Our current approach to obesity relies on the assumption that people have choices, often fail to make the right ones, and should be educated and helped to make better choices. This view is simplistic and clearly absurd, given the continued rise in the prevalence of obesity in countries that have been tackling the problem for decades. Are millions of people really choosing to be overweight?
People are not as free to choose as we would like to believe. Neurobiological desires for sweet and high-fat foods gave humans a survival advantage in a world where food was scarce and every calorie counted. Where food is inexpensive and easily available, biological processes related to eating can mirror addiction and will lead to our destruction. We need to change our approach. We need incentives beyond educational messages. Strategies that include individual interventions, school-based nutrition and activity interventions, incentives for active commuting and changes to the built environment should continue; however, we also need robust ways to restrict portion sizes and reduce the sale of sugar-sweetened beverages and other high-calorie, nutrient-poor food products. Our government needs to consider taxation as a tool to combat the consumption of these addictive foods and beverages, just as it regulates the sale of alcohol and tobacco products for the purposes of population health.In USA, Berkeley is the first city that will intoduce the soda-tax after a recent ballot. Berkeley’s Measure D proposed imposing a 1-cent-per-ounce general tax on sugar-sweetened beverages and sweeteners used to flavor drinks. The measure will not dedicate funding to a specific cause and did not require only a majority of the vote.
The researchers used survey data relating SSB consumption to price variations to calculate how changes in the price of SSBs affect the demand for SSBs (own-price elasticity) and for other beverages (cross-price elasticity) in India. They combined these elasticities and data on SSB sales trends, BMIs, and diabetes incidence (the frequency of new diabetes cases) into a mathematical microsimulation model to estimate the effect of a 20% tax on SSBs on caloric (energy) consumption, glycemic load (an estimate of how much a food or drink raises blood sugar levels after consumption; low glycemic load diets lower diabetes risk), the prevalence of overweight/obesity, and the incidence of diabetes among Indian subpopulations. According to the model, if SSB sales continue to increase at the current rate, compared to no tax, a 20% SSB tax would reduce overweight/obesity across India by 3.0% and the incidence of type 2 diabetes by 1.6% over the period 2014–2023. In absolute figures, a 20% SSB tax would avert 11.2 million cases of overweight/obesity and 400,000 cases of type 2 diabetes between 2014 and 2023. Notably, if SSB sales increase more steeply as predicted by drinks industry marketing models, the tax would avert 15.8 million cases of overweight/obesity and 600,000 cases of diabetes. Finally, the model predicted that the largest relative effect of an SSB tax would be among young men in rural areas.The results confirm previous studies, 20% may be the ceiling for a tax . But what happens to health?. Assumptions on a fall in consumption, are just that, assumptions. And former behaviour is extrapolated into the future. This is what happens to any model, and this is the uncertainty and courage that any politician must hold in taking a difficult decision. Such moment is closer than before. If you are not convinced, I would suggest you have a look at this documentary released last week:
The results indicate that obesity is associated with substantial healthcare cost increases and there are large differences in costs by degree of obesity. Specifically, severe obesity raises total direct medical costs by an average of 160 € per patient and year. With total medical costs averaging 600 € for normal-weight individuals, this means that severe obesity is associated with an increase in costs of 26 %. The effect of moderate obesity is more modest: it raises medical costs by 97 € or 16 %. Overweight has an even smaller impact, raising costs by 51 € or 8.5 %.Therefore, if obesity has an economic and health impact, what next?
Obesity is a multifactorial problem impacted by access to foods (supply) and food choices (demand). Neighborhood environments constrain the food choices available to individuals, while complex dietary decisions are driven by taste, cost, nutrition, convenience, and weight concerns. The complex nature of dietary choices therefore requires informed educational approaches that are strategically combined with guided nudges, and environmental interventions that improve access to promote healthier eating. Moreover, multi-institutional collaborations will likely be necessary to address the obesity epidemic.Since a multi-institutional approach is needed, somebody has to lead this effort. Is the government able to do it?. If so, don't delay it.
There are two ways of thinking about influencing behavior. The first is based on the standard rational model. That is, infl uencing what people consciously think about by increasing knowledge and awareness (known as the refl ective system ). This aproach assumes that the individual is a rational agent who surveys the situation to see what the various options are and then does a quick cost-benefi t analysis of those options in order to choose. The second approach is to alter the context within which people act (known as the automatic system ). This type of intervention is similar to the “nudge” outlined by Thaler and Sustein (2008), which often involves small changes to the choice environment. For example, one intervention tried to encourage school children to make healthier choices without alienating students by reducing their perceived choices. In a school cafeteria, what kids choose depends on the order in which the items are displayed.Els que llegiu aquest blog ja sabeu que m'hi he referit anteriorment en termes genèrics. Però aquest llibre esdevé més interessant perquè mostra amb molta precisió un canvi de perspectiva. Destaco una conclusió del primer capítol:
Rational food decisions often involve trade-off between short-term gains of sensory pleasure and longer term gains of health and wellness. Findings from behavioral economics research suggest that even when people are motivated to make healthy choices, external constraints in the decision-making process can prevent them from choosing optimally. Most of us prefer immediately gratifying short-term pleasure over our long-term goal of eating healthy. Errors in choices arise from systemic decision biases, emotion, and the limits of cognitive capacity.Atesa la importància de "l'epidèmia" potser caldria que més d'un hi fes una ullada. Encara que també vull anunciar que el capítol d'implicacions per a la política (el 12) és molt fluix. Us caldrà doncs una mica d'imaginació i reescriu-re'l vosaltres mateixos.
PS. Per aquells que associen desigualtat social amb menys satisfacció en la vida, els convé veure aquest post i el seu argument trontollarà una mica més.
Most OECD countries have enjoyed large gains in life expectancy over the past decades, thanks to improvements in living conditions, public health interventions and progress in medical care. In 2008, life expectancy at birth in Spain stood at 81.2 years, two years above the OECD average of 79 years.
Higher life expectancy is generally associated with higher healthcare spending per person, although many other factors have an impact on life expectancy (such as living standards, lifestyles, education and environmental factors). Total health spending accounted for 9.0% of GDP in Spain in 2008, which is equal to the average of OECD countries. In 2008, health spending as a share of GDP was the highest in the United States (which spent 16.0% of its GDP on health), followed by France (11.2%), Switzerland (10.7%), and Germany and Austria (both 10.5%). Spain ranks below the OECD average in terms of health spending per person, with spending of 2,902 USD in 2008, compared with an OECD average of 3,060 USD. Between 2000 and 2008, health spending per person in Spain increased, in real terms, by 4.7 % per year on average, a growth rate higher than the average in OECD countries (4.2%).
Throughout the OECD, tobacco consumption and excessive weight gain remain two important risk factors for many chronic diseases.
Spain has achieved progress in reducing tobacco consumption, with current rates of daily smokers among adults standing at 26.4% in 2006, down from 41% in 1985. However, smoking rates in Spain still remain higher than the OECD average of 23.3% in 2008. Sweden, the United States and Australia provide examples of countries that have achieved remarkable success in reducing tobacco consumption, with current smoking rates among adults below 17%.
Adult obesity rates in Spain are higher than the OECD average, but child rates are amongst the highest in the OECD. Two out of 3 men are overweight and 1 in 6 people are obese in Spain. One in 3 children aged 13 to 14 are overweight. The proportion of adults who are overweight is projected by the OECD to rise a further 10% during the next 10 years. Obesity’s growing prevalence foreshadows increases in the occurrence of health problems (such as diabetes, cardiovascular diseases and asthma), and higher health care costs in the future.
When asked, "How is your health in general?", 70% of people in Spain reported to be in good health, close to the OECD average of 69%. Despite the subjective nature of this question, the answers have been found to be a good predictor of people’s future health care use.
Preferences may also be influenced in more subtle ways than through the direct provision of information. An important example is what has been described as setting the default option by advocates of “libertarian paternalism” (e.g. Sunstein and Thaler, 2003). The underlying principle is that individual preferences driving an act of choice tend to be influenced by how the default option is configured. An example of the default option is the routine association of a certain side dish to a main course ordered in a restaurant. Customers may be entitled to demand an alternative side dish, but if they did not exercise this faculty they would receive the standard (default) option. Using a healthy option as a default instead of a less healthy one would have a significant effect on the number of customers eventually choosing to consume the healthy option. Actions involving changes in default options may display varying degrees of interference with individual choice and they may be perceived as more or less acceptable by consumers depending on the nature of the choices they aim to influence. For instance, changing the order in which food is arranged in a company cafeteria (Sunstein and Thaler, 2003) in order to steer consumer choices towards healthy options would seem to be a fairly non-intrusive action. However, other actions based on the same basic principle, i.e. changing the default option, may be perceived as much more intrusive. An example is policies making organ donations a default, with individuals being allowed to opt out upon request, have been viewed as most controversial and have been fiercely opposed in many countries, despite evidence which shows these policies may increase organ donations by as much as 25-30% compared to countries where the default is not consenting to donation (Abadie and Gay, 2006).
