Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems

To revise 1998 recommendations on childhood obesity, an Expert Committee, comprised of representatives from 15 professional organizations, appointed experienced scientists and clinicians to 3 writing groups to review the literature and recommend approaches to prevention, assessment, and treatment. Because effective strategies remain poorly defined, the writing groups used both available evidence and expert opinion to develop the recommendations. Primary care providers should universally assess children for obesity risk to improve early identification of elevated BMI, medical risks, and unhealthy eating and physical activity habits. Providers can provide obesity prevention messages for most children and suggest weight control interventions for those with excess weight. The writing groups also recommend changing office systems so that they support efforts to address the problem. BMI should be calculated and plotted at least annually, and the classification should be integrated with other information such as growth pattern, familial obesity, and medical risks to assess the child’s obesity risk. For prevention, the recommendations include both specific eating and physical activity behaviors, which are likely to promote maintenance of healthy weight, but also the use of patient-centered counseling techniques such as motivational interviewing, which helps families identify their own motivation for making change. For assessment, the recommendations include methods to screen for current medical conditions and for future risks, and methods to assess diet and physical activity behaviors. For treatment, the recommendations propose 4 stages of obesity care; the first is brief counseling that can be delivered in a health care office, and subsequent stages require more time and resources. The appropriateness of higher stages is influenced by a patient’s age and degree of excess weight. These recommendations recognize the importance of social and environmental change to reduce the obesity epidemic but also identify ways healthcare providers and health care systems can be part of broader efforts.

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Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report

Ten per cent of the world’s school-aged children are estimated to be carrying excess body fat (Fig. 1), with an increased risk for developing chronic disease. Of these overweight children, a quarter are obese, with a significant likelihood of some having multiple risk factors for type 2 diabetes, heart disease and a variety of other co-morbidities before or during early adulthood. The prevalence of overweight is dramatically higher in economically developed regions, but is rising significantly in most parts of the world. In many countries the problem of childhood obesity is worsening at a dramatic rate. Surveys during the 1990s show that in Brazil and the USA, an additional 0.5% of the entire child population became overweight each year. In Canada, Australia and parts of Europe the rates were higher, with an additional 1% of all children becoming overweight each year. The burden upon the health services cannot yet be estimated. Although childhood obesity brings a number of additional problems in its train – hyperinsulinaemia, poor glucose tolerance and a raised risk of type 2 diabetes, hypertension, sleep apnoea, social exclusion and depression – the greatest health problems will be seen in the next generation of adults as the present childhood obesity epidemic passes through to adulthood. Greatly increased rates of heart disease, diabetes, certain cancers, gall bladder disease, osteoarthritis, endocrine disorders and other obesityrelated conditions will be found in young adult populations, and their need for medical treatment may last for their remaining life-times. The costs to the health services, the losses to society and the burdens carried by the individuals involved will be great. The present report has been written to focus attention on the issue and to urge policy-makers to consider taking action before it is too late. Specifically, the report:

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1467-789X.2004.00133.x

Obesity in children and young people: a crisis in public health.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)60813-1.pdf

The global obesity pandemic: shaped by global drivers and local environments

Recently, dietary pattern analysis has emerged as an alternative and complementary approach to examining the relationship between diet and the risk of chronic diseases. Instead of looking at individual nutrients or foods, pattern analysis examines the effects of overall diet. Conceptually, dietary patterns represent a broader picture of food and nutrient consumption, and may thus be more predictive of disease risk than individual foods or nutrients. Several studies have suggested that dietary patterns derived from factor or cluster analysis predict disease risk or mortality. In addition, there is growing interest in using dietary quality indices to evaluate whether adherence to a certain dietary pattern (e.g. Mediterranean pattern) or current dietary guidelines lowers the risk of disease. In this review, we describe the rationale for studying dietary patterns, and discuss quantitative methods for analysing dietary patterns and their reproducibility and validity, and the available evidence regarding the relationship between major dietary patterns and the risk of cardiovascular disease.

Dietary pattern analysis: a new direction in nutritional epidemiology.

Objectives Because larger food portions could be contributing to the increasing prevalence of overweight and obesity, this study was designed to weigh samples of marketplace foods, identify historical changes in the sizes of those foods, and compare current portions with federal standardsMethods We obtained information about current portions from manufacturers or from direct weighing; we obtained information about past portions from manufacturers or contemporary publicationsResults Marketplace food portions have increased in size and now exceed federal standards Portion sizes began to grow in the 1970s, rose sharply in the 1980s, and have continued in parallel with increasing body weightsConclusions Because energy content increases with portion size, educational and other public health efforts to address obesity should focus on the need for people to consume smaller portions

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The Contribution of Expanding Portion Sizes to the US Obesity Epidemic

Preface Introduction: The Food Industry and "Eat More" PART ONE Undermining Dietary Advice 1. From "Eat More" to "Eat Less," 1900-1990 2. Politics versus Science: Opposing the Food Pyramid, 1991-1992 3. "Deconstructing" Dietary Advice PART TWO Working the System 4. Influencing Government: Food Lobbies and Lobbyists 5. Co-opting Nutrition Professionals 6. Winning Friends, Disarming Critics 7. Playing Hardball: Legal and Not PART THREE Exploiting Kids, Corrupting Schools 8. Starting Early: Underage Consumers 9. Pushing Soft Drinks: "Pouring Rights" PART FOUR Deregulating Dietary Supplements 10. Science versus Supplements: "A Gulf of Mutual Incomprehension" 11. Making Health Claims Legal: The Supplement Industry's War with the FDA 12. Deregulation and Its Consequences PART FIVE Inventing Techno-Foods 13. Go Forth and Fortify 14. Beyond Fortification: Making Foods Functional 15. Selling the Ultimate Techno-Food: Olestra Conclusion: The Politics of Food Choice Appendix: Issues in Nutrition and Nutrition Research Notes List of Tables List of Figures Index

https://link.springer.com/content/pdf/10.2307%2F3343179.pdf

Food Politics: How the Food Industry Influences Nutrition and Health

Traditional ways of preventing and treating overweight and obesity have almost invariably focused on changing the behavior of individuals, an approach that has proven woefully inadequate, as indicated by the rising rates of both conditions. Considering the many aspects of American culture that promote obesity, from the proliferation of fast-food outlets to almost universal reliance on automobiles, reversing current trends will require a multifaceted public health policy approach as well as considerable funding. National leadership is needed to ensure the participation of health officials and researchers, educators and legislators, transportation experts and urban planners, and businesses and nonprofit groups in formulating a public health campaign with a better chance of success. The authors outline a broad range of policy recommendations and suggest that an obesity prevention campaign might be funded, in part, with revenues from small taxes on selected products that provide "empty" calories-such as soft drinks-or that reduce physical activity-such as automobiles.

Halting the Obesity Epidemic: A Public Health Policy Approach

In an article that forms part of the PLoS Medicine series on Big Food, guest editors David Stuckler and Marion Nestle lay out why more examination of the food industry is necessary, and offer three competing views on how public health professionals might engage with Big Food.

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Big Food, Food Systems, and Global Health

The greater energy content of larger food portions could be contributing to the increasing prevalence of overweight. Prevention guidelines recommend ″sensible" portion sizes but do not define them. The US Department of Agriculture (USDA) defines standard serving sizes for dietary guidance, and the Food and Drug Administration (FDA) defines standard servings for food labels. To use these standards in counseling, nutritionists must know the sizes of portions available in the marketplace. We determined marketplace portion sizes, identified changes in these sizes with time, and compared current marketplace portions with federal standards. Most marketplace portions exceed standard serving sizes by at least a factor of 2 and sometimes 8-fold. Portions have increased over time; those offered by fast-food chains, for example, often are 2 to 5 times larger than the original size. The discrepancy between marketplace portions and standard servings suggests the need for greater emphasis on the relationship of portion size to energy intake as a factor in weight maintenance. J Am Diet Assoc. 2003;103:231-234.

https://www.foodpolitics.com/wp-content/uploads/jada2003expandingportions1.pdf

Marion Nestle

Papers

The Contribution of Expanding Portion Sizes to the US Obesity Epidemic

Food Politics: How the Food Industry Influences Nutrition and Health

Halting the Obesity Epidemic: A Public Health Policy Approach

Big Food, Food Systems, and Global Health

Expanding portion sizes in the US marketplace: Implications for nutrition counseling