Addressing Obesity ByChanging Environments

Kelly D. BrownellYale University

www.YaleRuddCenter.org

Nutrition in schools

Sugared beverages & taxes

Food marketing and children

Examples ofMajor Initiatives

Food labeling

A Conceptual Scheme

Knowledge

Motivation

How Best to Make Change?

Educate

Implore

Medicate

Operate

TheIndividual

Less Obesity?

CDC, BRFSS

% of US Population GettingRecommended Physical Activity (1986-2000)

NHANES

% of US Adults GettingRecommended Fruit & Vegetable Servings

0

20

40

60

80

100

1994 1996 1998 2000 2003 2005

Youth RiskBehav Survey

% of US Children GettingRecommended Fruit & Vegetable Servings

0

20

40

60

80

100

1999 2001 2003 2005 2007

What Are We Doing Now?

Knowledge

Motivation

Educate

Implore

TheIndividual

Less Obesity?

Knowledge

Motivation

How Best to Make Change?

Educate

Implore

Medicate

Operate

TheIndividual

Less Obesity?

OptimalDefaults

Economics

Legislation

Environment

Regulation

TheIndividual

Less Obesity?

Another Example – Organ Donation

Johnson & Goldstein, Science, 2003“Do defaults save lives?”

Disastrous Defaults(examples)

• The economics of food

• Food marketing

• Portions

• Too much access

• Too little access

Food Marketing

Food Marketing

Powerful

Relentless

Exploitative

TVAdvertising

Adver-gaming

Other YouthWebsites

Bunnies

Life

Hannah Montana

Clifford Crunch

Mighty Bites

Honey Sunshine

Puffins

Cheerios

Kix

EnviroKids Organic

Mini Wheats

Organic Wild Puffs

The Best Dozen

None

TVAdvertising

Adver-gaming

Other YouthWebsites

x x x

x

x x x

x x x

x x x

x x x

x x x

x x

Reese’s Puffs

Cap’n Crunch

Count Chocula

Trix

Froot Loops

Smorz

Lucky Charms

Golden Grahams

Cinnamon Toast Crunch

Corn Pops

Cocoa Puffs

Fruity/Cocoa Pebbles x x x

The Worst Dozen

RWJF $100million/yr

vs.Child

Marketing

January 4!

The Special Case ofSugar-Sweetened Beverages

The World’sMost Valuable Brand?

% Calories Per Day From 2 Beverages

Nielsen & Popkin. Am J Prev Med, 2004

0

2

4

6

8

10

1977-78 1989-91 1994-96 1999-2001

Milk

Soft Drinks

• Single greatest source of added sugar

• Poor calorie compensation

• Targeting of vulnerable populations

• Sugar may be addictive

• Gratuitous addition of caffeine

• Completely empty calories

Why Soda?

• Rock solid proof of harm

SSBs: How Much?

Average intake = 50 gallons/yr (189 liters)

Average child = 175 calories/day

Children Ages 2-18

Empty calories = 40% of total intake

Largest contributor to overall intake SSBs + Juice Drinks, 173 kcal/day

Reedy & Krebs-SmithJ Amer Dieteitic Assn, 2010

Brownell et al.New Engl J Med, 2019

How Worriedis Industry?

Millions Spent Lobbying Coke & Pepsi + ABA

Los Angeles TimesFeb 7, 2010

Household Budget SurveysExpenditure records (all beverages)Household income & number of residents

Industry ReportsMarket volume & market value

Sugared Beveragesin Latin America

UnderestimatesCaptures about 50% of intake

Data: Datamonitor 2009, Euromonitor 2009, Andreyeva et al 2011

Consumption TrendsPeru, 1997 - 2009

Data: Peru, Encuesta Nacional de Hogares

Consumption TrendsMexico, 1984 - 2008

Data: Mexico, Encuesta Nacional de Ingresos y Gastos de Hogares

Consumption Trends & Income

Data: Mexico, Encuesta Nacional de Ingresos y Gastos de Hogares

Consumption Trends & Income

Data: Mexico, Encuesta Nacional de Ingresos y Gastos de Hogares

Estimated Revenue (20% tax)

$2.66 billion

$256 million

$857 million

$2.37 billion

Brazil

Chile

Colombia

Mexico

Peru $191 million

Revenue (US Dollars)

Calculations based on Datamonitor 2010, Euromonitor 2010, World Bank 2009

Who Are TheChange Agents?

Legislators federal, state, local

Legal Authorities e.g., state attorney’s general

The Press

Litigators

Dr. Thomas FriedenNYC Commissioner of Health

Michael BloombergMayor

LegalDefaults

Game ChangingDevelopments

NYC trans fat ban in restaurants

Menu labeling

White House Announcements

Soda tax proposals

Conn. Attorney General – Smart Choices

www.YaleRuddCenter.org