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obesity Archives - ChangingMedia

Aug 22
0

We Just Keep Doing Dumb Stuff

By | Health, The Global Is Local | No Comments

Do you ever wonder if we are a species of idiots?

I generally don’t feel that way, actually, but sometimes it seems like the only viable hypothesis. It explains SO many things about our behaviors.

This afternoon I read that lots of young women in this country think that exposing themselves to harmful radiation on a regular basis for the purpose of slightly changing the color of their skin is a good idea.

Question: Is this dumb, or smart?

Answer: Dumb. The increase in risk level for skin cancer as a result of using a tanning bed is 100 percent for those younger than 25, and 75 percent for those under 35.

Don’t worry, lots of guys are dumb too, as are almost all groups of people, divided any way you like — age, gender, race, geographical origin, religion, cultural heritage, etc. All groups do things that are bad for us, more often than not with a pretty good grasp of the facts about what makes the practice dumb.

I won’t bother to list examples beyond tanning and smoking, though, because despite the fact that culturally ingrained practices are dumb, they are often passionately defended by their practitioners. And, let’s face it, there’s just not enough space here for equal opportunity mockery of all of our traditions, so if your family or friends love to eat fried food, binge drink, self-flagellate, do drugs, run marathons, drive fast, or listen to terrible, terrible music (Bieber, Public Health Enemy No. 468), I am not going to take you to task at the moment. Rest easy, your practice is safe from my attention, but be aware that you are probably doing something dumb on a regular basis.

Smoking is one of my favorite examples, but not for the general populace, although I think we can agree that most smokers know that their habit is harmful. What really amazes me are the health care workers who I see at the side entrance of hospitals or long term care facilities, taking their smoke break. There are few people out there who have a clearer idea of the harm they are inflicting on themselves.

Obviously I don’t have any suggestions about how to alter the fact that we all do things that are bad for us. If I did, clearly I would have applied for my grant from the Robert Wood Johnson Foundation, hired a staff of investigators, and maybe patented something.

The obvious solution — more education — has a fatal flaw, exemplified by the smoking nurses: it doesn’t work. People who know better just do it anyway. This isn’t true of all behaviors, or all groups — harm reduction strategies in Baltimore and elsewhere involving educating IV drug users about needle re-use have been quite effective over the past 30 years, leading to lower infection rates for HIV, Hepatitis C, and other diseases.

Maybe the true problem is that education efforts are ineffective. Some are unfortunately ineffective because they operate based on incorrect assumptions, such as those with a strong basis in religious or cultural opinion rather than fact, like abstinence-only pregnancy prevention programs or vaccine avoidance. However, there are lots of hours and dollars spent on methods that are scientifically validated, and yet many long term, population level problems persist. According to a 2012 publication from the World Health Organization, effective health education requires interventions at individual, local, regional, and state and/or national levels. This requires comprehensive policy guidance that presupposes informed, or at least engaged politicians and leaders, which is not always the case.

Money is a factor as well, of course, both in the form of raw capital needed to produce materials and pay salaries, but also in terms of competing interests. Often the things we do that we know we shouldn’t have a strong economic interest behind them, and so those who try to counteract the negative effects of the behaviors are working against vested interests as well as their clients/friends/family members.

In the meantime, remember that family and peers have the greatest level of influence on behavior, so be an advocate for the well-being of those around you.

Apr 18
0

Bikemore in Baltimore!

By | Health, The Global Is Local | No Comments

(The second in a Spring series about cycling in Baltimore: Why planning for strictly vehicular travel makes pedestrians and bicycles an unwelcome nuisance rather than a welcome expectation.)

In my last column, we began discussing the bicycle culture of Baltimore. Recently, I had the chance to continue that discussion with Bikemore Executive Director Chris Merriam and Board Member Dave Love. I asked Chris to frame the relationship that bicycling has with public health, how one impacts the other, and how Bikemore’s efforts are designed to improve both the health of the community and the acceptance of bicycles on Baltimore streets.

“There’s a huge public health aspect to what we do,” says Chris, who was recently award an Open Society Institute Fellowship to further Bikemore’s mission of advocating for cycling and cyclists’ rights in Baltimore. “Cycling is a means of addressing the obesity problem in Baltimore — and all over the country of course. This is a working class city, though. It’s not like Washington D.C. or San Francisco. Not everyone belongs to a gym or eats healthy food all the time. The corner store diet of chips and soda is such a pervasive issue here.”

Chris has a background in urban planning, which informs his perspective. He agrees that our transportation system is a major component of public health, and a major obstacle to improving it. “We have a substandard [public] transportation system. For instance,  I’ll see people waiting for hours at a time for buses that will take them to work. A lot of the job sprawl in the area is such that many jobs for lower income people are in suburban malls, in Towson or Whitemarsh. Using public transit, depending on where people live, can take a long time: take one bus, take another bus, take the light rail, and there’s a lot of waiting around in between.”

And yet, despite the obvious advantages of a more bike-friendly city, Bikemore and other bicycling advocacy groups are trying to counteract 80 years of car-based engineering on our cities. Designing both vehicles and cities for strictly vehicular travel makes pedestrians and bicycles a nuisance rather than an expectation, and that is reflected in driver attitudes. Often the relationship between bikers and drivers is fraught with animosity.

Dave thinks that this may change due to sheer volume of bikes on the road, remembering his time in Berkeley, California: “Regardless of where I’m going, there would be three or four people on the same path, at a stop light five or six bikes back up. We wait just like traffic…If we got enough people on the roads, we could be looking at a sea change.”

But getting Baltimore drivers not to see red when they see a skinny person in spandex “in the way” is more than just a matter of numbers. Culture has to change too, and Bikemore realizes that Baltimore is a city with its own needs, and certainly its own culture.

People cite Portland as the ultimate case study. But remember, Portland is largely homogeneous, doesn’t have a lot of conflict, has a lot of taxpayers, is relatively young, etc. We can learn lessons from other cities, but we need to be wary of the ‘if they can do it, why can’t we?’ game.

Chris and Dave believe that these problems can be solved, but it will take effort on three fronts: education, infrastructure, and policy. They are leading in all three of these areas, but if you see the Bikemore sign around town, you are seeing education in action. Whether it’s a Bike Valet stand at the Food Truck Gathering or a presentation to a group of innovators at a conference like Reinvent Transit, Bikemore is constantly encouraging awareness and mutual respect between bikers and drivers.

Housekeeping: I wanted to address a couple of questions that came up in comments last time. First, the marked gender gap in bike commuters. I have two thoughts on factors that might be contributing to the disparity:

  1. It seems likely that there are safety-related differences in male and female biking behavior, as there are in many other activities. These safety concerns are related to both the perceived and actual intrinsic dangers of the activity itself and the external threats associated with being a single woman without a protective (vehicular) barrier. This study here comes to some similar conclusions, but I welcome any comments.
  2. There is reporting bias of some sort. This study from Stanford refers to a bias on survey forms that minimize or aggregate the kinds of trips that women tend to make (leaving aside the 50’s housewife stereotype slathered on the surface of the whole premise).

Second, how to get involved:

There are a number of groups that are active in the City, Bikemore being today’s obvious example. Velocipede and other bike shops and coops are all educators and advocates worth knowing, and of course join the Bike Party on the last Friday of each month.

Next Time: Who should bike in Baltimore, how, and why?

IMAGE CREDIT. Benson Kua
Jan 01
0

The Weight of Evidence

By | Exeter Gardens | No Comments

So I was reading The Economist‘s recent special report on obesity. It’s pretty standard Economist fare – on the one hand but on the other, government can only do so much, meanderings down the path of arguments from left and right only to end up right back somewhere in the middle. (Don’t get me wrong. I love The Economist, but it’s rather like having a conversation with that uncle of yours who knows more than you’ll ever know and loves to sit there dismantling your preconceptions, but never seems to move from his seat.) My mind was beginning to meander a little itself when this little tid-bit caught my eye:

“Removing corn subsidies is a much-touted solution. However, a paper by Bradley Rickard of Cornell University argues that removing America’s subsidies for corn and soyabeans would have produced only a small dip in calorie consumption.”

That corn subsidies distort and pervert the American food system by incentivizing the production of unhealthy food (think high-fructose corn syrup; think soda, corn chips and almost the entire contents of your nearest 7-Eleven) is something of a catechism among advocates for food justice and sustainable agriculture. I know I’ve made the argument several times myself. But is it true?

Through the power of the inter-webulator, I pulled up the paper in question. I must confess that much of it is well over my head, involving statistics and differential equations and many other things that were presumably covered in school while I was thinking about girls. Essentially though, the paper attempts to model the effect of removing all farm subsidies on the cost of commodities and the behavior of consumers, concluding that removing such subsidies would have only a minor – and diminishing – effect on either.

I would think it’s very difficult for fellow economists to evaluate the soundness of those predictions, let alone a layman. It’s hard to imagine the withdrawal of subsidies wouldn’t disrupt the profit models of agribusiness and major corn peddlers like McDonalds and PepsiCo to some extent. Their vociferous lobbying efforts certainly suggest so. Any attempt to bring some analytical rigour to this question is welcome, though (oh god, now I’m starting to sound like that Economist editorial voice). It just may be that the authors didn’t quite focus on the right one.

Unless I’m missing something in the thicket of equations and statistical terminology, the study seems only to explore the question of whether the elimination of farm subsidies (including indirect subsidies through trade tariffs) would lead to lower consumption of calories, and so a drop in obesity rates. It does not explore what would happen if the production of healthy fruits and vegetables were subsidized and incentivized in the same way that corn is subsidized today. (Interestingly, it mentions several restrictions on the growing of fruits and vegetables, and concludes that the withdrawal of the current system of subsidies would cause people to eat more of them.)

Perhaps agribusiness would simply turn all the apples in the orchards into high fructose apple syrup and perpetuate the calorie-bomb system of food manufacture. But perhaps not. Surely there are ways to incentivize the growing (and the eating) of healthy foods. Supporting urban agriculture and local food initiatives comes to mind.

One other note from the study is potentially revealing – “marketing input” in the selling of cereals, baked goods, beverages and food that’s consumed outside the home (eating out – meaning, to a great extent, fast food) accounts for over 90 percent of the “cost share” of those (highly-processed) products. Ninety percent. That figure suggests that it’s dirt cheap to produce crap and that its producers spend enormous amounts of money convincing you to eat it. (Note too: “The cost share of marketing inputs is relatively low for food products that involve little processing.”)

The authors take this as evidence that the removal of subsidies would have a negligible effect on the cost structure of production, essentially because these commodities are so cheap to produce already. And they may have a point. Technology has made it possible to produce so much corn so cheaply that subsidies may not make much of a difference either way. But doesn’t that result from it being in the interests of industry to create such a system? Couldn’t all that ingenuity, innovation, and technological wizardry be put to use to produce an abundance of healthy food choices for all? All it takes is the right … incentives.