̽��ֱ�� of Cambridge - Thomas Burgoine

Why we just can't stop eating: the complex truth behind obesity

cjb250 — Mon, 23 Jul 2018 08:27:40 +0000

Britain has seen a dramatic transformation in recent years in its attitude towards food. We have gone from being a country ridiculed for its bland, carb-heavy cuisine, for whom the chicken tikka masala was the height of exoticness, to becoming a nation obsessed with food.

But alongside this obsession with food has come a growing understanding of the impact that our diet has on our bodies – not only on our waistlines, but also on conditions such as diabetes, heart disease, cancer, and even dementia.

This relationship between our diet and our weight is simple: you eat too much, you get fat. Hence, some would argue, the solution should be equally simple: you eat less, you lose weight.

If only it were this easy. Anyone who has tried to shed a few pounds – and, crucially, to keep them off – knows that the answer is rarely so straightforward. In fact, even the food – and volume – that we ‘choose’ to eat is influenced by a surprising number of factors.

Obesity is often characterised as nothing more than greed and lack of willpower. ̽��ֱ��truth is far more complex.

Cedric Bousquet

Chattering teeth

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Neighbourhoods with more takeaways amplify social inequalities in unhealthy eating and obesity

cjb250 — Wed, 11 May 2016 18:00:57 +0000

̽��ֱ��study from the Centre for Diet and Activity Research (CEDAR) at the ̽��ֱ�� of Cambridge, suggests that policies to improve the food environment in towns and cities could be helpful in tackling social inequalities in diet and health.

Nearly two-thirds of adults are overweight or obese in the UK, and it is thought that this may be due in part to increased takeaway food consumption: the amount spent on takeaway foods over the past decade has risen by almost a third (29%) in the UK, where £28 billion worth of takeaway foods are now purchased annually.

To observe the relationships between neighbourhoods, education, diet and obesity, researchers at CEDAR used data from a cohort of almost 6,000 adults aged 29–62 years in Cambridgeshire. Individuals were asked about their highest educational attainment, eating patterns, were weighed and measured by trained researchers, and had the density of takeaway outlets in their home and work neighbourhoods calculated. ̽��ֱ��results are published today in the American Journal of Clinical Nutrition.

For the first time the researchers observed consistent differences in diet and weight by education at all levels of neighbourhood exposure to takeaway outlets. Furthermore, where exposure to takeaway outlets was greatest, differences in diet and weight across education groups were most pronounced. In other words the availability of takeaways seemed to be amplifying existing social inequalities.

Individuals with greatest exposure to takeaway outlets consumed around a third more unhealthy takeaway food per day if they were the poorest educated (47g per day) than if they were highest educated (36g per day). Over a year, this is the equivalent of over 4kg of extra unhealthy food. ̽��ֱ��least educated also had the greatest risk of obesity where the exposure to takeaway outlets was highest.

̽��ֱ��findings confirm previous studies showing that takeaway food consumption, weight and the likelihood of being obese are all associated with either living or working near high numbers of takeaway food outlets. They also strengthen the evidence showing that eating takeaways and being obese are linked to socioeconomic disadvantage, indicated by a low level of education.

“Neighbourhoods are clearly important in shaping what all of us eat, no matter how educated we are,” explains Dr Thomas Burgoine from CEDAR, part of the Medical Research Council Epidemiology Unit at the ̽��ֱ�� of Cambridge. “But this effect appears to be much greater for those with lower levels of education.”

Compared to those least exposed and most educated, those most exposed and least educated were over three times more likely to be obese. Dr Burgoine says: “This double burden of neighbourhood and individual level disadvantage goes some way to explaining current UK socioeconomic inequalities in levels of obesity – in other words, why we see more obesity in disadvantaged groups.”

̽��ֱ��researchers used low educational attainment as an indicator of individual level disadvantage. Low educational attainment is commonly associated with lacking behavioural and economic resources, such as cooking skills, food and nutrition knowledge, adequate cooking equipment and a shopping budget that affords healthy purchases, which may increase the influence of an unhealthy neighbourhood food environment.

Dr Pablo Monsivais, senior author of the study, adds: “Higher educational attainment brings with it many advantages, including more money to spend on fresh, healthier foods, as well as better knowledge of food and nutrition, and the tendency to dedicate more time to preparing meals at home, which we know are healthier than those bought out of the home. Without these advantages, people may be more vulnerable to their environment.”

̽��ֱ��findings suggest that efforts to improve diets and health by regulating the number of takeaway outlets on our high streets might be particularly effective for those of lower socioeconomic status and therefore help to reduce inequalities in diet and obesity. Such policies are already beginning to be implemented in a number of UK regions and in south Los Angeles, for example. In the UK, people living in deprived neighbourhoods are generally exposed to higher numbers of takeaway food outlets.

“Our results suggest that these policies will be effective across socioeconomic groups, but, critically, particularly for the most disadvantaged. This could help to reduce socioeconomic inequalities in diet and health,” says Dr Monsivais. “This is important because attempts to encourage more healthy living at an individual level have largely failed to reduce health inequalities. This failure has been attributed to such initiatives proving especially ineffective among disadvantaged populations.”

̽��ֱ��study was funded by the British Heart Foundation, Cancer Research UK, the Economic and Social Research Council, the Medical Research Council, the NIHR and the Wellcome Trust.

Reference
Burgoine, T et al. Does neighborhood fast-food outlet exposure amplify inequalities in diet and obesity? A cross-sectional study. Am J Clin Nutr; 11 May 2016; DOI: 10.3945/ajcn.115.128132

People who live or work near to a greater number of takeaway outlets are more likely to eat more takeaway food and to be overweight, but new research indicates that neighbourhoods that are saturated with fast food outlets may be particularly unhealthy for people who are socioeconomically disadvantaged.

Neighbourhoods are clearly important in shaping what all of us eat, no matter how educated we are. But this effect appears to be much greater for those with lower levels of education.

Thomas Burgoine

Graham Holliday

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Opinion: Local takeaways create a double burden for obesity

Anonymous — Wed, 11 May 2016 08:13:24 +0000

People in the UK are spending more than ever on takeaway food and there’s good reason to believe that this is contributing to the nation’s obesity problem. Two-thirds of UK adults are either overweight or obese.

But the amount of excess weight the nation is carrying isn’t equal. On average, people in socially disadvantaged groups – those less educated or on lower incomes – are more likely to be overweight. This can be explained by the fact that the socially disadvantaged tend to have less time for cooking, less knowledge about healthy eating and less money for healthy food. Levels of takeaway food consumption are also greater in disadvantaged groups.

Disadvantage can also be environmental. We know that disadvantaged neighbourhoods tend to have greater numbers of takeaway outlets. Although all UK neighbourhoods have become less healthy in the last two decades, disadvantaged neighbourhoods have become unhealthier fastest. It would seem to make sense then that unequal neighbourhoods could be contributing to unequal waistlines.

“But I never use my local takeaway”

This, of course, assumes that neighbourhood food access influences what people eat and how much they weigh. A growing body of evidence suggests that it does. In an analysis, using data on nearly 6,000 people from the Fenland Study in Cambridgeshire, we showed that the greatest neighbourhood exposure to takeaway food was linked to consuming the equivalent of an additional serving of French fries per week and nearly doubling one’s odds of obesity.

We might like to believe that we make entirely free choices about what, when and where to eat. And we often hear from people that they never use their local takeaway outlets. But given that we need to buy our food from somewhere, we’re all influenced to some degree by what’s on offer within our environment. For people living or working in areas full of takeaways but short on healthier options, unhealthy choices are likely to be the easiest or only option. Among our Cambridgeshire adults, as many as 47 takeaway outlets were present within just a mile of one person’s home. And growth in the takeaway sector over two decades outpaced that of supermarkets, convenience stores and restaurants, so our environment has become more imbalanced towards greater availability of takeaway food.

Understanding levels of influence

Our new study explores the interplay between social disadvantage and access to neighbourhood takeaway outlets. We used low educational attainment as a marker of social disadvantage – so it’s also an indication of lacking the social, economic, behavioural and psychological resources that might leave people more vulnerable to their environment. For example, less well off consumers are particularly price sensitive, and may be disproportionately affected by the lure of takeaways serving large portions at low prices.

This picture of the effects of a disadvantageous unhealthy neighbourhood being compounded by social disadvantage came through clearly in our analysis. People with the greatest exposure to takeaway outlets consumed a third more unhealthy takeaway food per day if they were the least educated than if they were highest educated. These differences would add up over a year to an additional consumption of over 4kg of unhealthy food. By comparison, people with least exposure to takeaway outlets consumed only a fifth more takeaway food if they were least educated.

In the paper, we also compared the odds of being obese for those facing this double burden of individual and neighbourhood disadvantage. We found that those least educated and most exposed to takeaways were three times more likely to be obese than the most educated and least exposed.

So while neighbourhood takeaway food access is important in shaping everyone’s diet and weight, the effects seem to be greater for those with less education. This means that where takeaways are most abundant, inequalities in diet and obesity are likely to be amplified.

What’s the takeaway message?

̽��ֱ��good news is that this situation can be addressed. Fixing the food environment alone isn’t going to cure the obesity crisis, but healthier food choices can be better supported by modifying and shaping the geography of food access across our neighbourhoods.

Our results suggest that if we reduce takeaway access in particular, this will not only benefit all social groups, but will also minimise differences in consumption between social groups. Changing neighbourhoods may seem like a radical step, and there may be challenges, but such efforts are currently underway and are endorsed by NICE, Public Health England, the Greater London Authority and the Academy of Medical Royal Colleges.

Traditional individually-focused efforts, such as improving nutrition knowledge and cooking skills, may also be important but their success will be limited if we continue to live in neighbourhoods that make unhealthy choices the easy and cheap option. ̽��ֱ��effects of takeaway food outlet access on diet and weight and the implications of this access for social inequalities are now being realised by researchers and public health bodies and constitute a potentially important point of intervention for improving the health of all of us.

Thomas Burgoine, Career Development Fellow (Post-doctoral Research Associate), ̽��ֱ�� of Cambridge and Pablo Monsivais, Senior ̽��ֱ�� Lecturer, ̽��ֱ�� of Cambridge

This article was originally published on ̽��ֱ��Conversation. Read the original article.

̽��ֱ��opinions expressed in this article are those of the individual author(s) and do not represent the views of the ̽��ֱ�� of Cambridge.

Thomas Burgoine and Pablo Monsivais (Centre for Diet and Activity Research) discuss how takeaways can make social inequality worse.

Jeremy Tarling

Fish and chips

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