Yesterday, 20 family physicians in Contra Costa County, California, ripped up their membership cards in the American Academy of Family Physicians in protest over the AAFP’s partnership with Coca-Cola.

The director of the Contra Costa Department of Health Services, Dr. William Walker, announced that he was resigning his 25-year membership in AAFP.  In his statement, Dr. Walker said:

…I am appalled and ashamed of this partnership between Coca-Cola and the American Academy of Family Physicians. How can any organization that claims to promote public health join forces with a company that promotes products that put our children at risk for obesity, heart disease and early death.

…The AAFP is supposed to be an organization that works to protect the health of children not put them at risk. Their decision to take soda money is all the more unconscionable because, unlike doctors in the 40s, they well know the negative health impact of soda. There is no shortage of documentation that soda is a major contributor to our nation’s obesity epidemic.

…Let me be clear about something: as disappointed as I am with the American Academy of Family Physicians for being duped into thinking that Coca Cola wants to help promote health, the real problem here is our children are being put at risk.

Companies like Coca Cola are polluting our communities with deceptive advertising promoting products that put our children’s health at risk.

…as a family practice doctor and the Health Officer for Contra Costa, I do have a prescription for every parent, teacher, community leader and student:

Look beyond the glitzy advertising that makes you think pouring liquid containing sugar into your body is healthy. Read the label. Look at the ingredients. I’m not suggesting that you boycott sugared drinks, but please make an informed decision about what you are consuming.

I’m calling on every city and neighborhood in our County to fight back against the industry that pushes these harmful products. I ask the American Academy of Family Physicians to end this unhealthy partnership and to join us in leading this important campaign to take back the health of our residents and end the obesity epidemic.

Strong words, indeed.  I hope that the AAFP – and other health and nutrition organizations that might consider food industry partnerships – pay close attention to these words.

* The event was covered in the Contra Costa Times. The Health Department’s website includes the press release and also a video and podcast.

Addendum:

Now that the Smart Choices program is on hold, it’s time to take a look at what else is on food packages these days.  My current favorite example is the huge IMMUNITY banner across Kellogg’s Cocoa Krispies.

I don’t know how you interpret this but my mind boggles at the very idea that eating Cocoa Krispies might protect kids against swine flu.

Apparently, the minds of the San Francisco attorney general’s staff are equally boggled.  They just sent a warning letter to Kellog:

“Specifically, the Immunity Claims may falsely suggest to parents that cereals like Cocoa Krispies are more healthy for their children than other breakfast foods that are not high in sugar and not highly processed.  The Immunity Claims  may also mislead parents into believing that serving this sugary cereal will actually boost their child’s immunity, leaving parents less likely to take more productive steps to protect their children’s health.”

The city attorneys are asking Kellogg to provide copies of all of the consumer and scientific research the company used to establish this claim, or else.  If they don’t get these documents, they will “seek an immediate termination or modification of the advertising claim….”

Good idea.  I can’t wait to see how Kellogg’s – ever at the leading edge of advertising claims – will respond.

But wait!  Shouldn’t the FDA be taking this on?

For kids:

The Institute of Medicine has a new report out on setting standards for school meals.  As easily seen in the report summary, the committee offered three main recommendations:

* Increasing the amount and variety of fruits, vegetables, and whole grains

* Setting a minimum and maximum level of calories

* Focusing more on reducing saturated fat and sodium

Its report comes with a handy table summarizing the differences between current breakfast standards and those recommended by the IOM committee.  These are refreshingly food-based and follow the three main principles noted above.

For communities:

New York City’s ever active health department did a study on the availability of fruits and vegetables in low-income areas and found just what you might expect – few, if any, supermarkets carrying fresh produce.  To address the gap, the city has instituted the FRESH program, “Food Retail Expansion to Support Health,” to get healthier foods into the inner city.

So much is going on these days that it is hard to keep up with it.  Enjoy!

Kelly Brownell and his colleagues at the Rudd Center at Yale have produced another well researched – and in this case, gorgeously presented – report on the ways cereal companies market their products.

Even a quick look at its summary gives an unambiguous result: most of the marketing dollars are aimed at pushing sugary cereals at kids.  Companies use TV and the Internet to push the least nutritious cereals.

None of this is particularly surprising but it’s great to have the data.  Information about marketing budgets for specific products is hard to get.  It is easy to understand why companies would rather nobody knew how much they spent to get kids to pester their parents to buy Froot Loops or Cocoa Puffs.

Most troubling is the dual marketing.  Advertising aimed at kids pushes sugar.  Advertising aimed at parents uses health claims and self-endorsements like the late (and not lamented) Smart Choices program I discussed in previous posts.

Companies may argue that sugary cereals are good because they encourage kids to drink milk, but the Rudd Center researchers also have shown that kids are happy to eat non-sweetened cereals  Furthermore, if they add their own sugar, they are putting in less than the cereal companies put in.

The bottom line: forget industry self-regulation.  It doesn’t work.

FDA: it’s time to take on health claims.

Big news!  According to an AP report today, the group that runs the Smart Choices program has announced that it will “postpone” active recruitment of new products and will not encourage use of the logo while the FDA is in the process of examining front-of-package labeling issues.

Who says the FDA does not have any power?  I think it does.  And let’s welcome it back on the job.

As for my nutrition colleagues in the American Society of Nutrition, the group that competed to manage the program and has been defending it ever since, here’s what they now say:

Dear ASN Member,

Today the Smart Choices Program announced the decision to voluntarily postpone active operations and not encourage wider use of the Smart Choices Program logo. This move follows an announcement by FDA Commissioner, Margaret Hamburg, M.D. on Oct. 20, 2009, which said that the agency intends to develop standardized criteria on which future front-of-package (FOP) nutrition or shelf labeling will be based. In a letter captioned, “Guidance for Industry” and posted on its website, the FDA stated: “We want to work with the food industry − retailers and manufacturers alike − as well as nutrition and design experts and the Institute of Medicine, to develop an optimal, common approach to nutrition-related FOP and shelf labeling that all Americans can trust and use to build better diets and improve their health.”

ASN commends the FDA on its announcement of intent to develop standardized criteria on which front-of-pack nutrition and shelf labeling could be based. In addition, ASN fully supports the decision of the Smart Choices Program Board of Directors to postpone their active operations as FDA works to address both front-of-pack and on shelf labeling.  “ASN will continue to provide nutrition science expertise within the dialogue on front-of-pack labeling in order to best serve the interests of the health of Americans,” said ASN President Jim Hill in a statement to media.

Sincerely,

ASN Executive Board

As I have explained in previous posts about Smart Choices, the ASN should never have gotten involved in this dubious enterprise in the first place.  The organization was lucky to get out of this so easily.  I hope it does not make the same mistake again.

The press had a field day with the Smart Choices logo on Froot Loops.  As Rebecca Ruiz at Forbes puts it, “the uproar over the program has conveyed a definitive message to industry: Don’t try to disguise a nutritional sin with a stamp of approval.”

It’s too little too late for fish policy, alas, but the EU is trying.  It is asking for comment on its Green Paper on Reform of the Common Fisheries Policy.  If the Green Paper is too much to tackle, try the Citizens’ Summary.  It explains why it’s so important to urge the EU to make sustainability a priority in fish policies.

The Monterey Bay Aquarium’s Seafood Watch program has a new report out on The State of Seafood.  Fisheries are at a turning point, it says, and we must act now, or goodbye fish.

And the Seafood Choices Alliance publishes a webletter, Afishionado.  Its latest issue deals with the effects of climate change on fish migration, invasive species, and ocean acidification.  The short articles come with references, which I always appreciate.

Many groups are doing excellent work to promote seafood sustainability.  Support what they do!

It is one of the great oddities of nutrition that public health guidelines invariably recommend salt reduction but the science is so hard to do that the value of doing so can’t be proven unequivocally.  Hypertension specialists insist that salt reduction is essential for controlling high blood pressure, and many people with high blood pressure can demonstrate that this is true.

So why can’t the science show it?  I’d say because even the lowest salt intakes are higher than recommended.  Because everyone consumes higher-than-recommended amounts, it’s impossible to divide people into meaningful groups of salt eaters and see whether low-salt diets work.

With that said, here are the latest events in the salt wars:

1.  An article by a group of investigators in California and Washington state, “Can dietary sodium be modified by public policy,” argues that it makes no difference who you are, everybody consumes salt in the same range.  Therefore, there is no point in trying to lower it.

2.  Not so, say critics, who point out that the authors of that study consult with the food and salt industries (and, therefore, have conscious or unconscious biases) and that plenty of evidence demonstrates the value of salt reduction.

3.  ConAgra says it will cut the salt in its products by 20% in the next few years, according to an article in Bloomberg News (in which I am quoted).  Why is ConAgra doing this? To lower the salt before the company is forced to.  Regulators are well aware that nearly 80% of the salt in American diets comes from processed and pre-prepared foods, not salt shakers.

Expect to hear lots more about the need to reduce salt intake this year.

The FDA has a new “Dear Industry” letter announcing that it is going to set some rules for those “better-for-you” stickers on the front of junk food packages.  Why?   “FDA’s intent is to provide standardized, science-based criteria on which FOP [front of package] nutrition labeling must be based.”

What this is about, of course, is all those self-endorsement labels food companies like PepsiCo (Smart Spot),  Kraft (Sensible Solution), and many companies collectively (Smart Choices) have been putting on their products.

The companies set up their own nutrition criteria and then applied those criteria to their own products. Surprise!  A great many of their products qualified for the “better-for-you” labels.

I’m guessing Smart Choices was the final straw for the FDA. The idea that the Smart Choices check mark could go onto Froot Loops was so astonishing, and the subject of so much ridicule, that the FDA had to act.  If nutrition criteria are developed independently, most junk foods would not qualify.

The FDA also says it will be testing how well consumers understand different kinds of package labels.  It gives a bunch of examples.  Want to know how the FDA is thinking about this?  Check out its handy backgrounder, which if nothing else is an excellent introduction to the entire issue of front-of-package labels.

Have a preference about what to use?  Write the FDA at this address:

Division of Dockets Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, rm. 1061, Rockville, MD 20852. All comments should be identified with the title of the guidance document: Guidance for Industry: Letter Regarding Point of Purchase Food Labeling.

Addendum, October 22: Here are two additional documents to add to the collection.  First, a letter to representative Rosa DeLauro responding to her complaint about the Smart Choices program.  Second, is a a summary of the talking points used by Commissioner Margaret Hamburg in her press conference on the new FDA initiatives.   My conclusion:  the FDA is back on the job!