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The following week on Wednesday, Oct. 19, Popkin gave a keynote address to the National Institute of Child Health and Human Development NICHD Global Health Conference. His talk entitled Socio-ecological Factors and the Double Burden of Malnutrition Among Children and Adolescents in Low- and Middle-Income Countries focused on the double burden of malnutrition and the new nutrition reality. He highlighted the trends and underlying factors linked with changes in both overweight and undernutrition and showed how in many countries (including nearly all low- and middle-income countries), stunting and wasting — key measures of undernutrition — are slowly declining while overweight and obesity are rapidly increasing among children.

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On Thursday, Sept. 29, Dr. Barry Popkin testified at a special U.S. Food and Drug Administration (FDA) public meeting in support of policies to improve the American diet and diet-related diseases. He joined six other consumer, research, government, and industry representatives who were invited to comment before an Independent Expert Panel as part of an ongoing operational review of the FDA’s human foods program. Popkin’s comments focused on the high content of ultra-processed foods in the current American diet; the link between poor diet and non-communicable diseases, including obesity; and the global experience with regulatory options that can impact food purchases and encourage healthier choices. He provided evidence from Chile on the effectiveness of front-of-package warning labels, a policy that the current administration has prioritized in the Biden-Harris Administration National Strategy on Hunger, Nutrition, and Health published this week.

The FDA’s Independent Expert Panel will continue accepting public comments on the agency’s human foods program operations through its online stakeholder portal until Oct. 7, 2022.

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Popkin, W.R. Kenan Jr. Distinguished Professor in the Department of Nutrition at the UNC Gillings Global School of Public Health, is lead author of “Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships,” which was published August 26 in Obesity Reviews in collaboration with the Saudi Health Council and the World Bank. Other Gillings School coauthors are Shufa Du, MD, PhD, associate professor, Melinda Beck, PhD, professor, and postdoctoral fellow Will Green, PhD, all of the nutrition department.

The relationship between obesity and COVID-19 is controversial, and little analysis has been done on the role obesity plays in how individuals experience the virus. Researchers examined the available published literature on individuals infected with the virus and found that those with obesity (BMI over 30) were at a greatly increased risk for hospitalization (113%) as a result of the virus, more likely to be admitted to the ICU (74%) and had a higher risk of death (48%) from the virus.

The new paper reviews immunological and biomedical data to provide a detailed layout of the mechanisms and pathways that link obesity with increased risk of COVID-19 as well as an increased likelihood of developing more severe complications from the virus.

Obesity is already associated with numerous underlying risk factors for COVID-19, including hypertension, heart disease type 2 diabetes, and chronic kidney and liver disease. Metabolic changes caused by obesity – such as insulin resistance and inflammation – make it difficult for individuals with obesity to fight some infections, a trend that can be seen in other infectious diseases, such as influenza and hepatitis.

During times of infection, uncontrolled serum glucose, which is common in individuals with hyperglycemia, can impair immune cell function.

“All of these factors can influence immune cell metabolism, which determines how bodies respond to pathogens, like the SARS-CoV-2 coronavirus,” says Beck. “Individuals with obesity are also more likely to experience physical ailments that make fighting this disease harder, such as sleep apnea, which increases pulmonary hypertension, or a body mass index that increases difficulties in a hospital setting with intubation.”

Previous work by Beck and others have demonstrated that the influenza vaccine is less effective in adults with obesity. The same may be true for a future SARS-CoV-2 vaccine, says Beck.

“However, we are not saying that the vaccine will be ineffective in populations with obesity, but rather that obesity should be considered as a modifying factor to be considered for vaccine testing,” she says. “Even a less protective vaccine will still offer some level of immunity.”

The pandemic’s resulting lockdown has led to a number of conditions that make it harder for individuals to achieve or sustain a healthy weight. Working from home, limiting social visits and a reduction in everyday activities – all in an effort to stop the spread of the virus – means we’re moving less than ever, says Popkin. The ability to access healthy foods has also taken a hit. Economic hardships put those who are already food insecure at further risk, making them more vulnerable to conditions that can arise from consuming unhealthy foods.

“We’re not only at home more and experience more stress due to the pandemic, but we’re also not visiting the grocery store as often, which means the demand for highly processed junk foods and sugary beverages that are less expensive and more shelf-stable has increased,” he says. “These cheap, highly processed foods are high in sugar, sodium and saturated fat and laden with highly refined carbohydrates, which all increase the risk of not only excess weight gain but also key noncommunicable diseases.”

Popkin, who is part of the Global Food Research Program at UNC, says the findings highlight why governments must address the underlying dietary contributors to obesity and implement strong public health policies proven to reduce obesity at a population level. Other countries, like Chile and Mexico, have adopted policies from taxing foods high in sugar to introducing warning labels on packaged foods that are high in sugar, fats and sodium and restricting the marketing of junk foods to children.

“Given the significant threat COVID-19 represents to individuals with obesity, healthy food policies can play a supportive – and especially important – role in the mitigation of COVID-19 mortality and morbidity,” he says.

Contacts:

Barry Popkin

popkin@unc.edu

Melinda Beck

melinda_beck@med.unc.edu

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Barry Popkin, PhD, is a co-author on “Body weight impact of the sugar-sweetened beverages tax in Mexican children: A modeling study,” which was published in the April 2020 issue of Pediatric Obesity.

Childhood obesity is a strong predictor for obesity later in life, which can also lead to chronic illnesses such as diabetes, hypertension and heart disease. This is the first study to attempt to estimate the benefits the SSB tax may have health trajectories for children and adolescents in Mexico.

To estimate the one-year effect of the tax on body weight of children ages 5 to 17, the team implemented a dynamical model of childhood growth and obesity, re-calibrated to the Mexican population, assuming that the known reductions in SSBs purchases would reflect changes in consumption of the beverages.

Findings show that one year after the implementation of the current 10-percent tax, children and adolescents should have experienced an average reduction in body weight of 0.26 and 0.61 kg. For those who had been high consumers of SSBs, the team estimates the positive impact on body weight would be even greater, with an average body weight reduction of 0.50 kg for children and 0.87 kg for adolescents.

The team also evaluated data using higher tax rates and projected that those rates would produce even more positive health outcomes for children and adolescents.

“Taxation represents one of the most effective ways to reduce consumption of unhealthy SSB’s, which can make a meaningful impact on future excessive weight gain and significantly reduce the long-term risks of becoming obese,” says Popkin. “If the taxation revenue is used to support child and adolescent healthy eating, then the benefits of such taxes are enhanced.”

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A new approach is needed to help low- and middle-income countries reduce obesity and undernutrition at the same time as the issues become increasingly connected, according to the first paper in a four-paper report published in The Lancet.

“We are facing a new nutrition reality where major food system changes have led the poorest countries to have high levels of overweight and obesity along with undernutrition,” said Barry M. Popkin,  lead author of the first paper and W.R. Kenan Jr. Distinguished Professor of nutrition at the UNC Gillings School of Global Public Health. “Our research shows that overweight and obesity levels of at least 20% among adults are found in all low-income countries. Furthermore, the double burden of high levels of both undernutrition and overweight occurs primarily in the lowest-income countries — a reality that is driven by the modern food system. This system has a global reach and is preventing low- and even moderate-income countries and households from consuming safe, affordable and healthy diets in a sustainable way.”

Read more in coverage by ZME Science, further information from the UNC press release, or the full paper published in The Lancet.

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Listen to Popkin & Brownell discuss the history, rationale, best options, and successes of soda taxes in Episode 13.

Listen to their discussion of the Nutrition Transition over time and the unique approach of Chile vs. Obesity in Episode 14.

Find all the Policy 360 podcasts on iTunes here
.

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What do you think the future holds for the global diet?

There’s two issues here. The current future, the way the global diet’s going across the world, there’s a rapid increase in what I call ready-to-eat or ready-to-heat foods, convenience foods. They could be bars and cereals that you can eat right away or they may be items you need to heat up, frozen dinners or things you purchase in the store that you take home and heat up. That’s been a massive change.

On the other hand, we have this push both in Europe and in the US and increasingly in some low income countries to go back to a more traditional way of cooking food and eating real food.

These two different pushes are clashing. Right now, the retail sector’s winning out. By far the biggest growth is in proportion of the world’s population and the absolutely numbers consuming processed packaged foods.

There certainly is a push to eat healthier real food, but it’s so far affecting mainly upper educated populations in the US and Europe of consuming and cooking and going back to eating real food only or mainly real foods   such as fruits and vegetables, poultry, fish, meats that you can buy in the store and then  cook them.

I’d say right now the future holds for the global diet essentially a worsening of what we have, except for the countries that are now seriously adding many, many regulatory efforts to try to change the diet. We do not know what will happen from those.

Chile’s a global leader in attempting to create a healthier diet.  First they instituted the beverage tax. They’re now instituted a ban on marketing to children of unhealthy foods and beverages. Very soon, they’re going to implement a law that’s been passed to ban all unhealthy food marketed to all groups between 6am and 10pm, which is all encompassing and includes all media, movie, TV, and the internet which display any of these unhealthy foods so that marketers will only be able to market what they term healthy foods, which are lower in sodium, added sugars, unhealthy fats and calories.

We don’t know how these regulations in countries like Chile, France and others are really going to impact our diet. It’s part of the global push by countries to try to control the really health costs which are kind of running out of control in terms of obesity, diabetes and all the cancers.

Read the full interview here.

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The downturn in calorie intake is not so much a watershed in the fight against obesity as a first step down a long and hard road to better nutrition, according to Barry Popkin, professor of public health at the University of North Carolina at Chapel Hill, whose latest research paper flagged up the shift.
The drop in calories is largely attributable to the high level of public attention to sugar-sweetened beverages, such as colas and lemonades, says Popkin. That’s a good thing but, he says: “Americans are still eating a really bad diet. We haven’t increased whole grain. Still over 50% or 60% of the calories in kids and adults are from refined carbohydrates, desserts, fast food and savoury snacks.”
That means, he says, “more than half the calories for kids and adults in America are from junk food”.

Read the full article in The Guardian here.

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There is no perfect way to measure American calorie consumption. But three large sources of data about diet all point in the same direction. Detailed daily food diaries tracked by government researchers, data from food bar codes and estimates of food production all show reductions in the calories consumed by the average American since the early 2000s. Those signals, along with the flattening of the national obesity rate, have convinced many public health researchers that the changes are meaningful.

This story is the first article in a series titled Scaling Back, which will focus on Americans’ changing eating habits.

A second brief article, It’s Hard to Count Calories, Even for Researchers, goes more in-depth to explain the data sources used in the above-mentioned story, the National Health and Nutrition Examination Survey (NHANES), data from the United States Department of Agriculture, and commercial data sources. The article features comment from Dr. Popkin, and also succinctly examines the strengths and weaknesses of each data source – while focusing on areas of agreement between the data provided by each source.

All three sources tell us that Americans are consuming fewer caloric beverages than they did a decade ago. Calories from beverages are down in every group in both the Nielsen and NHANES surveys, and calories from added sugars are dropping in the U.S.D.A. measures.

Read the full New York Times – The Upshot articles here and here, and look for more in the Scaling Back series.

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