News Counting the cost of calories Obesity is a significant public health issue. Marion Nestle spoke with Ben Jones about calories and why anti-obesity measures must prevail. Q: How do you account for the rise in obesity? The reasons for it may be obvi- Dr Marion Nestle received her BA in 1959 from the ous, but what would you put it down to? University of California, Berkeley, in the United States of A: It’s because people are eating America. She earned a doctorate in molecular biology, more. On the simplest level, people have also from Berkeley, and then did postdoctoral work in to be eating more or moving less, or do- Biochemistry and Developmental Biology at Brandeis ing both. The evidence is much stronger University and joined the faculty in Biology. From 1986 for eating more than it is for changes in to 1988, she was senior nutrition policy advisor in the physical activity. Evidence for a decline Department of Health and Human Services in the USA in physical activity is small, but there is Courtesy of Marion Nestle plenty of evidence that people are eating Marion Nestle and editor of The Surgeon General’s Report on Nutrition more now than 30 years ago. and Health. Her research examines scientific and So you have to ask the question: socioeconomic influences on food choice, obesity and food safety, emphasizing why are people eating more? In the the role of food marketing. She is the author of numerous articles in professional United States, eating more can be at- publications and is author or co-author of seven books, including Why calories tributed to changes in agricultural count: from science to politics written with Malden Nesheim. policies in the 1970s that paid farmers She writes the Food Matters column for the San Francisco Chronicle, blogs to grow more food. The result was an at foodpolitics.com and for the Atlantic Food Channel and tweets from increase in calories in the food supply. @marionnestle. The second big change was in the way investments worked. Wall Street, which had formerly valued blue-chip stocks that gave long, slow returns on invest- A: Well, I’m a public health person, would have nothing to say. But obesity ment, suddenly began demanding higher so I ask: what kind of a world do we is also a societal matter because at some and faster yields. want to live in? Do we want to live in a point type 2 diabetes has to be treated. These changes put extraordinary world in which there’s lots of tooth decay Hardly anyone can afford the cost of pressure on food companies. They had or do we want to fluoridate our water? lifelong treatment, so society has ethi- to do two things at once: sell products Do we want to live in a world in which cal interests in keeping citizens healthy. in an environment in which there was people have goiter and its consequences already twice as much food available as a result of not having enough iodine Q: Are the arguments against controlling as anybody could eat, and grow their or do we want to iodize salt? These are obesity rates as much economic as they profits every 90 days. Food companies public health measures. Why would we are health-orientated? had to find new ways to sell food. They not want a public health environment A: Well, they are both. The eco- did that by increasing the size of food that protects people against the con- nomic argument is one that that policy- portions; promoting consumption of sequences of obesity? Obesity is not a makers understand. But from a public foods eaten outside the home, either disease in itself, but it raises the risk for health standpoint, you want your popu- in restaurants or other places; and by diseases that are extremely expensive lation to be healthy because it’s better for creating an environment in which it for individuals and for society. You want individuals, it’s better for families, and became socially acceptable to eat food to prevent obesity because it’s easier to it’s better for society as a whole. at any time of day and anywhere – in prevent than to treat. It’s ironic that in the USA, the cars, in your hand, on the street – places military has become one of the greatest where eating had never been accept- Q: But it’s harder in the case of food, is it forces for anti-obesity measures because able. Suddenly snacking became okay, not, because people will always say that it can’t get enough volunteers who are food was sold absolutely everywhere, they want a choice as to what they can at a reasonable bodyweight and healthy in drug and clothing stores that never put into their own bodies? enough to fight. Obesity has become used to sell food. There’s plenty of re- A: That is the same argument that an enormous problem for the military. search that shows that larger portions, was given for cigarettes, for fluoridated frequent eating and having food avail- water, for chlorinated water and for Q: Are they taking measures against able everywhere encourages overeating. other highly effective public health mea- obesity, then? So, it worked. sures. Some people may feel that their A: They are taking more action individual rights are being taken away. than any other institution in American Q: How do you balance the need to Public health always has to balance the society because they are confronted with inform people about their health, the rights of individuals against the benefits volunteers who are too overweight to dangers of obesity and diet-related to society. If individual cases of obesity meet their standards, or who gain so disorders, with their basic choice as to and, for example, type 2 diabetes were much weight that they develop type 2 what they want to eat? simply a personal matter, then society diabetes or other problems that have to 566 Bull World Health Organ 2012;90:566–567 | doi:10.2471/BLT.12.040812 News be treated. They are asking their suppli- these products are associated with de- Q: Do you think agencies like the World ers to produce foods that are healthier, velopment and other cultural values, Health Organization (WHO) are doing and are looking for ways to limit calories they are readily accepted. The compa- enough in the fight against obesity? or provide incentives for losing weight. nies there know how to use culturally- A: They’re never doing enough. specific markers for advertising. They They can only do what they can. I’m Q: Do you think that governments need design the marketing to appeal to love, impressed that the nutrition depart- to take more of a lead against obesity? family, status and whatever emotional ment at WHO understands that non- A: Absolutely, because the food values are common to that particular communicable diseases have to be as companies aren’t going to do that by culture. This is about selling products. much of a priority as under-nutrition. themselves. Eating less is very bad for It’s not about health. The object is to WHO has to figure out what, with its business. Even if food companies wanted sell products regardless of their effects limited resources and limited man- to help people eat less, they couldn’t. on health. The governments of these date, it can do to help Member States They are not public health agencies. countries ought to be taking a really hard address obesity as well as malnutri- Their priority is to shareholders and look at such practices and think about tion. WHO can take the moral high to increase their profits every 90 days. the long-term health consequences and ground on such issues and should be Healthier food is more expensive to pro- costs. In 2005, an anthropology gradu- doing that. duce. It’s up to governments to set some ate student at New York University was limits that will apply to food companies doing field work in a remote village Q: Why did you write a book about across the board. The playing field needs in Guatemala. All of a sudden, Pepsi calories (Why calories count: from sci- to be level, and only government can products appeared. The company set up ence to politics, University of California make it level. villagers with carts and trucked in sup- Press, 2012)? plies. Her dissertation documents the A: If you’re talking about body Q: Surely food companies have some results: bodyweights went up and teeth weight, you’re talking about calories. So level of responsibility to treat their con- went bad. The marketing is directed at you’d better pay attention to how much sumers with a bit more respect? status and upward mobility, and framed you’re eating, which is just as important A: A food company official who I as helping communities with develop- as what you’re eating, if not more so. met in London recently says his compa- ment. The framing makes it difficult for ny has a vested interest in keeping people public health personnel to intervene Q: Is it enough to tell people how many healthy because they’ll buy more food successfully. calories there are in something? for a longer period of time. Maybe, but A: No, and my co-author Malden companies have only one requirement Q: But these products aren’t necessarily Nesheim and I do not advise that. We and that’s to make a profit. When there’s cheap.