The Current - Tackling the obesity epidemic

Episode Date: November 20, 2024

A new study says three quarters of adults in the U.S. are obese or overweight, while figures put two thirds of Canadians into the same category. We look at what’s contributing to our collective weight gain and how to tackle the growing problem of obesity. 

In 2017, it felt like drugs were everywhere in the news, so I started a podcast called On Drugs. We covered a lot of ground over two seasons, but there are still so many more stories to tell. I'm Jeff Turner, and I'm back with Season 3 of On Drugs. And this time, it's going to get personal. I don't know who Sober Jeff is. I don't even know if I like that guy.

On Drugs is available now wherever you get your podcasts. This is a CBC Podcast. Hello, I'm Matt Galloway and this is The Current Podcast. Three quarters of adults in the United States are overweight or living with obesity. Yes, you heard that right. Three quarters, 75%. Canada is not far behind. As of 2023, more than two thirds of Canadians over the age of 18 and one in three children were considered obese or overweight. There are a lot of factors contributing to those numbers, but what we eat is a big one. And we'll get into the role of ultra processed food and all

of this in just a moment and how the food we buy at the grocery store and what it costs is contributing to our collective weight gain. But first, I am joined by Marie Eng. She is the lead researcher of a new study looking at obesity in the United States. Marie, good morning. Good morning. Thanks for having me, Matt. Thank you for being here. Your research found, as I mentioned, that three quarters of American adults are obese or overweight. You called this an epidemic. Why did you use that word? Because the issue is really widespread. So our study looked at the prevalence of overweight and obesity in the United States and among all 50 states from 1990 to 2021 and forecast to 2050.

Basically, no state is spared. Obesity and overweight have more than doubled in adult and adolescent in the past 30 years. And we forecast that by 2050, over 260 million people will be experiencing overweight and obesity. So it's a very serious issue that we are facing. The study relies on body mass index, known as the BMI. This is a tool to measure obesity. One of the things we know is that BMI doesn't take into consideration things like muscle mass and body composition. So with that in mind, what is concerning you the most about this rise in obesity beyond the numbers? Right. So the widespread of the epidemic, as you just put it,

is reflecting the issue that is at the systemic level. So it's no longer just like an individual choice or will, but the number of people that are experiencing is showing that a system failure, that the social, economic and commercial factors are making it challenging for people to stay healthy. A system failure. Correct. So basically, for example, if you think about the urban planning in the United States, many places do not have safe open space for people to pursue physical activities. Even the choice of healthy food can be very limited because of the cost. And in some places, they have to drive miles to go to a supermarket

and grocery to get fresh produce. So it really is not simply like whether someone choose to be healthy, it's that there's actually factors that's hindering their choices. Tell me more about that and what you see systemically as causing this rise in overweight and obese people. Yeah, so I think in the past few decades, there has been a lot of aggressive marketing of unhealthy food. And also urban planning has not been modernized

to take into account the needs of people in terms of creating that safe space. Children these days do not walk to school as much as before. And even in school, lunch are not always providing the healthiest choices. So the whole environment is not conducive for healthy behavior, essentially. As the numbers have changed, there has been a change in the stigma around weight as well.

There is a body positive movement, what we've talked about on this program, what's known as a fat acceptance movement. What impact has that had, do you think? The normalization of body weight is making it harder to reverse the trend, essentially. So we really want to shift the focus to thinking it from a health perspective, that obesity, it will increase the risk of diabetes, cardiovascular diseases, and also shorten lifespan. The life expectancy of Americans are trailing behind its high-income counterpart. So it is not simply about shape and sizes. It's really a health issue that we are talking about. What has to change then to make a dent in these numbers? Because as you've said, the numbers have grown substantially over the course of 30 years.

And whatever is being done to address this issue clearly isn't working. So what should we do? Yeah, so before, the intervention usually emphasizes on individual lifestyle changes, emphasizing on behavioral changes. So what we are trying to advocate is the whole system approach, where it's no longer just individual, but we need stronger governance to exert forces to impose stronger regulation on, for example, food marketing, to provide subsidies to enable people to purchase healthy food, even modernizing urban planning to ensure people have that safe space to walk and to exercise.

Marie, we'll leave it there. Thank you very much. We're going to talk about some of those interventions in just a moment. But thank you for being here. Thanks for having me. Marie Eng is an affiliate associate professor in the Institute for Health Metrics and Evaluation at the University of Washington. In 2017, it felt like drugs were everywhere in the news, so I started a podcast called On Drugs. We covered a lot of ground over two seasons, but there are still so many more stories to tell. I'm Jeff

Turner, and I'm back with season three of On Drugs. And this time, it's going to get personal. I don't know who Sober Jeff is. I don't even know if I like that guy. On Drugs is available now wherever you get your podcasts. Perhaps you had a bowl of cereal, maybe some flavored yogurt or a protein bar this morning. All of those foods have something in common. They are ultra-processed foods, and they are part of the problem that we are talking about. Chris Van Tulleken is a physician and author of the book Ultra-Processed People. Chris, hello to you.

Good morning, Matt. What do you make of these numbers coming out of Canada and the United States? The United States headline in particular is grabbing a lot of attention. Three quarters of adults overweight or living with obesity. What do you make of that? Well, they mirror the situation in the UK. It's in some senses, it's great you're covering this study because it's not enormously surprising. The factors that drive pandemic obesity.

It was interesting to hear Marie earlier talk about an epidemic. I think we could safely describe it as a pandemic. Those factors have remained unaltered or have exaggerated over the last 30 years that we've seen this explosion. And the stats in child health are the things that should never stop to shock us. I mean, they're just appalling. How much does what we eat, I mean, I rattled off some of the things that people might have had for breakfast this morning. How much does what we eat factor into those numbers that we're talking about? So Marie mentioned urban planning.

I think exercise activity are extremely good. In fact, we've got pretty good data that 90% of pandemic obesity, particularly, and obesity isn't the only diet-related disease, is make it very clear that the problem is structural. So people are forced through their own economic circumstances to eat food that is engineered to drive weight gain. So there's not a lot of consensus in nutrition. But the thing that everyone agrees on is that the population obesity we're talking about is driven by the marketing and availability of industrially processed foods that are high in energy, saturated fat, salt, and sugar. And that's what causes diet related disease. Whether we call them ultra processed or other things, it is industrially processed food that is the problem. No one thinks that we are cooking more unhealthy food at home.

So it is the marketing and the production of substances that is very hard to stop eating that is the proximate cause of the problem. Are all ultra-processed foods the same? I mean, again, I said at the beginning, maybe the cereal that you had, the bagel that you had, the yogurt that you had, the protein bar that you had, those are all ultra-processed foods, but are they equal? They all sound healthy. Well, so this is the focus of a lot of my research in London at the moment. The food industry likes to say, look, the term ultra processed food is too broad. It encompasses all these healthy foods like breakfast cereals and yogurts. Well, we can use established guidelines, Canadian dietary guidelines, World Health Organization, UK guidelines for fat, salt, sugar, and calories to show that 99%

of ultra-processed food is excessive for calories, fat, salt, and or sugar. So the idea of healthy ultra-processed food is a myth. There is a problem that ultra-processed food emits quite a lot of unhealthy foods. So in Canada and the global north, particularly particularly we have fancy ultra processed food that may not use additives so it may not quite technically be ultra processed but it will function in the same way it will still be behind well so so if you think of some of the fancy ready meal lasagnas you might buy at a at a high-end store they might just be made using kitchen ingredients they wouldn't quite count as ultra processed but they would still function in your body. You would eat them to excess.

They're still high in fat, salt, and sugar. So ultra-processed food, what the evidence, it's a brilliant research tool that tells us where the problem is. It's with industry. And it tells us about the kind of products we need to regulate. But whilst it is not all equally harmful, there is almost no ultra-processed product you can name that will not have a harmful nutritional profile. It will be excessive for salt, fat, or sugar. Can I go back to something that you've said and something that you said over time, which is that, I mean, it's not your fault, it's the food. You said that people are forced to eat this.

You could imagine that there are people who are listening who are saying, come on, people aren't forced to eat anything. You have free that there are people who are listening who are saying, come on, people aren't forced to eat anything. You have free will to put in your mouth what you put in your mouth. How are people forced to eat food that is bad for them? So many people living at the poverty line or not even the poverty line in Canada and the UK will be people just living with low incomes, simply cannot afford to get healthy food. And when we talk about healthy food, if we talk about the diet, the other consensus in nutrition is that if you eat, you know, fresh fruit, vegetables, meat, fish, nuts, and pulses, that stuff is good. Everyone agrees on that. That stuff costs money,

not just when you buy it, but it goes off quickly. You have to have skills and time to prepare it. And you need equipment. In the UK, we have many families, more than a million families, who don't have freezer storage space, who only cook with a microwave. And so then preparing fresh food is a problem. And in the moment, the gig job economy that both our nations face means that people work two shifts. We've seen rising inequality. So people who say, oh, it's a choice, you can go and buy a bag of lentils from the shop

and it won't cost you that much money. But when you build in all the other costs and skills associated with that, it becomes an incredibly expensive food to cook. Eating lentils on their own is not enormously interesting. So we have masses of data on this. People living with low incomes are unable to eat healthy diets. And that's not really up for debate. You know, we've got data from many, many countries showing that. So they're forced. What do we do about that? Part of that is about ensuring that people have an income such

that they can afford, as you said, freezers and space. But a lot of what you also focus on in your excellent book and in the work that you do is around figuring out ways to regulate the food industry such that it has less sway over our diets more broadly. me so marie also used the word regulation we and a lot of her research previously i was thinking about is on tobacco control now the thing to remember it feels odious to compare food and tobacco for some people feels like well food isn't all bad in fact the food industry and the tobacco industry were the same industry for a long time in the mid-1980s the biggest cigarette and food companies were the same companies so So they used the same molecules, the same marketing techniques, and the same distribution network to sell harmful food as being used for cigarettes. So we need to look to regulatory policies that are the same. Now, the most important thing for me is the goal is not to stop people eating bad food. The goal is

to increase justice, affordability, and availability, and equality in the food system. Chris, is there any jurisdiction that successfully tackled obesity through regulation? So, South, no one's got on top of it because it takes a while to fix it, and the food industry's influence is very pervasive. But what you need is tobacco-style regulation, marketing restrictions, get the cartoon characters off the box of sugary cereal, don't have ads for kids, don't have computer games funded by the big food companies. And then you have progressive taxation, and you need to ring-fence the tax. If you're going to tax a candy bar or a soft drink, you need to take that money and drive down the price of good food

and promote that good food. And then you have lots of other policies, warning labels on the food. And so this is being done in South and Central America. And early results from Chile, Mexico, Argentina are good. It works, but the food industry is extremely good at undermining it. Chris, we'll leave it there. Good to talk to you. Chris Van Tulleken is a physician and author of Ultra Processed People. One of the areas that has moved into that area of regulation is Newfoundland and Labrador. It has one of the highest rates of obesity in this country.

Two years ago, that province introduced a sugar tax on sweetened beverages like pop. Scott Harding is an associate professor in the Department of Biochemistry at memorial university in st john's been researching the effectiveness of the province's sugar tax scott hello to you good morning matt thanks for having me how does this tax work in newfoundland labrador so the um the tax uh that the government of newfoundland labrador introduced was uh designed to target some sugar sweetened beverages so it's not a sugar tax per se where taxes it taxes candy bars and other types of ultra-processed foods like your previous guest was speaking about.

But what it does target is any of the sugar-sweetened, ready-to-drink beverages that you'd purchase, say, at a grocery store or in a restaurant. So this would be sodas and fruit juices and these sorts of things. But it excludes a number of beverages

that organizations like the World Health Organization would consider sugar-sweetened. But it excludes a number of beverages that organizations like the World Health Organization would consider sugar sweetened. So it would exclude things like 100% juice or like from fruits or vegetables or even sweetened milks, like chocolate milk is excluded from the tax here. Given what Chris was saying, what was the goal of this tax as it was imposed in Newfoundland and Labrador? We feel it was, that was the goal. It was to target the obesity issue that we have. I think you alluded to it, but like in the eastern provinces, like Newfoundland and New Brunswick, the rate of obesity is actually in the 40s. It's, you know, closer to 45% now. So it's staggering here. It's almost one in two people would be considered

obese, not just overweight. So the target was basically that, to improve the health of Newfoundlanders and Labradorians through, I guess, the reduction in the consumption of these foods that are known to cause obesity and have no other nutritional value other than to provide calories. Do we know whether it's working? I mean, I know the data is still being collected, but thus far... Yeah, we're still analyzing the first year, post-implementation, and I don't have that data available to speak about today, but we did analyze what the situation looked like before the tax was implemented.

And we did it for a couple of reasons. One being, with your previous caller, your guest alluded to, was the equity of when these taxes are applied. Because everybody would agree that any tax that gets applied on any society is going to affect those in the marginal income area worse than those in the higher incomes. But we were also interested for this particular tax because of issues around

what's the choice if you switch from the sugar-sweetened beverages, what are you going to switch to? Are you switching to another unhealthy drink that's not taxed? Or are you going to switch to what the Canada's Food Guide recommends, and that being water? And that's particularly important in Canada and even in Newfoundland when it comes to whether or not people trust their tap water. Do they drink tap water? And if they don't, well, what's the next affordable drink that they consume?

And usually it's not bottled water or purchased water. It's going to be some other version of a commercially produced beverage like a diet soda or some of these fruit juices. What sort of pushback has there been to this? I mean, Chris Vantolica in his book and in his research talks a lot about the muscle of the industry to fight against. It's extraordinary, powerful and successful in its lobbying and to fight against similar kind of taxes around the world. What sort of pushback has there been in Newfoundland and Labrador? At the start, when the tax was implemented, there was a lot in the media from the side of the manufacturer

kind of pushing it as though it could end up with job losses and these sorts of things. I don't know. They seem to me to be red herrings. I don't think the soda industries are in any kind of danger of going bankrupt. But the pushback from the province in terms of the population was pretty high, and we collected some of this opinion data in our surveys. And the tax is not popular because it is another tax. Some people see it as just another way for the government to take some tax money from the population. another way for the government to take some tax money from the population. But everybody seemed to agree in the data that we collected that if it is being collected, that they wanted it spent on health promotion or some kind of government program that actually

helps with the health of the people in the province. So while unpopular, it seems to be understood as to why it was implemented. I have to let you go, but do you know, do you have a sense as to when you'll know whether it's working? Soon. We have some, we're very close, and I wish this was a month later. We have your number, so maybe we'll call you back. Yeah, yeah, exactly. That'd be great, yeah. But part of this is really about changing behavior, as you've said.

Yeah, it's a behavioral change, and that's what we're looking at is whether or not that's what we're looking at in the first year. And it takes more than one year. That's the thing. We need multiple years to understand if the behavior changes. Because really, we're trying to target those, you know, the youth and the young adults to change their behaviors. Because these diseases take 20 years to develop. The cancers and the heart disease and diabetes. I have a feeling we will ring you back.

In the meantime, Scott, thanks for this. Thank you, Matt. Scott Harding is an associate professor in the Department of Biochemistry at Memorial University in St. John's, Newfoundland. Your thoughts on this welcome, you can email us thecurrentatcbc.ca. For more CBC podcasts, go to cbc.ca slash podcasts.