Banning Trans Fats – Mary Bonds
Over the past thirty years obesity has emerged as a serious public health problem in the United States. According to the Center for Disease Control, in 2008 all but one state (Colorado) had a prevalence of obesity >20% (1). Thirty-two states had obesity prevalence greater than 25% in 2008 (1). And 6 states (Alabama, Mississippi, Oklahoma, South Carolina, Tennessee, and West Virginia) had the highest prevalence of obesity in the country at 30% or higher (1). These high rates of obesity are especially concerning since obesity is a major risk factor for several other serious diseases including cardiovascular disease, stroke, type II diabetes, high blood pressure, high cholesterol, and certain types of cancer.
The costs in human life, quality of life and medical care expense associated with obesity and these other diseases are significant. The CDC estimates that cardiovascular disease is the leading cause of death in the country (2). Diabetes can lead to serious health impairments such as limb amputation and blindness. Obesity has also been linked to depression and low self-esteem. The CDC estimates that in 2008 annual medical care costs associated with obesity reached $147 billion, for diabetes $116 billion, and for cardiovascular disease and stroke a whopping $448 billion (2).
The obesity epidemic is not restricted to adults. According to the CDC the prevalence of obesity among children aged 2-19 has tripled over the past 30 years (1). Obese children are experiencing the same serious illnesses associated with obesity in adulthood. For example, rates of type II diabetes, hypertension and high cholesterol are rising among children aged 2-19 as well. Obese children have been found to experience lower self-esteem, depression, and reduced capacity for learning in school more than average-weight children (6).
The rates of obesity are highest among lower income populations within the U.S. The states with the highest rates of obesity are also those with the poorest economies (3). With the current unstable U.S. economy, characterized by a growing unemployment rate, experts project that low income families will likely continue to find the costs of healthier foods prohibitively expensive (3). There is concern that rates of obesity will continually increase in lower income populations.
Given such negative health outcomes associated with obesity and in light of the potential for steadily rising obesity rates, many public health advocates and lawmakers have turned toward policy-making to prevent obesity on the population level. One population level approach to reducing obesity has been to pass laws banning the use of trans fats. In the period from 2006 through 2009 several cities and states have proposed, and are adopting, bills that will restrict trans fats to 0.5mg per serving or ban them altogether in restaurant, grocery stores, cafeterias, etc.(4).
The approach of banning trans fats is based on the belief that removing them from the American diet we will reduce risks for cardiovascular health and obesity. Trans fats, typically found in oils and shortenings used in restaurant food preparation and in many pre-packaged snack foods, have a greater negative impact on cholesterol levels than naturally occurring fats (5). Unlike saturated fat, that only increases LDL (bad cholesterol), trans fats both increase LDL and also decrease HDL (good cholesterol,) thus greatly increasing the risk of coronary artery disease (5). Given the evidence, the USDA recommends reducing trans fats intake to as low a level as possible (5).
The ban on trans fats is premised on the belief that reducing the dietary intake of trans fats, alone will yield the beneficial health outcomes of reduced cardiovascular disease and obesity. Reliance upon the ban of trans fats alone to reduce obesity assumes that people will not be subject to the risk of becoming obese or developing cardiovascular disease by other means such as consuming other high caloric, low nutritious foods or continuing a sedentary lifestyle. It also assumes that people will not substitute other harmful oils such as palm or coconut oil which are also very harmful to health due to their high levels of saturated fats. A ban on trans fats does nothing to promote healthier fats such as the monounsaturated and polyunsaturated fats or to promote consumption of healthier fresh fruits and vegetables.
Prior to banning trans fats fast foods were especially high in trans fats. Just as an example, a McDonald large fries contained 8 grams of trans fats, Kentucky Fried Chicken’s chicken pot pie contained 14 grams of trans fats, and even KFC combo meal contained as many as 15 grams of trans fats. Given their potential for such serious cardiovascular health risk, it is great that these trans fats for most menu items of these corporations are reduced to zero. However, I do not believe that reliance upon the ban alone is going to be adequate to reduce obesity and cardiovascular health. I believe that banning trans fats as an approach to preventing obesity is a step toward the right direction but it is flawed in several important ways. Therefore, reliance upon it alone will fail to achieve the public health goal of reducing obesity.
Argument 1: A ban on trans fats still does not prevent over-eating in general or eating equally fattening foods also known to contribute to obesity.
Obesity is a complex condition with multiple contributing factors (8). A program aimed at effectively preventing obesity must address as many contributing factors as possible. Most agree, though, that the main cause of obesity is a combination of an inbalance in calories consumed and energy expended. Over-eating is complex and not well understood.
The Trans fat ban fails to address over-eating. Even after the ban is in effect, restaurants can still serve portion sizes much larger than the USDA recommended portion size, thus allowing diners opportunities to consume more food than required to maintain a healthy weight. People can also still continue to cook and eat unnecessarily large portions of food at home, school and/or work. For example, while Pillsbury pre-made holiday cookies only contain 0.5g of trans fats per serving, a person could eat multiple servings and exceed the restricted 0.5 per serving size. The ban also does not address compulsive over-eating. For obese individuals who engage in overeating (out of boredom or stress) and have a set diet and sedentary lifestyle, the ban of trans fats does nothing to motivate a change in their pattern of over eating.
Also, although trans fats have been reduced to zero on most menu items, many of the remaining food items still contain high levels of other fats, sugars and other unhealthy ingredients likely to cause weight gain. Just one example is the seemingly healthy Crispy Chicken Caesar Salad without dressing on KFC’s menu that contains 19 grams of total fat (6 grams of saturated fat) (7).
Banning trans fats also does not prevent or reduce the use of other unhealthy ingredients in food products available to the public. Many restaurants and food manufacturers can substitute other oils that are high in saturated fats for trans fats in food preparation. Products high in saturated fats and sugar and low in vitamins and whole grains are still available to consumers and at much lower prices than healthier foods like fresh fruits and vegetables. So, banning trans fats does nothing to mitigate other sources of over-consumption of unhealthy foods and it does nothing to educate the public about appropriate portion size and selection of healthier foods for their diet. In this way, banning trans fats alone is unlikely to have the anticipated impact of reducing obesity.
Argument 2: The ban on trans fats targets only the nutritional aspects of obesity while not addressing the need to increase physical activity to fight obesity.
In terms of weight loss, evidence suggests that successful programs should combine nutritional changes as well as engagement in increased physical activity (8, 9). Banning trans fats as a means to reduce the prevalence of obesity is flawed in that it only addresses the first objective, modifying the diet. A sedentary lifestyle is also a major contributing factor to the obesity epidemic and a program that targets only one aspect of the diet will not be as effective in reducing obesity.
Katz (2009) reviewed programs aimed at weight control in children and concludes the research shows that children benefit most from school-based programs than those implemented outside school (9). The article also notes gender differences in terms of success of programs aimed at increasing physical activity: girls appeared to benefit more from programs based upon social learning theory, whereas boys benefited more from environmental reforms (9). The ban of trans fats fails to acknowledge the need for reforming activity levels at all and this I a major flaw in the trans fat ban as well.
Argument 3: The ban of trans fats makes no attempt to engage the population targeted for the program to persuade them to eat healthier and exercise more.
Applying the Community Coalition Action Theory in addressing other public health problems has shown some success. Preventing obesity is a public health problem to which this theory is well-suited to be applied as well. The ban of trans fats approach fails to do this in that the major cities targeted for the bans are not those with the highest rates of obesity. This is another major flaw to that approach.
The Community Coalition Action Theory holds that by getting community leaders to adopt the mission of bringing about the change in public health behavior first and then to motivate members of the community to work on bringing about the change as well. In terms of applying this to obesity, it would be important to get important leaders in communities most affected by poverty since obesity seems to be more prevalent among the poor. Such leaders could be those in churches, schools, local businesses.
Proposed Intervention
An alternative approach to the ban of trans fats that might be more effective in reducing obesity would be to form a group of members who share the common goal of reducing obesity. It would be important to gather a diverse group of members (ie., both professional, business owners, residents, school teachers, students, parents, grassroots). The group would be responsible for setting a specific goal(s) to achieve the result of reducing obesity. For example, the group could set as its first goal to lobby city planners to create “safe routes” for children to be able to ride their bikes or walk to school and to locate more grocery stores in areas where there are currently none available. The group could also lobby law makers to pass laws that provide an incentive to supermarkets to locate in under-served populations. Another example might be for members of the group to speak at different organizations to spread the message of the importance of healthy diet and exercise. There are limitless goals the group could set really. These are some great examples the Center for Disease Control suggests (1). Once a group achieves the first goal, they could move onto the next one so that they have momentum and are continually working toward the overall goal of reducing obesity.
This intervention would be an improvement over the ban of trans fats in several ways. First, the formation of a community coalition group whose goal it is to reduce obesity engages the population being impacted who therefore have more motivation to achieve the goal. This group of motivated individual can take organized action to improve the health of their community.
Second, the community group would set agenda items that would address both the nutritional aspects of obesity as well as the physical activity aspects of obesity. This is where the ban on trans fats failed as an approach because it only addressed one nutritional aspect of the American diet. Using a community coalition group will ensure that both the nutritional and physical activity aspects of obesity are addressed.
Finally, the community coalition group’s interaction with various groups in the community could address issues motivating over-eating. For example, community coalition members could partner with local Weight Watchers programs to learn more about what motivates over-eating and to bring these topics back to the coalition group in order to design programs that would encourage healthier diet and exercise habits in those who over eat.
Conclusion
The reasons why people are obese are complex and an approach to preventing obesity needs to take this into account and address both nutritional aspects as well as physical activity aspects of the condition. The ban of trans fats is a helpful first step but it alone cannot address obesity. The formation of community coalitions who set out to improve the health of their own communities and set goals toward achieving improved public health is an alternate approach I suggest would be superior to the use of only the ban of trans fats in fighting obesity. The community coalistin will be a successful alternative approach because it offers the ability for the group to attack multiple factors which could be leading to obesity: nutrition as well as physical activity as well as many other factors contributing to obesity such as availability of supermarkets in the neighborhood.
References
1. Center for Disease Control. Percent of Obese (BMI ≥30) in US Adults. Atlanta, GA: Center for Disease Control. http://www.cdc.gov/obesity/data/trends.html#County.
2. Center for Disease Control. Heart Disease Statistics. Atlanta, GA: Center for Disease Control. http://www.cdc.gov/heartDisease/statistics.htm
3. Trust for America’s Health. How Obesity Policies are Failing America. Washington, DC: Trust for America’s Health. http://healthyamericans.org/reports/obesity2009/
4. The National Conference of State Legislatures. Trans Fat and Menu Labeling Legislation. Washington, D.C.: The National Conference of Stat Legislatures. http://www.ncsl.org/default.aspx?tabid=14362
5. The Campaign to Ban Partially Hydrogenated Oils. Ban Trans Fats http://www.bantransfats.com/
6. Science Daily. Trans Fat Leads To Weight Gain Even On Same Total Calories. 2006. http://www.sciencedaily.com/releases/2006/06/060619133024.htm
7. Kentucky Fried Chicken Menu. http://www.yum.com/nutrition/documents/kfc_nutrition.pdf
8. Anderson, PM, Butcher, KE. Childhood Obesity: trends and potential causes. Future Child 2006; 16:19-45
9. Katz, D.L. School-Based Interventions for Health Promotion and Weight Control: Not Just Waiting on the World to Change. Annual Reviews of Public Health. 2009. 30:253-272.
10. Butterfoss, F., Kegler, M. Community Coalition Action Theory. 2002.
11. http://healthyamericans.org/assets/files/TFAHHamburgtestimony.pdf
The costs in human life, quality of life and medical care expense associated with obesity and these other diseases are significant. The CDC estimates that cardiovascular disease is the leading cause of death in the country (2). Diabetes can lead to serious health impairments such as limb amputation and blindness. Obesity has also been linked to depression and low self-esteem. The CDC estimates that in 2008 annual medical care costs associated with obesity reached $147 billion, for diabetes $116 billion, and for cardiovascular disease and stroke a whopping $448 billion (2).
The obesity epidemic is not restricted to adults. According to the CDC the prevalence of obesity among children aged 2-19 has tripled over the past 30 years (1). Obese children are experiencing the same serious illnesses associated with obesity in adulthood. For example, rates of type II diabetes, hypertension and high cholesterol are rising among children aged 2-19 as well. Obese children have been found to experience lower self-esteem, depression, and reduced capacity for learning in school more than average-weight children (6).
The rates of obesity are highest among lower income populations within the U.S. The states with the highest rates of obesity are also those with the poorest economies (3). With the current unstable U.S. economy, characterized by a growing unemployment rate, experts project that low income families will likely continue to find the costs of healthier foods prohibitively expensive (3). There is concern that rates of obesity will continually increase in lower income populations.
Given such negative health outcomes associated with obesity and in light of the potential for steadily rising obesity rates, many public health advocates and lawmakers have turned toward policy-making to prevent obesity on the population level. One population level approach to reducing obesity has been to pass laws banning the use of trans fats. In the period from 2006 through 2009 several cities and states have proposed, and are adopting, bills that will restrict trans fats to 0.5mg per serving or ban them altogether in restaurant, grocery stores, cafeterias, etc.(4).
The approach of banning trans fats is based on the belief that removing them from the American diet we will reduce risks for cardiovascular health and obesity. Trans fats, typically found in oils and shortenings used in restaurant food preparation and in many pre-packaged snack foods, have a greater negative impact on cholesterol levels than naturally occurring fats (5). Unlike saturated fat, that only increases LDL (bad cholesterol), trans fats both increase LDL and also decrease HDL (good cholesterol,) thus greatly increasing the risk of coronary artery disease (5). Given the evidence, the USDA recommends reducing trans fats intake to as low a level as possible (5).
The ban on trans fats is premised on the belief that reducing the dietary intake of trans fats, alone will yield the beneficial health outcomes of reduced cardiovascular disease and obesity. Reliance upon the ban of trans fats alone to reduce obesity assumes that people will not be subject to the risk of becoming obese or developing cardiovascular disease by other means such as consuming other high caloric, low nutritious foods or continuing a sedentary lifestyle. It also assumes that people will not substitute other harmful oils such as palm or coconut oil which are also very harmful to health due to their high levels of saturated fats. A ban on trans fats does nothing to promote healthier fats such as the monounsaturated and polyunsaturated fats or to promote consumption of healthier fresh fruits and vegetables.
Prior to banning trans fats fast foods were especially high in trans fats. Just as an example, a McDonald large fries contained 8 grams of trans fats, Kentucky Fried Chicken’s chicken pot pie contained 14 grams of trans fats, and even KFC combo meal contained as many as 15 grams of trans fats. Given their potential for such serious cardiovascular health risk, it is great that these trans fats for most menu items of these corporations are reduced to zero. However, I do not believe that reliance upon the ban alone is going to be adequate to reduce obesity and cardiovascular health. I believe that banning trans fats as an approach to preventing obesity is a step toward the right direction but it is flawed in several important ways. Therefore, reliance upon it alone will fail to achieve the public health goal of reducing obesity.
Argument 1: A ban on trans fats still does not prevent over-eating in general or eating equally fattening foods also known to contribute to obesity.
Obesity is a complex condition with multiple contributing factors (8). A program aimed at effectively preventing obesity must address as many contributing factors as possible. Most agree, though, that the main cause of obesity is a combination of an inbalance in calories consumed and energy expended. Over-eating is complex and not well understood.
The Trans fat ban fails to address over-eating. Even after the ban is in effect, restaurants can still serve portion sizes much larger than the USDA recommended portion size, thus allowing diners opportunities to consume more food than required to maintain a healthy weight. People can also still continue to cook and eat unnecessarily large portions of food at home, school and/or work. For example, while Pillsbury pre-made holiday cookies only contain 0.5g of trans fats per serving, a person could eat multiple servings and exceed the restricted 0.5 per serving size. The ban also does not address compulsive over-eating. For obese individuals who engage in overeating (out of boredom or stress) and have a set diet and sedentary lifestyle, the ban of trans fats does nothing to motivate a change in their pattern of over eating.
Also, although trans fats have been reduced to zero on most menu items, many of the remaining food items still contain high levels of other fats, sugars and other unhealthy ingredients likely to cause weight gain. Just one example is the seemingly healthy Crispy Chicken Caesar Salad without dressing on KFC’s menu that contains 19 grams of total fat (6 grams of saturated fat) (7).
Banning trans fats also does not prevent or reduce the use of other unhealthy ingredients in food products available to the public. Many restaurants and food manufacturers can substitute other oils that are high in saturated fats for trans fats in food preparation. Products high in saturated fats and sugar and low in vitamins and whole grains are still available to consumers and at much lower prices than healthier foods like fresh fruits and vegetables. So, banning trans fats does nothing to mitigate other sources of over-consumption of unhealthy foods and it does nothing to educate the public about appropriate portion size and selection of healthier foods for their diet. In this way, banning trans fats alone is unlikely to have the anticipated impact of reducing obesity.
Argument 2: The ban on trans fats targets only the nutritional aspects of obesity while not addressing the need to increase physical activity to fight obesity.
In terms of weight loss, evidence suggests that successful programs should combine nutritional changes as well as engagement in increased physical activity (8, 9). Banning trans fats as a means to reduce the prevalence of obesity is flawed in that it only addresses the first objective, modifying the diet. A sedentary lifestyle is also a major contributing factor to the obesity epidemic and a program that targets only one aspect of the diet will not be as effective in reducing obesity.
Katz (2009) reviewed programs aimed at weight control in children and concludes the research shows that children benefit most from school-based programs than those implemented outside school (9). The article also notes gender differences in terms of success of programs aimed at increasing physical activity: girls appeared to benefit more from programs based upon social learning theory, whereas boys benefited more from environmental reforms (9). The ban of trans fats fails to acknowledge the need for reforming activity levels at all and this I a major flaw in the trans fat ban as well.
Argument 3: The ban of trans fats makes no attempt to engage the population targeted for the program to persuade them to eat healthier and exercise more.
Applying the Community Coalition Action Theory in addressing other public health problems has shown some success. Preventing obesity is a public health problem to which this theory is well-suited to be applied as well. The ban of trans fats approach fails to do this in that the major cities targeted for the bans are not those with the highest rates of obesity. This is another major flaw to that approach.
The Community Coalition Action Theory holds that by getting community leaders to adopt the mission of bringing about the change in public health behavior first and then to motivate members of the community to work on bringing about the change as well. In terms of applying this to obesity, it would be important to get important leaders in communities most affected by poverty since obesity seems to be more prevalent among the poor. Such leaders could be those in churches, schools, local businesses.
Proposed Intervention
An alternative approach to the ban of trans fats that might be more effective in reducing obesity would be to form a group of members who share the common goal of reducing obesity. It would be important to gather a diverse group of members (ie., both professional, business owners, residents, school teachers, students, parents, grassroots). The group would be responsible for setting a specific goal(s) to achieve the result of reducing obesity. For example, the group could set as its first goal to lobby city planners to create “safe routes” for children to be able to ride their bikes or walk to school and to locate more grocery stores in areas where there are currently none available. The group could also lobby law makers to pass laws that provide an incentive to supermarkets to locate in under-served populations. Another example might be for members of the group to speak at different organizations to spread the message of the importance of healthy diet and exercise. There are limitless goals the group could set really. These are some great examples the Center for Disease Control suggests (1). Once a group achieves the first goal, they could move onto the next one so that they have momentum and are continually working toward the overall goal of reducing obesity.
This intervention would be an improvement over the ban of trans fats in several ways. First, the formation of a community coalition group whose goal it is to reduce obesity engages the population being impacted who therefore have more motivation to achieve the goal. This group of motivated individual can take organized action to improve the health of their community.
Second, the community group would set agenda items that would address both the nutritional aspects of obesity as well as the physical activity aspects of obesity. This is where the ban on trans fats failed as an approach because it only addressed one nutritional aspect of the American diet. Using a community coalition group will ensure that both the nutritional and physical activity aspects of obesity are addressed.
Finally, the community coalition group’s interaction with various groups in the community could address issues motivating over-eating. For example, community coalition members could partner with local Weight Watchers programs to learn more about what motivates over-eating and to bring these topics back to the coalition group in order to design programs that would encourage healthier diet and exercise habits in those who over eat.
Conclusion
The reasons why people are obese are complex and an approach to preventing obesity needs to take this into account and address both nutritional aspects as well as physical activity aspects of the condition. The ban of trans fats is a helpful first step but it alone cannot address obesity. The formation of community coalitions who set out to improve the health of their own communities and set goals toward achieving improved public health is an alternate approach I suggest would be superior to the use of only the ban of trans fats in fighting obesity. The community coalistin will be a successful alternative approach because it offers the ability for the group to attack multiple factors which could be leading to obesity: nutrition as well as physical activity as well as many other factors contributing to obesity such as availability of supermarkets in the neighborhood.
References
1. Center for Disease Control. Percent of Obese (BMI ≥30) in US Adults. Atlanta, GA: Center for Disease Control. http://www.cdc.gov/obesity/data/trends.html#County.
2. Center for Disease Control. Heart Disease Statistics. Atlanta, GA: Center for Disease Control. http://www.cdc.gov/heartDisease/statistics.htm
3. Trust for America’s Health. How Obesity Policies are Failing America. Washington, DC: Trust for America’s Health. http://healthyamericans.org/reports/obesity2009/
4. The National Conference of State Legislatures. Trans Fat and Menu Labeling Legislation. Washington, D.C.: The National Conference of Stat Legislatures. http://www.ncsl.org/default.aspx?tabid=14362
5. The Campaign to Ban Partially Hydrogenated Oils. Ban Trans Fats http://www.bantransfats.com/
6. Science Daily. Trans Fat Leads To Weight Gain Even On Same Total Calories. 2006. http://www.sciencedaily.com/releases/2006/06/060619133024.htm
7. Kentucky Fried Chicken Menu. http://www.yum.com/nutrition/documents/kfc_nutrition.pdf
8. Anderson, PM, Butcher, KE. Childhood Obesity: trends and potential causes. Future Child 2006; 16:19-45
9. Katz, D.L. School-Based Interventions for Health Promotion and Weight Control: Not Just Waiting on the World to Change. Annual Reviews of Public Health. 2009. 30:253-272.
10. Butterfoss, F., Kegler, M. Community Coalition Action Theory. 2002.
11. http://healthyamericans.org/assets/files/TFAHHamburgtestimony.pdf
Labels: Nutrition, Obesity, Physical Activity, Sapphire
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