Relative Food Prices and Obesity in U.S. Metropolitan Areas: 1976-2001

This study investigates the impact of food price on obesity, by exploring the co-occurrence of obesity growth with relative food price reduction between 1976 and 2001. Analyses control for female labor participation and metropolitan outlet densities that might affect body weight. Both the first-difference and fixed effects approaches provide consistent evidence suggesting that relative food prices have substantial impacts on obesity and such impacts were more pronounced among the low-educated. These findings imply that relative food price reductions during the time period could plausibly explain about 18% of the increase in obesity among the U.S. adults in metropolitan areas.     

Fast food prices,obesity, and the minimum wage

Recent proposals argue that a fast food tax may be an effective policy lever for reducing population weight. Although there is growing evidence for a negative association between fast food prices and weight among adolescents, less is known about adults. That any measured relationship to date is causal is unclear because there has been no attempt to separate variation in prices on the demand side from that on the supply side. We argue that the minimum wage is an exogenous source of variation in fast food prices, conditional on income and employment. In two-stage least-squares analyses, we find little evidence that fast food price changes affect adult BMI or obesity prevalence. Results are robust to including controls for area and time fixed effects, area time trends, demographic characteristics, substitute prices, numbers of establishments and employment in related industries, and other potentially related factors.     

Food prices and body fatness among youths

We examine the effect of food prices on clinical measures of obesity, including body mass index (BMI) and percentage body fat (PBF) measures derived from bioelectrical impedance analysis (BIA) and dual energy X-ray absorptiometry (DXA), among youths ages 12 through 18 in the National Health and Nutrition Examination Survey. This is the first study to consider clinically measured levels of body composition rather than BMI to investigate the effects of food prices on obesity outcomes among youths classified by gender and race/ethnicity. Our findings suggest that increases in the real price per calorie of food for home consumption and the real price of fast-food restaurant food lead to improvements in obesity outcomes among youths. We also find that a rise in the real price of fruits and vegetables leads to increased obesity. Finally, our results indicate that measures of PBF derived from BIA and DXA are no less sensitive and in some cases more sensitive to the prices just mentioned than BMI, and serve an important role in demonstrating that rising food prices (except fruit and vegetable prices) are indeed associated with reductions in obesity rather than with reductions in body size proportions alone.     

The Growing Price Gap between More and Less Healthy Foods: Analysis of a Novel Longitudinal UK Dataset

Objectives

The UK government has noted the public health importance of food prices and the affordability of a healthy diet. Yet, methods for tracking change over time have not been established. We aimed to investigate the prices of more and less healthy foods over time using existing government data on national food prices and nutrition content.

Methods

We linked economic data for 94 foods and beverages in the UK Consumer Price Index to food and nutrient data from the UK Department of Health''s National Diet and Nutrition Survey, producing a novel dataset across the period 2002–2012. Each item was assigned to a food group and also categorised as either “more healthy” or “less healthy” using a nutrient profiling model developed by the Food Standards Agency. We tested statistical significance using a t-test and repeated measures ANOVA.

Results

The mean (standard deviation) 2012 price/1000 kcal was £2.50 (0.29) for less healthy items and £7.49 (1.27) for more healthy items. The ANOVA results confirmed that all prices had risen over the period 2002–2012, but more healthy items rose faster than less healthy ones in absolute terms:£0.17 compared to £0.07/1000 kcal per year on average for more and less healthy items, respectively (p<0.001).

Conclusions

Since 2002, more healthy foods and beverages have been consistently more expensive than less healthy ones, with a growing gap between them. This trend is likely to make healthier diets less affordable over time, which may have implications for individual food security and population health, and it may exacerbate social inequalities in health. The novel data linkage employed here could be used as the basis for routine food price monitoring to inform public health policy.     

The timing of the rise in U.S. obesity varies with measure of fatness

There are several ways to measure fatness and obesity, each with its own strengths and weaknesses. The primary measure for tracking the prevalence of obesity has historically been body mass index (BMI). This paper compares long-run trends in the prevalence of obesity when obesity is defined using skinfold thickness instead of BMI, using data from the full series of U.S. National Health Examination Surveys. The results indicate that when one uses skinfold thickness rather than BMI to define obesity, the rise in the prevalence of obesity is detectable 10-20 years earlier. This underscores the importance of examining multiple measures of fatness when monitoring or otherwise studying obesity.     

Trends in the Association between Obesity and Socioeconomic Status in U.S. Adults: 1971 to 2000

Objective: To study the secular trends in the disparity of obesity across socioeconomic status (SES) groups among U.S. adults. Research Methods and Procedures: We used national representative data collected in the National Health and Nutrition Examination Surveys conducted in 1971 to 1974, 1976 to 1980, 1988 to 1994, and 1999 to 2000 from 28, 543 adults 20 to 60 years old. Obesity was defined based on BMI calculated using measured weight and height. Trends in the relationship between obesity and education levels were analyzed controlling for age, gender, and ethnicity. Results: The disparity in obesity across SES (less than high school, high school, and college or above to indicate low, medium, and high SES, respectively) has decreased over the past 3 decades. In National Health and Nutrition Examination Surveys I (1971 to 1974), there was as much as a 50% relative difference in the obesity prevalence across the three groups, but by 1999 to 2000, it decreased to 14%. This trend was more pronounced in women. The trends of diminishing disparities in obesity were also revealed by our logistic and linear regression analyses. The odds ratio converged to 1 from the 1970s to 2000. In most sociodemographic groups, the relationship between BMI and SES (coefficients) has been weakened over time. Discussion: The association between SES and obesity has been weakened over the past 3 decades, when the prevalence of obesity increased dramatically. There are considerable variations in the changes in the associations across gender and ethnic groups. Our findings suggest that individual characteristics are not likely the main cause of the current obesity epidemic in the U.S., whereas social‐environmental factors play an important role. Strategies for obesity prevention and management should target all SES groups from a societal perspective.     

Food consumption trends and drivers

A picture of food consumption (availability) trends and projections to 2050, both globally and for different regions of the world, along with the drivers largely responsible for these observed consumption trends are the subject of this review. Throughout the world, major shifts in dietary patterns are occurring, even in the consumption of basic staples towards more diversified diets. Accompanying these changes in food consumption at a global and regional level have been considerable health consequences. Populations in those countries undergoing rapid transition are experiencing nutritional transition. The diverse nature of this transition may be the result of differences in socio-demographic factors and other consumer characteristics. Among other factors including urbanization and food industry marketing, the policies of trade liberalization over the past two decades have implications for health by virtue of being a factor in facilitating the ‘nutrition transition’ that is associated with rising rates of obesity and chronic diseases such as cardiovascular disease and cancer. Future food policies must consider both agricultural and health sectors, thereby enabling the development of coherent and sustainable policies that will ultimately benefit agriculture, human health and the environment.     

Food price volatility

The high food prices experienced over recent years have led to the widespread view that food price volatility has increased. However, volatility has generally been lower over the two most recent decades than previously. Variability over the most recent period has been high but, with the important exception of rice, not out of line with historical experience. There is weak evidence that grains price volatility more generally may be increasing but it is too early to say.     

Micronutrient deficiency and the prevalence of mothers' overweight/obesity in Egypt.

I examine the relationship between micronutrient deficiency and the prevalence of mothers' overweight/obesity in Egypt using the 1997 Egyptian Integrated Household Survey. The ordered logit results show an overlap between micronutrient deficiency and the prevalence of mothers' overweight/obesity in Egypt. The odds of being overweight/obese are 80.8% higher for micronutrient deficient mothers than for non-deficient mothers, keeping all other variables constant. These results have at least two interesting policy implications. First, as the potential impact of the interaction between micronutrient deficiency and chronic diseases is not well known, the coexistence of micronutrient deficient and overweight/obese women can raise new and serious public health problems in the country. Second, the Egyptian food subsidy program, which lowers the relative prices of energy-dense, nutrient-poor food items, can be one of the major factors for the emergence of overweight/obese and micronutrient deficient mothers in the country. Changing the orientation of the food subsidy program may help to simultaneously address this double burden of mothers' malnutrition.     

The price of ultra-processed foods and beverages and adult body weight: Evidence from U.S. veterans

The consumption of ultra-processed foods in the U.S. and globally has increased and is associated with lower diet quality, higher energy intake, higher body weight, and poorer health outcomes. This study drew on individual-level data on measured height and weight from U.S. Department of Veterans Affairs medical records for adults aged 20 to 64 from 2009 through 2014 linked to food and beverage price data from the Council for Community and Economic Research to examine the association between the price of ultra-processed foods and beverages and adult body mass index (BMI). We estimated geographic fixed effects models to control for unobserved heterogeneity of prices. We estimated separate models for men and women and we assessed differences in price sensitivity across subpopulations by socioeconomic status (SES). The results showed that a one-dollar increase in the price of ultra-processed foods and beverages was associated with 0.08 lower BMI units for men (p ≤ 0.05) (price elasticity of BMI of −0.01) and 0.14 lower BMI units for women (p ≤ 0.10) (price elasticity of BMI of -0.02). Higher prices of ultra-processed foods and beverages were associated with lower BMI among low-SES men (price elasticity of BMI of −0.02) and low-SES women (price elasticity of BMI of −0.07) but no statistically significant associations were found for middle- or high-SES men or women. Robustness checks based on the estimation of an individual-level fixed effects model found a consistent but smaller association between the price of ultra-processed foods and beverages and BMI among women (price elasticity of BMI of −0.01) with a relatively larger association for low-SES women (price elasticity of BMI of −0.04) but revealed no association for men highlighting the importance of accounting for individual-level unobserved heterogeneity.     

The effect of rising obesity on eligibility to serve in the U.S. public health service commissioned corps

This study investigates how rising obesity has affected eligibility to serve in the United States Public Health Service Commissioned Corps (PHSCC), the uniformed service charged with protecting and promoting public health in the U.S. Data are drawn from the National Health and Nutrition Examination Surveys. Between 1959 and 2010, the percentage of eligible civilians who exceed the weight-for-height and body fat standards of the PHSCC rose from 9.05% to 18.24% among men, and from 6.13% to 23.10% among women. Simulations indicate that a further 1% increase in population body weight will result in an additional 3.42% of men and 5.08% of women exceeding PHSCC accession standards.This study documents an under appreciated consequence of the rise in obesity: fewer Americans eligible to develop and implement a public health response to obesity through the PHSCC. This illustrates how a public health problem can undermine the public health labor force, compromising a response and risking a self-reinforcing trend. These findings are timely as the Patient Protection and Affordable Care Act (ACA) calls for a major expansion of the PHSCC.     

Food Shortages and International Agricultural Programs

The most recent data indicate an unconscionable 842 million people are chronically hungry in the world, 94 percent in developing countries. India, China, and other Asian countries that were the center of concern over hunger in 1960 have been among the most successful at increasing food production and consumption. Current food shortages, both chronic and acute, are concentrated in sub-Sahara Africa. There, production has lagged behind needs and fluctuations from natural and human-caused disasters have generated recurring food shortages and need for food aid. Three elements played critical roles in Asia and are likely to be the key to solving food shortages in Africa: rural/agricultural economic growth that generated increased incomes for the rural poor, stability of food prices, and non-agricultural economic growth. U.S. universities have educated many of the agricultural scientists in developing countries and those at CGIAR centers. The international agricultural programs of U.S. universities that have been important in maintaining links between U.S. and foreign institutions and in facilitating the training of developing country scientists need continued financial support.     

Stemming the obesity epidemic: a tantalizing prospect

Objective: Obesity is a growing problem worldwide, but there are no good methods to assess the future course of the epidemic and the potential influence of interventions. We explore the behavior change needed to stop the obesity epidemic in the U.S. Research Methods and Procedures: We modeled the population distribution of BMI as a log‐normal curve of which the mean shifts upward with time due to a positive population energy balance. Interventions that decrease food intake or increase physical activity result in more favorable trends in BMI. Results: The recently observed trend in average BMI implies that the average U.S. adult over‐consumes by ～10 kcal/d. If this trend continues unaltered, obesity prevalence will exceed 40% for men and 45% for women in 2015. To stop the epidemic, it suffices to decrease caloric consumption by ～10 kcal or walk an extra 2 to 3 minutes per day, on average. Discussion: This leads to a paradox: little behavior change seems sufficient to halt the epidemic, but in practice this proves hard to achieve. The obesogenic environment is the likely culprit. Individuals trying to maintain a healthy weight need to be supported by environments that stimulate physical activity and do not encourage over‐consumption. Research should show what measures are effective.     

Health care costs and financing in world perspective.

Expenditures for health services, as a percentage of national wealth (gross national product, or GNP), have been rising throughout the world. Data to quantify this trend are available for many industrialized countries. The share of health spending derived from governmental sources has also been increasing. Mandatory or social insurance has developed to support health services in 70 nations. While widely used for paying doctors on a fee basis or by capitation, in Latin America doctors are organized in polyclinics and paid by salaries. General revenues are used to support Ministry of Health programs. Among health expenditures, the largest share goes to hospitalization. Cost sharing by patients is widely used to control rising costs. World trends have promoted equity in health care delivery.     

Endogenous Price Bubbles in a Multi-Agent System of the Housing Market

Economic history shows a large number of boom-bust cycles, with the U.S. real estate market as one of the latest examples. Classical economic models have not been able to provide a full explanation for this type of market dynamics. Therefore, we analyze home prices in the U.S. using an alternative approach, a multi-agent complex system. Instead of the classical assumptions of agent rationality and market efficiency, agents in the model are heterogeneous, adaptive, and boundedly rational. We estimate the multi-agent system with historical house prices for the U.S. market. The model fits the data well and a deterministic version of the model can endogenously produce boom-and-bust cycles on the basis of the estimated coefficients. This implies that trading between agents themselves can create major price swings in absence of fundamental news.     

Converging prevalences of obesity across educational groups in Switzerland

Objective: To assess whether the rapid increase in obesity prevalence among persons with higher education levels observed in one U.S. study is also observed in a European adult population. Research Methods and Procedures: This study involved continuous surveillance of the adult population of Geneva, Switzerland (1993 to 2004), with annual random, independent, cross‐sectional, representative samples (6635 men and 6558 women, ages 35 to 74 years) and analysis of 12‐year trends in obesity prevalence across educational level subgroups. Results: Obesity prevalence in men had an upward trend in the medium education subgroup (p < 0.02), a borderline upward trend in the high education subgroup (p < 0.08), but no trend in the low education subgroup. There was a borderline trend interaction between the male low and medium education subgroups (p < 0.09). Obesity prevalence in women had a borderline increase in the low education subgroup (p < 0.08), an almost borderline increase in the high education subgroup (p = 0.11), but no significant trend in the medium education subgroup. There was no evidence of trend interaction between the female education groups. Discussion: In Geneva, as in the United States, the inverse association between education level and obesity rates has weakened over time among men, but, inconsistent with the U.S. findings, has persisted for women. Explanations may include more physically demanding occupations for men with low education levels and different attitudes toward body image between the sexes.     

Do additional SNAP benefits matter for child weight?: Evidence from the 2009 benefit increase

We know that youth who live in low-income households tend to have lower nutritional health outcomes—including higher rates of obesity—when compared to their higher-income counterparts. The Supplemental Nutrition Assistance Program (SNAP) is the largest U.S. federal nutrition program and has been found to improve food security and to serve as an income support. It is less clear how SNAP may affect obesity in low-income youth. From a policy perspective, it is essential to understand how the largest federal nutrition assistance program influences the health of children and adolescents. We use the exogenous increase in SNAP benefits that was a part of the American Recovery and Reinvestment Act (ARRA) to identify how a change in benefits is linked with obesity in youth. We find evidence that the ARRA increase in SNAP benefits is associated with healthier weight outcomes in three of the four age groups examined. SNAP-eligible toddlers are less likely to be overweight and adolescents are less likely to be obese. These findings can help policy makers understand how additional SNAP benefits from the Families First Coronavirus Response Act may influence weight outcomes in children and adolescents.     

Young adult cancer incidence trends in Taiwan and the U.S. from 2002 to 2016

BackgroundPrevious studies have not examined young adult cancer incidence trends in Taiwan, or comprehensively compared these trends at two nations with different population genetics, environmental exposures, and health care. Therefore, we compared the incidence rates and trends of the most common young adult cancers diagnosed at 20–39 years of age in Taiwan and the U.S.MethodsIncidence rates from 2002 to 2016 were calculated from the Taiwan National Health Insurance Research Datasets and the U.S. Surveillance, Epidemiology, and End Results Program. For trend assessment, average annual percent change (AAPC) values were calculated from 15 years of data using Joinpoint Regression Program. We also obtained sex or age of diagnosis stratified estimates.ResultsThe age-standardized overall young adult cancer incidence rate significantly increased from 2002 to 2016 in both Taiwan (AAPC=1.1%, 95% CI: 0.8–1.5%) and the U.S. (AAPC=1.8%, 95% CI: 1.1–2.4%). Cancers with significantly decreasing trends in Taiwan included cancers of the nasopharynx, liver, and tongue, which were not among the most common young adult cancers in the U.S. Cancers with significantly increasing trends in both Taiwan and the U.S. included colorectal, thyroid, and female breast cancers. Lymphoma, ovarian cancer, and lung and bronchus cancer had significantly increasing trends in Taiwan but not in the U.S. Although cervical cancer had significantly decreasing trends in both nations among those 30–39 years of age, its trend was significantly increasing in Taiwan but decreasing in the U.S. among those 20–29 years of age.ConclusionThe types of common young adult cancers as well as their incidence rates and trends differed in Taiwan and the U.S. Future studies should further understand the etiological factors driving these trends.     

The business cycle,health behavior,and chronic disease: A study over Three decades

The effect of macroeconomic fluctuations on individual health remains highly debated. We estimate the effect of the business cycle on health and health behavior in the U.S. using the NLSY79 panel data for 11,406 respondents between 1979 and 2014. Most of our survey respondents have no chronic illness in 1979, and develop these conditions during the sample period. This allows us to estimate the true effect of economic fluctuation on the likelihood of developing chronic conditions. The results indicate a considerable difference in the cyclic variation of chronic diseases. After controlling for innate individual characteristics such as family health history, and unobserved regional characteristics, we find that obesity decreases during economic downturns, while diabetes, hypertension, and congestive heart failure increase. Sub-sample analyses show that Blacks are more likely to develop diabetes and hypertension and are less likely to develop obesity during economic downturns than other racial groups. The incidence of obesity declines during recessions for women, while males are more likely to develop diabetes. Income loss, particularly among Blacks, and lack of change in physical activity mediate these differential effects.