The Impact of Big Food on Obesity in the United States
Obesity
Obesity is a major global health problem and contributes to 4.7 million premature deaths yearly.[1] Global obesity rates have nearly tripled since 1975.[2] Obesity is an epidemic[3] in the United States, with obesity rates of 41.9% for adults aged 20 and over and 19.7% for youth aged 2-19.[4] The estimated annual medical cost of obesity was nearly $173 (2019).[5]
Overweight and obesity is “abnormal or excessive fat accumulation that may impair health,” defined as having a high body-mass-index (BMI) measured in kg/m².[6] For adults, a BMI ≥ 25 is overweight and a BMI ≥ 30 is obese, while for children BMI-for-age percentiles are used.[7] [8] Obesity is a risk factor for leading causes of death including heart disease, stroke, diabetes and cancer.[9] [10]
How did the obesity epidemic happen?
WBAL-TV 11 Baltimore aired a news segment in September 2022 entitled “How did the obesity epidemic happen?” as part of their “Weight of the nation” series, showing some of the causes, drivers and solutions for obesity.[11] Anne Palmer[12] from the Johns Hopkins Center for Livable Future, kicks off the segment by stating, “It’s a perfect storm of a lot of really bad factors that have gotten us here”.[13] Factors such as “Big plates, big portions, big advertising,” and that “food is so ubiquitous and it’s everywhere you look,” says Dr. Bill Dietz, Director of the STOP Obesity Alliance.[14]
Palmer adds that supermarkets have gotten much bigger, with only about 10,000-15,000 supermarket products in the 1970s, to now 50,000-80,000 products, usually more processed foods.[15] The segment mentions that many processed foods contain more salt, sugar and fat to make them last longer and taste better. “Widely available, inexpensive and tastes good. It’s [processed food] designed to make people overweight,” says Dr. Dietz.[16] The segment cited a National Institutes of Health study where, in 2 weeks, adults on a processed diet gained 0.9kg/2lbs while those on an unprocessed diet lost the same amount.[17] [18]
The segment highlights the attraction to convenience and cost, that people are cooking less and rely on quick and easy meals, while healthy food can be more expensive and is not even available in many neighborhoods which lack supermarkets, a factor in food insecurity. People are also more sedentary and have less physical jobs. Dr. Kuldeep Singh, Director of the MD Bariatric Center at Mercy joked, “Now we don’t even go to the grocery store. We just order! What is next? Is somebody going to put food in our mouth?”[19]
Big Food
This prevalence of processed foods featured in the segment is related to the rise of Big Food, which are the leading multinational food and beverage companies.[20] In the US, the ten largest food companies control over half of all food sales,[21] which means consumer choice “is largely an illusion.”[22] More than 70% of US food supply is ultra-processed.[23] [24] Ultra-processed food consumption is associated with increased risk of obesity and related cardiometabolic outcomes.[25]
According to the Guardian, Big Food’s economic power has led to growing political power in the US, “which in turn has led to laws that put profits before food and worker safety, consumer rights and sustainability.”[26] During the 2020 election cycle, the food industry spent $175m on political contributions, compared to $29m spent in 1992, which means lobbying has increased sixfold.[27] Globally, the ultra-processed food industry has consistently engaged in political activities to influence global-level non-communicable disease policy, such as delaying, weakening or preventing public health regulation.[28]
How can obesity be prevented?
Obesity is preventable. Some of the ways to tackle obesity mentioned in the segment are monetary incentives for food stamp recipients to purchase fruits and vegetables, taxing sugary beverages and creating more green space for recreation.[29] Other solutions identified by WHO include recommendations at the individual level to limit fats and sugars, increase consumption of healthy and nutritious foods, and engage in regular physical activity.[30]
However, WHO highlights that “individual responsibility can only have its full effect where people have access to a healthy lifestyle,” and it is also on the societal level to support these recommendations through “policies that make regular physical activity and healthier dietary choices available, affordable and easily accessible to everyone, particularly to the poorest individuals.”[31]
WHO provides recommendations for the food industry to: reduce the fat, sugar and salt content of processed foods; to ensure healthy and nutritious choices are available and affordable to all consumers; to restrict marketing of unhealthy foods especially those aimed at children and teens; and to support regular physical activity practice in the workplace.[32]
The growing influence of Big Food and the ultra-processed food industry shows that better safeguards are needed to protect non-communicable disease policy and public health regulation against commercial interference and conflicts of interest at the global and national levels.[33]
References
[1] Ritchie, H. and Roser, M. (2017). Obesity. [online] Our World in Data. Available at: https://ourworldindata.org/obesity.
[2] World Health Organization (WHO) (2021). Obesity and overweight. [online] World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
[3] Mitchell, N.S., Catenacci, V.A., Wyatt, H.R. and Hill, J.O. (2011). Obesity: Overview of an Epidemic. Psychiatric Clinics of North America, [online] 34(4), pp.717–732. doi:10.1016/j.psc.2011.08.005. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228640/.
[4] Bryan, S., Afful, J., Carroll, M., Te-Ching, C., Orlando, D., Fink, S. and Fryar, C. (2021). NHSR 158. National Health and Nutrition Examination Survey 2017–March 2020 Pre-pandemic Data Files. National Health Statistics Reports, [online] 158. doi:10.15620/cdc:106273. Available at: https://stacks.cdc.gov/view/cdc/106273.
[5] Centers for Disease Control and Prevention (2021a). Adult Obesity Facts. [online] Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/obesity/data/adult.html.
[6] World Health Organization (WHO) (2021).
[7] World Health Organization (WHO) (2021).
[8] Centers for Disease Control and Prevention (2021b). Defining Adult Overweight and Obesity. [online] Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/obesity/basics/adult-defining.html.
[9] Ritchie, H. and Roser, M. (2017).
[10] Centers for Disease Control and Prevention (2021a).
[11] WBAL-TV 11 Baltimore (2022). How did the obesity epidemic happen? | Weight of the Nation. [online] YouTube. Available at: https://www.youtube.com/watch?v=eL692D1WXjU.
[12] Johns Hopkins Center for a Livable Future (n.d.). Anne Palmer. [online] Johns Hopkins Center for a Livable Future. Available at: https://clf.jhsph.edu/about-us/staff/anne-palmer [Accessed 12 Nov. 2022].
[13] WBAL-TV 11 Baltimore (2022).
[14] WBAL-TV 11 Baltimore (2022).
[15] WBAL-TV 11 Baltimore (2022).
[16] WBAL-TV 11 Baltimore (2022).
[17] WBAL-TV 11 Baltimore (2022).
[18] NIH study finds heavily processed foods cause overeating and weight gain (2019). NIH study finds heavily processed foods cause overeating and weight gain. [online] National Institutes of Health (NIH). Available at: https://www.nih.gov/news-events/news-releases/nih-study-finds-heavily-processed-foods-cause-overeating-weight-gain.
[19] WBAL-TV 11 Baltimore (2022).
[20] Stuckler, D. and Nestle, M. (2012). Big Food, Food Systems, and Global Health. PLoS Medicine, [online] 9(6), p.e1001242. doi:10.1371/journal.pmed.1001242.
[21] Stuckler, D. and Nestle, M. (2012).
[22] Lakhani, N., Uteuova, A. and Chang, A. (2021a). The illusion of choice: five stats that expose America’s food monopoly crisis. [online] the Guardian. Available at: https://www.theguardian.com/environment/2021/jul/18/america-food-monopoly-crisis-grocery-stores
[23] Samuelson, K. (2019). America’s packaged food supply is ultra-processed. [online] Northwestern Now. Available at: https://news.northwestern.edu/stories/2019/07/us-packaged-food-supply-is-ultra-processed/.
[24]Ravandi, B., Mehler, P., Barabási, A.-L. and Menichetti, G. (2022). GroceryDB: Prevalence of Processed Food in Grocery Stores. medRxiv. [online] doi:10.1101/2022.04.23.22274217. Available at: https://www.medrxiv.org/content/10.1101/2022.04.23.22274217v1.full.
[25] Poti, J.M., Braga, B. and Qin, B. (2017). Ultra-processed Food Intake and Obesity: What Really Matters for Health—Processing or Nutrient Content? Current Obesity Reports, [online] 6(4), pp.420–431. doi:10.1007/s13679-017-0285-4. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5787353/.
[26] Lakhani, N., Uteuova, A. and Chang, A. (2021b). Revealed: the true extent of America’s food monopolies, and who pays the price. [online] the Guardian. Available at: https://www.theguardian.com/environment/ng-interactive/2021/jul/14/food-monopoly-meals-profits-data-investigation.
[27] Lakhani, N., Uteuova, A. and Chang, A. (2021b).
[28] Lauber, K., Rutter, H. and Gilmore, A.B. (2021). Big food and the World Health Organization: a qualitative study of industry attempts to influence global-level non-communicable disease policy. BMJ Global Health, 6(6), p.e005216. doi:10.1136/bmjgh-2021-005216. Available at: https://gh.bmj.com/content/6/6/e005216.
[29] WBAL-TV 11 Baltimore (2022).
[30] World Health Organization (WHO) (2021).
[31] World Health Organization (WHO) (2021).
[32] World Health Organization (WHO) (2021).
[33] Lauber, K., Rutter, H. and Gilmore, A.B. (2021).blo
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