Brian Wansink.  Slim by Design: Mindless Eating Solutions for Everyday Life.  William Morrow, 2014.

In his new book, Wansink, the author of Mindless Eating (Amazon’s #1 Best Seller in Eating Disorders, Self-Help) and guru of Cornell’s Food and Brand Lab, promotes the idea that small changes in the food environment will encourage healthier eating.

Wansink, of course, is the behavioral economist who conducts clever and revealing experiments proving this point: the bottomless soup bowl (people eat and eat and eat), the Super Bowl study (students eat more from larger containers), the organic aura hypothesis (people perceive foods with health claims as having fewer calories), the stale popcorn study (if it’s there, people will eat it).

His studies are fun and I especially like his work because it shows how much environmental factors influence food choice.  If so, we need policies to change the environment to make the healthy choice the easy choice.

Wansink, however, usually interprets his work as suggesting what you—as an individual—can do to counter the environmental forces: pay attention, use smaller plates, snack-proof your house.

He does that in this book too, but also has suggestions for actions that restaurants, supermarkets, and food makers can take to sell healthier foods and still make money.   If you are a fast-food restaurant, for example, you can:

Make it motivating

• Start a Healthy Habits loyalty card—five punches and the sixth healthy item is free.
• Give 5 percent off the healthier combo version: diet versus regular, baked versus fried.

He says:

Give away a sixth meal?  Give a 5 percent discount?  On a $5 meal that’s a 25-cent loss.  Think of it instead as a $4.75 gain, because diners could have easily otherwise gone somewhere else.  And it’s a $9.50 gain if they brought a friend.

Could this start a movement?

In an e-mail, Wansink writes:

My goal is for this book to ignite a Slim by Design Movement that transforms restaurants, grocery stores, workplaces, schools into healthier places that guide us to make smarter, healthier choices. The book tells people exactly what they can ask their favorite restaurant or grocery store to do, and the web site allows them to complete abbreviated scorecards and post them to Facebook and Twitter to show people there are simple, scalable, solutions that can make all of us Slim by Design.

Policy change, anyone?

The Alliance for a Healthier Generation (founded by the American Heart Association and the Clinton Foundation) and the American Beverage Association (funded mainly by Coca-Cola and PepsiCo) jointly announced this week that the major soft drink companies were pledging to reduce beverage calories consumed per person nationally by 20% by 2025.

The Alliance, Coca-Cola, Dr Pepper Snapple, PepsiCo, and the American Beverage Association placed a full-page ad in yesterday’s New York Times:

The Alliance says:

This is a tremendous undertaking by the industry, one that should be applauded, and also one that will not come easily. The industry will leverage every ounce of their national and local influence, product innovation and marketing muscle to reach this ambitious and necessary goal. And when this goal is reached, we believe it will not only signal a shift in access to reduced-calorie options, but also a positive shift in consumer interest in these no-and lower-calorie options.

The New York Times quotes former president Bill Clinton (it also quotes me*):

This is huge…I’ve heard it could mean a couple of pounds of weight lost each year in some cases…in low-income communities, sugary sodas may account for a half or more of the calories a child consumes each day.

In a statement, Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, said:

We congratulate the Alliance for a Healthier Generation and the beverage industry for continued action towards reducing the beverage calories consumed by people across the United States. We are especially pleased that this commitment will target communities with disproportionately high consumption rates of sugar-sweetened beverages. We look forward to working with the Alliance and beverage industry to measure and monitor the impact of this commitment on the health of our country.

Despite the congratulations, I can’t take this as anything more than public relations.

Soda sales are going to decline by that much anyway.

Although the Alliance says the companies will do this through national initiatives to educate consumers about smaller portions, lower-calorie beverages, and water, and to focus these efforts in lower income communities, they really don’t have to do a thing.

All they have to do is wait for these trends to continue.  The Times quotes me on this point:

While they’re making this pledge, they are totally dug in, fighting soda tax initiatives in places like Berkeley and San Francisco that have exactly the same goal,” said Professor Nestle, who has just finished a book about the industry.

Here’s what I mean:

The American Beverage Association and soda companies are putting millions into fighting soda tax initiatives in San Francisco and Berkeley.

As the Center for Science in the Public Interest says, if the soda industry really were serious about helping Americans drink less of sugary products, it

could accelerate progress by dropping its opposition to taxes and warning labels on sugar drinks. Those taxes could further reduce calories in America’s beverage mix even more quickly, and would raise needed revenue for the prevention and treatment of soda-related diseases.

And, CSPI says, the soda industry should stop opposing and, instead, should support Representative Rosa DeLauro’s Sugar-Sweetened Beverage Tax Act of 2014 (the SWEET Act), which aims to tax caloric sweeteners.  This would raise $10 billion a year to help prevent and treat diseases caused by excess soda consumption.

But the CEO of Pepsi says the soda industry isn’t getting enough appreciation for its efforts to counter obesity.

Politico ProAg‘s Helena Bottemiller Evich reports that at a meeting sponsored by the Robert Wood Johnson Foundation (RWJF) to applaud the soda industry’s announcement, Indra Nooyi, PepsiCo’s CEO,

expressed frustration with the endless criticism from activists who blame much of the obesity epidemic on the food industry despite what she sees as significant progress from the biggest brands in America…“Why not give industry a compliment and then talk about the next step?…We have now stemmed the growth in calorie consumption, which is huge…I look at those trends and think industry has done pretty well, as a whole.

Why the RWJF, a major funder of initiatives to counter obesity, seems so cozy with Pepsi is curious.

The coziness is especially curious because of Mrs. Nooyi’s “We.”  If the industry is “doing well,” it’s because health advocates, some of them funded by RWJF, have forced soda companies to change their practices.

The one significant accomplishment: an admission that sodas contribute to obesity

As the Wall Street Journal puts it,

The move is an implicit acknowledgment by the soda industry that longtime staples like Coke, Pepsi-Cola and Dr Pepper have played a role in rising obesity rates.

Now that really is a sign of progress.

Last Friday, I received a phone call from Todd Kerr, the publisher of The Berkeley Times, a community newspaper in Berkeley, CA.  He was preparing a story on the Berkeley soda tax and could not find University of California (UC) faculty who were willing to speak with him.

They were, they told him, under a gag order from the president’s office not to talk to reporters about the soda tax.

I can understand his frustration.  I spoke or e-mailed about 10 people with knowledge of this issue and only two would allow me to quote them for attribution.

For starters, the idea of a gag order seems contrary to current practice.

• Michael Pollan, a Berkeley journalism professor, says he publicly endorses the tax, and so have other professors.
• Chancellor’s Professor Robert Reich wrote a column endorsing it, and UC Berkeley posted his comments on its website.
• UCSF has featured research on the health implications of a soda tax on its website.
• The 50th anniversary celebration of Berkeley’s Free Speech Movement (FSM) starts this week.

But the rumor is serious and deserves investigation.

I sent out queries to try to find out if the rumor could have any basis in fact.

Mr. Kerr kicked off the process by giving me the names of the three faculty members he said had refused to speak with him about the soda tax.

I was able to track them down.  Here is what they told me (not for direct quotation or attribution):

• Source #1: Mr. Kerr had asked scientific questions outside the respondent’s area of expertise.
• Source #2: Mr. Kerr stated that his paper does not take a stance on issues, so HE can’t write for or against the tax.  This respondent’s understanding is that Berkeley faculty members can state opinions on any voting matter as long as they do not claim to speak for the university.
• Source #3: University counsel advised this respondent that faculty can say what they want as private citizens, but not as UC employees.  This source’s understanding is that state employees are not permitted to work to alter the conduct or outcome of matters on which the public is voting.  And, if the food industry were to sue a faculty member for something said in the course of an election campaign, the university would not provide legal resources or defense.

Source #3’s comments especially demanded further inquiry.  I did some more consultation of UC faculty, legal staff, and professional staff.

UC policy on political speech is governed by state law

As one source explained, there is no gag order on faculty.  There are, however, state statutes that limit the University’s ability to take positions on ballot measures that are before the voters (be sure to look at the Webinar slide show).  These state in a Q and A:

May a University employee endorse a ballot measure in his/her private capacity and identify himself/herself by University title?

Yes. A University official may allow use of his/her name and title for identification purposes in the same manner as others who sign an endorsement. An express disclaimer of University endorsement is required only where the context might reasonably cause confusion as to whether the endorsement is made in an official or unofficial capacity.

My queries eventually landed in the Office of the President of the UC System.  Steve Montiel, Media Relations Director, one of only two people in all of this who was willing to be quoted by name, said:

All University of California employees, including faculty, have the right to express their personal opinions about any matter of civic importance, including ballot measures. Consistent with state law, however, longstanding University policy prohibits university resources from being used to oppose or support a ballot measure. Only the UC Board of Regents can take a public position on a ballot measure, and it has done so in the past.

I also consulted Michele Simon (the second quotable) about state policy.  She notes that this is standard policy for institutions receiving state funding.  UC is a state school and, therefore, is not allowed to use state funds to take political positions.

She reminded me that at Stanford, a private institution, Henry Miller of the conservative Hoover Institute violated Stanford’s no-position policy on ballot measures when he did a TV ad opposing Proposition 37, the GMO labeling initiative, using his Stanford affiliation.

When we learned of the ‘No on 37 ‘ commercial, we immediately asked to have it changed so it would be in compliance with Stanford policies,” said Debra Zumwalt, the university’s vice president and general counsel. “While everyone at Stanford is entitled to espouse whatever political view he or she may choose, we do not allow people affiliated with Stanford to take a political position in a way that could imply that it is Stanford’s position.”

In my own experience, UC’s policy also sounds like standard practice.  When the Sugar Association threatened me with a lawsuit (see documents under Controversies at the bottom of the Media pages), that’s pretty much what NYU lawyers told me.  If I said something libelous, I would be responsible for the legal consequences.  Luckily, the Sugar Association never sued.

So—how did this rumor get started?  

Here’s what I learned.

A group of faculty advocating for the soda tax asked to meet with university legal counsel for advice about how to protect themselves and the university against potential lawsuits filed by, for example, the American Beverage Association (ABA), which has been especially aggressive in fighting the tax.  The ABA’s actions reminded them of the cigarette industry’s fight with the UC system over the tobacco control archives now housed at UCSF.

Some of the legal advice to faculty—if you speak at a soda tax rally, represent yourself as an individual,not a representative of the university, and do so on your own, not the university’s time—can be interpreted as restrictive even if it is not meant as such.

UC’s policy on academic freedom

Please note that UC, since the time of the Free Speech Movement, has developed a clear policy on academic freedom:

…academic freedom depends upon the quality of scholarship, which is to be assessed by the content of scholarship, not by the motivations that led to its production. The [policy]…does not distinguish between “interested” and “disinterested” scholarship; it differentiates instead between competent and incompetent scholarship. Although competent scholarship requires an open mind, this does not mean that faculty are unprofessional if they reach definite conclusions. It means rather that faculty must always stand ready to revise their conclusions in the light of new evidence or further discussion. Although competent scholarship requires the exercise of reason, this does not mean that faculty are unprofessional if they are committed to a definite point of view. It means rather that faculty must form their point of view by applying professional standards of inquiry rather than by succumbing to external and illegitimate incentives such as monetary gain or political coercion. Competent scholarship can and frequently does communicate salient viewpoints about important and controversial questions [my emphasis].

My translation: if faculty opinions about the soda tax are based on research—and plenty of research is available to back up the rationale for and potential efficacy of such a tax (see Rudd Center and Bridging the Gap)—faculty not only have the right but also have the responsibility to express opinions about them.

UC faculty: get out there and support the tax!

And wish the FSM a happy 50th anniversary.

 

A reader, Alice Campbell, writes:

Dr. Nestle,

Coca-Cola’s new product marketing, “Share a Coke with “insert name here”” has got me thinking. I will admit, initially my thought on the topic was limited to disappointment at the limited chances of finding a can with my name on it. However, I have been pondering, is this marketing strategy an attempt by Coca-Cola to avoid responsibility for the health consequences associated with selling an sugar filled, unhealthy product? Will they attempt to claim that that the suggested serving sizes is half of the container because they are suggesting you share? I have not observed an increase in people sharing their can of Coke. Your thoughts on the issue would be appreciated.

Love the question, particularly because I was given one of these, name made to order.  This can is most definitely not to share, not least because it’s the 7.5-ounce size (nevertheless, 90 calories and a whopping 25 grams of sugar).

Don’t you wish you had one with your name on it?

That’s the point.  This has been one of Coke’s most successful public releations campaigns, ever.

But Share a Coke has generated criticism that it violates Coke’s promise not to market to kids.  In Ireland, the cans appear with the 100 most popular names of children ages 7 and 8.

In countries like Pakistan, the cans are labeled with “mama” or “papa,” again raising questions about the target age group.

The campaign may be generating buzz—it’s fun to see your name on a Coke can— but once you have one, that’s it.  Share a Coke is fizzling as a sales generator.

Better get your collectors’ item now!

The big nutrition scare last week was the study in Nature finding that in mice and, maybe, humans, artificial sweeteners mess up the microbiome and make some people even more intolerant of glucose.

The authors conclude that their results call for a reassessment of massive use of artificial sweeteners.

The study is complicated and difficult to read but the Wall Street Journal has a nice summary.  It explains why the study is getting so much attention:

The new Nature study marks a significant advance because it brings together two separate areas of research—the role of sweeteners in raising blood sugar levels, and the complex workings of the vast colonies of bacteria that inhabit the gut. Individuals can have differing bacterial colonies in their gut, meaning people respond differently to what they consume.

The study involved several experiments.  These found:

• Mice fed saccharin, sucralose, or aspartame had significantly higher blood-glucose levels than mice whose diet included sugar, or just water.
• Mice with sterilized digestive tracts, who were given bacterial transplants from artificial-sweetener-fed mice, displayed higher blood sugar levels than those receiving bacterial transplants from sugar-fed mice.
• People who typically use artificial sweeteners have different kinds of bacteria in their intestines than those who do not.  They also are more glucose intolerant.
• Seven volunteers fed artificial sweeteners for four days displayed higher blood-sugar levels as well as altered populations of bacteria in their gut.

The Wall Street Journal quotes the Calorie Control Council (the trade association of makers of artificial sweeteners).  The CCC said:

The results from the mouse experiments may not apply to humans, while the human experiments had a small sample size. It said further research was needed.

Despite my lack of enthusiasm for artificial sweeteners, I think the Calorie Control Council has a point.

The excellent report by Kenneth Chang in the New York Times explains why.

At present, the scientists cannot explain how the sweeteners affect the bacteria or why the three different molecules of saccharin, aspartame and sucralose result in similar changes in the glucose metabolism.

Chang ends with this:

Dr. Frank Hu, a professor of nutrition and immunology at the Harvard School of Public Health who did not take part in the study, called it interesting but far from conclusive and added that given the number of participants, “I think the validity of the human study is questionable.”

Here’s why I’m not fond of artificial sweeteners:

• They taste bad (to me)
• They have no demonstrated effectiveness in helping people lose or maintain weight.
• They are artificial, and violate my rule to “never eat anything artificial.”

Do they mess up the microbiome and cause glucose intolerance, insulin resistance, and metabolic syndrome?

That would be fascinating, but I’m reserving judgment pending further research.

In the meantime, I’ll take sugar—in moderation, of course.

Mission: Readiness, the organization of former high-ranking military officials concerned about obesity and other health problems in military recruits and personnel, has just released “Retreat Is Not An Option: Healthier School Meals Protect our Children and our Country.”

• Currently, 12 percent of active duty service members are obese based on height and weight—an increase of 61 percent since 2002—which is resulting in serious problems with injuries and dismissals.
• The obese service members in the brigade in Afghanistan were 40 percent more likely to experience an injury than those with a healthy weight, and slower runners were 49 percent more likely to be injured.
• The military spends more than $1.5 billion annually treating obesity-related health conditions and replacing those discharged because they are unfit.
• 70% of young Americans are ineligible for military service because of overweight, lack of education, or criminal records.  The ineligibility percentages range from a low of 62% in Hawaii to 78% in Mississippi.

The report concludes:

We understand that some schools need additional support to help meet the updated standards, such as better equipment and more staff training, and that support should be provided. At the same time, moving forward with implementation of the standards for all schools is paramount. Students depend on schools to reinforce efforts by parents and communities to put them on track for healthy and productive lives. Healthy school meals and snacks are a vital part of that effort. When it comes to children’s health and our national security, retreat is not an option.

This is a direct criticism of the School Nutrition Association (SNA), which has called for such a retreat.  In response, SNA said:

Recent reports by Mission: Readiness and other organizations have mischaracterized both the impact of the new standards on school meal programs and the scope of the regulatory relief requested by School Nutrition Association and other groups. SNA’s Myth vs Fact sheet on the new standards addresses how the new rules have contributed to a decline in student lunch participation, increases in food waste and financial instability in many school meal programs.

USDA’s data, however, argue otherwise.

The SNA, which receives nearly half its income from companies that sell food products to schools, now finds itself in opposition to the military as well as to USDA and consumer school food advocates.

If anything needs to retreat, it’s SNA.

As for why the military is concerned, take a look at this photo taken at the Las Vegas airport, sent to me yesterday by Andy Bellatti.

Remember the Healthy Weight Commitment Foundation (HWCF)—16 big food companies that account for about one-third of calories in the marketplace—and the companies’ pledge in 2010 to reduce the total number of calories they sold by 1.5 trillion by 2015?

As I wrote in my post on the pledge,

What are we to make of all this?  Is this a great step forward or a crass food industry publicity stunt?*  History suggests the latter possibility.  Food companies have gotten great press from announcing changes to their products without doing anything, and every promise helps stave off regulation.

On the other hand, the RWJF [Robert Wood Johnson Foundation] evaluation sounds plenty serious, and top-notch people are involved in it.  If the companies fail to do as promised, this will be evident and evidence for the need for regulation.

So now we have the RWJF-funded evaluation.

The study examining HWCF’s pledge shows that the largest calorie cuts came from sweets and snacks; cereals, granolas and other grain products; fats, oils and dressings; and carbonated soft drinks.  The companies participating in the pledge sold 60.4 trillion calories in 2007, the year defined as the baseline measurement for the pledge. In 2012, they sold 54 trillion calories. This 6.4 trillion calorie decline translates into a reduction of 78 calories per person in the United States per day.

Barry Popkin and his colleagues in North Carolina report this evaluation in two parts.  The first says:

The 16 HWCF companies collectively sold approximately 6.4 trillion fewer calories (–10.6%) in 2012 than in the baseline year of 2007. Taking
into account population changes over the 5-year period of 2007–2012, CPG [Consumer Package Goods]caloric sales from brands included in the HWCF pledge declined by an average of 78 kcal/capita/day. CPG caloric sales from non-HWCF national brands during the same period declined by 11 kcal/capita/day, and there were similar declines in calories from private label products. Thus, the total reduction in CPG caloric sales between 2007 and 2012 was 99 kcal/capita/day.

The second paper looked at sales data for households.  It concludes that although sales of calories declined, they were already declining before the pledge.

Post-pledge reductions in calories purchased from HWCF brands were less than expected, and reductions in calories purchased from non-HWCF name brands and PLs [Private Labels] were greater than expected after economic, sociodemographic, and secular factors were accounted for.  If the 16 HWCF companies had been able to maintain their pre-pledge trajectory, there should have been an additional 42 kcal/capita/day reduction in calories purchased from HWCF products in 2012 among households with children.

Mary MacVean’s account in the Los Angeles Times quotes any number of experts calling this an impressive achievement that will not, however, “reverse the epidemic of childhood obesity, especially among poor people and some minority groups.”

She quotes Popkin:

The calories purchased has really gone down. And most of the decline is in the kind of food you and I would call junk food or junk beverages.. But not all the news is positive…What we don’t have is an increase in beans, whole grains, produce.

Much publicity will be made of this small step in the right direction.  But what does it mean?

Is the reduction in calories due to lower sales of packaged foods in general—the secular trend—or to food companies’ taking the pledge seriously.  I vote for secular trends—fewer sugary soft drinks and sugary cereals.

The lack of evidence for increased purchases of healthier foods also is troubling.

Big retailers still show no evidence of promoting healthier foods.

Overall, this pledge is about selling packaged food products, not foods.

And what counts is what’s actually eaten.

The bottom line: Eat your veggies.

If you do—and manage to keep packaged, highly processed foods to a minimum—you don’t need to worry about any of this.

Addition, September 19:  I learned about these papers from a reporter, who sent me the two reports and an accompanying commentary by officials of the Robert Wood Johnson Foundation.  I learned later that the journal also published another commentary on the papers, this one by Dariush Mozaffarian, now dean of the Friedman School at Tufts.  His analysis makes clear that the reduction in calories is fully explained by secular trends, of which food companies were well aware:

In this setting, the pledge appears to have been a stroke of marketing genius, turning their steadily declining calorie sales into a novel opportunity for self-promotion, an easily publicized but deceptive “sham” pledge that merely reflected ongoing trends…Although the food industry is a necessary partner for effective future solutions to address suboptimal diet, now the leading modifiable cause of U.S. deaths, we must remain vigilant and cautious about their intentions and objectively assess the evidence for real change—especially for promises that appear too good to be true.

 

While I’m thinking about trade negotiations, I came across this example of why trade negotiators fight over every word.

NPR’s The Salt reports that member nations of the Food and Agriculture Organization (FAO) are in the process of developing guidelines for responsible investment in agriculture and food systems.

Responsible investment, they say,

is essential for enhancing food security and nutrition and supporting the progressive realization of the right to adequate food in the context of national food security. Responsible investment is a significant contribution to enhancing sustainable livelihoods, in particular for smallholders, and members of marginalized and vulnerable groups, creating decent work for all agricultural and food workers eradicating poverty, fostering social and gender equality, eliminating the worst forms of child labour, promoting social participation and inclusiveness, increasing economic growth, and therefore achieving sustainable development.

The guidelines are responding to concerns over “land grabs” — the term used to describe how corporations and governments are taking advantage of unclear land ownership in developing countries to buy up large tracts, regardless of consequences for previous users of the land.

Land grabs displace small farmers and have become the focus of advocacy by Oxfam.

In contrast, says FAO, responsible investment contributes to food security and nutrition through:

Increasing sustainable production and productivity of safe, nutritious, diverse, and culturally acceptable food and reducing food loss and waste.

At issue is the meaning of “culturally acceptable.”

The US delegation demanded a definition, objecting that the lack of one could lead to trade barriers against, for example, genetically modified foods.

It suggested this:

For the purposes of this document, consumers, through the free exercise of their choices and demand, determine what food is culturally acceptable.

In other words, says The Salt, “as long as somebody wants to buy it, it’s fine.”

The African delegations forged a compromise.

In the current version of the document, “culturally appropriate food” enables

consumer choice by promoting the availability of and access to food that is safe, nutritious, diverse and culturally acceptable, which in the context of this document is understood as food that corresponds to individual and collective consumer demand and preferences, in line with national and international law as applicable.

Aren’t you glad they got that settled?