I’m in Europe trying to keep up with the farm bill from afar.  The House Ag Committee has come up with a a 557-page “discussion draft” of what it cutely calls the Federal Agriculture Reform and Risk Management (FARRM) Act.

Its stated purposes are to (1) cut spending, (2) reduce the size of government, and (3) “make common-sense reforms to agricultural policy.”

The first two make the third goal an oxymoron.  I don’t see how #3 is possible, given #1 and #2.

Unlike the Senate version, the House bill:

• Cuts current spending by $35 billion over 10 years (as compared to the Senate’s $23 billion or so).
• Takes the difference out of SNAP (food stamps).  The proposed cut is $16 billion compared to $4.5 billion in the Senate version, an action that is ostensibly supposed to improve “program integrity and accountability.”

As Politico puts it, the House is

demanding deeper cuts from nutrition programs for the poor while embracing a greater government role in supporting farmers — something that won’t sit well with tea party conservatives.

Virtually all of that difference is explained by the much larger savings from food stamps — a $16 billion-plus package that triples what the Senate approved and imposes tougher income and asset tests that will disqualify hundreds of thousands of working-class households now getting aid.

The proposed deep cuts to SNAP are shocking for two reasons:

• The harm they will do to low-income households
• The breach in the long-standing deal that put SNAP in the farm bill in the first place

SNAP is in the farm bill because rural states needed the votes of urban states to pass subsidies and other supports for Big Ag producers of commodities.

This deal worked for states with large numbers of urban poor.  If their representatives voted for farm supports, farm-state representatives would vote for SNAP benefits.

This was classic logrolling.

Is the deal now breaking down?   Is Congress really willing to sacrifice benefits to the poor to maintain benefits for Big Ag?

According to The Hill, the House cuts are nothing but political posturing:

Rep. Collin Peterson (Minn.), the top Democrat on the House Agriculture Committee, agreed to the cuts as a pragmatic way of moving forward with legislation important to rural lawmakers.

In an interview with The Hill, he said much of the cuts would be restored in a conference with the Senate.

…Peterson said he would have made different reforms to food stamps, and had offered an alternative plan to the GOP that was rejected. He defended his decision to back the final product as both pragmatic and politically savvy.

“It is what had to be done in order to get through committee and through the House floor,” he said.

Pragmatic and politically savvvy?  Let’s hope he’s right.

Anti-hunger advocates, however, are taking no chances.  They gathered in Washington this week to oppose the cuts.

This is a critical time.  Add your voice!

I’ve been at meetings in London and Geneva on non-communicable (what we call chronic) diseases and how to prevent them. 

On the way to Europe, I did some catching up on reading past issues of The Lancet and ran across this letter from Sally Casswell of the School of Public Health at Massey University in Auckland. 

Professor Casswell was responding to an article arguing that a major priority in chronic disease prevention should be to strengthen the capacity of countries to deliver primary care services.

Yes, professor Casswell writes, primary care is important.  But it is even more important to focus prevention efforts on the environmental factors that influence the behavior of individuals and cause them to need primary care services in the first place.

Do we really want to continue to live in a world where the oversupply and marketing of tobacco, alcohol, unhealthy processed foods, and soft drinks is tolerated simply to allow continuing profits for the shareholders of the transnational corporations producing and distributing them, while the taxpayer funds the health services and pharmaceutical response to the ensuing disease and injury?

This is a refreshing way to look at this problem, and one well worth pondering.

The third part of the PLoS Medicine series on Big Food (which I co-edited with David Stuckler) is now out.  Happy Fourth of July!

Here’s the entire PLoS collection of papers on this topic:

Editorial: PLoS Medicine Series on Big Food: The Food Industry Is Ripe for Scrutiny, The PLoS Medicine Editors, PLoS Medicine: Published 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001246

Essay: Big Food, Food Systems, and Global Health, David Stuckler, Marion Nestle, PLoS Medicine: Published 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001242

Essay: The Impact of Transnational “Big Food” Companies on the South: A View from Brazil, Carlos A. Monteiro, Geoffrey Cannon, PLoS Medicine: Published 03 Jul 2012 | info:doi/10.1371/journal.pmed.1001252

Perspective: Thinking Forward: The Quicksand of Appeasing the Food Industry, Kelly D. Brownell, PLoS Medicine: Published 03 Jul 2012 | info:doi/10.1371/journal.pmed.1001254

Policy Forum: Soda and Tobacco Industry Corporate Social Responsibility Campaigns: How Do They Compare?, Lori Dorfman, Andrew Cheyne, Lissy C. Friedman, Asiya Wadud, Mark Gottlieb, PLoS Medicine: Published 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001241

Policy Forum: Manufacturing Epidemics: The Role of Global Producers in Increased Consumption of Unhealthy Commodities Including Processed Foods, Alcohol, and Tobacco, David Stuckler, Martin McKee, Shah Ebrahim, Sanjay Basu, PLoS Medicine: Published 26 Jun 2012 | info:doi/10.1371/journal.pmed.1001235

Policy Forum: “Big Food,” the Consumer Food Environment, Health, and the Policy Response in South Africa, Ehimario U. Igumbor, David Sanders, Thandi R. Puoane, Lungiswa Tsolekile, Cassandra Schwarz, Christopher Purdy, Rina Swart, Solange Durão, Corinna Hawkes, PLoS Medicine: Published 03 Jul 2012 | info:doi/10.1371/journal.pmed.1001253

It’s hard to know what to say or do about pesticides in foods.  They are there and cannot easily be avoided. 

Are they harmful in the small doses found on foods?   Convincing studies one way or the other are hard to do. 

The Alliance for Food and Farming is an industry group with a stated mission “to deliver credible information to consumers about the safety of all fruits and vegetables.”

Its new report is called “Scared Fat.”  It reassures you that pesticides on fruits and veggies do no harm, so relax.

 The Maryland Pesticide Network and the Johns Hopkins Center for a Livable Future take a precautionary approach: whenever possible, avoid.

They have produced Best Management Practices Guide for Mimimizing or Eliminating Use of Pesticides for homeowners, farmers, property managers who want to do just that or at least minimize use of these chemicals.

If you prefer to avoid, take a look.

And enjoy your  4th of July salads!

My once-a-month (first Sunday) Q and A column in the San Francisco Chronicle deals with recent city initiatives.

Q:Why do municipalities continue to try to tell us what to eat or drink through taxes (the 1-cent soda tax on the Richmond ballot in November) or outright bans (eliminating super-size soft drinks, proposed by Mayor Michael Bloomberg in New York)?  Richmond residents could just buy their sodas in neighboring towns, and 1 cent seems hardly enough to influence anyone. New Yorkers could just buy two drinks if they want more. Isn’t this all rather silly?

A: Silly? On the contrary. These are dead-serious attempts to address the health problems caused by obesity through “environmental” change – changing the context in which we make food choices.

By now, health officials are well aware that asking individuals to take responsibility for making their own healthy food choices hasn’t got a prayer of success in the face of a marketing environment that encourages people to eat everywhere, all day long, in very large portions and at relatively low cost.

This is the default food environment, where it’s useless to tell people they need to eat less and expect them to do it. They can’t. Instead, it makes sense to try to change the food environment to make healthy choices the easy choices.

Healthy by design?

Suppose, for example, that all kids’ meals at fast-food restaurants were healthy by design and automatically provided milk or water.

You could still order a soda for your kid, but you would have to ask for it – and pay extra. If you are like most people, you won’t bother. That’s why the default matters.

Cities are trying to change the default. One change may or may not make a difference – we don’t know that yet. But changing the default might well make healthy choices easier in schools, fast-food restaurants and other institutions.

Bloomberg’s proposal in New York, to ban sodas larger than 16 ounces, is one such step. From my standpoint, 16 ounces is generous. It’s two full servings and provides about 50 grams of sugars, 200 calories and 10 percent of daily calories for someone who consumes 2,000 calories a day.

Portion sizes used to be a lot smaller. Decades ago, Coca-Cola advertised 16-ounce bottles as “big” and enough to serve three over ice.

If we could recognize that larger portions have more calories – and act on this knowledge – we might have an easier time maintaining weight. But we can’t, at least not easily.

The Richmond soda tax proposal recognizes that more than half of Richmond schoolchildren are overweight or obese. This percentage is higher than in other areas of Contra Costa County.

Even more striking, city officials estimate that two-thirds of Richmond adolescents consume more than 400 calories a day from soft drinks.

Kids who habitually drink sugary sodas tend to have worse diets, to be fatter and to display more risk factors for chronic diseases than kids who don’t.

This makes sugar-sweetened beverages an obvious target for environmental approaches to obesity prevention. Sugary sodas have calories but no nutrients. They are consumed in large amounts. They are highly correlated with obesity and health risks. They are “liquid candy.”

Sugary drinks should be once-in-a-while treats, not daily fare.

Richmond officials hope that the tax will encourage healthier choices. They deliberately set the proposed tax small so it would not unduly burden low-income residents.

One penny per ounce – 16 cents on a 16-ounce soda – may not be enough to change behavior, but it sends a clear message: It’s less expensive to drink water, and it’s healthier to reduce soda intake.

Funding programs

The Richmond proposal has one other critically important feature. It specifies that soda tax revenue will be used to fund city programs to address and reduce childhood obesity, especially in low-income areas where obesity rates are high.

These experiments are worth national attention. They may well do some good for individuals, and I can’t see how they would cause harm in any way except, perhaps, to the economic interests of soda companies.

Soda companies are taking these initiatives seriously. They are pouring millions of dollars into lobbying and community campaigns against both proposals.

Both have elicited plenty of public discussion, much of it focused on the rights of individuals versus the public health interests of government.

What I like about these initiatives is that they do not infringe on individual rights – people can buy as much soda as they want. The proposals simply try to make the default food environment slightly more conducive to healthy choices.

I’m hoping both proposals go forward. I can’t wait to see how they play out.

The Supreme Court ruling that the Affordable Care Act (ACA) is indeed constitutional means that Americans will now have greater access to health care as well as to services to help prevent disease.

The American Public Health Association summarizes the benefits: 

• 31 million Americans are projected to gain health coverage by 2019
• 54 million U.S. families have additional benefits, including greater access to preventive health care services
• 2.5 million young adults up to age 26 are able to stay on their parents’ health insurance plans;
• nearly 18 million children with pre-existing conditions are protected from insurance coverage denials;
• seniors can access preventive services

Let’s add menu labeling to the list.  The ACA takes menu labeling national.  The FDA proposed the rules for this process more than a year ago, with no further action.

The Supreme Court says go for it. 

FDA: No more excuses.  Get busy!

The online, open-access journal Public Library of Science – Medicine, better known as PLoS Medicine, is doing a series of articles on Big Food.  I’m its co-editor, with David Stuckler in the U.K.

Here’s what’s online so far. 

Editorial: PLoS Medicine Series on Big Food: The Food Industry Is Ripe for Scrutiny, by the PLoS Medicine Editors, PLoS Medicine, 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001246

Essay: Big Food, Food Systems, and Global Health, by David Stuckler, Marion Nestle, PLoS Medicine, 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001242 

Essay: Food Sovereignty: Power, Gender, and the Right to Food, by Rajeev C. Patel, PLoS Medicine, 26 Jun 2012 | info:doi/10.1371/journal.pmed.1001223

Policy Forum: Soda and Tobacco Industry Corporate Social Responsibility Campaigns: How Do They Compare?, by Lori Dorfman, Andrew Cheyne, Lissy C. Friedman, Asiya Wadud, Mark Gottlieb, PLoS Medicine, 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001241

Policy Forum: Manufacturing Epidemics: The Role of Global Producers in Increased Consumption of Unhealthy Commodities Including Processed Foods, Alcohol, and Tobacco, by David Stuckler, Martin McKee, Shah Ebrahim, Sanjay Basu, PLoS Medicine, 26 Jun 2012 |info:doi/10.1371/journal.pmed.1001235

Twitter chat: To follow the Twitter chat that took place on June 27, search for #plosmedbigfood.

More next week.  Stay tuned.

As the co-author of a recent book called Why Calories Count: From Science to Politics, I am well aware of how difficult it is to lose weight.

The problem

• When you are dieting and losing weight, you require fewer calories to maintain and move your smaller body, and your metabolism and muscle activity—and, therefore, your total energy expenditure–slow down.
• To maintain the weight loss, you need to eat less than you did before you began dieting.

But what would happen if you could adjust your diet to keep your energy expenditure from slowing down?

Enter Ebbeling et al in JAMA, with a comprehensive study to address precisely that question.  The results of the study and editorial comments on the findings demonstrate how complicated and difficult it is to obtain definitive answers to questions about diet composition and calorie balance.

• The investigators asked whether calorie-controlled diets containing varying amounts of carbohydrate, fat, and protein, and varying in glycemic load (a measure of rapidly absorbable carbohydrates in foods) affected total energy expenditure in obese people who had just lost 10% to 15% of their weight, but were still obese.
• They found that the diet lowest in carbohydrate did not slow down energy expenditure as much as did the low-glycemic index diet, or the one lowest in fat.
• They concluded: “The results of our study challenge the notion that a calorie is a calorie from a metabolic perspective.”

This study took years and involved a very large number of state-of-the-art physiological measurements.

But I want to focus on the question of whether calories from all sources are metabolically equivalent.   Here’s my understanding of the study.

The methods

Ebbeling et al started by offering $2500 to obese volunteers to participate in a 7-month weight-loss trial.   In my view, the 21 subjects who finished the study worked hard for that money.

They had to participate sequentially in a:

• Weight-monitoring phase for 4 weeks, during which they ate their typical diets while the investigators monitored their weight.
• Weight-loss phase for 12 weeks, during which they were fed pre-prepared diets calculated to contain about 60% of their usual calorie intake so they would lose about 2 pounds a week.  The average weight loss over 12 weeks was an impressive 14.3 kg (31.5 pounds).
• Weight-stabilization phase for 4 weeks, during which they were fed pre-prepared diets that provided the reduced number of calories needed to maintain their newly reduced weights.
• Testing phase of 4 weeks on each of three pre-prepared test diets (total: 12 weeks).  All three test diets provided the number of calories needed to maintain the reduced weight.  During each of the 3 testing periods, investigators measured—not estimated—the subjects’ total daily energy expenditure (resting metabolism plus activity).

The composition of the diets

DIETS	CARB%	FAT%	PROTEIN%	DECREASE IN TOTAL ENERGY EXPENDITURE, Calories/Day
Weight-loss	45	30	25	Not reported
Low-fat (high-carb)	60	20	20	~400
Low-Glycemic Index	40	40	20	~300
Very low carb (high-fat)	10	60	30	~100

Note that whenever one component of a diet gets changed, the other two components change too.   Because protein usually occurs in foods in relatively low amounts, a low-fat diet is necessarily a high-carbohydrate diet, and vice versa.

The results

• The weight-loss part of this study showed that when overweight people were allowed to eat only calorie-controlled pre-prepared diets, they lost weight quickly and maintained the weight loss.
• The test-diet part of the study showed that the diet lowest in carbohydrate (and, therefore, highest in fat) had the least effect in slowing down total energy expenditure.   The diet that slowed down overall energy expenditure the most was the one lowest in fat.

If these results are correct, people eating high-fat, low-carbohydrate diets are likely to have the easiest time maintaining weight loss.  In contrast, people on low-fat, high-carbohydrate diets are likely to have a harder time maintaining weight loss.

But does this mean that calories from different sources have different effects on metabolism?  Proponents of the Atkins (high-fat, low carb) diet say yes, according to an account in USA Today (in which I am also quoted).

I’m still skeptical.  The subjects in this study lost and maintained weight under highly controlled, calorie-restricted conditions, in which the calories came from a relatively low-fat, moderate-carbohydrate, high-protein diet (average diets contain 10% to 15% protein).

The accompanying editorial notes that heat losses are greater for protein than for carbohydrate or fat, and also raises questions about whether physical activity declined more with the low-fat (high-carb) diet than the others.  It also notes:

Each diet was consumed for only 4 weeks. A weight stabilization protocol…may not have adequately accounted for changing energy needs associated with readjustment to new diets.

These provocative results…emphasize the current incomplete knowledge base regarding the importance of dietary macronutrients and energy expenditure, especially after weight loss.

Under the relatively short, highly controlled feeding conditions of this study, the composition of the diet may indeed matter to metabolism.  But does diet composition matter for weight maintenance in the real world?

Other longer term studies of “free-living” people out and about in their communities show little difference in weight loss or maintenance between one kind of diet and another.

More research needed!

The bottom line

• If you want to lose weight, eat less (it worked well for the subjects in this study).
• It may help to avoid excessive consumption of sugars and easily absorbed carbohydrates.
• Once you’ve lost weight, adjust your calorie intake to maintain the weight loss.
• And understand that science has no easy answers to the weight-loss problem.