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Wednesday, 12 February 2014

Minimum Pricing of Discretionary Calories as a Potential Government Intervention.



As a general rule, I think it's safe to assume that cheap energy foods are driving the obesity epidemic.
I'm talking about sugar in drinks and lollies, flour in pasta and noodles and bread (one only has to include potatoes, normally a respectable enough vegetable, after deep frying and other extreme processing) and cheap oils. And the mixture of all 3 in biscuits, pastries, cakes, and "treats".

These are the foods the consumption of which has increased during the obesity epidemic. WHO reports that consumption of animal fats has decreased, but total fat consumption has increased. Where intake of calories has increased, these are the foods supplying the extra.

To give only one example, this paper (Behavioral risk factors for obesity during health transition in Vanuatu, South Pacific) found that

"Both the nutrient content and the preparation methods of tinned fish likely contribute to its association with obesity. Tinned fish canned in oil or sauce has higher fat content than most types of fresh fish (
). Furthermore, based on our observations, tinned fish and meat are often served with instant noodles and rice, whereas fresh fish and meat more often accompany dishes made with traditional root crops and vegetables, which are less calorie-dense by comparison. A heavy reliance on tinned fish in urban areas was noted during the first known nutrition survey conducted in Vanuatu in 1951 (), and has been observed in many areas of the Pacific ().
Our findings are similar to those of the Vanuatu Ministry of Health 1998 NCD survey, which highlighted associations among obesity and daily consumption of nontraditional fat sources (OR=2.19), including oil, margarine/butter, milk, fresh meat, poultry, tinned meat, and tinned fish (). However, our analyses suggest that tinned fish might contribute more to the risk of nontraditional fats compared to fresh meat (including poultry). In fact, including fresh meat in the nontraditional fats category might actually weaken the observed association, since this emerged as a protective factor in linear regression models, perhaps because fresh meat displaces other less healthy options in the diet."

Tinned fish eaten in the Pacific is canned in soy oil. This, as well as the fact of it being eaten with instant noodles or rice, cancels out the antiobesigenic effects of fish oil omega 3 fatty acids (and, indeed, of protein) in the manner described in this review (Of Mice and Men; Factors abrogating the antiobesity effect of Omega-3 fatty acids).

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In the USA, consumption of omega 3 has remained low, but that of omega 6 has climbed
Now it may be that butter is fattening, but this does not mean that it drives obesity (to do this a food has to not only supply energy, it also has to promote fat storage and overeating; there are particular hormonal pathways for this and every fat or carbohydrate or combination of the two doesn't influence these pathways to the same extent or even in the same direction - see the Of Mice and Men paper again - here is where a calorie is not a calorie). But let's assume, for avoiding arguments' sake, evidence to the contrary notwithstanding, that butter and soy oil are equally fattening at 9 calories per gram.
500 grams of butter, in New Zealand costs $4-5.
At $8.49 for 2 litres, soy oil is half that price per calorie.
Extra virgin olive oil, which everyone thinks is healthy, is $11.99 a litre, only a little more expensive than butter. Still cheap for 9,000 calories.
The idea of a minimum price, rather than a tax, is twofold; people might choose to use less fat because the cheapest fats would cost more. But the fats that are nutritious (butter is an important source of fat-soluble vitamins) or healthful (olive oil is thought to contain beneficial antioxidants) would not be affected, if their price were to be used as the benchmark for a minimum price for all fats.

How would this apply to sugars?
White sugar costs $1.91 for 500g (it gets complicated here because sugar becomes much cheaper in bulk, more nutritious sweeteners not so much.
Honey (the cheap clover variety) costs $5.19 for 500g. If that's too high a price for sugar, let's look at the least refined form of sugar - treacle. At $6.75 per Kg (price from cache), more than sugar (especially bulk sugar) but still cheap for 4,000 calories.

(Note: I am using prices from the Countdown website because they are available and internally consistent. I shop at Pak'nSave in Auckland so I'm used to prices being a bit lower. The examples I've used here are just that - examples).

From here on in, it's a job for experts. Foods have different prices per calorie at different sizes. It's relatively easy doing this with pure fats and sugars, it will be harder for me to calculate, say, for noodles vs potatoes without knowing the carbohydrate %. (I'm not an economist, I'm not even a shop assistant.)
But here we have white bread - only $1.48 for 600g.
And here's wholemeal bread, at $3.99 for 750g, about twice the price. Not much of a comparison here as the wholemeal bread is likely more processed than the white bread (read the label people, apparently it is no longer possible to bake bread without adding soy protein and a bunch of other non-traditional additives), but still, Government think it's healthier, and maybe it still is, and Government will be the ones responsible for administering any antiobesity food pricing system or tax.
And I'd rather they altered the food environment by pricing up the cheap, empty calories to be closer in price to the more nourishing ones, as opposed to taxing all fats (which would increase the cost of butter or olive oil more than that of soy or corn oil, because they cost more to start with), or taxing saturated fat, which would miss out gutter oils and cheap calories altogether. Similarly, taxing sugars would increase the price of honey or molasses more than that of white sugar or HFCS.
And yes, I know all the arguments as to why honey is so little different from sugar/HCFS as to make no difference. Those arguments apply if you think fructose is uniquely toxic, or if you're treating a condition for which carbohydrate needs to be restricted. But in the context of this discussion, how many people do you know who became obese eating honey without eating other junk carbohydrates? Honey has a flavour which tends to prevent it being overused in cooking in quite the same blithe way that sugar can be. And, low vitamin content and mere traces of minerals notwithstanding, it's a complete food for many of the bees in a hive. And it's well Paleo too, hunter-gatherers lap it up. Any regime of food pricing for health has to be about Lesser Evils, not Perfect Diets.
Based on these examples, we might come up with a minimum price of 0.1c per calorie (Kcal of course, food calories are always Kcal in physical terminology). This would give us a minimum price of $9.00 for a litre of soy or olive oil, $4.50 for 500g of butter, $4.00 for 1kg of sugar or honey. This conveniently rounded, decimal rate is almost perfect for these foods at present prices, and works across fat and sugar.

However, a Big Mac, at 492 calories, would have a minimum price of 49c. It has the more expensive protein in it, and the cost of extra labour and overheads, so it already costs more than that. Large fries would have about the same minimum price as a Big Mac, but are cheaper than Big Macs in reality (no meat, fries are just starch and oil). Processed fast food would need a higher rate, if you did want to target those calories. I'm not singling out McDonalds for effect; a KFC menu gives much the same result. But this does show targeting junk food won't catch the cheapest and emptiest calories, just some of the foods most likely to be addictive. And a change of price at the supermarket is a way of educating people about the quality of their food, which may carry over into the fast food environment. And far and away, calories consumed at home still outweigh those eaten at fast food joints.

Food Spending, Smaller

So, back to the drawing board? I've taxed the limits of my rudimentary comprehension here. My brain hurts already. No more sums for me, but feel free to add your own.

Postscript; minimum pricing for one source of empty calories, alcohol, is already under investigation.
Much of the logic behind this initiative is similar to the the arguments I've raised.

 Let’s say the rate was set at $1.20. A 750 ml bottle of wine with 13 percent alcohol content has 7.7 standard drinks so could not be sold for less than $9.24. Not really much of a change there. However, a 3-litre cask of wine with 12.5 percent alcohol content contains 30 standard drinks so could not be sold for less than $36 – more than twice the current retail price.

And the drawbacks listed at the end of the article also apply to minimum pricing on food.

However, minimum pricing is not a magic bullet and is likely to have different effects on different populations. New Zealand is likely to be far more successful in reducing the use and misuse of alcohol across the spectrum if minimum pricing is introduced alongside a wider suite of policies.
For starters, without the recommended increase in the excise tax on alcohol or other similar measures, the additional revenue gathered under minimum pricing goes to the alcohol producers. In Canada, the state is the retailer, so this is not an issue. However, in New Zealand, this would be a lost opportunity for government, where even a small price increase is likely to result in significant additional revenue. That revenue would go a long way towards funding other harm-reduction activities, such as treatment, prevention or education. Perversely, if left in the coffers of the alcohol industry, it could be spent on measures designed to increase alcohol consumption (for example through increased expenditure on marketing).





29 comments:

AlmondD'oh said...

Tax the instant noodles to subsidize for butter? Unhealthy "foodstuffs" are a whole lot cheaper, and more accessible for the poor. But making empty calories more expensive doesn't solve the problem: it just means the poor would have a lot less to eat.

At the local food bank, you are only allowed to donate non-perishable foods. I bought some crackers, pasta, and canned soup for donation. I know they are not the healthiest, but it's better than nothing. Sometimes I think obesity is also largely a disease of poverty. Bacon and eggs are a lot more expensive than oatmeal and rice. For a package of $6.99 bacon, you can buy two packs of 1kg oatmeal.

tess said...

yep, I've heard a number of young'uns speak of living on ramen when they first start out in life after college.... I don't want to THINK about poor children trying to build bodies and brains on them!

Galina L. said...

It is just my opinion, but the only blame I lay of a fast-food industry is the availability of food. I do believe that the culture of instant gratification played a role in the obesity epidemic. It used to be normal to wait till you come home or till some arranged meal time to have your food. Snacking was frown upon at.
Nowadays most people consider experiencing hunger to be a suffering, and not having snacks at home - a form of a child abuse or some reckless parenting.

I think everybody knows about the famous "marshmallow experiment" (http://www.newyorker.com/reporting/2009/05/18/090518fa_fact_lehrer?currentPage=all)
I guess, the inability to delay gratification has a potential to damage not only figures, but other aspects of life.

George Henderson said...

It's a fair question whether making noodles, sugar and soy oil cheaply available to poor people is, aside from the obesity and diabetes this inadvertently causes, helping to prevent death from hunger.
In NZ the law has just been changed to allow perishable produce donations to food banks.
If minimum pricing was combined with a sugar-sweetened beverages tax, and removal of GST from fresh produce (i.e. non-manufactured goods defined as perishables, perhaps the same legal definition for foods previously barred from food banks could be adopted) then there would be some compensation. But no-one cares about increased tax on cigarettes which makes larger inroads in the pockets of the poor than food pricing ever will.
If a government expects a policy to improve health they shouldn't always look for an increased tax take as well. Good health is supposed to save the country money.

Spittin'chips said...

Thanks for the heads up on soy protein in bread. I blindly make sandwiches for the kids' lunches so will pay more attention.

AlmondD'oh said...

@ Tess: Most infant formulas are now made with soy proteins and sweetened with corn syrup solids. I shudder to think about the effect on their brain development.

AlmondD'oh said...

@Galina: I find it hard to lay blame on the fast food industry. Obesity is unfortunately common with people with lower incomes, and when you're poor and working two jobs, it's very hard to drop by the grocery store and cook a meal from scratch. I know that when I'm hungry, $3 will buy me three hamburgers at McDonalds (with meat, cheese, onions, bread) as opposed to maybe 500g of fresh kale. It's hard to think ahead when you're living paycheque to paycheque.

George Henderson said...

I shop where poor people shop (because I'm poor, but also the choice is better, e.g. more offal)
and what I see obese people buying (and I hate this kind of personal observation, can't a scientist make it statistical and impersonal?) is sugar, rolls, pastries, biscuits, pizzas, pies, non-dairy spreads, cereals, sweet bars, sodas. Very high refined-carb diets, relatively low fat but most of that bad.
It wouldn't matter what fast food they ate, the food they buy from the supermarket is dooming them already. If they dumped some of that and ate more burgers and fried chicken (at a higher price per calorie) they would actually be healthier.

Galina L. said...

I actually was not blaming, I wanted to say that the mere existence of a food industry is contributing to a weight-problem, but it is the by-product of a free market, and in order to fight it it would be necessary to start building socialism first.Socialism is not the perfect society to live in, I am not for it.

In US poor people often work two jobs at minimal wage, and are too tired to spent extra time to deal with the whole process of food preparation. Cooking itself is not necessary time-consuming, but it also includes groceries shopping, planning, washing dishes and cookware, cleaning the kitchen surfaces and the floor, washing stove and refrigerator, probably even taking care to avoid creating the environment friendly for cockroaches and mice. Home coking is getting in a luxury category in US, like having time and energy to do exercise. I do not advocate for the limiting assess for poor people to a convenient food, they deserve to have a break.

I just think that it is normal for an efficient economy to have members of the society to get sicker as time goes by, it is consistent with the history of developing civilizations. Civilization allowed sicker and shorter people to successfully compete for the environment with strong and physically healthy hunter-gatherers.

George Henderson said...

True, Galina, those are good points.
Socialist states, including the older democracies, were more likely to provide kitchens in workplaces and schools. You would get at least one nourishing meal a day even if you were busy. And in supposedly "free" societies like the USA the women still stayed home to cook.
But if you tried to provide such meals today, you would run up against the rising tide of coeliac and allergies, of veganism and fat, carb and sugar phobia, of anorexia and entitlement.
You wouldn't get far sending women back to the kitchen either.

You're right about civilization being at the expense of sickness, the Industrial Revolution being the ultimate extreme of that, but there are exceptions, think of G.B. Shaw and Sydney and Beatrice Webb reforming the slums, wartime rationing as a nutrition programme to improve productivity and health, even Pennington with the Dupont executives - it can be done; it should be expected that any government will act paternalistically in time of crisis, and, getting it wrong, as happened in recent times, is historically the exception.

AlmondD'oh said...

@Galina: I am curious. What is it about a socialist system that you don't think will be working?

I, for like, think some socialist institutions are okay but only if they are a part of the democratic process and there are overseeing bodies to make sure that powers are not abused. (ex. policing) I will be very interested to hear your thoughts if you care to elaborate more.

Galina L. said...

Almond, complex systems like economy is impossible to micro-manage without creating a dis-functioning state of existence.Imagine micromanaging climate. It was an illusion and a utopia that humans could create a perfect society by eliminating rich people and inequality. Somebody has to manage how everything function.If owner of a business is absent(because of being killed or running abroad to stay alive), it would be a government agent making business decisions. In a free society big part of regulation is delegated to market forces. If you exclude it from the whole process by making it practically illegal to have your own business, or at least to buy things elsewhere at low price and sell it in the place with a higher demand at a higher price, you would need more bureaucrats to decide which products go where, how much of something should be made, what is necessary for production, and so forth. Humans just can't do it even if they try hard because they are dealing with complex system. It was more or lees corruption-free only during the rule of Stalin because people were reasonably afraid for their life to do things carelessly. We always experienced ridiculous temporary and permanent shortages of food, toilet paper, furniture, clothes items like socks could just disappear from stores in a whole country for periods of time, being able to buy a car with your own money used to be a privilege.I remember periods when butter, cheese and vodka were rationed.It was difficult to buy meat in most parts of Russia, Moscow, where I came from was slightly lucky in that regard. However, I remember a period when only meat item available for sale for couple months was frozen ducks. It was ridiculous and mind-blogging.

We all knew how to cook, mend clothes, fix broken household items, how to wash hair without good shampoo and at the absence of a conditioner.It was a norm that both parents worked. My responsibility was to cook dinner since I was 10 years old, but I was given simple chores in a kitchen since 5 - 6 years old. My mom was busy enough going to work and staying in lines in stores buying food.
Economy went into shambles into every single country where socialism was given a chance. Even in west European countries where capitalism was never questioned, socialistic policies impacted economy negatively. Look at the Spain, for example, they have an astonishing unemployment rate like 23 %, and it is way higher for the people under 25. Why? Because in order to take care of workers the government made it prohibitively expensive for employers to fire them, so they are afraid to hire. In US Detroit is a good example of good intentions backfired.

I commented several times in different places that Western attitude toward medicine reminds me Soviet Union attitude toward economy.

George Henderson said...

In Canada, government (at provincial level) has alcohol monopoly and is main alcohol retailer.
http://www.ccsa.ca/2013%20CCSA%20Documents/CCSA-2013-Canadian-Drug-Summary-Alcohol-en.pdf

This makes harm-reduction policies such as minimum pricing or restrictions on advertising to be practicable.
I doubt it seriously impinges on anyone's freedom, people still get drunk in Canada.

Galina L. said...

George,
Regulations have to exceed certain level to mess-up economy, it is like taking a medicine - sometimes it is necessary or beneficial or has a placebo effect, but if you take too much or just a little of some serious staff like cortisol, than you wouldn't know what to treat first.

Galina L. said...
This comment has been removed by a blog administrator.
George Henderson said...

@ Galina,
perhaps whether state control leads to enough for everyone and little that's bad, or to months of frozen ducks, boils down to one thing; talent. Whether the people managing things are talented and competing to benefit their people. The Soviet system was particularly good at crushing talent, and was easily fooled by quackery, because of the imperative to "improve" the people enough to be worthy of socialism.
The Scandinavian states have not let socialist principles undermine their economies - and isn't the USA heavily in debt anyway? If it wasn't for their military power and influence they might be in the same state as Greece.
The problem in Greece, Spain, Italy is middle-class entitlement, it's a selfish, benefits only version of socialism rather than a top-down planning version.

George Henderson said...

In fact, when people can vote in a government that gives them benefits, and vote out one that asks sacrifices, that's not socialism - it's no different from voting in a government that gives tax cuts, or voting out one that raises taxes.

Galina L. said...

No, US is not comparable with Greece, especially if you look at their budget deficit from the percentage point of view. Bush-son inherited from Clinton a hefty budget proficit, which disappeared and then turned into a huge deficit after two wars ans some tax-cuts which favored rich people. During Obama administration the deficit continues to shrink.

Talented people came into a management when they are pushed toward the top by the functioning system which favors efficiency and professionalism. In Soviet Russia talented people were like a lightening rod - were getting hitting first.

AlmondD'oh said...

@Galina: Thank you for your thoughtful reply. It seems that trouble always follows whenever the deciding powers are left to one single governing body with no oversight. The one problem I have with "free markets" is that sometimes people are willing to pursue profits at the expense of people. I find it unsettling that certain industries exist to profit from peoples' ill health, and this problem is so deeply-rooted that I think it will take a considerable change in peoples' thinking before any changes can take place.

George Henderson said...

For some reason I'm not smart enough to understand, countries can be heavily in debt but have little or no budget deficit. I think the budget is just about keeping up the relatively small payments and interest, and ignores the massive debt itself.

fredmull said...

I am a person living in a "flyover" state in the US, otherwise known as the grainbelt and also, less humorously, as the Bible Belt. I see these problems as so complex as to be unfixable, at least on a national scale. Corporate farms, grain subsidies, farm bills, feed lots, soy/corn/wheat fields as far as the eye can see.. These are what make up %75 of our corporate/political systems. Anyone remember Michele Obama and her healthy families initiative? No, because she was told to forget it by her hubby's donors. If the wife of the Commander in-Chief cant get any traction then how can any mere mortal?
A poor person living in an urban area has to rely on convenience foods from the bodegas....a poor person living in a suburban area has to rely on whatever store is in reasonable walking distance or on public transportation routes....a poor peron in a rural area has to typically rely on Walmart.....
Anyway, I think small changes are happening but there are going to be multiple generations who are going to grow up sick and diseased due to their lifestyle choice, or lack thereof. Personal education is a must.
Anyway, sorry for the length, and thanks for the blog and your many insightful comments on other blogs.

Maggie said...

Fred,
I agree with everything you said, and especially the need for personal education. Just wanted to point out that in Virgina, where I used to live, there was a large hispanic enclave that I think worked in construction, landscaping and maybe agriculture. Anyway, the local Walmart catered to this population by stocking tripe and liver and other kinds of offal in the meat department and they also had a large organic produce section. But this is where personal education comes in. The regular Wally World patron wouldn't normally be buying this stuff. The transportation issue is key also, I think. I now live in wonderful walkable Pacific NW city and I don't drive anymore. Today I walked three miles round trip in the rain with my shopping cart to meet a rancher in a parking lot who was delivering my order of pastured lamb heart, liver, kidney, and mince. So it's here but not that easy to find or acquire if you're a walker.

George G said...

Honey
"it's a complete food for many of the bees in a hive."
I'm being pedantic but that's not true.
Bees rely on pollen for protein, vitamins and minerals.
Honey is close to 100% simple sugars - mainly fructose (about 38.5%) and glucose (about 31.0%) and some sucrose

George Henderson said...

Thanks George G, that's what I wanted to know.
Obviously processing the pollen into honey gives access to the protein etc. But bees certainly survive for long periods of time on honey alone, and larvae don't have access to pollen
http://insects.about.com/od/antsbeeswasps/qt/How-Honey-Bees-Keep-Warm-In-Winter.htm
I wonder if there are symbiotic microbes that generate amino acids and vitamins in the bees. The egg the larvae hatches from will supply some nutrition.
The jazz saxophonists John Coltrane and Eric Dolphy lived on a mix of honey and vitamins as a "health" elixir and brain food.
Dolphy died of diabetes aged 36. Coltrane of liver cancer aged 40.

George Henderson said...

Eventually, Coltrane and Dolphy's devotion to music developed into a relentless quest to find God. They began living on a steady diet of honey, and conversation was reserved for all things holy.

"Eric Dolphy died from an over dose of honey," arranger/band leader Gil Evans believed. "Everybody thinks that he died from an overdose of dope but he was on a health kick. He got instant diabetes. He didn't know he had it. He's eating nuts and a couple little jars of honey every day [and] it killed him. He went into a coma and never came out of it."

http://www.furious.com/perfect/ericdolphy2.html

George Henderson said...

Anecdote from an interview with Buddy Collette when he was talking about his relationship with Eric Dolphy:

While I was in New York, which was 1963, or the year before he died, I was taken to Charles Lloyd's apartment. And Charles— I had gotten him with Chico in the same group. So Charles said, "Hey, why don't you stay at my apartment?" It was only about $120 a month or some ridiculous fee. So I grabbed it. But Eric used to come by every day and we'd talk. Sometimes we went out to breakfast, a little cereal, and then we'd go and duet for about three hours, and then we'd go to lunch, although he wasn't eating any lunch then. He told me he and [John] Coltrane were on health food pills and honey, two or three tablespoons of honey. I didn't think that sounded too good, but he felt that it made them much stronger if they played. That was the thing they were going through.

from the bottom post on this forum http://forum.saxontheweb.net/showthread.php?111665-Killer-Trane-track-Autumn-Leaves/page2

George G said...

"processing the pollen into honey gives access to the protein etc. But bees certainly survive for long periods of time on honey alone, and larvae don't have access to pollen"

Pollen is not really processed into honey.
And larvae absolutely depend on pollen (mixed with nectar) for their growth.
"Pollen is high in protein and rich in nutrients. ..
When the pollen foragers return to the bee colony they scrape the pollen off their legs and place it into an empty cell of the honeycomb. Another house bee will come by soon and pack it tightly down for storage. During storage, beneficial microbes added by the bees, known as probiotics, will partially digest the pollen making the nutrients more available to the bees. At this point it is known as bee bread and is ready for use as food. Nurse bees who are only 5-15 days old, will eat this pollen which will then be converted into royal jelly by a special gland in their head, this will be fed to the young larva for three days. If the royal jelly is fed beyond three days, the larva will begin development as a queen bees. "
"Larvae are initially fed with royal jelly produced by worker bees, later switching to honey and pollen."
http://en.wikipedia.org/wiki/Honey_bee#Pollen

Spittin'chips said...

George, don't ask my why I was looking at a certain lady's blog, but I must say I admire your calm and reasoned interaction with her 'team'.

A bit confused as to why you would bother, but admirable all the same.

Have a good one.

George Henderson said...

@ George
Yes, I realise now that nectar is the source of honey, pollen is the source of other nutrients. And especially phytotoxic pollens and (I think) exudates are collected for propolis extraction.
I remember reading that bees consistently place these different types of pollen (the nutritional and the medicinal) in pouches on different legs to prevent confusion, which if true is a pretty wonderful work of evolution.

@ Chip, thanks. I do get some good stuff there every six months or so (like the paper on low HbA1c being bad for you, without which I would have ignored a couple of papers in which high HbAic is not harmful if you don't actually have diabetes, or if you get it very late in life. Which makes the blood sugar theory of diabetes look just a little like the cholesterol theory of heart disease. Interesting).
And also because debating with people who disagree is essential for identifying and if possible correcting flaws in one's logic, evidence or exposition.
You just need to know when to quit such a conversation and never look back.