On the occasion of the two-year anniversary of Michelle Obama’s Let’s Move! campaign, it’s time to reflect again on what the campaign means for the White House, for childhood obesity, and for the food movement.

A year later, I summarized some of the campaign’s accomplishments.  From the beginning, I’ve been impressed with its smart choice of targets: to reduce childhood obesity by improving school food and inner city access to healthy foods.

I’m reminded of the political savvy that went into the campaign by an editorial in The Nation (February 6), “America’s First Lady Blues.”  In it, Ilyse Hogue writes about Michelle Obama’s careful treading of the fine line between marital independence and submission, using Let’s Move! as an example.

Hogue praises Mrs. Obama’s choice of a target that looks “soft,” but is anything but:

In an effort to fit Michelle’s role into a traditional profile, the media constantly reminds us that her work is on presumably soft subjects, primarily her hallmark cause to end childhood obesity…Slurs aside, what critics miss is that this campaign is not aimed at soft targets.

The food and beverage industry is a powerful lobbying force, spending nearly $16.3 million in the 2008 cycle to defeat initiatives—like a “soda tax” and limits on aggressive advertising aimed at kids—that would encourage a healthier diet and thus cut into its massive profits.

To tackle childhood obesity, we’ll have to confront complicated issues of race, class, entrenched corporate power, and access to healthy food.

Indeed we will.  Childhood obesity is a focal point for issues of social justice.

Happy birthday Let’s Move!  And many more.

So many comments came in to my blog post on Paula Deen’s diabetes announcement, “weighing in on Paula Deen,” that I thought it was worth revisiting in my monthly (first Sunday) column in the San Francisco Chronicle.  The question (edited) came from a blog reader:

Q: I have been diagnosed with type 2 diabetes and am very confused about insulin resistance, and what carbohydrates I can and cannot eat. So much of what I read is contradictory.

A: The first line of defense against type 2 diabetes is weight loss, but you would never know it from listening to Paula Deen, the celebrity Southern cook who recently announced that she has this disease, or even to the American Diabetes Association.

Having diabetes is no joke. It is a leading cause of blindness, kidney failure, leg and foot amputations, and premature death.

The disease comes in two forms – type 1 and type 2 – but type 2 accounts for 95 percent of cases. In both, levels of blood sugar are too high as a result of problems with insulin, a hormone that enables the body to use blood sugar for energy. But the reasons differ.

Type 1 is an autoimmune disease. It causes the pancreas to stop making insulin or not make enough. Type 1 is not yet preventable and requires insulin treatment.

In type 2, insulin may be available, but body tissues resist its use.

Being overweight is the key factor in type 2. Most people can prevent it by not gaining weight. And most people with the type 2 disease can eliminate symptoms by losing some weight.

Genetics is certainly a factor – many overweight people never develop the disease – but 85 percent or more of people diagnosed with type 2 diabetes are overweight or obese.

In genetically predisposed people, being overweight causes insulin resistance. Metabolism does not handle excess calories very well, and this means calories from any source, not just carbohydrates.

Fast food, soft drinks

Children and adults who habitually consume fast food as well as soft drinks tend to take in more calories and weigh more and are more likely to develop symptoms than people who eat healthier diets and are more active.

This makes healthy eating and physical activity the most important approaches. The vast majority of overweight people at risk of type 2 diabetes can prevent symptoms by losing a few percent of their body weight and doing a couple of hours a week of moderate – not necessarily vigorous – physical activity. The same works for treatment. Some people will still need medications, but the drugs work better with diet and physical activity.

As the Centers for Disease Control puts it, “all diabetes-care programs should make healthy weight a priority.”

Dietary advice for type 2 diabetes is the same as advice for everyone else: Eat a wide variety of relatively unprocessed foods, especially vegetables, fruits and whole grains, and don’t consume too much junk food or too many sugary beverages.

Scientists may argue endlessly about the relative importance of calories, sugars and refined carbohydrates in the diets of people with type 2 diabetes, but everyone agrees that eating less of all three would help resolve symptoms.

Why isn’t weight loss better recognized as a treatment strategy? Paula Deen’s announcement said nothing about losing weight.

The ADA does talk about weight loss on its website ( www.diabetes.org), but you must search hard through several complicated screens before you find, “Losing just a few pounds through exercise and eating well can help with your diabetes control and can reduce your risk for other health problems.”

Pharmaceuticals

I can’t help wondering if the lack of prominence given to weight loss might have something to do with the influence of pharmaceutical companies.

A few years ago, I gave a talk on the importance of weight loss in control of type 2 diabetes at an ADA annual meeting. Although many conference talks dealt with drug treatment, mine was the only one on diet – except for a session on sugars sponsored by Coca-Cola.

The exhibit hall was packed with drug company representatives dispensing free pens, writing pads, books, lab coats and stethoscopes – all with corporate logos.

The influence of drug companies on diabetes advice is worth attention. Deen represents a drug that costs hundreds of dollars a month. Drug companies give the ADA millions every year.

Eating less and being active make no money for anyone (unless people can be induced to join commercial weight-loss programs).

Losing weight is a losing battle for many people. It’s hard to lose weight in today’s “eat more” food marketing environment.

Teachable moment

But a diagnosis of type 2 diabetes should be a teachable moment. Shouldn’t the ADA more strongly urge people with the disease to eat less, eat better and move more, and help everyone find ways to cope with “eat more” messages?

The health and economic costs of type 2 diabetes, and its preventability, are reason enough to demand changes in the food environment. The ADA should be working hard to make it easier for everyone to eat more healthfully, be more active and avoid the need for a lifetime of diabetes medications.

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

This article appeared on page G – 4 of the San Francisco Chronicle

Tim Lang, professor of food policy at City University, London, writes that the U.K. food industry is fighting back over initiatives to reduce calories and mitigate climate change.

He sends an article from the British trade publication, The Grocer, about how the U.K. government has reneged on its “responsibility deal” with industry to reduce calories in food products. 

The idea was to demand that food companies reformulate products, control portion size, and take “action to shift to lower calorie options.”

But now, in response to industry protests,  the U.K. Department of Health is simply inviting food companies to help in the development of calorie-reduction policies.

To this invitation to the fox to guard the chickens, professor Lang comments:

Those of us following the currently fashionable ‘nudge’ theory and other ‘Food Policy lite’ initiatives will note this leak about softening the Responsibility Deal on calorie reduction here in England with concern…Perish the thought that sections of the Food Industry might have lobbied hard to stop any efforts to reduce portion size. Perish, indeed.

Another article in The Grocer points out that Tesco, Britain’s leading food retailer, is pulling out of an agreement to put carbon labels on products becausedoing so is too much trouble.

Professor Lang writes:

Here is the world’s 3^rd largest food retailer, Tesco, apparently saying that the carbon label (a weak system for changing behaviour in the first place, perhaps) takes too much time. Well, well, well.

If this is true…the implications are considerable, not least for the planet, given that a third of European (i.e., rich consumers) greenhouse gas emissions are due to food.

He gives as sources for that statement:

• Tukker, A., et al., Environmental Impacts of Diet Changes in the EU. 2009, European Commission Joint Research Centre Institute for Prospective Technological Studies: Seville.
• Tukker, A., et al., Environmental Impact of Products (EIPRO): Analysis of the life cycle environmental impacts related to the final consumption of the EU-25. EUR 22284 EN. 2006, European Commission Joint Research Centre.: Brussels.
• Audsley, E., et al., How Low Can We Go? An assessment of greenhouse gas emissions from the UK food system and the scope for reduction by 2050 2010, FCRN and WWF: Godalming, Surrey.

So much for voluntary actions by industry.  Regulation anyone?

 This just in: The European Commission issued a statement of regret that the European Parliament vetoed its proposal to allow “percent less” health claims on food packages yesterday.  These are statements that a product contains 15% less sugar, for example.

The Commission thinks such claims will encourage reformulation of food products.  The Parliament believes that such claims are misleading and will promote sales of junk foods. 

Which is right? Who knows?

Nature, the prestigious science magazine from Great Britain, has just published a commentary with a provocative title–The toxic truth about sugar—and an even more provocative subtitle: Added sweeteners pose dangers to health that justify controlling them like alcohol.

The authors, Robert Lustig, Laura Schmidt and Claire Brindis, are researchers at the University of California medical center in San Francisco (UCSF).

They argue that although tobacco, alcohol and diet are critically important behavioral risk factors in chronic disease, only two of them—tobacco and alcohol—are regulated by governments to protect public health.

Now, they say, it’s time to regulate sugar.  By sugar, they mean sugars plural: sucrose as well as high fructose corn syrup (HFCS).  Both are about half fructose.

Their rationale?

• Consumption of sugars has tripled over the last 50 years.
• Many people consume as much as 500 calories a day from sugars (average per capita availability in the U.S. is about 400 calories a day)
• High intake of fructose-containing sugars induce metabolic syndrome (high blood pressure, insulin resistance), diabetes, and liver damage.
• Sugars have the potential for abuse.
• Sugars have negative effects on society (mediated via obesity).
• Too much of a good thing can be toxic.

Therefore, they argue, societies should intervene and consider the kinds of policies that have proven effective for control of tobacco and alcohol:

• Taxes
• Distribution controls
• Age limits
• Bans from schools
• Licensing requirements
• Zoning ordinances
• Bans on TV commercials
• Labeling added sugars
• Removal of fructose from GRAS status

In a statement that greatly underestimates the situation, they say:

We recognize that societal interven­tion to reduce the supply and demand for sugar faces an uphill political battle against a powerful sugar lobby, and will require active engagement from all stakeholders.

But, they conclude:

These simple measures — which have all been on the battleground of American politics — are now taken for granted as essential tools for our public health and well-being. It’s time to turn our attention to sugar.

What is one to make of this?  Sugar is a delight, nobody is worried about the fructose in fruit or carrots, and diets can be plenty healthy with a little sugar sprinkled here and there.

The issue is quantity.  Sugars are not a problem, or not nearly as much of a problem, for people who balance calorie intake with expenditure.

Scientists can argue endlessly about whether obesity is a cause or an effect of metabolic dysfunction, but most people would be healthier if they ate less sugar.

The bottom line?  As Corinna Hawkes, the author of numerous reports on worldwide food marketing, wrote me this morning, “there are plenty of reasons for people to consume less sugar without having to worry about whether it’s toxic or not!”

I was invited yesterday to a press event to announce the results of a survey conducted by Share Our Strength’s Cooking Matters program.  The program and the survey, It’s Dinnertime: A Report on Low-Income Families’ Efforts to Plan, Shop for and Cook Healthy Meals, are sponsored by the ConAgra Foods Foundation.

I went because I was interested in the survey and also because I admire the work of chef Sara Moulton who, among many other things, works with Share Our Strength on this program.

Cooking Matters is part of Share Our Strength’s No Kid Hungry Campaign.  Its goal is to help low-income families increase access to public food resources (food assistance benefits, farmers’ market coupons) and produce healthy meals at low cost.  It does this through a 6-week course that teaches shopping strategies, meal planning, and cooking.

The research produced some important findings, perhaps obvious:

• 8 out of 10 low-income families cook at home at least 5 times per week, more if they are poorer.
• 85% of low-income families consider eating healthy meals to be important and realistic.
• Low-income families struggle to put healthy meals on the table: food costs and preparation time are big barriers.
• Low-income families are eager for cooking and budgeting tips and tools.

Where does ConAgra fit in?

ConAgra owns countless food product brands that pack the center aisles of supermarkets.

Working under the premise that it takes more than food to fight hunger, the ConAgra Foods Foundation, a national sponsor of Cooking Matters, funded It’s Dinnertime as part of its ongoing strategy to find sustainable solutions to help surround kids with the nourishment they need to flourish.

The ConAgra Foods Foundation is funded solely by ConAgra Foods.  One of the study’s conclusions is very much in ConAgra’s interest.

A better understanding of the health benefits of frozen and canned fruits and vegetables could also put more healthy options in reach for low-income families: While 81 percent of low-income parents rated fresh produce as extremely healthy, that rating drops down to 32 percent when it comes to frozen fruits and vegetables and 12 percent with canned fruits and vegetables.

The program works to improve the image of frozen and canned fruits and vegetables among low-income families.

Ordinarily, food industry-sponsored programs make me squirm.  This one makes me squirm less than most even though Sara Moulton was cooking with at least one ConAgra product: Wesson Oil.

But the program worked with 18,000 families last year and its goals make sense.

Canned and frozen fruits and vegetables really do retain much of the nutritional value of fresh produce unless they are loaded with salt and sugars.  Sara was cooking with low-salt products and the dishes she made were easy, inexpensive, nutritious, and quite delicious.

I’m impressed with how this program teaches families to fend for themselves in today’s tough environment.

Now, if ConAgra would just get busy promoting policies to improve access to healthy foods for everyone….

 

A new diet study just out from the American Journal of Clinical Nutrition went to a lot of trouble to prove the obvious.  When it comes to weight loss, how much you eat matters more than the proportion of fat, carbohydrate, and protein in your foods.

Researchers at the Pennington Biomedical Research Center got volunteers to eat diets that were supposed to differ in proportions of fat (40% vs 20%), carbohydrates (35% vs. 65%), and protein (25% vs. 15%).

The results of the study are consistent with the findings from many previous studies:

• The major predictor for weight loss was adherence to the diet.
• People on all of the diets lost weight by six months, but regained some of it by two years.
• The study had a high drop-out rate (hence the importance of adherence).
• It was hard for people to stick to the diets, especially those at the extremes of one dietary component or another.

In my book with Malden Nesheim coming out on April 1, Why Calories Count: From Science to Politics, we review the previous studies of whether what you eat matters more to weight loss than how much you eat.

Some people find it easier to stick to diets that are higher in protein and fat.  I’m guessing that proponents of low-carbohydrate diets will argue that none of the diets in this particular study was really low in carbohydrate.

But studies show that people have a hard time adhering to diets that are very low in carbohydrate.  The low range in this study—35%—is at the lower end of acceptability for many people.

The bottom line: all diets work if you stick to them.

I was fascinated to read Cookson Beecher’s Food Safety News’ analysis of current campaigns to label genetically modified foods (GMOs).

It brought back memories of the time I served as an obviously ignored consumer representative on the FDA’s Food Advisory Committee.  Back in the early 1990s, the FDA formed this committee to get advice on issues that might be controversial.  It asked us for advice about whether to approve GM foods and, if so, whether they should be labeled.

We learned later that the FDA was using the committee to give it a heads up on decisions that were already made.  The FDA had every intention of approving GMOs (I wrote about this in my book Safe Food: The Politics of Food Safety).

I and the other three consumer representatives argued as strongly as we could that labeling was essential:

• Consumers have a right to know
• Consumers want to know (polls showed this overwhelmingly, even in 1994)
• Not-labeling will induce distrust of biotech foods and the biotech industry
• Not-labeling will end up hurting the biotech industry (in Europe, definitely.  Monsanto is no longer selling GM corn in France and BASF has moved its biotech operations to the U.S.)
• Not-labeling will stimulate the organic industry (it did!)
• The FDA allows plenty of process labeling (e.g., made from concentrate, irradiated)
• Not-labeling will make the FDA look as if it was in bed with the biotech industry
• Transparency is always the right thing to do

Too bad our arguments failed.  Eighteen years later, not-labeling has caused no end of problems for the biotech industry.  This issue is not going away.

The FDA has approved many GM fruits and vegetables but it is impossible to know whether they are offered for sale in supermarkets (as I discussed in Safe Food, Hawaiian papayas are the most likely candidates).

But most corn, soybeans, and cotton grown in America are GM.  So are sugar beets.

Campaigns to require labeling of GM foods are heating up.

• Washington state is considering legislation
• California may have a ballot initiative
• 14 states, among them Oregon, New York, Maryland and Vermont, considered bills last year
• Alaska passed a law requiring GMO labeling of fish and shellfish in 2005
• 50 countries require disclosure of GM ingredients

The “Just Label It!” campaign is collecting signatures.  If this is an issue you care about, signing on is easy.

A study published online in the American Journal of Public Health fiddled around with red (avoid) and green (eat me) labels on items in a hospital cafeteria.

The investigators measured sales before the start of the intervention.  About a quarter of items sold were in the red category and 42% were green—these hospital workers were already making healthy choices.

The intervention took place in two 3-month phases.  The first phase just involved traffic light labels.  In the second phase, the investigators moved the items around to make the green-labeled products more visible and accessible.

The results: labels alone led to decreases in sales of red-labeled items and increases in sales of those with green labels.

For example, sales of red-labeled drinks decreased by 16.5%.  When the drinks were made less accessible, sales declined by an additional 11.4% (sales of bottled water increased).

No wonder the food industry in Great Britain fought so hard against traffic light front-of-package labeling.  No wonder the Grocery Manufacturers Association and Food Marketing Institute much prefer their own guaranteed-not-to-work system.

And data like these surely explain why the FDA is taking so long to do anything with the Institute of Medicine’s proposed labeling system—not exactly traffic lights, but pretty close.

This study provides further evidence for the value of such schemes for helping people make healthier choices.

FDA: get busy!