by Marion Nestle

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Jan 28 2015

WHO versus noncommunicable (chronic) disease: where’s the sugar target?

The World Health Organization (WHO) released two reports within the last week aimed at preventing noncommunicable diseases.  Although the second is all about reducing sugar intake, the first report is about everything but.

1.  The Global Status Report on Noncommunicable Diseases, 2014.* 

The WHO press release points out that the report calls for:

more action to be taken to curb the epidemic, particularly in low- and middle-income countries, where deaths due to NCDs are overtaking those from infectious diseases. Almost three quarters of all NCD deaths (28 million), and 82% of the 16 million premature deaths, occur in low- and middle-income countries.

How?  By working to achieve 9 targets:

  • Target 1: A 25% relative reduction in risk of premature mortality from CVDs, cancer, diabetes, chronic respiratory diseases.
  • Target 2: At least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context.
  • Target 3: A 10% relative reduction in prevalence of insufficient physical activity.
  • Target 4: A 30% relative reduction in mean population intake of salt/sodium.
  • Target 5: A 30% relative reduction in prevalence of current tobacco use in persons aged 15+ years.
  • Target 6: A 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure, according to national circumstances.
  • Target 7: Halt the rise in diabetes and obesity.
  • Target 8: At least 50% of eligible people receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes.
  • Target 9: An 80% availability of the affordable basic technologies and essential medicines, including generics, required to treat major NCDs in both public and private facilities.

Don’t dietary sugars have something to do with diabetes and obesity?  How come no specific target?  This is especially odd in light of the second report.

2. Guideline: Sugars Intake for Adults and Children [see updated, revised publication released March 2015]

The WHO makes three recommendations about intake of added (“free”) sugars:

  • A reduced intake of free sugars throughout the lifecourse (strong recommendation).
  • Reducing the intake of free sugars to less than 10% of total energy intake (strong recommendation).
  • A further reduction of the intake of free sugars to below 5% of total energy intake (conditional recommendation)

Why no target for sugar reduction to 10% of energy  in the first report?

The omission is glaring.  Could politics be involved?  It’s hard to think of any other explanation.

WHO needs to speak with one voice on NCD targets, guidelines, and recommendations.

* Along with the NCD target report, WHO also released:

**Thanks to Dr. Karen Sokal-Gutierrez for alerting me to the lack of a sugar target.

Sep 23 2014

No, the U of California does NOT forbid faculty to express opinions about the soda tax

Last Friday, I received a phone call from Todd Kerr, the publisher of The Berkeley Times, a community newspaper in Berkeley, CA.  He was preparing a story on the Berkeley soda tax and could not find University of California (UC) faculty who were willing to speak with him.

They were, they told him, under a gag order from the president’s office not to talk to reporters about the soda tax.

I can understand his frustration.  I spoke or e-mailed about 10 people with knowledge of this issue and only two would allow me to quote them for attribution.

For starters, the idea of a gag order seems contrary to current practice.

But the rumor is serious and deserves investigation.

I sent out queries to try to find out if the rumor could have any basis in fact.

Mr. Kerr kicked off the process by giving me the names of the three faculty members he said had refused to speak with him about the soda tax.

I was able to track them down.  Here is what they told me (not for direct quotation or attribution):

  • Source #1: Mr. Kerr had asked scientific questions outside the respondent’s area of expertise.
  • Source #2: Mr. Kerr stated that his paper does not take a stance on issues, so HE can’t write for or against the tax.  This respondent’s understanding is that Berkeley faculty members can state opinions on any voting matter as long as they do not claim to speak for the university.
  • Source #3: University counsel advised this respondent that faculty can say what they want as private citizens, but not as UC employees.  This source’s understanding is that state employees are not permitted to work to alter the conduct or outcome of matters on which the public is voting.  And, if the food industry were to sue a faculty member for something said in the course of an election campaign, the university would not provide legal resources or defense.

Source #3’s comments especially demanded further inquiry.  I did some more consultation of UC faculty, legal staff, and professional staff.

UC policy on political speech is governed by state law

As one source explained, there is no gag order on faculty.  There are, however, state statutes that limit the University’s ability to take positions on ballot measures that are before the voters (be sure to look at the Webinar slide show).  These state in a Q and A:

May a University employee endorse a ballot measure in his/her private capacity and identify himself/herself by University title?

Yes. A University official may allow use of his/her name and title for identification purposes in the same manner as others who sign an endorsement. An express disclaimer of University endorsement is required only where the context might reasonably cause confusion as to whether the endorsement is made in an official or unofficial capacity.

My queries eventually landed in the Office of the President of the UC System.  Steve Montiel, Media Relations Director, one of only two people in all of this who was willing to be quoted by name, said:

All University of California employees, including faculty, have the right to express their personal opinions about any matter of civic importance, including ballot measures. Consistent with state law, however, longstanding University policy prohibits university resources from being used to oppose or support a ballot measure. Only the UC Board of Regents can take a public position on a ballot measure, and it has done so in the past.

I also consulted Michele Simon (the second quotable) about state policy.  She notes that this is standard policy for institutions receiving state funding.  UC is a state school and, therefore, is not allowed to use state funds to take political positions.

She reminded me that at Stanford, a private institution, Henry Miller of the conservative Hoover Institute violated Stanford’s no-position policy on ballot measures when he did a TV ad opposing Proposition 37, the GMO labeling initiative, using his Stanford affiliation.

When we learned of the ‘No on 37 ‘ commercial, we immediately asked to have it changed so it would be in compliance with Stanford policies,” said Debra Zumwalt, the university’s vice president and general counsel. “While everyone at Stanford is entitled to espouse whatever political view he or she may choose, we do not allow people affiliated with Stanford to take a political position in a way that could imply that it is Stanford’s position.”

In my own experience, UC’s policy also sounds like standard practice.  When the Sugar Association threatened me with a lawsuit (see documents under Controversies at the bottom of the Media pages), that’s pretty much what NYU lawyers told me.  If I said something libelous, I would be responsible for the legal consequences.  Luckily, the Sugar Association never sued.

So—how did this rumor get started?  

Here’s what I learned.

A group of faculty advocating for the soda tax asked to meet with university legal counsel for advice about how to protect themselves and the university against potential lawsuits filed by, for example, the American Beverage Association (ABA), which has been especially aggressive in fighting the tax.  The ABA’s actions reminded them of the cigarette industry’s fight with the UC system over the tobacco control archives now housed at UCSF.

Some of the legal advice to faculty—if you speak at a soda tax rally, represent yourself as an individual,not a representative of the university, and do so on your own, not the university’s time—can be interpreted as restrictive even if it is not meant as such.

UC’s policy on academic freedom

Please note that UC, since the time of the Free Speech Movement, has developed a clear policy on academic freedom:

…academic freedom depends upon the quality of scholarship, which is to be assessed by the content of scholarship, not by the motivations that led to its production. The [policy]…does not distinguish between “interested” and “disinterested” scholarship; it differentiates instead between competent and incompetent scholarship. Although competent scholarship requires an open mind, this does not mean that faculty are unprofessional if they reach definite conclusions. It means rather that faculty must always stand ready to revise their conclusions in the light of new evidence or further discussion. Although competent scholarship requires the exercise of reason, this does not mean that faculty are unprofessional if they are committed to a definite point of view. It means rather that faculty must form their point of view by applying professional standards of inquiry rather than by succumbing to external and illegitimate incentives such as monetary gain or political coercion. Competent scholarship can and frequently does communicate salient viewpoints about important and controversial questions [my emphasis].

My translation: if faculty opinions about the soda tax are based on research—and plenty of research is available to back up the rationale for and potential efficacy of such a tax (see Rudd Center and Bridging the Gap)—faculty not only have the right but also have the responsibility to express opinions about them.

UC faculty: get out there and support the tax!

And wish the FSM a happy 50th anniversary.

 

May 27 2014

Olivier de Schutter finishes tenure as UN Special Rapporteur on the Right to Food

Olivier de Schutter must be finishing up his six-year term as the United Nations Special Rapporteur on the Right to Food.

His final report to the U. N. Human Rights Council

Objectives such as supplying diverse, culturally-acceptable foods to communities, supporting smallholders, sustaining soil and water resources, and raising food security within particularly vulnerable areas, must not be crowded out by the one-dimensional quest to produce more food,

In a speech to the annual summit of the World Health Organisation (WHO), Reuters reports: 

Unhealthy diets are now a greater threat to global health than tobacco. Just as the world came together to regulate the risks of tobacco, a bold framework convention on adequate diets must now be agreed, he said.

De Schutter, who has held his post of special rapporteur on the right to food since 2008 and earlier headed the Paris-based International Federation of Human Rights, reports to the U.N. Human Rights Council in Geneva.

In 2005, a U.N. convention on tobacco control aimed at reducing deaths and health problems caused by the product went into force after long negotiations under the umbrella of the WHO.

In a report to the rights council in 2012, de Schutter said a similar accord on food should include taxing unhealthy products, regulating food high in saturated fats, salt and sugar, and “cracking down on junk food advertising.”

That report also called for an overhaul on the system of farm subsidies “that make certain ingredients cheaper than others”, and for support for local production “so that consumers have access to healthy, fresh and nutritious foods.”

De Schutter  reports that public procurement can and should be used to ‘buy justice’ in food systems (also see press release):

“Public procurement represents a rare opportunity to support more nutritious diets and more sustainable food systems in one fell swoop,” he said, as he released his final publication as UN Special Rapporteur on the right to food.

Recalling that OECD countries spend an average of 12% of GDP on public procurement, and developing countries only slightly less, he identified five principles for using public procurement to support the realization of the right to food:

  • Source preferentially from small-scale food producers and help them to access tenders
  • Guarantee living wages and fair prices along the food supply chain
  • Set specific requirements for adequate food diets
  • Source locally whenever possible and impose sustainability requirements on suppliers; and
  • Increase participation and accountability in the food system

De Schutter has done honorable work as Special Rapporteur and his role in this position will be missed.

Feb 11 2014

Room for Debate: CVS to stop selling cigarettes

The New York Times Room for Debate blog asked me to comment on What other unhealthy products should CVS stop selling?

Here’s my response: Next, Cut the Soda and Junk Food.

Good for CVS! Cigarettes are in a class by themselves. The evidence that links cigarette smoking to lung cancer and other serious health problems is overwhelming, unambiguous and incontrovertible. So is the evidence that the mere presence of cigarettes is sufficient to create demand, especially among young people.

When the anti-cigarette smoking movement began, the issues were simple: stop people from starting to smoke and get people who smoked to stop — by making it difficult, uncomfortable and expensive for smokers to continue their habit. The ultimate goal? Put cigarette companies out of business. This, of course, has been politically impossible, not least because cigarette companies pay such high taxes.

If CVS wants to promote health, it could increase sales of healthy snacks, and stop selling sugary foods and drinks.

Although there are many parallels in company marketing practices, food is not tobacco. For all tobacco products, the response is simple: stop. Food is more complicated. We must eat to survive. A great number of foods meet nutritional needs. The evidence that links a particular food product to health is often uncertain. This is because each food is only one component of a diet that contains many foods in a lifestyle that might involve other factors that affect health: activity, alcohol, drugs, stress and let’s not forget genetics.

With that said, if CVS really wants to promote health, it could consider increasing its sales of fruits, vegetables and healthy snacks, and stop selling sodas, ice cream, chips and other junk foods. Those foods may not have the same bad effect on health as tobacco, but eating too much of them on a regular basis is associated with weight gain, obesity and the conditions for which obesity is a risk factor, like Type 2 diabetes and heart disease. If CVS wants to counter obesity, dropping soft drinks is a good place to start. They have scads of sugars, and kids who drink them regularly take in more calories, are fatter and have worse diets than kids who do not.

Jan 10 2014

Action on Sugar to the food industry: reduce sugar now!

A group of public health experts based mainly in Britain have announced a new anti-sugar campaign.

Called Action on Sugar, it is modeled on Great Britain’s campaign to get the food industry to gradually reduce salt in processed foods—voluntarily.  That campaign is considered to have led to a reduction of 25% to 40%.

Action on Sugar’s objective: Reduce sugar in packaged foods by 20% to 30% over the next 3 to 5 years.

Action on Sugar is a group of specialists concerned with sugar and its effects on health. It is successfully working to reach a consensus with the food industry and Government over the harmful effects of a high sugar diet, and bring about a reduction in the amount of sugar in processed foods. Action on Sugar is supported by 18 expert advisors.

As one of the experts put it, “Everywhere, sugary drinks and junk foods are now pressed on unsuspecting parents and children by a cynical industry focused on profit not health”—just like the tobacco industry behaves.

You have to love the British press:

New Picture

Enjoy the weekend!

 

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Dec 10 2013

Yes, one more post on the meaning of “natural”

At a talk I gave for CQ Roll Call in Washington, DC last week, an audience member asked about the definition of “natural.”  I thought I had said everything there was to say about it (see post from August).  Wrong.

Another member of the audience sent me the definition of “natural” produced by, of all things, the  Treasury Department’s Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF).

Three federal agencies deal with “natural.”

The FDA

In answer to the question, “What is the meaning of ‘natural’ on the label of food?,” the FDA says:

From a food science perspective, it is difficult to define a food product that is ‘natural’ because the food has probably been processed and is no longer the product of the earth. That said, FDA has not developed a definition for use of the term natural or its derivatives. However, the agency has not objected to the use of the term if the food does not contain added color, artificial flavors, or synthetic substances.

The USDA

The USDA discusses “natural” in the context of organic foods, in order to distinguish “natural” from organic:

Natural. As required by USDA, meat, poultry, and egg products labeled as “natural” must be minimally processed and contain no artificial ingredients. However, the natural label does not include any standards regarding farm practices and only applies to processing of meat and egg products. There are no standards or regulations for the labeling of natural food products if they do not contain meat or eggs.

The ATF

This agency is in charge of regulating alcoholic beverages, largely for tax-collection purposes.  Its “ATF Ruling 85-4” does not actually define the term “natural,” but instead says when ATF takes no exception to its use.

(1) Any grape fruit, citrus or agricultural wine may be designated “natural” if it is made without added alcohol or brandy…No other type of wine may be designated as “natural.”

(2) A distilled spirit may be designated as “natural” if is solely the result of distillation, with or without mingling of the same class and type of spirits or simple filtration which does not alter the class or type of the product.

(3) A malt beverage may be designated “natural” if it is made without adjuncts (additives) other than those additives which do not remain in the finished product, either by precipitating out or by combining with other components of the product and the resulting compound precipitates or is filtered out.

I am not making this up.

CSPI thinks it’s time to phase out the use of “natural.”  OK by me.

Addition: Michele Simon, who blogs at Eat, Drink, Politics, writes (she’s not making this up either):

In fact, ATF is how housed within the Department of Justice.

Historically, ATF had all jurisdiction over alcohol (and was within Treasury), which is where that rule must have come from.

ATF still maintains jurisdiction over criminal activity, but now, the Alcohol and Tobacco Tax and Trade Bureau oversees labeling. That’s housed within Treasury.

This explains the split in 2002 (click here).

Clear as mud? So maybe you can add a fourth agency to your list!

Nov 21 2013

More on food company sponsorship of nutrition research and practice

The American Society of Nutrition (ASN) is not the only nutrition society raising issues of conflict of interest (see yesterday’s post).  The Academy of Nutrition and Dietetics (AND) is the subject of two recent analyses of this problem.

FoodNavigator-USA interviewed a number of people, including me, about the implications of these reports.  Opinions differ, to say the least.

But here’s what I said:

Sponsorship perverts science

However, Dr Marion Nestle, Paulette Goddard professor of nutrition, food studies, and public health at New York University, said it was wishful thinking to assume that companies that make their money selling soda and chips as well as water, juice and oatmeal could provide a “full” picture.

The issue, she said, was not whether FNCE delegates were capable of distinguishing facts from sponsored spin in conference handouts.

She told us: “That’s not the right question. Most people are unaware of how such things influence their opinions. Substantial research on sponsorship by tobacco, drug, and chemical companies provides such evidence. There is not yet as much research on the effects of food industry sponsorship but the few studies that exist are completely consistent with research on other industries.”

It’s stunningly easy to design studies that accomplish these goals

Asked whether it was unfair to automatically dismiss industry-funded research and information rather than judging it on its merits, Nestle said: “In my opinion, agriculture, food, nutrition, and health professionals should dismiss industry-sponsored research out of hand, and journals should not accept industry-sponsored papers. 

“There is only one reason for food companies to sponsor research—so they can use the results in their own interests. 

“Sponsorship perverts science.  Sponsored research is not about seeking truth or adding to public knowledge.  It is about obtaining evidence to defend or sell the sponsor’s product, to undermine research that might suggest that a product is unhealthy, to head off regulation, and to allow the product to be marketed with health claims. 

“It’s stunningly easy to design studies that accomplish these goals and to conduct them in ways that meet the scientific criteria of peer-reviewers.”

She added: “Peer reviewers, journal editors, and readers ought to be asking: Why did the sponsor fund this study?  Was the research question designed to permit an answer that might not meet the sponsor’s goal?  Was the study conducted in a way that permitted an answer against the sponsor’s interest?  Sponsored studies almost always fail these tests of independence.”

I think corporate sponsorship poses huge problems for the credibility of nutrition researchers and nutritionists in general.  The issue requires much more discussion than it has received to date.

Let the debates begin!

Sep 11 2013

Why the public still distrusts GMOs: Nature Biotechnology gives the reasons

Nature Biotechnology, a research journal for biotechnology academics, has the most enlightened explanation I’ve seen recently about why genetically modified (GM) foods don’t go over well with the public (I discussed suchN reasons in detail in Safe Food: The Politics of Food Safety).Its editorial states that despite years of evidence for the safety of eating GM foods,

Consumers are concerned about the close (some might say cushy) relationships between regulators and companies. They are concerned about food safety data being difficult to obtain from regulatory agencies. The revolving door between agribusiness and regulatory agencies and the amounts spent on political lobbying also raise red flags. Even academics have fallen in the public’s esteem, especially if there’s a whiff of a company association or industry funding for research.

Of course, the public’s misgivings about GM food go beyond just the risk to health. Corporate control of the food supply, disenfranchisement of smallholder farmers, the potential adverse effects of GM varieties on indigenous flora and fauna, and the ‘contamination’ of crops grown on non-GM or organic farms all play into negative perceptions. And for better or worse, GM food is now inextricably linked in the public consciousness with Monsanto, which has seemingly vied with big tobacco as the poster child for corporate greed and evil.

What are industry and academic scientists to do about such attitudes?

 Changing them will require a concerted and long-term effort to develop GM foods that clearly provide convincing benefits to consumers—something that seed companies have conspicuously failed to do over the past decade.

Well, yes.  This was the situation in 2003 when I first wrote Safe Food, and nothing had changed by the second edition in 2010.  Or by now, apparently.

This industry still depends on Golden Rice to save its reputation.  Maybe it ought to start working on some of the other issues mentioned in this editorial.