The New England Journal of Medicine has just published a series of articles on sugar-sweetened beverages to  coincide with presentations at The Obesity Society’s annual meeting.  Here are links to the articles.  I’ve extracted brief quotes from some of them.  And here’s a summary in the New York Times.

Perspective: J.L. Pomeranz and K.D. Brownell, Portion Sizes and Beyond — Government’s Legal Authority to Regulate Food-Industry Practices.

Regulations that affect “ordinary commercial transactions” (such as the sale of a product) are presumed to be constitutional if they have a rational basis and if the government body enacting them has the appropriate knowledge and experience to do so.

In the case of New York City’s portion-size restrictions, for example, the health department is an expert public health body that reviewed relevant scientific evidence on the health hazards associated with consumption of sugar-sweetened beverages and the effect of portion sizes on consumption patterns. The proposed policy thus has a rational basis….

Original Article: Q. Qi and Others, Sugar-Sweetened Beverages and Genetic Risk of Obesity

The study concludes: “the genetic association with adiposity appeared to be more pronounced with greater intake of sugar-sweetened beverages.”

Original Article: J.C. de Ruyter and Others,  A Trial of Sugar-free or Sugar-Sweetened Beverages and Body Weight in Children

We conducted an 18-month trial involving 641 primarily normal-weight children from 4 years 10 months to 11 years 11 months of age. Participants were randomly assigned to receive 250 ml (8 oz) per day of a sugar-free, artificially sweetened beverage (sugar-free group) or a similar sugar-containing beverage that provided 104 kcal (sugar group). Beverages were distributed through schools….Masked replacement of sugar-containing beverages with noncaloric beverages reduced weight gain and fat accumulation in normal-weight children.

Original Article: C.B. Ebbeling and Others, A Randomized Trial of Sugar-Sweetened Beverages and Adolescent Body Weight

We randomly assigned 224 overweight and obese adolescents who regularly consumed sugar-sweetened beverages to experimental and control groups. The experimental group received a 1-year intervention designed to decrease consumption of sugar-sweetened beverages, with follow-up for an additional year without intervention….Among overweight and obese adolescents, the increase in BMI was smaller in the experimental group than in the control group after a 1-year intervention designed to reduce consumption of sugar-sweetened beverages, but not at the 2-year follow-up

Editorial: S. Caprio, Calories from Soft Drinks — Do They Matter?

These randomized, controlled studies — in particular, the study by de Ruyter et al. — provide a strong impetus to develop recommendations and policy decisions to limit consumption of sugar-sweetened beverages, especially those served at low cost and in excessive portions, to attempt to reverse the increase in childhood obesity.

Clinical Decisions: T. Farley, D.R. Just, and B. Wansink, Regulation of Sugar-Sweetened Beverages

This one is a point/counterpoint.  On the basis of the evidence just presented, should government regulate sugary drinks?

New York City Health Commissioner Tom Farley says yes:

If a harmful chemical in schools were causing our children to get sick, people would demand government regulation to protect them. It is therefore difficult to argue against a government response to an epidemic of obesity that kills more than 100,000 persons a year in the United States and has an environmental origin.7

Federal, state, and local governments already regulate the food system, from farm to retail, in many ways and for many purposes, ranging from support of agriculture to prevention of foodborne illness. The question is not whether we should regulate food, but rather whether we should update food regulations to address this new epidemic.

David Just and Brian Wansink say no:

We must also recognize that the universe of foods that contribute to childhood obesity is much larger than sugar-sweetened beverages. Such a narrowly defined approach would have minimal chance for overall success. Rather, we must consider approaches that will involve parents, schools, and pediatricians in leading children toward more healthful eating habits and increased physical activity. In truth, we cannot hope to create regulations that restrict behavior holistically.

I’d say we now have plenty of evidence that habitual use of soft drinks raises risks for obesity, and plenty of evidence for the need for regulation.

Yes, it would be nice if “leading children to eat better” worked, but parents, teachers, and everyone else needs lots of help in coping with today’s food environment.

The New England Journal has done a great public service in publishing these papers as a series, and the authors all deserve much praise for taking on these difficult research projects.

OK city agencies: get to work!

USDA Secretary Tom Vilsack has this to say about our dysfunctional Congress’s leaving town without passing the 2012 Farm Bill:

In a year that has brought its share of challenges to America’s farmers and ranchers, the House Republicans have added new uncertainty for rural America.

Unfortunately, House Republicans left Washington without passing comprehensive, multi-year food, farm and jobs legislation, leaving thousands of farming families exposed.

U.S. agriculture is fighting to maintain the tremendous momentum it has built over the past three years, but with natural disasters and other external forces threatening livelihoods of our farmers and ranchers, certainty is more important than ever.

Americans deserve a food, farm and jobs bill that reforms the safety net for producers in times of need, promotes the bio-based economy, conserves our natural resources, strengthens rural communities, promotes job growth in rural America, and supports food assistance to low-income families. Without the certainty of a multi-year bill, rural communities are being asked to shoulder undue burdens.

Mal Nesheim and I have just written a piece for Nova Science Now, based on our book, Why Calories Count: From Science to Politics.

Is a Calorie a Calorie?

By Malden Nesheim and Marion Nestle

Ever since the 19th century, nutritionists and the general public have accepted the “calorie” as the unit of choice for describing the energy content of food. Yet some scientists still debate whether all food calories are the same.

Do calories from a chocolate bar, for example, have the same effect on your waistline as the same number of calories from an orange? Putting it another way—and getting to a oft-invoked question in the debate—will you be more successful losing weight with calories from a low-fat diet than with the same number of calories from a low-carbohydrate diet? Or might the reverse be true? (As protein typically occurs in low amounts in foods—10 to 15 percent in the average diet—a low-fat diet is necessarily a high-carb diet, and vice versa.)

To read the rest of it and see how Nova illustrated it, click here.

I am a strong supporter of labeling GMO foods.  Consumers have the right to know.

That’s enough of a reason to support California’s Prop. 37.  There is no need to muddy the waters with difficult-to-interpret science.

My e-mail inbox was flooded with messages yesterday about the new long-term rat study reporting that both GMO corn and Roundup (glyphosate herbicide) increase mammary tumors in mice.

The study, led by Gilles-Eric Séralini, concludes:

The results of the study presented here clearly demonstrate that lower levels of complete agricultural glyphosate herbicide formulations, at concentrations well below officially set safety limits, induce severe hormone-dependent mammary, hepatic and kidney disturbances… the significant biochemical disturbances and physiological failures documented in this work confirm the pathological effects of these GMO and R treatments in both sexes.

These results are so graphically shocking (see the paper’s photographs), and so discrepant from previous studies (see recent review in the same journal), that they bring out my skeptical tendencies.  (Note: Although Séralini is apparently a well known opponent of GMOs, his study—and that of the review—were funded by government or other independent agencies.)

For one thing, the study is weirdly complicated.  To its credit, it went on for two years (much longer than the typical 90 days for these kinds of studies).

But it involves ten separate groups of 20 mice each (10 males and 10 females) fed diets containing GMO (Roundup-resistant) corn, grown with Roundup or not, or fed control diets (non-GMO corn) with or without Roundup added to their drinking water at three different levels.

I needed a Table to keep this straight.

CONTROL AND TREATMENT GROUPS

Complicated studies require careful interpretation.  Here are the main tumor results.

LINES: The dotted line is the control.  The three corn doses (11%, 22%, 33%) correspond to thin, medium and bold lines, respectively.

BARS: 0 = Control.  R = Roundup.  A, B, and C correspond to the three levels of Roundup in drinking water.

Besides complications, the study raises several issues:

• Incomplete data: the authors state that “All data cannot be shown in one report and the most relevant are described here.”  I’d like to know more about what the control rats ate and whether there were differences in the amounts of diets consumed, for example.
• Lack of dose response: the authors explain that 11% did as much harm as 33% as a threshold effect.  This requires further study to verify.
• Statistical significance: The paper doesn’t report confidence intervals for the tumor data (the bars don’t look all that different to me).

The California Prop. 37 proponents (and I’m totally with them) already have a strong “right to know” argument.  They don’t need to be distracted by the kinds of scientific arguments that are already raging about this study (see, for example, the British Science Media Centre’s collection of criticisms).

For more information about the study:

The British Sustainable Food Trust has a website devoted to this study.

Tim Carman wrote about it in the Washington Post (I’m quoted)

Andrew Pollack has a sensible piece in the New York Times

France calls for a ban on GM foods

Additional clarification: I very much favor research on this difficult question.   There are enough questions about this study to suggest the need for repeating it, or something like it, under carefully controlled conditions.

Yesterday, JAMA released a theme issue on obesity with several articles of particular interest, starting with New York City Health Commissioner Tom Farley’s Viewpoint.  About portion sizes, Dr. Farley notes:

As publicly traded companies responsive to the interests of their shareholders, food companies cannot make decisions that will lower profits, and larger portion sizes are more profitable because most costs of delivering food items to consumers are fixed….The sale of huge portions is driven by the food industry, not by consumer demand….The portion-size studies strongly suggest that, with a smaller default portion size, most consumers will consume fewer calories.  This change will not reverse the obesity epidemic, but it can have a substantial effect on it.

Lots of interesting food for thought here.  Take a look:

Viewpoint

The Role of Government in Preventing Excess Calorie Consumption:  The Example of New York City
Thomas A. Farley, MD, MPH
JAMA. 2012;308(11):1093 doi:10.1001/2012.jama.11623

The Next Generation of Obesity Research:  No Time to Waste
Griffin P. Rodgers, MD; Francis S. Collins, MD, PhD
JAMA. 2012;308(11):1095 doi:10.1001/2012.jama.11853

FDA Approval of Obesity Drugs:  A Difference in Risk-Benefit Perceptions
Elaine H. Morrato, DrPH, MPH; David B. Allison, PhD
JAMA. 2012;308(11):1097 doi:10.1001/jama.2012.10007

Cardiovascular Risk Assessment in the Development of New Drugs for Obesity
William R. Hiatt, MD; Allison B. Goldfine, MD; Sanjay Kaul, MD
JAMA. 2012;308(11):1099 doi:10.1001/jama.2012.9931

Original Contribution

Exercise Dose and Diabetes Risk in Overweight and Obese Children:  A Randomized Controlled Trial
Catherine L. Davis, PhD; Norman K. Pollock, PhD; Jennifer L. Waller, PhD; Jerry D. Allison, PhD; B. Adam Dennis, MD; Reda Bassali, MD; Agustín Meléndez, PhD; Colleen A. Boyle, PhD; Barbara A. Gower, PhD
JAMA. 2012;308(11):1103 doi:10.1001/2012.jama.10762

Association Between Urinary Bisphenol A Concentration and Obesity Prevalence in Children and Adolescents
Leonardo Trasande, MD, MPP; Teresa M. Attina, MD, PhD, MPH; Jan Blustein, MD, PhD
JAMA. 2012;308(11):1113 doi:10.1001/2012.jama.11461

Health Benefits of Gastric Bypass Surgery After 6 Years
Ted D. Adams, PhD, MPH; Lance E. Davidson, PhD; Sheldon E. Litwin, MD; Ronette L. Kolotkin, PhD; Michael J. LaMonte, PhD; Robert C. Pendleton, MD; Michael B. Strong, MD; Russell Vinik, MD; Nathan A. Wanner, MD; Paul N. Hopkins, MD, MSPH; Richard E. Gress, MA; James M. Walker, MD; Tom V. Cloward, MD; R. Tom Nuttall, RRT; Ahmad Hammoud, MD; Jessica L. J. Greenwood, MD, MSPH; Ross D. Crosby, PhD; Rodrick McKinlay, MD; Steven C. Simper, MD; Sherman C. Smith, MD; Steven C. Hunt, PhD
JAMA. 2012;308(11):1122 doi:10.1001/2012.jama.11164

Health Care Use During 20 Years Following Bariatric Surgery
Martin Neovius, PhD; Kristina Narbro, PhD; Catherine Keating, MPH; Markku Peltonen, PhD; Kajsa Sjöholm, PhD; Göran Ågren, MD; Lars Sjöström, MD, PhD; Lena Carlsson, MD, PhD
JAMA. 2012;308(11):1132 doi:10.1001/2012.jama.11792

Surgical vs Conventional Therapy for Weight Loss Treatment of Obstructive Sleep Apnea:  A Randomized Controlled Trial
John B. Dixon, MBBS, PhD, FRACGP; Linda M. Schachter, MBBS, PhD; Paul E. O’Brien, MD, FRACS; Kay Jones, MT&D, PhD; Mariee Grima, BSc, MDiet; Gavin Lambert, PhD; Wendy Brown, MBBS, PhD, FRACS; Michael Bailey, PhD, MSc; Matthew T. Naughton, MD, FRACP
JAMA. 2012;308(11):1142 doi:10.1001/2012.jama.11580

Dysfunctional Adiposity and the Risk of Prediabetes and Type 2 Diabetes in Obese Adults
Ian J. Neeland, MD; Aslan T. Turer, MD, MHS; Colby R. Ayers, MS; Tiffany M. Powell-Wiley, MD, MPH; Gloria L. Vega, PhD; Ramin Farzaneh-Far, MD, MAS; Scott M. Grundy, MD, PhD; Amit Khera, MD, MS; Darren K. McGuire, MD, MHSc; James A. de Lemos, MD
JAMA. 2012;308(11):1150 doi:10.1001/2012.jama.11132

Editorial

Progress in Filling the Gaps in Bariatric Surgery
Anita P. Courcoulas, MD, MPH
JAMA. 2012;308(11):1160 doi:10.1001/jama.2012.12337

Progress in Obesity Research:  Reasons for Optimism
Edward H. Livingston, MD; Jody W. Zylke, MD
JAMA. 2012;308(11):1162 doi:10.1001/2012.jama.12203

Betsy McKay of The Wall Street Journal organized and moderated a debate on this question.  I was a participant along with Brian Wansink , the John S. Dyson professor of marketing at Cornell University and Michael D. Tanner, senior fellow at the Cato Institute.

The debate is lengthy—you can read all of it online—but here are my initial responses to the two questions asked of me.

WSJ: What role should government play in addressing the obesity epidemic?  

DR. NESTLE: The government is up to its ears in policies that promote obesity. To name only a handful: supporting production of food commodities, but not of fruits and vegetables; permitting food and beverage companies to deduct marketing expenses from taxes; permitting SNAP benefits [food stamps] to be used on any food, thereby encouraging food companies to market directly to low-income groups.

Research on the prevalence of obesity shows that after decades of remaining at the same level, it began to increase sharply in the early 1980s. Our sense of personal responsibility did not change then. What did change was the food environment, transformed by food industry imperatives to increase sales, to one that increasingly urged people to “eat more” by making it socially acceptable to eat anywhere, anytime, and in very large amounts. In this kind of food environment, all but the most mindful eaters overeat. Few of us are in that category.

The food, beverage and restaurant industries collectively spend roughly $16 billion a year to promote sales through advertising agencies, perhaps $2 billion of that targeted at children. Marketing to children is well established to encourage kids to want advertised products, pester their parents for them, and believe that those products are what they are supposed to be eating. The “I am responsible” argument does not work for children (I’m not aware of evidence that it works well for adults either). Because regular consumption of junk foods and sugary drinks is linked to obesity in children, marketing these products to them is overtly unethical.

To expect food and beverage companies, whose sole purpose is to increase sales and report growth in sales every quarter, to voluntarily stop marketing to children makes no sense. On ethical grounds alone, government intervention is essential.

Given the personal and economic costs of obesity—currently estimated at $190 billion a year—governments have many reasons to promote the health of their populations. Just ask the military.

WSJ: Let’s talk about some specific initiatives. Will Mayor Bloomberg’s cap on soda sizes reduce soda consumption? What about the proposed municipal tax of a penny an ounce on sugary drinks in Richmond, Calif.?

DR. NESTLE: If only education and personal responsibility worked to improve eating behavior. Brian Wansink’s research clearly shows that his own students, diligently educated to understand the effect of large food portions on eating behavior, will still eat more when given more food—and, more seriously, they will underestimate the amount they have eaten.

Education must be backed up by a supportive environment. So why not create a food environment that makes it easier for people to eat less? Mayor Bloomberg’s idea of capping soda sizes at 16 ounces is an interesting approach to doing just that. A 16-ounce soda is not exactly abstemious. It is two standard servings, 50 grams of sugar and 200 calories.

To suggest that food laws will not change behavior makes little sense. For one thing, anti-obesity initiatives have scarcely been tried. For another, the history of anti-smoking interventions suggests quite the opposite. Attempts to get smokers to quit by invoking personal responsibility made little headway. Smokers quit when the government made smoking so inconvenient and expensive that it became easier to stop than to continue.

The intense response of soda companies to Mayor Bloomberg’s cap on soda size is testimony to the effectiveness of regulatory approaches. The companies would not be putting this kind of effort or spending millions to oppose an action they expected to fail.

I participated last week in a New York Times blog debate on this question:

Is organic food worth the expense?

A recent study by scientists at Stanford University found that fruits and vegetable labeled organic are, on average, no healthier than less expensive conventional produce, although they have lower levels of pesticide residue.

Are there other benefits that outweigh the cost of organic food? Is there a place for organic farming in a world with severe food shortages and rising food prices?

My answer: Buying organic is a personal choice.

Marion Nestle, the Paulette Goddard professor in the Department of Nutrition, Food Studies and Public Health at New York University, is the author of “Why Calories Count: From Science to Politics.” She blogs at FoodPolitics.com and is on Twitter.

Questions about organic food raise three issues: productivity, benefits and costs. Productivity is easy. Since the early 1980s, careful productivity studies conclude that organic yields are only slightly lower than conventional yields, and organic production leaves soils in much better shape — boding well for future productivity. The yield difference is too small to have much of an effect on world food supplies.

Next, benefits. If crops are grown without pesticides, they won’t contaminate soil and water, foods will contain fewer pesticides, and people who eat organic foods will have lower levels in their bodies. The Stanford study and others confirm all this. Critics of organics say: “So what. Pesticides are safe.” They point out that nobody has ever died from eating industrially produced broccoli. Although science does not presently demonstrate long-term harm from eating pesticide-treated vegetables, pesticides are demonstrably harmful to farm workers and to “nontarget” wildlife, and they accumulate in soils for ages. If pesticides were all that benign, the government wouldn’t need to regulate them, but it does.

The Stanford study made a big deal about nutrients, but nutrients are not the point. The point of organic production is its effects on the health of people and the planet. The investigators did not examine the overall health impact of organics, no doubt because such studies are difficult to conduct and interpret. For one thing, people who buy organics tend to be better educated and wealthier — characteristics that track with good health anyway.

That leaves the cost question. Organics cost more because they require greater amounts of hand labor. Are they worth it? Personally, I prefer not to be a guinea pig in a long-term pesticide experiment. I’m also fortunate to have the choice.

We should be doing all we can to give everyone else the same choice.

Here are the other debaters

• The Ecological Case Against Organics

  Christie Wilcox, blogger, Scientific American

• Focus on the Right Kind of Organic Farming

  Raj Patel, Institute for Food and Development Policy

• Food for the Wealthy, Not for the Poor

  Bjorn Lomborg, Copenhagen Consensus Center

• Lessons From the Farm

  Tom Philpott, Maverick Farms

You have to hand it to BPI (Beef Products Inc), the producer of  “Lean Finely Textured Beef (LFTB)”—a.k.a. “pink slime.”  The company deserves a prize for chutzpah (translation: outrageous audacity).

It has just filed a defamation (“veggie libel”) lawsuit for $1.2 billion (!) against an amazing cast of characters:

• ABC News (owned by Disney)
• TV news anchor Diane Sawyer
• ABC correspondent Jim Avila
• ABC correspondent David Kerley
• Gerald Zirnstein , former USDA employee who invented the term “pink slime”
• Carl Custer, former USDA employee
• Kit Foshee, whistleblower former BPI employee

South Dakota, apparently, has a veggie libel law to protect companies making food products from people who say mean things about them (recall: the Texas cattlemen vs. Oprah Winfrey).  Nobody has ever tested the constitutionality of veggie libel laws but I don’t know anyone who thinks they will stand up in court—free speech and all that.

BPI says the company lost 80% of its sales, a loss of $20 million per month, following news broadcasts about “pink slime.”  It had to close three facilities—in Texas, Kansas, and Iowa—and fire 650 workers at those places as well as 85 others at the company’s headquarters in South Dakota.

As I’ve written before, I see the “pink slime” episode as reflecting a lack of transparency in the beef industry and BPI’s efforts to defend its products as an example of power politics in action.

BPI is fighting back, hard.

• It created its own website: Beef is Beef
• It got some congressional representative to get the Congressional Research Service to write a report on the “pink slime” episode.
• And now this lawsuit.

The responses:

ABC News says, “The lawsuit is without merit. We will contest it vigorously.”

Bill Marler, the Seattle attorney who specializes in representing victims of food poisonings, has taken on this case and is representing Custer and Zirnstein.

Marler points out:

• You can buy a lot of Pink Slime for $1.2 billion.
• Someone should have told BPI’s lawyer it is not a great PR move to repeat the same charge that your client is now claiming harmed them in the first place.
• The lawsuit is without merit.
• We intend to defend this bogus, unwarranted and frivolous claim brought by BPI against these two former FSIS public employees.
• We are also contemplating filing a counter-claim against PBI.

Let the charges and countercharges begin!

This one will be almost as much fun to watch as the equally absurd legal squabbles between the Sugar Association and the Corn Refiners Association over what to call High Fructose Corn Syrup.  I’ll do a post on that next week sometime.