Search results: Ultra processed foods

Just because all of the major nutrition professional organizations partner with food companies, does not make it a good idea.  If nothing else, partnerships with food companies raise reputational risks.  They give the appearance of conflicted interests, as David Ludwig and I warned in 2008.  I have also written about the hazards of food industry sponsorship of professional organizations in Food Politics, Soda Politics, and Unsavory Truth.  Here’s what they are doing now.

Academy of Nutrition and Dietetics (AND, formerly the American Dietetic Association)  OOPS.  My error.  This should be the American Diabetes Association (even worse).  Abject apologies.  This is what I get for not reading more carefully.  Apologies again.

If I seem to be picking on AND, it’s because it is bigger and gets into more trouble than other nutrition professional societies.

The latest example: According to Reuters, a former AND officer, Elizabeth Hanna, has sued the organzation for “firing her for objecting to what she called a “pay to play” scheme to promote the no-calorie sweetener Splenda.

In its 2022 annual report, the ADA said Splenda was one of a group of “elite” supporters that had given more than $1 million, along with Bayer Healthcare, Blue Cross Blue Shield of Illinois, Helmsley Charitable Trust and others.

On its website, Splenda publishes “diabetes-friendly recipes,” endorsed by the ADA. Hanna, a registered dietitian nutritionist, said she refused to approve the endorsement of several of these recipes in July.

…The U.S. Centers for Disease Control and Prevention states on its website that some studies have found possible health risks associated with the sweeteners, but that more research is needed.

American Society for Nutrition (ASN)

I am a member of this society and raise objections every time I get something like this in my e-mail.

Sponsored Webinar: Oral Health and Nutrition: Imperative for Healthy People 2030 and US Dietary Guidelines   Sponsored By: Mars Wrigley and the Oral Health Alliance.  The 2020-2025 Dietary Guidelines (DGA) identified dental caries as a major diet-related chronic disease of public health concern….

Doing this sort of thing risks reputation.

Evidence:  In a video on ultra-processed foods, the Financial Times identifies the ASN as “food industry advocacy group.”

The ASN’s executive director assures me they will ask for a correction.

Society for Nutrition Education and Behavior

Et tu?

It just announced a webinar, “Latinos love affair with Mangos: Maintaining Generational Food Traditions to Improve Health Outcomes.”

This is “a webinar sponsored by the National Mango Board, SNEB Organizational Member.”

The mango is…one of the world’s most popular fruits, and a staple food across Spanish speaking countries of North America, South America, and the Caribbean. Beyond its culinary popularity, an expanding body of research shows associations with mangos and risk reductions for inflammation and metabolically- based chronic disease, many of which disproportionately impact Hispanic American populations.

Mangos as opposed to any other fruit?

I am also a member of this society.

Overall comment

Are the reputational risks—and the loss of integrity—worth the money?  I don’t think so.

I received an e-mailed news release from the UN Food and Agriculture Organization (FAO) about its latest report.

The press release headline: Hidden costs of global agrifood systems worth at least $10 trillion.  154-country study makes case for true cost accounting to guide policy.

Our current agrifood systems impose huge hidden costs on our health, the environment and society, equivalent to at least $10 trillion a year, according to a ground-breaking analysis by the Food and Agriculture Organization of the United Nations (FAO), covering 154 countries. This represents almost 10 percent of global GDP.

According to the 2023 edition of The State of Food and Agriculture (SOFA), the biggest hidden costs (more than 70 percent) are driven by unhealthy diets, high in ultra-processed foods, fats and sugars, leading to obesity and non-communicable diseases, and causing labour productivity losses. Such losses are particularly high in high- and upper-middle-income countries.

This report, FAO says, presents initial cost estimates.  A report next year will focus on ways to mitigate these costs.  Governments, it says, “can pull different levers to adjust agrifood systems and drive better outcomes overall. Taxes, subsidies, legislation and regulation are among them.”

The FAO director says: “the future of our agrifood systems hinges on our willingness to appreciate all food producers, big or small, to acknowledge these true costs, and understand how we all contribute to them, and what actions we need to take. ”

The report urges governments to use true cost accounting to address the climate crisis, poverty, inequality and food security.

True cost accounting (TCA), according to the report is:

A holistic and systemic approach to measuring and valuing the environmental, social, health and economic costs and benefits generated by agrifood systems to facilitate improved decisions by policymakers, businesses, farmers, investors and consumers.43

Translated, this means trying to assign numbers to the externalized and hidden costs of food production and consumption, meaning not just what you pay at the cash register but also the costs you pay in other ways for health care, animal welfare, biodiversity, polluted water and soil, and climate change.

These, says this report, add up to about $12.7 trillion a year.

The idea is to get food producers to pay their fair share of these costs—issues of accounting and accountability (according to the Scientific Group of the UN Food Systems Summit). 

The report comes with a big collection of resources:

• Read the full digital report
• Read the In Brief
• Read the Interactive story: Beyond the price tag
• Watch the Video: State of Food and Agriculture 2023. Revealing the true cost of food to transform agrifood systems
• Read the press release: Hidden costs of global agrifood systems worth at least $10 trillion

Read the background papers:

• Hidden costs of agrifood systems and recent trends from 2016 to 2023
• Revealing the hidden costs of agrifood systems to enhance their value
• Accounting for the hidden costs of agrifood systems in data-scarce contexts
• The role of true cost accounting in guiding agrifood businesses and investments towards sustainability
• True cost accounting applications for agrifood systems policymakers

That should be plenty to keep us all busy for quite a while.  Enjoy and ponder.

I was in Mexico City last week giving the keynote at the FoodTech Summit & Expo.   I could hardly wait to get to the nearby Chedraui supermarket to see what the Mexican warning labels on food packages looked like in practice.

Mexico has high obesity prevalence, especially in children (~35%).  Public health officials hope the warning labels will alert the public to avoid overconsuming processed foods.

Here’s what I saw.

I.  It looks like at least half the products on shelves carry warnings of excessive salt, sugar, saturated fat, or calories, or artificial sweeteners.

II.  One of the regulations says that if a product aimed at children requires a warning label, it cannot display cartoon characters.  For products made before the law, supermarkets comply by pasting stickers over the cartoons.

III.  Food companies are doing everything they can to hide the warning labels.  They make sure the warnings are hidden when they stock the packages on shelves (the only reason you can see the two bottles with the warnings is that I turned them around.

The warnings must be working.  Food companies are evading, undermining, and fighting the new regulations.  Several lawsuits are in progress.  I will be following their progress with great interest.

My messages to the food technology congress:

• Do not make ultra-processed junk food.
• Stop fighting public health measures.

My distant* but dearly loved cousin, Michael Kravit, sent this from Taiwan.  Seems like a really good idea.

I’m working on a book chapter on snack foods (for an updated edition of What to Eat) and I counted the number of feet of shelf space devoted to snacks—chips, crackers, cookies, toaster pastries, candies, etc—in the Ithaca Walmart: 4,100 linear feet, or 0.8 mile.

OK.  Some of them are nuts or dried fruit.  But the great majority?  Mostly ultra-processed and highly profitable to their makers.

*Definition of a distant cousin: he’s the grandson of my first cousin, which I think makes him twice removed.

Poisoned, the food safety film featuring the lawyer, Bill Marler,  is now available to watch on Netflix.

I wrote about earlier when I saw it at the Tribeca Film Festival.

It’s totally worth watching, and not only because I have a cameo in it.

Bill Marler explains why.  I reproduce his post with permission.

After Netflix Poisoned – What would I do with a Food Safety Magic Wand?

By Bill Marler on August 4, 2023

Over two months ago, while watching the premiere of the documentary, “Poisoned,” at the Tribeca Film Festival in NYC, I got thinking again about how little in the past 30 years I feel I have moved the needle on food safety – pathogens and certainly, human nutrition.  Now that “Poisoned” is up on the Netflix platform, it has become the most watched documentary in the world – at least for the last few days.

The real issues to me is how do we engage the food industry, policy makers, academics and most importantly consumers, to focus on driving the numbers down on the pathogens that kill us quickly and the products that kill us over time?

I will focus on pathogens as I have for the last 30 plus years. I will leave it to some very smart people who are rightly concerned about the millions of us who become sick and die due to inadequate nutrition – especially the millions of illnesses and deaths due to heart disease, diabetes and obesity caused by ultra-processed foods, salt, sugar, and fat.

There is so much to do, and the list is long. So, what would I do with a Food Safety Magic Wand on day one?

1. Vaccinate. The first thing I would do is mandate that all food service workers be vaccinated against hepatitis A.  Perhaps to some, not the most pressing food safety issue, but it is forefront of my mind.  In the past few months, I finished up litigation around a hepatitis A outbreak involving one ill food service work who infected nearly 50 people, hospitalizing most, killing four and causing two liver transplants.  With regret, I forced a family-owned restaurant chain to file for bankruptcy.  All of this could have been prevented by a safe vaccine that has been around for decades.  It is time for the restaurant industry and the CDC to step up.

• Investigate. Invest in public health surveillance over human pathogens, like, Listeria, E. coli and Salmonella, etc.  A dirty truth is that most culture-confirmed illnesses are never attributable to a food source, so people never know what sickened or killed them. Not because the source was not food, but because we fail to invest adequate resources in the epidemiologists that investigate illnesses and track those illnesses to the cause. Tracking illnesses to the cause gets tainted product off the market and helps us all understand what products and producers to avoid.  We need to continue to invest in the science of whole genome sequencing, so we know with certainty which pathogens are causing which illnesses. Foodborne illness epidemiology helps us understand the root cause of an outbreak and helps prevent the next one from happening at all.

• Relegate. Allow public health officials access, especially during an outbreak investigation, to all areas around farms that grow fruits and vegetables.  It is long past time to allow investigators access to neighboring cattle, dairy, chicken, or hog operations that spill billions of deadly pathogens into the environment, via air or water.  We need to think of our growing regions as an integrated system and that all sectors responsible need to play a role.  Access allows investigators to understand the likely cause of an outbreak, and again, what can be done to prevent the next one.

• Advocate. Make all pathogens that can sicken or kill us adulterants.  In 1994 Mike Taylor making E. coliO157:H7 and adulterant has saved countless lives and has saved the beef industry from my lawsuits. We can do the same for all food producers, especially chicken, turkey, and pork.  Remember, in the 1990’s nearly all the lawsuits I filed were E. coli cases linked to ground beef.  Today that is zero.  Think about it.

• Educate. Give everyone a thermometer and provide better education to middle and high school teachers and students around food safety and human nutrition policy, not in a dry, technical way, but by sharing engaging history, microbiology, patient stories, and case studies. We need to teach how and why our food can be unsafe and what consumers can do about it.

• Consolidate. Finally, make a single federal agency out of USDA/FSIS, FDA, and the food safety parts of CDC, NOAA, and EPA, to oversee food safety and human nutrition. Making food safety and human nutrition its own agency would help increase governmental accountability,  close regulatory loopholes, facilitate the collection and sharing of information and facilitate critical change.  I might have a suggestion for someone to run it.

With the CDC estimating 48,000,000 are sickened each year, 125,000 hospitalized, and 3,000 die from food, preventing pathogenic foodborne illness is no simple matter.  And, if you consider the millions that are impacted by the lack of adequate and safe nutrition, we have a lot to do.  However, it can be done, and the six ideas above are a small start.

“Doing anything is better than doing nothing,” my Marine drill sergeant father used to say.  He used to require my brother and I to make our beds every morning and bounce quarters on them.  For the longest time I thought this was punishment.  But it was not punishment, it was accomplishment, that you could build on for the rest of the day.  Doing “little” things, like the six things above, are accomplishments. Doing them starts a process that will continue to make all our lives just a little bit safer.

A reader who wishes to remain anonymous sent me an account of the development of the new Nordic Nutrition Recommendations, pointing out what they do not contain: a recommendation to reduce ultra-processed foods [Note: this is an updated and slightly corrected version of what was first posted on July 9].

Indeed, on pages 253-255 (this is a long report), you will find this statement:

The backstory here is one of effective food industry lobbying.

The Nordic Nutrition Recommendations do not say:  reduce consumption of ultra-processed foods.

The story begins with two authors who were asked to sum up the health effects of ultra-processed foods, and to advise the committee writing the recommendations.  They did so.  Their initial background paper concluded with these recommendations:

(1) Limit the consumption of ultra-processed foods.

(2) Choose less processed form of foods within each food group when possible.

(3) Cook at home and choose freshly prepared foods when eating out.

The committee revised the background paper.  It omitted the three recommendations but concluded:

Recommendations to limit ultra-processed foods, and choose foods of lower processing level, when possible, may enhance and support several of the existing FBDGs [food-based dietary guidelines] and help individuals select more healthful foods that align with the overall NNR2022 [last years Nordic Nutrition Recommendations] guidelines within each food category. For example, such advice would support choosing plain, unsweetened yoghurt instead of flavored, sweet yoghurt; choosing oatmeal or muesli based on grains, nuts, and dried fruits over sweetened, refined breakfast cereals; and choosing chicken breast/thighs over chicken nuggets.

The revised document was opened for public comment and a hearing.  A great many representatives of food companies objected to saying anything negative about ultra-processed foods.  This Excel spreadsheet lists the 60 people who commented and their main objections.

After the hearing, the committee preparing the recommendations wrote a draft report based on the comments.  The section on ultra-processed foods is on pages 152-153.  It begins:

There is currently no consensus on classification of processing of foods, including UPFs. The dominating UPF classification (NOVA classification group 4) contains a variety of unhealthy foods, but also a number of foods with beneficial health effects.

It also says:

Health effects. Regular intake of UPF encourages over-eating and intake of foods in the UPF category of the NOVA classification has been suggested associated with increased risk of obesity, cardiovascular disease, type 2 diabetes, cancer, depression, and premature mortality …However, no qSRs [qualified systematic reviews] support these suggestions.

These negative views of the UPF concept differ from the views of the background document (however politely stated) and clearly were influenced by the overwhelmingly negative views of food industry representatives.

The draft report also was opened for public comment.  These comments also are listed in an Excel document. Some favor the changes benefiting the food industry; others—but many fewer—object to them (these last are summarized in yet another document).

The final Nordic Nutrition Recommendations are somewhat of a compromise between public health and food industry views, but generally favor the food industry position.  The new Nordic Nutrition Recommendations are less critical of the UPF concept, but do not say “reduce consumption of ultra-processed foods.”

The NOVA food classification system, which first defined ultra-processed foods, was published by Carlos Monteiro, a professor of public health at the University of São Paulo, and his colleagues in 2009.*  About the Nordic recommendations, my informant writes:

I have come to realize that this is not at all about evidence. It’s about power, and who gets to define what’s important in nutrition science. “The establishment” refuses to accept that someone from Brazil, a country they regard as inferior, should be allowed to tell them they have been wrong in their nutritionism-approach. They claim NOVA is based on ideology, not science….And now this is getting in the way of public health.

My take-home lesson:  The food industry came out in force on this issue and greatly overwhelmed the few comments of public health advocates.  The message here seems clear: public support for reduction of ultra-processed food needs to be widespread, clear, and forceful.

*Definition of ultra-processed foods

• Industrially produced
• Bearing no evident relationship to the foods from which they were derived
• Formulated to be irresistably delicious (if not addictive)
• Usually containing color, flavor, and texture additives
• Often high in salt, sugar, and fat (but these are culinary ingredients that do not in themselves make foods ultra-processed)
• Cannot be made in home kitchens (because they are industrially produced and contain ingredients unavailable to home cooks)

Addition

An additional document was sent to me after this post and the response from nutritionists involved in the NNR, which I posted the following week.  It is from the authors of the background document expressing their concerns about the changes made.

UNICEF does not want its statements to be compromised by conflicted interests with food and beverage companies that make formula or foods for children.

Here’s how UNICEF will be dealing with the food and beverage interests.

This publication explains just how UNICEF intends to avoid conflicts of interest with companies making products that do not promote childrens’ health.

The practices and products of a subset of the F&B industry whose primary business is the production, distribution, marketing and retailing of ultra-processed foods and beverages (UPF) pose particular concern. The companies producing these unhealthy, nutrient-poor UPF – rich in sugar, salt, trans-fats and food additives and preservatives – are major drivers of today’s broken food system and the global epidemic of childhood overweight and obesity and diet-related non-communicable diseases…It is now widely accepted that the practices and products of the UPF industry harm children’s and adolescents’ lives and have become the main commercial determinant of childhood malnutrition and disease.

Evidence shows that direct partnering with the UPF industry (i.e., working with) and voluntary UPF industry initiatives do not translate into large-scale sustainable results in transforming food systems for children. Further, direct funding engagements with UPF industry stakeholders pose a significant reputational risk to the credibility of UNICEF programming and independence as governments’ trusted advisor for policy formulation, normative guidance and programme scale-up for children and adolescents.

UNICEF says it will, among other measures (my emphasis):

• Continue to advocate for the F&B industry not to be included in public policy making.
• Continue avoiding all partnerships with F&B industries that violate the Code.
• Avoid all partnerships with ultra-processed food and beverage (UPF) industries.
• Exclude Code violators and UPF industries in UNICEF-led business platforms.
• Engage responsibly with the F&B industry in humanitarian response.

These commitments are a major public health advance.  Let’s hope UNICEF sticks with them.

The FDA is asking for public feedback on an updated research study to decide which front-of-package labeling design will work best to help the public choose healthy fpackaged foods.

To submit comments, go here.  They are due by July 17.

I’ve written about this issue previously.

The FDA tried to do this a decade ago.  But the Grocery Manufacturers Association (now Consumer Brands Association) did an end run and volunteered to use Facts Up Front/Guideline Daily Amounts, which nobody understands or pays attention to.  The FDA caved in and let that happen.

Now countries all over the world are putting warning labels on foods high in calories, fat, salt, and sugar, most of them ultra-processed.

The FDA says it will  test 8 front-of-package label designs to see which work best in conveying healthfulness. The study materials are here and here.

Earlier, if those links don’t work, it proposed to test all of these designs.

I don’t think any of the choices is as compelling as Chile’s warning labels, which can be understood easily by children and people who cannot read.

Among the FDA’s choices, here’s my preference (it’s most like the labels from Canada and Brazil).

This still requires people to figure out what it means if the colors differ, as they do here, but surely everyone will understand that the more red boxes, the worse.

One other complaint: Since this effort started, the concept of ultra-processed has become much more prominent and is backed up by a tremendous amount of research.

Avoiding ultra-processed foods is the key message needed now.

The FDA’s proposals will take care of most ultra-processed foods, but miss the point.  Whatever the FDA chooses will be out of date no matter when it appears.

Never mind.  This is a step in the right direction.  Food industry opposition to any of it is strong.

It’s important to tell the FDA to get busy on this, and to strengthen the warning.

Write the FDA NOW!