The explosion in obesity

This chart comes courtesy of Tim Iacono, and it absolutely blew me away. I knew that obesity rates had been soaring, but I didn't appreciate how much and how quickly.

Every state in the country has seen an increase in obesity over the last 20 years, and many of these increases have been dramatic--consider that in 1994, not a single state had an obesity rate greater than 20%, but by 2008, only one state (Colorado) has a rate below that same 20% threshold. Tennessee and Oklahoma somehow pulled off the incredible feat of going from sub-15% to over-30% during this time period. Yikes.

Ultimately, this map raises as many questions for me (Why did it soar so quickly? Is it a result of a broad-based change in our food supply? Or is it due to a change in behavior in response to economic factors, like consistently "accommodative" monetary policy?) as it does concerns (How the hell are we going to afford to pay for all the health problems that this obesity creates? Am I totally certain that I'm doing everything in my power to avoid becoming part of that statistical trend?). I think this dynamic therefore has incredibly wide-ranging implications for our nation, encompassing issues both political and societal, and both in terms of public health and economic sustainability.

Along with the fate of Social Security and other public and private pension plans, I think that this dynamic will turn out to be one of the most important ones to keep track of over the next 20 to 25 years. How we as a society decide to deal with our ever-growing group of elderly citizens, as well as our overweight (or otherwise unhealthy) citizens will in large part determine the fate of our nation as a whole. Stay tuned.

How I'm contributing to Bolivian obesity

Yes, you read that headline properly. It's sometimes odd to consider how individual actions can have impacts on people in cities, states, and countries that we know little about and have never visited, but such is life in the increasingly flat world in which we all live. In the same way that weather conditions in Australia can have a significant impact on global food prices, seemingly innocuous decisions and behavioral shifts by American consumers can have wide-ranging effects around the world.

That was the essence of this article from the New York Times, which discussed the very strange dynamic that has taken hold in Bolivia as a result of the American consumer's growing taste for quinoa, a food that I eat quite a bit of.

With an exceptional balance of amino acids, quinoa... is virtually unrivaled in the plant or animal kingdom for its life-sustaining nutrients.

But while Bolivians have lived off it for centuries, quinoa remained little more than a curiosity outside the Andes for years, found in health food shops and studied by researchers — until recently.

Now demand for quinoa is soaring in rich countries, as American and European consumers discover the “lost crop” of the Incas. The surge has helped raise farmers’ incomes here in one of the hemisphere’s poorest countries. But there has been a notable trade-off: Fewer Bolivians can now afford it, hastening their embrace of cheaper, processed foods and raising fears of malnutrition in a country that has long struggled with it.

The shift offers a glimpse into the consequences of rising global food prices and changing eating habits in both prosperous and developing nations. While quinoa prices have almost tripled over the past five years, Bolivia’s consumption of the staple fell 34 percent over the same period, according to the country’s agricultural ministry.

The resulting quandary — local farmers earn more, but fewer Bolivians reap quinoa’s nutritional rewards — has nutritionists and public officials grasping for solutions.

Ironically enough, many Bolivian farmers are using their financial windfall from quinoa exports to buy cheap processed American foods like white bread and Coca-Cola, causing a spike in malnutrition rates.

So perversely, by looking out for my own health and nutrition, I'm in fact indirectly causing a deterioration in the health of the very people who enable my decision. Kinda sucks when you think about it, but what is the alternative? Yes, I could figure out a way to grow my own quinoa, but doing so would deprive the Bolivians of their income--it seems like the conscientious American consumer's options are to either contribute to Bolivian poverty or else contribute to Bolivian obesity. Which is better? Does it matter?

These are always difficult questions to answer, and I struggle with them a lot. Here in America, we often try to save the world, but sometimes our actions end up doing more harm than good. Does that failure mean that we're better off doing nothing, or is there value to our good intentions? I'm ambivalent... what do you think?

[New York Times]

Gyms experiment with incentivization

Given my obvious interest in obsession with the topic of incentives, I was interested by this Boston Globe article (a couple of weeks old, but new to me).

Every year, we resolve to hit the gym more often and get fit. And by the end of January, many of us have missed workouts or given up altogether.

According to Yifan Zhang, a 2010 graduate of Harvard College, part of the problem is that customers see gym membership fees as money spent, or “a sunk cost, especially if you pay at the beginning of the year.’’ That prompted the idea for Gym-Pact in Boston, which she created with Harvard classmate Geoff Oberhofer.

Gym-Pact offers what Zhang calls motivational fees — customers agree to pay more if they miss their scheduled workouts, literally buying into a financial penalty if they don’t stick to their fitness plans. The concept arose from Zhang’s behavioral economics class at Harvard, where professor Sendhil Mullainathan taught that people are more motivated by immediate consequences than by future possibilities.

Zhang and Oberhofer translated that principle to workout motivation. If missing a workout cost people money, they’d be more motivated to stick with it, they thought.

In general, I tend to think that people respond more powerfully to incentives (positive inducements) than they do to punishments (negative impacts)--hence the proliferation of white-collar crime. But the immediacy dynamic that is cited in this piece is interesting and important--people respond to incentives most powerfully when the payoff is immediate, less so when it is delayed. That psychological tendency in large part describes the puzzle of why people (in general) do not work out more often.

I think that testing a concept like Gym-Pact suffers from some design problems (specifically, self-selection bias), given that it would take a very unique type of gym-goer to opt in to such a program. That is to say, the people most likely to choose to sign up for such a program are those who are most likely to remain vigilant about their workouts--a self-fulfilling prophecy of sorts. I'd be surprised if anyone who knew (or suspected) themselves to be lazy or fickle about their workout schedule would choose such a program, knowing that there was a high likelihood of a financial punishment. But it's an interesting concept nonetheless.

[Boston Globe]

America is dying

Or, it soon will be... that's the only explanation for this:

Yup, that's exactly the kind of innovation we're looking for to get us out of this economic mess. Better yet, pizza with a cookie crust! Now we're talking...

A great one from the Journal of Consumer Research

As you can probably tell from my lack of posts yesterday, I'm not yet fully recovered from my trip back from Italy. I fell asleep at my desk about five times yesterday, and I'm still pretty out of it. But I came across this study from the Journal of Consumer Research, and the abstract alone was intriguing enough for me to write a post about it. Essentially, the researchers conclude that credit cards make you fat (though they use bigger and more confusing words...how I miss academia). Emphasis is mine.

Some food items that are commonly considered unhealthy also tend to elicit impulsive responses. The pain of paying in cash can curb impulsive urges to purchase such unhealthy food products. Credit card payments, in contrast, are relatively painless and weaken impulse control. Consequently, consumers are more likely to buy unhealthy food products when they pay by credit card than when they pay in cash. Results from four studies support these hypotheses. Analysis of actual shopping behavior of 1,000 households over a period of 6 months revealed that shopping baskets have a larger proportion of food items rated as impulsive and unhealthy when shoppers use credit or debit cards to pay for the purchases (study 1). Follow-up experiments (studies 2–4) show that the vice-regulation effect of cash payments is mediated by pain of payment and moderated by chronic sensitivity to pain of payment.

I wonder further if our shift from a cash-based economy to a credit (or debit)-based economy has further increased the amount of impulse buying across all categories. It's a lot easier to throw down a credit card and sign on a dotted line than it is to go to the bank, withdraw cash, and then physically hand over the bills. This dynamic is especially acute on larger purchases, where we'd certainly think a little longer before handing over $500 for a handbag (for example) if we had to do in hard currency.

Even if we are living within our means (and many who use credit cards are not, which is a whole separate issue), it seems that the increased use of plastic has meant worse consumer choices. We are more likely to spend conspicuously, to make large purchases, and apparently to buy junk food with cards than with cash. Obviously the increased use of credit (and fractional reserve banking) has enabled the growth of our economy that we now hold dear, but I wonder if some of the unintended consequences of credit are worse than we might appreciate. Strange unintended consequences like this one are particularly troubling.


[Journal of Consumer Research]
(h/t Naked Capitalism)

Revisiting self-defeating behavior

Last week, I wrote a post about self-defeating behavior, focusing on the fact that Americans' most frequent "moderate physical activity" actually consists of preparing themselves a meal. I was therefore amused to read this piece in The Observer, entitled "Why exercise won't make you thin". To summarize,

More and more research in both the UK and the US is emerging to show that exercise has a negligible impact on weight loss... The Mayo Clinic, a not-for-profit medical research establishment in the US, reports that, in general, studies "have demonstrated no or modest weight loss with exercise alone" and that "an exercise regimen… is unlikely to result in short-term weight loss beyond what is achieved with dietary change."

"It's simple maths," says Professor Paul Gately, of the Carnegie Weight Management institution in Leeds. "If you want to lose a pound of body fat, then that requires you to run from Leeds to Nottingham, but if you want to do it through diet, you just have to skip a meal for seven days." Both Jebb and Gately are keen to stress that there is plenty of evidence that exercise can add value to a diet: "It certainly does maximise the amount you lose as fat rather than tissue," Jebb points out. But Gately sums it up: "Most people, offered the choice, are going to go for the diet, because it's easier to achieve."

First of all, these kinds of conclusions (and headlines) are incredibly dangerous for the average reader, and border on irresponsible journalism. While "exercise alone" will rarely help you LOSE weight, it is absolutely essential for maintaining weight and preventing weight gain. Clearly, calorie ingestion is the biggest lever when it comes to effecting weight loss, especially since we all typically eat too much to begin with. You don't need to burn what you never ingested. If you're obese, start by eating less, not by walking on a treadmill.

But buried deep within The Observer's semi-sensational article is one of the more important points--that of the self-defeating behavior (emphasis mine).

In what has become a defining experiment at the University of Louisiana, led by Dr Timothy Church, hundreds of overweight women were put on exercise regimes for a six-month period...Against all the laws of natural justice, at the end of the study, there was no significant difference in weight loss between those who had exercised – some of them for several days a week – and those who hadn't...Some of the women even gained weight.

Church identified the problem and called it "compensation": those who exercised cancelled out the calories they had burned by eating more, generally as a form of self-reward. The post-workout pastry to celebrate a job well done – or even a few pieces of fruit to satisfy their stimulated appetites – undid their good work. In some cases, they were less physically active in their daily life as well.

This study (and its conclusion) seems to be MUCH more important than those on which The Observer chooses to focus. Exercise certainly isn't useless, as the headline of the article seems to want to indicate. It may not be as efficient as a diet in terms of losing weight, but it is certainly longer-lasting and absolutely essential as a prevention tool. But if you're using your exercise as an excuse to eat more terrible food, well you're just going to be treading water (or, doing this).

I really hope that people don't read articles like this and use it as fuel for their self-defeating behavior, missing the important points buried within. While headlines like these easily generate clicks and page-views, they only confuse the public as to what they should or shouldn't be doing to lead a healthy lifestyle. So seriously, people, go to the gym.

[The Guardian]

Self-defeating behavior at its best

There are any number of paths to take when discussing the obesity epidemic in America, and most of them have been beaten to death. We are all basically aware by now that obesity rates have gone parabolic in the last two decades, doubling in adults and tripling among children. Reasons are well-documented--we're not exercising enough, we're eating too much, we're eating the wrong foods, the quality of food produced has declined, ad nauseum.

But a study published yesterday in the American Journal of Preventive Medicine placed a new spin on the issue, finding that Americans are in fact engaging in self-defeating behavior when it comes to their health. In a study that categorized activity by type (sedentary, light, moderate, and vigorous), doctors found that:

Only 5.07 percent of Americans reported doing any vigorous-intensity activity like running, while at the other end of the scale, more than 95 percent said they had engaged in the highly sedentary activity of eating and drinking. The next most common activity was another sedentary one -- watching television or a movie, which eight in 10 Americans did.

The "most frequently reported moderate activities were food and drink preparation (25.7 percent), followed by lawn, garden, and houseplant care (10.6 percent)," the study said.

It's already been well-documented that relatively few Americans are engaging in sufficient vigorous exercise. But I think that the finding that the most frequent moderate activity (the next level below vigorous) was preparing a meal is more interesting. I'm not even certain how this qualifies as a moderate activity to begin with, but it's the absolute epitome of self-defeating behavior. The only thing I can imagine that would be worse would be if Americans' most vigorous activity in a day was to get in their car and drive to the McDonald's drive-thru.

Self-defeating behavior is never pretty, and it's something that I've discussed in multiple contexts already on this blog. But this is a new one, and I don't have much to add on the topic except to shake my head and say, "wow".

[PhysOrg.com]