Search results: Ultra processed foods

Serge Hercberg, who originated the NutriScore front-of-package labeling system used in France and several other European countries send me a link to this review by several Italian investigators.   To refresh memory, this is how NutriScore works.

It’s a bit complicated but this paper is even more so.  Its writing seems obfuscating, but judge for yourself.

The review: Uncovering the Effect of European Policy-Making Initiatives in Addressing Nutrition-Related Issues: A Systematic Literature Review and Bibliometric Analysis on Front-of-Pack Labels.  Nutrients2022, 14(16), 3423; https://doi.org/10.3390/nu14163423

Conclusions: “The most recent goal of EU policy-makers is to find a harmonized and universal labelling system to adapt in all European countries. However, observing the structure of the extant literature, there might be two current risks that should be avoided. The first risk is to outline a labelling scheme that is not fully supported by converging evidence as derived from multiple different constructs. The second one refers to the risk of implementing a labelling scheme grounded on valid results and high levels of citations, supported by a network of authors, but overlooking the fragmentation of other valid positions in the literature that together contribute to depicting an environment in which the different and still valid results reflect the diversity of alternatives that are equally effective, but less supported. In conclusion, the right choice of FoPL would benefit both consumers and the food industry, but there are still additional knowledge and usage gaps that must be fulfilled to define the proper universal option that supports consumers toward healthier and more informed food choices.”

Funding: The research received non-conditional funding from Federalimentare.

Conflicts of Interest: The authors declare no conflict of interest.

Comment: Federalimentare is the Federazione Italiana dell’Industria Alimentare, the major Italian food trade association.  It strongly opposes use of NutriScorre (no surprise).  The authors do have a conflict of interest, but either do not recognize it or are denying it.

I think what they are saying that NutriScore and other front-of-pack systems are not “fully supported by converging evidence,” suggesting that better alternatives would “benefit both consumers and the food industry.”

But what’s really going on here is that front-of-pack labels discourage puchases of ultra-processed foods.  It is understandable that the food industry dislikes them.

This paper is part of a concerted effort by the Italian food industry to discredit NutriScore.

Serge Hercberg, a professor of nutrition at the University of Paris, is under intense personal attack from Italian Twitter trolls, who have been posting insulting and threatening anti-Semitic tweets about his background (Polish Jewish) and his work with NutriScore.

Nutri-Score is not perfect (no such scheme can be) but the only explanation for these attacks must be that it is working.  The attacks are strong evidence for its effectiveness.

Who would ever imagine that a front-of-package food label would elicit anti-semitic vitriol.

Tough times, these.

The Task Force on Hunger, Nutrition, and Health released its comprehensive report yesterday.

The report’s purpose is to inform the upcoming White House Conference on Hunger, Nutrition, and Health.  If so, it’s going to leave the White House in a quandary.

The report has lots of useful information, beautifully presented, and does all it should on adddressing hunger.

But as I read it, the report, titled Ambitious, Actionable Recommendations to End Hunger, Advance Nutrition, and Improve Health in the United States,” is not nearly ambitious enough when it comes to nutrition and health.

It makes far too many recommendations—30.  That’s always a bad sign (too many to do).  .

Really, only 2 recommendations are needed.  These should establish or expand federal agriculture, food, and nutrition policies to ensure:

1.  Adequate, affordable food and nutrition for everyone.
2.  Healthy diets for everyone, meaning those that follow Dietary Guidelines and are largely plant-based, balanced in calories, and low in undesirable fats, sugars, and salt (i.e., ultra-processed foods).

The hunger recommendations do the job: they call for ensuring benefits sufficient to meet households’ basic needs.

But the second?  A mess.

Here is the most obvious example [my comments follow] .

Recommendation #9: “Reduce the marketing of foods that do not align with the latest DGA and increase the marketing of foods that align with the latest DGA to children and populations with disproportionate rates of diet-related chronic conditions” [Good! But not through the recommended voluntary methods by industry.  That won’t work; it requires legislation]

But here’s Recommendation #25: “Increase the ability of food companies to communicate with consumers about the evidence for healthfulness of certain food products and nutrients.”  [Uh oh]

This comes with three action items:

1. FDA should expeditiously update its definition of the word “healthy” [good] and incentivize food companies to use the terminology and/or associated symbol in their food packaging and marketing [Yikes!] and increase the proportion of products on the market that meet the “healthy” definition [OK, as long as they are not gaming the system].
2. Congress and/or FDA should improve and streamline the process for application, review, approval, and use of health claims and qualified health claims on food packages. [No!  If it’s one thing we don’t need, it’s more misleading health claims]. 
3. Congress and/or FDA should create a new process for communicating about foods, nutrients, and other bioactive ingredients that may prevent or treat disease through label claims. [No!  We do not need more claims for the benefits of ultra-processed food products].

What’s missing from this report?

• Anything about ultra-processed foods and their effects on calorie intake and overall health.  The term is mentioned once, but only in the context of ‘more research needed’ (Recommendation #19).
• A clear statement of the benefits of soda taxes in reducing consumption of sugar-sweetened beverages.  Why isn’t there one?  A box explains: “Task Force members voiced diverse perspectives on this topic.”
• A clear statement about making SNAP align with Dietary Guidelines.  This is mentioned, but only in the context of pilot research (recommendation #2), and therefore contradicts recommendations #3 and #5.  #3:  Increase nutrition security by promoting dietary patterns that align with the latest Dietary Guidelines for Americans (DGA) through federal nutrition programs.  #5:  Leverage the federal nutrition programs’ power in economic stimulus to support food systems that promote foods that align with the latest DGA.”
• Firm calls on Congress to pass legislation to do what is needed.

What happened?  One member of the committee explained to me that its membership included everyone from anti-hunger advocates to food industry representatives, and too many vested interests were at stake.  Members could not agree on anything that would make a real difference to policy.  Anything substantive met strong resistance.

When it comes to public health policy, which this most definitely is, the food industry has no business being at the table.

This was a recommendation of the 2019 Lancet Commission on the Global Syndemic of Obesity, Undernutrition, and Climate Change.  Read that report.  It explains why including the food industry in policy recommendations that might reduce sales is not a good idea.

If I had been a member of this Task Force, I would have called for a minority report on policies for reducing consumption of sugary drinks and ultra-processed foods.  But that, of course, is why I’m no longer appointed to such committees.

• Read the Executive Summary
• Read the Full Report
• Read the Press Release
• Register here for the Webinar hosted by the co-chairs: Wednesday, Aug. 31 at 2:00 p.m. ET.

JAMA Internal Medicine has just published an editorial I wrote: Preventing Obesity—It Is Time for Multiple Policy Strategies

As it explains, it is a commentary on a research article by Joshua Petimar, et al, Assessment of Calories Purchased After Calorie Labeling of Prepared Foods in a Large Supermarket Chain  

Both papers are behind paywalls, but here are the key points of the supermarket article:

Question  Was calorie labeling of prepared foods in supermarkets associated with changes in calories purchased from prepared foods and potential packaged substitutes?

Findings  In this longitudinal study of 173 supermarkets followed from 2015 to 2017, calories purchased from prepared bakery items declined by 5.1% after labeling, and calories purchased from prepared deli items declined by 11.0% after labeling, adjusted for prelabeling trends and changes in control foods; no changes were observed among prepared entrées and sides. Calories purchased from similar packaged items did not increase after labeling.

Meaning  Calorie labeling of prepared supermarket foods was associated with overall small declines in calorie content of prepared foods without substitution to similar packaged foods.

I was really interested in this study because the “large supermarket chain” that supplied reams of data was so obviously Hannaford, which has long been ahead of the curve in trying to encourage customers to make healthier food choices.

In 2005, Hannaford initiated a Guiding Stars program that ranked–and still ranks–products by giving them zero to three stars depending on what they contain.

I wrote about the first-year evaluation of this program way back in 2006.  It did help customers to make better choices.

Now, all these years later, the FDA is contemplating doing some kind of front-of-package label.  As I said, Hannaford is way ahead.

But the point of my editorial is that single interventions rarely do better than what this study found.

I argue here for trying multiple strategies at once:

My interpretation of the current status of obesity prevention research is that any single policy intervention is unlikely to show anything but small improvements.

Pessimists will say such interventions are futile and should no longer be attempted.

Optimist that I am, I disagree.  We cannot expect single interventions to prevent population-basedweight gain ontheirown,but they might help some people—and might help even more people if combined simultaneously with other interventions.

….Widespread policy efforts to reduce intake of ultraprocessed foods through a combination of taxes, warning labels, marketing and portion-size restrictions, dietary guidelines, and media education campaigns, along with policies for subsidizing healthier foods and promoting greater physical activity, should be tried; they may produce meaningful effects.

Politically difficult? Of course. Politically impossible? I do not think so.

Unless we keep trying to intervene—and continue to examine the results of our attempts—we will be settling for the normalization of overweight and the personal and societal costs of its health consequences.

Here’s Ted Kyle’s commentary on my commentary on ConscienHealth.

Thanks to Lisa Young and three other readers for sending along this one.

The press release: New Research Finds Consumption of Peanuts Supports Weight Loss, Lowers Blood Pressure and Improves Glucose Levels

The Study: Petersen, K.S.; Murphy, J.; Whitbread, J.; Clifton, P.M.; Keogh, J.B. The Effect of a Peanut-Enriched Weight Loss Diet Compared to a Low-Fat Weight Loss Diet on Body Weight, Blood Pressure, and Glycemic Control: A Randomized Controlled Trial. Nutrients 2022, 14, 2986. https://doi.org/10.3390/nu14142986.

Conclusion: Intake of 35 g of peanuts prior to two main meals per day, in the context of an energy-restricted diet, resulted in weight loss comparable to a traditional low-fat weight loss diet without preloads. Greater systolic blood pressure reductions were observed with peanut intake, which may lower cardiovascular disease risk.

Funding: This research was funded by The Peanut Institute…The funder had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Conflicts of Interest: J.B.K., P.M.C. and K.S.P. received a grant from The Peanut Institute to conduct this study. The funder had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Comment: The funder had no role?  That’s what they all say.  That may be true in this instance, but but much research demonstrates otherwise, and funders are unlikely to pay for studies that might give them unfavorable results.

The underlying purpose of this study was to demonstrate that if you are on a weight-loss diet, you can eat lots of peanuts and still lose weight: “70 g/d of peanuts may be included in an energy-restricted weight loss diet without attenuating weight loss over a 6-month period.”  Of course you can, if you stick to a low-calorie diet.

I’m all for eating nuts.  Substituting them for ultra-processed snack foods is a reasonable approach to dieting, but don’t expect to lose any more weight eating nuts than from any other source of calories.  This is a marketing study, aimed at encouraging you to eat more peanuts.

Since I’ve figured out how to enbed videos, you might want to take a look at this one.

This one is about Nutri-Score, a front-of-package labeling system that started in France but is used in several European countries.  The system balances the healthful and unhealthful aspects of processed foods, and assigns a composite color-coded score, from A (very healthy) to E (oops), and from green to red.

Once you know how the system works, you can easily figure out which ultra-processed foods are best avoided.

The video is in French with English subtitles (but also comes in French without subtitles or with Spanish subtitles).

For more about Nutri-Score go here and here.
For what I’ve written previously about Nutri-Score, go here.

Canada has joined the ranks of countries with front-of-package food labels alerting customers to products high in salt, sugar, and saturated fat.

I learned about this in a press release from Kate Comeau, Communications Advisor, Mission, Canada | Heart & Stroke

The official announcement from Health Canada is here. 

It comes with an explanatory Infographic.

I think the warning labels used in some Latin American countries work better, but this is a big step forward and is likely to cover the great majority of ultra-processed foods—and those are the ones that are best avoided.

Congratulations to Canadians who pushed for this.  Progress!

Carole Bartoletto, who works with dining services at UCLA, sent me two items.

• A toolkit to encourage dining halls to promote choices of meals with lower carbon footprints.
• A research study: Increasing the Selection of Low-Carbon Footprint Entrées through the Addition of New Menu Items and a Social Marketing Campaign in University Dining.

I started with the research study.

Its title requires translation.  Low-carbon footprint means plant-based.  In this case, it means Impossible brand plant-based meat alternatives.

Their intervention succeeded in encouraging substitution of Impossible for beef, but had unintended consequences.

Although the intervention was followed by a decrease in sales of beef entrées and increase in sales of plant-based meat entrées, sales of other vegetarian entrées also decreased.

Students replaced vegetarian choices with Impossible burgers?

To their credit, the authors acknowledge the problem.

It is also worth discussing the nutritional differences between plant-based meat and other low-carbon footprint options. In general, lower-carbon foods (i.e., plant-based and sustainably-raised fish) tend to be healthier, but this is not always the case. Plant-based meat products such as Impossible™ are ultra-processed and relatively high in sodium and saturated fat. Consuming ultra-processed foods has been linked with higher calorie intake and weight gain (Hall et al., 2019).

The toolkit, in contrast, includes Impossible products but does not focus on them.  It presents a variety of vegetarian and vegan options as low-carbon options with many illustrations of ways to present this information.

This could be useful, and maybe more useful, without the Impossible products, especially if the ultra-processed meal alternatives discourage choices of vegetarian options.

Take a look and see what you think.

Note: an educational intervention in Great Britain that also gave participants free plant-based meats found more of them sto be consumed, unsurprisingly.

ADDITION, July 1: I received this message in response to this post from Hannah Malen, at UCLA:

Dear Marion,

As one of your fans and newsletter subscribers, I was excited to see that you covered the low-carbon footprint dining intervention we did at UCLA! I collaborated with the innovative and talented folks at UCLA Dining as part of my dissertation work. It was an awesome experience to design, implement, and study a real-world intervention.

Unfortunately, I was a bit disappointed by your summary of the study. I felt your assessment overlooked some of the nuances that make this work challenging and important.

1) Low-carbon footprint does not mean only plant-based in this case. We created low-, medium-, and high-carbon footprint cutoffs based on life cycle analysis data and feasibility of real-world implementation. The criteria were created for the purposes of classifying menu items AND educating students about the relative impacts of different foods. Based on our criteria, low-carbon footprint included vegetarian menu items with < 2 ounces of cheese AND menu items with sustainable fish. I think this is worth noting because low-carbon footprint doesn’t have to mean ONLY plant-based or vegan…it also means some vegetarian items with cheese are NOT low-carbon footprint.

2) The decision to add Impossible plant-based meat alternative products to the menu was strategic and led by our Dining Director. As we know, it can be hard to appeal to meat-eaters, and Impossible-type products have been more successful than many other alternatives. While sales of the new Impossibile products did coincide with decreases in sales of other vegetarian items, I don’t think it’s accurate to say they discouraged choices of vegetarian options. We studied and saw shifts across basically all categories of menu items, which I think is a strength of the research. We also saw that overall, sales of low-carbon footprint items increased, while sales of medium- and high-carbon footprint items decreased. On average, this corresponded with an 8% decrease in the carbon footprint of entrees sold.

All this to say, it’s complicated, and I’m proud that we are among the first to look at the dynamics of introducing Impossible plant-based meat alternatives into food environments. Of course it’s ideal if eaters swap beans or veggies for meat, but the path to get there is certainly not easy.

Thanks for the opportunity to share our work and respond to your coverage. (And thanks to Carole for being a champion of the work and leader in creating the toolkit!)

Kind regards,

Hannah

Hundreds of reports of illness from eating Lucky Charms cereal have intrigued food safety experts.

The FDA is investigating, but being really cagey about it.

Everybody seems to know that reference number 1064 refers to Lucky Charms cereal.

The FDA has received 529 reports of adverse effects.

Food safety lawyer Bill Marler has been following the situation.

Since late 2021, the crowd sourcing website iwaspoisoned.com has received 6,400 reports from people complaining of classic food poisoning symptoms of nausea, vomiting and diarrhea after eating Lucky Charms cereal. General Mills, the maker of the cereal, has said that is has investigated the situation and there is no apparent link between the reported illnesses and Lucky Charms.

The Washington Post quotes experts calling for a recall, Bill Marler among them.

Although, there has been no scientific proven link, be it chemical or an allergen, between the several thousand illnesses and Lucky Charms,” Marler said, “my advice to General Mills is to recall the product and reset its trust with the consuming public until more is known.

Is there a link?  Or is this just a matter of people getting sick, remembering they ate this cereal, and putting the two together—even though no cause-and-effect exists.