Search results: sugar policy

Last week, the USDA sent out a press release announcing the last four Final Rules for school meals under the Healthy, Hunger-Free Kids Act (HHFKA) of 2010:

• Smart Snacks: this makes “modest improvements” to standards implemented in the 2014 – 2015 school year in accordance with the interim final rule.
• Local School Wellness Policy: requires schools to meet the Smart Snacks standards.
• Community Eligibility Provision (CEP): allows schools with high poverty rates to provide free breakfast and lunch to all students.
• Administrative Review: updates the administrative review processes used by state agencies to monitor federally-funded school meal programs.

The press release summarizes USDA’s view of what’s most beneficial in these policies:

• Improving the nutritional quality of all school food.
• Increasing farm to school programs to more than 42,000 participating schools;
• Coordinating school meal certification with SNAP.
• Implementing national professional standards for school nutrition employees.
• Expanding At Risk After School Meals Program to all states;
• Revising the Child and Adult Care Food Program nutrition standards.
• Implementing mentor-based training for school nutrition professionals through the Team Up for School Nutrition Success initiative.

You probably won’t want to read all the fine print.  Fortunately, others have done just that.

Bettina Siegel at The Lunch Tray

• Wellness policies will be required to prohibit on-campus marketing of foods and drinks that fail to meet the Smart Snacks nutritional standards.
• Whether companies can market “copycat” snacks in schools (Smart Snacks-compliant versions of junk food available in supermarkets) is left up to local districts.
• Also left to local districts are policies about incentive programs, such as Box Tops for Education or fast food coupons passed out to kids for reading books.
• School wellness policies will be required to set nutritional standards for foods and drinks offered to kids at classroom parties or by teachers as treats, but districts can determine the actual policies.
• Schools will be allowed to sell hard-boiled eggs, low-sodium canned vegetables, and peanut butter and celery.

Her bottom line:

With the finalization of these four rules, the historic work of the Obama administration in improving children’s school food environment is now complete. But, of course, we’re already one year overdue for the next CNR [Child Nutrition Reauthorization], a process which could easily roll back or weaken these reforms – many of which have already been overtly threatened by House Republicans.

CSPI’s Take on What’s New

• Local wellness policies must address marketing of foods and drinks that do not meet the Smart Snacks standards.
• Local wellness policies must involve the public and school community and produce an annual progress report.
• Local wellness policies must designate a school official for compliance and undergo administrative review every 3 years.
• School districts must update goals for nutrition promotion, nutrition education, physical activity, and school wellness activities based on evidence-based strategies.

CSPI says the new rules mean local wellness policies can and should:

• Shift unhealthy school fundraisers to profitable healthy food or non-food fundraisers
• Ensure that school celebrations support healthy eating and physical activity
• Use non-food rewards
• Provide ample opportunities for physical activity, quality physical education, and recess

My comments

Nutritionism: Many of the complaints about USDA’s nutrition standards derive from their focus on single nutrients—fat, salt, sugar—rather than on foods. Boiled eggs weren’t allowed because of their fat and cholesterol content, but copy-cat snack foods were.  If the standards applied to minimally processed whole foods, they would make more sense. USDA now has to take comments on whether to eliminate the standard for total fat from Smart Snacks because of the egg issue and the confusing nature of current research on saturated fat (also a problem resulting from studying one nutrient at a time).

Politics:  Regardless of how trivial some of these rules may appear, USDA’s school food standards must be considered an extraordinary achievement.  Against all odds—unrelenting opposition from companies that supply junk food to schools, Congress, and, weirdly, the School Nutrition Association—the new rules will improve the nutritional quality of school meals and snacks, at least most of the time.  School districts with officials who care deeply about improving the food served to kids now have a mandate to do so.  Those who don’t will have a harder time doing a bad job.  Applause to USDA for bringing the rules to closure.  May they survive the next round of lobbying.

I’m at the Summer Academy in Global Food Law and Policy in Getxo, Spain speaking about Soda Politics and was happy to see Healthy Food America’s analyses of how Philadelphia passed a soda tax.

Jim Krieger starts out with a reminder that all cities are different and all politics is local, but in this case Philadelphia did an outstanding job on the

• Political path: a budget proposal to be passed by the City Council
• Timing: end of budget speech while still a new mayor
• Framing: source of revenue to fund pre-K
• Community base: a coalition
• Financial support: Bloomberg and Arnold foundations
• Media buzz
• An effective champion in Mayor Jim Kenney  

All of these are essential elements in any advocacy campaign.

Casey Hinds, also of Healthy Food America, focuses on why Mayor Kenney’s messaging was so effective.  She quotes from his

• Interview in the New York Times
• Response to Bernie Sanders’ criticisms
• His interview with Politico’s Helena Bottemiller Evich

This last interview is particularly inspiring.  He knew what he was doing, and why.

KENNEY: It never was a grocery tax. From my perspective and my opinion, their miscalculation is that they thought the people were stupid and that they would totally eat the idea of a grocery tax. In the end, diet [beverages] became part of it because it was part of the negotiation to get us the nine votes or the 13 votes we needed. It was always about sugar-sweetened beverages. It was never about anything else. I think people recognize that this was a way to generate significant revenue without raising their real estate taxes, without raising their wage taxes, without raising business taxes, because those are all the taxes that we’ve always [used] to fund education.

…BOTTEMILLER EVICH: So when the other cities, states, call you, what are you going to tell local officials about going down this road?

KENNEY: Tie it to initiatives that the public wants. Build a coalition around those initiatives. And just continue to grow the coalition and don’t worry about the big money. It’s clear now that the big money isn’t all it’s cracked up to be.

We need more politicians like this.

First the good news

The USDA is applying its school-food rules  to child and adult care programs.  It has just released its final rule for these programs.  These go into effect in October 2017.

Previously, the USDA released standards for the Women, Infants and Children program and for the National School Lunch Program.

Now all three food assistance programs are more or less aligned with the Dietary Guidelines.

The child and adult feeding programs will specify more fruits and vegetables, less sugar and fat, but have reduce the standards for whole grain-rich products and sodium.  Presumably, this will make the rules more acceptable to people who don’t like them, of which there are many (see below).

And now the bad news

The House has released its child nutrition reauthorization bill, with the Orwellian title: “Improving Child Nutrition and Education Act.”  Like all such titles, this one means the opposite of what it says.

The House bill increases reimbursements for school breakfasts (good), but then lowers the nutrition standards for school meals and makes it harder for schools to qualify for universal free meals.  Here’s the committee’s bill summary.  And here is what the House Education and Workforce Committee says in its fact sheet.

The Hagstrom Report quotes Margo Wootan of Center for Science in the Public Interest saying that the House bill will:

• Freeze sodium reduction for at least three years.
• Require yet another scientific review of sodium.
• Weaken the whole grain standards.
• Let junk food back into schools
• Allow schools to replace fresh produce with dried (without a sugar limit), canned (without a sodium or sugar limit), and frozen fruits and vegetables, thereby allowing schools to replace fresh apples and carrots with sugary fruit snacks, potato chips, jam, or trail mix containing candy.

The Center on Budget and Policy Priorities says this bill will increase food insecurity among children.

Fortunately, not everyone in the House loves this bill.  A letter signed by 111 House members details objections.

The House will be working on this bill tomorrow.  What will the Senate do?

School food advocates: it’s time to get busy.  Here’s the list of House members.  Write to yours today!

Talk about soda politics! I can hardly believe it but soda taxes have become an issue in the Democratic primary campaign.

This started when Hillary Clinton came out in favor of Philadelphia Mayor Jim Kenney’s proposed soda tax.

I’m very supportive of the mayor’s proposal to tax soda to get universal pre-school for kids. I mean, we need universal pre-school. And if that’s a way to do it, that’s how we should do it.

Given the Clinton Foundation’s long-standing relationship with Coca-Cola, this was unexpected.

In short order, Bernie Sanders distanced himself from her position:

I do not support Mayor Kenney’s plan to pay for this program with a regressive grocery tax that would disproportionately affect low-income and middle-class Americans. I was especially surprised to hear Hillary Clinton say that she is “very supportive” of this proposal. Secretary Clinton has vowed not to raises taxes on anyone making less than $250,000 per year. For reasons that are not clear, she has chosen to abandon her pledge by embracing a tax that targets the poor and the middle class while going easy on the wealthy. That approach is wrong for Philadelphia, and wrong for the country.

This, in turn, induced Paul Krugman, who seems to have little love for Sanders anyway, to weigh in:

It does seem worth pointing out that progressivity of taxes is not the most important thing, even when your concern is inequality. Notably, Nordic countries — very much including Denmark, which Sanders has praised as a model — rely heavily on the VAT, which is a regressive tax; but they use that revenue to pay for a strong social safety net, which is much more important.

If we add in the reality that heavy soda consumption really is destructive, with the consequences falling most heavily on low-income children, I’d say that Sanders is very much on the wrong side here. In fact, I very much doubt that he’d be raising the issue at all if he weren’t still hoping to pull off some kind of political Hail Mary pass.

Soda tax proponents wish that Sanders had better understanding of the health issues.

• Laurie David points out that “there’s nothing populist about soda” and expands on that in HuffPo
• Nancy Huehnergarth says “Senator Sanders is wrong: A soda tax is progressive, not regressive.”
• Margot Sanger-Katz in the New York Times

Proponents say Diabetes is regressive.

Here’s information from the table from Soda Politics on framing the soda-tax debate (see page 385).

Wonder of wonders, the UK’s Chancellor of the Exchequer, George Osborne, has put a soda tax into his new budget initiative (see BBC account, the video and text of Osborne’s speech, and the Treasury department’s fact sheet on the soda tax).

Here’s how the tax is supposed to work:

Osborne says the tax will bring in £520 million ($732 million) in the first year, and he intends to use it to fund more sports in schools.

But it goes into effect in April 2018.  This is to give the industry time to reformulate products with less sugar.  But—the delay also gives the industry ample time to block the tax.

Public Health England supports the tax (see statement).

But the soda industry wasted no time reacting to this bad news.

• Coke, Pepsi, and other soft drink companies strongly objected.
• The immediate result: a fall in their stock prices.
• The immediate reaction: Sue the government.  On what grounds?  Discrimination.  The tax does not affect sugary juices, milkshakes, or processed foods.

The makers of artificial and alternative sweeteners think this will be a win for them.

Will the tax help reduce obesity?  On its own, that would be asking a lot.

Jamie Oliver, the British chef who favors the tax, says of course it won’t work on its own.  It needs to be accompanied by six additional actions (food labels, better school food, curbs on marketing to kids, etc.).

Why are soda companies so worried about this?  It could be catching.

• Mexico already taxes sodas, and the Philippines, India, and South Africa are considering them.
• Berkeley has already passed a soda tax.
• The proposed tax in Philadelphia looks like it has widespread support.

Will the UK tax stick?  Watch Big Soda pull out every stop on this one.

And think about what they are doing to fight soda taxes when you read or hear that soda companies want to be part of the solution to obesity.

Last summer, Brian Wansink, a friend and Cornell colleague and the editor of the new Journal of the Association for Consumer Research, asked me to write a commentary on a paper to be published in its inaugural issue.

The paper turned out to be by a group of authors, among them John Peters and Jim Hill, both members of the ill-fated Global Energy Balance Network, the subject of an investigation by the New York Times last August.

Titled “Using Healthy Defaults in Walt Disney World Restaurants to Improve Nutritional Choices,” the paper described the benefits of improving the composition of kids’ meals at Disney World.

The healthy defaults reduced calories (21.4%), fat (43.9%) and sodium (43.4%) for kid’s meal sides and beverages sold in the park. These results suggest that healthy defaults can effectively shift food and beverage selection patterns toward healthier options.

The authors explain:

This work was supported by the Walt Disney Company and by the National Institutes of Health…The Walt Disney Company and the National Institutes of Health had no role in the design, analysis, or writing of this article. Full disclosure: JH is a consultant for the Walt Disney Company and for McDonalds; KA is a consultant for the Walt Disney Company.”

I thought Disney’s sponsorship of this research and its withholding of critical baseline and sales data on kids’ meals that the company considered proprietary did indeed deserve comment, and wrote my piece accordingly.  Brian Wansink soon accepted it for publication but to my surprise, gave it to Peters et al. for rebuttal.  They filed a lengthy response.  I was then given the opportunity to respond, and did so, briefly.

The paper by Peters, et al. did was published in the journal’s first issue.   This issue also includes several commentaries on other papers (none of which are accompanied by rebuttals).

My commentary—and the back-and-forth—however, were omitted.

After some discussion, the journal published my commentary online.  You have to scroll down to find it.  The site provides no links to it in the table of contents or in the article by Peters et al.

Is it possible that Disney or the authors’ contractual relationships with Disney could have had anything to do with the omission of my accepted-for-publication commentary?  Brian Wansink says no, they just ran out of room (despite room for others).

Whatever.

Here’s what I wrote:

Dietary nudges for obesity prevention: They work, but additional policies are also needed

In 2006, the Walt Disney Company announced a new initiative to improve the nutritional quality of meals served to children at its theme parks. The company would be changing the default kids’ meals—the components that come without having to be ordered separately–to include low-fat milk, juice, or water rather than soft drinks, and sides such as apple sauce or carrots rather than French fries. Parents who wanted sodas or fries for their children would have to ask for them, something many might not bother to do. Health groups had long advocated for this policy change (Wootan 2012).

As I commented to a reporter at the time, “going to Disney World is an excuse for eating junk food…Disney or its advisers must be feeling they have some responsibility” (Horovitz and Petrecca 2006). Indeed, the healthier defaults were part of a larger effort by Disney to deal with its contribution to obesity in America. After ticket prices, food is the second greatest source of revenue at Disney World. Although reducing the amount of food consumed at the parks might help create a less “obesogenic” food environment, revenues might fall. But the default change might be revenue neutral. By 2008, Disney could report that two-thirds of U.S. customers ordering kids’ meals had accepted the default, with no loss in sales. In Hong Kong Disney parks, nearly all customers accepted the default. The report, however, did not include data on the numbers or proportions of customers ordering kids’ meals (Walt Disney Company 2008).

Disney’s more recent summary of its child health initiatives states that it is funding investigators at the University of Colorado to conduct a more formal evaluation of use of the default options (Walt Disney Company 2015). The paper by Peters et al. (2016) in this issue of the Journal presents the results of that research. Their work confirms the ongoing effectiveness of the strategy. Nearly half the customers ordering kids’ meals accepted the healthy default side dishes and two-thirds accepted the healthier beverages. These choices resulted in significant reductions in the calories, fat, and sodium in purchased kids’ meals, but not sugar (Peters et al 2016).

The authors argue that gentle nudges changes like these are preferable to more coercive policies that smack of nanny statism. Such reductions help, but are they enough to make a real difference? To answer this question, it would help to know what else the children were eating along with the drink and side dishes. Although the authors were given raw sales data, Disney did not permit them to use this information as part of the overall analysis. The company also refused to provide information about the number of children who visited the park or the number of kids’ meals sold.

These missing pieces raise red flags because this is a Disney-funded study that produced results that Disney can use to advertise itself as a company that cares about kids’ health, and to deflect attention from Disney World’s’ reputation as a junk-food paradise. Corporate funding of research introduces conflicts of interest and reduces the credibility of the results, not least because the biases inherent in such research are largely unconscious, unintentional, and unrecognized (Moore et al 2005) The results of this study merit especially careful scrutiny. Taking them at face value, the default strategy worked well for the drink, but the sides are still a problem, and so are the sugars. They do not reveal much about what kids eat in a day at Walt Disney World

Nudges like this default are an important part of strategies to counter childhood obesity. But are they enough to deal with the public health problem? To make a real difference, they need to be accompanied and supported by a range of policy approaches. Current thinking about such approaches recommends combining insights from behavioral research, economics, and public health to establish a food environment far more conducive to making the healthy choice not only easy choice, but also the preferred choice. Doing so is likely to require multiple actions—for example, regulation of nutrient content and marketing; incentives such as subsidies of healthier foods; disincentives such as taxes, warning labels, and nutritional rating systems for unhealthier foods; and education of adults and children (Hawkes et al 2015). Disney’s voluntary default is a small step in the direction of such policies, but many more are needed if we are to make real progress in reducing the prevalence of childhood obesity.

• Margo G. Wootan. Children’s meals in restaurants: families need more help to make healthy choices.   Childhood Obesity 2012;8(1):31-33.
• Bruce Horovitz and Laura Petrecca.  Disney to make food healthier for kids.  USA Today, October 17, 2006.
• Walt Disney Company. Walt Disney Company—2008 Corporate Responsibility Report. 2008.
• Walt Disney Company.  Magic of Healthy Living brochure.  2015. https://thewaltdisneycompany.com/sites/default/files/MOHL_Brochure.pdf.
• John C. Peters, Jimikaye Beck, Jan Lande, Zhaoxing Pan, Michelle Cardel, Keith Ayoob, and James Hill. Using healthy defaults in Walt Disney World restaurants to improve nutritional choices.  J Assoc Consumer Res., 2016;1:1.
• Don A. Moore, Daylian M. Cain, George Loewenstein, and Max H. Bazerman, editors.  Conflicts of Interest: Challenges and Solutions in Business, Law, Medicine, and Public Policy.  Cambridge University Press, 2005.
• Corinna Hawkes, Trenton G Smith, Jo Jewell, Jane Wardle, Ross A Hammond, Sharon Friel, Anne Marie Thow, Juliana Kain.  Smart food policies for obesity prevention. The Lancet 2015;385:2410–2421.

And here’s my response to the rebuttal by Peters et al.

The response from Peters and Hill still fails to acknowledge the severity of the problems posed by Disney’s sponsorship of their research—the company’s failure to produce data essential for proper interpretation of study results, and the level to which sponsorship by food companies biases such interpretations.  At one point, Disney boasted of the results of this research, confirming its benefit to marketing goals.  The threat of industry sponsorship to research credibility has received considerable press attention in recent months, as must surely be known to these authors.^1,2 

1  Anahad O’Connor.  Coca-Cola funds scientists who shift blame for obesity away from bad diets.  New York Times, August 9, 2015. http://well.blogs.nytimes.com/2015/08/09/coca-cola-funds-scientists-who-shift-blame-for-obesity-away-from-bad-diets/

2  Candice Choi.  AP Newsbreak: Emails reveal Coke’s role in anti-obesity group.  US News, November 24, 2015.  http://www.usnews.com/news/business/articles/2015/11/24/apnewsbreak-emails-reveal-cokes-role-in-anti-obesity-group

My latest Viewpoint, “Corporate funding of food and nutrition research: science or marketing,” was published yesterday in JAMA Internal Medicine 2016;176 (1):13-14.  doi:10.1001/jamainternmed.2015.6667.

It’s been a tough month for the soda industry.

• Yesterday, members of Mexico’s Nutritional Health Alliance held a press conference to complain that a Coca-Cola Christmas television ad violated the human rights of the indigenous people of the Mixe community of Totontepec.
  

  The ad, released by Coca-Cola in late November on social media as part of its “OpenYourHeart” Christmas advertising campaign shows young people who are outsiders to the Mixe indigenous community arriving to build a Christmas tree of wood and Coca-Cola bottle caps, distributing Coca-Cola to young people from the community and transmitting the message “Stay United” in the Mixe language.

  Coca-Cola removed the ad from its social media channels, but you can watch a version produced by the Alliance in which Mixe youth comment on the ad. The Alliance also has produced a translation.

Al Jazeera produced a video analysis.

• On November 6, the New York Times reported that the University of Colorado was returning a million dollar grant that had paid for the Global Energy Balance Network (GEBN), the group funded by Coca-Cola that said you didn’t need to worry about what you ate as long as you were active.
• On November 24, AP reporter Candice Choi published e-mails between the U. Colorado scientist behind the GEBN.  These revealed that “Coke helped pick the group’s leaders, edited its mission statement and suggested articles and videos for its website.”
• Coca-Cola’s chief scientist, Rhona Applebaum, immediately resigned.
• On November 29, Helena Bottemiller Evich wrote in Politico how health advocates are running endless campaigns for so taxes, and that these will soon be coming to a polling place near you.
• On November 30, the UK’s Commons Health Committee called for a 20% tax on sugar-sweetened beverages.
• On December 1, the GEBN closed shop as a result of loss of funding.
• This week’s issue of The Lancet Diabetes and Endocrinology contains an opinion piece by U North Carolina professor Barry Popkin and Corinna Hawkes of City University London arguing that the world is eating too much sugar and that changes in policy are needed to encourage reduced consumption of sugary drinks.  According to Politico Morning Agriculture, the American Beverage Association (ABA) is most unhappy about the piece.  It claims that the prevalence of obesity and diabetes are rising but soft drink sales are falling in the U.S., saying “This proves that beverages are not driving these epidemics.”  [Comment: as I discuss in Soda Politics, only half the population drinks sugary beverages meaning that those who do drink them drink a lot.  Also, diabetes rates are falling in the U.S.]
• The ABA won a battle in San Francisco, but is surely losing the public relations war.  It sued the city over a Board of Supervisors ban on ads for sugary drinks on city property and requiring warning labels on all billboards and other surfaces within the city.  The ABA argued that both laws violate the First Amendment.  You might think this argument would get thrown out of court immediately, but you would be wrong, as the Supreme Court is becoming more hostile to such laws.  If you want to hear how the Board of Supervisors reacted to this, click here for the meeting transcript. (thanks to Politico Morning Agriculture for this item too and to Michele Simon for clarifying the legal issues).

I keep getting asked “why pick on sodas?”  The answer: they are an easy target, low-hanging fruit in public health terms.  They contain sugars but nothing else of redeeming nutritional value, are strongly associated with diets that raise the risk of obesity and its consequences, and are heavily marketed as what you need to be happy.  The industry is fighting hard and on many fronts to maintain sales.  Advocates are keeping its lawyers and lobbyists busy.

All this was just in the last month.  Expect more to come.