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I write a monthly first-Sunday column for the San Francisco Chronicle. This one is on the latest Dietary Guidelines.

Dietary Guidelines try not to offend food industry

Sunday, February 6, 2011

Q: What do you think of the new Dietary Guidelines that were announced earlier this week? Is there anything very new or different? And how important are these guidelines, anyway?

A: I was stunned by the first piece of the 2010 Dietary Guidelines for Americans that I saw online (dietaryguidelines.gov): “Enjoy your food, but eat less.”

Incredible. The federal government finally recognizes that food is more than just a collection of nutrients? It finally has the nerve to say, “Eat less?”

But this statement and others directed to the public do not actually appear in the guidelines. That document repeats the same principles that have appeared in dietary guidelines for decades.

The 2010 guidelines just state them more clearly. (For the news story on the guidelines, go to sfg.ly/gdgsc0.)

Obesity prevention

Its 23 recommendations are aimed at obesity prevention. They focus on eating less and eating better. “Eat better” guidelines suggest eating more vegetables, fruits, whole grains, low-fat milk, soy products, seafood, lean meats and poultry, eggs, beans, peas, nuts and seeds – all are foods.

But the “eat less” advice is about nutrients: sodium, saturated fat, cholesterol and trans fats. The guidelines even coin a new term for the “eat less” nutrients of greatest concern: “solid fats and added sugars,” annoyingly abbreviated as SoFAS.

Here is one SoFAS guideline: “Limit consumption of … refined grain foods that contain solid fats, added sugars, and sodium.”

Nutrient-based guidelines require translation. You have to delve deeply into the 95-page document to find the food translations. Eat fewer solid fats? This means cakes, cookies, pizza, cheese, processed and fatty meats, and, alas, ice cream. Less sugar? The major sources are sodas, sports drinks, energy drinks and fruit drinks.

Why don’t the guidelines just say so? Politics, of course.

Official policy

Dietary guidelines are an official statement of federal nutrition policy. They influence everything the government says and does about food and nutrition. The guidelines determine the content of school meals, the aims of food assistance programs and the regulation of food labeling and advertising.

But their most powerful effect is on the food industry.

Why? Because advice to eat less is very bad for business.

Banal as their recommendations may appear, dietary guidelines are hugely controversial. That is why I was so surprised by “Enjoy your food, but eat less.”

Consider the history. In 1977, a Senate committee chaired by George McGovern issued dietary goals for the United States. One goal was to reduce saturated fat to help prevent heart disease. To do that, the committee advised “reduce consumption of meat.”

Those were fighting words. Outraged, the meat industry protested and got Congress to hold hearings. The result? McGovern’s committee reworded the advice to “choose meats, poultry and fish which will reduce saturated fat intake.”

This set a precedent. When the first dietary guidelines appeared in 1980, they used saturated fat as a euphemism for meat, and subsequent editions have continued to use nutrients as euphemisms for “eat less” foods.

Then came obesity. To prevent weight gain, people must eat less (sometimes much less), move more, or do both.

This puts federal agencies in a quandary. If they name specific foods in “eat less” categories, they risk industry wrath, and this is something no centrist-leaning government can afford.

Eat less, move more

So the new guidelines break no new ground, but how could they? The basic principles of diets that protect against chronic disease do not change. Stated as principles, the 2010 dietary guidelines look much the same as those produced in 1980 or by the McGovern committee.

In my book, “What to Eat,” I summarize those basic principles “eat less, move more, eat plenty of fruits and vegetables, and don’t eat too much junk food.” Michael Pollan manages this in even fewer words: “Eat food. Mostly plants. Not too much.”

Everything else in the guidelines tries to explain how to do this without infuriating food companies that might be affected by the advice. And the companies scrutinize every word.

The soy industry, for example, is ecstatic that the guidelines mention soy products and fortified soy beverages as substitutes for meat and as protein sources for vegetarians and vegans.

The meat industry is troubled by the suggestion to increase seafood, even though the guidelines suggest meal patterns that contain as much meat as always.

The salt recommendation – a teaspoon or less per day, and even less for people at risk for high blood pressure – is unchanged since 2005, but stated more explicitly. The salt industry reacted predictably: “Dietary guidelines on salt are drastic, simplistic and unrealistic.”

In a few months, a new food guide will replace the old pyramid. Thanks to a law Congress passed in 1990, dietary guidelines must be revisited every five years. Expect the drama over them to continue.

But for now, enjoy your food.

Marion Nestle is the author of “Food Politics,” “Safe Food,” “What to Eat” and “Pet Food Politics,” and is a professor in the nutrition, food studies and public health department at New York University. E-mail her at food@sfchronicle.com, and read her previous columns at sfgate.com/food.

This article appeared on page H – 3 of the San Francisco Chronicle

I have now had time to look at the full report of the 2010 Dietary Guidelines–all 95 pages of what they are calling “the policy document.”

Oh no!  What happened to the Selected Messages for Consumers that I posted yesterday?  “Enjoy your food” is not in it and neither are any of the other clear, straightforward messages.  This is a big disappointment.

Nevertheless, the document is well worth reading.

It addresses my complaints about the executive summary.  It explains the meaning of the annoying SOFAS (solid fats and added sugars).  It discusses the need to improve the food environment.

Let me share a few thoughts about selected issues.

SOFAS

The report translates its advice (pages 62-68).   It translates  “Cut back on foods and drinks with added sugars,” a nutrition euphemism, as:

Drink few or no regular sodas, sports drinks, energy drinks, and fruit drinks.  Eat less cake, cookies, ice cream, other desserts, and candy.  If you do have these foods and drinks, have a small portion.

But it translates “Cut back on solid fats” in yet another euphemism:  “Select lean meats and poultry, and fat-free or low-fat milk and milk products.”  This, no doubt, is to avoid the politically impossible “eat less meat.”

Added sugars

The report lists synonyms for added sugars that you might find on a food label (page 75).  The 2005 Dietary Guidelines included “fruit juice concentrates” on that list.  The 2010 guidelines do not.  The Table lists “nectars” but not fruit juice concentrates.  How come?  It doesn’t say.

Food group patterns

The report describes healthy patterns for diets ranging from 1,000 to 3,200 calories a day.  For a diet containing 2,000 calories, you are only allowed 258 calories a day from SOFAS.  That’s all? One 20-ounce soft drink contains more than that and so does  one tablespoon of butter and a 12-ounce soft drink.  No wonder the guidelines don’t want to be specific about foods when they mean “eat less.”

Sodium

The recommendation to reduce sodium intake to 2,300 or 1,500 mg per day is addressed to the wrong people.  Individuals cannot do this on their own since most salt is already added in restaurant and processed foods.  The report recognizes this:

• Consume more fresh foods and fewer processed foods that are high in sodium.
• Eat more home-prepared foods, where you have more control….
• When eating in restaurants, ask that salt not be added….
  

Vegetarian and vegan diets

The report includes diet plans for lacto-ovo vegetarians and vegans (pages 81 and 82).  Applause, please.  When I was on the dietary guidelines advisory committee in 1995, we tried to say something useful about vegetarian diets but were forced to add something about the nutritional hazards of such diets, minimal as they are.  Not having to do this is a big improvement.  But you too only get 258 calories for SOFAS.

How about changing the food environment?

The report makes it clear that the food environment strongly influences the food choices of individuals, and it urges efforts to

• Improve access to healthy foods
• Empower people with improved nutrition literacy, gardening and cooking skills
• Develop policies to prevent and reduce obesity
• And for kids, fix school meals, encourage physical activity, and reduce screen time

In short, there is plenty to work with here.  You just have to look hard and dig deep to find it.

What is the food industry’s reaction?

Just for fun, I’ve been tracking some of the industry reactions.  The soy people love it.  The report mentions soy along with nuts and seeds in the USDA’s meal patterns (page 79), and soy has its own category in the vegetarian and vegan diets (page 81 and 82).

The meat people don’t love it so much.  They are a little worried that seafood is pushed more than meat, but the American Meat Institute is giving it a nice spin, pointing out that the overall meat recommendation has not changed since 2005.

And the Salt Institute?  “Dietary Guidelines on Salt Drastic, Simplistic, Unrealistic.”

I rest my case.

I listened in on the conference call at which the Grocery Manufacturers of America and the Food Marketing Institute announced their new Nutrition Keys design for front-of-package labels.

My favorite comment: We are all “singing kumbaya” here.  Nutrition Keys, they said, was the result of a” monumental, historic effort” in which food companies “stepped up to the plate in a big way,” “with 100% support.”

Why did they go to all this trouble?  Because “A healthy consumer makes for a happy consumer.”

Kumbaya, indeed.

The real reason, as I explained yesterday, is to preempt the FDA’s front-of-package food labeling initiatives which might make food companies reveal more about the “negatives” in processed foods.

Here’s what GMA and FMI say the new label will look like:

Four of these things are required: Calories, Saturated fat, Sodium, and Total (not added) sugars.  Packages can also display up to two “nutrients to encourage” picked from this collection:  protein; fiber; vitamins A, C, and D; and potassium, iron, and calcium.

Let’s give these food trade associations credit for listing sugars instead of the Institute of Medicine’s recommendation for trans fat.  Trans fats are already gone from most processed foods.  Everyone cares about sugars.  But these are total sugars, not added sugars, which is what really matters.

And protein?  Since when does protein need to be encouraged in American diets?  We already eat twice the protein we need.  The rationale?  Vegetarians.   I repeat.  Since when don’t vegetarians get enough protein?  Never mind, protein makes the products look better.

Nutrition Keys merely repeats what’s on the Nutrition Facts labels, only worse.  It makes the percent Daily Values practically invisible.  Which is better?  High or low milligrams or grams.  You have to know this, and Nutrition Keys doesn’t help with that problem.

Nutrition Keys, says the industry, is about “more clarity in labeling.”  Really?  Here’s what it will look like on a food package.

I’ve been collecting reactions.

Although GMA and FMI insist they they are doing this in response to the First Lady’s Let’s Move campaign, the White House issued this statement:

The White House, including the First Lady, recognizes these companies for the leadership they have shown in advancing this initiative. We regard their commitment to dedicate space, for the first time, to an industry-wide front-of-pack label as a significant first step and look forward to future improvement. The FDA plans to monitor this initiative closely and will work with experts in the field to evaluate whether the new label is meeting the needs of American consumers and pursue improvements as needed. We will continue to work on seeking solutions for the problem of childhood obesity in America.

Congresswoman Rosa DeLauro was more forthcoming:

The industry’s unveiling today of its front-of-package labeling system is troubling and confirms that this effort should not circumvent or influence FDA’s effort to develop strong guidelines for FOP labels.

Given that negative and positive nutrients will not be differentiated on the package, there is significant risk that these labels will be ignored.  An adequate labeling system must clearly alert consumers about potentially unhealthy foods, and should not mislead them into believing that some foods are healthy when they clearly are not.

Reporters asked tough questions on the conference call about preemption of FDA efforts to do front-of-package labeling in a rational way (see my post from yesterday).  Perhaps space limitations made full accounts impossible:

• USA Today story (I’m quoted)
• Washington Post
• New York Times

My first San Francisco Chronicle “Food Matters” column for the new year deals with some predictions:

Q: Whatever you used as a crystal ball last year turned out to be a pretty good predictor of the most prominent food issues of 2010. How about trying again: What food matters will we be hearing about in 2011?

A: It doesn’t take a crystal ball to figure out what’s coming up with food issues. I’m happy to make predictions, especially since most seem fairly safe.

Dietary guidelines will be released this month. By law, they were due last year and are already late. What will they say? The 2010 guidelines advisory committee recommended eating more fruits, vegetables and whole grains, but introduced a new euphemism – SOFAs, or Solid Fats and Added Sugars – for the “eat less” advice. SOFAs really mean “cut down on fatty meat and dairy products” and “avoid sugary sodas.”

Will government agencies have the nerve to say so? Let’s hope.

The U.S. Department of Agriculture will issue a new food guide. The 2005 pyramid’s rainbow stripes proved impossible to teach and useless to anyone without a computer. I’ve heard a rumor that I will love the new design. I’m skeptical. I liked the original 1992 pyramid. It showed that bottom-of-the-pyramid foods were healthiest, making it unpopular with companies selling top-of-the-pyramid products. But it is healthier to eat some foods than others (see: dietary guidelines).

Will the USDA improve on the 1992 design? We will soon find out.

The fights over food safety will continue. At the last possible moment, Congress passed the food safety bill by a large majority. Now the fights really begin.

Funding will be most contentious, with the actual regulations not far behind. The Congressional Budget Office absurdly considered the bill’s provisions to be “budget neutral.” They are anything but.

The bill’s provisions require the Food and Drug Administration to hire more inspectors just at a time when Republican lawmakers have sworn to cut domestic spending. The FDA also must translate the bill’s requirements and exemptions for small farmers into regulations.

Rule-making is a lengthy process subject to public comment and, therefore, political maneuvering. Watch the lobbying efforts ratchet up as food producers, large and small, attempt to head off safety rules they think they won’t like.

Expect more lawsuits over the scientific basis of health claims. The Federal Trade Commission just settled a $21 million claim against Dannon for advertising that yogurt protects against the flu. The agency also has gone after scientifically unsubstantiated claims that omega-3s in kiddie supplements promote brain development and that pomegranate juice protects against prostate problems. POM Wonderful has already countersued the FTC on grounds that the First Amendment protects commercial speech. I’ll be watching this case carefully.

The FDA will issue new front-of-package label regulations. The FDA has promised to propose an at-a-glance symbol to indicate the overall nutritional value of food products. Food companies like the Guideline Daily Amount spots they are using in the upper corners of food packages because the symbols are factual but nonjudgmental. The FDA, however, is considering red, yellow and green traffic-light symbols that do convey judgments. Food companies say they will not voluntarily use a symbol that tells people to eat less of their products.

Will the FDA have the courage to make traffic lights mandatory? It will need courage. The new British government dealt with the traffic-light idea by summarily dismantling the food agency that suggested it.

Corporations will seek new ways to co-opt critics. Under the guise of corporate social responsibility, food companies have been making large donations to organizations that might otherwise criticize their products. The most recent example is the decision by Save the Children, formerly a staunch advocate of soda taxes, to drop that cause coincidentally at a time when its executives were negotiating funding from Coca-Cola.

Such strategies remind me of how the Philip Morris cigarette company distributed grants to leading arts groups. Expect food companies to use generosity to neutralize critics and buy silence.

School meals will make front-page news. Congress passed the Healthy, Hunger-Free Kids Act last month. Now the USDA must implement it by setting nutrition standards, adding fresh fruits and vegetables (some locally grown) and expanding eligibility.

President Obama has promised to restore the $4.5 billion “borrowed” from the SNAP (food stamp) program to fund this act. The scrambling over the regulations and financing should make excellent spectator sport.

Farm bill advocates will be mobilizing. You might think it too early to be worrying about the 2012 Farm Bill, but I’ve already gotten position papers analyzing commodity and food-assistance issues from groups gearing up to lobby Congress to bring agricultural policy in line with nutrition and public health policy.

I have a personal interest in such papers. I will be teaching a course on the Farm Bill at New York University next fall. Please get busy and write more of them!

Happy new year, and let’s see how my guesses play out.

The November issue of San Francisco Medicine is devoted to Food for Thought: Practical Nutrition for Physicians (the entire issue is online).

It’s got a great collection of short articles, if I may say so myself.  A throwback to the days when I taught nutrition at the University of California San Francisco School of Medicine, my contribution, the first one, is called “Doctor’s Orders: What Should Doctors Tell Patients About Nutrition?”

I am a realist. I am well aware of the fact of time constraints, and my list of suggestions for what doctors should tell patients about diet and health is necessarily short. Fortunately, it doesn’t take long to tell patients that what they eat matters to their health. It takes only a minute to explain that healthy eating simply means attending to food variety, minimal processing, and moderation.

This collection is worth a read.  For example:

• David Wallinga: An Unhealthy Food System: Suggestions for Physician Advocacy
• Brian Raymond: Taking Action: A Health Sector Guide to Food System and Agricultural Policy
• Kelly Brownell: How the Food Industry Drives Us to Eat
• Narsai David: Eating Sensibly: Using Common Sense and Moderation
• Shannon Udovic-Constant, MD, and Steve Heilig: Health Policy Perspective: Sugar Politics Versus Health

Take a look and use!

The World Health Organization (WHO) has a new, tough report out: “Set of recommendations on the marketing of foods and non-alcoholic beverages to children.”

It’s policy aim: to reduce the impact on children of marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt.

Here are some of its recommendations (edited):

• Given that the effectiveness of marketing is a function of exposure and power, the overall policy objective should be to reduce both the exposure of children to, and power of, marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt.
• To achieve the policy aim and objective, Member States should consider different approaches, i.e. stepwise or comprehensive, to  reduce marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt, to children.
• Settings where children gather should be free from all forms of marketing of foods high in saturated fats, trans-fatty acids, free sugars, or salt.
• Governments should be the key stakeholders in the development of policy and provide leadership, through a multistakeholder platform, for implementation, monitoring and evaluation. In setting the national policy framework, governments may choose to allocate defined roles to other stakeholders, while protecting the public interest and avoiding conflict of interest.
• Considering resources, benefits and burdens of all stakeholders involved, Member States should consider the most effective approach to reduce marketing to children of foods high in saturated fats, trans-fatty acids, free sugars, or salt.
• Member States should cooperate to put in place the means necessary to reduce the impact of crossborder marketing (in-flowing and out-flowing) of foods high in saturated fats, trans-fatty acids, free sugars, or salt to children.

The Rudd Center at Yale has just released Fast Food F.A.C.T.S., a thoroughly comprehensive report on the marketing of fast food to children and adolescents.

The report lavishly illustrates and extensively documents the ways in which fast food companies market to kids, the strategies they use, and the effects of these efforts on kids’ diets.

Readers: add it to your library!  FDA and FTC: get busy!

Addition: Advertising Age reports on the fast food industry’s response to the Rudd Center report.  All the industry can come up with, says Advertising Age, is a “canned response.”  Looks like the Rudd Center got it right.

The most thoughtful comments I’ve seen on the proposal to block food stamp recipients from buying sodas come from Andy Fisher’s post on Civil Eats.

Mr. Fisher is currently a Kellogg Food and Society Fellow with the Institute for Agriculture and Trade Policy in Minneapolis.  He is the Co-Founder/Executive Director of the Community Food Security Coalition (CFSC).

I have added the red-highlighted emphases:

Banning Soda for Food Stamps’ Recipients Raises Tough Questions

October 8th, 2010  By Andy Fisher

On Thursday, New York City Mayor Michael Bloomberg announced that he had asked the US Department of Agriculture to allow the city to exempt soda from the permitted list of items its 1.7 million food stamp recipients can purchase with their benefits. This ban would last for two years, enough time to assess its effects and determine whether the ban should be continued on a permanent basis. New York City food stamp recipients spend an estimated $75 million to $135 million of their $2.7 billion in food stamps annually on soda, according to AP.

Anti-hunger and public health advocates at odds over proposal

Public health advocates contend the obesity epidemic is costing the US hundreds of billions of dollars per year in increased health care costs, and sugar sweetened drinks are a major factor.   They correctly note that low income persons tend to have higher rates of diet related diseases than the general public: poor New Yorkers have twice the rate of adult-onset diabetes than compared to the wealthiest. Mayor Bloomberg noted, “Sugar-sweetened drinks are not worth the cost to our health, and government shouldn’t be promoting or subsidizing them.”

On the other hand, anti-hunger advocates argue that food stamp recipients should have the same freedom of choice at the supermarket checkout counter as any middle class person. Exercising that freedom is a matter of personal dignity that the poor all too often are not afforded. Restricting soda is the first step in a slippery slope toward further demeaning regulations on what food stamp recipients can buy.  They correctly point out that poor people often can’t afford produce, as nutritious foods tend to be more expensive per calorie than less healthy food.

The anti-hunger community is correct that historically, as a nation, we have treated the poor paternalistically. American social, educational and health policy is littered with countless examples of this failed approach. Regulating what food stamp recipients can and can’t buy with their benefits puts forth the message that they are not capable of making good decisions, and the government needs to set forth boundaries to protect them from their own poor choices. To the contrary, some studies have shown that food stamp recipients actually buy more nutritious food per dollar than non-food stamp recipients.

Anti-hunger advocates are also right that poor people typically can’t afford nutritious foods. Highly processed foods, such as ramen, fill up a belly more cheaply than broccoli and whole wheat pasta.  In our food system, high calorie foods with low nutritional value are cheaper than nutrient dense foods. For example, a 12 pack of 12 ounce cans of Coke (144 oz) at Kroger’s costs $2.79 on sale, while a half gallon (64 ounces) of Minute Maid orange juice (also a Coca Cola Inc. product) is $2.49. The bad choice is the cheap choice.

On the other hand, public health groups are dead-on accurate that it is irresponsible public policy to be subsidizing with tax dollars the purchase of unhealthy products that will burden society with increased health care costs in the future.  As a nation, we’re subsidizing soda companies $4 billion annually through the food stamp program. In return, decades later, the public will be stiffed with the hospital bill for billions of dollars more for extra health care costs from these poor dietary choices.

Thorny issue raises questions

Why are anti-hunger advocates in the absurdly precarious position of protecting the right of poor people to drink soda? Do I have a right as an American to poison myself with “soft” drinks that can dissolve the rust off a car? Does it matter whether I use my own money or tax dollars?  Should freedom of choice apply to products of marginal utility if not harmful products?

Why does it cost Coca-Cola more to produce a half-gallon of orange juice than a half gallon of Coke? How do we reverse this situation, such that healthful products are more affordable and unhealthy products are more costly?

Are food stamps an income support program- or as the program’s new name indicates, a Supplemental Nutrition Assistance Program? If it is a “supplemental nutrition” program, then shouldn’t USDA define which products are nutritious based on Institute of Medicine standards, and limit purchases to these products? USDA does this with the Women Infants and Children (WIC) program, which is widely touted for saving billions in health care costs.

If food stamps are an income support program, and anti-hunger advocates want to maximize poor people’s freedom of choice, then why shouldn’t food stamps be distributed as cash rather than as a debit card good for food purchases? Doesn’t receiving cash maximize a person’s dignity as it bestows trust upon that person that he or she will make the right choice with their money?  Would food stamps not then become a welfare program, and be subject to the negative public perception of welfare?

The real story behind food stamps is that it is neither a nutrition program nor an income support program. It is a massive subsidy for the food retailers, grocery manufacturers, and industrial growers. That is why commodity groups, the Grocery Manufacturers of America and the Food Marketing Institute all line up behind the food stamp program every five years when the Farm Bill is being debated. They know the extra buying power food stamps provides to low income Americans will end up in their pockets.

In their noble effort to reduce human suffering and to improve the livelihood of the 41 million Americans on food stamps, anti-hunger advocates are caught in an ever-tightening bind. They frame food stamps as a nutrition program, because a nutrition program has more public support and more powerful allies in Congress than a welfare or income support program. Yet, burgeoning rates of chronic diseases and the growing presence of the public health community as a player in federal food and farm policy, translates into increased accountability for the nutritional impact of the food stamp program.

What boat are both camps missing?

There is one very important point neither the anti-hunger nor the public health advocates are making. Our tax dollars, especially the $80-90 billion spent annually on federal food programs, are a powerful force in shaping the food system. Food stamps, like school meals and WIC, should be the cornerstone of a food system that is grounded in principles of environmental sustainability, social justice, and health. Directed toward the small farm economy, community-oriented retailers, brokers, and processors, even a modest percentage of these funds could ignite a transformation of our food system.

Consider this. While nationally food stamp recipients are spending $4 BILLION per year on soda, in 2009, only $4 MILLION of food stamps were redeemed at farmers markets. This difference is shaped by the fact that USDA has not equipped farmers markets with free debit card terminals (which are needed to accept food stamp benefits), and prohibited federal nutrition education programs to promote farmers markets. Does this mean the Department of Agriculture values soft drinks one thousand times more than farmers markets?

Mayor Bloomberg has proposed only half the solution. USDA should grant him the waiver he requests if and only if New York City agrees to redirect the $75-$135 million that would have otherwise been spent on soda to programs that encourage food stamp recipients to purchase locally grown foods at farmers markets, community supported agriculture farms, and other community-oriented venues.