1. Addressing Obesity By Changing Environments Kelly D. Brownell Yale University

2. www.YaleRuddCenter.org

3. Nutrition in schools Sugared beverages & taxes Food marketing and children Examples of Major Initiatives Food labeling

4. A Conceptual Scheme

5. Knowledge Motivation How Best to Make Change? Educate Implore Medicate Operate The Individual Less Obesity?

6. CDC, BRFSS % of US Population Getting Recommended Physical Activity (1986-2000)

7. NHANES % of US Adults Getting Recommended Fruit & Vegetable Servings

8. Youth Risk Behav Survey % of US Children Getting Recommended Fruit & Vegetable Servings

9. What Are We Doing Now? Knowledge Motivation Educate Implore The Individual Less Obesity?

10. Knowledge Motivation How Best to Make Change? Educate Implore Medicate Operate The Individual Less Obesity?

11. Optimal Defaults Economics Legislation Environment Regulation The Individual Less Obesity?

12. Another Example – Organ Donation Johnson & Goldstein, Science, 2003 “Do defaults save lives?”

13. Disastrous Defaults (examples) The economics of food Food marketing Portions Too much access Too little access

14. Food Marketing

15. Powerful Relentless Exploitative

17. TV Advertising Adver- gaming Other Youth Websites Bunnies Life Hannah Montana Clifford Crunch Mighty Bites Honey Sunshine Puffins Cheerios Kix EnviroKids Organic Mini Wheats Organic Wild Puffs The Best Dozen None

18. TV Advertising Adver- gaming Other Youth Websites xxx x xxx xxx xxx xxx xxx xx Reese’s Puffs Cap’n Crunch Count Chocula Trix Froot Loops Smorz Lucky Charms Golden Grahams Cinnamon Toast Crunch Corn Pops Cocoa Puffs Fruity/Cocoa Pebbles xxx The Worst Dozen

19. RWJF $100 million/yr vs. Child Marketing January 4!

20. The Special Case of Sugar-Sweetened Beverages

21. The World’s Most Valuable Brand?

22. % Calories Per Day From 2 Beverages Nielsen & Popkin. Am J Prev Med, 2004 0 2 4 6 8 10 1977-781989-911994-961999-2001 Milk Soft Drinks

23. Single greatest source of added sugar Poor calorie compensation Targeting of vulnerable populations Sugar may be addictive Gratuitous addition of caffeine Completely empty calories Why Soda? Rock solid proof of harm

24. SSBs: How Much? Average intake = 50 gallons/yr (189 liters) Average child = 175 calories/day

25. Children Ages 2-18 Empty calories = 40% of total intake Largest contributor to overall intake SSBs + Juice Drinks, 173 kcal/day Reedy & Krebs-Smith J Amer Dieteitic Assn, 2010

27. Brownell et al. New Engl J Med, 2019

28. How Worried is Industry?

29. Millions Spent Lobbying Coke & Pepsi + ABA Los Angeles Times Feb 7, 2010

30. Household Budget Surveys Expenditure records (all beverages) Household income & number of residents Industry Reports Market volume & market value Sugared Beverages in Latin America Underestimates Captures about 50% of intake

31. Data: Datamonitor 2009, Euromonitor 2009, Andreyeva et al 2011

32. Consumption Trends Peru, 1997 - 2009 Data: Peru, Encuesta Nacional de Hogares

33. Consumption Trends Mexico, 1984 - 2008 Data: Mexico, Encuesta Nacional de Ingresos y Gastos de Hogares

34. Consumption Trends & Income Data: Mexico, Encuesta Nacional de Ingresos y Gastos de Hogares

35. Consumption Trends & Income Data: Mexico, Encuesta Nacional de Ingresos y Gastos de Hogares

36. Estimated Revenue (20% tax) $2.66 billion $256 million $857 million $2.37 billion Brazil Chile Colombia Mexico Peru$191 million Revenue (US Dollars) Calculations based on Datamonitor 2010, Euromonitor 2010, World Bank 2009

37. Who Are The Change Agents?

38. Legislators federal, state, local Legal Authorities e.g., state attorney’s general The Press Litigators

39. Dr. Thomas Frieden NYC Commissioner of Health Michael Bloomberg Mayor Legal Defaults

40. Game Changing Developments NYC trans fat ban in restaurants Menu labeling White House Announcements Soda tax proposals Conn. Attorney General – Smart Choices

41. www.YaleRuddCenter.org