JAMA Internal Medicine has just published an editorial I wrote: Preventing Obesity—It Is Time for Multiple Policy Strategies

As it explains, it is a commentary on a research article by Joshua Petimar, et al, Assessment of Calories Purchased After Calorie Labeling of Prepared Foods in a Large Supermarket Chain  

Both papers are behind paywalls, but here are the key points of the supermarket article:

Question  Was calorie labeling of prepared foods in supermarkets associated with changes in calories purchased from prepared foods and potential packaged substitutes?

Findings  In this longitudinal study of 173 supermarkets followed from 2015 to 2017, calories purchased from prepared bakery items declined by 5.1% after labeling, and calories purchased from prepared deli items declined by 11.0% after labeling, adjusted for prelabeling trends and changes in control foods; no changes were observed among prepared entrées and sides. Calories purchased from similar packaged items did not increase after labeling.

Meaning  Calorie labeling of prepared supermarket foods was associated with overall small declines in calorie content of prepared foods without substitution to similar packaged foods.

I was really interested in this study because the “large supermarket chain” that supplied reams of data was so obviously Hannaford, which has long been ahead of the curve in trying to encourage customers to make healthier food choices.

In 2005, Hannaford initiated a Guiding Stars program that ranked–and still ranks–products by giving them zero to three stars depending on what they contain.

I wrote about the first-year evaluation of this program way back in 2006.  It did help customers to make better choices.

Now, all these years later, the FDA is contemplating doing some kind of front-of-package label.  As I said, Hannaford is way ahead.

But the point of my editorial is that single interventions rarely do better than what this study found.

I argue here for trying multiple strategies at once:

My interpretation of the current status of obesity prevention research is that any single policy intervention is unlikely to show anything but small improvements.

Pessimists will say such interventions are futile and should no longer be attempted.

Optimist that I am, I disagree.  We cannot expect single interventions to prevent population-basedweight gain ontheirown,but they might help some people—and might help even more people if combined simultaneously with other interventions.

….Widespread policy efforts to reduce intake of ultraprocessed foods through a combination of taxes, warning labels, marketing and portion-size restrictions, dietary guidelines, and media education campaigns, along with policies for subsidizing healthier foods and promoting greater physical activity, should be tried; they may produce meaningful effects.

Politically difficult? Of course. Politically impossible? I do not think so.

Unless we keep trying to intervene—and continue to examine the results of our attempts—we will be settling for the normalization of overweight and the personal and societal costs of its health consequences.

Here’s Ted Kyle’s commentary on my commentary on ConscienHealth.

One of the points of my Monday “industry-funded study of the week” posts is that companies usually get the results they want.  Exceptions do exist.  Here’s one of those rare ones.

The study: Changes in Biomarkers of Non-Alcoholic Fatty Liver Disease (NAFLD) upon Access to Avocados in Hispanic/Latino Adults: Secondary Data Analysis of a Cluster Randomized Controlled Trial.  Lorena S. Pacheco, Ryan D. Bradley, Cheryl A. M. Anderson and Matthew A. Allison.  Nutrients 2022, 14(13), 2744; https://doi.org/10.3390/nu14132744

Rationale: Non-alcoholic fatty liver disease (NAFLD) is a common cause of abnormal liver functions tests and of increased increased risk for morbidity and mortality.  Monounsaturated fatty acids such as those in avocados havew been associated with improved NAFLD-related markers.

Hypothesis: “We hypothesized compared to low avocado intake, high avocado intake would have a beneficial effect on oxidative stress and hepatic health indicated by greater reductions in liver function tests and NAFLD fibrosis score.”

Results: “No statistically significant differences were observed between low and high avocado allotment groups” in anything measured.

Conclusion: “Varied intake of avocados resulted in no effects on biomarkers of NAFLD in healthy adults, free of severe chronic disease.”

Funding: “The parent research was funded by The Hass Avocado Board.”

Conflicts of interest: “The authors declare no potential conflict of interest. All authors report the grant from the Hass Avocado Board….The Hass Avocado Board funded the parent trial and provided all the trial’s avocados at no cost to study participants. The parent trial funder had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.”

Comment: The authors say they have no conflicts of interest but I think they do; the Hass Avocado Board paid for a study of the effects of avocados on NAFLD markers.  Such payments are well established to predict results that favor the sponsor’s interests.

Nevertheless, the results came out contrary to those interests, and the authors were unambiguous in saying so.  In this case, the assertion that the sponsor had no role seems credible, even though it often is not.

High marks to the authors. 

Douglas Frantz & Catherine Collins.  Salmon Wars: The Dark Underbelly of America’s Favorite Fish.  Henry Holt, 2022.  (355 pages)

I was asked to do a blurb for this one.  Here’s what I said:

Salmon Wars is a deep dive into the damage caused by current fish-farming methods to ocean environments, wild fish and their habitats, and to the farmed fish themselves.  It is also a dismal account of the failure of governments to stop such practices.  Salmon farming needs reform.  Until it does, read this book, and you will never eat farmed salmon again.

As for what to do about the hazards of salmon farming—lice, pollution, reduction of wild salmon, escape from pens, requirement for feeder fish and the depletion of those stocks, the authors have three suggestions:

(1) Know the risks and rewards of eating farmed salmon and insist on more transparency.

(2) Take responsibility for insisting on better ways of raising farmed salmon.

And (3)

The third step is for governments to stop putting a thumb on the scale when weighing economic interests versus the public wellbeing.  Governments should take responsibility for protecting the environment and public health.  They should adopt strict curbs on the use of chemicals by salmon farmers.  They should require notification of all relevant authorities of every escape or suspected escape, and those reports should be made public.  Food labels should be thorough, accurate, and reflect how the salmon was raised…There must be similar global efforts to protect the public health and the welfare of salmon.

This is a hard-hitting book and, as you might expect, it’s gotten some pushback.

Saving Seafood, a group that “conducts media and public relations outreach on behalf of the seafood industry,” says “New ‘Salmon Wars’ Book Is Full of Fictions. Here Are the Facts.”  Here are a couple of examples:

FICTION: Farmed salmon are crammed into cages.

FACT: Salmon occupy less than 4 percent of a typical marine cage. Farmers intentionally keep stocking densities low so fish have room to swim, grow, and mimic natural schooling patterns.

Farmers take great care to ensure the well-being of their salmon. Fish are vaccinated against several diseases, and pristine marine cage conditions are ensured with proper siting, regular fallowing (leaving sites unused), underwater cameras, and diver inspections.

FICTION: Farmed salmon are doused with pesticides and antibiotics.

FACT: Antibiotic use on salmon farms is far lower than that of any other agricultural animal producing industry in the world. In the rare instances when treatment is necessary, it is prescribed and overseen by licensed veterinarians under the oversight of government regulators.

In 2012 I visited a salmon farm above the Arctic Circle in Norway’s and wrote a post about it.

That one looked pretty good.  Now?  Others?  Who knows?

My recommendation: Visit one if you can.  Short of that, read this book.  Than decide what you think are the facts.

I’ve long been mystified by why the Chinese government promotes milk consumption so strongly and why Chinese grocery stores, like this one I saw in Beijing, devote so much space to selling dairy foods, when they can’t comfortably digest the lactose in milk.

Asian and many other populations stop making the enzyme that digests lactose sugar a few years after early childhood and become intolerant to that sugar.  So why continue to consume dairy products?

Nature has a new article shedding some light on the question of whether lactose tolerance is inducible.  Do people who eat dairy products develop tolerance?  Or is it just that people who can eat dairy do eat dairy?

• Dairying, diseases and the evolution of lactase persistence in Europe:  Here we provide detailed distributions of milk exploitation across Europe over the past 9,000 years using around 7,000 pottery fat residues from more than 550 archaeological sites. European milk use was widespread from the Neolithic period onwards but varied spatially and temporally in intensity…In the UK Biobank cohort of 500,000 contemporary Europeans, LP [lactose persistence] genotype was only weakly associated with milk consumption and did not show consistent associations with improved fitness or health indicators.

The authors propose:

• Lactose intolerant people drank milk when it became available.
• Under conditions of famine or exposure to diarrhea-inducing pathogens, consuming lactose made the diarrhea worse.
• This acted as a selection pressure for continuing production of the lactase enzyme.
• But population fluctuations, settlement density and wild animal exploitation are better explanations for the persistence of the enzyme than the extent of milk usage.

An editorial expands on these ideas.

• The mystery of early milk consumption in Europe:  The authors propose instead two alternative evolutionary avenues to explain the rise in prevalence of alleles for LP, related to [1] shortages of food or [2] the consequences of increased exposure to disease-causing agents (in relation to animals, crops or from living in close proximity to others without proper sanitation). In either situation, or in a combination of both scenarios, an individual’s ability to diversify their diet away from crops and meat, which might be affected by shortages, and to take advantage of the hydration and calories afforded by dairy products, could be extremely beneficial.

Or you can listen to a podcast:

• How humans adapted to digest lactose — after thousands of years of milk drinking:  Humans have been drinking milk for thousands of years, but it seems that they were doing so long before the ability to digest it became prevalent. Then, around 2,000 years ago, this ability became common in Europe, presenting a mystery to researchers — why then? Now, by analysing health data, ancient DNA and fats residues from thousands of ancient pots, scientists have worked out what caused this trait to suddenly spread throughout Europe.

And take a look at a Nature article from 2019:

• Early Europeans bottle-fed babies with animal milk: Writing in Nature, Dunne et al. describe an analysis of spouted vessels found in ancient graves of infants in Germany that indicates that these artefacts contained animal milk. This evidence suggests that such vessels were used to feed animal milk to children, providing crucial insight into the diet of developing infants in prehistoric human populations.

The dairy industry says a little lactose is harmless to people who are lactose intolerant, and milk’s nutritional benefits outweigh its risks.  Early Europeans—and today’s Chinese—must think so too.

And sorry, but I can’t resist:

Q.  Why do cows have hooves?

A.  Because they lactose.

I’m getting caught up on reports this week.  Here’s one from the US Agency for International Development:  COVID-19 and Nutrition Analytical Framework

The purpose of the Framework:

• Allow policymakers and implementers to better track the interaction of the COVID-19 pandemic and nutrition
• Provide a tool for planning policies, programs, and interventions
• Help identify data gaps
• Support a systems approach to addressing problems “caused, increased, or intensified by the COVID-19 pandemic”

The Framework:

What I like about this Framework is how it so clearly identifies the upstream system levels of intervention: food, health, social, education, and infrastructure.

It’s also interactive, but for that you have to go to its source and click on each section.

Thanks to Lisa Young and three other readers for sending along this one.

The press release: New Research Finds Consumption of Peanuts Supports Weight Loss, Lowers Blood Pressure and Improves Glucose Levels

The Study: Petersen, K.S.; Murphy, J.; Whitbread, J.; Clifton, P.M.; Keogh, J.B. The Effect of a Peanut-Enriched Weight Loss Diet Compared to a Low-Fat Weight Loss Diet on Body Weight, Blood Pressure, and Glycemic Control: A Randomized Controlled Trial. Nutrients 2022, 14, 2986. https://doi.org/10.3390/nu14142986.

Conclusion: Intake of 35 g of peanuts prior to two main meals per day, in the context of an energy-restricted diet, resulted in weight loss comparable to a traditional low-fat weight loss diet without preloads. Greater systolic blood pressure reductions were observed with peanut intake, which may lower cardiovascular disease risk.

Funding: This research was funded by The Peanut Institute…The funder had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Conflicts of Interest: J.B.K., P.M.C. and K.S.P. received a grant from The Peanut Institute to conduct this study. The funder had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Comment: The funder had no role?  That’s what they all say.  That may be true in this instance, but but much research demonstrates otherwise, and funders are unlikely to pay for studies that might give them unfavorable results.

The underlying purpose of this study was to demonstrate that if you are on a weight-loss diet, you can eat lots of peanuts and still lose weight: “70 g/d of peanuts may be included in an energy-restricted weight loss diet without attenuating weight loss over a 6-month period.”  Of course you can, if you stick to a low-calorie diet.

I’m all for eating nuts.  Substituting them for ultra-processed snack foods is a reasonable approach to dieting, but don’t expect to lose any more weight eating nuts than from any other source of calories.  This is a marketing study, aimed at encouraging you to eat more peanuts.

R.C. Harris.  Party Food: A Partisan History of Food & Farming in America.  Common Ground, 2021 (147 pages plus an index).

The author, a politics professor at Washington & Lee University, sent me a copy of her book, which I have now read.

I love the cover.

This is a book about the differing views of Farm Bill provisions among Democrats and Republicans.

Harris points out, correctly, that recent books about food policy in the United States, mine among them, say practically nothing about the role of the two political parties in deciding food issues.  Here, she corrects this omission.

She does so using a sports analogy–red and blue teams with one goal: to win.  A brief excerpt:

Setting the Stage: Farmers on Welfare in a Capitalist Society

The main problem in our story is that farm policy is really about giving farmers federal dollars to stay in business—and this idea tends to divide the red team from the blue team.  The history of modern farm policy in the United States is essentially the history of social welfare policy—a policy designed to prop up the incomes of farm families…As a nation of independent, hardworking, self-sufficient citizens and immigrants, America has always been more likely to embrace capitalism and less likely to expect government support than nations with a history of kinds, vassals, and peasants.  This means America is much more centrist and market-oriented in its economic policy, making welfare the exception rather than the rule. (p.53)

I get what she’s saying and her points are worth considering, but I wish she had used a word other than “farmers.”  The ones who get corporate welfare in America are not your small subsistence farmers or even those of medium size.

A more precise term here would be Big Agriculture.

The Farm Bill is welfare for the rich.  That’s why the red team is for it.

But her contention that the food movement needs to pay more attention to party politics demands attention.

Voting really matters to our players on the field.  In fact, we learned that partisan farm policy is really field policy—what will keep the team on the field.  And, interestingly enough, this has a lot to dow with what is in the fields and on the tables (and on the menus, and in the regrigerator, and for sale at the store or local farmers market) where the players are elected.  In other words, political teams want to be re-elected so they can keep making political plays.  (p. 131)

As I keep saying, if you want the food movement to have power, run for office.

Maybe it’s time for a third team?