Popkin feels - Population Reference Bureau

Outline: Why is this occurring?
• Global Patterns and Trends
• How we eat : start with diet quality, quantity
• What We Drink
• How We Move
• The World is Flat and Fat: globalization has
occurred for centuries
• How do we proceed
“Over 1.3 billion people in the world are overweight”
Figure 1. Stages of the Nutrition Transition
Urbanization, economic growth, technological changes for work, leisure,
& food processing, mass media growth
Pattern 1
Paleolithic man/
Hunter-gathers
• Wild plants &
animals
• water
• Labor intensive
Lean & robust,
high disease
rate
Low fertility,
low life expectancy
Pattern 2
Settlements begin/
Monoculture period/
Famine emerges
• Cereals
dominate
• water
• Labor-intensive
Nutritional
deficiencies
emerge, stature
declines
High fertility,
high MCH mortality,
low life expectancy
Source: Popkin 2002 revised 2006.
Pattern 3
Industrialization/
Receding Famine
Pattern 4
Noncommunicable
Disease
• Starchy, low variety,
low fat, high fiber
• water
• Labor-intensive
work job/home
• Increased fat, sugar,
processed foods
• caloric beverages
• Shift in technology
of work and leisure
• Reduced fat, increased
fruit, veg, CHO, fiber
• Increase water, Reduce
caloric beverage intake
• Replace sedentarianism
w/ purposeful activity
MCH deficiencies,
weaning disease,
stunting
Obesity emerges,
bone density problems
Reduced body fatness,
improved bone health
Accelerated life
expectancy, shift to
increased DR-NCD,
increased disability
period
Extended health aging,
reduced DR-NCD
Slow mortality decline
Pattern 5
Behavioral Change
Stages of the Nutrition Transition
Urbanization, economic growth, technological changes for work, leisure,
& food processing, mass media growth
Pattern 3
Industrialization/Receding Famine
Pattern 4
Noncommunicable Disease
Pattern 5
Behavioral Change
• starchy, low variety,
low fat,high fiber
• water
• labor-intensive work
at job and home
• increased fat, sugar,
processed foods
• Caloric beverages
• shift in technology of
work at job & home
MCH deficiencies,
weaning disease,
stunting
obesity emerges,
bone density problems
reduced body fatness,
improved bone health
Slow mortality decline
accelerated life expectancy,
shift to increased NR-NCD,
increased disability period
extended health aging,
reduced NR-NCD
• reduced fat, increased
fruit, veg,CHO,fiber
• Increase water, Reduce
caloric beverage intake
• Replace sedentarianism
w/ purposeful activity
Source: Popkin (2002). Pub. Health Nutr 5:93-103.
Over the last 20 years in the lower and middle
income transitional world and the past 60-150
years for the higher income world
• BMI distribution: major shift upwards
• Foods, beverages consumed change to
processed ones almost completely in many
subpopulations
• Modern global food industry becomes
dominant
• Modern technology at home and in the
economic marketplace, travel, leisure
becomes globally available
• Globalization of modern mass communication
“Over 1.3 billion people in the world are overweight”
High Income vs. Transitional and
Low Income Countries
• Trend toward a higher BMI in higher income
countries reaches back a century but major
increase seen in the mid 80’s to the present.
• In contrast, minimal obesity in most of
developing and transitional world until the last
20-30 years with very large, rapid shifts
upwards in the past 20 years.
• Now at a point where the world is fat and the
dynamics are leading our dietary and activity
patterns and obesity patterns toward some
type of convergence, at least for the present!
“Over 1.3 billion people in the world are overweight”
Prevalence Trends of Overweight in Danish Children:
Obesity Increases Gradually
Bua J, Olsen LW, Sorensen T. Obesity 2007 15(4):977-985.
.1
BMI Distribution Shifts among Mexican women 18-49 y
(National Surveys 1988, 1999 y 2006)
1988
.02
.04
.06
2006
0
Kdensity BMI
.08
1999
10
15
20
25
30
35
40
BMI (Kg/m2)
From Juan Rivera
45
50
55
60
65
Overweight more than tripled among Chinese men and doubled among
women. The 11-Year Change in the BMI Distribution for a CrossSection of Chinese Adults 20-45.
Percent
20
18
1989 cross-section (n=4978)
16
1997 cross-section (n=4639)
14
2000 cross-section (n=4679)
12
2004 cross-section (n=4166)
10
8
6
4
2
0
15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38
Body Mass Index
Source: Bell et al, Int’l Jour. Obes 2001.25:1-8
Patterns Of Overweight & Obesity Globally For Nationally Representative Samples
(Percentage overweight + Obese)
<10%
10-20%
21-30%
31-40%
41-50%
>51%
Arctic Ocean
Arctic Ocean
North Pacific Ocean
Indian Ocean
South Pacific Ocean
South Atlantic Ocean
Source: The World is Fat
(Penguin, Dec 2008)
Annual Absolute Change in the Prevalence of Overweight
and Obesity in 7 Countries from 1985/1995 to 1995/2006
(BMI≥25.0 for adults; IOTF equivalent for children)
2.0
1.9
Annual percentage change
1.7
1.5
1.0
Children
1.3
0.9
Adult Females
1.2
1.1
1.0
1.0
1.0
0.9
0.8
0.7
1.0
0.9
0.8
0.6
0.5
0.5
Adult Males
0.5
0.5
0.4
0.3
0.4
0.1
0.0
0.1
0.1
-0.02
-0.5
Australia
U.K.
U.S.A.
Brazil
Russia
China
Indonesia
Vietnam
Mexico
Popkin (2007) nature reviews, cancer 7:61
Annual Absolute Change in the Prevalence of
Overweight in 2 Countries in Two Successive Periods
1.2
Annual percentage change
1.0
Children
1
Adults
0.8
0.8
0.7
0.6
0.7
0.6
0.6
0.6
0.4
0.3
0.2
0
Brazil 1975-89
Brazil 1989-1997
USA 1978-91
USA 1991-2001
Popkin et al(2006) Obesity 14: 1846-1853
The Shifting of Obesity Toward the
Poorest Women In Southeast Brasil
30
Percentage
25
20
25% Poorest
25%
25%
25% Richest
16.5
14.8
15
10.3
10
6.6
8.0
11.6
13.2
15.0
12.1 13.2
9.1
8.2
5
0
1975
1989
1997
Source: Monteiro, Conde and Popkin 2002 - Pub Health Nut 5(1A): 105-112
The burden of disease is shifting
rapidly towards the poor.
• By burden, we refer to the greater prevalence
of poor diets, sedentarianism, obesity, NRNCD’s among the poor
• Evidence from Brazil points to a clear shift in
obesity and other risk factors.
• Studies on the shifts in diet among various
income groups in China point towards a
similar shift occurring there in 10-15 years
• These relationships replicated across many
countries in smaller studies.
“Over 1.3 billion people in the world are overweight”
Multilevel Study: Gross National Product,
Household SES and Obesity Across 37 Countries
• Probability of obesity as a function of individual SES,
the country’s per capita GDP and an interaction term
between household SES and per capita GDP from a
multilevel logistic model
• National wealth and individual SES as joint
predictors of obesity: a study on 148,579 women
from 37 developing countries
• Monteiro,. Conde, Lu, and Popkin (2004). Obesity
and inequities in health in the developing world. IJO
28:1181-1186 [women] and a review: 2004 Bull
WHO 82: 940-46 ( added men)
“Over 1.3 billion people in the world are overweight”
Predicted Prevalence (%) of Women’s Obesity
in Extreme SES at Different Country’s GNP
40
25% lower SES
25% higher SES
Percentage
30
20
10
0
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
GNP (US$ per capita)
Source: Monteiro et al. IJO (2004 ) 28:1181
and Bulletin WHO (2004) 82:940-46.
Dietary Quality issues may be
better understood than quantity
• Transfats – very often removing transfats is
viewed as a way to address obesity which it is
not the case. Actually shifting to other fats might
actually slightly increase the energy density of
many processed foods.
• Fruits and vegetables – unclear affects on
obesity. The idea that these low energy dense
foods are the answer is yet to be clearly shown.
“Over 1.3 billion people in the world are overweight”
The transfat story: one of the more studied. Transfats have a
threefold greater impact than other saturated fats on CHD.
1%E
2%E
3%E
4%E
5%E
100
% Change in CHD
80
Trans
60
40
20
Sat
0
-20
-40
Mono
Poly
Hu et al, NEJM 1997: 337
Slide provided by Walt Willett
9.131
What drives caloric increases and
leads to added energy imbalance?
• Energy density: minimal long-term research
• Food components: unclear except for few 12 mo.
long-term diet studies that show high protein, high
fat, or high complex CHO can work if calories are
reduced.
• Reasonable clarity on caloric beverage effect but
no clear sense about the mechanisms
• But what is driving dietary change and keeping
calories higher: that is much clearer
“Over 1.3 billion people in the world are overweight”
Sources of Major Global
Dietary Shifts
• Increased intake of caloric sweeteners
• Edible oil increases in most of the lower and
middle income economies
• Increased animal source foods
• Increased intake of processed foods, refined
carbohydrates
• Reduce intake of fruits and vegetables and
legumes
• Reduced preparation time, increased intake of
pre-cooked foods
“Over 1.3 billion people in the world are overweight”
From Traditional to Modern Meals
From Traditional to Modern Snacking
From Traditional to Modern.....
Marketing of Food
Major Global Dietary Shifts
• Edible oil increases in most of the developing
and transitional economies
“Over 1.3 billion people in the world are overweight”
Relationship Between the Proportion of Energy from Each Food Source
and Gross National Product Per Capita with the Proportion of the
Population Residing in Urban Areas Placed at 25%, 1990
Annual per capita
national income
(in constant 1993
US $s)
Source: Food balance data from the FAOUN; GNP data from the World Bank; regression work by UNC-CH
Drewnowski & Popkin (1997) Nutr Rev 55:31
Relationship Between the Proportion of Energy from Each Food Source
and Gross National Product Per Capita with the Proportion of the
Population Residing in Urban Areas Placed at 75%, 1990
Annual per capita
national income
(in constant 1993
US $s)
Source: Food balance data from the FAOUN; GNP data from the World Bank; regression work by UNC-CH
Drewnowski & Popkin (1997) Nutr Rev 55:31
Edible Oil Consumption Still Rising in China
(grams per day per capita)
Year
1989
1997
2006
Poorest (lowest income tertile)
11.8
26.5
30.8
15
29.7
30.9
Richest (highest income tertile)
17.4
31.3
30.9
Average for total adult population
14.8
28.9
30.9
% of all calories per capita from edible
oil
4.9
11.2
12.4
Middle income tertile
Source: China Health and Nutrition Survey for adults aged 20-45
The Effect of Income Changes on
Total Fat Intake in China
•
•
For every 10% increase in income, intake of
the proportion of energy from fat is increasing
greater among the poor than the rich in
China. Most importantly there are significant
changes found in all income groups
Source: Du et al, SSM 59:1505-1515;Popkin
and Du (2003) J Nutr. 133:3898S-3906S. &
Guo, Mroz, Popkin (2000). Econ Dev Cul
Chg 48:737-760
“Over 1.3 billion people in the world are overweight”
The Relationships Between Income Changes and the Proportion of
Energy from Fat Consumed: Income Elasticity and the Change in the
Income Elasticity Between 1989 and 1997 in China
A. 1989
B. 1997
0.4
0.3
0.2
95% Confidence
Interval
0.1
0
-0.1
95% Confidence
Interval
-0.2
5.58 5.98 6.38 6.78 7.18 7.58 7.98 8.38
Income per capita (log)
Elasticity change
Elasticity change
0.4
0.3
95% Confidence
Interval
0.2
0.1
95% Confidence
Interval
0
-0.1
-0.2
5.58 5.98 6.38 6.78 7.18 7.58 7.98 8.38
Income per capita (log)
Source: Du et al, SSM 59:150559:1505-1515.
Major Global Dietary Shifts (cont)
• Increased intake of caloric sweeteners,
predominantly from beverages but also small
amounts in thousands of processed foods
• Causes of global beverage intake: varied.
Certainly combination increased accessibility,
lower price, & income dynamics, marketing
“Over 1.3 billion people in the world are overweight”
The Relationship Between Changes in
Gross National Product per Capita and Caloric Sweetener
Note: The Major Changes Affect the Lower and Middle Income Countries!
Kcals/capita/day added sugar
500
400
1962
397
2000
402
418
362
287
300
257
203
200
155
131
100
90
0
Lowest
2nd lowest
3rd lowest
4th lowest
highest
GNP/capita groupings of countries in 1962
Source : Popkin and Nielsen (2003) Obesity Res 11
What is driving the increasing
intake of sweeteners
• Shift from food to beverages as source of
sweeteners. 1/3rd to 2/3rds Beverages in US
• Is there habituation to sweeteners that pushes
outward our need for them? Unclear, untested
• Is the intense noncaloric diet sweetener revolution
affecting our needs for total sweetness?
• Many unanswered questions in this area
“Over 1.3 billion people in the world are overweight”
How We Drink
• A vast shift from breast milk and water to a
large variety of caloric beverages
“Over 1.3 billion people in the world are overweight”
Remarkably Short History for Caloric Beverages:
Might the Absence of Compensation Relate to This Historical Evolution?
Earliest possible date
Definite date
US Soda Intake 52/gal/capita
(2004)
Modern Beverage Era
10,000 BCE - present
Pre-Homo Sapiens
200,000BCE - 10,000 BCE
Origin of Humans
US Coffee Intake 46 gal/capita
(1946)
Juice Concentrates (1945)
US Milk Intake 45 gal/capita
(1945)
Coca Cola (1886)
Pasteurization (1860-64)
Carbonation (1760-70)
Liquor (1700-1800)
Lemonade (1500-1600)
Coffee (1300-1500)
Brandy Distilled (1000-1500)
Tea (500 BCE)
100000 BCE
10000 BCE
200000 BCE
Homo Sapiens
200000 BCE
Beginning
of Time
Water, Breast Milk
Beer (4000 BCE)
2000 BCE
0
AD
Milk (9000 BCE)
Wine (5400 BCE)
BCE
Wine, Beer, Juice
(8000 BCE)
(206 AD)
Caloric Beverages and Weight Gain
• Studies of appetitive sensations (e.g. hunger,
fullness, prospective consumption) support
the view that fluids are less satiating than
solid foods
• Dietary compensation over shorter, longer
periods. Beverages by macronutrient
composition have same effect. Minimal food
calorie reduction is found
“Over 1.3 billion people in the world are overweight”
Daily Beverage Consumption Trends of Mexican Children, 1999-2006
Sodas
Sweetened Juice Drinks
Whole Milk
Other
400
Calories per capita (kcal)
343
300
200
16
190
165
226
17
100
0
45
297
24
26
110
116
37
8
1999
19
2006
Children aged 1-4
158
86
17
38
55
1999
2006
Children aged 5-11
Note: Sweetened juice drinks include 100% fruit juice with sugar added and agua fresca[water, juice, sugar).
Sodas include carbonated and noncarbonated sugar bottled beverages.
Source: Barquera et al, 2008
Beverage Consumption Trends of Mexican Adolescents
and Adult Women, 1999 and 2006
High sugar
High calorie low benefit
Low calories
400
350
Kcal per day
366
349
7
4
109
300
120
250
200
150
154
145
7
12
47
225
100
50
250
52
100
81
0
1999
2006
1999
2006
Year
12-18 years of age
19-49 years of age
Note High sugar is composed of mainly soft drinks, sweetened juices, agua frescas and alcohol.
High calorie and low benefit is mainly whole milk. Low calories are slightly sweetened coffee and skim milk
Source: Barquera et al, J of Nutrition (in press for 2009)
Calories from beverages per day
Per Capita Change in Calories from Beverages
Between 1965 and 2002 among US adults
500
Unsweetened Coffee & Tea
Low Fat Milk
Diet
Juices
Whole Fat Milk
Alcohol
Soda/Fruit Drinks
Other Caloric Beverages
451
22
400
359
17
284
300
14
54
234
200
3
47
26
100
119
0
1.30
21
11 6
1965
117
41
102
99
127
70
36
14
10
41
57
0.30
180
1977
11
0.50
40
25
4
1989
1.30
11
2002
Duffey & Popkin (2007)Obesity 15: 2739
Little Change in Water Intake, Major Increase in US intake of
Calorically-Sweetened Beverages among US adults
Water
Unsweet Coffee & Tea
Low Fat Milk
Diet
Nutrients
Caloric
120
101.5
Ounces per day
100
18.5
79.7
80
11.6
60
1.0
13.9
1.7
15.3
4.6
2.3
15.2
8.1
40
20
43.4
45.6
1989
2002
0
*To convert ounces to grams, divide by 0.035 and to convert fluid ounces to milliliters multiply by 29.57.
Duffey & Popkin (2007) Obesity 15: 2739
So what about noncaloric beverages?
• Water research: very limited. Some studies
beginning to suggest important direct calorie
replacement and possibly added effects of water
on energy intake, weight and metabolic
functioning.
• Sweetened diet beverages: This is a complex
picture. Our work in process suggests it is the diet
linked with these beverages that determines the
effect and not the diet beverages per se though
there are issues unresolved in the sweetener
world related to intense noncaloric sweeteners
{see Mattes and Popkin, AJCN (2009) 84:}
“Over 1.3 billion people in the world are overweight”
The A To Z Study: The Relationship of Water Intake with
Adjusted Mean Daily Total Energy Intake
Drinking water
Source: Stookey et al, Obesity (2007) 15:3013
The A To Z Study: The Relationship of Water Intake
with Mean Body Weight
Drinking water
Source: Stookey et al, (in press) Obesity
The A To Z Study: The Relationship of Water Intake with
Mean Fasting Plasma Insulin
Drinking water
Source: Stookey et al, manuscript 2008
The A To Z Study: The Relationship of Water Intake with
the Metabolic Syndrome
Drinking water
Source: Stookey et al, manuscript 2008
Major Global Dietary Shifts
• Increased animal source foods
“Over 1.3 billion people in the world are overweight”
Price Policies Are a Great Option:
Price Elasticities of Demand
China
1990
S. Korea
1962-92
Morocco
1969-85
Beef
-1.04
-.49
-1.63
Pork
-.98
-.57
NA
Poultry
-.53
-1.07
-1.26
Fish
-.81
-.34
-.17
AIDS Demand Models Various Sources Cited in Delgado & Courbois 1998
Real World Prices, 1990 US$
500
100 kg Beef
400
300
1 MT Maize
200
100 kg Poultry
100
70-72
80-82
90-92
94-96
2020
AIDS Demand Models Various Sources Cited in Delgado & Courbois 1998
Major Global Dietary Shifts
in Eating behaviors
• Increased consumption of fried foods, snacks
• Reduced preparation time, increased
processed and prepared foods
• Increased eating away from home
“Over 1.3 billion people in the world are overweight”
The Predicted Probability of Snacking Behavior in China,
1991 and 2004
0.3
Probability
0.25
0.24
1991
2004
0.2
0.19
0.15
0.15
0.1
0.1
0.11
0.117
0.15
0.13
0.12
0.11
0.1
0.08
0.05
0
low
Middle
Income
high
Low
Middle
high
Education
Source: CHNS 1991 and 2004; Adjusted for socio-demographic factors Zhihong Wang et al (2008) Asia Pac J Clin
Nutr 17:123
The Predicted Probability of Consuming Excessive Fried Foods in
Chinese Urban Residents, 1991 and 2004
0.6
1991
2004
Probability
0.5
0.3
0.51
0.42
0.4
0.4
0.51
0.49
0.37
0.41
0.39
0.31
0.3
0.39
0.3
0.2
0.1
0
low
Middle
Income
high
Low
Middle
high
Education
Source: CHNS 1991 and 2004; Adjusted for socio-demographic factors Wang et al (2008) Asia Pac J Clin Nutr 17: 123
Note: excessive fried foods represents more than 20% of kcal from fried foods.
The Proportion of Energy Consumed from Foods
Prepared Away from Home among children and adolescents
39.7
40
38.5
34.8
preparation
consumption
Percent
30
24.3
20
15.4
13.1
9.4
10
7.7
0
1977 1996
1994 2002
US
(age 2-18)
Cebu
(age 13-19)
1991
2000
China
(age 2-18)
1994 2003
Russia
(age 2-18)
Source: Adair and Popkin, Obes Res.(2005)13:1281
How We Move
• Shifts in the
composition of
occupations and the
activity within each
occupation
• Shifts in production at
home: new assets,
reduced time in all
activities
• Shifts in the ways
we travel
• Shifts in leisure
“Over 1.3 billion people in the world are overweight”
From Traditional to
Modern Household Production
From Traditional to Modern
Economic Work at Home
From Traditional to Modern Market Work
From Traditional to Modern Leisure
From Traditional to Modern.....
Transportation
Urbanized Countries have most of the Labor Force in Service Industries
(Simulations Assuming 75% of the Population Living in Urban Areas)
90
80
Service
70
Income
60
50
40
30
Manufacturing
20
10
0
Agriculture
-10
1965
1970
1975
1980
1985
1990
Year
Source: Popkin, B.M. (1999) “Urbanization, Lifestyle Changes and the Nutrition Transition”.
World Development 27.
Chinese Adults in the Same Occupations Use Much Less Energy:
the Physical Activity Profiles of Urban Chinese Adults Aged 20-45,
1989 and 2006
80.0
70.1
1989
62.6
1997
2006
Percent
60.0
45.5
40.0
41.0
27.7
24.3
20.0
13.5
9.7
5.7
0.0
Light
Moderate
Heavy
Physical Activity
Source: Du Lu, Zhai, Popkin. (2002) Pub H Nutr 5:169-174.
Shift In MET Hours per Week by Activity
Among Chinese Men (18-55 Years Old)
500
Leisure activity
Travel activity
Domestic activity
Occupational activity
MET hours per week
450
400
350
300
250
200
0
1991
1993
1997
1997
Year
Source: Ng and Popkin, manuscript
2000
2004
2006
Shift In MET Hours per Week by Activity
Among Chinese Women (18-55 Years Old)
500
Leisure activity
Travel activity
Domestic activity
Occupational activity
MET hours per week
450
400
350
300
250
200
0
1991
1993
1997
Source:Ng & Popkin, manuscript
1997
Year
2000
2004
2006
Color TV Ownership Has Skyrocketed in China, 1989-2006
(% Who Own TV Sets among Families with Children from CHNS)
100
92.4
98.0
% of households with TV's
83.8
80
75.5
60
53.4
37.7
40
28.1
20
15.0
5.2
0
1989
1997
Low Income
Medium Income
2006
High Income
Source: Du Lu, Zhai, Popkin. (2002) Pub H Nutr 5:169-174.
Odds of Becoming Overweight/obese According to
Household Vehicle Acquisition: 1989 to 1997
2.5
Odds ratio
2.0
Men (n=779)
Women (n=897)
2.16
1.5
1.0
0.5
0.9
0.91
0.46
0.0
Gained non-motorized vehicle
Source: Bell et al (2002) Obesity Research 10:277_283.
Gained motorized vehicle
No change in vehicle ownership was the referent category. Adjusted
for baseline age, weight, education, urban residence and change in
work-related activity, energy intake, smoking status,alcohol
consumption, income, and television ownership. Those who were
obese in 1989 were excluded.
The World is Flat and Fat:
Globalization has Occurred for Centuries
• Naïve idea that globalization is a phenomena
of the past few decades
• Consider how Columbus et al introduced from
the Americas to the cuisines of the world: Chili
peppers in Asia, Potatoes in Europe, and
tomatoes in Italy are examples. Or noodles
from Asia to Italy.
• Recent rapid acceleration in areas such as
communications technology, transportation
systems, distribution technologies affect how
we eat, move, drink. Think of red bull’s
impact globally in 5 years vs coke in 70 years.
“Over 1.3 billion people in the world are overweight”
How do we proceed?
• Clearly action needed at all levels; however I
believe the only way to produce concerted
change is to look to the models of tobacco
use, seat belt, other major public health
changes
• Regulations, taxation, mass education are key
components
• Examples: Mexico Beverage campaign, US
Farm Bill, Brazil and Singapore schools
“Over 1.3 billion people in the world are overweight”
Edible Oil Control in China is Just One
Example: Must be Country-Specific
• Edible Oil prices likely to continue falling due
to international trade
• Impact is greater for the poor
• Greater disparities in health by income groups
• Regulate composition of edible oils (improve
quality)
• Taxes on edible oils
(regardless of imported or domestic)
• Encourage steamed/broiled/braised foods
“Over 1.3 billion people in the world are overweight”
The Effects of Changes in the Price of Edible Oil in China
A. Change in the Proportion of Energy Due to
a 10% Increase in Real Price of Edible Oils
0.3%
0.2%
2.0%
0.31% 0.31% 0.32%
0.13% 0.08%
Elasticity (% change in demand due to
10% increase in real price of edible oil)
Change in the% of energy from macronutrients
from a 10% increase in the price of edible oil
0.4%
B. Demand Elasticity for Macronutrients
0.15%
0.1%
0.0%
-0.1%
-0.2%
-0.3%
-0.4%
-0.40%
-0.45%
-0.48%
-0.5%
1.5%
1.0%
1.15%
1.34%
0.76%
0.50%
0.5%
0.68%
0.42%
0.0%
-0.5%
-1.0%
-1.5%
-1.23%
-2.0%
-2.5%
-3.0%
-2.33%
-2.84%
-3.5%
-0.6%
%energy from
protein
%energy from
fat
% energy from % energy from % energy from
protein
fat
carbs
%energy from
carbs
Total
Rich
Poor
Source: China Health and Nutrition Surveys
Mexico Initiative on Beverages
• Remove all whole milk, shifted now to 1.5%
and later to skim milk all gov’t programs
• Schools: working to ban all sugar sweetened
beverages, provide safe water, allow water,
low fat milk to be sold
• Taxation being considered: tax added sugars
in beverages per gram, fat in milk
• National media effort—began Feb 25 with
launch of Mex. Beverage Guidelines
• Source:Rivera et al, Salud Publica Mex
2008;50:173-195.
“Over 1.3 billion people in the world are overweight”
Effects of Price Changes on Whole Milk
and Soft Drink consumption in Mexico
Change in consumption (ml/day)
Overall
0.04
Soda
0
2.79
2.83
Whole Milk
-10
-20
-30
-40
-60
Rich
10% increase in soda price
10
-50
Poor
-48.22
-49.33
-46.56
Program and policy effectiveness:
Are we ready for preventive action?
Major research gaps exist.
• Macroeconomic options: price changes matter,
governments subsidize wrong foods now
• Regulations: TV advertising, other advertising,
edible oil contents, school meals, school PE, etc
• Reprints (pdf files) and citations can be found on
www.nutrans.org. New book The World Is
Fat (Penguin Press) forthcoming Dec. 2008
“Over 1.3 billion people in the world are overweight”
Policy Actions – Next Steps
• Beverages–regulate, restrict, tax, discourage
all sugary beverages, fruit juices, saturated fat
in milk
• Labeling–simple new options in US, other
countries. Calories, servings, and star or
check if this is deemed by scientists in the
country a healthy choice–new horizons
• Look at refined carbohydrates, sugars and
find more targets
• Work on portion size pricing, ways to
discourage larger portions.
“Over 1.3 billion people in the world are overweight”