Sue Roberts

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POLICY OPTIONS FOR PROMOTING HEALHTY ENVIRONMENTS
TO ADDRESS THE GLOBAL OBESITY EPIDEMIC
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center

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Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
3
OBESITY CRISIS
As we look to the future and where childhood
obesity will be in 20 yearsit is every bit as
threatening to us as the terrorist threat we face
today. It is the threat from within.
US Surgeon General Richard Carmona TIME/ABC
Obesity Summit June 2004
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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OBESITY EPIDEMIC
Energy Intake gt Energy Expenditure
Obesity CVD Cancer Diabetes Hypertension
Stroke
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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OBESITY EPIDEMIC FACTORS
Energy Intake
US Food Supply US Food Consumption
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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OBESITY EPIDEMIC FACTORS
Energy Intake
Agricultural policy promoting excess food
production Commodities (i.e. corn) Cheap
commodities Food supply Calorie increase
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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OBESITY EPIDEMIC FACTORS
US Food Supply
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
Pulnam, et.al. Food Review 2332, Sept Dec
2000.
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OBESITY EPIDEMIC FACTORS
Energy Intake
Per Capita Sweeteners
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
Haley et. Al., USDA, ERS, June 2003.
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OBESITY EPIDEMIC FACTORS
Energy Intake
Mismatch between feast-or-famine environment of
human ancestors in which eating preferences
evolved and modern environment where food is
ubiquitous and cheap
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
Smith, Obesity and Natures Thumbprint, E-FAN no
04004, May 2004.
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OBESITY EPIDEMIC FACTORS
Energy Intake
Per Capita Total Calories
NHANES Data
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
CDC, MMWR Weekly 53 (04) 80-82, Feb 6, 2004.
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OBESITY EPIDEMIC FACTORS
Energy Intake
Per Capita Calories
CSFII Data
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
Charmugam, et.al, JADA 1037867, July 2003.
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OBESITY EPIDEMIC FACTORS
Energy Intake
Consumption Sweet Food
1 Energy Intake Soft Drinks 2 Energy Intake
Sweet Desserts
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
Block, J Food Compost Anal 173-4437, June 2004
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OBESITY EPIDEMIC FACTORS
Energy Intake Children

• Calorie intake increasing driven by high sugar
  foods and drinks1
• 2 meet Food Guide Pyramid recommendations1
• Soft drinks displace milk and fruit juice2
• Competitive foods available in 98 of senior high
  schools3
• Each additional can of soda increases risk of
  becoming overweight by 604

1. Gleason, USDA Rpt No CN-01-CD1, Jan 2001 2.
Harnack, et. al. JADA 994436, 1999 3. Wechster,
J Sch Health 71313, 2001 4. Ludwig, Lancet
357505, 2001
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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OBESITY EPIDEMIC FACTORS
Energy Intake
Food Marketing
Marketing approaches matter for public health.
They influence our own and in particular our
childrens patterns of behaviors. Given that
they are designed to succeed, they have serious
consequences for those at whom they are targeted.
Gro Harlem Brundtland
Director General of WHO
Address to the 55th World Health Assembly 2002
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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OBESITY EPIDEMIC FACTORS
Energy Intake
Food Marketing to Children

• Establish brand loyalty as early as possible
• Get kids to pester parents
• Get kids to think theyre supposed to have their
  own special foods (like Lunchables)

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
Nestle, Time/ABC News Obesity Summit, June 2004
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OBESITY EPIDEMIC FACTORS
Energy Intake
Food Marketing to Children

• TV Advertising
• 10,000-20.000 food ads/year
• Mostly high sugar, high fat, fast food
• Exposed kids choose advertised foods at higher
  rates
• TV Energy, fat, sweet salty snacks,
  carbonated drinks
• Fruits vegetables
• TV Obesity

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
Story French, Inti J Behav Nutr Phy Act 113,
Feb 2004 Coon Tucker, Minerva Pediatr, 54
(5)423, Oct 2002
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OBESITY EPIDEMIC FACTORS
Energy Intake Food Marketing to Children
In School Promotions

• Product Sales
• Vending
• Pouring Rights Contracts (MN 77)
• Branded Fast Food
• Fundraisers
• Rebate Programs

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
US GAO Rpt, Public Education Commercial
Activities in Schools, Sept. 2000.
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OBESITY EPIDEMIC FACTORS
Energy Intake Food Marketing to Children
In School Promotions

• Direct Advertising
• Bill boards, buses, Channel One
• Indirect Advertising
• Corporation sponsorship
• Educational programming

• Market Research
• Polls
• Internet tracking

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
French JADA 1021785 (2002)
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OBESITY EPIDEMIC FACTORS
Energy Intake Food Marketing to Children
Product Placement
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
Samuels, etal. Food Beverages Marketing
Practices Aimed at Children, Nov 2003.
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OBESITY EPIDEMIC FACTORS
Energy Intake Food Marketing to Children
Internet Advergames
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
www.nabiscoworld.com
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OBESITY EPIDEMIC FACTORS
Energy Intake Food Marketing to Children
Toys/Products with Brand Logo
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
Samuels, etal. Food Beverages Marketing
Practices Aimed at Children, Nov 2003.
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OBESITY EPIDEMIC FACTORS
Energy Intake Food Marketing to Children
Targeted Promotions - Dunk Win
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
www.pcrm.org
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OBESITY EPIDEMIC FACTORS
Energy Intake Food Marketing
Certain chocolates and cocoa may provide
cardiovascular health benefits
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
www.cocoapro.com
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OBESITY EPIDEMIC FACTORS
Energy Intake Global Food Advertising

• 40 Billion
• Greater than GNP of 70 of nations
• 500 on unhealthy food for every 1 on healthy
  food

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
Internatl Assoc Consumer Food Organ.,
Broadcasting Bad Health, July 2003.
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OBESITY EPIDEMIC FACTORS
Energy Expenditure
Leisure Time Physical Inactivity
BRFSS for 35 states DC Telephone survey
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
CDC, MMWR, 53 (04)82, Feb 6, 2004.
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OBESITY EPIDEMIC FACTORS
Energy Expenditure
Poor infra structures for physical activity
States Spending of Federal Funds
Pedestrian Projects .55/person Highways
Bridges 72/person
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
Zykofsky, Creating Livable Walkable Communities
ASTPHND Natl Mtg, June 2004.
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OBESITY EPIDEMIC FACTORS
Energy Expenditure
Limited physical education in schools

• 1 in 3 high school youth do not engage in
  vigorous physical activity
• Less than 30 youth attend daily physical
  education

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
Zykofsky, Creating Livable Walkable Communities
ASTPHND Natl Mtg, June 2004.
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OBESITY EPIDEMIC FACTORS
Energy Expenditure
Childhood Veal Syndrome

• Encourage sedentary behaviors over an active
  lifestyle
• Remove or restrict routine physical activity
• Chauffeur for short trips
• Restrict spontaneous decisions to play outdoors
• Confine to four walls of school or home most of
  the day

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
Zykofsky, Creating Livable Walkable Communities
ASTPHND Natl Mtg, June 2004.
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OVERCOMING OBESITY
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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OBESITY
Energy Intake gt Energy Expenditure
200 300 Calories
Minor Increase In Activity
Eat less Fighting words
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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PUBLIC HEALTH STRATEGIES
REAL War REAL Food REAL Action
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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PUBLIC HEALTH STRATEGIES
REAL Action

• Effective public policies
• Appropriate infrastructure
• Implementation programs
• Adequate funding
• Monitoring evaluation
• Continuing research

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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PUBLIC HEALTH STRATEGIES

• Health Interventions
• Public Policies
• Litigation

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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PUBLIC HEALTH STRATEGIES
Health Interventions

• Empower individuals
• Personalized goals
• Shared decision making
• Skill building
• Healthy environment in which to succeed

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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PUBLIC HEALTH STRATEGIES
Public Policies
Focus on ENVIRONMENT that has lead to colossal
nutrition health problems
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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PUBLIC HEALTH STRATEGIES
Public Policies
National Guidelines

• Dietary
• One department responsible for guidelines,
  safety, research, food policy
• Healthy lifestyles Act 2004 (S2399) IOM to
  develop guidelines
• Physical Activity

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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PUBLIC HEALTH STRATEGIES
Public Policies
Accurate Information

• Build public awareness
• Hard hitting messages
• Health literacy in all education
• Clear food labeling - healthy food logo
• Clear health claims
• Label restaurant menus

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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PUBLIC HEALTH STRATEGIES
Public Policies - Agriculture
Agricultural Policy Food Policy Health Policy
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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PUBLIC HEALTH STRATEGIES
Public Policies - Agriculture

• Food safety
• Food security

• Promotion of healthy foods
• Marketing
• Incentives for quality not quantity
• ( salt, sugar, fat, size)
• Emphasis on local, sustainable, just food system
  as alternatives to corporate controlled
  industrial food system

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
40
PUBLIC HEALTH STRATEGIES
Public Policies
Marketing/Media

• Regulate food advertising to children in all
  media
• Ban junk food ads
• Equal time to nutrition messages
• Repeal tax deduction for advertising junk food
  to children

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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PUBLIC HEALTH STRATEGIES
Public Policies
Marketing / Media

• Eliminate/limit cross promotion between popular
  childrens media characters and unhealthy food
  instead use for healthy foods
• Do not rely on self monitoring has not worked

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
Yach, et.al., J. Pub Health Pol., 243/4274, 2004
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PUBLIC HEALTH STRATEGIES
Public Policies
Fiscal

• Subsidies for healthy foods
• Subsidies for physical activity
• Tax foods low in nutrient density
• Incentives for employers

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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PUBLIC HEALTH STRATEGIES
Public Policies
Food Programs

• Increase health education
• Emphasis on healthy foods
• Coupons for fruits, vegetables, whole grains
• Local production
• Emphasis on maternal nutrition, breast feeding,
  at risk children

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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PUBLIC HEALTH STRATEGIES
Public Policies
Urban Planning

• Enhance opportunities for walking/cycling
• Accessible
• Safe
• Outdoor advertising
• Zoning

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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PUBLIC HEALTH STRATEGIES
Public Policies
Schools

• Healthy living classes mandatory
• Promote healthy foods
• All school foods
• School gardens
• Develop education around food system
• Ban unhealthy foods

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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PUBLIC HEALTH STRATEGIES
Public Policies
Schools
Reducing Carbonated Drinks
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
James, et. al., BMJ doi10.1136/bmj.38077,458438,E
E, April 2004
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PUBLIC HEALTH STRATEGIES
Public Policies
Investment

• Surveillance
• Research
• Evaluation

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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PUBLIC HEALTH STRATEGIES
Public Policies
Engage ALL Stakeholders

• Individuals
• Policy makers
• Communities
• Parents

• Schools
• Food Beverage Industry
• Employers
• Health Professionals

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
49
PUBLIC HEALTH STRATEGIES
Public Policies
Health Professionals

• Need to become public health advocates
  involved in policy and social change
• Need to strengthen policy and law in education

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
Aul et.al., Am J Pub Health, 93121984, Dec2003
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PUBLIC HEALTH STRATEGIES
Public Policies
HeLP America  Act (S2558)
Title I - Healthier Kids and Schools     Title
II - Healthier Communities and Workplaces     A
Incentives for a Healthy Workforce     B Healthy
Communities     C Family Smoking Prevention and
Control
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
51
PUBLIC HEALTH STRATEGIES
Public Policies
HeLP America  Act (S2558)
Title III - Responsible Marketing and Consumer
Awareness   Title IV -
Reimbursement and Coverage of
Preventive Services   Title V - HeLP America
Trust Fund   Title VI - Research
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
52
PUBLIC HEALTH STRATEGIES
Litigation

• Option when policies do not change
• Can improve public health
• from an investment point of view it a lawsuit
  does not have to be successful to constitute a
  threat

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
UBS Warburg, Absolute Risk of Obesity, Nov 2002
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PUBLIC HEALTH STRATEGIES
Litigation
Issues

• Food industry
• Advertising
• Disclosure of nutritional information
• Lack of warning of risk

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
54
PUBLIC HEALTH STRATEGIES
Litigation
Issues

• Economic
• Why do low income have highest rates obesity?
• Schools
• Duty to maintain safe and healthy environment for
  students

Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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PUBLIC HEALTH STRATEGIES
Litigation
Personal Responsibility in Food Consumption Act
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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OBESITY CRISIS
Public debate - We need to be involved
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center
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PUBLIC HEALTH STRATEGIES
First they ignore you, Then they laugh at
you, Then they fight you, Then you win
Gandhi
Susan L. Roberts, JD, MS, RD Drake University
Agricultural Law Center