Preventing Chronic Disease . Addressing the Proximal Causes of Obesity: The Relevance of Alcohol Control Policies. Prev Chronic Dis 2. DOI. http: //dx. doi. PEER REVIEWEDAbstract. How long does alcohol stay in your system? 12 ounce bottles of beer a night from Wednesday. Many policy measures to control the obesity epidemic assume that people consciously and rationally choose what and how much they eat and therefore focus on providing information and more access to healthier foods. In contrast, many regulations that do not assume people make rational choices have been successfully applied to control alcohol, a substance — like food — of which immoderate consumption leads to serious health problems. Alcohol- use control policies restrict where, when, and by whom alcohol can be purchased and used. Access, salience, and impulsive drinking behaviors are addressed with regulations including alcohol outlet density limits, constraints on retail displays of alcoholic beverages, and restrictions on drink “specials.” We discuss 5 regulations that are effective in reducing drinking and why they may be promising if applied to the obesity epidemic. Top of Page. Introduction. Overweight and obesity are global problems, affecting most people in developed countries and a growing proportion of those in the developing world (1). The immediate cause of overweight and obesity is well understood (consumption of calories in excess of energy expended), and the means to reduce overweight and obesity have also been identified (reduce calorie consumption and engage in more physical activity). 2-Year-Old Works Out. Hypertension (High Blood Pressure). The guidelines for prevention and control of overweight and obesity in.
Yet most people cannot lose weight or sustain the weight loss long- term (2). Evidence suggests that increased food consumption plays a larger role in the obesity epidemic than does decreased physical activity (3). Many restrictive food- related policy- level interventions to address the obesity epidemic have been proposed but have yet to be adopted broadly, including taxes on low- nutrient foods and beverages, advertising restrictions, and restrictions on fast- food outlets. In contrast, schools are quickly adopting policies to control the nutritional quality of school meals and snacks. Other community- wide policies more readily adopted include increasing access to fruits and vegetables and menu labeling, both of which assume that people will make better choices with more access and relevant information. However, convincing evidence of effectiveness of either of these approaches is lacking (4). Effective policy interventions to control consumption of alcohol, another substance that, if consumed in excess, can lead to serious health consequences, focus on limiting access to alcoholic beverages by restricting where, when, and by whom they can be purchased and consumed. Although policy lessons from tobacco- use control may also be informative, the parallels between moderate alcohol and food consumption make alcohol a more relevant comparator. Just as moderate consumption of alcohol does not necessarily lead to harm, moderate consumption of low- nutrient foods is also not likely to increase the risk of diet- related chronic diseases; conversely, any use of tobacco is harmful. The differences between alcohol and food are notable. Alcohol is a controlled substance that is not essential for survival. It is also psychoactive, banned altogether for people under certain ages (2. United States), and many of the harms from its consumption are immediate. Although alcohol- related injuries and diseases are related to the total quantity of ethanol consumed in a given period, the relevance for some diet- related chronic diseases is not simply the total number of calories, but also the nutritional value provided in those calories. Despite these differences, alcohol- use control policies offer useful examples of how excess consumption of food might be controlled. Given the magnitude and cost of the growing obesity epidemic, society must go beyond current thinking in addressing the problem. The consumption of both food and alcohol is related to the social context in which the substance is consumed. Data from multiple countries indicate a close connection between the amount of alcohol consumed by the average drinker and the prevalence of heavy alcohol use in the population (5). For alcohol, the correlation has supported the use of population- level approaches, such as taxation and outlet density control, to tackle problems related to alcohol use. A similarly strong correlation exists between the mean body mass index (BMI) and the percentage of the population that is obese (6,7). Because BMI is a reflection of energy balance, the distribution of BMI across a population indicates that common factors affect the eating behaviors and exercise habits of everyone. Therefore, societal- level measures are likely a relevant and necessary approach to reduce the prevalence of overweight and obesity, much as they are with regard to alcohol use. We analyzed multiple reviews of alcohol policy (8- 1. Given the lack of evidence that the policies would influence rates of obesity, we selected those with evidence of feasibility or effectiveness for alcohol control. Policies had to address issues identified in research as potentially effective for addressing the obesity epidemic. Therefore, the alcohol policies selected for discussion are those that restrict access, discourage impulsive behaviors, limit quantities consumed, or inform consumers about the harms from alcohol misuse. The Table lists various relevant policies, although many of these are unlikely to be politically and socially acceptable for addressing the obesity epidemic. A few of the policies may eventually resonate positively with decision makers and with the public, given their similarity to existing measures used in other fields, namely alcohol- and tobacco- use prevention. We discuss the 5 most promising alcohol- use control policies for translation to obesity control in the current policy climate: 1) density restrictions, 2) rules on display and sale practices, 3) portion control, 4) pricing measures, and 5) warnings about potential harm. Top of Page. Density Restrictions. Alcohol policy. Density regulations limit the number of licenses that are issued to permit the sale of alcohol. Places with a high alcohol outlet density have higher rates of violence, injuries, and drunk- driving fatalities than those with a low density of such establishments (8,1. Furthermore, where the number of alcohol outlets increases, so does the level of drinking (1. Similarly, where alcohol outlet density has been reduced, the health consequences associated with problem drinking have decreased (1. Density restrictions work in 2 ways. First, they reduce the frequency of cues related to drinking. Second, density restrictions make alcohol less accessible, effectively increasing the cost of getting it. When the costs of drinking go up, drinkers (including alcoholics) will moderate consumption (2. Relevance to obesity control. Easy access to foods high in calories and low in nutritional value is a stimulus of hunger and the desire to eat (2. However, proximal cues are often perceived in ways that are difficult or impossible for people to recognize (2. People often experience the illusion that their desires for food develop solely from within, based on true need, rather than being stimulated by external cues (2. The ubiquitous presence of food undermines people’s ability to control impulsive eating behaviors, which are triggered by a physiologic reflexive dopamine reaction (2. Limiting the density of food outlets, in particular outlets that primarily sell food items high in calories and low in nutritional value, could help reduce consumption of such foods. Density limits could be applied to food outlets by type of food sold; a few localities already have ordinances in place that restrict the opening of new fast- food outlets (2. Such ordinances could be expanded to cover convenience stores or specialty food outlets devoted to the sale of foods high in discretionary calories (eg, doughnut shops, ice cream parlors). Licensing and outlet density restrictions may also help curb sales of food in places that are not primarily food outlets. Licenses are typically required only for food outlets that that sell perishable food. Outlets selling food that doesn’t spoil, such as highly processed candies, salty snacks, sugar- sweetened beverages, and foods that do not need refrigeration, are generally not required to be licensed or inspected. Establishments with vending machines typically do not obtain food licenses. Consequently, hardware stores, bookstores, worksites, gas stations, schools, and other nonfood outlets and public venues are increasingly likely to sell nonperishable foods or have vending machines (2. Although restricting exposure to low- nutrient snack foods may help control obesity by reducing the appetitive stimulation they generate (2. The ubiquity of unhealthy food was lower before 1. Today, a minority of people in developed countries could be considered “moderate” eaters, if normal weight for height is a marker of moderate eating (1). Much attention is devoted to increasing the availability of fresh fruits and vegetables in low- income areas designated as “food deserts,” defined as areas whose residents live more than one- half mile from a supermarket and do not have access to a vehicle (2. Less than 5% of the American population lives in areas than can be classified as food deserts, yet 6. Nevertheless, just as in some localities all establishments that serve alcohol are required to serve food and nonalcoholic beverages, a policy that requires food outlets to have some minimum number of healthy options may be a policy alternative. However, obesity is less the result of eating insufficient healthy foods and more the consequence of eating too many unhealthy ones. Restrictions on unhealthy foods are more promising than promotion of healthy foods in controlling obesity (3. Top of Page. Display and Sales Restrictions.
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