Public Health Response to Obesity

The case of Connor McCreaddie, an 8yo obese boy living with his mother in Wallsend, North Tyneside, a distance north of London, raises some interesting questions. I happened to rediscover this story as I was looking up some references on genetics and obesity. If you haven’t heard about the story here’s the short version: Connor is 8 years old, currently in the third grade and weighs somewhere in the range of 200 lbs. The story was plastered over the newswires last February/March as local social services, who had been working with the family for some undetermined amount of time, considered Connor at risk of health sequelae from his obesity. Not really a story worth consideration at that, until the authorities considered taking little Connor into custody because his mother was unable to keep him from eating junk food.

To quote Dr. Colin Waine, the Director of the National Obesity Forum in Nottingham, England, Connor’s lifestyle was “extremely dangerous” and might lead to diabetes, heart disease and nervous system disease in his early 20’s. He added, “He’s really at risk of dying by the age of 30.”

That’s still not the real story here.

The issue has less to do with obesity and more to do with state-run management of a public health service. In more modern-day examples of epidemics, or the worst possible case, a pandemic, the forces that manage health on a grand scale need to have a plan of action. A model of the worst possible scenario in recent history was the influenza epidemic of 1918. The pandemic flu was responsible for the deaths of between 20 and 40 million people worldwide. The epidemic called the “Spanish Flu,” probably originated in China but struck early in Spain for unknown reasons. The virulence of the influenza virus was thought to be due to spontaneous genetic recombination—a technique viruses utilize to overcome herd immunity—creating a strain particularly lethal to humans. Chance recombination did it then and might do it again in the future. What then could the forces of today do in the face of a public health crisis such as an influenza pandemic? And might we model our public health fight against obesity in the same way?

The short answer is no. Pandemics with rapid respiratory transmission and short incubation times requires an entire population to isolate themselves from others. A friend of mine is currently working on a pandemic response model.
I asked him, “What do we do in a pandemic?”
He put it simply, “Stay home. Don’t go to the grocery store, don’t go to work, don’t go to a shopping mall or a movie. Isolate yourself. And if you must go out, wear a mask.”

So how does any of this relate to childhood obesity and Connor McCreaddie? Returning from the model of a pandemic, the obesity issues of childhood worldwide are quite often being referred to as an epidemic. And with that designation comes a public health response. Enter the authorities with the capacity to create sanitariums for tuberculosis patients and quarantines for infected households. Could the easy access to cheap, high calorie foods lead to government run sanitariums where those among us who become obese are housed and fed government sanctioned low calorie foods? I wont say it isn’t possible, but short of that, what can the hamstrung public health services do to stem the tide of obesity?

We’re back once again to a response model of an epidemic. Each response needs to systematically deliver prevention and sequestration of the elements that create the epidemic. And how that might work with obesity is an fascinating consideration with few easy answers. Food is everywhere and present at every event. Here’s a few observations:

1. Government Consensus Panel Nutrition Advice: Toothless. The advice being delivered mutely over already chaotic media and internet portals is sadly inadequate and haphazardly delivered. The answer here needs to begin with primary education and adult re-education. Short of that, the panels will convene and deliver diatribes on the wisdom of drinking milk or eating beef and the evil that resides in Big Food as they deliver soda pop, chips and corndogs.

2. Isolation: Extremist. Taking Connor McCreaddie into custody and isolating him from the outside (junk food) world solves the problem on a small scale but at what price to human freedom?

3. Legislative Action: Not out of the realm of possibilities. Taxation of foods considered “unhealthy” might sound easy, but determining which foods are unhealthy has been a struggle against an army of special interest lobbyists and food freedom fighters. Any healthy food, such as a carrot, might be rendered unhealthy with the right cooking technique and sauce.

4. Government Run Food Sources: Stand up George Orwell. A very futuristic solution, which offers a state-run grocery store where your scanned card tells how many calories you are purchasing for a designated number of family members. “Sorry sir, you cant purchase cheese. You’re over your cheese budget for the month.”

I say so what if Connor McCreaddie has a shortened life expectancy. That's right, so what. Might not all the homeless citizens in poorer areas and near homeless shelters have a shortened life expectancy as well? What then do we do to offset the epidemic of homelessness? The solution seems rather easy. Build them homes. And what about mountain climbers and skydivers? Don’t they have a mortality rate that mirrors obesity? Should we collectively save them from themselves? A certain amount of freedom is necessary, and the freedom to overeat is unfortunately one of those inalienable rights.

San Diego

A conference in San Diego brought some street level observations into focus. First, the number of homeless in this city is large and from what I can see, there isn’t much in the way of a safety net for them to fall back on. But then, I’m conferencing and staying on the affluent waterfront, what would I expect? A walking tour took me to the upper part of the city and the location of the homeless shelter. As I passed a man was yelling obscenities at no one in particular and appeared in desperate need of mental health counseling. I scurried past.

On the waterfront, the USS Midway is a spectacular museum piece with a variety of naval aircraft on display to chronicle the history of carrier-based aviation. In the tiny park in front of the USS Midway a sometimes-large collection of the homeless have found a place to congregate and sleep. I sat and spoke with a woman.

“Where are you from?” I asked her.
“Here there and everywhere. Mostly Cincinnati is where I grew up.”
“What brought you here?”
“It’s just where I ended up.”
“Do you like living here?”
She looked long and hard. “Expletive. Do I look like I like living here?”

The San Diego homeless population is divided up into homeless urbanites and homeless agricultural workers. The urban homeless make up the bulk of the two groups currently estimated to be 6,300 persons in San Diego proper. The woman I was talking to started to become agitated so I dropped the probing questions.

“Have you eaten today?”
“Just the ‘expletive’ people leave in the trash. You know you people leave food around like it doesn’t matter. Yur kids eat a corndog halfway and toss it. I never lived that way.”
“We do have a lot.”
“Damn right you have a lot. You have no idea how much you have.”

From Foreign Protein to Dead Pets

The protein content of food has recently been thrust into the media spotlight by a spate of pet food contaminations and deaths. The culprit it seems was finally determined to be melamine, or as they call it in China, “melamine scrap” added to animal feed. Why then we have to be asking, would anyone add melamine scrap to animal feed or grain? To understand the ruse we need to travel to the heavily contaminated region of Northeast China, where the practice is common.

The first order of business is defining melamine and in particular, “melamine scrap.” Retrogressing from there, and more fundamental, why add it to foods? Melamine is a nitrogen containing compound (shown above) with a chemical structure similar to urea, the nitrogen waste vehicle of mammals. Melamine can be produced in industrial style processes using urea and very high pressure. Melamine is used in those same industrial processes to produce a number of plastics and a variety of fire retardant clothing. In yet other large industrial processes in China, producing fertilizers and again plastics, a residue left over in chunks falling to the bottoms of vats is called “melamine scrap” which instead of being discarded, is sold to local agricultural middlemen. The white chunks of melamine are crumbled and broken up into a protein containing food, like a single grain product or flour, or a combination of milled grains. By adding the chemical the middleman in the process artifically boosts the protein content, without having to buy expensive protein powder. In reality to all comes down to testing. The process of testing the food or flour, as I'll outline, is fooled by the presence of melamine and the protein content using current testing methods shows an elevated level of protein in the product.

Boosting the "apparent" protein content of grains
Melamine is a nitrogen containing molecule with amine group side chains. That’s not amino acid side chains, but rather amine side chains. Thus in the two methods used to test a bulk lot of feed or grain for protein, both the Kjeldahl Method and the Dumas Method assay for nitrogen. From there, the relationship between the nitrogen content of the sample and the protein content is extrapolated. However, if there is a nitrogen containing molecule in the feed or grain, like “Melamine Scrap” the nitrogen content is artificially boosted and the extrapolation to protein content is also incorrectly boosted. Since the food purchasers are primarily interested in the protien content, and the middle man can boost "apparent" protein content with melamine scrap, crude measures of nitrogen content allow for both to claim their product is protein rich. Thus the cheap "melamine scrap" from industrial processes is worth it’s weight in gold to a Chinese middleman peddling bulk grains or feeds.

Toxicity to Humans
In a nutshell: no one knows. However, having stated that, the FDA out of an “abundance of caution” declared 6,000 hogs to be contaminated due to consuming melamine tainted chow. The porkers were excluded from the human food chain. The Pesticide Action Network (PAN) of North America lists melamine but regards it as a virtual unknown. The WHO and EPA both essentially have no information on it, or in the case of the EPA, limited information. The FDA and USDA are currently investigating the pet food scare and establishing methods of screening for melamine in foods. Many of the animals apprear to have simply died of ammonia exposure from the metabolism of melamine. The final tally is melamine one, understanding of human toxicity from chronic exposure to melamine, zero.

Trust
Now we get into the issue of trust. Having learned about this very sinister way the analysis of a food for protein content can be manipulated with melamine, a tasteless, odorless nitrogenous compound, the question remains, should the marketplace respond in kind? As consumers of grain and protein containing foods, how would you view a product containing protein if it were produced in China? And how many Western food producers purchase protein products or grain products from China and add them to commonly consumed foods?

In short, I trust the food supply a little less and will scrutinize packed products a little closer now that I’ve learned how commonplace it is in Northeast China to spike foods with melamine. In the end, the words of William Shakespeare say it all: “Love all, trust a few. Do wrong to none.”