100 Ways to Fight Obesity: A New Freakonomics Radio Podcast

Listen now:

Our latest Freakonomics Radio podcast is called “100 Ways to Fight Obesity.” (You can subscribe at iTunes, get the RSS feed, or listen via the media player above. You can also read the transcript;  it includes credits for the music you’ll hear in the episode.)

Steve Levitt runs a  consulting firm called The Greatest Good. It is occasionally hired by a philanthropist or foundation to look into societal problems. That’s what happened recently, when the Robert Wood Johnson Foundation asked The Greatest Good to put together a brainstorming session on childhood obesity. Stephen Dubner moderated the event. In this podcast, you get to be a fly on the wall as a dozen participants explore the biological, behavioral, political and economic angles of obesity.

The participants are: Peter Attia, a former surgeon who now runs a nonprofit focused on nutrition; Kelly Brownell from the Rudd Center For Food Policy & Obesity at Yale; Geoffrey Canada of Harlem Children’s Zone; Bill Dietz, the former director of the Division of Nutrition, Physical Activity, and Obesity at the CDC; Chris Economos, who studies obesity and childhood nutrition at Tufts ; Steven Gortmaker of the Harvard School of Public Health; Nobel laureate Daniel Kahneman; Harvard economist David Laibson; RWJF Health Group senior vice president Jim Marks; Brian Mullaney, co-founder of Smile Train and WonderWork; Eric Oliver, a political scientist at the University of Chicago who has written a book about obesity; and Mary Story from the School of Public Health at the University of Minnesota. 

For all the myths surrounding obesity and weight loss, the fact is that 17% of children and adolescents in the U.S. are now obese. Chris Economos puts this in context:

ECONOMOS: The obesity rates for children have tripled in the United States over the last 40 years. And there are dramatic health and societal consequences that result from that. Some are immediate and some are long-term, particularly because childhood obesity leads to adult obesity. 

Research shows that half of obese children become obese adults, compared to about 25% of non-obese children. And the cost to society is high: obesity-related healthcare makes up almost 20 percent of our total healthcare spending, which represents nearly 20 percent of our GDP.

Geoff Canada gives his perspective on why this problem is so hard to fix:

CANADA: I have become increasingly convinced, and I’m no scientist, that a lot of this is addictive behavior, that the sugar that folks consume, it is an instant feedback, eating a Twinkie. Maybe I’m the only one that gets that satisfaction from doing it, but lots of families I think are using food because the rest of their lives are so horrible that this is something that you can enjoy. And now Geoff wants to take that from you, too.

As you’ll hear, no idea was off the table, no matter how daunting or unpalatable. In fact, an idea that Levitt floated is one that he’s been dreaming of for a while.


Perspective

If Americans cut down on fast food and higher cost-lower nutrition processed foods, might we reduce GDP by about the same amount we spend on obesity-related healthcare?

Neither the healthcare industry nor the food manufacturers and purveyors want to take a cut in revenues. They have opposing objectives and it's much easier for us to give in to our taste buds and reward needs.

Armando

People could also do things like exercise, while still eating their Big Macs and gulping down their Coca-Colas. That way the food industry doesn't suffer any and the exercise industry actually benefits.

Granted the actual health of the patient, obesity aside, wouldn't change, but it would certainly be an improvement. I think the sedentary lifestyle of people accounts for their weight and health-problems more so than the food they eat.

James

My own hypothesis is that a lot of obesity really is down to malnutrition. So much of that "delicious, safe, affordable food" (most of which tastes far from delicious to me) is either empty calories, like soft drinks, or has been processed in ways that remove a lot of the micronutrients. The body knows it's missing them, even though the stomach is full, and turns on the hunger stimulus. Those without self-control or a serious exercise program to burn the excess calories thus paradoxically become obese through starvation.

I wonder if anyone has ever done a comparative analysis of the body types of the customers of say Whole Foods vs conventional supermarket vs McDonalds.

Matt Aquavia

The comparative analysis will only reveal that people with adequate income and who understand how nutrition affects health tend to shop at places like whole foods. This doesn't give any new info on why 1/3 of americans are obese. Also the calories in calories out argument is proven to be false. You have to change your body chemistry and its metabolism. What we do need to do is to have people pay for there healthcare based on there health index. a 400 pound man should be paying significantly more in premiums than myself who is a healthy 155 lbs.

Jeff D.

Well, that is what I've always called the "girth of poverty". Cheap caloric intake typically lacks nutrients, thus the body craves more caloric intake. The body is consuming without feeding.

Julien Couvreur

It seems to me that the first step to solving the obesity problem is understanding what causes it.
This podcast mentions two theories in passing: (1) problem of sugars and insulin resistance, and (2) caloric balance.
It turns out those two are pretty different. Journalist Gary Taubes searched for rigorous studies that support the caloric balance theory, and it seems the evidence does not warrant the widespread belief it attracts.
Anyways, whichever one is correct should inform how to improve nutrition. How could we expect any success otherwise?
Then you can involve economists and psychologists.

Also, regarding the ideas of government regulation of food marketing, the guest seems to suggest that marketing is undesirable and manipulates individuals. If that is true, then why aren't broccoli producers also taking advantage of this manipulation?
I suspect the real problem goes deeper. It is not that marketers manipulate consumers, but that they advertise stuff that consumers actually want and enjoy. Our increased ability to satisfy our impulses (fast food, snacks) may be at odds with our evolutionary traits (we enjoy sugar, but we can't handle much).

Assuming the problem is sugars, if people are motivated to stay healthy, then you could have credit card rewards or penalties. Maybe you choose a credit card which is connected to your health insurance's premium (raise premium if you eat bad). Or don't allow transactions in certain unhealthy stores. You could think of more such tools of self-restraint which people could commit to (probably on a New Year, as part of resolutions).

Read more...

Philip

I agree with Julien. These two theories (insulin resistance and caloric balance) are diametrically apposed and whenever an "expert" lumps them together I almost immediately discount their opinions. It's either on or the other, not both. I think that Taubes and others have proven that caloric deficits don't lead to long-term weight loss and that while exercise is extremely beneficial, it really doesn't help manage weight in the long run.

I've applied the insulin resistance theory to great results in my life (though I accept the n=1 does not make for a generally applicable experiment).

Myron Jobra

Not true. Weight loss (gain) = calories in - calories out. The issue is that people only THINK they understand (and can easily calculate) the calories out portion of the equation. In reality, calories out cannot be determined from an online calculator. It varies from person to person. Metabolisms change, insulin resistance (or sensitivity) builds up, leptin resistance (or sensitivity) builds up, etc. All of these things impact the calories out portion of the equation and make it harder to understand.

No one has proven that a caloric deficit doesn't lead to long-term weight loss because no one has sustained a caloric deficit for the long run. Why? Because the calories out portion changes, which disrupts the caloric deficit.

This brings us to a question: How do we apply this information to ensure weight loss? Answer: If you want to lose weight, you must achieve and sustain a caloric deficit. One can do this by cutting down on caloric intake and exercising more in the short run, but eventually this will lead to a decline in metabolism. At that point, one must either repeat the previous step or bring metabolism back up.

The next question is: How do I increase the metabolism? This one is not so simple, but the solution is usually increasing caloric intake slowly. Sometimes it can be achieved by addressing hormonal issues (leptin and insulin) through manipulating carbohydrate intake. However, it's important to note that one cannot simply lose weight endlessly through trying to regulate insulin and leptin. These hormones

Read more...

frankenduf

wonder if canada's conjecture is true- that is, do horrible lives correlate with obesity- if so, there should be an obesity spike along with the Great Recession

beasers

In the UK at least, during the current economic recession, sales of cheap, lower quality foodstuffs are up, standard supermarket range products are down and the "premium" offerings are pretty static. So it would appear that people are generally trading down a bit in quality, which generally means poorer nutritional content, more salt and fat. Poor nutrition doesn't just lead to obesity though, you need to throw in high blood pressure, heart disease and cancer risk - from what we're told anyway...

Enter your name...

You'd have to account for fast-food and restaurant changes, not just grocery store sales. If I'm buying more cheap junk at the grocery store, but less at McDonald's, then my overall diet hasn't changed. It just looks like it's changed, according to the database at the grocery store.

Nathan Vrubel

This has been a interesting discussion. I do have a question that I think wasn't addressed and it concerns the amount of time required for "proper nutrition". The panel discussed how cheap foods tend to have a high sugar content and are quick meals. From my families experience, we think about food a lot! Going to the grocery store, cooking, cleaning, planning, etc. We found that eating healthy is a slight increase in our budget, but it is a big drain in our schedules. I would expect this to be consistent with other families. You have to invest some combination of money or time into eating healthy, and unfortunately, a large percentage of the population can't do that for their daily lives.

On rewards side of the discussion; we receive a mental feedback when we eat (I guess dopamine). I wonder if there is a way we can increase the dopamine levels from healthy foods and decrease them from junk food?

As for the cost of high sugar foods, my assumption is that the profit margin is higher for foods with high sugar, so they are pushed harder (e.g. advertised more). This is a bit of a stretch, since we find so many foods in the grocery store that have added sugar when there is really no need (salsa, yogurt, pasta sauce, etc.). So why are manufactures adding sugar to these products... because there a market. Taxing sugars, (or conversely, removing corn subsidies) could help reduce the profit margin and force a shift in supply.

Read more...

matt aquavia

I cant is an excuse for fat people and lazy people. if you care about yourself and your family then you will find time and energy to make sure that the option to eat healthy is present. "I can't" has created this problem.

MK

A couple comments:

Peter Attia said the first ingredient in baby formula is HFCS. He is simply wrong. When I heard this I checked our formula -- Enfamil purchased at Wal Mart, so it's not like it's some organic off brand bought at our local food co-op -- and HFCS is nowhere to be found. In fact, I don't see HFCS in any of the baby food we buy. Alarmists like Attia like to oversell the problem, and that severely harms their message.

That plays into my second point -- anyone who says that unhealthy food costs more than healthy food simply doesn't do any grocery shopping. Vegetables and fruit are far less expensive than processed food. As someone mentioned above, there is a time cost involved, but money-wise it's just untrue that it costs more to eat healthy. Sure, if you buy non-GMO, organic, locally-grown kale it may cost more than a box of macaroni and cheese, but there is no evidence to support the idea that GMO or conventional food is unhealthy.

Read more...

Armando

That's not true.

Per calorie, buying fast-food is cheaper than vegetables/fruits.

Sure, you can buy a 10 lb. bag of potatoes from Coscto and get about 110 calories per medium-sized potato, but all you're getting are carbohydrates and some potassium. Go buy the equivalent (in $$$) burgers off the dollar menu at McDonald's and you'll get many more calories plus protein and fat.

Strictly from a macronutrient and calorie standpoint I think fast food wins out no matter how you look at it.

MonkeyChow

Maybe a calorie from fast food is cheaper than a calorie from a bag of potatoes, or maybe not. But I don't think comparing the cost per calorie of any two food items is MK's point.

The interesting question is whether a healthy diet is more expensive than an unhealthy diet.

My experience has been the same as MK's, that provided you have access to both a grocery store and a kitchen (which isn't always the case) healthy food is cheaper than junk.

Enter your name...

I don't think that shaming parents produces better behavior, especially when you posit that their bad nutritional choices is due to having a bad life. I believe it would be far more effective to use peer pressure, and even to make nutrition an aspirational luxury. Instead of "You bad mommy, you let your child get fat", you want to take the tone of "Don't believe what the television shows (or what the kids say 'everybody else is eating'). Most of the mothers in our neighborhood feed their children fruit or vegetables at every meal."

Examples of what's simple and inexpensive are also helpful. Instead of recipes for fancy stuffed citrus, you want ads that say "Adding fruit to breakfast is as easy as giving your child a banana with his cold breakfast cereal" or "Frozen vegetables (now available at the local convenience store—after all, they already had freezers installed for ice cream) have all the nutritional benefits of fresh vegetables."

Read more...

James

Interesting bit of news on the relationship between weight loss and gastrointestinal bacteria: http://news.sciencemag.org/sciencenow/2013/03/gut-microbiomes-surgical-weight-.html?ref=hp

"In many people with type 2 diabetes, the disease vanishes almost immediately after (gastric bypass) surgery, too quickly to be explained by the gradual weight loss that happens later. Patients also describe not being as hungry, or craving foods like salad that they hadn't liked much before."

Joe

I'm surprised there's been no mention of the Farm Bill, particularly from a group of economists. This is a modern problem, arising just 40 years ago, so I'd love to hear their take on how the Farm Bill has affected things like the obesity epidemic (you have to put all of that subsidized corn somewhere), immigration (what has cheap corn done in Mexico?), and the environment (monoculture and heavy fertilization).

About the only thing I can't attribute to our food policy is gun violence...

Enter your name...

The transcript says that 1,000 (extra) calories costs $1 worth of life expectancy. Does anyone know what the total social cost is? Does it depend on whether those extra calories result in overweight vs obesity vs morbid obesity?

Tarrou

A lot of talk about subtle economics and cost comparisons and nutrition. Some of which is actually probably useful. But it seems to me that the simplest and most obvious solution is the one everyone is missing, because it is mean. Make it socially unacceptable to be fat, and fewer people would be fat. It's the shortest, easiest, cheapest and simplest way to affect the obesity rate. People may argue for not subsidizing corn, and hell, I agree. But low grade verbal bullying and social ostracism is a far more potent tool. So the question becomes, how much do you want to decrease obesity? Enough to torture a fat teen emotionally for years? Is it worth that? Or are we only using "nice" tools and abstracts on the problem? Put another way, how serious are we about the problem? If we're only "sugar subsidy" serious, we're going to have a lot of obesity in the future, I can tell you that.

Kes

It already IS socially unacceptable to be fat. Note that in this episode, the number one concern of kids as a consequence of being overweight or obese was being picked on. Fatness is a severe transgression of social norms.

However, the issue with this is that obesity can be genetically related, and in most cases, is not a matter of failure of individuals, but can be the product of the environment and interaction with individual genetics, as well as choices. There are a variety of confounding variables which lead to obese conditions.

We already DO torture people for being fat. They are less likely to be employed and will always have to answer questions regarding their weight, which can be linked to their value as a person. (For example when Chris Christie was considered a potential candidate by the media, the question asked was "Is he too fat to be president" and not something regarding his policies.) If fat shaming was effective at changing behaviors, then all teenage girls would be waifs. Ostracizing fat people has not produced any positive results, but instead has contributed greatly to eating disorders and our unhealthy relationship with ourselves, our bodies and food.

Why not see what we can accomplish with less stick, more carrots. literally.

Read more...

PBkitchyKachoo

Two thoughts: 1) Endocrine disrupting chemicals need to be part of the discussion about obesity and type 2 diabetes. We don't just have rising obesity rates, we also have increasing infertility and a rise in hormone related cancers. It seems to me that endocrine disrupting chemicals might have something to do with that.

2) I've heard repeatedly that using food crops like soybeans and corn for fuel is a bad idea because it drives up the cost of food. But maybe using corn for fuel would not only help our fossil fuel problem but also decrease our consumption of corn syrups. Increasing the value of corn would not only allow us to scale back corn subsidies but also rid us of the tyranny of cheap sweeteners. Maybe we could make corn so expensive that no one wants to use it to feed cows.

Tarrou

Let me see if I get this straight. We pay taxes to subsidize corn production, which makes corn syrup the cheapest available sweetener. We then pay taxes to further subsidize corn to make biofuel cheaper (at a minimum of the same rate, otherwise who would grow fuel?). The biofuel mandated by the federal government doesn't actually exist. So we pay farmers twice to grow the same crop, but not for sweeteners, so we can do (something?) with the corn to make a fuel that doesn't exist, and presto! Less obesity! You should be in congress.

Eyal

very interesting podcast and i agree that this is a very tricky issue to tackle in many aspects.
yet, i think that with all those experts, something was missing for me - something that levitt mentioned for a second towards the end (besides that gross tapeworm...) - self control.

i came across a few studies about the correlation between obesity and Attention Deficit Hyperactivity Disorder - ADHD symptoms in obese people is 27-30% (Altfas, 2002; Levy et al., 2009) and when it comes to a BMI of 40 and above, it could jump to 42% (Altfas, 2002).

this means that self regulation, especially in more obese people, is a very strong component. and think of the fact that your obese mama has undiagnosed ADHD and you don't, and you learn your eating habits from a person who has lower self control than you, chances are you are one of those 70% who are influenced by those who had undiagnosed ADHD and do the shopping and cooking for you and teach you their eating habits.

AND IN GENERAL...

i am kind of sad that through all of Freakonomics episodes, i have not come across any impact of ADHD on the economy.

so many entrepreneurs have (un)diagnosed ADHD and are driving innovation
so many prisoners (24-67% of inmates - Gudjonsson and colleagues, 2009) have ADHD and have a huge impact on both society and economics
so many young people with ADHD have a much harder time studying and working than their peers (Dipeolu, 2010) which is why so many of them are either unemployed or trying to build their own businesses
teens with ADHD are 4 times more likely to be in a car accident, more likely to drive before they have a license, or get speeding tickets.

all these have HUGE impact on society (if you dig a bit more, you'll find some other disturbing numbers). more car accidents, more obesity, more prisoners, more unemployment. and drugs? ADHD more likely to use them because they are self medicating. same for alcohol. and gambling.

90% of americans have no idea that they have ADHD according to a national survey.

yet, on the bright side, many more entrepreneurs and innovators.

Dubner, Levitt, i think it's time you guys did a show on ADHD's impact on the economy! even though i loved the tapeworm diet, which probably should get its own show too... ;)

Read more...

Tarrou

It's almost as if you create a psychological "disorder" which is so ill-defined as to be ubiquitous, and then can correlate it to anything you like! With symptoms like "Impatience" and "Procrastination", I'd hazard a guess that right about 100% of the population can claim at least one symptom. So if only 27-30% of obese people display ADHD symptoms, and 33% of the population is obese, then ADHD actually is lower in fat people.

Eyal

thanks for backing everything with actual scientific papers based on studies of 60 years.

and btw it is not a psychological disorder, it is a psychiatric disorder (dictionary if needed). which means that if you look at an ADHD brain and "normal" brain in an MRI machine (those big machine that are used to look inside your head using magnets), they look different. that's called SCIENCE.

and brush up on your percentage calculations, they seem to come from a parallel universe.

good day

Statspotting

To really understand the scale of this issue, you can state the obesity stats this way: More than two-thirds of adults in the US are overweight.

http://statspotting.com/obesity-statistics-68-percent-of-all-adults-in-us-are-overweight/

Winslow P. Kelpfroth

I encourage people toward obesity, for the same reason I encourage other people to smoke. It's in my interest to have such people contribute to the pension systems from which they have a diminishing probability of collecting. If everyone maintained a high level of physical fitness the actuarial tables used by retirement systems would need substantial revising and everyone would need to either work until death or contribute a larger fraction of their working income to retirement savings. A larger ball of retirement money seeking investment opportunities would lower the returns on such savings, which would, in turn, require more retirement savings.

James

This might be true if the obese, smokers, and so on would have the grace to simply die, quickly and inexpensively. Unfortunately for your theory, they tend to linger, racking up far more in medical costs than their eventual deaths would save the pension system.

As for staying healthy and working until death, my now 98 year old neighbor has, and he's still spry enough to do yard work and throw sticks for his dog to chase.

rer

Take a look at "New Way to Lose Weight? Changing Microbes in Guts of Mice Resulted in Rapid Weight Loss" -- http://www.sciencedaily.com/releases/2013/03/130327144124.htm

padugan

3 steps in order to get people to eat better. 1. make the healthy food taste as good or better than the junk food. 2. the healthier food needs to be the same price as the junk food. 3. make the healthier food easy to prepare. that's it. no need for exotic taxes and rewards, no need to engineer some parasite / tapeworm.

James

1) Healthy food already does taste better.
2) Why make healthy food the same price? It's cheaper now (with reasonable selective shopping).
3) It is easy to prepare, though of course you can get as complicated as you like - kind of like the difference between painting your ceiling white, and doing a Sistine Chapel number on it :-)

Roger von Oech

I was most interested in the dynamics of the session. It seemed that most of the "obesity industry insiders" were more likely to go with big government and more regulation approaches (one person said "ban all marketing"). The "outsiders" seemed more open to divergent ideas (sometimes offbeat), and more open to personal responsibility in the matter of over-eating. I prefered the outsiders' suggestions.

Devorah Klein

I agree compeletely. What also surprised me the most was how not outsider the outsiders were. It seems like if you really wanted something more divergent, bringing in designers or others from outside the academia-non-profit world.

MB18

The comments supporting the "eat what you want and then work it off" lifestyle are flat out wrong and have been proven so by good science. A person can so quickly consume a number of calories way beyond a reasonable exercise regimen for a busy person. Jogging for one hour (who has time or the ability) will only burn approx 1000 calories (depending on weight and speed of the runner). One trip to McDonalds or one Chipotle burrito can so quickly undo the caloric benefit of exercise. The true benefit of exercise is improvement in cardiovascular health. For weight loss, the tried and true method is a balanced healthy diet replete with whole grains, fruits, veggies, and healthy meat. Scientifically proven but getting this adopted on a large scale is difficult.

James

But you're missing the other half of the equation, which is that when you adopt an active lifestyle, you discover that you don't want to eat nearly as much (especially if you time meals so that you eat a little bit soon after exercise), and that you also want to eat different things.

As to who has time, you learn to MAKE time. You can, for instance, bike to work instead of driving, climb stairs instead of waiting for an elevator (which often saves time, too), do stretches & isometric exercise at your desk... And how much time do you really NEED to spend sitting in front of a TV, anyway?

tmeier

Tax sugar the same way you tax cigarettes, you'll solve the obesity problem and the deficit simultaneously.