Christina D. Economos is an expert researcher in nutrition and obesity, however, her work focuses more on people than on nutrients. She is a professor of Nutrition Science and Policy at Tufts University in Boston, the only independent nutrition school in the United States, and founder of the Obesity180 prevention program, focused on attacking the problem of childhood obesity not so much with prescriptions, but with changes in the social and family environment where children live, especially the most disadvantaged. She argues that without systemic change involving entire communities, it will not be possible to prevent the childhood obesity epidemic in the future.
We tend to be petulant in Mediterranean countries because we don’t have as much obesity, but then we look at the predictions about the rise in childhood obesity and the smile fades from our faces. The United States appears to be at the forefront of something that is actually a global problem.
It is absolutely global, not only in developed nations, but also in developing countries that, while lagging behind the US and the UK, are approaching the same rate. Predictions are that in the next two decades, if drastic measures are not taken, we will see a worldwide obesity epidemic in both developed and developing countries.
Obesity affects mainly developing countries and low-income people in rich countries. Does being poor make you fat?
In developing countries you see it in both high and low income populations. It is complicated, but without a doubt a big contributor is the consumption of highly processed foods. As we replace fresh, less calorie-dense, nutrient-rich and fiber-rich local foods with highly processed, high-fat, sugar-salt and high-calorie dense foods, we consume more calories in less time. Western processed foods and diets are starting to spread for convenience, for the ability to make them quite cheap, for the fact that they can have a long shelf life. There are a lot of variables, but we see that the consumption of these foods is increasing worldwide.
After the Great Depression and World War II, it seemed that the United States was in a unique position to provide healthy and affordable food to its population. Food became affordable, but not healthy. What went wrong and how could that be used as a warning to other countries?
I believe that the pursuit of development and economic prosperity is something shared throughout the world. You are right that the United States was able to move in that direction before many countries, but with that comes the desire for greater comfort. Instead of buying fresh food and spending a couple of hours preparing a meal, we take a shortcut with food that is already prepared that satisfies working parents and people. We also need to feed a lot of people in a short time, and our schools became much more efficient in this regard with processed and packaged food instead of cooking from scratch. All of that was later shifted to the work environment, and it was at the expense of fresh food. Processed foods are made to be very tasty, and often have more sugar, fat, and salt.
“Obesity is absolutely global. It occurs in developed and developing countries, which are approaching US rates. If we do not take action, the prediction is a global obesity epidemic in the coming decades.
Add to that the proliferation of sugary drinks in the population of all age groups, which add unnecessary calories to the diet. In places where tap water is not safe, a large number of highly calorie, sugary drinks are often consumed, from juices to energy drinks. You can see that in many developing countries when you travel.
We could say then that these are the two main factors in the development of childhood obesity: the consumption of sugary drinks and the fact that people no longer cook at home.
In the US, we spend more than 50% of our dollars eating out. The data comes from our group of economic research services. Now there is a great effort to establish restaurants and foods that are healthier, but it has started recently, it is a growth area of the market. Over the past 20 years, they have mainly been less healthy foods.
Does your Obesity180 program intervene in those things when it reaches a community?
We work a lot with schools and restaurants, which are two areas where children acquire a large quantity of their food. In the US, if you are a child from a low-income family, you can receive free or reduced price meals at school. That can contribute half of your calories, and it’s a really important area to make sure the dietary intake of those meals is the best it can be.
Plus, kids eat a lot of food outside the home in what we call the fast-service segment like Burger King and McDonald’s. Families eat this fast service more often because it is less expensive, fast and highly appetizing. We have done a lot of work in restaurants, in the school space, and in preschools to ensure that children receive healthy food in these settings.
Then there is the retail environment, which consists of buying food from grocery stores and consuming it at home, but that is a very individual choice. When you walk into a supermarket, you can buy whatever you want, but you are pushed by different stimuli, such as the shelves at the end of a aisle. They could have healthy products instead of unhealthy products, for example, or also near the cash register.
Are companies susceptible to these changes? Because they will probably want to maximize profits instead of offering healthy foods.
Yes, they are, and we have published some work that shows that what is good for children can also be good for business. We have worked with different restaurant chains that demonstrate that when they make children’s meals healthier, they do not lose market share but actually gain it, because parents want healthier options.
Now they have to taste good, look good, and be kid-friendly. For many years, in the United States the children’s menu has been two or three foods such as macaroni and cheese, pizza and Nuggets of chicken. But we’ve worked with restaurants that have tried truly innovative foods, and kids love them. It takes a little more effort and a little more cost, but you can get that money back. It just takes some innovation and some forward thinking owners to do it. Healthy food can be profitable if done right, it is a growing trend. I think with millennials In charge for years to come, as they become leaders, he will become increasingly popular.
“Millennials care about the environment and think in more holistic terms: health, nutrition, climate change. They don’t just care about the nutritional content, but also about how the food was grown and the environmental impact it will have.
For a long time, it seemed that health and economic performance were at odds. But when we consider the burden of preventable diseases in society, the accounts no longer come out.
That’s right, and let me add that in recent years, there is another very important emerging trend, which is sustainability and planetary health. The generation that is now 20, 30 years old is very concerned about the environment and they are thinking in more holistic terms: health, nutrition and climate change. They are not only concerned with the nutrient content, but also with how the food was grown and what kind of environmental impact it will have.
Children appear to be highly vulnerable to an increasingly competitive environment and pressure from parents to perform better academically, and end up as stressed as their parents. Is this psychological pressure also related to health problems like obesity?
I am not an expert in mental health, but I know quite a bit about stress levels in children because we measured them in many of our studies. And you are absolutely right that stress has a physiological impact, and for some children it can lead to sleep disturbances, eating disturbances, or eating disorders. Therefore, we must be very careful with the way we exercise as parents and think that a healthy diet with a lot of physical activity and water consumption can help to counter some of the stress that children feel.
If we allow stress to lead to the consumption of highly processed foods and more time in front of the screen, it becomes an unhealthy situation. There are programs in the United States right now to incorporate stress management in high school, reduce homework, and try to create more complete people. I think there has been tremendous pressure on young children at a very young age, especially in the United States, and I am sure they have seen that in Spain as well. Right now there is some reaction and people are realizing that spending ten hours a day in front of the screen has adverse consequences in sedentary lifestyle, depression and social isolation.
One of the interesting things about his program is that it involves the entire community. In Europe we have state health systems and people tend to expect them to take care of things. Can the cooperative model be exported to other countries?
Yes, definitely. We have worked with some colleagues in Australia and other countries that seek this model of participation and dissemination, where they seek to impact all the microsystems within a community to work together. It becomes a holistic approach for children living in that community, from medical care to the food supply, the education system, public health, etc. We have seen that it is successful in the United States and we definitely believe that it is exportable, you have similar microsystems in most countries.
Do you really think we can prevent the obesity epidemic? The predictions are bleak.
They are, but I think we can. Even in the United States, two thirds of children are not overweight or obese, so there is surely a way to prevent it. We have to make sure that all children are surrounded by healthy systems. The problem is that often the most disadvantaged children are subject to unhealthy environments while the most disadvantaged children are protected, there is a lot of inequality. In the US, low-income children develop overweight, obesity, and other chronic conditions, such as asthma, from exposure to poor air quality and, as you mentioned earlier, adverse childhood experiences with toxic stress environments. They are the ones who bear the brunt of disease. But I believe we can achieve a healthy environment and policies that are equitable so that all children can live healthy lives.