Gut Check
“Obesity Is a Disease”: Examining the Self-Regulatory Impact of This Public-Health Message
Crystal Hoyt, Jeni Burnette & Lisa Auster-Gussman
Psychological Science, forthcoming
Abstract:
In the current work, we examined the impact of the American Medical Association’s recent classification of obesity as a disease on weight-management processes. Across three experimental studies, we highlighted the potential hidden costs associated with labeling obesity as a disease, showing that this message, presented in an actual New York Times article, undermined beneficial weight-loss self-regulatory processes. A disease-based, relative to an information-based, weight-management message weakened the importance placed on health-focused dieting and reduced concerns about weight among obese individuals — the very people whom such public-health messages are targeting. Further, the decreased concern about weight predicted higher-calorie food choices. In addition, the disease message, relative to a message that obesity is not a disease, lowered body-image dissatisfaction, but this too predicted higher-calorie food choices. Thus, although defining obesity as a disease may be beneficial for body image, results from the current work emphasize the negative implications of this message for self-regulation.
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Occupational Characteristics and the Obesity Wage Penalty
Jennifer Bennett Shinall
Vanderbilt University Working Paper, January 2014
Abstract:
This paper demonstrates that accounting for two key occupational characteristics eliminates the unexplained wage gap experienced by the heaviest women in the labor market. Obese women are more likely to work in jobs that emphasize personal interaction, but they are less likely to work in jobs that emphasize physical activity. Although jobs that emphasize personal interaction are higher paying, obese women who work in such jobs receive lower wages than non-obese women, and their wage penalty offsets the premium to working in a job emphasizing personal interaction. Together, these results suggest that taste-based discrimination may be driving occupational sorting among obese women and, as a result, is at least one source of the wage penalty experienced by obese women.
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Racism, Segregation, and Risk of Obesity in the Black Women's Health Study
Yvette Cozier et al.
American Journal of Epidemiology, forthcoming
Abstract:
We assessed the relation of experiences of racism to the incidence of obesity and the modifying impact of residential racial segregation in the Black Women's Health Study, a follow-up study of US black women. Racism scores were created from 8 questions asked in 1997 and 2009 about the frequency of “everyday” racism (e.g., “people act as if you are dishonest”) and of “lifetime” racism (e.g., unfair treatment on the job). Residential segregation was measured by linking participant addresses to 2000 and 2010 US Census block group data on the percent of black residents. We used Cox proportional hazard models to estimate incidence rate ratios and 95% confidence intervals. Based on 4,315 incident cases of obesity identified from 1997 through 2009, both everyday racism and lifetime racism were positively associated with increased incidence. The incidence rate ratios for women who were in the highest category of everyday racism or lifetime racism in both 1997 and 2009, relative to those in the lowest category, were 1.69 (95% confidence interval: 1.45, 1.96; Ptrend < 0.01) and 1.38 (95% confidence interval: 1.15, 1.66; Ptrend < 0.01), respectively. These associations were not modified by residential segregation. These results suggest that racism contributes to the higher incidence of obesity among African American women.
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The income body weight gradients in the developing economy of China
Darjusch Tafreschi
Economics & Human Biology, forthcoming
Abstract:
Existing theories predict the income gradient of individual body weight to change sign from positive to negative in process of economic development. However, there are only few empirical studies which test this hypothesis. This paper adds to the literature on that topic by investigating the case of China. Using individual and community data from the 1991-2009 waves of the China Health and Nutrition Survey regression analyses suggest that after controlling for important confounding factors (1) higher income is positively related to future growth of individuals’ BMI in less developed areas (i.e. BMI growth is 0.7-1.5 percentage points higher when comparing the richest with the poorest individuals), but negatively related to BMI growth in more developed areas (i.e. BMI growth is 0.8-1.6 percentage points lower for the richest individuals), and (2) that concentrations of overweight are “trickling down” to lower income ranks as regions become more developed. Moreover, the reversal of the income gradient appears to happen at earlier stages of development for females.
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The Impact of Restaurant Calorie Labels on Food Choice: Results from a Field Experiment
Brenna Ellison, Jayson Lusk & David Davis
Economic Inquiry, April 2014, Pages 666–681
Abstract:
Using field experiment data, we compare the effectiveness of calorie labels to a “fat tax” at reducing calories ordered. Results from a structural model of consumer demand show that numeric labels did not influence food choice, but symbolic traffic light labels caused restaurant patrons to select lower-calorie menu items; thus, adding a traffic light symbol could enhance the effectiveness of the numeric calorie label (as currently proposed by the Food and Drug Administration). Additionally, our model projects that labels can both reduce intake more than a 10% tax on high-calorie items and a 10% subsidy on low-calorie items.
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Steven Cummins, Ellen Flint & Stephen Matthews
Health Affairs, February 2014, Pages 283-291
Abstract:
National and local policies to improve diet in low-income US populations include increasing physical access to grocery stores and supermarkets in underserved neighborhoods. In a pilot study that evaluated the impacts of opening a new supermarket in a Philadelphia community considered a “food desert” — part of the Pennsylvania Fresh Food Financing Initiative — we found that the intervention moderately improved residents’ perceptions of food accessibility. However, it did not lead to changes in reported fruit and vegetable intake or body mass index. The effectiveness of interventions to improve physical access to food and reduce obesity by encouraging supermarkets to locate in underserved areas therefore remains unclear. Nevertheless, the present findings suggest that simply improving a community’s retail food infrastructure may not produce desired changes in food purchasing and consumption patterns. Complementary policy changes and interventions may be needed to help consumers bridge the gap between perception and action. The replication of our findings in other settings and research into the factors that influence community residents’ receptivity to improved food access are urgently required.
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Diane Gilbert-Diamond et al.
JAMA Pediatrics, forthcoming
Objective: To assess the prospective association between the presence of a bedroom television and change in body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), independent of television viewing, in a nationally representative sample of US children and adolescents.
Design, Setting, and Participants: We conducted a random-digit prospective telephone survey that captured children and adolescents from across the United States. Participants included 6522 boys and girls aged 10 to 14 years at baseline who were surveyed via telephone about media risk factors for obesity. Weighted regressions assessed adiposity at 2- and 4-year follow-up, controlling for television and movie viewing, video-game playing, parenting, age, sex, race or ethnicity, household income, and parental educational level.
Results: Distributions for age, sex, race or ethnicity, and socioeconomic status were similar to census estimates for the US population. Sample weighting methods accounted for higher dropout rates among ethnic minorities and those with lower socioeconomic status. Bedroom televisions were reported by 59.1% of participants at baseline, with boys, ethnic minorities, and those of lower socioeconomic status having significantly higher rates. In multivariate analyses, having a bedroom television was associated with an excess BMI of 0.57 (95% CI, 0.31-0.82) and 0.75 (0.38-1.12) at years 2 and 4, respectively, and a BMI gain of 0.24 (0.02-0.45) from years 2 to 4.
Conclusions and Relevance: Having a bedroom television is associated with weight gain beyond the effect of television viewing time. This association could be the result of uncaptured effects of television viewing or of disrupted sleep patterns. With the high prevalence of bedroom televisions, the effect attributable to this risk factor among US children and adolescents is excess weight of 8.7 million kg/y.
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How negative descriptive norms for healthy eating undermine the effects of positive injunctive norms
Mina Staunton et al.
Journal of Applied Social Psychology, forthcoming
Abstract:
Healthy eating intentions were assessed as a function of theory of planned behavior variables and manipulated group norm salience. Participants (n = 119) were exposed (or not) to a positive injunctive norm that their fellow students approve of eating healthily, and (or not) to a negative descriptive norm that their fellow students do not eat healthily. A significant interaction emerged. When a negative descriptive norm was made salient, participants exposed to a positive injunctive norm reported significantly lower intentions to eat healthily. When no descriptive norm was given, exposure to a positive injunctive norm had no effect. The results suggest the weakness of manipulated injunctive norm salience in the health domain, and the importance of investigating the interactive effects of referent group norms.
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Healthful Food Decision Making in Response to Traffic Light Color-Coded Nutrition Labeling
Joerg Koenigstorfer, Andrea Groeppel-Klein & Friederike Kamm
Journal of Public Policy & Marketing, forthcoming
Abstract:
This article investigates whether traffic light color-coded nutrition information helps low- (vs. high-) self-control consumers make more healthful food choices within a given product category. Two in-store lab studies assess the effects of traffic light colors. The colors indicate low (green), medium (amber), and high (red) levels of four negative food nutrients (sugar, fat, saturated fat, and salt). The color-coding was implemented on nutrition labeling schemes shown on the front of actual food packages (pasta meals in Study 1; cereal bars in Study 2). Consumers with low self-control to resist food temptations, but not those with high self-control, make more healthful food choices in response to the color-coded labeling. The behavior is congruent with their long-term goals of controlling their food choices and is evident when traffic light colors vary between both nutrients and products (Study 1) and when traffic light colors vary between nutrients but not products (Study 2). The authors derive theoretical implications and draw conclusions from the perspectives of public policy, retailing, and manufacturers.
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Better Moods for Better Eating?: How Mood Influences Food Choice
Meryl Gardner et al.
Journal of Consumer Psychology, forthcoming
Abstract:
How do moods influence one’s preference for foods? By introducing the role of enjoyment- versus health-oriented benefits of foods in the mood and food consumption relationship, this research informs both temporal construal theory and mood management framework by positing that mood influences the choice between healthy versus indulgent foods through its impact on temporal construal, which alters the weights people put on long-term health benefits versus short-term mood management benefits when making choices. The results from four experiments show that a positive mood cues distal, abstract construal and increases the salience of long-term goals such as health, leading to greater preference for healthy foods over indulgent foods. The results also show that a negative mood cues proximal construal and increases the salience of immediate, concrete goals such as mood management, leading to greater preference for indulgent foods over healthy foods.
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Sleep duration and body mass index and waist circumference among US adults
Earl Ford et al.
Obesity, February 2014, Pages 598–607
Objective: To examine the form of the relationship between sleep duration and anthropometric measures and possible differences in these relationships by gender and race or ethnicity.
Design and Methods: Data for 13,742 participants aged ≥20 years from the National Health and Nutrition Examination Survey 2005-2010 were used. Sleep duration was categorized as ≤6 (short sleepers), 7-9, and ≥10 hours (long sleepers).
Results: Short sleepers were as much as 1.7 kg/m2 (SE 0.4) heavier and had 3.4 cm (SE 1.0) more girth than long sleepers. Among participants without depression or a diagnosed sleep disorder, sleep duration was significantly associated with body mass index (BMI) and waist circumference in an inverse linear association in the entire sample, men, women, whites, African Americans, and participants aged 20-39 years. No evidence for statistical interaction by gender and race or ethnicity was observed. Regression coefficients were notably stronger among adults aged 20-39 years. Compared to participants who reported sleeping 7-9 hours per night, short sleepers were more likely to be obese and have abdominal obesity.
Conclusions: In this nationally representative sample of US adults, an inverse linear association most consistently characterized the association between sleep duration and BMI and waist circumference.
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Gregory Privitera & Faris Zuraikat
Appetite, forthcoming
Abstract:
The objective of this study was to test if proximity of a food or preference for a food influences food intake in a competitive food environment in which one low calorie/low fat (apple slices) and one higher calorie/higher fat (buttered popcorn) food was available in the same environment. The proximity of popcorn and apple slices was manipulated and 56 participants were randomly assigned to groups. In Group Apples Near, apple slices were placed near (within arms reach) a participant and popcorn was placed far (2 m away). In Group Popcorn Near, buttered popcorn was placed near and apple slices were placed far. As a control for the absence of a proximity manipulation, Group Both Near had both test foods placed near. Although participants rated the popcorn as more liked than apples, the food that was placed closer to the participant was consumed most in the two experimental groups, regardless of preference (R2 = 0.38). Total energy intake was reduced most when popcorn was placed far from a participant compared to when it was placed near (R2 = 0.24). The effects reported here were not moderated by BMI and did not vary by sex. In all, the results support the hypothesis that making a low calorie food more proximate will reduce total energy intake and increase intake of a low calorie food, even when a higher calorie and more preferred food is also available, but less proximate.
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Association Between Casino Opening or Expansion and Risk of Childhood Overweight and Obesity
Jessica Jones-Smith, William Dow & Kristal Chichlowska
Journal of the American Medical Association, 5 March 2014, Pages 929-936
Importance: Economic resources have been inversely associated with risk of childhood overweight/obesity. Few studies have evaluated whether this association is a direct effect of economic resources or is attributable to unmeasured confounding or reverse causation. American Indian–owned casinos have resulted in increased economic resources for some tribes and provide an opportunity to test whether these resources are associated with overweight/obesity.
Objective: To assess whether openings or expansions of American Indian–owned casinos were associated with childhood overweight/obesity risk.
Design, Setting, and Participants: We used repeated cross-sectional anthropometric measurements from fitness testing of American Indian children (aged 7-18 years) from 117 school districts that encompassed tribal lands in California between 2001 and 2012. Children in school districts encompassing American Indian tribal lands that either gained or expanded a casino were compared with children in districts with tribal lands that did not gain or expand a casino.
Main Outcomes and Measures: Per capita annual income, median annual household income, percentage of population in poverty, total population, child overweight/obesity (body mass index [BMI] ≥85th age- and sex-specific percentile) and BMI z score.
Results: Of the 117 school districts, 57 gained or expanded a casino, 24 had a preexisting casino but did not expand, and 36 never had a casino. The mean slots per capita was 7 (SD, 12) and the median was 3 (interquartile range [IQR], 0.3-8). Among districts where a casino opened or expanded, the mean change in slots per capita was 13 (SD, 19) and the median was 3 (IQR, 1-11). Forty-eight percent of the anthropometric measurements were classified as overweight/obese (11 048/22 863). Every casino slot machine per capita gained was associated with an increase in per capita annual income (β = $541; 95% CI, $245-$836) and a decrease in percentage in poverty (β = −0.6%; 95% CI, −1.1% to −0.20%) among American Indians living on tribal lands. Among American Indian children, every slot machine per capita gained was associated with a decreased probability of overweight/obesity by 0.19 percentage points (95% CI, −0.26 to −0.11 percentage points) and a decrease in BMI z score (β = −0.003; 95% CI, −0.005 to −0.0002).
Conclusions and Relevance: In this study, opening or expanding a casino was associated with increased economic resources and decreased risk of childhood overweight/obesity. Given the limitations of an ecological study, further research is needed to better understand the mechanisms behind this association.
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Scott Lear et al.
Canadian Medical Association Journal, 4 March 2014, Pages 258-266
Background: Household devices (e.g., television, car, computer) are common in high income countries, and their use has been linked to obesity and type 2 diabetes mellitus. We hypothesized that device ownership is associated with obesity and diabetes and that these effects are explained through reduced physical activity, increased sitting time and increased energy intake.
Methods: We performed a cross-sectional analysis using data from the Prospective Urban Rural Epidemiology study involving 153 996 adults from high, upper-middle, lower-middle and low income countries. We used multilevel regression models to account for clustering at the community and country levels.
Results: Ownership of a household device increased from low to high income countries (4% to 83% for all 3 devices) and was associated with decreased physical activity and increased sitting, dietary energy intake, body mass index and waist circumference. There was an increased odds of obesity and diabetes with the ownership of any 1 household device compared to no device ownership (obesity: odds ratio [OR] 1.43, 95% confidence interval [CI] 1.32–1.55; diabetes: OR 1.38, 95% CI 1.28–1.50). Ownership of a second device increased the odds further but ownership of a third device did not. Subsequent adjustment for lifestyle factors modestly attenuated these associations. Of the 3 devices, ownership of a television had the strongest association with obesity (OR 1.39, 95% CI 1.29–1.49) and diabetes (OR 1.33, 95% CI 1.23–1.44). When stratified by country income level, the odds of obesity and diabetes when owning all 3 devices was greatest in low income countries (obesity: OR 3.15, 95% CI 2.33-4.25; diabetes: OR 1.97, 95% CI 1.53–2.53) and decreased through country income levels such that we did not detect an association in high income countries.
Interpretation: The ownership of household devices increased the likelihood of obesity and diabetes, and this was mediated in part by effects on physical activity, sitting time and dietary energy intake. With increasing ownership of household devices in developing countries, societal interventions are needed to mitigate their effects on poor health.
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The relationship between body fat mass percentiles and inflammation in children
Kanakadurga Singer et al.
Obesity, forthcoming
Objective: Obesity has been associated with markers of increased systemic inflammation in both human and animal studies. Increased inflammation is linked to metabolic and cardiovascular disease. The objective of this study was to evaluate the association between percentile body fat and inflammation in a nationally representative sample of US children.
Design and Methods: We studied 6,950 children aged 8 to 18 years of age between 1999-2004. Measurement of body fat percentage was measured by dual-energy x-ray absorptiometry DEXA scan and converted to an age- and sex-adjusted percentile. The main outcome measures were abnormal c-reactive protein (CRP > 1.0 mg/dl) and absolute neutrophil count (ANC > 6000).
Results: Children with higher levels of body fat (≥70th%) had a higher odds of having elevated CRP (OR 2.88-10.69) and elevated ANC (OR 2.14 to 3.24) compared with children with body fat <70th percentile.
Conclusions: The link between inflammation and body fat in children warrants further longitudinal research to understand the temporal relationship between overweight/obesity and inflammation in the pediatric obese population and its implications for chronic disease risk.
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The Economics of Information, Deep Capture, and the Obesity Debate
Trenton Smith & Attila Tasnádi
American Journal of Agricultural Economics, forthcoming
Abstract:
The economic theory of regulatory capture predicts that industry groups will attempt to influence their regulators (for example, by lobbying for rules that exclude competition). It has been suggested that the same logic applies to any powerful institution with the ability to affect industry profits. When the aim of industry is to alter the public’s perception of its product (for example, by disseminating favorable messages to the news media or via an advertising campaign, or by funding industry-friendly scientific research), the end result has been dubbed deep capture. We develop a formal model of deep capture, in which consumers have imperfect information about product quality, and a dominant producer is able to increase his profits by altering the parameters of the consumer’s search problem. We demonstrate the empirical relevance of the phenomenon with a discussion of the food industry response to the obesity epidemic.
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Jennifer Bennett Shinall
Vanderbilt University Working Paper, February 2014
Abstract:
Obesity rates have more than doubled in the last two decades, and yet obese individuals continue to experience both wage and employment penalties in the labor market. This paper conducts the first in-depth review of the ten local and state laws protecting obese workers across the United States. After reviewing the legislative history, enforcement procedures, and remedies available under each law, I use empirical methods to assess each law’s efficacy in improving labor market outcomes of the obese. From this analysis, I conclude that the laws in two cities — Madison, Wisconsin and Urbana, Illinois — have been the most effective because they provide discrimination victims with swift, low-cost access to justice.
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Local Food Prices and Their Associations With Children’s Weight and Food Security
Taryn Morrissey, Alison Jacknowitz & Katie Vinopal
Pediatrics, March 2014, Pages 422-430
Objectives: Both obesity and food insecurity are important public health problems facing young children in the United States. A lack of affordable, healthy foods is one of the neighborhood factors presumed to underlie both food insecurity and obesity among children. We examine associations between local food prices and children’s BMI, weight, and food security outcomes.
Methods: We linked data from the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative study of children from infancy to age 5, to local food price data from the Council for Community and Economic Research (C2ER) Cost-of-Living Index (n = 11 700 observations). Using ordinary least squares (OLS), linear probability, and within-child fixed effects (FE) models, we exploit the variability in food price data over time and among children who move residences focusing on a subsample of households under 300% of the Federal Poverty Level.
Results: Results from ordinary least squares and FE models indicate that higher-priced fruits and vegetables are associated with higher child BMI, and this relationship is driven by the prices of fresh (versus frozen or canned) fruits and vegetables. In the FE models, higher-priced soft drinks are associated with a lower likelihood of being overweight, and surprisingly, higher fast food prices are associated with a greater likelihood of being overweight.
Conclusions: Policies that reduce the costs of fresh fruits and vegetables may be effective in promoting healthy weight outcomes among young children.
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Michelle Cardel et al.
Obesity, February 2014, Pages 497–503
Objective: To examine and compare the relationships among diet, physical activity, and adiposity between home-schooled children (HSC) and traditionally schooled children (TSC).
Design and Methods: Subjects were HSC (n = 47) and TSC (n = 48) aged 7-12 years old. Dietary intakes were determined via two 24-h recalls and physical activity was assessed with 7 days of accelerometry. Fat mass (FM), trunk fat, and percent body fat (¿) were measured by dual-energy X-ray absorptiometry (DXA).
Results: Relative to HSC, TSC demonstrated significantly higher BMI percentiles, FM, trunk fat, and ¿; consumed 120 total kilocalories more per day; and reported increased intakes of trans fats, total sugar, added sugars, calcium, and lower intakes of fiber, fruits, and vegetables (P < 0.05). At lunch, TSC consumed significantly more calories, sugar, sodium, potassium, and calcium compared to HSC (P < 0.05). Physical activity did not differ between groups. Traditional schooling was associated with increased consumption of trans fat, sugar, calcium (P < 0.05); lower intakes of fiber, and fruits and vegetables (P < 0.05); and higher FM, ¿, and trunk fat (P < 0.01), after adjustment for covariates.
Conclusions: These data suggest HSC may consume diets that differ in energy and nutrient density relative to TSC, potentially contributing to differences in weight and adiposity.