Sara Bleich*

Sara Bleich*

Senior Advisor for COVID-19, US Department of Agriculture
on leave from Harvard T.H. Chan School of Public Health
*Harvard PhD Program in Health Policy Alumna & Faculty Member

Dissertation Title:  "Obesity Policy and the Public"

Globally, obesity has reached epidemic proportions affecting more than 300 million adults. This dissertation focuses on adult obesity and uses several interdisciplinary methods to explore the intersection between public policy and obesity prevention/control. The first paper is a longitudinal analysis of the primary drivers of the obesity epidemic in developed countries and the contributions of various markers of development to increased caloric intake. The results indicate that rising obesity is primarily the result of consuming more calories, and that the increase in caloric intake is associated with technological innovations such as reduced food prices as well as changing sociodemographic factors such as increased urbanization and increased female labor force participation.

The second paper uses propensity scores to examine the independent contributions of insurance status (e.g., Seguro Popular vs. uninsured) and health professional supply (e.g., number of doctors and number of nurses per 1000) on coverage of antihypertensive therapy among adults with hypertension in Mexico. The findings suggest that having Seguro Popular (SP) insurance is associated with higher rates of antihypertensive treatment and blood pressure control. Further, Seguro Popular may be most effective in areas with a high health professional to patient ratio. Finally, the results indicate that 3,381 cardiovascular deaths among the uninsured could potentially be avoided through enrollment in SP; approximately six percent of total cardiovascular mortality for the SP-eligible population in 2004.

The third paper uses multivariate regression analysis to assess public trust in scientific experts on obesity and its relationship to both awareness of nutritional recommendations and appropriate behavioral change. This paper also identifies those sociodemographic groups associated with high and low trust in scientific experts. The findings show that trust in scientific experts is the strongest predictor of public attention to nutritional recommendations from scientific experts; that public attention is significantly associated with weight-related behavior; that women and more educated individuals have significantly higher odds of trusting scientific experts; and that Hispanics and older individuate have significantly lower odds of trusting scientific experts. While the focus and scope of each of these papers is quite different, they each share a common concern for improving our understanding of those factors which may contribute to or reduce the escalation of obesity and its related diseases.

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