News

Increasing Incidence of Obesity the Topic of 2004 Alumni Day

With the Centers for Disease Control and Prevention now reporting that approximately 64% of U.S. adults are either overweight or obese and approximately 15% of U.S. children are overweight, EPH alumni and other healthcare professionals convened for EPH's Alumni Day on June 4 to hear from experts about one of the most dangerous and fast-growing public health problems in the U.S. and around the world.

While everyone agrees that the increasing incidence of obesity is a problem, reaching consensus about the reason for it is much more difficult, with experts assigning responsibility in varying proportions to a list of culprits including the food industry, human genes, public school cafeterias and vending machines filled with high fat and high sugar foods, failures in personal responsibility, government agricultural subsidies, an increasingly sedentary modern lifestyle, cultural traditions that celebrate life events with food, and advertising that constantly convinces us to consume.

Faculty panelists, Derek Yach, Loretta DiPietro, Marlene Schwartz, and Susan Mayne answer the audience's questions.

Alumni Day keynote speaker Kelly Brownell, PhD, Professor of Psychology and Epidemiology, Chair of the Department of Psychology and Director of the Yale Center for Eating and Weight Disorders, attributes the obesity epidemic to the "toxic environment" in which Americans live. Brownell argued that the quantity and availability of unhealthy foods, the food industry's slick advertising and enormous portion sizes, and the declining amount of physical activity that Americans engage in all contribute to the toxic environment. In a world in which unhealthy food is available everywhere from gas stations to drug stores, larger meal sizes are available for pennies more than regular sizes, industry pressures affect governmental decisions, and hundreds of millions of dollars are spent on advertising, the deck is stacked against the average person, who, Brownell argued, is "hardwired to like a diet that's high in sugar, fat, calories, and variety."

Kelly Brownell, keynote speaker, addresses Alumni Day audience.

"We are," he says, "at the very interesting point in history... where we have to address how we are going to deal with [obesity]... as a world"--and he believes that trying to change the environment is our best bet. There are parallels, he notes, between the food and tobacco industries. Brownell believes that the food industry is most vulnerable for its targeting of children with advertisements, and believes that that advertising is "one of the first doors that has opened to us in order to do something about obesity as a public health issue because I think the public will race for the protection of children as a broad concept." He noted, however, that change from the top levels of industry and government will likely be slow to come and emphasized the importance of taking action at the grassroots and state levels. Current efforts at those levels include eliminating school vending machines stocked with soft drinks and unhealthy snacks, requiring that calorie count information appear on restaurant menus, and improving the school lunch program.

Looking at obesity from a global perspective, Derek Yach, MB, ChB, BSc, MPH, formerly Executive Director of Noncommunicable Diseases and Mental Health at the World Health Organization (WHO), stated that "diet and diet-related factors have a disproportionate impact on total global mortality in all parts of the world."   He discussed WHO's Global Strategy for Diet, Physical Activity and Health (the Global Strategy), the development of which he directed. The Global Strategy, a non-binding resolution endorsed by all of WHO's 192 member states on May 22, seeks to shift the emphasis from individual diets to the world's food system as a whole, and to facilitate and encourage, among other things, the development of national plans for diet and physical activity, government provision of accurate and balanced information on diet and physical activity, and the establishment of food and agricultural policies that protect and promote health.

Marlene Schwartz, PhD, Co-Director of the Yale Center for Eating and Weight Disorders, spoke about the obesity epidemic and children, and argued that food advertising should promote healthy foods, particularly those which kids in the U.S. do not eat enough of. Pointing out that "it is just as unhealthy for a normal weight child to go to school and have a can of Coke, a bag of chips and a chocolate fudge bar for lunch as it is for an overweight child," Schwartz emphasized that the dialogue around eating and kids should be about health and nutrition, not merely about weight.

The role of physical inactivity in the obesity epidemic was discussed by Loretta DiPietro, PhD, MPH, Associate Professor of Epidemiology in the Division of Environmental Health Sciences.    She stated that "the human body is not programmed to decrease energy intake in response to decreased work activity." This biological reality, when coupled with decreasing levels of physical activity, contributes to the obesity epidemic. DiPietro emphasized that labor saving devices like e-mail, riding lawnmowers, internet shopping and remote controls all alleviate the need for people to get up and move around. In addition, many aspects of the modern built environment, like elevators and zoning laws not requiring the building of sidewalks, discourage or prohibit physical activity.

Collectively, the speakers' comments made clear the enormous effect that the confluence of decreased physical activity and the ubiquitous nature of unhealthy foods have had on waistlines around the world. And expanding waistlines are just the first signs of the problems that lie ahead: a recent paper in the Journal of the American Medical Association, entitled "Actual Causes of Death in the United States, 2000," concluded that unless current trends change, obesity is poised to overtake tobacco as the leading preventable cause of death in the U.S. Susan Mayne, PhD, Associate Professor of Epidemiology in the Division of Chronic Disease Epidemiology, noted that because approximately one-third of cancer deaths are due to nutrition, lack of physical activity and obesity, the obesity epidemic is jeopardizing recent public health gains in decreasing cancer mortality.

The speakers' presentations were followed by a luncheon at which healthy entrées of crab cake with red pepper remoulade, quail stuffed with fig, and napoleons of roasted eggplant, zucchini, and tomato with goat cheese were served (in her introduction of the day's program, Elaine Anderson, Director of Alumni and Community Affairs at EPH, joked "there was no debate about what the topic at this year's Alumni Day should be, but there was debate about what the lunch that followed these speakers should be").

At the luncheon, J. Michael McGinnis, MD, MPP, Senior Vice President at The Robert Wood Johnson Foundation and former Assistant Surgeon General and Deputy Assistant Secretary for Health, Department of Health and Human Services, delivered a special address entitled "Obesity and Public Health." He also received the Award for Excellence in Health Promotion from the Association of Yale Alumni in Public Health (AYAPH) for 30 years of outstanding contributions to public health under the last four U.S. presidents.

Also honored at the luncheon were James Malloy, MPH '67, President of Health Management Consulting Associates, Inc., who received the Alumni Distinguished Service Award, and Patti Harvey Rose, EdD, MPH '85 and James Rawlings, MPH '80, who were inducted into the Public Service Honor Roll.

- Story by Christy Gordon.