One of the most interesting measures that passed was the soda tax in Berkeley. San Francisco voters also voted in favor of the tax, but did not reach the 2/3rds majority needed to pass. (The 2/3rds threshold has to do with California law on new taxes.) Others have tried institute a soda tax. The two most notable examples were New York City and Richmond, CA. Both resulted in the American Beverage Association (ABA), an industry trade group, spending millions of dollars to defeat the measures. The ABA spent a few more million in the recent ballot initiative in Berkeley. By law, companies have a fiduciary responsibility to maintain profits for their shareholders. Thus, my conclusion is that they had to spend this money. They feared profits would decline if these measures passed.
Monday, November 10, 2014
Friday, February 28, 2014
Remember that game where you guess how many jelly beans are in a jar? Well, if I guess once, I'll probably be wrong. But if I'm allowed to guess 500 times, I might get it right once. But that doesn't mean I'm a good guesser of jelly beans numbers.
The same concept applies to research studies. The more times you test a question, the more likely you are to get a postive result. That doesn't mean that the answer to the question is "yes". It just means you guessed so many times that your were bound to get a correct answer.
The New York Times Missed this point in their article when they wrote the headline:
"Obesity Rate for Young Children Plummets 43% in a Decade"
Sounds like a huge drop. I wish it was. But the researchers tested many age groups to see if there was a decline over 10 years. They checked the age ranges 2-5, 6-11, 12-19, 20-39, 40-59, and >60. When you "guess" if there is a decrease in obesity in all of these age groups, you are likely to find one "yes".
The researchers admit this and even caution interpreting their results this way:
"When multiple statistical tests are undertaken, by chance some tests will be statistically significant (eg, 5% of the time using α of .05). "
And they conclude:
"Overall, there have been no significant changes in obesity prevalence in youth or adults between 2003-2004 and 2011-2012. "
Yet some how the New York Times missed this, and focused their headline on a minor result. While we might have made small gains against childhood obesity, we haven't really begun to change the trajectory of the epidemic.
Friday, January 24, 2014
When I saw Mrs. Obama speak last year at the PHA conference, she was really starting to emphasize that marketing is a big cause of overeating. You can provide all the "health choices" you want, but if you price the unhealthy ones lower, and have ads all over the television for them, they are going to sell more.
The new PHA agreement with Subway takes a step in the right direction. As part of the agreement, Subway will form a policy on advertising to children. (Hopefully PHA will have to approve this policy.) In addition, they will spend $41 million to advertise fruits and veggies to children. This type of advertising is badly needed to compete with the billions of dollars that advertise junk foods to kids.
So the real question is: will this get kids to eat healthier at Subway? In our study of what teenagers buy at Subway and McDonald's, we found they were eating a lot of processed food, few veggies, and a lot of calories.
My view is that the change in marketing is a positive step. But, there is still a problem with much of the food at Subway. We found that teens ate 2,149 mg of sodium in a Subway meal. That's more than 3 times what the National School Lunch Program recommends. Now, in truth, salt amounts are not very important for young kids. But the amount of salt tells us that the food at Subway is highly processed. For instance, the meat and bread have a lot of salt because they are highly processed. And we know that processed food leads to many of the problems of obesity. Notably, in the agreement they were only able to agree to 935mg of sodium in kids meals. That is more than our panel of experts and RAND recommended (700mg).
How else could we know if kids are eating healthier at Subway? I would want to know if they are eating more vegetables. I do not see any specifics in this agreement about Subway reporting how many servings of veggies they are selling to kids. PHA often does require these types of reports, but I do not see it in the press release. The best way to study this is doing what I did: collect receipts from kids and calculate what they are eating. But, it would be much easier if Subway would give vegetable sales out, so that researchers (like me) could analyze it.
What happens if they do get kids to eat more veggies, and somehow less meat and refined grains? What happens when the kids get to the cash register? For those of you who frequent Subway, you know there is a giant display of cookies. The sales clerk almost always asks, "Would you like a cookie and a drink with your sub?" Having cookies at the cash register is a risk factor for disease. So the easiest thing Subway could have done to improve health is to move the cookies to a place kids are less likely to ask for them, and parents are less likely to buy them.
I congratulate Subway and PHA for the agreement, but would like to see some objective and public research/analysis. Without this analysis, the public will not know if this is another Subway marketing scheme or an improvement in what kids are eating.
Wednesday, May 15, 2013
I took another course where we really dove into the evidence around salt. Dr. Charles McCormick showed us evidence that there was tremendous variation in salt's relationship with blood pressure. In addition, weight was an important determinant of blood pressure, that overshadowed the effects of salt. Finally the ratio of sodium to potassium was a stronger predictor of high blood pressure, than sodium alone. (Potassium is found in fruits and vegetables.)
A good review of the recent evidence doubting the connection between salt and cardiovascular mortality is here, by friend Dr. Sean Lucan. He states, "Attempting to Reduce Sodium Intake Might Do Harm and Distract From a Greater Enemy."
There have been many skeptics in the salt and high blood pressure connection. Now we finally have an ally: the prestigious Institute of Medicine. They issued a report today saying:
“These new studies support previous findings that reducing sodium from very high intake levels to moderate levels improves health,” said committee chair Brian Strom, George S. Pepper Professor of Public Health and Preventive Medicine at the University of Pennsylvania Perelman School of Medicine. “But they also suggest that lowering sodium intake too much may actually increase a person’s risk of some health problems.”
Wednesday, April 24, 2013
"How do you know if your patient is eating well?"
The first responses I received from the audience were:
"Test blood sugar."
Finally, a brilliant student said, "Talk to them."
I had to reframe the question to: "How would you assess a patient's eating by only talking to them?" We then had a good talk on objective methods to assess eating behaviors.
I was floored that most of the first answers to the question were, "order more tests." The medical community has already taught these early medical students that a test is the answer to every question in medicine. Is it any surprise that we order too many tests with minimal value?
On the positive side, we spent the rest of the hour talking about nutrition and behavior. I was surprised how well the students knew about current concepts in nutrition. I hope the next generation of physicians become engaged with their patients about nutrition. I have faith they will, as long as the current system does not steer them in the wrong way.
Friday, January 25, 2013
So local food may not be the answer to global warming. But, was that the problem it was supposed to solve?
Growing and purchasing food locally has other advantages. It makes food-born illness easier to track, as we know where the food is grown. In an even larger sense, it promotes social cohesion and social interaction.
Many of the problems in our food system arise because we do not know where food comes from. We do not know who grew it or how they grew it. For instance, let's take eggs. For those that eat animal products, would you eat an egg if you knew the hens lived in a crowded, dark shelter with feces covering the ground? Or would you prefer to eat an egg that came from a farmer that you could ask how the animal lived, what it was fed, and how fresh the egg was? Buying directly from a farmer does not require a food label; it just relies on talking.
We have created a society that is not in touch with real food. We don't know what food is. We think a Big Mac is food. Buying locally restores our connection to where our food comes from. We have to weigh those benefits with the possible negative consequences of local food.
We don't need to eat all our food locally. We just need to be more conscious of where our food comes from. Eating locally is only part of the answer to the problems with our food system. It surely solves some problems, but not all.
Monday, December 31, 2012
I like social media. It's a fun way to stay in contact with friends. Since I've lived in so many places (and gone through so many years of education), I have friends all over. Since people are so busy, social media makes it easy for me to stay up to date with what my friends are up to. In the last few years, I've felt like I've been in contact with more people than usual. This is good, as social connection is a key to human happiness.
Only so much can be conveyed over social media. Sure I can see who was married and what movies my friends like. But a lot of human communication is through tone of voice and facial expression. Status updates do not convey feelings or emotions the way a face-to-face conversation does. Though I feel more connected to more people now, I feel less deeply connected to my close friends.
My new year's resolution: Call a friend.
Let's be more specific. Training Peaks says not to make resolutions, but to make plans. I plan to talk 2 friends a month. The preferred method is via face-to-face conversation. This is pretty easy for my friends in California. For those far away, I plan a video chat. So friends, do not be surprised if I randomly video call you. I know that a recent NPR report said that many were uncomfortable with video chat, because the person you are calling may be having a bad hair day. But, the expert reminded us: "Your parents, maybe your siblings or a very close friend, the people that you really want to video-call with are probably people that wouldn't mind if you're having a bad-hair day. They've seen your bad-hair days. They don't care."
I know that 2 friends a month seems like a small task, but think of how many of you I actually spoke to in a real face-to-face conversation in the past year. Want to get the year started off to a good start? Be one of the first to help me with my plans. Contact me and let me know when you are free. You can find me on Facebook, Gmail, Google+ (hangout preferred!), or your other favorite social media.