by Marion Nestle

Posts dated: March2013

Mar 7 2013

Lancet series on chronic diseases, many of them diet-related

The Lancet has just published a series of articles on non-communicable diseases (NCDs) the collective term for heart disease, type 2 diabetes, and other chronic conditions caused in large part by poor diets, lack of physical activity, or cigarettes or alcohol.

Since food politics is a big part of this discussion, these papers are worth a look.  For example, as editor Richard Horton explains in his editorial:

So where are the global conferences on NCDs, the research meetings, the task forces, the grand challenges initiated by funders and foundations? They don’t exist. We, the global health community, understand that chronic diseases are a present danger to the health of our societies. Yet we are unable to translate that understanding into real political action. We cannot quite bring ourselves to put heart disease, stroke, cancer, chronic respiratory disease, diabetes, or mental ill-health, together with their associated risk factors, on an equal footing with childhood pneumonia and diarrhoea, preventable maternal death, or epidemics of AIDS, tuberculosis, and malaria. The disconnect between the reality of people’s lives in countries and the concerns of professional and political leaders has rarely been greater.

Here are the papers in this series.  Read them and ponder.

Independent global accountability for NCDs

Robert Beaglehole, Ruth Bonita, Richard Horton

Full Text | PDF

NCDs: a challenge to sustainable human development

Helen Clark

Full Text | PDF

Embedding non-communicable diseases in the post-2015 development agenda

George Alleyne, Agnes Binagwaho, Andy Haines, Selim Jahan, Rachel Nugent, Ariella Rojhani, David Stuckler, for The Lancet NCD Action Group

Summary | Full Text | PDF

Country actions to meet UN commitments on non-communicable diseases: a stepwise approach

Ruth Bonita, Roger Magnusson, Pascal Bovet, Dong Zhao, Deborah C Malta, Robert Geneau, Il Suh, Kavumpurathu Raman Thankappan, Martin McKee, James Hospedales, Maximilian de Courten, Simon Capewell, Robert Beaglehole, on behalf of The Lancet NCD Action Group

Summary | Full Text | PDF

Inequalities in non-communicable diseases and effective responses

Mariachiara Di Cesare, Young-Ho Khang, Perviz Asaria, Tony Blakely, Melanie J Cowan, Farshad Farzadfar, Ramiro Guerrero, Nayu Ikeda, Catherine Kyobutungi, Kelias P Msyamboza, Sophal Oum, John W Lynch, Michael G Marmot, Majid Ezzati, on behalf of The Lancet NCD Action Group

Summary | Full Text | PDF

Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries

Rob Moodie, David Stuckler, Carlos Monteiro, Nick Sheron, Bruce Neal, Thaksaphon Thamarangsi, Paul Lincoln, Sally Casswell, on behalf of The Lancet NCD Action Group

Summary | Full Text | PDF

Promotion of access to essential medicines for non-communicable diseases: practical implications of the UN Political Declaration

Hans V Hogerzeil, Jonathan Liberman, Veronika J Wirtz, Sandeep P Kishore, Sakthi Selvaraj, Rachel Kiddell-Monroe, Faith N Mwangi-Powell, Tido von Schoen-Angerer

Summary | Full Text | PDF

Improving responsiveness of health systems to non-communicable diseases

Rifat Atun, Shabbar Jaffar, Sania Nishtar, Felicia M Knaul, Mauricio L Barreto, Moffat Nyirenda, Nicholas Banatvala, Peter Piot

Summary | Full Text | PDF

Mar 5 2013

Let’s Move! Celebrates its 3rd Birthday–At Walmart’s

Last week, First Lady Michelle Obama did a national tour to celebrate the third anniversary of her Let’s Move! campaign to end childhood obesity within a generation.  

As explained in the White House press release, the tour was to focus on school lunches, physical activity, and getting businesses involved—“Healthy Families, Thriving Businesses.”

To that end, she visited a Walmart in Springfield, Missouri to congratulate the company on its pledge to open 300 stores in communities with limited access to affordable healthy foods, to reduce salt and sugars in its products, to make healthier food more affordable, and to put front-of-package logos on healthier foods.

As the press release explained (and as Walmart says in its own):

Walmart is one of many businesses across the country that is making healthy changes to support their customers, because they recognize that what’s good for their customer’s health is also good for their business. Following the tour, Mrs. Obama will deliver remarks about how supporting the health of American families is also good for business, and remind consumers that it’s up to them to continue demanding healthier options.

Did this mean that the new emphasis of Let’s Move! would be on personal responsibility?  Mrs. Obama explained further in the Wall Street Journal:

Take the example of Wal-Mart. In just the past two years, the company reports that it has cut the costs to its consumers of fruits and vegetables by $2.3 billion and reduced the amount of sugar in its products by 10%. Wal-Mart has also opened 86 new stores in underserved communities and launched a labeling program that helps customers spot healthy items on the shelf.

The best reported account of this visit is by Eddie Gehman Kohan at Obamafoodorama.  She points out that this particular Walmart is not located in an underserved community.  She also did the math and calculated that the savings in the cost of fruits and vegetables work out to 16 cents per week per customer.

At this point, I thought it was time for a field trip.

I was in Ithaca, NY over the weekend and checked out its Walmart to see what its Let’s Move!-inspired actions looked like on the ground.  I particularly wanted to see how its “Great for You” labeling program was working out.   This, you may recall, identifies healthy products with this logo:

Although the labeling program was announced a year ago, I had to search hard to find any examples.  Here are a couple in the produce section.

 

 

 

 

 

 

 

 

Only a few bins of produce were marked with those labels.  There’s a tiny one in the picture below in front of some clementines from Honduras, but none of the other foods in that section had labels.

 

 

 

 

 

 

 

 

I could not find another such label anywhere else in the store.

How else was this Walmart promoting healthier eating?  Its big in-store promotion that day was right along the produce section: a large display of Oreo Mega Stuf cookies (the ones with twice the filling and twice the calories of regular Oreos).  A man was handing out free samples and dollar-off coupons.  When I picked up a package to read the label he said “Don’t do that. Treat yourself.”

The Ithaca Walmart is a quarter of a mile from Wegmans, so I did some comparison shopping.  I was surprised to find that the prices were remarkably close—about the same or only slightly higher (explaining why the Walmart price advantage is only a couple of cents a day).

But the people who shopped in Wegmans looked more affluent and healthier than Walmart shoppers.

Although the prices are similar—and the fresh foods at Wegmans are of higher quality—that Walmart is much less crowded, sparsely staffed by poorly paid employees,  and somehow makes it more comfortable for very poor people to shop there.

My conclusions:

  • Walmart makes produce available at market prices to people who don’t feel comfortable going to Wegmans.  
  • Walmart promises to open stores in low-income areas where Wegmans will not.

On this basis, does Walmart deserve this high level of White House praise and attention?

I don’t get it. 

Mar 3 2013

Food Matters: Horsemeat scandal has eaters nervous

My monthly (first Sunday) column in the San Francisco Chronicle is now out, this time on the horsemeat scandal.

Q: It makes me sick to think that anyone could eat horsemeat. I don’t see how it could get into so many foods. Tell me how I can be sure I’m not eating it.

A: From this side of the Atlantic, the discovery of horsemeat in European hamburger and frozen dinners is the most riveting of scandals, replete with DNA technology, veterinary drugs, impossible-to-trace supply chains, smuggling, organized crime and outright fraud – not to mention the usual finger-pointing, cover-ups and protestations of shock that accompany food crises.

It is easy to explain how horsemeat got into vast amounts of hamburger and prepared meals. Horses are expensive to house and feed. Something has to be done with them when they are no longer wanted for farming, transport, racing or recreation. Horsemeat is edible, even delicious to some, and costs less than beef.

Complications

In Europe, the supply chains are exceptionally complicated, involving countless companies in more than 21 countries that process, transport or sell horses or horsemeat. The complexity makes it relatively easy to use horses to smuggle people or drugs, to label horsemeat as beef or to slip it into hamburger.

This would just be a matter of economic fraud if people didn’t care whether they ate horsemeat. But some Europeans, and most Americans, care very much. Like you, many people are appalled at the idea of eating any companion animal, let alone one symbolic of the rugged West.

Beyond cultural prohibitions, there are other reasons to avoid eating meat from horses not raised for food. Horses are routinely treated with veterinary drugs, legal and not. The drug traces found in European horsemeat may be too low to cause harm, but hardly seem likely to promote human health.

How long horsemeat has been passed off as European beef is unknown, as is why officials in Ireland decided to do DNA tests on supermarket meals in the first place. Whether done as routine testing or because of a tip, the results were startling. More than one-third of the tested “beef” samples contained horsemeat. Later tests in Great Britain identified “beef” meals made entirely from horsemeat.

This, as the Guardian’s writer Felicity Lawrence wrote in her guide to the scandal, can only be “industrial scale adulteration.”

The ensuing crisis forced many food companies and retailers to recall vast numbers of products, some intended for school meals. Nestlé (no relation) recalled pasta meals, but issued assurances that such products do not leave Europe and that none of its American products contains horsemeat-laden European beef.

What to make of this? In our food studies programs at New York University, we discuss food as a marker of cultural identity. People in other nations eat horsemeat. But like you, about 80 percent of Americans are appalled at the idea of eating horsemeat and oppose slaughtering horses for food or any other reason.

Yet horsemeat used to be eaten by Americans (and still is, by some), and even more so by pets. As Malden C. Nesheim and I wrote in our book about the pet food industry, “Feed Your Pet Right,” horse slaughterhouses created pet food companies to dispose of the meat. Through the 1940s, nearly all domestic horsemeat ended up in pet food.

Under pressure from horse lovers and animal welfare advocates, pet food companies replaced horsemeat with meat from other animals. Although horsemeat is permitted in pet food, and in theory could show up in rendered byproducts and meals, no American company would knowingly use it as an explicit item in an ingredient list. One can only imagine the uproar if it did.

Inspection issues

In 2007, Congress blocked the Department of Agriculture from inspecting slaughterhouses, effectively banning their use. As unintended consequences, the 140,000 or so unwanted horses each year had to be transported to slaughterhouses in Canada or Mexico, and populations of neglected and abandoned horses increased. As a result, Congress permitted horse slaughterhouses to reopen last year, but the USDA has yet to authorize inspectors to work in them.

Could American beef be contaminated with horsemeat? We had a similar scandal in the 1950s. But if U.S. officials are testing hamburger for horsemeat DNA these days, they aren’t saying.

Because horsemeat is not produced here, it won’t be in butcher shops or supermarkets – unless the stores imported it or acquired contaminated products before the recalls, or unless the USDA assigns inspectors and allows horse slaughterhouses to reopen. Right now, without DNA testing, you can’t be sure.

You find this alarming? Short of going vegetarian, you have an option: Buy kosher meat. Jewish dietary laws prohibit horsemeat – horses are not ruminants and do not have cloven hooves – and kosher slaughterhouses are diligent about excluding forbidden animals.

This gives the horsemeat scandal one clear winner: Sales of kosher meat are booming.

Mar 1 2013

Does sugar cause diabetes? Is a calorie a calorie?

I spent a lot of time last week talking to reporters about the widely publicized study in PloS One that correlates sugar and diabetes.

The study is based on an econometric model of data food availability and diabetes prevalence in many countries.  Such data are not particularly reliable, but the authors did the best they could with what they had.  They are quite forthcoming about the limitations of their model and the data on which it is based [see addition below].

Their principal conclusion: for every 150 kcal/person/day increase in sugar availability (about one can of soda/day), diabetes prevalence increases by about 1%.

Because no other dietary, weight, or behavioral factor shows this kind of effect in their model, it is tempting to interpret the study as demonstrating that sugar is a risk factor for diabetes independent of calorie intake or body weight.

I’m not so sure.  Take a look at the summary figures and decide for yourself.

Figure 1.  Relationship between obesity and worldwide prevalence of diabetes.

Figure 1 Relationship between obesity and diabetes prevalence rates worldwide.

Despite outliers, this figure shows an obvious and strong correlation between obesity and diabetes.  Compare this to Figure 2.

Figure 2.  Relationship of sugar availability to worldwide diabetes prevalence.

Figure 2 Adjusted association of sugar availability (kcal/person/day) with diabetes prevalence (% adults 20–79 years old).

The correlation here is much less obvious.  Without statistical tests, you could just as easily draw the line straight across the graph.  The statistical significance is much weaker than that in Figure 1.

This means that these data cannot easily distinguish between several possibilities:

(a) Calories –> Obesity –> Diabetes

(b) Sugar –> Diabetes

(c) Sugar –> Calories –> Obesity –> Diabetes

While waiting for science to clarify these distinctions, the bottom line is the same for all of them.

As I explained in yesterday’s post, everyone would be healthier eating less sugar.

Addition: The authors have posted detailed comments about their methods.