I was lucky enough to be invited to a holiday reception at the White House last week to see the decorations up close and the President and First Lady from a distance.

Never mind the Christmas trees in every room.  The gingerbread house!*

 

It comes with its very own garden, hoop houses, beehive, and kale:

The candy vegetables were not to be eaten.

But the cookies most definitely were.

Here’s to a happy, healthy, and well nourished holiday season!

*Obama Foodorama explains how White House pastry chef Bill Yosses and his colleagues created this masterpiece.

If you happen to be in Washington DC, take a look at FOOD: Transforming the American Table 1950–2000 at the Smithsonian National Museum of American History.

 

Julia Child’s kitchen is the featured exhibit, but the history of the industrialization of the U.S. food supply is well worth a look.

I especially like quirky collections of food objects.  Here’s one from the exhibit:

 

If you are in New York City, you can see Our Global Kitchen: Food, Nature, Culture at the American Museum of Natural History and check out the New York Times review so you know what to look for.

Also in New York is Lunch Hour at the New York Public Library.  If you can’t get there, the library has an online version of the exhibition.

If you happen to be in Switzerland and anywhere near Lake Geneva, Nestlé’s Alimentarium in Vevey has a special display of quirky collections: sardine cans, sugar cubes, and fruit wrappers, for example.  You can find it easily from its fork stuck into Lake Geneva.

Food exhibits seem to be the current Big Thing.  I’m trying to take advantage of them while they are around.  You too?

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.

More than 80 health groups, doctors, and nutritionists (including me) just sent a letter urging Nickelodeon and its parent company, Viacom, to adopt stricter standards for its advertisers to children.

Marketing to children is the frontier of healthy eating efforts.  As the Institute of Medicine reported in 2005, marketing directed at children is demonstrably effective at getting kids to want products, pester their parents for them, and believe that snacks, fast food, and sodas are “kids’ food” and what they are supposed to be eating.

Efforts to get food companies to cease and desist targeting kids for ads run up against business imperatives to expand sales and report growth to Wall Street every quarter.

For some years now, the kids’ TV station Nickelodeon has been struggling to find an economically viable way to restrict marketing of the worst products.  But if Nickelodeon establishes commonly accepted nutrition standards for products it permits to be advertised, those standards will exclude most advertisers.  “Economically viable” is what this is about.

This is precisely the same dilemma caused by the ill-fated Interagency Working Group report earlier this year.  I thought its proposed standards were too generous.  Food companies thought they were too restrictive.  The government backed off.

Now Center for Science in the Public Interest (CSPI) is trying another method.  It organized a letter-writing campaign to press Nickelodeon to adopt nutrition standards like those adopted by Disney a few months ago.

If you think this is a good idea, you too can sign onto the campaign right here.

Short of regulation, public pressure might be just what’s needed to encourage Nickelodeon—and food companies—to stop marketing junk foods to kids.  

The digital age may be upon us but I see no sign that books are disappearing.  They flood in, and a great many of them are worth reading and adding to my office library.  Here are a few recent ones on various aspects of the food movement.

Michelle Obama, American Grown: The Story of the White House Kitchen Garden and Gardens Across America, Crown, 2012.

Sometimes a garden is just a garden, but this one is a movement on its own.  As the First Lady explains:

I wanted this garden to be more than just a plot of land growing vegetables on the White House lawn.  I wanted it to be the starting point for something bigger…I was alarmed by reports of skyrocketing childhood obesity rates and the dire consequences for our children’s health.  And I hoped the garden would help begin a conversation about this issue—a conversation about the food we eat, the lives we lead, and how all of that affects our children.  

Sally Fairfax, et al.,  California Cuisine and Just Food.  MIT Press, 2012.

I wrote the foreword to this account of the development of the San Francisco Bay Area food movement, starting with:

California Cuisine and Just Food takes a deep and comprehensive look at past and present efforts to bring tastier, healthier, locally grown, and ethically produced food to San Francisco Bay Area eaters, poor as well as rich.  The story is inspiring.  The authors of this collectively written account, cautious academics as they must be, describe the development of the Bay Area food scene as a “district” rather than as a social movement.  But I have no such compunctions.  It looks like a social movement to me.  This book is about how the Bay Area food movement evolved to what it is today: a vibrant community of highly diverse groups working on highly diverse ways to produce better quality food and promote a more just, healthful, and sustainable food system—for everyone along the entire system of what it takes to produce, transport, sell, prepare, serve, and consume food.

Katherine Gustafson, Change Comes to Dinner:  How Vertical Farmers, Urban Growers, and Other Innovators are Revolutionizing How America Eats, St. Martins, 2012.

I blurbed this one:

In her wildly successful cross-country search for alternatives to our industrialized food system, Katherine Gustafson comes up with a terrific new word: “hoperaking,” the gathering of inspiration (and the opposite of muckraking).  The people whose work she describes here should inspire anyone to get busy and start planting.

Robin Shulman, Eat the City: A Tale of the Fishers, Foragers, Butchers, Farmers, Poultry Minders, Sugar Refiners, Cane Cutters, Bee Keepers, Wine Makers, and Brewers Who Built New York, Crown Publishers, 2012.

Eat the City is about the men and women who came to New York City–now and in the past–and planted gardens, harvested honey, made cheese, and brewed beer and made New York what it is today.  Robin Shulman uses their stories to bring this rich history to life and to reflect on the forces that brought immigrants and their food traditions to this city.   Not all of these stories have happy endings, but they inform, move, and inspire.

My monthly (first Sunday) Food Matters column for the San Francisco Chronicle deals with the aftermath of the defeat of two California soda tax ballot initiatives.

Q: As one who campaigned for the soda tax in Richmond, I’m so discouraged by the millions spent by the soda industry to defeat it there and in El Monte (Los Angeles County). I don’t see how anyone without that kind of money can do anything to reverse obesity and diabetes.

A: Patience. These things take time.

Losing the soda tax campaigns taught health advocates some important lessons, not least that money buys votes. But it also taught that appeals to voter concerns about higher prices, job losses and personal autonomy are more effective than appeals based solely on health considerations.

Nobody likes taxes, and soda taxes are regressive, meaning that they impose a greater burden on the poor. Although the poor drink more sodas and have higher rates of obesity, and are likely to derive the most benefit from drinking less soda, taxes are still a hard sell.

Because dietary choices seem so personal, the influence of the food marketing environment on personal choices is not intuitively obvious. Everyone “knows” that larger food portions have more calories, but that doesn’t stop anyone from eating more calories when confronted with supersize foods or drinks.

The public health route

That’s why public health approaches work better than just telling people to eat less or eat better. The most effective measures change the environment of food choice by encouraging better options with price subsidies or portion-size caps and discouraging unhealthier choices, which is where taxes, bans on toys, and restrictions on marketing come in.

Such measures aim to make healthy choices the default. Most people are happy to live with the default option.

Food companies want their products to be the default. They will always oppose measures that might reduce sales, and they have no lack of resources to do so.

How might public health advocates counter such opposition?

Community approach

The Richmond example suggests the need for public health approaches that are community-based. This means going into communities and asking residents how they view the causes and consequences of their own health problems, and what they think should be done to fix those problems.

Communities set the goals. Advocates help communities achieve them.

This approach is fine in theory, but difficult in practice. Nobody makes food choices in a vacuum. Soda and fast food companies market their products to low-income and minority groups, and make sure their products are inexpensive, readily available and ubiquitously advertised.

To gain traction, food and beverage companies support the activities of community groups, sponsor playgrounds, and place their brand logos on everything they can. My favorite recent example is Coca-Cola’s $3 million gift to Chicago to fund an educational campaign to counter obesity and diabetes (no, I did not make this up).

Community-based campaigns not only can focus on the health consequences of poor diets but also can demonstrate to residents just how food companies put corporate health above public health and engage low-income communities in achieving corporate goals.

Teaching how the food marketing environment works should stimulate plenty of questions about why healthier foods aren’t more widely available in communities – and at affordable prices. It should raise questions about why school lunches aren’t better, and why soda advertising pervades athletic facilities. It should get people thinking about what food and beverage companies are actually doing in low-income communities.

Community-based public health should encourage residents to want to change their food environment.

It should get them thinking about wanting stores to provide healthier foods. Or they might want a farmers’ market, community gardens, better school food, and cooking lessons for their kids.

A method that works

These things really can help change eating behavior. The American Heart Association recently published a massive review – with rankings – of environmental interventions aimed at improving personal diets, physical activity levels, and smoking habits (See Circulation 2012; 126:1514-1563).

The review cites evidence for strategies to improve diets such as media campaigns, price subsidies, school meals and gardens, and restrictions on marketing, as well as taxes as portion caps. Some of these interventions are expensive, but others are not.

A review like this gives advocates plenty to work with.

Soda tax initiatives will not be going away. Neither will other such measures. Community leaders across the country will be continuing to introduce them as a means to reduce health care costs and to generate needed revenue for health-promoting activities.

It’s worth starting now to engage communities in efforts to improve their own health. Next time, engaged communities may be ready to vote for health over corporate interests.

Grassroots efforts take time. It’s too soon to be discouraged.

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

Artificial sweeteners are a terrific example of why correlation does not necessarily mean causation (see previous post).

Their use has increased in parallel—is highly correlated—with rising rates of obesity.  But could artificial sweeteners cause obesity?

Unlikely as that idea may seem, Brazilian researchers thought  it was worth careful investigation.

They did a preliminary study of sweeteners and weight gain in rats.

They report: although total calorie intake was similar in all rats, the rats fed artificial sweeteners gained more weight than those fed sucrose (table sugar).

The investigators fed the rats yogurt containing either sucrose, aspartame, or saccharin along with unlimited amounts of rat chow.

The rats must not have liked the taste of the artificial sweeteners because they ate more of the sucrose-containing yogurt than the kind with artificial sweeteners. They compensated for less yogurt by eating more rat chow.

Although saccharin and aspartame promoted relatively fewer calories from yogurt intake when compared to sucrose, increases in calories from chow intake effectively compensated for decreases in calories from yogurt, in such a way that there was a similar total caloric intake among all groups after the 12-week period of the experiment.

As they put it, “Possible explanations for weight-gain in saccharin and aspartame groups without increasing energy intake are still widely speculative.”  They suggest that artificial sweeteners might induce:

• Reduced energy expenditure.
• Excessive insulin secretion.
• Increased fluid intake and retention.

What are we to make of this?

This is a small, preliminary study using only 10 rats in each of the three groups.

The differences in calorie intake were small and small calorie differences are difficult to measure.

Bottom line: this is an interesting result that needs to be repeated with greater numbers of rats and even more careful calorie measurements.

Reference: Fernanda de Matos Feijó et al.  Saccharin and aspartame, compared with sucrose, induce greater weight gain in adult Wistar rats, at similar total caloric intake levels.  Appetite 2012; 60:203-207. doi: 10.1016/j.appet.2012.10.009

 

 

 

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