ENDO 2023 Preview:  Junk Food

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Maria T. Balhara discusses her ENDO 2023 sessions on food’s impact on human health  

A three-session symposium on our everchanging food environment, “Impact of the Changes in Food Environment in the Development of Obesity,” looks at endocrine-disrupting chemicals, climate change, and processing methods and how these factors impact endocrine health, specifically obesity. Endocrine News talks to one of the moderators of these sessions, Maria T. Balhara, a south Florida high school senior, whose research concentrates on how chronic health conditions are affected by what we eat and how we live.

Food has changed in recent years. Whether it’s climate change altering the nutrients in crops, the ever-growing availability and consumption of ultra-processed foods like sodas and potato chips, or even the presence of endocrine-disrupting chemicals (EDCs) in fast food, what we eat now is vastly different from the food on the dinner tables of previous generations.

A special symposium at ENDO 2023 in Chicago, titled, “Impact of the Changes in Food Environment in the Development of Obesity,” will focus on how these changes are contributing to the obesity epidemic and aims to raise awareness of the impact of food changes on weight – specifically, how the current food environment is an obesogenic factor.

One of the moderators of the session is Maria T. Balhara, a high school senior from South Florida with a strong interest in understanding diet and health disparities, whose research focuses on the intersections of processed food consumption, socio-economic factors, and the increased risk of chronic health conditions. (Balhara’s study, which found that teenagers consumed less ultra-processed food during the COVID-19 pandemic, reversing a 30-year trend, was presented at ENDO 2022 in Atlanta.)

Balhara, who became a member of the Endocrine Society because of its emphasis on mentorship and education, as well as its promotion of diversity, equity, and inclusion, worked closely with Barbara Gisella Carranza Leon, MD, a clinical practitioner at Vanderbilt University Medical Center in Nashville, Tenn., to develop the proposal for this symposium.

Carranza Leon says that Balhara’s initial idea of nutrition and its impact on obesity caught the attention of the Society’s Annual Meeting Steering Committee, and as they worked to develop the symposium’s curriculum, they incorporated how climate change affects food into Balhara’s original idea. “It has been my pleasure to work with her,” Carranza Leon says. “I am impressed by her enthusiasm and hard work. I believe this is the first time a high school student has submitted a symposium suggestion that was accepted to be presented at our national meeting. I am sure she will have a very successful career no matter what she plans to do in the future.”

Endocrine News caught up with Balhara to talk about what to expect from this special symposium, her interest in nutrition, how food and culture are intertwined, and those plans for the future.

Endocrine News: What led to your interest in endocrinology?

Maria T. Balhara: My interest in endocrinology and cardiology emerged as an extension of my passion for understanding diet and health disparities. Many endocrine dysfunctions are influenced by modifiable lifestyle factors such as long-term diet, exercise, and stress management, which are themselves shaped by socio-economic elements. By understanding the underlying socio-economic elements that influence these modifiable factors, we can develop targeted preventative interventions to decrease the burden of chronic illnesses.

EN: What can you share about the session you’re moderating?

MTB: I’m excited to share an overview of the symposium, focusing on endocrine health and modifiable environmental risk factors:

Presentation 1: “Climate Change and Food Nutrients”: This talk will explore the impact of climate change on food nutrients, specifically how factors such as rising CO2 levels, temperature fluctuations, and changes in precipitation patterns are affecting nutrient concentrations and bioavailability. We will discuss the potential implications of these changes on human health, concentrating on micronutrient deficiencies and their effects on endocrine function and overall well-being.

Presentation 2: “Processing Matters: How Food Processing Impacts Obesity”: In this talk, we will examine the role food processing plays in obesity development, investigating the mechanistic connections between processed food consumption and disruptions in endocrine function, such as alterations in appetite-regulating hormones and insulin resistance. Additionally, we will explore the broader socio-economic factors that contribute to the widespread availability and consumption of processed foods, emphasizing the role of food environments such as food deserts in health disparities.

Presentation 3: “Endocrine Disruptors in Fast Food”: This talk will analyze the presence of EDCs in fast food, focusing on the role these compounds play in disrupting hormonal signaling and metabolic function. We will discuss common EDCs found in fast food items, such as phthalates and bisphenol A, and their potential impact on endocrine health. Moreover, we will explore strategies to minimize exposure to EDCs and improve endocrine health outcomes.

Many endocrine dysfunctions are influenced by modifiable lifestyle factors such as long-term diet, exercise, and stress management, which are themselves shaped by socio-economic elements. By understanding the underlying socio-economic elements that influence these modifiable factors, we can develop targeted preventative interventions to decrease the burden of chronic illnesses.

EN: What are some examples of how food has changed in the past few years, and what are the implications for people?

MTB: One of the most notable changes in food systems is the rapid increase in ultra-processed food consumption. It has been linked to a higher risk of developing obesity, type 2 diabetes, cardiovascular disease, and certain types of cancer. Additionally, these foods can displace healthier, nutrient-dense options in the diet, exacerbating micronutrient deficiencies and increasing the risk of malnutrition. People located in food deserts, which have limited access to affordable and nutritious food, are at particular risk for these conditions.

Further, climate change has been shown to affect the nutrient composition of staple crops. The decline in nutrient content of these crops can have serious consequences for global health, particularly for populations that rely heavily on these crops as their primary sources of micronutrients. The resulting nutrient deficiencies can impair endocrine function and overall health, as well as exacerbate existing health disparities.

The increasing use of chemicals in food production, packaging, and processing has led to the presence of EDCs in various food items. These chemicals can interfere with hormonal signaling and metabolism, leading to adverse health outcomes. Fast food, in particular, has been shown to contain high levels of EDCs such as phthalates and bisphenol A. Exposure to EDCs through food consumption has been associated with a range of health issues, including obesity, type 2 diabetes, reproductive disorders, and developmental problems. Reducing EDC exposure will be an investment in human health, particularly in vulnerable populations such as pregnant women, infants, and children.

EN: With all these factors that contribute to obesity, this symposium seems like a good way to change the thinking that obesity is a “cosmetic disease” or just a lack of willpower.

MTB: Emphasizing that the obesity epidemic is not a cosmetic issue or a matter of willpower, the symposium points to three key environmental factors that are undermining the quality of our food supply: Ultra-processed foods impacting appetite regulation and insulin resistance, hormone-disrupting EDCs in fast foods, and climate change reducing food nutrients. Recognizing the vital role of these environmental factors affecting food supply allows endocrinologists to take actionable steps, such as educating patients, keeping abreast of the latest research, increasing awareness, and promoting policy changes that improve the food supply at its source to enhance overall health. Thus, the symposium urgently calls for addressing obesity by tackling its primary origin — the diminishing quality of our food supply.

…climate change has been shown to affect the nutrient composition of staple crops. The decline in nutrient content of these crops can have serious consequences for global health, particularly for populations that rely heavily on these crops as their primary sources of micronutrients. The resulting nutrient deficiencies can impair endocrine function and overall health, as well as exacerbate existing health disparities.

EN: Can you speak more about what can be done to address these changes in food?

MTB: A transition to sustainable food systems to reduce obesity urgently requires both supply and demand side interventions. Supply side interventions can increase access to healthier foods, and demand side interventions can encourage healthier food choices among consumers.

The supply interventions include nutrient-sustainable food production practices in face of climate change; strengthening regulations and guidelines for the use of chemicals in food production, packaging, and processing to minimize EDC exposure; and incentives to encourage the development of grocery stores in underserved areas.

The demand interventions can include front-of-package labeling systems that enable consumers to make informed choices, advocating for guidelines in the advertising of unhealthy foods to children, and integrating nutrition education into high-school curriculum.

Exposure to EDCs through food consumption has been associated with a range of health issues, including obesity, type 2 diabetes, reproductive disorders, and developmental problems. Reducing EDC exposure will be an investment in human health, particularly in vulnerable populations such as pregnant women, infants, and children.

In the long term, innovation and research investments are needed in both supply and demand factors in the food supply chain to address these changes in food and the development of obesity to reduce the burden of chronic disease.

EN: I read that your interest in nutrition stems from how culture and food are so much a part of each other.

MTB: The relationship between culture and food is complex and multifaceted. Food is a powerful expression of cultural identity, reflecting the history, values, and traditions of a particular community or region. Food often acts as a social connector, bringing people together. Further, many faiths have specific dietary guidelines. Cultural food practices can have both positive and negative impacts on health. Traditional diets, such as the Mediterranean diet, are often rich in nutrient-dense foods like fruits, vegetables, whole grains, and healthy fats, contributing to a lower risk of chronic diseases. Conversely, other cultural food practices, such as limited consumption of vegetables and protein and increased consumption of high-fat foods in traditional diets, can contribute to the development of obesity and related health issues.

EN: On that note, it seems like there could be cultural barriers to changing some people’s diets. Is that fair to say?

MTB: Cultural barriers can pose challenges to changing people’s diets. Food and culture are deeply intertwined, and people often have strong emotional attachments to their culinary traditions. Consequently, dietary changes can be sometimes met with resistance, as they can be perceived as an attack on cultural identity and values.

EN: What’s the main thing you hope attendees take away from this symposium?

MTB: The main takeaway I hope attendees gain from this symposium is a comprehensive understanding of the complex interplay between the changing food environment, endocrine health, and the development of obesity. By recognizing the multifaceted factors that contribute to obesity, such as climate change, food processing, and endocrine disruptors, we can develop targeted and effective strategies to tackle this public health challenge of obesity and improve endocrine health outcomes.

A transition to sustainable food systems to reduce obesity urgently requires both supply and demand side interventions. Supply side interventions can increase access to healthier foods, and demand side interventions can encourage healthier food choices among consumers.

EN: What’s next for you?

MTB: I will pursue my undergraduate degree at Vanderbilt University. Alongside coursework and research, I plan to work in initiatives that address health disparities.

Bagley is the senior editor of Endocrine News and writes the monthly “Trends and Insights” column that covers the latest breakthroughs in endocrine research. If you have a study that you think would be of interest, contact him at: [email protected].

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