Background, Career, and
Future
Barry Popkin
Department of Nutrition, School of Public Health and Medicine,
Department of Economics
The University of North Carolina at Chapel Hill
“Over 1.3 billion people in the world are overweight”
ASN Nutritional Epidemiology
Research Interest Section
Research Leader Webinar Series
Purpose of the Series: Hear about personal education and
research experiences of successful researchers in the
field of nutritional epidemiology. Learn what they are
doing to stay on the cutting edge of nutritional
epidemiology research, and get an opportunity to seek
advice to help your own research efforts.
“Over 1.6 billion people in the world are overweight”
Outline: Why is this occurring?
• Background: youth, maturation, nutrition entry to my life,
activist decade
• Research career: first phase hunger in the world, MCH
issues [USDA, Breast-feeding, Cebu]
• Second phase: larger SES forces on nutrition, the
nutrition transition
• Third phase: continue second phase,deepening
knowledge, add major policy push
“Over 1.6 billion people in the world are overweight”
Background: Upbringing
• Book the world is fat provides some depth on how I ate,
drank, moved, lived as a youth. Small midwestern town
in northern Wisconsin, very provincial, very poor
schooling, family very promotive of education
• College: University of Wisconsin. Big break—brother
told me about college year in India free funded program
• India: awoke me to world of poverty, slums of India,
villages of India. Also awoke me to global politics,
Vietnam war
“Over 1.6 billion people in the world are overweight”
Return from India
• Second senior year: interested in human welfare. Read
and thought about health and just hit on some papers on
nutrition. Decided to do senior thesis on the economics
of nutrition
• Civil Rights involvement, led group to North Carolina
•
Led to summer job with Off of Economic Opportunity,
400 of theses reprinted and sent all around,
congressional interest, involvement in hunger in
America, beginning of Headstart, more
“Over 1.6 billion people in the world are overweight”
Beyond Senior Year
• Woodrow Wilson fellowship, focus on nutrition and went
to Wharton economics. Increasing involvement
• Returned to Madison, increasing involvement in politics,
SDS, at least half time organizing in midwest, also MS
economics. Congressional testimony and article on
economic benefits of eliminating hunger for Senate, later
published in journal
• Left after 1 year for fulltime leftist organizing
“Over 1.6 billion people in the world are overweight”
Wandering Period
• After organizing, repression led me ultimately to Boston
and ABT associates after a year at UW with rural
negative income tax project as research associate
• Met someone I knew from my earlier nutrition economics
work. Introduced me to leftist faculty in nutrition at
Cornell. Welcomed me back to academia
• 1972 fall went to Cornell, set up int’l nutrition degree,
then Jan 73 joined agricultural economics doctoral
program
“Over 1.6 billion people in the world are overweight”
Cornell Onwards to
Nutr Economics Career
• Focused thesis on RCT of vitamin A and child 1-11
health. Used baseline data for dissertation. Graduated
summer 74. Took a job Rockefeller Foundation Asia in
Quezon City.
• 3 years in Phil. Started Laguna long, survey, began
Bicol Multipurpose, began to involve economics with
nutrition more systematically
• Jobs: turned down, accepted and new career
• UNC job 1977 to present
“Over 1.6 billion people in the world are overweight”
UNC Career Phase 1
• Attempt to get started. Wanted to merge nutrition with
econ work. Convinced USDA to give grant. Evaluate
FST,NLSP. Got small grant to do breast-feeding work.
Involved other economists in breast-feeding and
USDA work
• Built small very productive team. MCH, US food programs.
• Wanted Rolls Royce study to test all linkages of
determinants and consequences of maternal and infant
health related to infant feeding. Began Cebu project
“Over 1.6 billion people in the world are overweight”
Phase 2
• Learned in first phase to do NIH grants, got 4 or 5 on
Cebu project. Then passed Cebu baton to Linda Adair
• Felt scope of Cebu limiting, SES change could swamp
nutrition change, needed larger area to understand how
SES factors and nutrition interplay. Decided on China
and took 2 years to explore all options in China.
• China Health and Nutrition Survey part of first P01 for
NICHD along with set of Cebu projects
• China: first had done very cheap survey 1989 and led to
1991 and 1993
“Over 1.6 billion people in the world are overweight”
Nutrition Transition
• First CHNS results: saw undernutrition small, emerging
shifts in diet
• Sat back and read about dietary change across the
globe, demographic, SES, other nutrition-related factors
and outcomes. Broadened CHNS to capture and began
to write in-depth internal document on the nutrition
transition that ultimately led to many papers on the topic
“Over 1.6 billion people in the world are overweight”
Figure 1. Stages of the Nutrition Transition
Urbanization, economic growth, technological changes for work, leisure,
& food processing, mass media growth
Pattern 1
Paleolithic man/
Hunter-gathers
• Wild plants &
animals
• water
• Labor intensive
Lean & robust,
high disease
rate
Low fertility,
Low life expectancy
Pattern 2
Settlements begin/
Monoculture period/
Famine emerges
• Cereals
dominate
• water
• Labor-intensive
Nutritional
deficiencies
emerge, stature
declines
High fertility,
high MCH mortality,
low life expectancy
Pattern 3
Industrialization/
Receding Famine
Pattern 4
Noncommunicable
Disease
Pattern 5
Desired societal/
Behavioral Change
• Starchy, low variety,
low fat, high fiber
• water
• Labor-intensive
work job/home
• Increased fat, sugar,
processed foods
• caloric beverages
• Shift in technology
of work and leisure
• Reduced fat, increased
fruit, veg, CHO, fiber
• Increase water, Reduce
caloric beverage intake
• Replace sedentarianism
w/ purposeful activity
Obesity emerges, range
of other NR-NCD’s
Reduced body fatness,
Reduced NR-NCD’s
Accelerated life
expectancy, shift to
increased DR-NCD,
increased disability
period
Extended health aging,
reduced DR-NCD
MCH deficiencies,
weaning disease,
stunting
Slow mortality decline
“Over 1.6 billion people in the world are overweight”
Source: Popkin 2002 revised 2006.
Current Phase
• Continuing to deepen thinking, understanding of
dynamics of diet, activity, body composition change
across the globe
• US and international longitudinal work: trends, dynamics
key foci. All longitudinal when can
• Two projects as examples of current work: CHNS
and Cardia
• Activist examples: beverages in obesity, NCD and push
for more beverage panels, working on taxation, etc
“Over 1.6 billion people in the world are overweight”
Mismatch: Biology which has evolved over the
millennia Clashes with Modern Technology
Biology
Technology
Sweet preferences
cheap caloric sweeteners,
food processing benefits
Thirst and hunger/satiety
mechanisms not linked
Caloric beverage revolution
Fatty food preference
Edible oil revolution-high
yield oilseeds, cheap
removal of oils
Desire to eliminate exertion
Technology in all phases of
movement/exertion
“Over 1.6 billion people in the world are overweight”
CHNS
• 1991-2009: in-depth diet {note I focus in all work on
foods more than nutrients and work hard to measure
well}, detailed activity, body composition, SES
• Always all work multilevel from Laguna, Bicol, Cebu.
Measure at community, household, individual levels
• Now CHNS adding fasting blood, full CVD biomarkers,
stored buffy coat and GPS data
• Now my focus building full model from community
changes to HH to individual diet, activity, NS, NCD’s
“Over 1.6 billion people in the world are overweight”
Various levels of data & use
• Community
– Infrastructure
– Access to eating and food
shopping options
– Prices
– Health services
• Household
– Income & Assets
– Relations
• Individual
– Health outcomes
– Physical activity
– Diet
“Over 1.6 billion people in the world are overweight”
Associations
Causality / Direction
and strength of
relationships
Longitudinal
changes
Policy
recommendations
Urbanization & Urbanicity
• Urbanization: migration into cities; change in size, density and
heterogeniety of places1
• Urbanicity: extent to which a place exhibits urban
characteristics
• Dichotomous Urban-Rural vs. Continuous Urbanicity scale
– Heterogeneous variations in health missed by urban-rural
categorization.
– Economic, social & demographic change moves in a continuum.
– Scale is useful for understanding impacts of both initial levels
and changes in urbanicity as they related to health behaviors
and outcomes
New Urbanicity Scale (Jones-Smith & Popkin)
“Over 1.6 billion people in the world are overweight”
Urbanicity Scale Components
Health
Services
Modern & Traditional
Markets
Housing
Transportation
Supermarkets
Modern
Bars
Markets
Cafes
Open air food &
Traditional
Fuel markets
Markets
Economy
Urbanicity
Communication
Newspaper
Sanitation
Telephone
Postal Service
Cinema
Education
Color
TV
Computer
Cell Phone
Social
Services
Diversity
Social
networks
Communications
Which features define
and distinguish
urban places?
Population
Size
Population
Density
Galea and Vlahov 2005; Dahly 2007; National Research Council 2003;
Density
Housing
Transport
Health
Education
Market
Communication
Economics
Sanitation
Social Services
5.73
Modern Market
-3
1.7
1.0
0.69
-4.69
-5
-7
<0
>0 to 15
>15 to 30
>30
Change in individual components by level of overall change in urban score for
“Rural” Communities (1991-2006)
Jones-Smith & Popkin (working paper)
2.7
3.20
2.29
0.8
1.17
2.94
4.26
-2.12
-1.17
-0.30
0.48
0.6
2.2
2.42
3.92
1.07
-0.01
0.4
0.4
1.06
1.5
2.09
2.09
2.50
2.73
-1.20
-0.78
-1
0.61
0.2
0.13
1.12
1.11
1.37
0.8
0.6
0.42
0.0
1
0.00
1.56
3
-3.75
Change in urban score
5
4.58
Diversity
0.62
7
Population
6.24
Results: Heterogeneity in Urban Change for “Rural”
Communities (Initial Score<50)
e.g., Predicted Probability of Incident Overweight (1991-2004) by Change
in Urban Score Over Follow-up for Varying Levels of Initial Urban Score
Jones-Smith & Popkin (working paper)
“Over 1.6 billion people in the world are overweight”
New 2009-Geographic Information
System (GIS)
• Computerized map
– Plots of resource layers onto a coordinate system
– Spatially analyze the density and proximity of resources, environment
factors, and population characteristics
– locations can be geo-coded, or assigned a geographic reference, such
as latitude and longitude
•
Link to national and other community level data on
– Economics
– Population size & density
– Availability of facilities, markets and services
• Integrate dimensions of the built environment to link with individuallevel data to enable understanding of multiple levels of influence
– individual family/home; school/peers; Community; culture/society
“Over 1.6 billion people in the world are overweight”
Using GIS to Create Measures
of Environmental Context
• Take advantage of GIS flexibility
to define communities
appropriately
• Use GIS to calculate
frequency/density/proximity of
physical activity resources and
constraints within the
communities
• Create rich set of measures
associated with each respondent
• Determine association with
respondent physical activity, diet
and overweight/obesity patterns
“Over 1.6 billion people in the world are overweight”
8.05 km
8.05 km
8.05 km
8.05 km
CARDIA
• Reasonably good diet, good activity, body composition,
biomarkers
• Added contextual data via geographic coordinates.
Began this measurement work to create systems to
measure huge scale linkage to food, activity,etc 10 years
ago. Now longitudinal files and many papers coming out.
Penny Gordon-Larsen took over measurement and lead
• Now papers coming out on price to diet to obesity to
diabetes, more in future
“Over 1.6 billion people in the world are overweight”
More Precise Measurement of Food Prices
Previously
Commodities
Taxes
Food
expenditure
State-level
food $
(general)
“Over 1.6 billion people in the world are overweight”
Methods: Price Elasticity of Demand
• Elasticity= % change in demand
% change in price
• Own-price elasticity
%Δ $
%Δ
kcals
%Δ
Negative or
kcals
positive
Negative
• Cross-price elasticity
%
Δ
$
Combined 10% Change in Price Results in
Greater Percent Change in Outcomes: 20 year longitudinal
analysis of price and CARDIA cohort
Soda
Pizza
Soda & Pizza
Percent Change in outcome
0
-0.5
-0.3
-1
-1.5
-0.9
-1.1 -1.2
-1.1
-2
-2.5
-1.9
-2.3
-2.3
-3
-3.5
-4
-4.2
-4.5
Total Energy
Body Weight
HOMA-IR
Source: Duffey et al, Archives of Internal Medicine, in press not for distribution/use
Always Focused on Poverty, Equity,
Understand How Affecting the Poor
• Goes back to activism, USDA programs, SES of the poor
overseas, time constraints, etc
• Carlos Monteiro: global shift toward burden for the poor
“Over 1.6 billion people in the world are overweight”
Mentoring Young and Old
• Favorite approach is one-on-one with faculty and
students alike. This is my greatest pleasure.
“Over 1.6 billion people in the world are overweight”
My Unique Perspective
• Keen observation: linkage from personal experiences to
research and back. Use all literatures from social and
biomedical sciences . Early on read anthropology,
demographics, etc
• How do I focus on dynamics when others can not.
Unsure but critical to our future understanding.
• Always trying to meld all approaches, go into dynamics
and not looking just for the present
“Over 1.6 billion people in the world are overweight”
How to Prevent Obesity
• Caloric beverages: only element I feel has now a clear
justification for control.
• Water research: 2 RCT’s, much focus in my writing as I
attempt to understand how this basic element is
important for us and how leaving it has affected us.wb m
• Beverage guidelines and subsequent regs, taxes
[first US, then Mexico, working with China, bunch of
other countries]
• Other economic changes: just not clear to me yet
• Media regulations: for sure
“Over 1.6 billion people in the world are overweight”
Acknowledgements to My Many Key Collaborators:
University of North Carolina faculty co-investigators in various or many studies:
Linda Adair, Penny Gordon-Larsen, John Akin, Peggy Bentley, John Briscoe, Jane
Brown, Barbara Entwisle, Kelly Evenson, Pam Haines, Gail Henderson, David Guilkey,
Tom Mroz, Ron Rindfuss,Daniel Rodriquez, Anna Maria Siega-Riz, Yan Song, June
Stevens, Deb Tate,Dick Udry, Namvar Zohoori
Brazil: Carlos Monteiro
Philippines: Wilhelm Fleiger, Florentino S. Solon,
Others in the US: George Bray, Ben Caballero, Walt Willett, Suchi Ayala, Robert Black
China: Zhai Fengying, Du Shufa, Ge Keyou, Chen Chunming, Chen Xiaoshu
Mexico: Simon Barquera, Juan Rivera, Anabelle Bonvecchio Arenas, Sonia Rodriguez
Russia: Polina Kozyreva, Mikhail Kosolopov, late Michael Swafford, Alexander Baturin
Students and postdocs:
Past: Linda Adair, Colin Bell, Colleen Doak, Kiyah Duffey, Elena Glinskaya, Penny
Gordon-Larsen, Xuguang Guo, Lisa Jahns, Soowon Kim, Ying Liu, Mikhail Lokshin, Bing
Lu, Kathleen Mctigue, Michelle Mendez, Keri Monda, Samara Nielsen, Sahasporn
Paeratakul, Ruth Patterson, Kathleen Reidy, Marie Richards, Jodi Stookey, Nguyen
Thang, Tuan Nguyen, Carrie Waller, Youfa Wang, Monica Yamamoto, Claire Zizza
Current: Tracy Dearth-Wesley, Ningqi Hou, Jessie Jones-Smith, Shu Wen Ng, Carmen
Piernas, Huijun Wang, Zhihong Wang, Daisy Zamora
My right arms: Frances Dancy, Tom Swasey My Family
And many coauthors of a range of papers important in my career
“Over 1.3 billion people in the world are overweight”
THE BOOK
“The most serious epidemic ever
is insidiously engulfing the world.
Barry Popkin draws upon his
decades of research and
experience to describe its
origins–and a set of potential
solutions. Those interested in
the future of mankind should
read this book.”
Walter Willett, author of Eat,
Drink, and Be Healthy, and chair,
Department of Nutrition, Harvard
University
ASN Nutritional Epidemiology
Research Interest Section
Research Leader Webinar Series
Other upcoming webinars:
• December 2009 - Amy Subar, NIH/NCI
• January 2010 - Keith West, Johns Hopkins Bloomberg
School of Public Health
• February 2010 - Michele Forman, The University of
Texas
• March 2010 - Katherine Tucker, Tufts University
Contact Regan Bailey at baileyr@mail.nih.gov for details.
“Over 1.6 billion people in the world are overweight”