Nutrition - Food Insecurity and Public Health (Week 15)

The Role of the Food Industry in Chronic Disease

*Business Practices:* - Product design: Making foods as palatable as possible - Marketing: Promotes consumptions, creates consumer confusion about diet and health, misinforms the public about health consequences of the product - Retail distribution: Makes processed food ubiquitous & healthy food less available - Pricing: Lower cost of unhealthy foods encourages unhealthy consumption *Political Practices:* - Lobbying: Promotes policies that eliminate health regulations, lower taxes, increases sales - Campaign contributions: Increases industry's access to politicians - Sponsored research: Diminishes influence of independent research, confuses politicians and the public on health evidence - Philanthropy: Enhances credibility of corporations - Litigation: Delays or blocks health regulations *Marketing to Children:* - Research has found that for every 1-hour increase in TV viewing per day, there are higher intakes of sugar-sweetened beverages, fast food and overall calories - Children who watch more than 3 hours of television a day are 50% more likely to be obese than children who watch fewer than 2 hours - Food ads on television make up 50% of all the ad time on children's shows - Marketing of food to children on the internet is even more complex since the boundaries between content and pure advertising is often less clear than on television - In 2016, 56 of the biggest food companies placed 509 million banner ads and impressions on Cartoon Network & Nick.com. They placed 3.4 billion ads on Facebook and YouTube. - Advertising in schools, corporate sponsored educational materials, advertiser-sponsored video or audio programming, product sales contracts (with soda and snack food companies)

Food Insecurity Impacting Health

*Health Impacts for Adults:* - Cancer - Heart disease - Diabetes - Functional limitations - Hyperlipidemia - HTN - Obesity *Health Impacts for Kids:* - Behavioral and social-emotional problems - Poorer developmental outcomes - Iron deficiency anemia - Frequent stomach and headaches - Poorer educational performance and academic outcomes - Lower overall health related quality of life

Food Quality, Food Insecurity, and Children

*Kids Today:* - 1 in 10 have ADD - 1 in 3 kids are overweight or obese - 1 in 4 teens has Type 2 diabetes or prediabetes - 50% of schools has fast food served in cafeterias - Nearly 20% of calories for ages 12 to 18 comes from fast food, versus just 6.5% in the late 1970s *Food affects our ability to learn:* - Direct link between adequate nutrition and proper brain development - Among 6- to 12-y-old children, food insufficiency was associated with poorer mathematics scores, grade repetition, absenteeism, tardiness, visits to a psychologist, anxiety, aggression, psychosocial dysfunction, and difficulty getting along with other children - Students who ate more fast food overall had slower growth in academic achievement - Students who reported eating fast food once a day had slower growth in math, reading and science than students who ate no fast food *Other Effects:* - Food impacts many areas of health - Poor quality diets may contribute to nutritional deficiencies in iron, iodine, Vitamin D, B12, Ca, fiber - Fast food intake more than 3x a week is associated with greater odds of atopic disorders such as asthma, eczema or rhinitis, while asthma severity is almost 40% higher in teenagers and more than 25% in younger children - Further research confirmed that 3+ servings of fruit daily reduced the severity of symptoms for all three conditions *S/sx of a Poor Quality Diet in Children:* - Being underweight, overweight or obese - Constipation or changes in bowel habits - Being pale or lethargic - Tooth decay - Poor physical growth - Behavioral problems - Sleep issues - Problems w/ emotional and psychological development - Poor concentration or difficulties at school

The Food Industry and Climate Change

*The food industry one of the primary drivers of climate change* *Driving factors include:* - Deforestation - Soil erosion - Factory farming of animals - Food Transport - Refrigeration - Processing - Packaging of food

Food Processing

*What is Food Processing?* - Has been used for centuries to preserve food or make foods edible - Many types of food processing: Salt to preserve meat, spices for flavor, fermentation, cooking, drying, canning - Various levels of processing: Minimally processed, moderately processed, highly processed - Processing is used for safety, palatability, to improve nutritional quality and health inequities - Drawbacks: Nutrients can be destroyed and removed - *Food processing can lead to improvements in, or damage to the nutritional value of foods. Often both occur at the same time.* *Ultra-processed foods:* - Designed to be convenient & hyperpalatable - Contain low cost ingredients that translate into high profits for Big Food Companies - Made mostly from substances extracted from foods, such as fats, starches, added sugars, and hydrogenated fats - May also contain additives like artificial colors and flavors or stabilizers - *Ultra-processed foods contain an unevenly high ratio of calories to nutrients* *Why are processed foods so appealing?* - Price - Easily Accessible - Easy to prepare - Advertising (especially in children) - Our biology - Food engineering

Food Insecurity

*What is it?* - A household's inability to provide enough food for every person to live an active, healthy life. - Used to measure and assess the risk of hunger - Also refers to the lack of sufficient, safe and nutritious food that meets individuals dietary needs for an active and healthy life - In 2018 it was estimated that 1 in 8 people struggle with food insecurity. equating to over 37 million Americans, including more than 11 million children - Hunger and food insecurity are closely related while also being distinctly different concepts *Causes:* - Job loss - Unexpected bills - Accidents - Health crisis - Low wages - High cost of living expenses - Social isolation - Where you live - Age - Lack of health literacy *Effects of Food Insecurity:* 1. Serious health complications - People who are food insecure are disproportionately affected by diet-sensitive chronic diseases 2. Damage to a child's ability to learn and grow - Can have serious implications for a child's physical and mental health, academic achievement and future economic prosperity 3. Increased cost & burden on our healthcare system - According to the CDC, health care costs associated with food insecurity in the United States were $160.7 billion in 2014 - Cyclic relationship between food insecurity and chronic disease

Solutions

- Build the real cost of industrial food into the price. Include its impact on health care costs and lost productivity - Subsidize the production of fruits and vegetables (80% of government subsidies presently go to soy and corn which are used to create much of the junk food we consume) - Incentivize supermarkets to open in poor communities. Poverty and obesity go hand in hand - End food marketing to children - Change the school lunchroom - Invest in regenerative agriculture - End irresponsible relationships between medicine and industry - Lobby for reform; hold Big Food Corporations accountable. - *This is a social justice issue.*

Food Deserts

- Characterized as geographic areas where people lack access to affordable fresh and healthful food - Rural, minority, and low income areas often at risk - People's choices about what to eat are severely limited by the options available to them and what they can afford - 23 million Americans live in food deserts - However, the relationship is complex - Access is not the only factor - A study showed that distance to the nearest food outlet from home had little impact on dietary quality - Why? Socio-economic factors influence dietary quality and local food environment also plays a role - Convenience foods are often cheaper than fresh food - Fresh food selections may be poor or not culturally appropriate

Is Food Addicting?

- Currently there is no DSM-5 Diagnosis for food addiction - The "No Group": Food is not addicting because it does not cause the same physiological symptoms of withdrawal as drugs and alcohol - The "Yes Group": Certain foods (high in fat, sugar, salt) trigger the release of chemicals in the brain, like dopamine, that mirror the response that addicts experience when consuming drugs and alcohol - Certain foods are "engineered' to be as enticing as possible - Sugar stimulates the brain's reward centers through the neurotransmitter dopamine, exactly like other addictive drugs - Brain imagining (PET scans) shows that high-sugar and high-fat foods work just like heroin, opium, or morphine in the brain - Brain imaging (PET scans) shows that obese people and drug addicts have lower numbers of dopamine receptors, making them more likely to crave things that boost dopamine - Foods high in fat and sweets stimulate the release of the body's own opioids (chemicals like morphine) in the brain - Drugs used to block the brain's receptors for opioids (naltrexone) also reduce the consumption and preference for sweet, high-fat foods in both normal weight and obese binge eaters. - People develop a tolerance to sugar. They need more and more of the substance to satisfy themselves - Obese individuals continue to eat large amounts of unhealthy foods despite severe social and personal negative consequences. - Animals and humans experience "withdrawal" when suddenly cut off from sugar1 - Just like drugs, after an initial period of "enjoyment" of the food, the user no longer consumes them to get high, but to feel normal

Public Health Initiatives and Food Insecurity

- In an effort to "end food insecurity", government officials and policy makers focused on giving the US an adequate amount of calories but w/o a focus on the type of calories. Updated dietary guidelines, new public health policies. - The Farm Bill- costs 100 billion dollars per year. Subsidizes farmers to overproduce corn, soy & wheat. Contributes to increased industrial agriculture - The Supplemental Nutrition Assistance Program (SNAP)-central goal of SNAP is to alleviate hunger and malnutrition by increasing resources for the purchase of food for a nutritious diet *The Dark Side of Public Health Initiatives:* - These policy changes have dramatically helped to reduce food insecurity in our country, but they have caused other problems - The Supplemental Nutrition Assistance Program (SNAP) aims for recipients to "make healthy food choices within a limited budget - 75 % of food stamp money is used to purchase junk food, 10% of that value is soda - Coca-Cola is the biggest welfare recipient in America with 20% of the American revenue coming from food stamps - Approximately 20% of all the food stamp dollars go to Walmart

Food Policy Makers

- National Institute of health - Institute of Medicine - Food and Drug Administration - USDA - U.S. Department of Health & Human Services - FDA - Child Nutrition Reauthorization - They provide health services, program development, and create policy that establishes funding which supports health promotion & food safety

The Role of Processed Food in Chronic Disease

- Processed foods can have a negative impact on health - Empty calories that contribute to weight gain - Low nutrient density - Inflammatory - Toxic to our microbiome - Toxic to our brain - The combination elevates blood sugar levels, BP, and cholesterol which drives obesity, diabetes and heart disease

Social Determinants of Health and Food Insecurity

- Social determinants of health are the conditions in which people are born, grow, live, work and age that shape health - Include factors like socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, as well as access to health care - Addressing social determinants of health is important for improving health and reducing longstanding disparities in health and health care - Effective responses to food insecurity must address the overlapping challenges posed by the social determinants of health

Food Insecurity to Food Source

- We know that the cause of food insecurity is complex - Nutrient dense food are more expensive than highly processed food, so it is often more economical for families to purchase processed food - Fresh food requires time to cook and prepare. Cooking packaged foods or fast foods often takes less time to prepare. - Fresh food may not be as accessible as processed food