100 Ways to Fight Obesity (Ep. 120)

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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.


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.


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.


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.

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).



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).


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


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...

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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.



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.



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.


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.

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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."



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."


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...

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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?