace inhibitors Beta blockers Alpha agonists ARBs Other Insulin Glitizones Sulfonylureas Biguanides Others Fluoride Pesticides Antibiotics Fertilizers Sunblocks Antireflux Dyslipidemia HDL-C TG

13. Genetics Environment Hypertension IGT IFG Early DM Obesity Late DM Fertility drugs Aspirin Fluoride Pesticides Antibiotics Fertilizers Sunblocks Antireflux Herbal supplements OTC Phentermine Orlistat Sibutramine Resins Fibrates Statins Niacin OTC Ezetimibe Diuretics Ace inhibitors Beta blockers Alpha agonists ARBs Other 3.99 + $80.00 + $29.99 + $138.29 + $9.99 + $61.99 + $79.95 + $89.79 = Insulin Glitizones Sulfonylureas Biguanides Others $493.99 per month Dyslipidemia HDL Trig

14. The yearly cost for this sample individual? $5927.88

15. All diseases are like a costly game of Russian roulette “ Genetics loads the gun; the environment pulls the trigger.” -George Bray

16. What are leading theories in our environment making obesity worse? Diet Lack of exercise Inadequate sleep. (Average sleep amounts have fallen, and many studies tie sleep deprivation to weight gain.) Increases ghrelin. Endocrine disruptors, which are substances in some foods that may alter fats in the body. (HFCS) Nice temperatures. (Air conditioning and heating limit calories burned from sweating and shivering.) Fewer people smoking. (Less appetite supression.) Medicines that cause weight gain. Population changes. (More middle-agers and Hispanics, who have higher obesity rates.) Older birth moms. (That correlates with heavier children). Genetic influences during pregnancy. Darwinian natural selection. (Fat people outsurvive skinny ones). Assortative mating, or &quot;like mating with like,&quot; as Allison puts it. Translation: fat people procreating with others of the same body type, gradually skewing the population toward the heavy end. And possible bacteria in the gut! (Did the bacteria or obesity come first?) Are you fat? It Could Be the Air Conditioner By MARILYNN MARCHIONE, AP Medical Writer

17. Anything but… Cheap high calorie/high fat food and a lack of exercise

18. This is the sacred cow of dietary advice And I am sad to say I have to kill this poor cow. homework.uoregon.edu:8080/dchat/images/cow.gif

19. What if our losing weight battle is a combination of things (like a system)? Add nobody is completely to blame nor blameless Everyone is responsible because everybody bears some sort of burden from the cost of health care due to obesity

20. What has changed? Our politics has become more polarized Our economy has become more centralized and profit driven Our educational and public health systems need to focus on sustainable long-term needs for both individual and social growth

21. What is in our food supply? We add 77.2 grams of fat and 29.7 grams of caloric sweeteners per capita into our food supply. This makes high calorie food very cheap! Source: USDA (2006)

22. The simple carbohydrate breakdown Early in 2005 a pound of beet sugar cost 24 cents but high fructose corn syrup cost about half as much 13 cents a pound. HFCS has become a very common and cheap sweetener.

23. There is a new scientific paradigm emerging… The problem is neither fat nor carbohydrates The real problem is we are eating too much of the wrong type of fat and carbohydrates with very little fiber in our diet

24. The fiber trend… since 1907 We took out the fiber then put it back in

25. Refined breads and cereals are designed to taste better. Some people kept eating the bread and cereal without the fiber. The greater the refinement the worse it is for you.

26. There is little difference in the science behind these 3 leading diet books… The big difference is the writing style and health education

27. Dietary advice has not changed much- In thirty years, the USDA has not significantly changed dietary advice .

28. What do we eat? Males Females The calories we consume come from 49 %(males) to 52% (females) from carbohydrates {half that from sweeteners} 32.8% from fat 17.9 (males) 20.3 (females) from protein

29. How many calories do we eat? The average male consumes 2618 calories daily. The average female consumes 1877 calories daily.

30. How many calories make a pound of fat? About 3600 calories (above your resting metabolic rate) is a pound of fat (for the average person).

31. Cutting through the fat… There are good fats, bad fats and very ugly fats in our nation’s food supply : a) the good fats are Omega 3 fatty acids, monounsaturated fats and polyunsaturated fats c) the bad fats are saturated fats d) the ugly fats are trans-fat acids In the human body our liver turns these fats into the good (HDL), the bad (LDL and triglycerides) and the ugly (VLDL).

32. In 5 seconds, what do these labels say? Slow down and digest the food information you need because your health depends on it

33. The 3 stories about High Fructose Corn Syrup It is liquid candy. It has no nutrients and will leave you hungry. - my Nutrition instructor at WIU.

34. Beverages are less satiating than solid food. When consuming beverages, people don’t compensate by eating less food later simply because liquid calories do not register with appetite control. Cindy Goode, Hy Vee dietitian quoted in the Iowa City Press Citizen in December 2006.

35. High fructose corn syrup inhibits leptin (the satiety controlling hormone) and raises triglycerides in blood K. Neff, S.Elliot, M. Tschop, Dietary Fructose Reduce Circulating Insulin and Leptin Attenuates Postprandial Suppression of Ghrelin and increases Triglycerides in Women (2004) Journal of Clinical Endocrinology & Metabolism

36. All three say pretty the same thing: Empty calories you consume in soda pop will make you fat and more hungry

37. Why don’t get rid of HFCS? High fructose corn syrup is the cheapest thing in the food market. The profit margin is HUGE. Every restaurant in country sells it. We might have a recession without it. Maybe even a famine…

38. Making moral choices in a system of systemic violence is no easy task but being part of the problem not an answer to systemic violence.