Nutrition, Health, and Diet Related Disease

America’s obesity epidemic was the topic of discussion at the September 27 Edible Education: The Rise and Future of the Food Movement session at UC Berkeley. Dr. Robert Lustig, a neuroendocrinologist who studies childhood obesity at the University of California at San Francisco, spoke along with Patricia Crawford, a UC Berkeley professor who has traced the rise of the obesity epidemic and studies healthy food in schools.

Obesity Growth in U.S.
The most startling information came from Patricia Crawford who showed the rise in obesity in the U.S. over the past twenty years through a series of maps. In 1991 there was less than ten percent obesity in most state populations. But we gradually watched the map of the entire country get washed over in bright red, the color indicating the highest rates of obesity. Crawford says, "We need to create healthier food and activity environments to reduce obesity." She’s been working in the school system to figure out how to achieve these goals. Crawford has found that even Berkeley kids, who live in a healthy food mecca, share similar eating patterns to kids in the rest of the state. Crawford listed four activities that can help to control the obesity epidemic:

• Reduce sweet beverage intake
• Reduce fast food intake
• Control portion size
• Reduce time on the computer or tv

Crawford is working in policy development to reduce obesity by trying to get high calorie snacks out of schools and advocating for zoning policies on fast food restaurants near schools. Following Crawford's obesity maps were the equally startling comments on the toxicity of sugar by Dr. Robert Lustig.

Big Sugar's Nemesis

Robert Lustig’s bracing argument in a recent New York Times magazine article on the dangers of sugar convinced me to quit my own habit. Something about his explanation of the biochemistry of sugar resonates. He explains how sugar can be toxic because of the way it breaks down and overwhelms your liver. Lustig blames sugar for the skyrocketing obesity rates in the U.S. "A type of sugar called fructose is the cause of the current epidemic," says Lustig. “Our entire food supply has been adulterated with the addition of fructose for palatability and removal of fiber for shelf life." Lustig explains how so-called healthy snacks, like low fat yogurt, can be full of sugar. According to Lustig, sugar is even added to hamburger buns and hamburger meat. He ran through several decades of food policy to explain why sugar has become an additive but the main point Lustig makes is that there has been a lot of attention on fat but fat consumption has gone down in the U.S. while our sugar and refined carbohydrate intake has gone up.

Eat Your Fruit Don’t Drink It

Even if you skip the Milky Way and go for something healthier like an orange, you still have to watch out. That orange is much healthier if you don’t juice it. Says Lustig, “A good part of the fruit is fiber but when you juice a fruit you destroy the insoluble fiber. You need it to limit the rate of carbohydrate and fat absorption into the blood stream which gives your liver a chance to catch up. Fruit is good. Juice is bad and smoothies suck.”

Sugar has been linked to not only obesity but other chronic health problems like heart disease, cancer and memory loss. Lustig says the obesity epidemic is responsible for a 65-billion dollar decrease in work productivity and a 50-percent increase in health insurance premiums. Lustig left the audience with a question to ponder: “Can our toxic environment be changed without government or societal intervention especially when there are addictive substances involved? For Lustig the answer may be regulating sugar just like we do with alcohol and cigarettes.

View the video of the entire class:

The 13 week course, which is funded by the Chez Panisse Foundation in collaboration with West Oakland’s People’s Grocery, makes tickets available each Wednesday to the public.

UCSF professor Robert Lustig became an Internet video sensation when he spoke out about the evils of sugar in a post that went viral on YouTube. He was also recently featured in a New York Times Magazine cover story, "Is Sugar Toxic?" Lustig joins Forum in the studio to discuss sugar's role in diabetes, obesity and related diseases.

Original Broadcast: Thu, Apr 21, 2011 -- 10:00 AM

Host: Michael Krasny

Guest:
Robert Lustig, professor of pediatrics in the Division of Endocrinology and director of the Weight Assessment for Teen and Child Health (WATCH) Program at the UCSF Medical Center

Robert H. Lustig, MD, UCSF Professor of Pediatrics in the Division of Endocrinology, explores the damage caused by sugary foods. He argues that fructose (too much) and fiber (not enough) appear to be cornerstones of the obesity epidemic through their effects on insulin.

Related Article:
Is Sugar Toxic? (NYTimes)

After a summer of hearing about death panels and tea baggers, it's nice to finally see the discussion on health care reform turn to nutritious eating and exercise. What's interesting to this arugula-eating liberal, however, is that this conversation has started on the conservative side of the table. After President Obama's speech on health care last week, Rep. Charles Boustany, R-La., a cardiovascular surgeon, gave the GOP response. While supplying the nation with his rebuttal to President Obama's speech, he mentioned what I found to be a very interesting plea to include a sense of personal responsibility for one's health into the dialogue. According to Representative Boustany, "... insurers should be able to offer incentives for wellness care and prevention. That's something particularly important to me. I operated on too many people who could have avoided surgery if they'd made simply -- simply made healthier choices earlier in life."

This portion of the speech really surprised me. At face value, it makes sense that people should take responsibility for their own health and for insurers to offer incentives for healthy behavior. Yet eating well is more complex than deciding to have grilled vegetables for dinner instead of a double cheeseburger, particularly for those who are poor and without time and resources. It's no secret that unhealthy foods are simply cheaper and more prevalent than whole grains, fresh vegetables, and unprocessed meats. Think of McDonalds' popular dollar meals. Cheap meals are often the only food available for many Americans, and actual food choices are often nonexistent for people on constrained budgets.

Interestingly, the Centers for Disease Control and Prevention (CDC) recently released an obesity map of America. It's a depressing bit of data, but here you go:

CDC's Obesity Trends, which includes a breakdown of state by state percentages

It's disheartening to see that the obese population in numerous states is over 30%, with other states close behind. Yet, although I appreciate Mr. Boustany's commitment to healthy choices, I don't think providing "incentives for wellness care and prevention" is realistic without first implementing legislation to make healthier foods accessible to everyone -- rich, middle class and poor. For instance, both Republicans and Democrats have traditionally supported some serious corn and soy subsidies in the farm bill, making cheap corn and soy-based products pervasive in the American food system. Many nutritionists, doctors, and health professionals believe the prevalence of corn and soy in our diet has lead to those skyrocketing obesity rates in America. It doesn't seem fair to tell people they need to make "healthier choices earlier in life" without first changing the farm subsidy program so real food choices emerge. How about instead creating incentives for farmers to grow more nutritious crops so healthier foods are more affordable?

Another interesting feature of the CDC map is that the highest rates of obesity occur in traditionally conservative strongholds, including Mr. Boustany's home state of Louisiana, which has a 28.3% obesity rate compared to 23.7% for California. Mississippi's rate is a staggering 32.8%. Now I am not trying to claim that Democrats are healthier than Republicans. There are plenty of Republicans who run 10 miles a day and love tofu, and lots of Democrats who fry Snickers bars and drive if they are traveling more than 100 feet. It seems, however, that overall, states that favor conservative candidates are simply fatter (at least according to that pinko institution the CDC) than more liberal-leaning states.

So here's the question: in the name of better health care opportunities for all citizens (or even just those in Mr. Boustany's backyard), will Republicans embrace their own current plea for a healthier general public? Will they put their money where their mouth is and support a farm bill that evens the playing field for small family farms that want to grow something other than corn and soy? In the name of positive health care reform, will our Congressional leaders promote healthier school lunches, more money for food stamp recipients so they can purchase fresh vegetables instead of canned or frozen ones, and provide more money for public transportation options so people can get out of their cars and walk to bus stops, subways, and transit systems instead of driving?

Although I have serious doubts that our food system will be revamped any time soon, I am more hopeful after reading an opinion piece by Michael Pollan in last week's New York Times. In his essay, Mr. Pollan states "Agribusiness dominates the agriculture committees of Congress, and has swatted away most efforts at reform. But what happens when the health insurance industry realizes that our system of farm subsidies makes junk food cheap, and fresh produce dear, and thus contributes to obesity and Type 2 diabetes? It will promptly get involved in the fight over the farm bill — which is to say, the industry will begin buying seats on those agriculture committees and demanding that the next bill be written with the interests of the public health more firmly in mind." I hope he's right.