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

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Dr Marion Nestle received her BA in 1959 from the University of California, Berkeley, in the United States of America. She earned a doctorate in molecular biology, also from Berkeley, and then did postdoctoral work in Biochemistry and Developmental Biology at Brandeis University and joined the faculty in Biology. From 1986 to 1988, she was senior nutrition policy advisor in the Department of Health and Human Services in the USA and editor of The Surgeon General's Report on Nutrition and Health. Her research examines scientific and socioeconomic influences on food choice, obesity and food safety, emphasizing the role of food marketing. She is the author of numerous articles in professional publications and is author or co-author of seven books, including Why calories count: from science to politics written with Malden Nesheim.

She writes the Food Matters column for the San Francisco Chronicle, blogs at foodpolitics.com and for the Atlantic Food Channel and tweets from @marionnestle.

Q: How do you account for the rise in obesity? The reasons for it may be obvious, but what would you put it down to?

A: It's because people are eating more. On the simplest level, people have to be eating more or moving less, or doing both. The evidence is much stronger for eating more than it is for changes in physical activity. Evidence for a decline in physical activity is small, but there is plenty of evidence that people are eating more now than 30 years ago.

So you have to ask the question: why are people eating more? In the United States, eating more can be attributed to changes in agricultural policies in the 1970s that paid farmers to grow more food. The result was an increase in calories in the food supply. 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 investment, suddenly began demanding higher and faster yields.

These changes put extraordinary pressure on food companies. They had to do two things at once: sell products in an environment in which there was already twice as much food available as anybody could eat, and grow their profits every 90 days. Food companies had to find new ways to sell food. They did that by increasing the size of food portions; promoting consumption of foods eaten outside the home, either in restaurants or other places; and by creating an environment in which it became socially acceptable to eat food at any time of day and anywhere--in cars, in your hand, on the street--places where eating had never been acceptable. Suddenly snacking became okay, food was sold absolutely everywhere, in drug and clothing stores that never used to sell food. There's plenty of research that shows that larger portions, frequent eating and having food available everywhere encourages overeating. So, it worked.

Q: How do you balance the need to inform people about their health, the dangers of obesity and diet-related disorders, with their basic choice as to what they want to eat?

A: Well, I'm a public health person, so I ask: what kind of a world do we want to live in? Do we want to live in a world in which there's lots of tooth decay or do we want to fluoridate our water? Do we want to live in a world in which people have goiter and its consequences as a result of not having enough iodine or do we want to iodize salt? These are public health measures. Why would we not want a public health environment that protects people against the consequences of obesity? Obesity is not a disease in itself, but it raises the risk for diseases that are extremely expensive for individuals and for society. You want to prevent obesity because it's easier to prevent than to treat.

Q: But it's harder in the case of food, B it not, because people will always say that they want a choice as to what they can put into their own bodies?

A: That is the same argument that was given for cigarettes, for fluoridated water, for chlorinated water and for other highly effective public health measures. …