What You Don't Know

In another reading today, I came across a quote attributed to a congressman as he was speaking to his colleagues... He was talking to them about a policy decision or a program that they were considering and he said, "Don't pretend that you know what you don't know..."  This is attributed to Senator Moynihan and he was urging congress not to pass something with no knowledge of the theory that drove the idea or testing the theory itself.  

(I read this in a book chapter written by Eleanor Chelimsky.)

I want to think about that statement because it is very important.  I will think about it(out loud to you) in regards to the theory/idea that I support - that 1)providing access to information about food (calories for example) and 2)access to healthier foods (perhaps with lower pricing) will lead to informed eating and possibly a lessening of the obesity crisis that America and many countries now face.

Do I KNOW that the policies that make these strategies a reality will work?  NO.  Are the ideas based on a theory - YES.  Can this be tested?  Yes.  Has it been?  Yes - on a small scale.  Should we continue to test it when we implement it?  Yes.  Does the theory include more than just providing the information?  YES.  What else is needed?  Education and Promotion.  Should the evaluation of the policy also consider the amount of education and promotion that was delivered?  Absolutely.

What are we waiting for?  I have no idea!

Sufficient and Necessary

When I attended Dr. Jakicic's lecture last week, I wanted to point out one of the necessary components for addressing obesity that he did not include in his closing thoughts.
I thought of it again today as I recalled my studies as a Master's student last decade (2004-07).  I believe it was in a class that discussed disease etiology - or the processes that occur and lead to an illness.  Some things are necessary for a disease to occur, some of them are sufficient to cause the disease on their own and others only cause disease in the presence of some additional necessary factor.  
One example; Smoking.  Cigarette smoking is sufficient to cause lung cancer on its own but smoking is not necessary for lung cancer to occur.  Some people who never smoke also get lung cancer.  Sun burns may be necessary for one to get a certain type of skin cancer(but not sufficient).  DNA damage must also occur.  ETC

So Dr. Jakicic ended his presentation by saying that in order to address obesity, several disciplines need to work together. 
On the individual level, people who special in behavior modification or health coaching can work on motivating and supporting persons who are interested in losing weight.  Actually, they may even create programs to move people from not wanting to lose weight to making plans to change their lifestyle so they will.  Exercise specialists or kinesiologists stress the importance of physical activity as advised by the Physical Activity Guidelines.  This PA is not primarily for weight loss but for reducing the adverse consequences associated with being overweight.  Nutrition professionals encourage caloric modification and the adoption of the recommendations made in the Dietary Guidelines - foods to limit and foods to include.
[btw -reducing calories is sufficient for weight loss]
The piece that was left out is the one that is of most interest to me as a student and future researcher/policy analyst.
The missing piece is modifying the environment in which people find themselves so that the suggestions of the exercise and nutrition folks can actually be adopted.  The availability of healthy foods and food information and opportunities to be physically active and to sit less, at school, work, within faith communities,  restaurants, community places, etc.
This last piece is not enough - it is not sufficient, but it is absolutely necessary.  
We need the opportunity to use the skills and apply the knowledge - that's my passion.  I am not telling people what to do, but making it possible for them to do the right(healthy) thing, should they want to.

the high cost of cheap foods

I was in the grocery store with my Mom the other day and we were behind a man and his son (it seemed that they were father and son).  The little boy was in the front of the grocery basket, dirty feet hanging down, messy blond hair, and the cutest smile ever.  He might have been a teeny bit chubby, but really he was cherubic.  

The man with him was quite overweight - but attentive to the boy and really seeming to be doing his best.  In the main part of the shopping cart were about twenty or so frozen dinners - pot pies and dessert pies and sodas.  Oh and a half gallon of whole milk.  I don't remember any other things.  I told Mom, "That boy doesn't stand a chance."  Meaning that he was likely to add to the 16% of obesity in American children and later to the 32% of adult obesity.  She said, as she usually does, "you can't do anything about it though - even if it is true."  To which I replied, "But I can, I absolutely can and that is why I am in school."  Not to change that father or to "save" that child , but to impact population health through population strategy.

Just for curiosity, I positioned myself near to the register display and watched as the order of that duo was scanned. Every one of the frozen entrees cost less than a dollar.  In fact, they all cost less than 75 cents!  The sodas were also under a dollar except the two Mt. Dew brand ones, which were 1.25.  The only thing that cost more than two dollars was the whole milk and just barely.  

Then I watched as they scanned my Mother's groceries and the inverse was true.  We might have had ONE thing that was less than a dollar and our skim milk was a dollar MORE than the whole milk.

I absolutely believe that the price of food that is filling, nutritious and low in calories and fat must be adjusted with a policy or a strategy (free market possibilities exist!).  Remember there are little p policies and big P policies, so don't get upset about government intervention. (I favor big P but not everyone does)

I realize that there are some people that will choose the high calorie, fat, and sugar foods over the healthier ones no matter the cost, but I sincerely believe that if an affordable  option was there, more people would eat better.  I would like my future work to be finding out if what I think is in fact true.  Again, population effects are what I am after, not individual level change - I don't have the stomach for that business!!