(GraphiChris/Flickr)

A new study found “no strong evidence” that being within walking distance to food outlets was associated with being obese or not.

Researchers at UCLA and the Rand Corporation analyzed data from the California Health Interview Survey — nearly 100,000 people were included — and published their findings in Preventing Chronic Disease.

The L.A. Times picks up the story:

Given the attention to the idea of food deserts – areas with limited access to healthful food – and their effect on people’s health, the researchers wanted to find how much it mattered to have stores and restaurants within walking distance, which they defined as a mile from home.

But the number of fast-food outlets within three miles of home was associated with eating more fast food, fried potatoes and caloric soft drinks, and with less frequent consumption of produce, the researchers said. And they found that the number of large supermarkets within 1.5 miles and three miles of home was associated with drinking fewer caloric soft drinks.

They said “shopping patterns are weakly related, if at all, to neighborhoods in the United States because of access to motorized transportation.” …

“Evidence is more tentative than often presented in the news media and in policy arguments” linking obesity with the food environment, the researchers said. That is, the idea that people who live close to lots of fast-food outlets and far from big, well-stocked supermarkets are more likely to be overweight or obese, or to show other health results of poor eating habits.

“The evidence is not clear on whether promoting or discouraging a particular type of food outlet is an effective approach to promoting healthful dietary behavior and weight status,” the researchers said. Los Angeles has tried legislating the types of food outlets in South L.A. to help bring down obesity rates.

(La Piazza Pizzeria/Flickr)

Just over three months since voters in two California cities — Richmond and El Monte — flatly turned down soda taxes, a new Field Poll released Thursday found a majority of California voters say they would support a soda tax if the funds raised were devoted to children’s health.

While only 40 percent of voters said they favor a sugar-sweetened beverage tax, that number jumped to 68 percent if the proceeds will benefit school nutrition and physical activity programs.

“Voters in general don’t trust taxes that aren’t earmarked. They prefer to see taxes linked to something beneficial,” said Dr. Tony Iton, senior vice president of The California Endowment, which sponsored the poll. ”People that are engaged in constructing policy … should take heart in this poll and be able to look to it to construct subsequent measures for trying to engage the public support behind obesity prevention.”

“I think this poll shows that a campaign either statewide or locally in cities has an excellent chance,” Wendel Brunner, Contra Costa County’s director of public health, told the San Jose Mercury News.

But in the poll voters had the highest support — more than 80 percent — for increasing opportunities for being physically active, such as improved school sports fields and playgrounds — and keeping those facilities open after school and on weekends.

Chuck Finnie, with the American Beverage Association, pointed out that soda taxes have failed recently, not just in California, but, he says, in other places across the country. “Poll after poll shows Americans don’t believe taxing sweetened beverages is the way to reduce obesity,” Finnie said in a statement. “If we want to get serious about obesity, education — not taxes and regulation — is the right approach.”

Still, fully 75 percent of voters said they see a link between regular soda consumption and a person’s risk of being overweight or obese. But they don’t see the same risk from so-called energy drinks or sports drinks, and Iton finds that troubling.

“It’s heartening to see that soda consumption rates are beginning to dip,” he said, “but the concern is that people may be substituting with sports drinks, substituting with energy drinks, and those products have — in many cases — as much sugar in them. We’re concerned that those not be substituted for sodas.”

Californians were also highly supportive (85 percent) of having fresh, clean drinking water available in schools and other public places, such as parks. Availability of clean drinking water can be a significant challenge in some areas, especially rural school districts in the Central Valley. Many homes and buildings rely on well water, which can be contaminated with nitrites and nitrates from pesticide run-off, as well as naturally contaminated with arsenic.

Kids in school are “forced to either drink bottled water, which is expensive,” Iton says, “or to substitute fluids, using things like sodas.”

The California Endowment and the Field Poll have been tracking public awareness about sugar-sweetened beverages and obesity for three years. Iton says support for policies to “improve the environment” has been increasing.

These results dovetail with a recent Public Health Institute poll of rural California counties. In that survey, 94 percent of respondents said that obesity was a serious problem for the country, and 84 percent said it was a problem in their own communities.

(Justin Sullivan/Getty Images)

I don’t cover a lot of dieting stories here on State of Health. I figure you get enough of that elsewhere. For example, here are 88 million places I found by Googling “How can I lose 10 pounds?”

But I love evidence-based medicine. So when a group of respected researchers shatter widely-held beliefs about weight loss, I’m there. In Thursday’s New England Journal of Medicine, a group of researchers does just that.

In the review, the researchers categorized as myths those “beliefs held to be true despite substantial refuting evidence.” In other words, people have been repeating these ideas for so long, everyone thinks they’re true. But they’re not.

So, here we go:

Myth #1: Small changes — eating less or exercising more — done over time will yield large weight loss.  This myth comes from the idea that a pound is equal to 3,500 calories. But the short-term studies that looked at burning 3,500 calories to lose one pound were done 50 years ago. More recent research shows that individuals will burn calories differently as they lose weight. So the 100 calories you’re burning in exercise today will affect your body differently than the 100 calories you burned, say 18 months ago, when you started these small changes. Note that it’s not to say that exercising more — or eating less — is pointless (you will see why later in this post).

Myth #2: If you lose a lot of weight really fast, you’ll just gain it back really fast; you’ll have better long-term results if you lose weight slowly. When researchers actually looked at the studies, they found “no significant difference” between the two approaches in relation to long-term weight loss.

Myth #3: Physical-education classes, in their current form, play an important role in reducing or preventing childhood obesity. As a parent, I found this to be somewhat depressing, although the writers did include a caveat: “There is almost certainly a level of physical activity … that would be effective in reducing or preventing obesity. Whether that level is plausibly achievable in conventional school settings is unknown, although the dose-response relationship between physical activity and weight warrants investigation in clinical trials.”

Myth #4: Breast-feeding protects against obesity. Say it ain’t so! No less than the esteemed World Health Organization reported that breast-feeding is protective against obesity. But our myth busters found evidence of “publication bias” in the WHO research. Furthermore, the myth busters report a study of 13,000 children that found “no compelling evidence of an effect of breast-feeding on obesity.” They do stress that breast-feeding has other benefits for both infant and mother “and should therefore be encouraged.”

Myth #5: You burn 100 to 300 calories by having sex. The myth busters start with a premise that some people may find troubling: “Given that the average bout of sexual activity lasts about six minutes,” the myth busters say, “a man in his early-to-mid-30s might expend approximately 21 (calories) during sexual intercourse.” But it gets even better: “Of course, he would have spent roughly one third that amount of energy just watching television.”

The myth busters also highlight presumptions, “widely accepted beliefs that have neither been proved nor disproved.” They call for gathering solid evidence so these presumptions can be proved or disproved.

At present, there is no evidence to support these ideas:

• Regularly eating breakfast is protective against obesity.
• Eating more fruits and vegetables will result in weight loss or less weight gain, regardless of whether any other changes to one’s behavior or environment are made.
• Weight-cycling is associated with increased mortality. It’s likely that any observations that lead to this conclusion are confounded by a person’s health status.
• Snacking adds to weight gain and obesity. Studies have not consistently found an association.

The myth busters insist they are not nihilistic, and their report includes these facts:

• Exercise, exercise, exercise. “Regardless of body weight or weight loss, an increased level of exercise increases health,” the researchers write.
• Exercise “in a sufficient dose” helps with long-term weight maintenance.
• For overweight children, “parents and the home setting” should be included in any weight loss plan to improve success.

(Tessek: Flickr)

My KQED colleague Mina Kim produced a great piece examining whether higher soda prices leads to weight loss — and the health benefits that come with it. She profiled a 17-year-old football player from Tracy — Jorge Cota, who at 5’11″ weighed 321 pounds. He had high blood pressure and may have had heart and kidney problems. That was a year ago.

While Cota since has made many diet changes, the first thing he did was cut out his drink of choice, Dr. Pepper. He had been drinking two or three cans or bottles a day.

He’s since lost 70 pounds, Kim reports.

Still, Cota told Kim that he doubts a penny-per-ounce soda tax would make a difference in soda consumption. After all, a 20-ounce soda would go up only 20 cents.

Kim turned to Kelly Brownell, head of the Rudd Center for Food Policy and Obesity at Yale. As she reports:

His group has studied how pricing changes affect consumer behavior.

“The penny-per-ounce, which is the level of tax being discussed the most around the country, is enough to affect consumption, somewhere between 10 or 20 percent or so,” Brownell says. “[That] would be enough to not make it a terrible burden on consumers, but would affect consumption of the product enough to reduce health care costs.”

More importantly, Brownell says, passage of the tax would give a big boost to the national trend away from sugary drinks that’s already begun in school districts and communities where demand for fresh local food is growing.

“When the beverage industry claims that this really won’t affect consumption patterns, then why in the world are they fighting it so hard?” Brownell asks.

As State of Health reported earlier this year, not only does the reduced consumption reduce health care costs, researchers say, it can also save lives. Reduced consumption equals modest weight loss, which reduces risk of diabetes, and over 10 years researchers estimated 26,000 lives would be saved (or “premature deaths” avoided).

Last December, when the Richmond City Council was debating whether to investigate putting a soda tax on the ballot, I talked to Harold Goldstein of the California Center for Public Health Advocacy. As I reported then:

Goldstein cites a study from UC Berkeley Center for Weight and Health which looked at average daily caloric consumption from 1977-2001 and found the average American was eating 278 more calories each day. Almost half of those calories were from sweetened drinks. “The results were mind-blowing,” he said, but added, “I realize in my adult lifetime, the beverage industry has changed dramatically. It used to be one little glass with ice. If you wanted more, you had to pay more. Every restaurant now provides free refills. What comes out of the vending machine has gone from 12 ounces to 20 ounces.”

And all of those ounces come with calories.

People may oppose a soda tax for all kinds of reasons. Indeed Kim closes her piece with discussions from opponents who say it will drive people away from local businesses, that the tax flows into the general fund and is not mandated to be spent on anti-obesity programs (although voters can approve a non-binding measure to direct the money to sports fields and the like), but one thing is certain: sugary beverages are getting the national attention public health advocates have been pushing for.

Rosa Lara talks with Alejandra Nava at La Raza market in Richmond. Lara is a paid organizer for the community coalition against beverage taxes.

Earlier this week, KQED’s Mina Kim looked at the ongoing soda tax campaign in Richmond. In November, voters there will decide whether to impose a penny-an-ounce fee on sweetened drinks. Today, William Harless at California Watch drilled down into newly-released campaign finance disclosures and learned that — not surprisingly — tax opponents are outspending tax supporters.

What might be more surprising is that the margin is 10 to 1. Harless reports that the American Beverage Association, based in Washington and representing Coca Cola, PepsiCo et. al. has spent $150,000 since June. (Note that the City Council voted to put the tax on the ballot on May 15.)

Harless earlier reported that the beverage association is funding the Community Coalition Against Beverage Taxes. To date, that organization has spent an additional $200,000, again according to campaign finance records.

While dramatically outspent, more organizations are also joining the campaign to support the tax. From California Watch:

The California Center for Public Health Advocacy, a nonprofit group with offices in Oakland, Davis and Los Angeles, has spent about $21,600 on polling and focus groups.

Richmond City Council Member Jeff Ritterman, a cardiologist who is leading the campaign for the sweetened-beverage tax, said he believes soda drinkers will start to turn to tap water, saving money and drinking something healthier. He said the American Beverage Association is worried that Richmond will set a trend.

“I think they’re quite aware that if these dominoes begin to fall, a lot more will,” he said, referring to the two California cities, Richmond and El Monte, in Los Angeles County, that are considering penny-per-ounce sweetened-beverage taxes, which would be the first of their kind in the United States.

Ritterman and a handful of Bay Area residents have raised about $10,400 for their own campaign, dubbed Richmond Fit for Life, and have sent out brochures and mailers advocating for the tax, outlining obesity statistics and describing how it and a companion health measure are phrased on the November ballot.

Ritterman believes the tax could raise $3 million annually. A non-binding resolution passed by City Council the same night it voted to put the tax on the ballot recommends that the money be spent on obesity prevention programs. Opponents say they think the money would end up in the general fund.

Jeff Ritterman, Richmond city councilman who is championing the soda tax, on the campaign trail. (Photo: Mina Kim)

On MacDonald Avenue, the city of Richmond’s main drag, Jeff Ritterman is pulling a little red wagon that holds a plastic water cooler jug filled with forty pounds of sugar. Ritterman says that’s the average amount a child in Richmond consumes each year, just from drinking sodas. “The child gets overweight,” he says, “and the arteries of the heart fill up with bad fat. And that’s a real health problem.”

Ritterman is a retired cardiologist who likes to wear his graying hair in a ponytail. He’s also a city councilman and the man behind a November ballot measure that would make Richmond one of the first cities in the nation to impose a penny-per-ounce tax on sodas and other sugar-sweetened drinks.

According to a report from Contra Costa Health Services [PDF], more than half of Richmond’s children are overweight or obese.

At a shopping plaza, Ritterman’s wagon catches the attention of passerby Michael Bracey.

“I know what that sugar will do,” Bracey says. “It’ll swell you up and once you get swole up you going to get like you said, diabetes, high blood pressure or heart failure, you going to have one or the other. That’s what this sugar going to do, so I think it’s a good cause that you fighting right now, yeah, I’m behind it.”

Shopper Raymond Landry disagrees. Holding a tall can of Arizona iced tea, Landry says the tax hurts those who can least afford to pay it. And government, he says, shouldn’t control what he has a right to do.

“I understand it’s an effort to promote health,” Landry says. “But at the same time, it come at the expense of business and there has to be a balance between the two.”

That’s how opponents of the tax are casting this proposal. The tax would be imposed as a business license fee and would require any retailer that sells drinks with added sugar — including energy drinks and sweetened teas — to tally up all ounces sold and write a check to the city.

For weeks, 26-year-old, Richmond native Rosa Lara has been mobilizing local business owners against the measure. City officials project the tax could raise up to 8 million dollars a year to be used for things like more sports fields, nutrition education, and other anti-obesity programs geared at Latino and African American youth. But Lara says most of the people she talks to don’t believe that’s how the money will be spent

“When I approach the people to let them know what’s going on it’s to educate them on how it’s going to affect the businesses and where the money’s going,” Lara says. “The money is going to a general fund. There’s no strings attached to that money.”

Lara says she’s already signed up more than a hundred business owners against the tax. Her anti-tax signs can be found on the windows and shopping aisles of several businesses on 23rd Street, a hub of Latino-owned shops. Lara says business owners worry their customers will go to neighboring cities for cheaper sodas.

At La Raza Market, where cases of soda are stacked counter high, Alejandra Nava, a cashier, says trying to track all ounces sold could mean having to hire another person.

But what makes the outgoing Lara a particularly formidable tax foe is that she has the deep pockets of the American Beverage Association — the trade group that represents Pepsi Co, Coke and others — paying her for her work.

Karen Hanretty is the group’s vice-president of public affairs. “The American Beverage Association always opposes discriminatory taxes on our products,” she says. “We think it is fundamentally unfair to single out any soft drink as a unique contributor to obesity.”

But Harold Goldstein, head of the nonprofit California Center for Public Health Advocacy which supports the Richmond tax, says the real reason the soda industry is invested in the measure’s defeat is to discourage other cities from following suit. Late last month, the Southern California city of El Monte voted to put a soda tax measure — modeled on Richmond’s — on its November ballot. The Palo Alto Daily News reports that officials in San Mateo County are researching the idea of a soda tax for unincorporated areas of the county.

Goldstein draws an interesting parallel to another product, challenged on health issues. ”I think the soda industry is in the long run going to really go the way of the tobacco industry,” he says, “that people are going to begin to see that the soda industry has one thing in mind and that is to protect their profits.”

Back at his council office, Jeff Ritterman says he knows he has a tough fight on his hands but he says he’s determined to do this for the health his community — especially the kids who are so overweight.  ”Everybody loves their children and when we put the issue of children’s health front and center and we let people know what we’re doing then we get people’s support.

Then Ritterman begins working the phones … in his quest for votes this November.

Listen to Mina Kim’s report:

Could a public campaign against obesity help people in the same way anti-smoking campaigns have? (Dave Whelan: Flickr)

Expect to hear a lot about obesity prevention in the coming days. A four-part HBO documentary about the obesity crisis debuts next week. Today, the Centers for Disease Control opened a major conference examining strategies to help Americans with this significant health challenge. At a report released this morning, researchers said obesity prevalence will increase about 33 percent in the next 20 years — climbing from one-third of Americans affected now to a 42 percent rate by 2030.

And believe it or not 42 percent is good news — that’s down from the 50 percent estimated in prior years.

Despite first lady Michelle Obama’s Let’s Move campaign and its greater attention on childhood obesity, many public health leaders are frustrated with slow progress and say more must be done. They call for a different approach, using strategies similar to those used in the anti-tobacco movement. It was only after anti-tobacco advocates embraced community-based activism that smoking rates began to drop from a high of 42 percent in the mid-1960s to just over 19 percent today, they say.

Instead of approaching obesity as a personal issue, it needs to be redefined as a community challenge that calls for collective action and wide-ranging policy changes such as more informative food labels, limits on marketing to children, and taxes on unhealthy products, some public health experts argue.

Kaiser Health News published a lengthy piece examining the strategies and hurdles in adopting such action. State of Health excerpts from the article’s eight points:

Children are central. The vast majority of people who use tobacco take up the habit as teenagers, and one-third of kids who smoke daily will eventually die prematurely of tobacco-related illnesses, according to the Campaign for Tobacco Free Kids.

The health impact of obesity is similar: seriously overweight children are at greater risk of developing a multitude of health problems that can continue through adulthood, including diabetes, liver disease, heart disease, joint problems and asthma, and are more likely to become obese adults, a wide body of research has demonstrated.

Preventing harm to young people is a central goal of both anti-tobacco and anti-obesity campaigns.

Changing social norms is the goal. Dr. Jeffrey Koplan, former head of the CDC and vice president for global health at Emory University in Atlanta, remembers smoking a pipe while writing up patient notes at a prestigious New York hospital in the 1970s. (He gave up the habit more than 30 years ago.)

Today, that would be inconceivable: Smoking rates have been cut by more than half, intolerance of smoking in public places is widespread and anti-smoking policies are in place at hospitals, workplaces, and venues across the country.

Koplan is convinced the same shift in social norms is called for — and achievable — when it comes to childhood obesity. “Our (eating and physical activity) tastes, our preferences and our behaviors are learned and can be changed,” he said. It isn’t going to be easy and it isn’t going to be fast, but “we’re dealing with a population that would like to be thinner and that works in our favor,” he said.

We can’t just say no to food. “Tobacco we can get rid of entirely. … But we have to eat to live and make terms with food as the enemy,” said Dr. David Katz, director of Yale University’s Prevention Research Center.

That makes curbing childhood obesity a much more complicated issue than tobacco use, Katz and other experts agree. The message to kids and their families can’t be “stop, don’t do this,” which is clear and easy to understand. Instead it has to be “make good choices, do this in moderation, set boundaries,” a message that is considerably more difficult to convey.

There is no second-hand smoke equivalent. The American public was alarmed when it learned that the cigarette smoke non-smokers breathed in airplanes, bars and restaurants was dangerous.

“The notion that my behavior as a smoker can have an effect on you and can make you sick was critically important in accelerating people’s intolerance of smoking and their willingness to see the government take action,” said Michael Eriksen, director of the Institute of Public Health at Georgia State University.

There is no equivalent in the fight against obesity. “Your being obese does not affect me in the same direct way,” Eriksen said.

The role of industry is less clear. In the anti-tobacco fight, tobacco companies were painted as an enemy willing to lie and manipulate the American public for the sake of profits. In turn, the demonization of Big Tobacco — made possible by bitterly fought lawsuits and the release of thousands of company documents — cultivated a common sense of threat.

By contrast, public health advocates aren’t willing to turn food and beverage into enemies in the fight against obesity.

“With obesity (as compared to tobacco), there’s a much more nuanced relationship with industry,” said Dr. James S. Marks, director of the health group at the Robert Wood Johnson Foundation. Food and beverage manufacturers, restaurants, and grocery stores all have a vital role to play in making healthier food more widely available, he noted.

“We can’t regulate our way out of this,” said Jeff Levi, executive director of the Trust for America’s Health.  ”We need to work with industry cooperatively to help change consumers’ tastes and habits.”

Others are much less certain that the food and beverage industry can be trusted to be helpful partners.

“Some companies are making huge profits off obesity,” said Stan Dorn, a senior fellow at the Urban Institute, a public policy research center in Washington, D.C., “and I worry that people who are focused on anti-obesity strategies aren’t being tough enough on them.”

Learn More from KQED’s Quest:

(Uwe Hermann: Flickr)

A spoonful of sugar may have helped the medicine go down when Julie Andrews sang the song, but fast forward to the 21st century and sugar isn’t looking so sweet. Today in a provocative commentary in the journal Nature, researchers argue that sugar is so toxic to our bodies, it should be regulated in the same way alcohol and tobacco are.

The three writers, all from UC San Francisco, say that every country that has adopted the Western diet, with its hallmark of highly-processed food, has seen rising rates of obesity and the diseases that go with it, such as heart disease and diabetes. But, in a turn, they argue against blaming obesity itself. “Obesity is not the cause,” they write, “rather, it is a marker for metabolic dysfunction, which is even more prevalent.” Metabolic syndrome leads to diabetes, high blood pressure, heart disease, fatty liver disease and even cancer, they say.

And the culprit, they insist, is sugar, particularly its fructose component. “Fructose, which is the sweet part of sugar,” said co-author Robert Lustig in an interview, “is toxic beyond its caloric equivalent.” People often refer to sugar as “empty calories,” but they are far from that, the writers say. “A growing body of scientific evidence shows that fructose can trigger processes that lead to liver toxicity and a host of other chronic diseases. A little is not a problem, but a lot kills slowly.”

At this point I was getting a sinking feeling. Maybe it’s the way smokers felt when the bad news started coming out about tobacco in the late 50s and early 60s.

Sugar consumption has tripled worldwide in the last 50 years, the writers assert, and they say to combat the myriad health problems we face today, regulation is necessary. Sugar meets four criteria that merit government action. “The first in unavoidability,” Lustig said, “it’s everywhere. The second is toxicity beyond its calories. The third is potential for abuse because it activates the same areas of the brain as alcohol and tobacco creating a cycle of consumption and disease, and the fourth is negative impact on society.” The negative impact on society is largely seen through high health care costs because of the many diseases associated with high sugar consumption.

The authors suggest a combination of taxes on processed foods that contain sugar, and limiting access to children through tighter controls on vending machines in schools, for example. They also recommend promoting healthier foods in government programs for the poor, including the Women, Infants and Children program and Supplemental Nutrition Assistance Program (formerly called Food Stamps).

Not surprisingly, the Sugar Association doesn’t buy much of this. In a statement on their website, the Association says:

… the assertion that a food is less healthy just because it contains sugar is misleading and not science based. Numerous studies have confirmed that sugar makes many healthful foods palatable, which helps contribute to intakes of key vitamins and minerals necessary to maintain good health.

But Lustig views today’s commentary as the “opening salvo” in a long public health discussion. “I don’t expect anything to change anytime soon,” he said. “Nothing in public health changes overnight. It’s not possible to.”

And judging from some of the comments on a CNN story about the issue today, Lustig is right.  Here are just two examples:

• “unbelievable nannyism. But I forgot that this is America, the land of the hopelessly dependent and depressingly irresponsible,”
• “This article should be regulated as total garbage.”

But as the writers close their commentary in Nature, they point to other public health issues: the bans on smoking in public places; the promotion of the designated driver; and airbags in cars. “These simple measures–which have all been on the battleground of American politics–are now taken for granted as essential tools for our public health and wellbeing,” Lustig said. “It’s time to turn our attention to sugar.”

More: The Trouble With Sugar from KQED’s Forum