No Really, Coke is Good For You, Trust Me

I just read this commentary from Coca-Cola CEO Muhtar Kent that is so incredibly duplicitous, I really cannot believe that even the Wall Street Journal would publish it without significant editing. Let me tell you the punchline upfront: shockingly the CEO of Coca-Cola Corp. does not believe that a tax on sugary drinks will help curb obesity (now you'll understand why the Wall Street Journal published it). Basically his argument boils down to...well it doesn't quite boil down to anything, so let me summarize: Coke has lots of calories, but so do lots of other things. People need to exercise more. And, oh yeah, I employ lots of people.

To support this rambling, Mr. Kent has a great deal of evidence and insight into why Coke is not responsible for Americans becoming obese. For instance, he first pulls out the favorite claim of the American Beverage Association and the National Restaurant Association, Coke doesn't make people fat — people make people fat:

If we're genuinely interested in curbing obesity, we need to take a hard look in the mirror and acknowledge that it's not just about calories in. It's also about calories out.

Let's see, calories in > calories out = weight gain. True fact. Now, there are two ways that one could mess with that statement: 1) increase calories out, or 2) decrease calories in. But why drop your calories in when you could have it all just by exercising more! In case that didn't persuade you, Mr. Kent moves on to playing the victim:

Our industry has become an easy target in this debate. Sugar-sweetened beverages have been singled out for demonization in spite of the fact that soft drinks, energy drinks, sports drinks and sweetened bottled water combined contribute 5.5% of the calories in the average American diet, according to the National Cancer Institute. It's difficult to understand why the beverages we and others provide are being targeted as the primary cause of weight gain when 94.5% of caloric intake comes from other foods and beverages.

Hmmm... Can't imagine why you would be singled out. Americans get one in twenty of our calories from soft drinks, which — as it clearly states on Coke products — are "Not a significant source of calories from fat, saturated fat, trans fat, cholesterol, dietary fiber, vitamin A, vitamin C, calcium and iron." Which leads Mr. Kent to his next argument (confused yet):

Research from the United States Department of Agriculture shows that added sugars, as a percentage of total daily available calories, have declined 11% since 1970. Yet the percent of calories from added fats and flour/cereal products has increased 35% and 13%, respectively, during that same time period.

That's right — the 5.5% of absolutely empty calories that you get from his products are MUCH better than the fat and carb calories you get from eating other foods. I wonder what the Snack Food Association and International Foodservice Manufacturer's Assocation thought when reading this and whether they are going to start a round-robin blame game. "It's cereals making kids fat!" "No, it's Twinkies!" No, it's soft drinks." Finally, Mr. Kent pulls out the trump card:

Policy makers should stop spending their valuable time demonizing an industry that directly employs more than 220,000 people in the U.S., and through supporting industries, an additional three million.

That's right — don't tax us or you'll lose your job (I'm sure Dave will especially love that one).

There's more I could pillory in the commentary. It is actually quite a feat to put so much unrelated garbage in a mere 724 words that he should be awarded some prize just for that. I'm not sure that a soda tax will work to curb obesity and I think that it is actually a pretty crappy policy. Sodas are not cigarettes; no one is going to be upset if you are drinking caramel coloring, carbonated water, and sugar next to them the same way that there was social pressure to stop smoking. If we are going to invest in obesity prevention, it would be a lot smarter to make physical activity a priority by ensuring access to safe neighborhoods with amenities for kids to be able to play. It would mean reducing the work week so that parents can have time to spend with their kids supervising them and being able to go to grocery store and prepare dinner rather than buy it pre-made. But, of course, that would require investment of government dollars and increasing taxes, which you know Mr. Kent would be opposed to no matter what.

Practical Research Problems

One area of my research studies how much physical activity people perform and how those factors might be related to the physical environment in their neighborhoods. One of the "gold standard" methods to complete this kind of data collection is to use accelerometers to measure how much physical activity people do during the day. There are obviously problems, people forget to wear them, or they occasionally malfunction, but overall you expect pretty reliable physical measurements from them. One particularly innovative intervention is to use an automated text-messaging system to remind kids to be active based on their accelerometer readings.

Proving that you can take nothing for granted in research, there is one way that several industrious kids (in a different, London-based study) figured out how to get around the read-outs of the accelerometers, attach them to their dogs!:

The Health Blog was impressed by the cleverness of some 11- and 12-year-old obese children in east London, who were participating in an exercise research study.

The kids were supposed to be wearing pedometers to measure the number of steps they were taking each day. But some of those in the study got the bright idea to clip the pedometers to the collars of their pet dogs, upping the distance the youngsters appeared to be moving each day, according to the BBC. (WSJ Health Blog)

I've got to hand it to those kids, that's a pretty smart idea.

Healthy Eating: Easier Said Than Done

This article features a Milwaukee farmer, Will Allen, who, through hard work, natural charm, and, of course, ability, sustains a thriving farm a mile away from a Milwaukee housing project.

My heart gets all melty on the subject of our failure to provide quality food to the poor - not only because of the tragedy of people in poor areas having access only to the crappiest of food and sometimes dying because of it, but until recently, I found it hard to believe that obesity and other problems related to eating poorly are sometimes out of the control of people who suffer from it. Turns out not everyone lives in the suburbs near a grocery store and owns a car.

First, the disbelief. It used to be the case for me that when I saw obese people, I assumed not that they were malnourished, but that they were simply eating too much - of whatever, I didn't really know or care. But often what is actually happening is that they are not eating the right foods because they can't afford to buy the right foods. In the Will Allen profile, Mr. Allen claims that the Pick n' Save nearest to the housing project is a three-mile trip. If you don't have a car, you're going to march to the nearest place, which is likely to be a fast food joint or convenience store. Imagine making meal after meal of 7-11 products. You'd get few vitamins and you'd probably put on a few pounds. But when we see an overweight person, the first thought for many of us is not usually, "you need to be eating more foods that are good for you." It's "you need to eat less."

Also, I think our country has kind of a screwed up political narrative about this. For example, I've heard it argued (but am too lazy to do the actual research to confirm) that food stamps largely cover not-so-nutritious food. If that's true, I think it's because of tax-haters and also because the words associated with "urban farming" are not "healthy," "job creating," and "fun," but rather "out-of-touch," "liberal" and "organic." So, if someone were to buy locally-grown organic romaine lettuce at a farmers market with food stamps, a politician may get up on a dais and scream, "This is an excess and an outrage. I pledge to save the taxpayers of this great state millions of dollars by reforming the program so that we all have to make sensible choices." Or, "providing children with free and reduced lunch is a waste of taxpayer dollars. We need to take responsibility as a society and pack nutritious meals for our children, or pony up the cash to buy them." Meanwhile, parents working for low-wages and long hours do not have time to pack their children healthy meals, and corporate suppliers are paying and lobbying the same characters to guarantee that their white bread and peanut butter are food-stamp-eligible and/or sold in public schools.

What I find most disheartening is the child obesity risk presented by unequal access to healthy food, because it leads to horrible problems like heart and kidney disease. But as demonstrated above, it's not always a matter of "laying off the cookies and chips." It's often an access issue, and that's what farmers like Will Allen are trying to get to - access.

It would be an interesting experiment to use state or federal funds, or even private grants to start up more urban farms in currently vacant lots in Detroit, Philadelphia, Jackson, and elsewhere. It would create jobs, a marketplace, healthy food, and a great sense of community.

Other than that, much better qualified people than myself have proposed policy solutions. Organizations like Grist, Wholesome Wave, and the Philadelphia Food Trust seem to be doing a lot of interesting and good work towards equity and access to healthy food.

Swine Flu Reruns

Swine flu PSAs from the last swine flu outbreak in the 1970s. I hope that Obama's people (including Sebelius finally!) come up with better ads than these. But, in the kitsch department they are hard to surpass:

For those who might desire a more substantive discussion of the swine flu situation from people who actually know what they are talking about, let me recommend Aetiology and Effect Measure. Both are written by epidemiologists who have a great way of explaining what is going on in the news.

Public Health Emergency? Call Secretary--...Oh.

Do you think now that we have a public health emergency the Republicans will deign to confirm Kathleen Sebelius? Even though swine flu doesn't seem to be epic, it's a pretty big albatross around the neck of the Republicans in 2010 if even one person in America dies. I see an analogy forming: Public Health:Democrats::Security:GOP.

On a related note, here.

University of Hypocrisy

Today, Mark Blumenthal reports that the American Association of Public Opinion Researchers (AAPOR) censured Dr. Gilbert Burnham who is one of the authors of the Iraq War casualty paper.

Burnham was censured for not disclosing all of the study materials that were requested by AAPOR in their investigation, although it seems like he turned over just about everything. One of the main pieces that AAPOR claims was not turned over (though the allegations of what Burnham actually failed to be turned over is nowhere in the AAPOR press release) is the question wording. But, it seems (as Blumenthal notes), he did release his question template. Granted, it is not a survey instrument; but, I wonder if AAPOR has an Arabic translator to read the actual survey instrument -- and if so, how many members of AAPOR would be able to understand it. In response to the press release, at least two people (Blumenthal and Science blogger Tim Lambert) asked AAPOR to clarify what, exactly, Burnham failed to release to AAPOR. The answer

We do not provide public reports of the investigations but if there are other specific questions that I could answer, I would be happy to try to do so.

Basically, Burnham gets censured for not turning over all of his materials for review by an organization (of which, it should be noted, Burnham is not even a member) that cannot be bothered to turn over their own evidence used in the report. I have a lot of respect for AAPOR, and think that they did some great things during the election—aided tremendously by Mark Blumenthal—to make sure that the public and journalists knew how to interpret polls, but this is just absurd.^[1] What's good for the goose...

I am all for more transparency in data. I think that more needs to be done in social science (and public health) to deal with replication and increasing access to data^[2]; however, for an organization to claim that they can censure a non-member for ethical violations and then turn around and violate the same spirit of their rule strikes me as something members of AAPOR (I am not one) should address.

^[1] As a side note, I should mention that there are some problems with the Iraq studies. Their response rate is very high, particularly since they only went to sampled houses on a single day (although this National Journal summary quotes famous soc blogger Kieran Healy noting that this response rate is not unusual for Iraq) and, because of their sample size, the confidence intervals are very, very large. The appropriate venue for such debates, however, is in the academic press to challenge the validity of the findings, not for some organization to nitpick on violations of ethics of non-members.

^[2]In fact, a recent special issue of Sociological Methods & Research pertains to this very issue. I highly recommend the issue of the journal for many of the interesting points that are raised.