We talked before about our current system. How we are working on and how we're trying to educate, equip people with knowledge and then try to improve their motivation so that they can make these healthier choices. But meanwhile, we've got all these competing factors. So with respect to food and marketing, the actual food environment, these portions and so on. A lot of our interventions, are focused at this point in times with respect to weight loss treatment. We're trying to help the individual learn to self-monitor and we're taking them through all kinds of behavioral treatment and giving them a lot of assistance with respect to meeting with healthcare professionals and doing this on a weekly basis and there is this really intense individual level of modification. When we're able to do that, people are able to meet short-term improvements as long as they are in the program. But then putting people back in this environment drifts right back to baseline levels of behavior. So there's all these other competing demands, both respect to economy, time demands, availability, variability. This is organic, it must be healthier and so on. Drive-throughs that you've got to work your way through. Individual versus environment, where would be the more powerful place to intervene? Environment. I would think so. So our alternate approach to this is could we employ a system of optimal default surrounding our food environment, surrounding our portions and so on. Even going back to allowing people to know the calorie guidelines for example of what's on the menus. So we already know that in public health changing the environment results in effective outcomes at the population level. So that's why we have a variety of clean air law policies and so on and why we require immunizations for public schools and so on. When we're talking about the food environment and the obesity epidemic, we know that we have a set of very harmful defaults. We've got very large portions. We've got a whole lot of barely recognizable packaged food products when it comes to ingredient lists and chemical composition. Our culture has changed rather considerably and that people are eating out much more frequently than they did a couple of decades ago. Of course the food marketing and food business has radically changed in recent decades. Versus healthier defaults, whether or not we could have package labeling that was actually informative or more informative as opposed to not at all. Whether or not foods could be required to be reformulated. For example, with respect to trans fats or high-fructose corn syrup, certain additives, whether or not we might consider taxation for certain kinds of foods so much the way the tobacco industry has enacted change to incentivize healthier options. What's the word? Disincentivized? I don't know. Incentivize the healthier options and other things like menu labeling and then food marketing regulations. So I want to speak specifically about our focus for a few minutes about taxation and about menu labeling. With respect to menu labeling, and I have been involved in a couple of these studies where we're talking about trying to equip people with information about their food choices. Emily you talked before about how if you knew Caesar salad was almost 800 calories, you might opt for a hamburger instead. If that's what you happen to desire at the time you think you're making this healthier choice but due to a lack of information about that choice, you're just going based on. What may be you would suit with it. You saw a hamburger has all these fats and stuff that the salad can offer you better nutrition. Absolutely. Maybe so. You would make an informed evaluation, but it would be informed. That's the thought behind menu labeling is let people know. Give people as much information as possible and let them do accordingly. So there are studies about this where people were brought into a lab, given a set of menus and some tasks to do, like watch TV and evaluate the TV show or whatever. Hey, we're going to give you a free meal. Here are the calories of each of these menu. So that was a randomized control trials and people were randomized to receive calorie information. Some people were randomized to receive no calorie information. What we see is that the calorie labels really didn't make much of a difference. People still ordered the meals and each meal was around 1,600 calories. But when they received that information about how the average daily recommended intake should be about 2,000 calories, people replaced their choices in context. So you can see that they actually chose or ordered significantly lower calorie options. Another way of potentially changing the default surrounding food choices of the food environment would be to employ taxes. We see here what happened with respect to smoking rates for example. When New York State employed pretty hefty cigarette tax, when they really skyrocketed in the early 2000, smoking rates decreased. In turn it became much more difficult to purchase cigarettes. So this is the logic that informed the soda tax. So the soda tax is a suggestion and actually the Rudd Center, which is at the University of Connecticut and focuses on these types of policy issues put out a proposal to tax sodas, to incentivize smaller portions. What is the word? Discourage? Discourage. Thank you. So larger portion sizes. So the thought here is that this would decrease the consumption and reduce health care costs considerably. Also it generate revenue back to the localities that were employing this. But the issue with respect to why focus on soda is basically it contributes a lot to the calorie intake landscape on it on a daily basis. That's soda alone is the largest source of getting this non-nutritive high calorie diet. But there was some backlash. So when this policy reports came out, when this started to be talked about and policymakers were trying to push this through some of them. There was a pretty significant backlash and we can see a really radical increase in terms of how much the soda industry was willing to invest in saying no to the beverage tax. So they've got some power. Yeah. Just for context, what the National Education Association budget is for lobbyists and the children's health fund last year. So yeah, it speaks to where the priorities. Well, I don't know. Save that one for a happy hour or lunch or something like that. All right. So the point is as that this changing, the optimal defaults is not really as easy as we would like to believe it or would like to consider as being. So we as public health professionals have to consider this in context of a larger social consideration of a lot of what is out there it's personal responsibility. Well, it's the individual. The individual is not motivated. The individual needs to just do it and needs to eat healthier and exercise more. But we've got these extremely powerful environmental and socio-cultural messages even to the point of intervention at the public level. There's a lot of push back against that. Framing and positioning. Obviously, we as public health professionals know that personal responsibility is part of the equation, but there are a lot of factors that might undermine it. So how can we enhance the individual level? We want people to have access to being informed. We want them to have access to safe foods and ideally help children and other vulnerable populations to be free from commercial exploitation.
