Change in the way we talk about obesity

On Saturday night, NBC aired a re-run of an old episode of Saturday Night Live.  It is one of my favorites that I vividly remembering watching as a teenager when it originally aired back in 1990.  

There is one scene where Chris Farley and Patrick Swayze compete for a spot as a Chippendales dancer.  Watching it now, 25 years later, I was struck at how frank some of the discussion surrounding Farley's weight was at the end, and how, today, it would almost certainly cause offense among some. 

Here's some of the back and forth:

“Barney, we all agreed that your dancing was great and your presentation was very sexy. I guess in the end, we all thought Adrian’s body was just much, much better than yours . . . You see it’s just at at Chippendales our dancers have traditionally had that lean, muscular physique, where yours is fat and flabby
...
Adrian: If you’re really serious about going with me, it can only be because his body is so bad.
...
Barney, we considered the possibility that our heavieir females might consider a heavy, heavier man that they could identify with”

It's comedy, and it's funny.  But, now a quarter century later, I suspect many would see it as inappropriate.  It is now routine to see academic articles on stigma and shame associated with obesity.  On the one hand, it seems that it is  a topic that has been the news a lot over the past 25 years, and perhaps that has changed perceptions of the issue.  I'm also reminded of the controversy surrounding Jonathan Chait's piece in New York Magazine on the rise of politically correct speech.  Or, maybe I'm just getting old and  now pick up on greater sensitivities than I did when I was 15.

We've all probably read of the rising toll of obesity, but while it often seems the discussion about the issue has ramped up, maybe some of that is just availability or confirmation bias.  For example, drawing on a couple CDC data sources, we can see that the mean weight of men aged 40-49 has increased by about 13 lbs since 1990.  For women aged 40-49, it's about 16 lbs.  So, yes we're somewhat heavier on average.

I was interested to see that according to google's ngram viewer (which shows the relative prevalence of a word in books over time), there's only been a slight uptick in writing that uses the word "obesity" over time.

That data set ends in 2008.  What about searchers of the word "obesity".  Here's googletrends on that one since 2004 (the earliest start date it will allow).

We seem to have changed how much we're talking about obesity.  I wonder if the nature of the conversation has changed too?

Recommendations from the UK Food Police

A government task force in the UK has recommended that all new government policies include an "obesity test" to determine how the policy will affect weight and obesity.  

In the US, all new "economically significant" regulations already have to undergo a cost-benefit analysis.  Wouldn't a good cost-benefit analysis already incorporate effects on weight if they have substantive health and thus economic impacts?  Moreover, if you've ever read the federal cost-benefit analyses that are often conducted (as I have done), you'll see many of them are are based on some questionable methods or heroic assumptions.  Are we to believe that new obesity-impacts analyses will be better and more informative than present cost-benefit analyses?

In any event, here are the rest of the group's recommendations (I'd like to see a cost-benefit analysis on each of them):

“Introduce licensing for fast food outlets to control the location and numbers of outlets in a local community.

Practical cookery skills and clear food education to be a compulsory part of the school curriculum for pupils up to the end of key stage 3 (age 14).

Clear disclosure of calories per items on restaurant and café menus which adhere to a defined standard for font size, formatting, contrast and layout of menus.

The ban on advertising of unhealthy foods aimed at children should be extended to day-time TV, from 7am to 9pm.

A review needs to be undertaken of the economic and societal impacts of a hypothecated tax on a range of food and drink contents at levels which are deemed harmful to health.

Increase awareness, coordination and reach of the Government’s ‘Healthy Start’ Voucher scheme. Extend voucher scheme to incentivise those who become active partners in their health by quitting smoking, reducing weight, walking a set number of steps etc.

Establish a cross departmental permanent government task force on obesity. This supports similar recommendations made by other health organisations.

All new policies to be reviewed and assessed against an ‘obesity test’.”

Smaller plate size = lower consumption?

Having read a couple papers that looked at the amount of food people ate when using smaller vs. larger plates, I presumed it was something of a stylized fact that people ate less when using smaller plates.  However, this review study just released in Obesity Reviews, suggests that 

“Evidence to date does not show that dishware size has a consistent effect on food intake, so recommendations surrounding the use of smaller plates/dishware to improve public health may be premature.”

Guess I need to update my beliefs on this one.  Here's the whole abstract:

“It has been suggested that providing consumers with smaller dishware may prove an effective way of helping people eat less and preventing weight gain, but experimental evidence supporting this has been mixed. The objective of the present work was to examine the current evidence base for whether experimentally manipulated differences in dishware size influence food consumption. We systematically reviewed studies that experimentally manipulated the dishware size participants served themselves at a meal with and measured subsequent food intake. We used inverse variance meta-analysis, calculating the standardized mean difference (SMD) in food intake between smaller and larger dishware size conditions. Nine experiments from eight publications were eligible for inclusion. The majority of experiments found no significance difference in food intake when participants ate from smaller vs. larger dishware. With all available data included, analysis indicated a marginal effect of dishware size on food intake, with larger dishware size associated with greater intake. However, this effect was small and there was a large amount of heterogeneity across studies (SMD: −0.18, 95% confidence interval: −0.35, 0.00, I2 = 77%). Evidence to date does not show that dishware size has a consistent effect on food intake, so recommendations surrounding the use of smaller plates/dishware to improve public health may be premature.”

Fat and Happy

I ran across this interesting paper by  Frieder Kropfhäußer and Marco Sunder.  They study the relationship between body mass index (BMI) and life satisfaction for about 8,000 Germans measured from 2003 to 2011.   

Life satisfaction was measured via survey by asking people how satisfied they were with their life on a scale of 0=dissatisfied to 10=satisfied.

I used their estimates for all men and all women in their table 3 to construct the following graph.

They find no statistically significant relationship between BMI and life satisfaction for men (after controlling for earnings, age, education, and marital status).  If you had to predict the BMI that would yield highest life satisfaction for men, it would be 36 - well into the obese range.

For women, there is a clearer relationship.  Even still, the life-satisfaction-maximizing BMI for women is about 29, at the upper end of overweight and almost obese.

Now, maybe BMI affects earnings or marital status, which then has an indirect effect on life satisfaction; however, these results suggest that overweightedness in and of itself doesn't have much effect on the stated life satisfaction of men, and the "optimal" for women is far above what obesity researchers consider "normal."

It's hard to reconcile these findings with so much of what we read about obesity.

Price responsiveness to unhealthy food taxes and healthy food subsidies

I recently ran across this article published in Current Obesity Reports calling for more rigorous methods to assess the effects of soda and fat taxes.  The article makes a number of good points, but it also misses many more complications that should be included for a rigorous evaluation - for example, how do firms respond when subjected to new food policies?

Another example comes to us via this paper in the Journal of Marketing by Debabrata Talukdar  and Charles Lindsey.  If you want to tax unhealthy foods and subsidize healthy ones, the authors suggest regulators may face an up hill battle because consumers are less sensitive to rising prices for unhealthy foods and falling prices for healthy foods than the reverse.

A portion of the abstract:

“The results from multiple studies confirm that consumers exhibit undesirable asymmetric patterns of demand sensitivity to price changes for healthy and unhealthy food. For healthy food, demand sensitivity is greater for a price increase than for a price decrease. For unhealthy food, the opposite holds true. The research further shows that the undesirable patterns are attenuated or magnified for key policy-relevant factors that have been shown to decrease or increase impulsive purchase behavior, respectively. As the rising obesity trend brings American consumers’ food consumption behavior under increased scrutiny, the focal findings hold significant implications for both public policy makers and food marketers. ”

They conclude:

“For public policy makers, our findings imply that the efficacy of economic policy interventions in inducing healthier food consumption behavior will be much more limited than what is expected under the conventional premise of symmetric patterns of demand response. This may warrant that public policy officials lower their level of expectations regarding the effectiveness of so-called sin tax initiatives in curbing demand for unhealthy food.”