Search results: Ultra processed foods

I can hardly believe it but we are going to have to endure another round of dietary guidelines, these for 2025-2030.

Why endure?

Because they have basically said the same things since 1980:

• Eat more fruits and vegetables
• Balance calories
• Don’t eat too much of foods high in saturated fat, salt, and sugar

As I am fond of quoting Michael Pollan: “Eat food.  Not too much.  Mostly plants.”

The wording changes from edition to edition.  The editions get longer and longer.  And the basic problems—nutrients as euphemisms for the foods that contain them, more and more obfuscation–stay the same.

But maybe not this time?

ODPHP, the Health and Human Service Office of Disease Prevention and Health Promotion (of which I am an alum) has just announced “Proposed Scientific Questions to Inform the Development of the Dietary Guidelines for Americans, 2025-2030: Available for Public Comment April 15 to May 16!”

The questions whose answers will form the research basic of the forthcoming guidelines are listed here.

Several break new or necessary ground:

• What is the relationship between consumption of dietary patterns with varying amounts of ultra-processed foods and growth, size, body composition, risk of overweight and obesity, and weight loss and maintenance?  Comment: This was one of my big criticisms of the 2020-2025 guidelines; the word “ultraprocessed” was never mentioned, yet I consider it the most important nutrition concept to come along in decades.  So this is a big step forward.
• What is the relationship between beverage consumption (beverage patterns, dairy milk and milk alternatives, 100% juice, low- or no-calorie sweetened beverages, sugar-sweetened beverages, coffee, tea, water) and growth, size, body composition, risk of overweight and obesity, and weight loss and maintenance? risk of type 2 diabetes?  Comment: it will be good to have this clarified.
• What is the relationship between food sources of saturated fat consumed and risk of cardiovascular disease?  Comment: This is an old issue but one under attack as being irrelevant.  Let’s get it settled, if that is possible.
• What is the relationship between specific food-based strategies during adulthood and body composition, risk of overweight and obesity, and weight loss and maintenance?  Comment: With luck, this will resolve the diet wars over low-carb v. low-fat, etc.  My prediction: they all work for some people.
• What is the relationship between specific food-based strategies during adulthood and body composition, risk of overweight and obesity, and weight loss and maintenance?  Comment:  Finally, an unambiguous demand for research on diet and obesity (as opposed to euphemisms).

What’s missing here?  I think they should have a question on meat, since evidence on risk/benefit is also controversail.  OK, saturated fat is a euphemism for meat, but let’s stop using euphemisms.

What’s being ducked, at least in the guidelines?

There are two topics not on the list of questions to be examined by the 2025 Dietary Guidelines Advisory Committee that will be addressed in separate processes.

• Alcoholic beverages remain a high priority topic, but because it requires significant, specific expertise and has unique considerations, it will be examined in a separate effort led by HHS Agencies that support work on this topic.
• Sustainability and the complex relationship between nutrition and climate change is an important, cross-cutting, and high priority topic that also requires specific expertise. HHS and USDA will address this topic separate from the Committee’s process to inform work across the Departments.

Want to weigh in on this (please do!):  here’s how (read and follow the directions carefully to have maximum impact)

As usual ConscienHealth has interesting things to say about all this.  I particularly enjoyed:

So it’s both unsurprising and unimpressive to hear that people with strong views about nutrition believe the process is rife with conflicts of interest. A group that is disenchanted with the last output from this process lays it out with a new paper in Public Health Nutrition. But Tamar Haspel made the same point much more efficiently in a recent tweet:

“I think they should just let me write the Dietary Guidelines and call it a day.”

This also reminds me about the need to select a scientific committee as free of conflicted interests as possible.  The last committee was rife with them.  HHS/USDA ought to be starting the committee selection process fairly soon.  Stay tuned.

Last week was a busy time for high-level thinking about nutrition.

I’ll start with this from Chef José Andrés.

A message from @WCKitchen's @chefjoseandres on child #nutrition: Child nutrition programs play an essential role in ensuring food and nutrition security for the nation's youth. pic.twitter.com/kZ4i7JGYVK

— Bipartisan Policy Center (@BPC_Bipartisan) January 27, 2022

For the rest, I am indebted to Politico Morning Ag for gathering all this in one place.

Nutrition research: Last week, Sens. Cory Booker (D-N.J.) and John Cornyn (R-Texas) appeared at an event focused on “sustainable nutrition science” hosted by the Union of Concerned Scientists and Tufts University’s Friedman School of Nutrition Science and Policy.  The are sponsors of the Food and Nutrition Education in Schools Act.  I watched Booker’s remarkably inspiring talk and wish I could find a video or transcript of it.

Booker held hearings on nutrition last year.  I have a transcript of his opening remarks.  Here is an excerpt:

Now let’s be clear about something: the majority of our food system is controlled by a handful of big multinational companies. These big food companies carefully formulate and market nutrient-poor, addictive, ultra-processed foods — ultra-processed foods which now comprise 2/3 of the calories in children and teen diets in the U.S — and then these companies want us to believe that diet related diseases such as obesity and diabetes are somehow a moral failing, that they represent a lack of willpower or a failure to exercise enough.
That is a lie.
It is not a moral failing, it is a policy failure.

Food is Medicine: Food and Society at the Aspen Institute and Harvard’s Center for Health Law and Policy Innovation released a Food is Medicine Research Action Plan, a lengthy report detailing recommendations for how to bolster nutrition interventions in health care.

Food is the leading cause of poor health in the United States. Over half of American adults suffering from at least one chronic, diet-related disease. This health crisis has devastating effects for individuals and their and families and places an immense burden on our health system and economy. Though food is the culprit, it can also be the cure. Food and nutrition interventions can aid in prevention and management, and even reverse chronic disease. Introduced at large scale, proven interventions could save millions of lives and billions in healthcare costs each year.

Universal free school meals: The Bipartisan Policy Center released recommendations from its Food and Nutrition Security Task Force.   The report has recommendations for strengthening nutrition education and security in and out of school.  For example:

• Ensure all children, regardless of household income, have access to nutritious foods to allow them to learn and grow by providing school breakfast, school lunch, afterschool meals, and summer meals to all students at no cost.
• Make Summer EBT a permanent program and allow students to access EBT benefits during school breaks, holidays, closures, and other emergencies.
• Maintain and, if possible, strengthen nutrition standards for all programs to better align them with the latest Dietary Guidelines for Americans.

Pandemic EBT program: The Government Accountability Office recommended that USDA do a better job on nutrition assistance during emergencies and of implement the Pandemic-EBT program, which was supposed to give eligible school children charge cards for buying foods, but never worked well.

What a concept!  A government cracking down on illegally labeled Kellogg kids’ cereals, lots of them.

The Associated Press report of the matter, widely reproduced, does not say which cereals or show photos of the ones that were seized.

Mexico has seized 380,000 boxes of Corn Flakes, Special K and other Kellogg’s cereals, claiming the boxes had cartoon drawings on them in violation of recently enacted laws aimed at improving children’s diets.

These laws put warning labels on foods and beverage high in calories, sugar, saturated fat, trans fat, sodium, artificial sweeteners, and caffeine.  These cover practically all ultra-processed foods.

At the same time, restrictions were placed on the advertising of unhealthy products to children, so that products with warning labels cannot be advertised to children or use cartoon characters.

I’m wondering if some of the seized products violated the law by having cartoons on the package, like this one.

Here is what the boxes of sugary cereals are supposed to look like now.

I want to know more about what got seized.

But how terrific that the Mexican government is taking this public health measure seriously.

Felicidades!

If you want to know what preoccupies the FDA, takes up its time, and keeps it from giving food safety the attention it needs, try this for a burning issue: Revocation of the Standard of Identity for French dressing.

Why would the FDA go to all this bother (and it looks like a lot of bother?

Because it was petitioned to do so by the Association for Dressings and Sauces (ADS).

If, like me, you had never heard of this trade association,

it represents manufacturers of salad dressing, mayonnaise and condiment sauces and suppliers of raw materials, packaging and equipment to this segment of the food industry.

Background: Standards of Identity

These date back to the Federal Food, Drug, and Cosmetic Act of 1938. They say what a food product must contain, in what proportions, and, sometimes, how it must be manufactured. Foods called things like ‘milk chocolate,’ ‘bread’ and ‘ketchup’ have standards of identity.  Because some of these standards date back 80 years, the FDA has called for comments on modernizing them.

When the FDA extended the comment period, it explained the goals for updating Standards of Identity:

• Protect consumers against economic adulteration;
• Maintain the basic nature, essential characteristics and nutritional integrity of food; and
• Promote industry innovation by giving manufacturers the flexibility to produce healthier foods.

The French Dressing standards

Check this for level of effort over more than 70 years.

In the Federal Register of August 12, 1950 (15 FR 5227), we established a standard of identity for French dressing. We later amended that standard of identity in the Federal Registers of May 10, 1961 (26 FR 4012), February 12, 1964 (29 FR 2382), February 1, 1967 (32 FR 1127 at 1128), May 18, 1971 (36 FR 9010), and November 8, 1974 (39 FR 39554), to allow the use of certain ingredients in French dressing. We also re-designated the French dressing standard of identity as § 169.115 (21 CFR 169.115) (42 FR 14481, March 15, 1977).

The Association for Dressings and Sauces complained—in its January 1998 petition— that nonstandardized pourable salad dressings such as Italian, Ranch, cheese, fruit, and peppercorn, have proliferated as have those reduced in fat, “light,” and fat-free. Because of this variation, and because consumers now expect French dressing to contain tomato-derived ingredients, be reddish-orange color, and sweet, the French dressing standard of identity “no longer serves honesty and fair dealing in the interest of consumers.”

It took more than 20 years, but the FDA now agrees.

Commentary

Ted Kyle of ConscienceHealth.org, who always has thoughtful and interesting things to say about food issues (even when we disagree), asks a good question: Does Anybody Care What’s in French Dressing?  He points out that standards protect the integrity of real as opposed to ultra-processed foods.

The New York Times quotes food historian Ken Albala:

“I can picture the people at Kraft sitting down at a board meeting and the chief marketing guy saying, ‘Do you know the sales of French dressing have dropped off by x and y?’ ” Professor Albala said that the change could allow food companies to revamp their recipes for French dressing as a way to try to boost sales.

 The Times also noted:

In response to the F.D.A.’s announcement of the change on Twitter, some people mocked the agency on Wednesday and said that it should concentrate more on its regulatory role in the coronavirus pandemic. The agency said in the newly published rule that it had received at least one comment as part of its review that questioned its priorities.

My point precisely.

Let’s start 2022 off with a review sent to me by a reader who wishes to remain anonymous.

The review: Implementing the 2020–2025 Dietary Guidelines for Americans: Recommendations for a path forward. Sanders, L. M., Allen, J. C., Blankenship, J., Decker, E. A., Christ-Erwin, M., Hentges, E. J., Jones, J. M., Mohamedshah, F. Y., Ohlhorst, S. D., Ruff, J., &Wegner, J. (2021). J Food Sci. 86:5087–5099.  https://doi.org/10.1111/1750-3841.15969

Method: Based on a workshop aimed at developing strategies to promote adoption of dietary guideline recommendations.

Workshop funding: a grant from USDA with contributions from the Institute of Food Technologists.

Conflicts of interest: Mary Christ-Erwin is President and Owner of MCE Food and Agriculture Consulting and received an honorarium from the grant for moderating the meeting and panel and roundtable discussions. Julie M. Jones is a Scientific Advisor to USA Rice, Grain Foods Foundation, and the Quality Carbohydrate Coalition. John Ruff is an Investment Committee Member for Sathguru Catalyser Advisors Private Limited, the Asset Management Company of Innovation in Food and Agriculture Fund (IFA Fund) that invests in innovation-driven growth enterprises in the Food and Agriculture sectors, based in India. He is reimbursed for meeting fees and expenses related to attending committee meetings but has no investments in the fund. Lisa M. Sanders [Note: First author who wrote original draft] is the owner of Cornerstone Nutrition, LLC, a consultancy which has received funding from Kellogg Company, PepsiCo, and The Coca-Cola Company. Dr Sanders receivedwriting fees fromthe grant for development of this manuscript. JillWegner is an employee of Nestle. Jonathan C. Allen, Jeanne Blankenship, Eric A. Decker, Eric J.Hentges, Farida Y. Mohamedshah, and Sarah D. Ohlhorst have no conflicts to declare.

Comment: This workshop reflects a food industry perspective on the dietary guidelines.  Some of its reocmmendations make sense.  Others raise eyebrows, or should.

• The first recommendation: “Emphasize health benefits…gained through cooking at home.
• My favorite recommendation: “Leverage the current interest in science to debunk myths about food processing by demonstrating the similarity of techniques used to make foods at home and at scale in food industry, to show how food processing can contribute to the solution.”

This review is an excellent example of why the food industry needs to firmly excluded from nutrition policy discussions (for details on why, see my book, Unsavory Truth).

My strongest criticism of the 2020 dietary guidelines is that they fail to say anything about the health benefits of reducing consumption of ultra-processed foods (the junk food category strongly associated with excessive calorie intake, weight gain, and poor health).

Yet here we have a published review in a food science journal arguing for debunking “myths” about food processing.

They are not myths.  Evidence is abundant.

See, for example:

• Monteiro CA, Cannon G, Levy RB, et al.  Ultra-processed foods: what they are and how to identify them.  Public Health Nutr; 2019;22(5):936–941.
• Lawrence MA, Baker PI.  Ultra-processed food and adverse health outcomes.  BMJ. 2019 May 29;365:l2289.  doi: 10.1136/bmj.l2289.
• Hall KD, Ayuketah A, Brychta R, et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake [errata in Cell Metab. 2019;30(1):226 and Cell Metab. 2020;32(4):690]. Cell Metab. 2019;30(1):67–77.e3. doi: 10.1016/j.cmet.2019.05.008.

My former doctoral student and now colleague Lisa Young has been tracking the increase in portion sizes of junk foods for more than 20 years.  Our latest report has just come out in the American Journal of Public Health: Portion Sizes of Ultra-Processed Foods in the United States, 2002 to 2021.

At first introduction, most companies offered products in just 1 size; that size is smaller than or equal to the smallest size currently available. For example, the original size of a Coca-Cola bottle was 6.5 ounces; today it comes in 6 sizes marketed as single servings; these range from 7.5 ounces to 24 ounces, 4 of which have been introduced since 2002.

Since 2002, McDonald’s has reduced the sizes of its french fries and eliminated its “supersize” french fries and soda, but still offers quart-sized sodas and double burgers. While McDonald’s and Burger King decreased the size of their largest portion of french fries, they increased the sizes of their smallest portions. While Burger King reduced the sizes of it’s hamburger sandwiches, since 2002 they added a triple Whopper.

• Have more calories (if only this were intuitively obvious, but it is not)
• Encourage people to eat more
• Confuse people about how much they are eating

Our recommendations:

We think it is time to also consider caps and other legislatively mandated national policy options to require the food industry to make smaller food portions more available, convenient, and inexpensive:

•  offer consumers price incentives for smaller portions of ultra-processed foods,

•  discontinue the largest sizes of ultra-processed packaged foods and fast-food portions, and

•  restrict marketing of large portions of ultra-processed foods, especially those targeted to children and minorities.

Our article is accompanied by an editorial by Carlos Monteiro and Geoffrey Cannon, the inventors of the term, “ultra-processed”: Yes, Food Portion Sizes and People Have Become Bigger and Bigger. What Is to Be Done? 

Their point: reducing portion sizes is unlikely to work internationally.

In such countries, reduced portion sizes of ultra-processed foods would at best have limited effect, and most likely would be counterproductive if they were marketed to promote their consumption. Generally, the most rational guideline, for global as well as personal health and well-being, is to protect and promote minimally processed foods and freshly prepared meals and to discourage the consumption of ultra-processed foods altogether, together with statutory measures including fiscal policies and actions. These measures should make fresh and minimally processed foods cheaper and more available. Ultra-processed foods should be made more expensive and less available, if at all, especially in canteens and hospitals, other health settings, and in and near schools. Cosmetic additives should be banned or highly taxed.

We have much work to do.

What with all the pressure to make foods healthier, food manufacturers have been tweaking their products to reduce less healthful ingredients, especially salt and sugar.

Reformulated ultra-processed foods are still ultra-processed.

They raise the question: is a slightly healthier ultra-processed food a good choice?

These articles come from FoodNavigator-Asia.com, which tracks the food industry in that part of the world.

• Reformulating for the region: Coca-Cola, Nissin, Kirin and Hoow Foods weigh in on sugar, salt and fat reduction in APAC: Major brands across the region are continuing to double down on their reformulation efforts across sugar, salt and fat reduction after COVID-19 led to a rapid increase in consumer awareness and demand for healthier products. Read more
• Not so sweet situation: More than half of packaged beverages sold in Singapore contain high levels of sugar: Sixty per cent of packaged non-alcoholic beverages (NABs) sold on the Singapore market contain high amounts of sugar and would be assigned under Grade C or D in the soon-to-be-implemented Nutri-Grade system. Read more
• High pressure: Aussie retailers urged to prioritise sodium reformulation for private label products: Retailers in Australia should prioritise the sodium reformulation of private label products, which could help prevent over 500 deaths annually, according to a modelling study. Read more
• Encouraging reformulation: South Korea tightens food labelling standards for products with reduced sodium and sugar: South Korea has announced new, tighter standards for food firms looking to label their products as being reduced or lower in sodium or sugar, starting with the nation’s most-consumed food product, ramen. Read more

Healthy food? What’s that?

The FDA is working on a definition of “healthy” on food labels.

Blame KIND bars for all this.

The chronology of this saga.

2015: KIND puts the word “Healthy” on the labels of its whole-food bars.  FDA issues warning letter to KIND because its labels do not meet the requirements to make health claims.

2016: FDA reconsiders, says KIND can use “healthy.”   FDA issues request for information and comments on Guidance for Industry: Use of the Term “Healthy” in the Labeling of Human Food Products.

2017: FDA says it will reevaluate use of the term; holds public meeting on how to redefine the term “healthy” as a nutrient content claim.

2018: FDA’s Nutrition Innovation Strategy includes defining the term.

Healthy” is one claim that the FDA believes is ready for change, and we have already signaled our intention to update the criteria for this claim. The Agency is considering how to depict “healthy” on the package so that consumers can easily find it. Similarly, the FDA has also received requests for clarity on the use of “natural” in labeling. Just like other claims made on products regulated by FDA, we believe the “natural” claim must be true and based in science.

2019: The FDA proposes, and OMB approves, focus group review of a “healthy” icon on food packages.

As one of the methods for achieving this step of the Action Plan, the FDA is exploring the development of a graphic symbol to help consumers identify packaged food products that would meet an FDA definition for “healthy.” The symbol would be voluntary, allowing packaged food companies to place it on their products if the products meet the FDA definition of “healthy.”

2021: FDA again sends proposal to redefine “healthy to OMB, and announces further research on developing a ‘healthy” icon.

Nutrient Content Claims, Definition of Term: Healthy: The proposed rule would update the definition for the implied nutrient content claim “healthy,” and would revise the requirements for when the claim “healthy” can be voluntarily used in the labeling of human food products. In a separate but related action, on 7 May 2021 the FDA issued a notice in the Federal Register announcing that it is conducting preliminary quantitative consumer research on symbols that could be used in the future to convey the “healthy” claim on packaged foods.

The FDA has not said what definition it is considering.  I can think of three possible options:

• Nutrient-based: Below some level of sugar, salt, calories, or whatever
• Food-based: Must contain a fruit, vegetable, or whole grain
• Process-based: Must be unprocessed, processed, or minimally processed; cannot be ultra-processed

Anything other than process-based is too easy for food companies to game.

Center for Science in the Public Interest has plenty of concerns.

Allowing some products to carry a ‘healthy’ claim because they contain a minimal amount of a fruit, vegetable, or other recommended food would just make it easier for veggie chips and ‘fruit’ snacks to compete with fresh fruits and vegetables…No matter how FDA defines the term, consumers should realize that manufacturers will mostly be interested in using ‘healthy’ for marketing purposes—to sell you more processed food that you may not need.

The voluntary nature of the “healthy” symbol also raises questions.  If a food label does not use the symbol, how will anyone know if it’s not there because the product does not meet the definition of “healthy” or if its maker just chose not to use the symbol?

On “healthy,” whether word or symbol: stay tuned.