Your Brain on Potato Chips

Or, more accurately, a rat's brain on potato chips.  Last week, PLoS One published a very interesting paper by Dr. Tobias Hoch and colleagues on what happens in a rat's brain when it is exposed to a highly palatable/rewarding food (1).  Rats, like humans, overconsume highly palatable foods even when they're sated on less palatable foods (2), and feeding rats a variety of palatable human junk foods is one of the most effective ways to fatten them (3).  Since the brain directs all behaviors, food consumption is an expression of brain activity patterns.  So what is the brain activity pattern that leads to the overconsumption of a highly palatable and rewarding food?

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Seth MacFarlane: An Oscar Host who is Harmful to Comedy and the Public’s Health

This week’s post for Pop Health was co-written by Beth Grampetro, MPH, CHES. Beth has been working in college health promotion for 7 years and her interests include feminism online and in popular culture. You can follow her on twitter @bethg24. 

The role of society is important in public health.  Health is not just influenced by individual decisions and behaviors.  It is also influenced by our interactions with the world around us- our communities, our families, our workplaces, our schools, entertainment, celebrities, and the media.  These interactions can have a very strong influence (good or bad) on the public’s health.

With that in mind, we were horrified to witness host Seth MacFarlane’s monologue and ongoing commentary during Sunday night’s Oscars.  According to Nielsen ratings, approximately 40.3 million viewers tuned in to the Oscar telecast.  This broad audience watched MacFarlane, a widely known celebrity, make jokes about domestic violence, female actresses’ bodies, and various forms of discrimination.

In the opening number, MacFarlane sang a song entitled “We Saw Your Boobs”, about the scenes in various movies where actresses in the audience had appeared topless. While it has been reported that the actresses were in on the joke, it is nonetheless disturbing that this number passed muster- especially given that several of the scenes he referenced were from movies where the actresses he named portrayed rape victims.

Other jokes included a reference to Jennifer Aniston’s past as a stripper, a congratulatory statement about how great all the actresses who “gave themselves the flu” to lose weight looked in their dresses, and a comment about how Latino actors (in this case Javier Bardem, Salma Hayek, and Penelope Cruz) have difficult-to-understand accents “but we don’t care because they’re so attractive.”

MacFarlane also tried some jokes that had men as their targets but still managed to get mud on a few women in the process. He joked that Rex Reed was going to review Adele’s performance (a reference to Reed’s recent movie review in which he called Melissa McCarthy a “hippo”) and made a joke about 9-year-old nominee Quvenzhané Wallis dating George Clooney. Some defenders of MacFarlane’s performance argued that these jokes were meant to be about the men in question, but ignored the fact that they were made at the expense of women and girls.

The Oscars are billed as “Hollywood’s Biggest Night”, and it’s incredibly disappointing to see what is the biggest event for the entertainment industry turned into the worst office party in history, complete with a leering coworker who’s creating a hostile environment.  If MacFarlane succeeded at anything, it was reminding women that they’re expected to always be thin, be pretty, and be willing to shut up and take it, lest they spoil the whole evening.

There is evidence to show that (unfortunately) these types of jokes and messages that devalue women are believed and internalized within our communities.  For example, a 2009 study by the Boston Public Health Commission found that over half of teens surveyed blamed the singer Rihanna after she was beaten by her boyfriend Chris Brown.  In addition, research shows that a mere 3-5 minutes of listening to, or engaging in, fat talk can lead some women to feel bad about their appearance and experience heightened levels of body dissatisfaction.

Research also tells us that these internalized messages and social norms are correlated with serious public health outcomes.  For example, the CDC outlines the risk factors for sexual violence perpetration.  Under society level factors we find (among others):

• Societal norms that support sexual violence
• Societal norms that support male superiority and sexual entitlement
• Societal norms that maintain women's inferiority and sexual submissiveness
• Weak laws and policies related to gender equity

So the issue is much bigger than if Seth MacFarlane was funny or made a good Oscar host.  The issue is about the quality of the role models we choose to represent our communities and the messages they send.  These messages can have a broad and long lasting influence on public health.  We hope the Academy will choose wisely next year.

Salt Sugar Fat

I'd just like to put in a quick word for a book that will be released tomorrow, titled Salt Sugar Fat: How the Food Giants Hooked Us, by Pulitzer prize-winning author Michael Moss.  This is along the same lines as Dr. David Kessler's book The End of Overeating, which explains how the food industry uses food reward, palatability, and food cues to maximize sales-- and as an unintended side effect, maximize our waistlines.   Judging by Moss's recent article in New York Times Magazine, which I highly recommend reading, the book will be excellent.  I've pre-ordered it.

TAKING HEART FROM INDIAN PROGRESS

India, with its population of 1.2 billion, is planning to build 150 new medical schools in the next five years and at least 250 more in the following five years.  “India,” as Venkat Narayan, a lean, lively and vocal Indian academic who had flown in that morning from Emory School of Public Health in Atlanta to Delhi, put it, “is a place of magnificent chaos, where poverty and wealth co-exist, almost with no self-consciousness, a place where it is very difficult to get things done because of stifling bureaucracy but a place where you can get things done because of the permissive chaos!”  No-one minds a cow slowly crossing the road or minicab drivers lining up and having a pee on the verge even in prosperous neighbourhoods.

“When I was a medical student at Bangalore in 1980, there were two medical colleges and two colleges of engineering.  Now there are nine medical schools and 86 schools of engineering!” Venkat told me, with an energetic laugh. He admits that equity gets rough treatment in India.

I was visiting Delhi as a member of a review panel that has visited India eleven times in the past decade and reports to the prime minister, the minister for health and the ministry to offer informed comment on progress with the National Rural Health Program.  The panel is headed by Jeffrey Sachs, an economist who leads the Earth Institute at Columbia University. He is a valiant warrior for global awareness of poverty.  He has ‘skin in the game’ as his Institute has auspiced the formation of over 40 experimental development villages in Africa where education, health and agriculture capacity building is under way but self-limited to a sustainable budget.  

Sachs has strongly supported a rural health initiative in India to enlist social health workers, respected women in the villages who, with only days of training and no salary, assist young pregnant women to access facilities for safe delivery and neonatal care. There are now 800,000 of these women working effectively in rural India. Mobile phones and bicycles are their basic equipment.  Maternal mortality rates have continued to fall.  Infant mortality rates have been declining in India as a whole (more so in the cities, less so in rural areas) at 6% per annum. 

The rural health program is achieving other goals: there have been no reported cases of polio in India for two years.  Five years ago I recall learning how the polio vaccination team, concentrated around Kolkata, numbered an astonishing 400,000.

And now India, as we have done in Australia, is actively pursuing a program of managed decentralisation of health services.  Expenditure is slowly, slowly rising from 1% to 2% GDP.  Health districts, generally much larger than ours and working on budgets of about $40 per capita per annum, are forming.  It is interesting to see the complex tensions between federal, state and district, so familiar to us in Australia, played out at a mind boggling scale and stupendous complexity.  India gives democracy as a conversation among all citizens powerful and astonishing meaning.

Health statistics are sparse and hard to interpret.  What stats there are point upwards.  As I drove through urban slum areas all my thoughts about chronic disease prevention and primary health care were pounded by rough surf of the social realities of that vast country.  But India is moving and progress is occurring.  No shortage of work for doctors there!

Food Reward Friday

This week, Food Reward Friday is going to be a little bit different.  I've received a few e-mails from people who would like to see me write about some of the less obvious examples of food reward-- foods that are less extreme, but much more common, and that nevertheless promote overeating.  Let's face it, even though they're funny and they (sometimes) illustrate the principle, most people reading this blog don't eat banana splits very often, much less pizzas made out of hot dogs.

So this week's "winner" is something many of you have in your houses right now, and which was also the subject of an interesting recent study... potato chips!

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Body Fatness and Cardiovascular Risk Factors

I recently revisited a really cool paper published in the Lancet in 2009 on body fatness, biomarkers, health, and mortality (1). It's a meta-analysis that compiled body mass index (BMI) data from nearly 900,000 individual people, and related it to circulating lipids and various health outcomes.  This is one of the most authoritative papers on the subject.

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Food Reward Friday

This week's "winner"... the Banana Split!

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THE APOLOGY – FIVE YEARS ON*

On February 13^thfive years ago, the then Prime Minister, Kevin Rudd, and the leader of the opposition, Brendan Nelson, together presented an apology on behalf of the Australian people to our Indigenous brothers and sister.  The apology was offered on behalf also of the parliaments that passed the legislations that led to the forced removal of Aboriginal children from their parents.  http://www.dfat.gov.au/indigenous/apology-to-stolen-generations/rudd_speech.html .  Mr. Rudd explained the reason for the apology.

Let the parliament reflect for a moment on the following facts: that, between 1910 and 1970, between 10 and 30 per cent of Indigenous children were forcibly taken from their mothers and fathers; that, as a result, up to 50,000 children were forcibly taken from their families; that this was the product of the deliberate, calculated policies of the state as reflected in the explicit powers given to them under statute; that this policy was taken to such extremes by some in administrative authority that the forced extractions of children of so-called ‘mixed lineage’ were seen as part of a broader policy of dealing with ‘the problem of the Aboriginal population’.

Mr. Rudd then went on to say:

We need a new beginning—a new beginning which contains real measures of policy success or policy failure; a new beginning, a new partnership, on closing the gap with sufficient flexibility not to insist on a one-size-fits-all approach for each of the hundreds of remote and regional Indigenous communities across the country but instead allowing flexible, tailored, local approaches to achieve commonly-agreed national objectives that lie at the core of our proposed new partnership; a new beginning that draws intelligently on the experiences of new policy settings across the nation.

Let us resolve over the next five years to have every Indigenous four-year-old in a remote Aboriginal community enrolled in and attending a proper early childhood education centre or opportunity and engaged in proper preliteracy and prenumeracy programs.

After Mr. Rudd and Dr Brendan Nelson had completed their speeches they greeted members of the Stolen Generation in the distinguished visitors’ gallery in Parliament House.  The official report of the day http://www.fahcsia.gov.au/our-responsibilities/indigenous-australians/programs-services/recognition-respect/apology-to-australias-indigenous-peoples describes how ‘Aunty Lorraine Peeters [then] presented the Australian Parliament with the gift of a glass coolamon [created by Indigenous artist Bai Bai Napangarti].

Peeters

The coolamon contained a message thanking the Parliament for the apology on behalf of all those affected by removal from their families. In the message Aunty Lorraine explained that the coolamon was a traditional vessel for carrying children, and "a symbol of the hope we place in the new relationship you wish to forge with our people".’ 
‘‘The idea of the empty coolamon was poignant;’ said Brenda Croft, senior curator of Aboriginal and Torres Strait Islander Art at the National Gallery of Australia at the time. “It reinforced the idea of children being taken away from their communities,’’ she says. ‘‘It’s the indigenous form of the cradle. It was no accident.’’  The coolamon, together with the apology documents, are displayed in Parliament House.

How are we doing?  The Australian Bureau of Statistics offers encouragement. Infant mortality is improving.

INFANT MORTALITY RATES:  Aboriginal and Torres Strait Islander and non-Indigenous people 2001–2010

Source: ABS Deaths collection.

It remains the case, though, that we have an incomplete picture of life expectancy of our Indigenous people.  If it mattered to us we would probably do better at measuring it.  At present it is like sending soldiers into battle and not knowing how many are shot dead.  But

‘For those jurisdictions with reasonable information about Indigenous deaths, the median age at death in 2010 for Indigenous males ranged from 50.8 years for those living in the NT to 58.3 years for those living in NSW. These levels were around 20 years less than those for non-Indigenous males, which ranged from 64.9 to 79.6 years. The median age at death for Indigenous females in 2010 ranged from 55.4 years for those living in the NT to 67.1 years for those living in NSW. These levels were also around 20 years less than those for non-Indigenous females, which ranged between 75.2 and 84.9 years.’ http://www.healthinfonet.ecu.edu.au/health-facts/overviews/mortality

We get the parliament we elect:  that’s democracy.  Neither Mr. Rudd nor Dr Nelson lasted long and our parliament has descended from the mountain top to once again concentrate on the things that really matter to us and to them.  But it is a wonder, a treasured memory, that day, five years ago, when the cant, self-comforting delusion and bluster were stripped off the reality of the way in which we had treated Aboriginal Australians, and we said sorry.  Maybe other great days will dawn.  Maybe the coolamon is not empty after all.

*This article has been published in Australian Doctor

Food Reward Friday

This week's lucky "winner"... an unnamed hot dog-laden Pizza Hut monstrosity with tempura shrimp and mayonnaise!

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Why Do We Eat? A Neurobiological Perspective. Part VIII

In the (probably) last post of this series, I'll take the pieces that I've gradually outlined in previous posts, and put them together into a big-picture, common-sense framework for thinking about human eating behavior, and why we eat more today than ever before.

Why is Eating Behavior Regulated?

Let's start at the most fundamental level.  To be competitive in a natural environment, organisms must find rational ways of interacting with their surroundings to promote survival and reproduction.  One of the most important elements of survival is the acquisition of energy and chemical building blocks, either by photosynthesis, or (in the case of animals) eating other organisms.  This imperative drove the evolution of rational food seeking behaviors long before the emergence of humans, mammals, reptiles, amphibians, fish, worms, and even eukaryotes (organisms with nuclei).

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Why Do We Eat? A Neurobiological Perspective. Part VII

Welcome back to the series, after a bit of a hiatus!  In previous posts, we covered the fact that humans eat because we're motivated to eat, and many things can motivate us to eat.  These include factors related to energy need (homeostatic factors), such as hunger, and factors that have little to do with energy need or hunger (non-homeostatic factors).  These many factors are all processed in specialized brain 'modules' that ultimately converge on a central action selection system (part of the reward system); this is the part of you that decides whether or not to initiate eating behaviors.

This will be somewhat of a catch-all post in which I discuss cognitive, emotional, and habit influences on food intake.  Since these factors are not my specialty, I'll keep it brief, but I don't mean to suggest they aren't important.

Food 'Cost'

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Why Do We Eat? A Neurobiological Perspective. Part VI

In previous posts in this series, I explained that the brain (primarily the mesolimbic system) integrates various factors to decide whether or not to drive food seeking and consumption behaviors.  These include homeostatic factors such as hunger, and non-homeostatic factors such as palatability and the social environment.

In this post, I'll examine the reward system more closely.  This is the system that governs the motivation for food, and behavioral reinforcement (a form of learning).  It does this by receiving information from other parts of the brain that it uses to determine if it's appropriate to drive (motivate) food seeking behavior.  I covered its role in motivation in the first post of the series, so in this post I'll address reinforcement.

Behavioral Reinforcement

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Why Do We Eat? A Neurobiological Perspective. Part V

In previous posts, I explained that food intake is determined by a variety of factors that are detected by the brain, and integrated by circuits in the mesolimbic system to determine the overall motivation to eat.  These factors include 'homeostatic factors' that reflect a true energy need by the body, and 'non-homeostatic factors' that are independent of the body's energy needs (e.g. palatability, habit, and the social environment).

In this post, we'll explore the hedonic system, which governs pleasure.  This includes the pleasure associated with food, called palatability.  The palatability of food is one of the factors that determines food intake.

The Hedonic System

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Why Do We Eat? A Neurobiological Perspective. Part IV

In this post, I'll follow up on the last post with a discussion two more important factors that can affect energy homeostasis and therefore our food intake and propensity to gain fat: age and menopause.

Age

Although it often isn't the case in non-industrial cultures, in affluent nations most people gain fat with age.  This fat gain continues until old age, when many people once again lose fat.  This is probably related to a number of factors, three of which I'll discuss.  The first is that we tend to become less physically active with age.  The second, related factor is that we lose lean mass with age, and so energy expenditure declines.

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