I don’t usually take estimates of the cost of bad diets and obesity too seriously because they are necessarily based on multiple assumptions, none of them verifiable.  But I do like to collect them.  Here are two papers from the American Journal of Health Promotion estimating such costs.  One estimates the health benefits and savings in medical costs from diets reduced in saturated fat, sodium, and calories (a savings of $60-120 billion), and the other estimates cost savings and productivity increases for reduction in calories and sodium ($109-256 billion).  Whatever the real savings are, they are likely to be enormous.  And that’s just money.  It’s harder to put a value on quality of life.  Maybe that’s all we need to know at this point.

Yale’s Rudd Center for Food Policy has invented a Revenue Calculator for Soft Drink Taxes for estimating the amounts of money states and cities could raise from taxes on soft drinks.  You type in the state or city, estimate the size of the tax, decide what kinds of drinks it’s for, and push the  button.  Bingo.  California could raise about $1.8 billion a year from a 1 cent tax.

And the Department of Health and Human Service has hooked up with the Advertising Council for a new kids’ activity campaign on the Internet, this one using Maurice Sendak’s Wild Things tied in to a movie coming out in October.  I wasn’t so happy about the last such campaign, which featured Shrek and is still up on the site.  Shrek also advertises junk foods.  Maybe this one will work better?

We now have a piece mentioning the Smart Choices program in The Economist as well as a letter from Dr. Eileen Kennedy, the member of the Smart Choices program committee to whom the quotation about Froot Loops, “Better than a doughnut,” is attributed.

The Economist discusses the booming business of functional foods: “Consumers are swallowing such products, and the marketing claims that come with them.” It mentions the fuss over Smart Choices, but the best part is the caption to the illustration that comes with it.

It's practically spinach

And, I’ve been sent a copy of an e-mail letter to alumni from Dr. Eileen Kennedy, dean of the Friedman School of Nutrition Science and Policy at Tufts University, explaining her participation in the Smart Choices program:

Dear Friedman School Alumni,

There is an issue that has emerged as a result of a NY Times article that appeared in the business section on Sept 5, 2009. Since I believe I was grossly misquoted in the article and that the article does not accurately depict the Smart Choices program, I want to share with you some background on this program and my involvement.

In 2007, I was invited to join the Keystone Roundtable on Food and Nutrition. Keystone is a non-profit organization that brings individuals together around potentially controversial issues. The roundtable included health organizations, food companies, retailers, and academic researchers from a variety of U.S. universities. I was one of the academics who served pro bono on the roundtable. Initially, we met to discuss revisions to the FDA nutrition label. Ultimately, we decided to address the issue of Front of Pack Labels on food products. The final recommendations of the group were based on consensus science including the Dietary Guidelines for Americans, the FDA definition of healthy, WHO recommendations and the Institute of Medicine Scientific reports. The program that emerged from this meticulous process is called “The Smart Choices Program (SCP).” Food products that qualify as “better for you” get a check mark as well as disclosure of calories per serving and number of servings in a product.

I believe there are three major advantages to this program in addition to the rigorous scientific underpinnings.

First, the SCP is intended to improve food patterns at point of purchase – the super markets. To do this, food products are divided into 19 categories – based on research – that reflect how people buy food. All fruits and vegetables without additives automatically qualify.

Second – and a major plus – the program was tested prior to launch with consumers.

Finally, food companies who participate in the program have agreed to abandon their proprietary systems and adopt one system – the Smart Choices Program.

Thus, thousands of products using the SCP check mark will reach millions of consumers. It is a credit to the social responsibility of participating companies that because of the strict nutrition criteria, fewer of the individual food products will qualify for the Smart Choices Program.

As a non-industry board member, I have been targeted by negative emails, letters and even some phone calls. I regret that some of this hostility has been focused on the Friedman School and Tufts University and must note that I serve as an individual on the Smart Choices Program. Tufts University is not involved with it….

As nutritionists, we know that, in many ways, the science of nutrition is straight-forward. It is the translation of science into action that is often complex and can be contentious. Within our field, there are many opinions on how to improve the nutritional well-being of people worldwide. It is precisely at an academic institution like Tufts that we should have a respectful and open dialogue about these issues….For additional information, you may also want to go to www.smartchoicesprogram.com….

The letter gives me a chance to repeat a few points that I have made in previous posts (see Smart Choices, Scoring Systems) and on the general matter of corporate sponsorship of nutrition activities (tagged as Sponsorship).

First, this enterprise was paid for by participating companies to the tune of $50,000 each for a total of $1.67 million.  Social responsibility?  I don’t think so.  Companies usually get what they pay for.  Hence: Froot Loops.

Second, a comment on the research basis.  I have written extensively in Food Politics and in What to Eat about the influence of food companies on federal dietary guidelines and the compromises that result.  Even at its best, the process has to be impressionistic and cannot be either meticulous or rigorous.  The guidelines are meant to be generic advice for healthful eating.  They were never meant to be used – and cannot be used – as criteria for ranking processed foods as healthful.

The FDA standards for comparison to Daily Values on food labels are also worth a comment.  They were the basis of Hannaford supermarkets’ Guiding Stars program, which awards one, two, or three stars to foods that meet FDA-based criteria.  By those criteria, Froot Loops does not qualify for even one star.  If Smart Choices had relied on FDA criteria, such products would not be check marked.

Dr. Kennedy makes some excellent points in her letter and I particularly agree with one of them: nutritionists differ in opinion about how best to advise the public about diet and health.  Mine is that the Smart Choices program is a travesty and the sooner it disappears, the better.

September 29 update: The L.A. Times weighs in with a story (which quotes me).  It’s got another great comparison from a member of the Smart Choices committee:  “Cereal provides an array of nutrients and is a good breakfast…especially if the alternative is a sweet roll.”  My son, who saw the story, has this comment: “Hey! I think Froot Loops are a “Smart Choice.” After all, they have “froot,” don’t they? And maybe no nutritionist you know would recommend Froot Loops for breakfast, but what about for lunch or dinner?”

The terrific food writer and cookbook author, Martha Rose Shulman, gets lots of requests for nutrition information on her recipes.  What do I think about this?  Here’s her interview with me borrowed from Zester Daily (the site has the photos and links to her work):

Add Guesswork and Stir –  By Martha Rose Shulman (24 September 2009)

Many of the people who read my Recipes for Health column on The New York Times website are clamoring for me to include nutritional analyses with the recipes. Today you don’t have to be a nutritionist to add this kind of information. There are lots of computer programs that will calculate it for you. The problem is, none of the data is particularly accurate. So my editors and I resist. We question the value of the numbers and know that they’re too easy to tweak.

I don’t like nutritional data because I’ve always approached healthy eating not as a nutritionist, but as a cook. I’ve devoted my career to preparing delicious food that does no harm – not too caloric, not too fatty, with a focus on plant-based foods – because that’s the way I like to eat.

During my 20s I did toy with the idea of getting a degree in nutrition, but I always preferred the kitchen to the classroom. I audited an Introduction to Nutrition class, but stopped going when we had to memorize molecular formulas. I took biology courses at the University of Texas. My professor surely suspected I wasn’t destined for a future in science when I turned in a term paper composed as an epic poem, rhymed couplets and all, entitled “The Odyssey of my Breakfast.” (He gave me a B+.) Once I hit organic chemistry I dropped out and started teaching vegetarian cooking classes.

Still, I do want my NYTimes.com readers to be happy. So after I’d received several dozen emails asking why I don’t include such data with the recipes in my column, I emailed prominent nutritionist Marion Nestle and asked her what she would recommend if I were to get software to do the breakdowns.

“I don’t know any easy way to do this,” Nestle responded. “All software uses the same USDA database plus information from food companies, and all of it requires interpretation. A big reason has to do with measurement. If you give it even a moment’s thought, you realize that the nutrient contents have to vary with growing location, soil conditions, climate, transportation, and storage, so the amounts given in the database can only be approximations of what you are actually eating, particularly if you are not weighing the exact portions out. The data aren’t meaningless, but they don’t mean nearly as much as people think they do. I always laugh when I see calories listed as anything that doesn’t end with a zero. Measurements of nutrients just aren’t all that precise.”

Nestle directed me to the USDA National Nutrient Database, and I saw her point immediately. After typing in “broccoli,” I was offered 15 choices, including “broccoli, cooked, boiled, drained, with salt;” “broccoli, raw;” “broccoli, flower clusters, raw.” Then I had to indicate an amount, either in grams or cups (how do you measure a cup of broccoli florets?). But my recipes simply call for “1 bunch broccoli, broken into florets.” And how do they know how much salt I use? As often as not, I steam my broccoli — which I understand preserves more nutrients than boiling — but that wasn’t even an option.

I punched in garlic. The garlic cloves in the USDA database weigh 3 grams. I weighed my garlic cloves; the plump ones I like to use weigh 6 to 8 grams, the medium ones about 4 grams. Clearly the technicians at USDA do not come from the Mediterranean.

Nutrient analyses encourages us to see the food that we eat in terms of its carbohydrates, fats, proteins, vitamins and other micro-parts. But “nutritionism” doesn’t lead to better health. Michael Pollan makes this point eloquently in his book “In Defense of Food: An Eater’s Manifesto.” His seven-word maxim says just about all you need to know about a healthy diet: “Eat food. Mostly Plants. Not too much.”

Nestle concurs. “I am opposed to nutritional info,” she told me. “The basis of healthful diets is variety, relatively unprocessed foods, and not eating too much. Variety and processing matter because ‘real’ (relatively unprocessed) foods contain large numbers of required nutrients but in different amounts and proportions. If you vary food intake, you don’t have to worry about individual nutrients because the foods complement each other.”

The emails from my readers continue to arrive on a daily basis, but I have not yet bought any nutrition software. Marion urged me to “resist including nutrient analyses to the bitter end,” and so far, I’m holding firm.

I wouldn’t mind so much if I thought the data were reasonably accurate and could be put into context.  We know from studies using experimental animals that it is extremely difficult to induce nutrient deficiencies in animals that are fed a variety of foods providing sufficient calories.  The best way to avoid nutrient deficiencies is to eat a variety of minimally processed foods.  If you do that, you don’t have to worry about specific nutrients.  Vitamin D may be the one exception.  For that, get outside and expose your skin to some sun.  Even in winter!

Bon Apetit Management Company (“food services for a sustainable future”) offers an online guide to developing school gardens.  Called Student Gardens and Food Service, it is a step-by-step guide to planning a garden, growing food in it, using the food in the school’s food service program, and improving the soil through composting.  Should work for other prospective gardeners too!

Three items on the Smart Choices front (make that four – see below):

1.  Let’s start with the great video by ABC News [if the link doesn’t work, go to the ABC News site and search for Food Label Fight].  It features an incredulous Mark Bittman pulling check-marked products off supermarket shelves, along with Richard Kahn defending the program.  Kahn, as I discussed in What to Eat, defended the American Diabetes Association’s (ADA) implied endorsement of Post sugary cereals.  When Jane Brody wrote about this in the New York Times, the Association promised to remove its logo from the products and did so after a bit.

2.  The letter-writing campaign organized by Change.org has had the same effect: “Victory: Change.org Members Force Health Organizations to Back Away from Food Labeling Ploy.”

The new marketing program, called “Smart Choices,” is a front-of-the-package nutrition-labeling program designed in theory to help shoppers make smarter food choices.

But as the New York Times exposed last week, the selections are anything but healthy. One of the selections is Froot Loops, which was chosen, according to one board member, because “it’s better for you than donuts.” (No, we’re not kidding. We couldn’t make this up.)

Despite the program’s dubious standards, it maintained the appearance of legitimacy because researchers associated with three reputable organizations – American Diabetes Association, American Dietetic Association, and Tufts University – were on its board.

In response, thousands of Change.org members sent letters to the presidents of these three major research institutions urging them to remove their name from the program.

The result? All three organizations responded to the pressure this week by publicly distancing themselves from the food labeling scheme and officially asking Smart Choices to remove their name from its website and marketing materials – thereby publicly embarrassing and discrediting the program.

Fine, but this one isn’t over until the American Society of Nutrition (ASN) also extricates from its commitment to manage the program – a clear conflict of interest.

3.  The Institute of Medicine (IOM) is asking for nominations to a committee to study front-of-package labeling (what follows is edited from the request letter):

The IOM is searching for experts in the scientific, technical, and medical professions to be considered for a study committee titled Examination of Front of Package Nutrition Rating Systems and Symbols (Phase I). The sponsors are the CDC and FDA.   The Phase I committee will undertake a review of front-of-package nutrition rating systems and symbols…[and] will also plan for a Phase II.

Phase I will (a) identify front-of-package systems being used, (b) consider their purpose and overall merits, (c) identify the criteria underlying the systems and evaluate their scientific basis, (d) consider advantages and disadvantages, (e) plan Phase II which will consider the potential benefits of a single, standardized front-of-package food guidance system regulated by FDA (my emphasis).

Send the names of candidates to front-of-pack@nas.edu by October 5, 2009. You do not need to contact the individuals you nominate.

This is great news but I’m way too impatient.  This two-phase process will take years. Is the FDA really going to have to wait that long to take action on front-of-package labels such as Smart Choices?

FDA: How about issuing a moratorium on all front-of-package labels until the committees do their work?

4.  Update, September 24: On that very issue, Congresswoman Rosa de Lauro has asked the FDA to do an investigatation of the Smart Choices program.  Excellent idea!

I did a Q and A with Helena Bottemiller of the new food safety website, FoodSafetyNews.com about the politics of food safety.  It’s online at the site.  Here’s the text of the interview (absent the blurb and photograph):

Q: There has been a lot of rhetoric coming from Administration-appointed officials on food policy this year–on encouraging fruits and veggies, on promoting local food, on strengthening food safety. Do you think these ideas will make a big impact on the current food system, or are the institutional and political barriers to change too great?

A: It’s not one or the other; it’s both. Yes, federal support will encourage small farmers and organic production and these sectors will grow as a result, and that’s a good thing. But they still account for, and will continue to account for, only a tiny fraction of food production. I expect growth in alternative agriculture with big percentage jumps, but the base will be small for a long time. I think the question is whether the growth in alternative systems will place pressure on industrial agriculture to improve its practices. I hope so.

Q: You’ve written before about the “revolving door” at the U.S. Food and Drug Administration and the U.S. Department of Agriculture–where regulators have close ties to the sector that they regulate from moving between roles in government and industry. I know you’ve been supportive of Michael Taylor, a top advisor to FDA Commissioner Hamburg, despite his former ties to industry, because of his policy positions. Are we seeing a better revolving door?

A: Of course it persists and always will, and is a huge problem for governmental integrity. The Michael Taylor situation is not so simple. In some circles, his appointment is a deal-breaker; anti-GMO groups will never forgive him for his role in FDA approval and non-labeling of GM foods. Whether FDA will revisit the labeling issue, I have no idea–I wish it would–but Taylor has a long and consistently solid record in the food safety area. He performed food safety miracles at USDA in the mid-1990s and that makes him a good choice for food safety initiatives that I hope are coming at FDA. I think he needs to be given a chance.

Q: Do you think the Senate will address food safety this fall, and are you supportive of the bills? What do you think about the push back from small and sustainable agriculture folks?

A: I hope the Senate acts, and soon. If it doesn’t, FDA’s hands are tied and we can expect massive outbreaks of foodborne illness to continue unabated. Even so, Congress is not doing what everyone agrees needs to be done: create a single food safety agency with responsibility, authority, and resources to require safe food production from farm to table. Food safety is just like health care. Everyone knows what is needed but Congress is too corrupt to act.

As for small farmers: I think everyone producing food–no exceptions–should be using science-based food safety procedures with testing. Congress needs to make it possible for small-scale producers to do this. While getting local testing facilities in place, Congress also ought to provide for local slaughter. Both would make a big difference.

Q: In your opinion, what are the top five ways we could create a safer food supply?

A: 1. Require HACCP (science-based food safety regulations) with test-and-hold pathogens for all producers from farm to table.

2. Create a single food safety agency to monitor and enforce regulations, with adequate resources to do so.

3. Ban the use of antibiotics in animal agriculture for non-therapeutic purposes.

4. Do a major national education campaign for hand washing (and require restaurants to provide hot water, soap and towels for that purpose).

5. Reform election campaign laws so elected representatives can focus on public health rather than corporate health.

My Sunday (September 20) column in the San Francisco Chronicle deals with the sugar “crisis” I discussed here a few weeks ago:

Q: I saw you on “The Colbert Report” (Aug. 19) talking about sugar policy. Explain, please. I don’t understand why sugar policy is a topic for Comedy Central.

A: Neither did I until I saw Stephen Colbert douse himself with 5 pounds of sugar over the impending “crisis.” We have a sugar crisis? According to processed food manufacturers, we are about to run out of sugar. Horrors!

Earlier in August, Kraft and other food processors asked the U.S. Department of Agriculture to raise the quota on sugar imports. Sugar availability, they complained, is the lowest in years and it’s the USDA’s fault.

The USDA firmly controls amounts of sugar (sucrose) produced by American cane and beet growers through quotas. It even more firmly controls sugar imported from other sugar-growing countries through quotas and tariffs. And as corn is increasingly diverted to biofuels, less high-fructose corn syrup (HFCS) is around to make up the shortfall.

Should we worry?

The shortage is no crisis. At worst, it is temporary and will end as soon as the 2009 harvest is in. But processed food makers are right about one thing: Sugar is the most absurdly protected agricultural commodity in America.

For decades, no matter what it cost on the world market, quotas and tariffs ensured that Americans paid two or three times as much for sugar. High sugar prices cost American consumers about $3 billion a year. But because this works out “only” to about $10 per year per capita, nobody much cared.

If you think of $10 as trivial, you won’t give sugar protectionism another thought. But if you look at this system as an unnecessary transfer of $3 billion a year from 350 million Americans to a few thousand sugar growers and processors, you can understand why sugar policy is ripe for satire.

Here’s how the system works:

Quotas allow U.S. producers to grow only specified amounts of sugar cane and sugar beets each year, for which the USDA guarantees a higher-than-market price. Beets get 55 percent of the quota; cane gets 45 percent. The quotas are fixed. If you want to grow sugar beets in your backyard and sell the sugar to USDA at the favorable support price, too bad for you. You only get a quota if you already have a quota.

As for tariffs, the 2008 Farm Bill requires 85 percent of total sugar in the United States to be produced domestically, and allows only 15 percent to be imported. That 15 percent is distributed through quotas awarded to about 20 countries.

Above and beyond the quotas, imported sugar is subject to high tariffs. Mexico is an exception. Under NAFTA, Mexico gets to sell us as much sugar as it wants at the favored price. However, few countries in Africa hold quotas. What if you are an African cane-growing country and want the high quota price for your sugar? Not a chance.

Imports are never supposed to top 15 percent, so the USDA can’t increase the percentage. But we participate in the World Trade Organization, which obligates us to take world market sugar. Oops. These policies don’t match. Processed food makers must think the contradictions will allow the USDA to let in more sugar. Maybe, but the legalities are not yet decided.

Mind you, sugar producers and processors love this system. They argue that it keeps jobs in rural America and eliminates dependence on foreign sugar imports. To make sure nobody scrutinizes the system too carefully, they formed cooperatives to avoid antitrust laws.

Sugar producers are among the most generous and equal-opportunity contributors to congressional election campaigns, giving to both Democrats and Republicans. For decades, administrations of both parties have tried to end sugar supports. No such luck.

A shift’s brewing

Policies may change, because the gap between the prices for domestic and world market sugar – and for high fructose corn syrup – has narrowed recently. Sugar is now at war with HFCS. As HFCS is increasingly known as a key junk food ingredient, manufacturers are rushing to replace it with sucrose, which they can tout as “natural and unprocessed.”

Other sugar issues are also ripe for comedy. Most sugar beets are now genetically modified, leading many companies to avoid using beet sugar. In the South, sugar cane production pollutes the Everglades, which is costing billions of dollars to clean up. Investigative reporters are riveted by the feudalistic labor practices of sugar plantations.

And then there’s Cuba. Until the Castro revolution, that’s where we got most of our imported sugar. When relations improve, will Cuba get a sugar quota?

If sugar is responsible for any true crisis, it is because of its role as an ingredient in processed foods. Cheap sugar reduces the cost of candy and soft drinks. Cheap junk foods are highly profitable. Otherwise, our sugar policies make no sense in today’s global marketplace.

But we would be healthier eating less sugar, anyway. So here’s my solution to the non-crisis: Eat less sugar!

Someone whom I do not know, Zhiqi Yin, sent this message to this site in two places today:

I saw this on Twitter. “I am so sick of food Nazis like Marion Nestle who makes lots of money criticizing others. Marion, disclose who is paying you and $ you make.”  Kindly tell your audience when can we expect to see your financial disclosure telling us how much you make from writing books critical of the food industry, money you receive from speaking and other engagements, and grant and consulting money and your sources? Thank you.

Despite its unfriendly tone, the question is an important one in an era when opinion is so easily bought and sold, and evidence so increasingly demonstrates the influence of corporate funding on the outcome of tobacco, drug, and food research.

The purpose of food company influence is of course to increase sales and profits. In contrast, the goals of public health are to improve dietary intake and other health behaviors so that people will live longer and more active and productive lives.  Those of us devoted to public health, however, often find that our goals conflict with those of sales and profit.

As I explained in my book, Food Politics, I am in an unusual position for an academic researcher and I take the resp0nsibility that comes with this position quite seriously.  I am a tenured professor at New York University, a job that requires teaching, research, and public service (of which this blog is part).  For doing these things, I receive a full, hard-money salary that allows me to remain independent of corporate influence and gives me the freedom to write and speak as I think.   I do not need grants to do my research and writing.  I accept honoraria from some speaking engagements (these take substantial preparation and travel time), compensation for some writing assignments (ditto), and occasional royalties from sales of my books (which take years to research and write).  To fulfill my professorial obligations, I do not need to consult for pay or accept honoraria from food companies or other for-profit enterprises.

I wish that my books were best sellers.  I wish everyone would read them and think hard about what they say.   And I wish that more nutrition academics and professionals could be independent of corporate influence.

I am able to take full responsibility for what I think, say, and write.  I am paid to say what I think, not what someone else wants me to think or because what I write or say will help sell food products.   This is indeed a privilege and I am grateful for it.