Duke profs Story, Finkelstein combating obesity trends in America

Researchers at the Duke Global Health Institute have bulked up on more effective strategies to fight obesity by studying the factors that affect food choice and weight gain.

The November issue of the healthcare journal Health Affairs included publications by Eric Finkelstein, research professor of global health, and Mary Story, professor of community and family medicine and global health. Finkelstein’s article presented a longitudinal study of food and beverage consumption by adolescents and children across the United Kingdom, a survey that he believes may provide actionable evidence to inform policy makers and help with health industry reform. Story’s research—which was split into two publications—outlines trends in American eating habits and includes suggestions to improve the country’s diet.

“It’s not that our [results] were surprising, but in our world evidence is everything,” Finkelstein said. “Without data or evidence, it’s very hard to make a compelling case. We feel as though now we have good evidence, so when school administrators or policymakers want to make decisions, they can cite this study.”

Finkelstein’s project was based on a previous study in The New England Journal of Medicine that examined factors contributing to obesity in adults. Although those results provided substantial information about high-risk foods for adults, Finkelstein noted that the food industry and school administrators were hesitant to implement changes to their products in response.

“The key challenge [in these studies] is getting unbiased estimates,” he said. “For our study, we looked around the world to find the best data that would allow us to look at changes in consumption and how those changes affect changes in weight. Our dataset was really the best that we could come up with that had [long-term] data on kids’ weight change over time and food consumption change over time.”

Both Finkelstein and Story found that college-aged students tend to be at a higher risk for weight gain than the general population. The transition to a college environment marks an increase in food consumption and a gradual decline in physical activity, Finkelstein said, though other factors also play a role.

Many colleges across the country, however, have been at the forefront in seeking healthier alternatives in their areas, Story explained.

“A lot of changes have come from young people demanding more healthy foods, more locally grown foods, more vegan and vegetarian options, more ethnic foods,” she said.

Despite slight improvements in campus options and increased public awareness of obesity over the past few years, one of Story’s publications outlined how the American diet has improved only modestly over the last decade.

“Overall, when you look at Americans as a whole, in terms of fruits and vegetables and whole grains, almost 98 percent of people in the United States don’t meet their recommendation,” Story said. “It’s pretty dim. When you really look at the American diet, I’d give it a D.”

In light of their data, Finkelstein and Story were able to offer recommendations for policy changes that could address dietary issues in the U.S.

Finkelstein’s current research focuses on incentive strategies for healthy behaviors—such as implementing subsidies for health insurance and rewards for maintaining healthy weight or fitness goals or quitting smoking.

“We found that using reward schemes with different behavioral economic principles actually increases weight loss and extends the duration that people don’t gain weight as well as maintain physical activity and smoking cessation,” he said. “I certainly believe there’s a place for thoughtfully designed incentive and reward schemes to help people engage in these healthy behaviors.”

Story also described how a more effective calorie labeling strategy could help combat poor eating habits for college students in particular.

“Most college students need about 2,000 calories a day,” she explained. “If you saw that something was labelled as 1,800 calories, how would you react? More calorie labeling could help consumers eat healthier and might also motivate companies to make their products healthier.”