Search results: food strategy

While I’m on the topic of sugars (see yesterday’s post), the World Health Organization (WHO) has just called for public comment on proposed new guidelines for intake of “free” (added) sugars:

• Added sugar intake should be less than 10% of total calories per day (50 grams for a 2000 calorie-a-day diet)
• Intake below 5% of calories would confer additional benefits (25 grams)

Although the announcement casually mentions that the draft guidelines reaffirm a previous WHO sugar guideline from 2002, it just as casually fails to mention what happened to that guideline.

I, however, have perfect recall, particularly because I wrote about these events in the Afterword to the 2013 edition of Food Politics:

In the early 2000s, the World Health Organization (WHO) began work on a global strategy to reduce risk factors for chronic disease, obesity among them. In 2003, it published a research report that advised restricting intake of “free” (added) sugars to 10% or less of daily calories. Although this percentage was similar to that embedded in the USDA’s 1992 Pyramid (7–13% of calories, depending on total intake), sugar industry groups strenuously objected, enlisted senators from sugar-growing states to pressure the DHHS secretary to withdraw funding from WHO, and induced the DHHS chief counsel to send a critique of the report to WHO that had essentially been written by industry lobbyists. When released in 2004, WHO’s Global Strategy on Diet, Physical Activity, and Health omitted any mention of the background report or the 10% sugar recommendation.

“Strenuously objected” vastly understates what happened.

Why was the sugar industry so concerned?  One 12-ounce Coke or Pepsi contains about 40 grams of sugars.  Have one, and you’ve just about done your added sugars for the day.

WHO must either think that the research basis of the 10% sugar guideline is much stronger now (see references below), or that the political landscape has shifted so far in the direction of reducing sugar intake that governments will ignore industry groups this time.

I’m not so sure.  I think WHO needs all the help it can get with this one.

Submit comments here.  Now!

References

Reports commissioned by WHO

• Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies
• Effect on caries of restricting sugars intake: Systematic review to inform WHO guidelines

What happened to the previous guideline

• Waxman A. The WHO Global Strategy on Diet, Physical Activity and Health: the controversy on sugar. Development 2004;47:75–82
• Zarocostas J. WHO waters down draft strategy on diet and health. Lancet 2004;363:1373.
• Kaiser J.  The man behind the memos.  Science 2004;305:1552-1553.

Who knew that Wednesday’s New York State Supreme Court hearing on the lawsuit filed against New York City’s cap on sodas larger than 16 ounces would turn out to be a debate about race relations?

Let’s be clear.  This lawsuit is about only one thing and one thing only: to protect the profits of Big Soda—mainly, Coca-Cola and PepsiCo.  The lawsuit is funded by their trade association, the American Beverage Association (ABA), at what must be astronomical expense.

But to shift attention away from profit as a motive, the ABA enlisted two organizations of underrepresented groups—the NAACP and Hispanic Federation—to file an amicus brief on behalf of the soda companies.  The brief argues that the soda cap discriminates against citizens and small-business owners in African-American and Hispanic communities.  But it neglects to mention  that both “friends of the court” received funding from soda companies.

The financial arrangements between Big Soda and such groups demand further examination. Fortunately, we have Michael Grynbaum at the New York Times, who explains that:

The obesity rate for African-Americans in New York City is higher than the city average, and city health department officials say minority neighborhoods would be among the key beneficiaries of a rule that would limit the sale of super-size, calorie-laden beverages.

But the N.A.A.C.P. has close ties to big soft-drink companies, particularly Coca-Cola, whose longtime Atlanta law firm, King & Spalding, wrote the amicus brief filed by the civil rights group in support of a lawsuit aimed at blocking Mr. Bloomberg’s soda rules…Coca-Cola has also donated tens of thousands of dollars to a health education program, Project HELP, developed by the National Association for the Advancement of Colored People. The brief describes that program, but not the financial contributions of the beverage company. The brief was filed jointly with another organization, the Hispanic Federation, whose former president, Lillian Rodríguez López, recently took a job at Coca-Cola.

Soda companies have a long history of targeting their marketing efforts to Blacks and Hispanics, as shown in at least one book (and described in one of its reviews).

Last fall, the East Bay Express exposed how the soda industry exploited race issues and used them to divide and conquer in defeating the Measure N soda tax initiative in Richmond, California.

The No on Measure N workers’ paychecks were signed by political consultant Barnes Mosher Whitehurst Lauter & Partners (BMWL), which had been hired by the American Beverage Association….By the time that Big Soda had arrived, the issue of race was already a factor in the campaign. Some opponents of the tax had alleged that it was racist, arguing that it would unfairly harm low-income residents in the city. And the No on Measure N campaign…nurtured that sentiment. Indeed, there is evidence that the beverage association helped keep race at the forefront of the campaign as part of a strategy that exploited Richmond’s existing tensions.

…the beverage industry discovered a winning formula in Richmond last year that it might be able to replicate elsewhere…And if that were to happen, it could drive a wedge through traditional Democratic constituencies in many communities, with blacks and Latinos opposing their longtime political allies — progressives and environmentalists — just like they did in Richmond.

Is a cap on soda sizes discriminatory?  Quite the contrary.

Public health measures like this are about removing health disparities and giving everyone equal access to good nutrition and health.  This makes public health—and initiatives like the soda cap—democratic, inclusive, and anything but elitist.

But I can’t think of anything more elitist, less inclusive, and more undemocratic than suing New York City over the soda cap.

In funding this suit, the soda industry has made it clear that it will go to any lengths at any cost to protect its profitability—even to the point of dragging along with it the very groups that would most benefit from the initiative.

If the American Beverage Association and its corporate members really cared about Black and Hispanic groups, it would stop target marketing,  stop marketing to children, and stop pretending that sugar-sweetened beverages are an important part of active, healthy lifestyles.  It certainly would stop wasting these groups’ time and credibility on anti-public health lawsuits.

If I were teaching public health nutrition right now, here’s what I’d want students to read:

Geof Rayner and Tim Lang, Ecological Public Health: Reshaping the Conditions for Good Health, Routledge Earthscan, 2012.

Our case is that public health is an interdisciplinary project, and not merely the preserve of particular professionals or titles.  Indeed, one of the themes of the book is that public health is often improved by movements and by people prepared to challenge conventional assumptions and the status quo…In these cynical academic times, when thinking is too often set within narrow economistic terms—What can we afford? What is the cost-benefit of health action?—and when the notion of the ‘public’ is often replaced by the ‘individual’ or the ‘private,’ this book offers an analysis of public health which is unashamedly pro bono publico, for the public good.

David Stuckler and Karen Siegel, eds.  Sick Societies: Responding to the Global Challenge of Chronic Disease, Oxford University Press, 2011.

Sick Societies argues that we are building environments that are poorly designed for our boides: we create societies where tobacco, alcohol, and foods containing high levels of salt, sugar, and fats are the easiest, cheapest, and most desirable choices, while fruits, vegetables, and exercise are the most expensive, inaccessible, and inconvenient options.  The rise in chronic diseases is the result of a model of societal development that is out of control: a model that puts wealth before health.

Wilma Waterlander, Put the Money Where the Mouth Is: The Feasibility and Effectiveness of Food Pricing Strategies to Stimulate Healthy Eating, Vrije Universiteit, Amsterdam, 2012.

This one is for policy wonks and change agents.  This is Waterlander’s doctoral dissertation done as a published book but it is written clearly and forcefully.  Her conclusions:

The studies presented in this thesis show that the healthy choice is the relatively expensive choice; that price fundamentally affects food choice and may even form a barrier for low SES consumers in selecting healthier foods.  These findings make pricing strategies a justifiable tool to stimulate healthier choices…making healthier foods cheaper was found to be the most feasible pricing strategy to implement.

My latest publication is a commentary on the reversal of the Danish fat tax in New Scientist, November 26:

Fighting the flab means fighting makers of fatty foods

A YEAR ago in these pages, I congratulated the Danish government on its revolutionary experiment. It had just implemented a world-first fiscal and public health measure – a tax on food products containing more than 2.3 per cent saturated fat.

This experiment has now been dropped. Under intense pressure from the food industry in an already weak economy, the Danish government has repealed the fat tax and abandoned an impending tax on sugars.

Nobody likes taxes, and the fat tax was especially unpopular among Danish consumers, who resented having to pay more for butter, dairy products and meats – foods naturally high in fat.

But the real reason for the repeal was to appease business interests. The ministry of taxation’s rationale was that the levy on fatty foods raised the costs of doing business, put Danish jobs at risk and drove customers to buy food in Sweden and Germany.

In June this year, a coalition of Danish food businesses organised a national repeal-the-tax campaign. The coalition said that fat and sugar taxes would cause the loss of 1300 jobs, generate high administrative costs and increase cross-border shopping – precisely the arguments cited by the government for its U-turn.

We can now ask the obvious questions. Did the tax achieve its aims? Was it good public policy? What should governments be doing to reduce dietary risk factors for obesity?

The purpose of food taxes is to reduce sales of the products concerned. In bringing in its fat tax, the Danish government also wanted to raise revenue, reduce costs associated with obesity-related diseases, and increase health and longevity. A year is hardly time to assess the impact on health, but the tax did bring in $216 million. Danes will now face higher income taxes to make up for the loss of the fat tax.

Business groups insist that the tax had no effect on the amount of fat that Danes ate, although they chose cheaper foods. In contrast, economists at the University of Copenhagen say Danish fat consumption fell by 10 to 20 per cent in the first three months after the tax went into effect. But it is not possible to know whether it fell, and cross-border shopping rose, because of the tax or because of the slump that hit the Danish economy.

A recent analysis in the BMJ suggests that 20 per cent is the minimum tax rate on food to produce a measurable improvement in public health. The price of Danish foods hit by the tax increased by up to 9 per cent, enough to cause a political firestorm but not to make much of a difference to health.

Is a saturated-fat tax good public policy? A tax on sugary drinks would be a better idea. To see why, recall that obesity is the result of an excess intake of calories over what we burn. Surplus calories, whether from carbohydrate, protein or fat, are stored as body fat. All food fats are a mix of unsaturated and saturated fatty acids; all provide the same number of calories per unit weight.

Saturated fats raise the risk of coronary heart disease, although not by much. Trans fats, banned in Denmark since 2003, are a greater risk factor. Because the different saturated fatty acids vary in their risk, imposing a single tax on them as if they are indistinguishable is difficult to support scientifically.

For these reasons, anti-obesity tax measures in other countries have tended to avoid targeting broad nutrient groups. Instead, they focus on processed foods, fast food or sugary drinks – all major sources of calories. Taxing them seems like a more promising strategy.

What else should governments be doing? That they have a role in addressing the health problems caused by obesity is beyond debate, not least because they bear much of the cost of dealing with such problems. In the US, economists estimate the cost of obesity-related healthcare and lost productivity at between $147 billion and $190 billion a year. The need to act is urgent. But how?

One lesson from Denmark is that small countries with open borders cannot raise the prices of food or anything else unless neighbouring countries also do so. But the greater lesson is that any attempt to encourage people to eat less will encounter fierce food-industry opposition. Eating less is bad for business.

In the US, state and city efforts to tax sugary drinks have met with overwhelming opposition from soft-drink companies. They have successfully spent tens of millions of dollars lobbying legislators and convincing the public that such measures deprive voters of their “right to choose” or, as in Denmark, can damage the economy.

What’s more, the poor cannot be expected to support measures that increase food costs, even though obesity-related problems are much more common among low-income groups.

If governments really want to reduce the costs of obesity-related chronic diseases, they will have to address the problem at its source: the production and marketing of unhealthy food products.

A review by the American Heart Association cites increasing evidence for the benefits of anti-obesity interventions: food taxes, subsidising healthy foods, media campaigns to promote exercise and good diet, restrictions on portion sizes, and restrictions on the marketing of unhealthy foods and their sale in schools.

Governments must decide whether they want to bear the political consequences of putting health before business interests. The Danish government cast a clear vote for business.

At some point, governments will need to find ways to make food firms responsible for the health problems their products cause. When they do, we are likely to see immediate improvements in food quality and health. Let’s hope this happens soon.

Marion Nestle is the author of Food Politics and What to Eat and is the Paulette Goddard professor of nutrition, food studies, and public health at New York University

Mayor Bloomberg’s proposal to limit sugary soft drinks to 16 ounces has elicited an industry counter attack as well as much attention to the role of sugary drinks in obesity.

The soda industry established a new organization, “Let’s Clear It Up,” with a website to spin the science.

Soda is a hot topic. And the conversation is full of opinions and myths, but not enough facts. America’s beverage companies created this site to clear a few things up about the products we make. So read on. Learn. And share the clarity.

Myth: The obesity epidemic can be reversed if people stop drinking soda. [I’m not aware that anyone is claiming this.  Bloomberg’s proposal is aimed at making it easier for soda drinkers to reduce calorie intake.]

Fact: Sugar-sweetened beverages account for only 7% of the calories in the average American’s diet, according to government data. [The figure applies to everyone over the age of 2—to those who do and do not drink sodas.  The percentage is much higher for soda drinkers.]

Coca-Cola is using a second strategy: divert attention.  Its full-page ad in Sunday’s New York Times said:

Everything in moderation.  Except fun, try to have lots of that.

Our nation is facing an obesity problem and we’re taking steps to be part of the solution.  By promoting balanced diets and active lifestyles, we can make a positive difference.

By “balanced diets” Coke means varying package sizes.  By “active lifestyles” Coke means partnerships with Boys & Girls Clubs of America and gifts to national parks.  This approach merits its own website: livepositively.com.

And then we have USA Today’s not-to-be-missed interview with Katie Bayne, Coke’s president of sparkling beverages in North America:

Q: Is there any merit to limits being placed on the size of sugary drinks folks can buy?

A: Sugary drinks can be a part of any diet as long as your calories in balance with the calories out. Our responsibility is to provide drink in all the sizes that consumers might need. [Need?]

Q: But critics call soft drinks “empty” calories.

A: A calorie is a calorie. What our drinks offer is hydration. That’s essential to the human body. We offer great taste and benefits whether it’s an uplift or carbohydrates or energy. We don’t believe in empty calories. We believe in hydration. [Water, anyone?]

Finally, there’s the Washington Post interview with Todd Putman, a former Coke marketing executive now in recovery.

Putman, whose positions at Coca-Cola included U.S. head of marketing for carbonated drinks, said in the interview that among his achievements was tailoring the company’s national advertising campaigns to specific groups. The approach helped Coca-Cola intensify marketing to target audiences such as African Americans and Hispanics.

“It was just a fact that Hispanics and African Americans have higher per capita consumption of sugar-based soft drinks than white Americans,” he said. “We knew that if we got more products into those environments those segments would drink more.”

Is the soda industry behind the Center for Consumer Freedom’s Nanny Bloomberg ad?  I’ve yet to hear denials.

I’m catching up on some reading over the long weekend.  Here are some selections from the latest issue of Childhood Obesity (Click here for the complete Table of Contents).

Food Marketing to Youth: Current Threats and Opportunities Marlene B. Schwartz, Amy Ustjanauskas Childhood Obesity. April 2012, 8(2): 85-88. First Page | Full Text PDF|

Revolution Foods: Equal Access for All Interview with Revolution Foods Co-Founders Kristin Richmond and Kirsten Tobey Childhood Obesity. April 2012, 8(2): 94-96 First Page | Full Text PDF|

Exploring Effectiveness of Messaging in Childhood Obesity Campaigns David L. Katz, Mary Murimi, Robert A. Pretlow, William Sears Childhood Obesity. April 2012, 8(2): 97-105.First Page | Full Text PDF|

Hard Truths and a New Strategy for Addressing Childhood Obesity Eric A. Finkelstein, Marcel Bilger Childhood Obesity. April 2012, 8(2): 106-109.First Page | Full Text PDF|

U.S. Government Initiatives Childhood Obesity. April 2012, 8(2): 167-168.First Page | Full Text PDF |

Yesterday, the FDA proposed long-awaited action against use of antibiotics for non-therapeutic purposes in animal agriculture.

From the outside, this might look more like inaction.  The agency is asking drug companies to voluntarily cut back on producing antibiotics for non-therapeutic purposes and to require veterinary oversight of use of these drugs.

The announcement comes in the form of three documents in the Federal Register.

• Final Guidance for Industry: The Judicious Use of Medically Important Antimicrobial Drugs in Food-Producing Animals.
• Draft Guidance for Industry aimed at assisting drug companies in voluntarily removing from FDA-approved product labels uses of antibiotics for production rather than therapy, and voluntarily changing the marketing status to include veterinary oversight.  This is open for public comment.
• A draft of a proposed Veterinary Feed Directive regulation,  also open for public comment, outlining how veterinarians can authorize the use of antibiotics in animal feed.

In an FAQ on the announcement, the FDA answers some obvious questions:

4. What is “judicious use” and what are FDA’s recommendations?

“Judicious use” is using an antimicrobial drug appropriately and only when necessary;

Based on a thorough review of the available scientific information, FDA recommends that use of medically important antimicrobial drugs in food-producing animals be limited to situations where the use of these drugs is necessary for ensuring animal health, and their use includes veterinary oversight or consultation.

FDA believes that using medically important antimicrobial drugs to increase production in food-producing animals is not a judicious use (my emphasis).

5. Why did FDA decide to do this now?

FDA has worked with many stakeholder groups and the U.S. Department of Agriculture (USDA) to develop a strategy that will be successful in reducing antimicrobial resistance while minimizing adverse impacts on animal health and disruption to the animal agricultural industry.

In June 2010, FDA released a draft guidance document explaining its recommendations for change and in the interim period sought and received input from various stakeholders, including the animal pharmaceutical industry, animal feed industry, veterinary and animal producer communities, consumer advocacy groups and USDA.

Translation: this has been in the works for a long time and is the result of extensive discussions with the relevant industries.

As Food Safety News explains, the reaction of just about everyone to this announcement has been tepid.

• Food safety advocates object to voluntary, because it never works.
•  The meat industry insists that non-therapeutic antibiotics are essential for producing cheap meat under crowded conditions.

For example, the National Pork Producers make the usual industry arguments:

Harm to small farmers: The guidance could eliminate antibiotics uses that are extremely important to the health of animals…And the requirement for VFDs [veterinary oversight] could be problematic, particularly for smaller producers or producers in remote areas who may not have regular access to veterinary services.

Voluntary equals regulation: The guidance, which does not have the force of law but may be treated as such by FDA, is a move to address an increase in antibiotic-resistant illnesses in humans, which opponents of modern animal agriculture blame on the use of antibiotics in livestock and poultry production.

The science is “junk”: But numerous peer-reviewed risk assessments, including at least one by FDA, show a “negligible” risk to human health of antibiotics use in food-animal production.

My interpretation:

The FDA’s position on non-therapeutic use of antibiotics in animal agriculture is quite clear.  The agency recognizes that based on the science, the use of antibiotics as growth promoters in animals poses a serious risk to human health.

I’m guessing this is the best the FDA can do in an election year.

This move looks to me like a direct challenge to drug companies and meat producers to clean up their acts and take some responsibility for the effects of their misuse of animal antibiotics on public health.

It’s also a challenge to food safety advocates to make sure that the FDA monitors the effects of its voluntary guidance and, if the industries don’t cooperate, that the FDA gets busy on real regulations.

Addition: The account in today’s New York Times explains why the FDA is starting with voluntary efforts:

The reason for the reliance on voluntary efforts is that the F.D.A.’s process for revoking approved drug uses is lengthy and cumbersome, officials said. The last time the F.D.A. banned an agricultural use of a medically important antibiotic against the wishes of its maker, legal appeals took five years. In this case, hundreds of drugs are involved, each with myriad approved uses in various animals.

“You and I and our children would be long dead before F.D.A. could restrict all of these uses on its own,” Ms. Rogers [of the Pew Foundation]said.

So many comments came in to my blog post on Paula Deen’s diabetes announcement, “weighing in on Paula Deen,” that I thought it was worth revisiting in my monthly (first Sunday) column in the San Francisco Chronicle.  The question (edited) came from a blog reader:

Q: I have been diagnosed with type 2 diabetes and am very confused about insulin resistance, and what carbohydrates I can and cannot eat. So much of what I read is contradictory.

A: The first line of defense against type 2 diabetes is weight loss, but you would never know it from listening to Paula Deen, the celebrity Southern cook who recently announced that she has this disease, or even to the American Diabetes Association.

Having diabetes is no joke. It is a leading cause of blindness, kidney failure, leg and foot amputations, and premature death.

The disease comes in two forms – type 1 and type 2 – but type 2 accounts for 95 percent of cases. In both, levels of blood sugar are too high as a result of problems with insulin, a hormone that enables the body to use blood sugar for energy. But the reasons differ.

Type 1 is an autoimmune disease. It causes the pancreas to stop making insulin or not make enough. Type 1 is not yet preventable and requires insulin treatment.

In type 2, insulin may be available, but body tissues resist its use.

Being overweight is the key factor in type 2. Most people can prevent it by not gaining weight. And most people with the type 2 disease can eliminate symptoms by losing some weight.

Genetics is certainly a factor – many overweight people never develop the disease – but 85 percent or more of people diagnosed with type 2 diabetes are overweight or obese.

In genetically predisposed people, being overweight causes insulin resistance. Metabolism does not handle excess calories very well, and this means calories from any source, not just carbohydrates.

Fast food, soft drinks

Children and adults who habitually consume fast food as well as soft drinks tend to take in more calories and weigh more and are more likely to develop symptoms than people who eat healthier diets and are more active.

This makes healthy eating and physical activity the most important approaches. The vast majority of overweight people at risk of type 2 diabetes can prevent symptoms by losing a few percent of their body weight and doing a couple of hours a week of moderate – not necessarily vigorous – physical activity. The same works for treatment. Some people will still need medications, but the drugs work better with diet and physical activity.

As the Centers for Disease Control puts it, “all diabetes-care programs should make healthy weight a priority.”

Dietary advice for type 2 diabetes is the same as advice for everyone else: Eat a wide variety of relatively unprocessed foods, especially vegetables, fruits and whole grains, and don’t consume too much junk food or too many sugary beverages.

Scientists may argue endlessly about the relative importance of calories, sugars and refined carbohydrates in the diets of people with type 2 diabetes, but everyone agrees that eating less of all three would help resolve symptoms.

Why isn’t weight loss better recognized as a treatment strategy? Paula Deen’s announcement said nothing about losing weight.

The ADA does talk about weight loss on its website ( www.diabetes.org), but you must search hard through several complicated screens before you find, “Losing just a few pounds through exercise and eating well can help with your diabetes control and can reduce your risk for other health problems.”

Pharmaceuticals

I can’t help wondering if the lack of prominence given to weight loss might have something to do with the influence of pharmaceutical companies.

A few years ago, I gave a talk on the importance of weight loss in control of type 2 diabetes at an ADA annual meeting. Although many conference talks dealt with drug treatment, mine was the only one on diet – except for a session on sugars sponsored by Coca-Cola.

The exhibit hall was packed with drug company representatives dispensing free pens, writing pads, books, lab coats and stethoscopes – all with corporate logos.

The influence of drug companies on diabetes advice is worth attention. Deen represents a drug that costs hundreds of dollars a month. Drug companies give the ADA millions every year.

Eating less and being active make no money for anyone (unless people can be induced to join commercial weight-loss programs).

Losing weight is a losing battle for many people. It’s hard to lose weight in today’s “eat more” food marketing environment.

Teachable moment

But a diagnosis of type 2 diabetes should be a teachable moment. Shouldn’t the ADA more strongly urge people with the disease to eat less, eat better and move more, and help everyone find ways to cope with “eat more” messages?

The health and economic costs of type 2 diabetes, and its preventability, are reason enough to demand changes in the food environment. The ADA should be working hard to make it easier for everyone to eat more healthfully, be more active and avoid the need for a lifetime of diabetes medications.

Marion Nestle is the author of “Food Politics” and “What to Eat,” among other books, and is a professor in the nutrition, food studies and public health department at New York University. She blogs at www.foodpolitics.com. E-mail comments to food@sfchronicle.com.

This article appeared on page G – 4 of the San Francisco Chronicle