Here’s One Way to Fight the Obesity Epidemic: Free Stomach Surgery

From the (U.K.) Times:

Up to a million obese people will be offered weight-loss surgery on the NHS, under controversial new guidelines.

The National Institute for Health and Care Excellence (Nice) has ruled that all obese people who have been given a diagnosis of type 2 diabetes in the past decade should be considered for stomach bands and bypasses. ...

Patient groups questioned how the health service would cope with the up-front cost, potentially running into billions of pounds, at a time when waiting lists for treatment have topped three million, the highest for six years. ...

How Google Fights Obesity

Last year, Google realized that its employees were eating too much free candy -- M&Ms, specifically.  So the company conducted a little experiment, and carefully tracked the results. Cecilia Kang, writing in the Washington Post, summaries:

What if the company kept the chocolates hidden in opaque containers but prominently displayed dried figs, pistachios and other healthful snacks in glass jars? The results: In the New York office alone, employees consumed 3.1 million fewer calories from M&Ms over seven weeks. That’s a decrease of nine vending machine-size packages of M&Ms for each of the office’s 2,000 employees.

The company has conducted similar experiments in an effort to reduce consumption of sugary drinks and encourage employees to consume less calories in the company's cafeterias.  “With a company as big as Google, you have to start small to make a difference. We apply the same level of rigor, analysis and experimentation on people as we do the tech side,” says Jennifer Kurkoski, a member of Google's HR team.

Good News for Child Obesity

We've blogged before about America's rising obesity rate and how to fight it, but the battle may have just gotten a little easier. A new report from the Centers for Disease Control (CDC) shows obesity rates dropping for low-income preschool children in 19 states between 2008 and 2011. From the Wall Street Journal:

The obesity analysis, by the federal Centers for Disease Control and Prevention in Atlanta, was based on data from 11.6 million children age 2 to 4. The survey group included children eligible for federally funded programs of maternal and child health and nutrition, such as the Special Supplemental Nutrition Program for Women, Infants and Children, known as the WIC program.

The decline was greatest in the U.S. Virgin Islands, where the obesity rate in such children fell to 11% in 2011 from 13.6% in 2008. Drops of more than one percentage point were also seen in Florida, Georgia, New Jersey, Missouri, and South Dakota.

Thomas Frieden, director of the CDC, called the results a "bright spot" and a "tipping point."

"For the first time in a generation, we're seeing it go in the right direction in 2- to 4-year-olds," he said on a conference call with reporters, calling the changes "small but statistically significant." He was quick to add, "We're very, very far from being out of the woods."

Of the 43 states measured, obesity rates for preschool children rose in 3 states and remained the same same in 21 states.

The History of Obesity Revisited

We've blogged before about the obesity epidemic, and whether or not it is a recent phenomenon; John Komlos and Marek Brabec have argued that obesity rates actually began rising in the early 20th century. A new study (abstract; PDF) by Paul von Hippel and Ramzi Nahhas looks at 60 years of data on child obesity and finds that the increase in obesity rates started with children born in the 1970s and 1980s. Von Hippel wrote to us in an email:

Intrigued by the conflicting extrapolation results, Ramzi Nahhas and I decided to look at measurements that were actually taken before 1960. We analyzed the heights and weights of children in the Fels Longitudinal Study, an ongoing study that since the 1930s has measured children from shortly after birth until age 18. Most of the children come from the area near Dayton, Ohio, which is not a mirror of the nation but has an obesity rate that is close to the national average.

More Evidence of the Link Between Obesity and Food Prices

"Our findings suggest that increases in the real price of one calorie in food for home consumption and the real price of fast-food restaurant food lead to improvements in obesity outcomes among youths.  We also find that an increase in the real price of fruits and vegetables has negative consequences for these outcomes."

That's from a new paper (abstract; PDF) by Michael Grossman, Erdal Tekin, and Roy Wada, called "Food Prices and Body Fatness among Youths."

Pay Your Weight to Fly

Our recent Freakonomics Radio podcast “100 Ways to Fight Obesity” looked at some of the social costs of America's increasing rate of obesity. One airline in Samoa is experimenting with defraying some of those costs. It will soon start charging passengers by the kilogram. From The Sydney Morning Herald

Samoa Air has become the world's first airline to implement "pay as you weigh" flights, meaning overweight passengers pay more for their seats.

"This is the fairest way of travelling," chief executive of Samoa Air, Chris Langton, told ABC Radio. "There are no extra fees in terms of excess baggage or anything – it is just a kilo is a kilo is a kilo."

From the Obesity In-Box

Our recent podcast on obesity has generated a lot of e-mail. (FWIW, one of the very first podcasts we ever did was also about obesity.) Here's one interesting angle, from a listener named Mark Gruen:

I just listened to your podcast on 100 ways to fight obesity and while I think there were many quality ideas presented, too many neglected the bodybuilder or strength athlete. I am a lightweight strongman competitor and sometimes eat 10,000 calories in a span of 3-4 hours after training for 5+ hours. These meals are generally high in sugar to support the lost muscle glycogen from my day's training. I am concerned that once you begin classifying foods as "good" or "bad" you burden people who you did not intend to. The government also does such a poor job with their diet recommendations; I wouldn't trust them with anything regarding food and diet.

I do love the idea of teaching families and children at school about being malnourished. Unfortunately, I see this as just another way for junk food to add in some vitamins and tell you that you can meet your daily intake just eating their products. Ultimately, people need to wake the hell up and realize that they need to do their own research (not just read a magazine) and determine the right diet for their family.

Paying People to Lose Weight

From Science World Report:

The participants were told to achieve the goal of losing 4 pounds per month up to a predetermined goal weight. The researchers kept track of their body weight every month for almost one year. The researchers told the participants in the incentive groups that they would receive $20 per month if they achieved the goal. And those who failed to achieve the goal would need to pay $20 each month that gets into the bonus pool. Participants in both incentive groups who finished the study were entitled to win the pool by lottery.

The researchers noticed that 62 percent of the participants in the incentive group achieved the goal, while just 26 percent from the non-incentive group hit the target. The mean weight loss of participants from the incentive group was 9.08 pounds and the mean weight loss for the non incentive group was 2.34 pounds.

"The take-home message is that sustained weight loss can be achieved by financial incentives," lead author Steven Driver, M.D., an internal medicine resident at Mayo Clinic, said in a press statement. "The financial incentives can improve results, and improve compliance and adherence."

How to Make School Lunches Healthier

An article in Choices by David R. Just and Brian Wansink illustrates how school administrators can use behavioral economics to nudge kids toward good eating choices and away from the obesity-causing junk food. Just and Wansink point out that administrators often face a difficult choice between nutritious meals and the bottom line:

It may be possible to replace the standard cheese pizza on white flour crust with pizza smothered in spinach, artichoke hearts, and other vegetables on a whole wheat flaxseed crust. But the healthier pizza is more expensive, and fewer children may want to eat it. Hence many school districts walk a tightrope. School districts must increase the health content of their sales while trying to avoid any reduction in their financial viability. Eliminating the less nutritional items often means eliminating the meal budget’s highest margin items. Further, child patronage of the school lunch program is understandably dependent upon schools offering foods that students are familiar with and that they like, and that will satisfy their appetites.

Cigarettes as Weight Control

We've noted before that the U.S. decline in smoking (among teens as well as adults) has likely contributed to the rise in obesity. In a new working paper (gated), John Cawley and Stephanie von Hinke Kessler Scholder consider the degree to which smoking is a conscious effort to avoid weight gain:

We provide new evidence on the extent to which the demand for cigarettes is derived from the demand for weight control (i.e. weight loss or avoidance of weight gain).  We utilize nationally representative data [the Health Behavior in School-Aged Children (HBSC) and the National Health and Nutrition Examination Surveys (NHANES)] that provide the most direct evidence to date on this question:  individuals are directly asked whether they smoke to control their weight.  We find that, among teenagers who smoke frequently, 46% of girls and 30% of boys are smoking in part to control their weight.  This practice is significantly more common among youths who describe themselves as too fat than those who describe themselves as about the right weight.

The derived demand for cigarettes has important implications for tax policy.  Under reasonable assumptions, the demand for cigarettes is less price elastic among those who smoke for weight control.  Thus, taxes on cigarettes will result in less behavior change (but more revenue collection and less deadweight loss) among those for whom the demand for cigarettes is a derived demand.  Public health efforts to reduce smoking initiation and encourage cessation may wish to design campaigns to alter the derived nature of cigarette demand, especially among adolescent girls.