Cancer Reserach Update

Solving Our Obesity Epidemic

May 16, 2012 | Issue 96

Also in this issue:

  1. In Brief: Preventing Cancer by the Numbers
  2. A Heavy Weight on Our Nation
  3. Setting Strategies for Prevention
  4. Same Snacks May Increase Intake

Shiriki K. Kumanyika, PhD, MPH
Solving our Obesity Epidemic

 Shiriki K. KumanyikaWe are living in an environment of obesity, says Shiriki Kumanyika, PhD, MPH, an epidemiologist at the University of Pennsylvania and one of the leading experts featured in the new documentary on obesity. The four-part film by the Institute of Medicine (IOM) and HBO has placed the Weight of the Nation in the spotlight.

The facts are alarming: Two-thirds of US adults and one-third of children are now overweight or obese. The percentage of children aged 6-11 who were obese increased from 7 percent in 1980 to almost 20 percent in 2008. The consequences are serious: Obesity increases the risk of seven types of cancer, diabetes, and heart disease. It contributes to five of the ten leading causes of death in the United States.

A member of the 2007 AICR/WCRF expert report and the writing panel of the 2009 policy report, Dr. Kumanyika was also a panel member of the IOM policy report. (See Setting Strategies for Prevention below.) She is also the founder of the African American Collaborative Obesity Research Network. 

CRU spoke with Dr. Kumanyika about how it’s now time to revamp the way in which we live.

"I firmly believe that we can fix this problem, in part because we have no choice. The current situation is untenable."

Q: This is a powerful documentary. Why do you think it’s important people watch it?

A: This series is a one-of-a-kind opportunity to obtain a scientifically sound and detailed explanation of what obesity means from a health perspective and to become sensitized to the personal struggles of people who are living with obesity (without the hype and even ridicule that often accompanies media portrayals of people with weight problems).

Q: Do you think kids should watch this? 

A: Parents may want to consider whether their children should see some of the more graphic depictions of the health consequences of obesity, but much of the content will be informative to children and youth who are old enough to understand it, particularly if parents actively engage in discussions with their children to help them to understand what is being portrayed. The films offer an outstanding opportunity for people, including within families, to begin conversations about what obesity means, why overweight and obesity affect so many people in our society and what can be done about it.

Q: The documentary states that 20% of cancer cases in women and 14% in men are caused by obesity. What are some other serious health problems of obesity?

A: High blood pressure, heart disease, osteoarthritis, and liver disease are some of the other obesity-related conditions. Type 2 diabetes is the chronic disease most closely linked to obesity. The potential to prevent diabetes and its consequences (which may include heart disease, kidney disease, blindness, and amputations) by preventing obesity is a strong takeaway from the HBO films.

Q:  In the film you visit an inner city store where we can see how high calorie, high-sugar foods are so cheap and accessible. What are some actions that parents and communities can take to make purchasing healthier foods easier?

A: Parents and community members can work with neighborhood store owners to improve the food options that are available, but they cannot do this alone. Retailers may be willing but face the risk that changing options will not be profitable if their youth or adult customers do not choose the new options with sufficient frequency. Feasibility is also an issue if stores do not have refrigeration or other resources needed.

Parents will need to form coalitions and connect with other organizations. Experts in retailing as well as public health professionals should be included in these efforts, to help with understanding key issues from the retailer’s perspective and to assist with the “social marketing” of healthier choices. Partnerships with non-profit organizations, health departments, and local universities can be very helpful for obtaining this expertise.

You can visit the Healthy Corner Stores Network for resources and ideas.

Q: You chaired an IOM Committee on Childhood Obesity Prevention, can you speak to why the issue of childhood obesity is so important to get a handle on now?

A: The crisis associated with the increases in prevalence of childhood obesity has been recognized for more than a decade, but we, in public health and in the society as a whole, have not been able to get ahead of the curve on this issue. Concerns relate to the health consequences and social problems that affect children with overweight or obesity and to the fact that being obese during childhood carries a substantial risk that the obesity will be lifelong. There are immediate consequences as well as longer-term effects, associated with the early onset of risks for type 2 diabetes, heart disease, and cancer. These risks accumulate over the life course.

The challenge is to actually turn things around so that the average child and adult will maintain a weight that is well within the healthy range.

Q: The IOM report highlights key strategies to combat obesity. Are there specific recommendations or strategies that you hope people can act on now?

A: The IOM report explains that all sectors of society have a stake in turning the obesity epidemic around and that leadership must come from within families and communities as well as from policy makers, businesses, and health professionals

The report calls for a comprehensive approach that changes the dynamics of several, interrelated environments that are key systems influencing obesity at the population level – physical activity environments, food environments, schools, workplaces and health care settings and the overarching information and messaging environments related to eating and physical activity. Changing the dynamics for communities of color and low-income communities is particularly critical, because the food marketing, physical activity, and messaging environments in these communities are even more obesity promoting than in communities in general and obesity and its consequences affect proportionately more people within these communities.

With your generous support, AICR funds reserch in diet, physical activity and weight management. Help us asvance our vital research mission with a donation, today.Q: There are so many challenges with stopping and reversing the rates of obesity that it seems overwhelming at times. Do you see it happening?

A: As I say in the documentary, “The weight of the nation is out of control, but we can fix that.” I firmly believe that we can fix this problem, in part because we have no choice. The current situation is untenable. The resources and attention being applied to the problem have increased markedly, perhaps to a tipping point. Taken together, the HBO series, the IOM report, the efforts of the partner organizations and in communities throughout the country can create what will be, in retrospect, a social movement that will have enough focus and energy to turn the obesity idemic around. We should all commit to being a part of this effort.

You can watch all the episodes of Weight of the Nation and find more resources online.

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1/3 Preventable pie chart In Brief: Preventing Cancer by the Numbers

Approximately 86,000 cases of breast cancers and 65,000 cases of colorectal cancers in the United States can be prevented by eating healthy, being physically active and staying lean, according to new estimates by the American Institute for Cancer Research.

For the 12 most common cancers, about one third of the most common cancers are preventable through eating a healthy diet, being physically active and maintaining a healthy weight.

The estimates draw on AICR/WCRFs 2009 policy report that estimated the percentage of each cancer that could be prevented through certain lifestyle changes. That percentage remains the same, but estimates on the number of cancer cases preventable change every year depending upon the incidence of a cancer.

Download flyer to see how many cases could be prevented for 12 different cancers. (PDF file)

Sources: AICR/WRCF, Policy and Action for Cancer Prevention 2009; Cancer Facts & Figures 2012, American Cancer Society.

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Research Roundup

A Heavy Weight on Our Nation

Adult calorie intake 71-74 & 05-08

Source: Institute of Medicine

If no action is taken to halt the rising obesity rate in the United States, 42 percent of the US population could be obese by 2030, finds a study published in the early online June issue of the American Journal of Preventive Medicine.

And the prevalence of severely obese could increase to 11 percent of the population, more than double that of 2010 prevalence. Those who are severely obese have a BMI of 40 or higher. Preventing the current prevalence from rising as predicted would result in a savings of nearly $550 billion in medical costs over the next two decades, the study projected.

The study used both national and state data to project trends in obesity prevalence. Study researchers evaluated the reports from almost 3.5 million adults.

Future trends in childhood obesity will have a major impact on adult obesity prevalence and related healthcare costs, note the authors. Increased access to recreational facilities, improvements in urban design, anti-obesity social marketing programs, worksite health promotion programs, could all slow obesity growth even further than these forecasts predict. Intervention that net even relatively small weight loss could result in substantial savings, concludes the study.

Source: Eric A. Finkelstein et al. Obesity and Severe Obesity Forecasts through 2030. American Journal of Preventative Medicine, 2012

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Setting Strategies for Prevention

Click on thumbnail for full-size chart

The challenges of stopping and reversing our nation’s obesity trend are complex, but there are key strategies that stand the best chance of success, concluded a new report released last week by the Institute of Medicine (IOM).

The IOM report evaluated more than 800 obesity prevention recommendations to identify those that could work together most quickly and effectively to meet five goals.

  1. Integrate physical activity into people’s daily lives.
    Recommendations include: improving the physical environment of communities and adopting physical activity requirements for licensed child care providers.
  2. Make healthy foods and beverages available everywhere.
    Recommendations include: adopting policies to reduce overconsumption of sugar-sweetened beverages; increasing the availability of lower-calorie and healthier restaurant foods for children; and ensuring all foods/beverages provided by the government follow nutrition standards.
  3. Transform marketing and messages about nutrition and activity.
    Recommendations include: implementing common standards for marketing foods and beverages to youths, and having the FDA and USDA adopt a single standard nutrition labeling system for all fronts of packages and retail store shelves
  4. Activate employers and health care professionals to support healthy lifestyles.
    Recommendations include: having health care providers adopt standards of practice for prevention, screening, diagnosis, and treatment of overweight and obesity; and worksites encouraging active living and healthy eating at work.
  5. Make schools a gateway to healthy weights.
    Recommendations include: K-12 students engaging in 60 minutes of physical activity per school day; teaching food literacy and nutrition science education in K-12; and school boards/state department of educations developing nutrition standards for foods sold/served outside of the federal programs.

Read the full report at the Institute of Medicine.

Source: Dan Glickman, Lynn Parker, Leslie J. Sim, Heather Del Valle Cook, and Emily Ann Miller, Editors; Committee on Accelerating Progress in Obesity Prevention; Food and Nutrition Board; Institute of Medicine. Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation. 2012.

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Same Snacks May Increase Intake

mixed Nuts in a Wooden BowlEating the same sweet or salty snack day after day may cause you to not like it as much as a healthier high-calorie snack, but it may also lead to increased snacking in general, suggests a preliminary new study published in the American Journal of Clinical Nutrition.

Study researchers focused on sensory specific satiety, when a person’s appetite for a food with a certain characteristics – such as sweet, salty, or fatty – is satiated. Foods that you tire of quickly might have a high sensory specific satiety, leading you to stop eating that food.

In the study, 118 participants were randomly split into three snacking groups: hazlenuts, chocolate or potato chips. All the snacks have about the same energy density. Both at the beginning and end of the study, all participants rated how much they liked six foods: the three test foods and another three that matched salty, savory and sweet. The researchers asked participants a series of questions to determine their sensory specific satiety for each food. Participants were then asked to eat as much of their assigned snack as they wanted.

Then, over the next 12 weeks, participants ate 263-calories worth of their assigned snack. A fourth group ate no added snacks. Researchers then compared the ratings and how much food participants ate before and after the study.

All the snackers ate more of the food at the end of the study than at the beginning. And sensory specific satiety was reduced for all of the snackers, meaning it would take more of that food to satisfy them. But the snackers who ate the nuts were the least likely to grow tired of the food. When compared to the hazelnut snackers, those who ate the chocolate and the potato chips reported liking their food less than they had 12 weeks before.

This is the first study to investigate the effects of long-term eating on liking, satiety, and intake, note the authors, and more research is needed.

Source: Tey SL, Brown RC, Gray AR, Chisholm AW, Delahunty CM. “Long-term consumption of high energy-dense snack foods on sensory-specific satiety and intake.” Am J Clin Nutr. 2012 May;95(5):1038-47. Epub 2012 Apr 4.

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