I was struck by headlines last week stating that a CDC study found that 78% of people hospitalized with Covid-19 were overweight or obese.

78%?  That is an enormous percentage.

I looked up the study: Body “Mass Index and Risk for COVID-19–Related Hospitalization, Intensive Care Unit Admission, Invasive Mechanical Ventilation, and Death — United States, March–December 2020.”

Summary

What is already known about this topic?

Obesity increases the risk for severe COVID-19–associated illness.

What is added by this report?

Among 148,494 U.S. adults with COVID-19, a nonlinear relationship was found between body mass index (BMI) and COVID-19 severity, with lowest risks at BMIs near the threshold between healthy weight and overweight in most instances, then increasing with higher BMI. Overweight and obesity were risk factors for invasive mechanical ventilation. Obesity was a risk factor for hospitalization and death, particularly among adults aged <65 years.

What are the implications for public health practice?

These findings highlight clinical and public health implications of higher BMIs, including the need for intensive management of COVID-19–associated illness, continued vaccine prioritization and masking, and policies to support healthy behaviors.

The data supporting the headline are found in Table 1 in the paper.  This shows that overweight and obesity do indeed account for 78% of hospitalizations, but also close to that percentage for ICU visits and mechanical ventilation, but “only” 73% of deaths.

Overweight and obesity were especially risky for people under age 65, although they caused plenty of problems for people over age 65 too.

Why do they make Covid-19 worse?  The best guesses have to do with inflammation and mechanical pressure on lungs.

I found these figures shockingly high.

Shouldn’t we be doing all we can to reduce the risks for overweight and obesity?  Yes we should.

And what are those risks?

• Poverty
• Racial discrimination
• Inadequate schools
• Unemployment
• Lack of adequate health care
• Air pollution
• And, of course, poor diets

If Covid-19 has taught us anything, it is that to prevent its bad effects, we need vaccinations and masking for sure, but we also need to change society.

The American Rescue Plan Act of 2021, otherwise known as the $1.9 trillion stimulus bill has lots of bits and pieces to strengthen elements of the food system.

This bill:

• Extends the 15% increase in SNAP benefits through September 30, 2021
• Makes more SNAP benefits available to Puerto Rico, Samoa, Marianas
• Increases support for WIC, especially for fruit and vegetable purchases
• Continues Pandemic-EBT (free meals for school children excluded from schools)
• Provides funds for debt relief and outreach for socially disadvantaged farmers
• Establishes a new grant program for restaurants and bars to meet payroll and other expenses
• Expands income support for families with children through tax credits for child care and earned income

In addition, the Biden Administrration has done some other things to reduce food insecurity

• Extends state waivers for free school meals through summer 2021

What’s still needed:

• A comprehensive plan for creating a food system that promotes health and sustainability
• Universal school meals
• Universal Basic Income

Some of these new measures are steps in that direction.  They just need to be continued.  Advocate!

I like potatoes and they have plenty of nutritional value along with their calories, but their calories mainly come from starch—a rapidly digested carbohydrate.

The Harvard Food Pyramid puts potatoes in the “Eat Sparingly” category, right at the top with red meat, butter, and sugary beverages.

Potato industry marketers to the rescue!  Take a look at the website of Potatoes USA, which has as its mission developing marketing campaigns for the industry.

Industry participation is key to making any campaign a success. Here you’ll find marketing tools that will help you promote the positive potato nutrition message.  Find the tools that match your organization, whether you’re looking for resources for retailers, manufacturers, consumers, foodservice operators, or information on potato nutrition.

Here you can find a toolkit on how to market potatoes:

For years we’ve talked about why you can eat potatoes. Now we’re talking about why you should eat potatoes. Getting the whole industry involved is key to getting this message heard. Find the tools you need to support the process with events in your area.

I was interested in what they have to say about nutrition, of course: “Potatoes are more energy-packed than any other popular vegetable and provide the carbohydrates, potassium and energy you need to perform your best.”

The nutrition campaign focuses on energy for performance.  It provides a Nutrition Facts label that reassures you that one 5.3-ounce potato has only 110 calories.

It doesn’t say much—anything, really—about how Americans mostly eat potatoes, which happens to be as fries or chips.

It does provide tons of information about marketing methods, the research sponsored by the potato industry, and even issues regarding international trade—a goldmine if you are interested in this sort of thing.

If you just want to eat them, watch out for the added fats.  The bigger the potato—and the more butter and sour cream—the higher the calories.

Mark Bittman.  Animal, Vegetable, Junk: A History of Food, from Sustainable to Suicidal.  Houghton Mifflin Harcourt, 2021.

This book comes with more than three pages of blurbs, starting with Al Gore and Leah Penniman and ending with José Andrés and Bryant Terry, so many and so glittery that I’m feeling a little left out that I wasn’t asked to do one.

I would have.  It’s a good book.  Bittman read a lot, is generous in citing sources (mine among them), and has done a thorough synthesis of the key events that transformed our food system from one that was healthy and sustainable (if hard on farmers) to today’s unsustainably industrialized system that is mainly set up to feed animals and fuel cars, and to encourage us to consume ultra-processed diets.   We pay the externalized costs of this system in overweight and chronic diseases that increase our vulnerability to COVID-19 and in environmental degradation and climate change.

Here are a few excerpts:

And while Deere & Co. [the tractor company] showed good will toward struggling farmers, its success in financially bonding those farmers virtually ensured that creditors remained profitable in the long run.  It’s also among the chief reasons why industrial agriculture is so difficult to change today.  Today, the company’s margins are almost four times as great from providing credit as they are from sales…Its 2019 profits were eleven billion dollars, a bit more than ten percent of the comb8ined profits of all two million-plus farms in the United States that same year [pp. 107-108]

In fact, the worse you were treated by American policy in the eighteenth and nineteenth centuries, the worse you were treated in the twentieth.  For example, the Social Security Act of 1935 and the Fair Labor Standards (sic!) Act of 1938 both excluded agricultural and domestic, thanks to influential southern Democrats who refused to protect the Black people working in those sectors.  This meant that the New Deal disproportionately excluded people of color from the most vital government protections….[p. 120].

You will hear, “The food system is broken.”  But the truth is that it works almost perfectly for Big Food.  It also works well enough for about a third of the world’s people, who have the money to demand and have at a moment’s notice virtually any food in the world.  But it doesn’t work well enough to nourish most of humanity, and it doesn’t work well enough to husband our resources so that it can endure,  Indeed the system has created a public health crisis (one whose effects have, in turn, exacerbated the deadly effects of COVID-19), and, perhaps even more crucially, it’s a chief contributor to the foremost threat to our species: the climate crisis.  The way we produce food threatens everyone, even the wealthiest and cleverest [p. 243].

The Republicans have figured out that if they can keep anyone who is against them from voting, they will win elections.  Here’s the latest ploy.

The Georgia House passed a bill last week making it illegal to hand out free pizza to people waiting in line to vote.

The bill says:

No person shall solicit votes in any manner or by any means or method, nor shall any person distribute or display any campaign material, nor shall any person give, offer to give, or participate in the giving of any money or gifts, including, but not limited to, food and drink, to an elector, nor shall any person solicit signatures for any petition, nor shall any person, other than election officials discharging their duties, establish or set up any tables or booths on any day in which ballots are being cast.

Georgia has make voting so difficult that people have to wait on lines for hours.  This encouraged formation of Pizza to the Polls, a group that hands out free pizza to people on line.

During the last election, Georgia officials said it was illegal to hand out pizza, but it wasn’t illegal then.

Now it might be.

You don’t understand why food is political?  How’s this for an example.

New York City is taking big steps to improve its food system.   Two reports are worth noting, one from the Mayor’s office and one from the Health Department.

I.  Mayor Bill de Blasio and Kate MacKenzie, Director of the Mayor’s Office of Food Policy (MOFP) have released Food Forward NYC: A 10-Year Food Policy Plan.

Here’s how they introduce this impressive report:

Food Forward NYC is the City’s first ever 10-year food policy plan, laying out an comprehensive policy framework to reach a more equitable, sustainable, and healthy food system by 2031.

Food Forward NYC emphasizes the importance of equity and choice – enabling a food system where everyone should be able to access the food they want wherever they may want it. To enable this choice, we need to support both our food workers and our food businesses. To strengthen the sustainability and resiliency of our food system, we need to rethink our food infrastructure and deepen our connections with the region.

Food Forward NYC is organized around five overarching goals:

1. All New Yorkers have multiple ways to access healthy, affordable, and culturally appropriate food.
2. New York City’s food economy drives economic opportunity and provides good jobs.
3. The supply chains that feed New York City are modern, efficient, and resilient.
4. New York City’s food is produced, distributed, and disposed of sustainably.
5. Support the systems and knowledge to implement the 10-year food policy plan.

The full report is here.  It was prepared in response to Local Law 40 of 2020 and recommendations from the New York City Council’s 2019 report, Growing Food Equity in New York City.  

New York City is a complicated place and it’s wonderful to have all this information put together in such a coherent way.  Let’s hope everyone gets behind this and puts the recommendations into action.

II.  The Bureau of Chronic Disease Prevention at the NYC Health Department has an update on its  National Salt and Sugar Reduction Initiative (NSSRI).

In October 2018, the Bureau announced draft sugar reduction targets.  Now they have updated them and added targets for salt reduction, as well.  As I was informed in an e-mail,

The NSSRI is a partnership of over 100 local city and state health departments, associations, and health organizations, convened by the NYC Department of Health. We have set voluntary sugar reduction targets for 15 categories of food and beverages. The targets represent a 10% reduction in sugar content of products by 2023, and a 20% reduction by 2026 for food with a 40% reduction for beverages.

The current public health landscape demonstrates that diet remains critical, even during a public health emergency like COVID-19. Diet-related health conditions such as diabetes and heart disease, which can increase the risk of severe illness from COVID-19, are important to address right now.

Here’s what one of the sugar reduction targets looks like:

The objective of NSSRI is this:

To promote gradual, achievable and meaningful reductions in sugar content in packaged foods and beverages. This is because intake of added sugars is associated with increased risk of excess weight, type 2 diabetes, hypertension, stroke, heart disease and cavities.

The targets are indeed gradual; the hope it that they will be met by 2026.

The targets are, of course, voluntary.  The best NSSRI can do is to encourage companies to comply and hold them accountable.

It’s a start.

Early in February I wrote about heavy metal toxins in baby foods.  A report, Baby Foods Are Tainted with Dangerous Levels of Arsenic, Lead, Cadmium, and Mercury, revealed:

• Arsenic, led, cadmium, and mercury are present in commercial baby foods at levels much higher than considered safe.
• Their sources: foods raised on contaminated soil and water, and vitamin/mineral pre-mixes.
• Baby food companies set their own safety standards for toxic metals.
• The FDA knows baby foods have high levels of toxic metals but isn’t doing anything about it.
• Some baby food companies refused to share data on this topic.

Politico has been following this story.  It reports:

• The FDA launched a working group on toxic food contaminants in 2017,  partly in reaction to an earlier EPA study that found food to be a source of about half the lead that kids get (see supplementary material in this paper).
• Preventing lead exposure would be good for society as well as for children.

In response to the “Tainted” report, the FDA now says it will set standards.

The FDA wrote baby food manufacturers to shape up.  The FDA, it says,

 is taking this opportunity to remind all baby and toddler food manufacturers and processors covered by the preventive control provisions of the rule Current Good Manufacturing Practice, Hazard Analysis, and Risk-Based Preventive Controls for Human Food…of your responsibility under the rulemaking to consider chemical hazards that may be present in foods when conducting your hazard analysis….FDA takes exposure to toxic elements in the food supply extremely seriously, especially when it comes to protecting the health and safety of the youngest and most vulnerable in the population.

And the FDA issued a statement to the food industry. 

Toxic elements are in the environment, and therefore in the food supply. The levels of arsenic, lead, mercury, and cadmium in certain foods depends on many factors, including: growing conditions; manufacturing and agricultural processes; past or current environmental contamination; and the genetic capacity of food crops to take up elements. We share the public’s concerns for the health of America’s children, and want to reassure parents and caregivers that at the levels we have found through our testing, children are not at an immediate health risk from exposure to toxic elements in foods. The FDA routinely monitors levels of toxic elements in food, and if we find that they pose a health risk, the FDA takes steps to remove those foods from the market.

Research has shown that reducing exposure to toxic elements is important to minimizing any potential long-term effects on the developing brains of infants and children. As such, this issue is among FDA’s highest priorities and we are actively working to make progress on identifying and implementing impactful solutions to make foods commonly consumed by infants and young children safer.

In the meantime, here’s what Beech Nut says on its website.

Toxic heavy metals are not good for babies’ health.  Baby food companies need to do much better in getting rid of these things if they want anyone to keep buying their products.

What to do in the meantime?  Feed kids small amounts of as wide a variety of foods as possible.  That’s good advice anyway.

Effects of Whole Grain Intake, Compared with Refined Grain, on Appetite and Energy Intake: A Systematic Review and Meta-Analysis.  Lisa M Sanders, Yong Zhu, Meredith L Wilcox, Katie Koecher, Kevin C Maki.  Advances in Nutrition, Published: 02 February 2021, nmaa178.

Conclusion: These results support the view that consumption of WG [whole grain] foods, compared with RG [refined grain] foods, significantly impacts subjective appetite, and might partly explain the inverse associations between WG food intake and risk of overweight, obesity, and weight gain over time.

Funder: This research was funded by Bell Institute of Nutrition, General Mills, Inc.

Author disclosures: KCM, MLW, and LMS are employees of Midwest Biomedical Research, which has received research funding from General Mills, Inc., Kellogg Company, and the Quaker division of PepsiCo. KK and YZ are employees of General Mills, Inc. The funding sponsor provided comments on early aspects of the study design. Interim analyses and the final data were shared with the sponsor prior to publication, but the final decision for all aspects of study conduct and manuscript content is that of the authors alone.

Comment: General Mills paid for the study, had input into the study design, and reviewed the data and analysis before publication.  Two of the authors are employed by General Mills and the others work for a company that gets funding from General Mills.  This is a study designed to help General Mills market products containing whole grains.

Marketing of whole grains is tricky.  The only label that counts is 100% whole grains.  Anything other than that is marketing hype.