Tag Archives: obesity

What FoodAnthropology Is Reading Now, December 22, 2018

David Beriss

A brief digest of food and nutrition-related items that caught our attention recently. Got items you think we should include? Send links and brief descriptions to dberiss@gmail.com or hunterjo@gmail.com.

Hopefully with the holidays looming, you will have time to enjoy these articles. Got any favorites from 2018? Let us know!

One of the top problems confronting the restaurant industry this past year has been what to do about sexual misconduct. Helen Rosner, writing in the New Yorker, provides one small idea for training people who work in restaurants to understand what constitutes unacceptable behavior. Meanwhile, stories about how people are dealing with sexual misconduct and its aftermath in different restaurants continue. Maggie Bullock wrote in The Cut about what happened when chefs Gabrielle Hamilton and Ashley Merriman tried to take over the Spotted Pig restaurant in New York. Quite a minefield. They are not the only ones struggling across that particular minefield, as Julia Moskin and Kim Severson note in this discussion with April Bloomfield, also from the Spotted Pig. Given that men were the perpetrators of the sexual misconduct in all these cases, it seems a bit odd to leave this paragraph with mostly stories of women struggling with the aftermath. Here is a very recent reminder that the industry is still dealing with the problem itself: Brett Anderson’s article about Tariq Hanna’s resignation from Sucré, a dessert empire in New Orleans, demonstrates quite clearly the deep dangers that come when power, sex, and careers are mixed.

Restaurant critics are also learning to deal with writing about these issues, along with all the other social questions that swirl around restaurants. Just two examples for now, but there are many more out there. First, this rather terse review of The Four Seasons from Pete Wells at the New York Times clearly raises the question of whether a restaurateur’s conduct should impact the customer’s dining choices or experiences (and the review may have had some rather interesting consequences). Second, this rather fascinating interview with Soleil Ho, the incoming restaurant critic at the San Francisco Chronicle, suggests that critics will be (or ought to be) thinking very carefully about ethical and social issues as they do their work.

As long as we are mentioning the work of Soleil Ho, take a look at this article she wrote about the nostalgia that seems to have long framed the restaurant menus of Vietnamese restaurants in the United States. Of course, the idea that memories of the country of origin and foods of the past haunt a lot of the restaurants run by immigrants of nearly every origin is one of the more fascinating elements in all the unresolvable debates about “authenticity” that will probably be with us forever.

And while we are discussing authenticity and nostalgia, we may want to bring on board appropriation, capitalism, industry, and more. Start with this amusing rant against industry-sponsored food “museums” by Erin DeJesus at Eater. I suppose I can see the point, but I have enjoyed similar museums in both the U.S and Europe (often kitschy, but if there are plenty of samples – chocolate, ice cream, cheese, beer – then I am a happy camper) and I hope we can trust that most visitors are aware that the ultimate goal of these places is commercial rather than educational. The tensions between well-meaning efforts to celebrate food and culture and commercialization are even more evident in this excellent story by Gustavo Arellano about the rise and commercial fate of National Taco Day in the U.S.

We might also want to ask if authenticity and nostalgia have any kind of reliable relationship with quality. Gustavo Arellano also recently wrote this article about the quality of food in small “mom and pop” immigrant restaurants. He points out that the search for the next hidden gem in the world of immigrant restaurants can often turn up restaurants that are not very good. He is correct of course, but this is just as true of any restaurant, not just those run by immigrants. Perhaps the more fundamental issue is that we tend to rely on some very simplistic (verging on racist) stereotypes about the relationship between ethnic identity and the ability to produce good food. Good cooking, like everything else, takes knowledge and practice. You may be born into a group, but you learn about food. And knowledge is not equally shared.

The politics that brought President Trump to power are complicated, but one often hears reference to resentful rural folks, especially in the West, where many feel that the Federal government controls too much of the land. And so when the administration moved to radically scale back the Grand Staircase-Escalante National Monument in Utah, it seemed like they were responding to those complaints. This important article by Kathryn Schulz explains the improbable rise of a destination restaurant near the National Monument and the complex cultural politics involved in the reduction of its size. And, by the way, it also demonstrates that the Trump administration’s choice to scale back the monument had little to do with resentful Westerners and everything to do with serving corporate interests. You must read this.

In other stories of complicated food politics, it seems like efforts by cities to manage street food vendors is especially fraught in places known for high tech industry, where free food, a desire to appear modern, and a desire for food diversity all seem to clash. This article, by Christine Ro, compares Silicon Valley, in California, and Bangalore, in India. For some reason, this reminds me of a discussion of the changing landscape of pie shops in London, related to meat, eels, vegans, and gentrification, explained by Ronald Ranta in this article.

We often read claims by amateur anthropologists about the supposed benefits of “traditional diets” for combatting the ills of our modern industrial eating. It turns out that actual anthropologists sometimes do actual research on these issues and, perhaps unsurprisingly, their conclusions are unlikely to support the ideas spread by the fans of fad diets. This excellent article by three anthropologists (H. Pontzer, B.M. Wood, and D. A. Raichlen), provides an overview of recent research on small scale societies and diet, along with some data from original research with the Hadza, in Tanzania, and concludes that we should be careful about how what they learned might apply to people in industrial societies. A very good read.

One of the things that food journalism does best is create authoritative mythologies, lists, and categories of things that we need to know. Here, for instance, is a glossary of southern food terms, provided by the editors at Garden & Gun, a publication whose main purpose is to promote authoritative mythologies, lists, and categories about the South. Know that the accuracy of this list may be disputed and that unless you know how to pronounce the terms properly (“lid,” for example, is a two syllable word in much of the South), it won’t help much anyhow.

Sometimes journalists tell us what we ought to think about and then they check back to see if we really did. Which can be very amusing. Bret Thorn and Nancy Kruse, writing in Restaurant Hospitality, provide us with predictions for food trends in 2019 and look back at their predictions for 2018. For the coming year, Thorn predicts the rise of West African cuisine, lager, oat milk, and kachapuri in the U.S., while Kruse celebrates Juniper Lattes, Rum & Coke Chicken and Ribs at Bahama Breeze, and the Maple Bourbon Shake from Krystal (which is a Southern little burger chain, curiously not mentioned in the glossary cited above). Also, Kruse notes that restaurant names are getting more amusing, noting, for example, “Hello, Sailor,” near Charlotte, NC. This article makes for a fantastic reading of the state of American food culture, although I am sure Walter Benjamin would be horrified.

If those trends are not enough for you, Sara Bonisteel provides an overview of the 17 most read food articles from 2018 in the New York Times here. From the Instant Pot to the untimely deaths of Jonathan Gold and Anthony Bourdain, along with stories of sexual misconduct, this is also probably a useful snapshot of the moment.

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Filed under anthropology, anthropology of food

Good Foods and Foods Good for Health: Hunger and Obesity in Samoa

Kitchen counter with (from left to right) large pot with rice, sugar, teapot, and a bowl with boiled bananas with coconut cream (fa'i fa'alifu). Photo by Jessica Hardin.

Kitchen counter with (from left to right) large pot with rice, sugar, teapot, and a bowl with boiled bananas with coconut cream (fa’i fa’alifu). Photo by Jessica Hardin.

Jessica Hardin
Brandeis University

After a cup of sugary tea, John, a Samoan physician, explained to me that the major cause of metabolic disorders in Samoa is the lack of “access to a lifestyle where you can pick your own food.” He immediately offered himself as an example; “My own battle is with food, because we are family oriented and I find that I am healthiest when I am overseas working.” In other words, John found himself “pining for healthy foods” because when eating with his family he had to eat what was available. John felt he was “healthier” when he was traveling because he could choose his own foods, which were “foods good for” health. Others I interviewed would often bring up craving “good foods,” that is fatty, salty, and sugary foods. One diabetes patient, Iona, explained his difficulty with changing his diet: “I can see the piece of pork lying there, and the fried chicken leg. Well, I crave it. It is tempting you, even when I am given food cooked with vegetables. That’s good because it helps with my diabetes. It is best for me.” These vegetable options were good for health but were not the good foods (meaai lelei) Iona craved. Both John and Iona felt unsatisfied and hungry even though they had access to food; they also both struggled with their weight and controlling their diabetes.

***

Obesity research in Samoa tends to obscure the experiences of people like John and Iona, that is the experience of hunger and craving in a environment known for imported food dependence and obesity – Samoa. Anthropologists are increasingly calling for bringing obesity and hunger research together as “contingent circumstance[s] of inequality” (Pike 2014). Obesity research in Samoa has documented why obesity and related metabolic disorders have increased so rapidly. This research tends to focus on the culture of eating, feasting, and access to imported foods. However, the other side of food dependence is a story of craving, hunger, and desire, which needs equal attention. The lack of attention to the experience of hunger in obesity research reflects the drive in obesity research ‘to do something’ about obesity. The “war on fat” is waged domestically and globally and the rhetoric of epidemics reinforces the idea that all fat is unhealthy, that excess weight is a disease, and stigmatizing weight and eating is an acceptable, and even desirable, way to address said epidemic. As a result, the medicalization and moralization of fat can obscure the co-presence of the abundance of imported, fatty-salty foods and (the experience or fear of) hunger.

In other words, while Samoa is dependent on imported, highly processed foods, and these foods have become incorporated into food sharing and food values, not everyone across Samoa has equal access to those foods. Fear of hunger and desire for satiety encourages many Samoans to eat good foods, when they are available, even when these same foods are not considered good for health.

***

Family meals: Chicken with cucumber and white rice. Photo by Jessica Hardin.

Family meals: Chicken with cucumber and white rice. Photo by Jessica Hardin.

Many of the diabetes patients I interviewed understood they needed to eat differently than the rest of their family, but by eating differently they felt different––hungry or left wanting––even if they had plenty of food to eat. Manu, in his sixties who visits the diabetes clinic every month (indicating that he is not in control of his diabetes) said: “everything I like is not allowed. But if you want to live you have to exercise and eat, well not eat, because your life is in trouble. Sometimes it’s hard so I just eat.” When I asked Manu to speak more about why he “just eats” it became apparent that Manu struggled because he felt there was no food for him to eat, “I eat what [my family] gives me.” Another diabetes patient iterated this: “whatever foods I get that’s it, if they give me pork I eat it all.” For Manu, not only were the things he liked off limits but also in his household there were no alternatives. For alternatives foods to be available, he would have had to request different foods or preparations styles, which may have required the family to spend resources differently. Manu did not cook and did not earn cash and so despite being an elder in his family, who presumably could make demands to change household consumption, he refrained. Just as Iona desired chicken legs, many of my interlocutors experienced deprivation when changing their eating habits. “It’s the kind of thing where you love eating salty food so it’s difficult to change,” explained a nurse in a district hospital. She laughingly said, “this hunger, this appetite continues,” even after eating.

 Lea, a woman in her late forties, lived alone with her son. Instead of insisting that her son work the plantation, which would be a reasonable

Family meals: Instant noodles (saimini) with tinned corned beef (pisupo). Photo by Jessica Hardin.

Family meals: Instant noodles (saimini) with tinned corned beef (pisupo). Photo by Jessica Hardin.

response given that would be the family’s only access to cash (from the sale of crops) and starchy foods, Lea insisted her son stay in school. This meant Lea tended to the plantation. She said sometimes “there is nothing, I don’t know where to find food, maybe in the ocean sometimes. Sometimes I only boil a bunch of bananas for the whole day and night.” Only bananas is an idiom of hunger because it suggests that meals are incomplete. Starches alone without good food does not constitute what Samoans would consider a “meal.” The incompleteness leaves the person feeling hungry, despite access to some food. Another woman, I interviewed noted that sometimes her household has “only taro” to eat. She said, “it’s better to eat even when it’s bad food.”

***

This desire, or hunger for complete meals or good food, may encourage some to eat good foods when they are available, even if they are “bad” for health. These decisions reflect social and economic constraints, but satiety, desire, craving, and hunger for good foods also influences food choices. Epidemiological research has richly documented this “natural experiment” but in documenting these factors and features of global change, the experience of those suffering from cash-poverty and disease are often omitted. Inequalities generate hunger and craving, even when there is food available.

Jessica Hardin is a PhD Candidate at Brandeis University and incoming Assistant Professor at Pacific University. She is the co-editor of the volume Reconstructing Obesity: The Meaning of Measures, the Measure of Meanings . This post is based on a chapter, which will appear in the volume, The History of the Ethnography of Hunger: Research, Policy, and Practice, edited by Ellen Messer.

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Filed under anthropology, diabetes, food and health, hunger, obesity, Samoa

Zucchini as a Gateway Drug: Cultivating food security in Iowa through gardening

cultivateia_fbook_cover2

Elizabeth Danforth Richey, PhD, MPH and Angie Tagtow MS, LD, RD
Iowa Food Systems Council, info@cultivateiowa.org

Do more with less. This mantra has become virtually universal in public health and social programming. In the face of the obesity epidemic and rising food insecurity, food pantries are increasingly taking on the role of nutrition educator and healthy lifestyle coach. Unfortunately, this work is expected to be done without the necessary resources. When healthy eating messages are provided in emergency feeding settings, too much of the food distributed through these networks is processed, shelf-stable foods with limited nutritional value. A food pantry staff explained, “It’s hard to ask clients to do something and not be able to give them the right foods to do it.”

One approach to creating accessible, affordable and healthy food environments is food gardening. Food gardening has become increasingly popular among community-and faith-based organizations, workplaces, schools, and among the general public. Food gardening can not only provide food insecure household with fresh local produce, but it can also infuse food bank and pantry food supplies with healthier foods through produce donation.

cultivateia_newspaper_ad_gardenersIn 2012, the Iowa Food Systems Council (IFSC) received a grant from the Wellmark Foundation to create a social marketing campaign to encourage food gardening as a way to increase the amount of healthy local produce in the food system accessed by food insecure Iowans. The goals of this campaign are to encourage: 1) low-resource Iowans to engage in food gardening and 2) gardeners to donate extra produce to emergency feeding networks (food banks and pantries) in their community. The project was designed and implemented by the IFSC’s Food Access and Health Work Group, a community of practice of 250-some partners engaged in some aspect of household or community food security research and/or programming. The multidisciplinary nature of community-based food security programming lent itself to an anthropological approach to understanding target communities within political, economic, historical, cultural and environmental contexts.

Project funding provided the luxury of 12 months of initial mixed-methods research to assess how messages could be effectively conveyed and the content of a social marketing campaign for each target audience. The assessment investigated the multi-layered challenges related to accessing healthy food, perspectives on gardening and produce consumption, produce donation, accessing fresh produce at food pantries, and other factors that could influence message distribution.

Key findings from the assessment were used as the basis for the state-wide social marketing campaign, including:

  • Broad partner support exists for the campaign, but financial and staffing challenges limit the expansion of garden promotion at an organizational level. 
  • There is low staff/client interaction time at emergency feeding locations.
  • Cost is the main barrier to housing, household resources, and food choice, all of which impact produce consumption rates among food-insecure Iowans.
  • Low-resource Iowans lack space for yard-based gardening, and perceive gardening as a time consuming activity.
  • Gardeners lack awareness of produce donation activities in their community, but are very supportive of the idea.
  • Gardeners are have specific concerns related to produce use and liability.

An executive summary of the initial research can be accessed here.

A marketing team took the key findings identified by researchers, and created the Cultivate Iowa campaign. This campaign was designed to be fun, positive and broad based. Rather than explicitly focusing on gardening as a way for resource-poor people to become less food insecure, it aims to provide general messages about cost savings, ease, and low-input gardening strategies. Implementation strategies, rather than the messages themselves, will target desired audiences. For example, materials will be distributed at WIC clinics and food pantries, and billboards will be placed in low-resource areas. Produce donation messages will focus on community engagement and donating any amount available. Cultivate Iowa aims to empower both low-resource and gardener audiences; a main concern is to avoid paternalistic or negative messages. As a key informant explained, “Zucchini is a gateway drug. Once you get growers hooked on how good donating feels, they will find other produce to share as well.”

The Cultivate Iowa campaign was launched on April 19, and will continue through the 2013 growing season. It will be promoted statewide through the Food Access and Health Work Group. Partner resources include campaign talking points, promotional items, brochures, postcards, posters, and vegetable seeds. In addition, a public and social media strategy will be implemented, including radio and TV, billboards, newspaper ads, Facebook and Twitter.

Beyond the marketing campaign, the initial research identified other issues cultivateia_poster2integral to the success of the campaign, such as supporting food pantries to expand their produce acceptance practices, promoting food panties to register at AmpleHarvest (think on-line dating for gardeners and food pantries), and creating educational materials about safe produce handling and storage practices.

So, how can you engage with the campaign? Regardless of where you live, visit the website to learn how you can cheaply and easily increase the fresh local foods in your diet. Pledge to donate produce in your community and find the nearest produce donation site to you. Help to support local and state level policy that creates garden-friendly communities, including public garden space, and tax incentives for commercial and private produce donation. More information about the campaign can be found at www.cultivateiowa.org.

Research will continue to assess the campaign’s impact on food gardening and produce donation in the state. Future strategies may include more focused efforts to promote state and local gardening-related policy, increasing engagement of retail partners, and more targeted messaging to specific populations such as SNAP users. (A little known fact is that SNAP benefits can be used to purchase edible plants and seeds.) Bringing anthropology to the table has worked to create a more effective program that situates the program objectives within the larger social structures in which the target audiences exist. Ultimately, our goal is to continue to encourage Iowans to Plant. Grow. Share. and to Plant. Grow. Save.

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Filed under agriculture, anthropology, economics, farming, food pantries, food security, gardening, markets, methods, nutrition, obesity, policy, SAFN Member Research, sustainability

Reflections on Food and Gastric Bypass Surgery Assessments

I’m writing this piece wearing two hats.  Yes, I am a card-carrying anthropologist with all that entails.  I’m also a licensed clinical psychologist.  In the latter role, I’ve been doing psychological assessments for gastric bypass and laparoscopy. These surgeries are increasing in number.  Furthermore, they are being given to teenagers and contemplated for younger children.  For many years, a patient who was going to get these surgeries had to go through a psych assessment before proceeding. I wanted to tell you what I do in these assessments. My questions involve food and the person’s relationship to food.

First, the intake questions focus on the person’s family history.  How does the patient view food culturally? How does it fit into their social life?  What specifically do they eat that we can see as “culturally-based eating?” Is the person’s family of origin prone to obesity?  (BTW, the politically correct term is severe, not morbid, obesity.)

Is there a psychiatric history of the person and family members? At times I’ve given a test to assess stability. Then I’ve asked what medications the person is taking.  This last point is crucial, because many medications, such as anti-depressants put on weight.  Is there a family history of Type II diabetes?   Has the person gone to the primary care physician and been tested for any kind of thyroid abnormalities?  What natural supplements are the person taking (and have they told their physician), since these supplements, too, can have side effects affecting weight, diet, and other medical conditions?

Second, the questions focus on the success or failure of different kinds of diets.  For the most part, the person has gone through many diets, none of which has worked.  The question is why.  Yes, the patient has told the doctor this.  But I ask them about their present eating habits.  I review their daily meals.  Despite the fact that they are preparing for surgery, many of them are still eating “badly” too much fat, salt, and random and inadequate meals.  Many people tend to drink caffeinated drinks.  Even though they don’t have sugar, caffeine can stimulate a sugar response as well as a cycle of highs and lows.

Third, the questions focus on whether the person has had a significant psychiatric and substance abuse history. Quite often, for example, the person has been sexually abused.  The purpose of these questions is to find out whether the person will follow instructions post-surgery, since violating instructions, i.e., eating too much and the wrong kinds of food can put the surgery at risk.

Fourth, the questions focus on how the person chooses to get medical information.  Does the person want it in written form, orally, and/or visually? Does the patient want a friend to come to the doctor’s office to help them with information?

Fifth, the questions focus on who is going to help the person post-surgery.  This is particularly important since the person may be incapacitated for a while.  Equally important, the patient is queried on family dynamics. One often finds that a patient’s partner “enables” the obesity by wanting the person to be overweight. There are lots of reasons for this.  The partner may want a larger person as their significant other.  The partner and the patient may be avoiding having sex because of the weight issue and other factors. I also ask the patient how s/he will deal with their new body at work and in their social life.  As is often the case, obese people are ignored, and changing one’s weight makes a person visible.  My impression after doing these assessments for over ten years is that this is a more sensitive issue for women than men. Men tend to be seen as more visible, women, less so.  Again, this gender difference worsens as people get older, more so for women.

I follow up several months later to see how the person is doing.  The follow-up reviews both weight and food compliance and family dynamics.   The purpose of the follow-up is to help the person maintain compliance and achieve success.

I’ve tried to be general here.  I look forward to specific comments and questions, because there are more physical and psychological concerns that are involved.  I’ve noticed that they can affect each gender differently.

Comments by Richard Zimmer

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Filed under anthropology, obesity, psychology

Behavioral Economics, Food and Culture

Picture courtesy of Emily Yates-Doerr

Try this as a thought experiment: Imagine a store that sells broccoli and doughnuts, along with everything else a grocery store sells.  Now, let’s manipulate the prices of those two items to see whether or not we can get people to buy more or less of each.  Why?  Well, we are going to assume that broccoli is healthier than doughnuts and we want to find out if we can get people to buy more of the former than the latter.  Of course, we can probably use price to influence these purchases.  But wait, you might say, that is silly.  Nobody substitutes broccoli for doughnuts.  People buy them for entirely different occasions.   And you might add that just buying them doesn’t tell us much.  Do people who buy broccoli actually eat it before it rots in the fridge?  Do they smother it in butter or cheese?  Is there someone out there who ponders whether or not to have doughnuts rather than broccoli with their steak?  Clearly this experiment leaves a lot of relevant information out of the picture.  We probably would not want to use this sort of experiment to figure out how to address obesity in the U.S.

One of the key insights of nutritional anthropology—of all anthropology, really—is that human behavior can best be understood holistically.  This means that food consumption choices, for example, can rarely be explained by only one thing, like price.  To understand why people purchase items at a grocery store—and why they later consume them, assuming they do—we need to look at the social relations those items help create and maintain, as well as the meanings people attach to particular goods.  We also want to put the whole set of transactions and meanings into historical and political-economic context.

In other words, when you buy broccoli or doughnuts, there is a lot of explaining to be done.  And if we, as a society, decide that we are too fat, we need to look very carefully at the whole context of fatness in figuring out what kinds of policies might help address the problem (for one good take on that, check out the wonderful book Fat: The Anthropology of an Obsession, edited by Don Kulick and Anne Meneley).

About a week ago, National Public Radio ran a story on an effort to encourage grocery store shoppers to buy healthier food.  The journalist, Allison Aubrey, cited a study by researchers at the University of Buffalo who set up an entire fake supermarket and then recruited some mothers to shop there.  They supplied the mothers with money and then manipulated prices on items they (the researchers) decided were healthy and junk in order to see if they could influence choices.  They discovered that prices can have an impact, although they also found out that the mothers would still buy “junk” if they had money left over after purchasing reduced price broccoli.  The reporter also found a “behavioral economist” who, citing a “theory of loss aversion,” said he found this behavior (by the mothers, not the researchers) unsurprising.

As far as I know, they did not study whether or not anyone ate any of the stuff they bought.

This is stunning, you have to admit.  No, not the price sensitivity.  I think that is pretty obvious.  Rather, the idea that researchers would set up an entire fake grocery store.  Why not study how people really shop, in real stores?  Why not see what they do with the food they buy?  And find out what their families do with it?  Maybe even ask them about it.  No, not in a survey.  Not even in a focus group.  Go watch them.  Hang out with them.  Follow them around.  Check out differences between what they think they do, say they do…and really do.  The fake grocery store merely allows researchers—perhaps this is what behavioral economists do—to assume away big chunks of social, cultural and historic context.  It turns out, of course, that there are anthropologists who have studied consumption practices in a more holistic manner.  Daniel Miller and colleagues (check out the Material World blog) have done some great work in this area, for example.  And read this brilliant story about what happens when an anthropologist observes a family actually eating breakfast.

The vigilant team here at FoodAnthropology has found even more fantastic recent work by anthropologists that help put these choices in context.  Amy Paugh and Carolina Izquierdo recently published work on the battles between parents and children over what constitutes healthy dining in the Journal of Linguistic Anthropology (“Why is This a Battle Every Night?: Negotiating Food and Eating in American Dinnertime Interaction,”2009, vol. 19, number 2).  Joylin Namie has produced some very useful recent work on the role children play in family food choices, writing recently in Anthropology News that “When it comes to food in US households, children may not be driving the car, but they are often driving the cart” (“The Power of Children Over Household Consumption,” 2008, volume 49, number 4, pages 11-12).  Price, it turns out, is only one factor in determining why people buy food.  We need, as these anthropologists (and many others) show, to pay attention to what people really do and to why they do it if we want to develop policies that will really address obesity.

Otherwise we may as well be comparing broccoli and doughnuts.

Posted by David Beriss.

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Filed under economics, media, nutrition, obesity