Type 2 diabetes is approaching epidemic proportions, mostly because of a sharp increase in the prevalence of obesity and the associated insulin resistance (1). Important risk factors in the pathogenesis of type 2 diabetes (sedentary lifestyle, poor diet, and changes in body composition) are essentially modifiable risks related to profound social and cultural changes that have taken place recently in our society. Several reports suggest that our more hectic pace of life, longer working hours, and changes in family roles all reward convenience in eating habits and limit time available for recreation and outside activities (2–10). Greater use of labor-saving devices, including the automobile, further reduce habitual activity levels. Widespread access to mass-produced high-calorie foods that are relatively inexpensive and widely advertised is reported. However, research in this area is in its infancy and more data are needed to support and clarify these assertions.
We focused on the issue of daily exposure to advertising and examined U.S. spending in 2001 on brand advertising via TV, print, outdoor billboard, and radio media that aimed to promote consumption of fast foods, sodas, and confectionery and the use of automobiles. Data were abstracted from an annual report on advertising statistics from TV, newspaper, magazine, outdoor billboard, and radio media in 10 categories and focused on the top 200 U.S. brands (11). Results showed advertising spending for the fast-food category involving nine brands was $3.5 billion. Spending in the separate food, confectionery, and beverages category was an additional $5.8 billion (including $785.5 million for the top five soda brands). Another $15.5 billion was spent in the automobile category. The magnitude of this advertising onslaught on U.S. adults and children in order to promote consumption of products that could be argued to directly and indirectly promote obesity is alarming. By comparison, the total administrative budgets in 2001 for the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) were $5.1 billion and $1.3 billion, respectively.
As a research community, we need to more systematically investigate the societal and cultural forces shaping our eating and exercise habits, including the use of advertising and marketing. Public health strategies, population-based educational programs, and political initiatives could build from this work. The current research focus in type 2 diabetes is on the development of medical treatments for diabetes symptoms and complications and on the basic science groundwork to support a cure. While this work is necessary, it will fail to stem the tide of U.S. adults and children who become insulin resistant as a result of poor eating patterns and sedentary lifestyles. We need to elevate social and cultural factors to the fore and stress primary prevention as strongly as treatment. The role of our current U.S. economic model, business practices, and political institutions has not yet been featured in the debate on our obesity epidemic. Research should clarify the link between these factors and sedentary lifestyles and obesity. Lessons from the fight against smoking teach us that business and politics have a central influence on our health behaviors and healthcare costs.
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Address correspondence to Garry Welch, PhD, Joslin Diabetes Center, Behavioral and Mental Health Research, 1 Joslin Place, Room 371, Boston, MA 02215. E-mail: [email protected].
