Here’s my piece from The Guardian, April 2, 2016.
Yesterday, JAMA released a theme issue on obesity with several articles of particular interest, starting with New York City Health Commissioner Tom Farley’s Viewpoint. About portion sizes, Dr. Farley notes:
As publicly traded companies responsive to the interests of their shareholders, food companies cannot make decisions that will lower profits, and larger portion sizes are more profitable because most costs of delivering food items to consumers are fixed….The sale of huge portions is driven by the food industry, not by consumer demand….The portion-size studies strongly suggest that, with a smaller default portion size, most consumers will consume fewer calories. This change will not reverse the obesity epidemic, but it can have a substantial effect on it.
Lots of interesting food for thought here. Take a look:
Viewpoint
The Role of Government in Preventing Excess Calorie Consumption: The Example of New York City
Thomas A. Farley, MD, MPH
JAMA. 2012;308(11):1093 doi:10.1001/2012.jama.11623
The Next Generation of Obesity Research: No Time to Waste
Griffin P. Rodgers, MD; Francis S. Collins, MD, PhD
JAMA. 2012;308(11):1095 doi:10.1001/2012.jama.11853
FDA Approval of Obesity Drugs: A Difference in Risk-Benefit Perceptions
Elaine H. Morrato, DrPH, MPH; David B. Allison, PhD
JAMA. 2012;308(11):1097 doi:10.1001/jama.2012.10007
Cardiovascular Risk Assessment in the Development of New Drugs for Obesity
William R. Hiatt, MD; Allison B. Goldfine, MD; Sanjay Kaul, MD
JAMA. 2012;308(11):1099 doi:10.1001/jama.2012.9931
Original Contribution
Exercise Dose and Diabetes Risk in Overweight and Obese Children: A Randomized Controlled Trial
Catherine L. Davis, PhD; Norman K. Pollock, PhD; Jennifer L. Waller, PhD; Jerry D. Allison, PhD; B. Adam Dennis, MD; Reda Bassali, MD; Agustín Meléndez, PhD; Colleen A. Boyle, PhD; Barbara A. Gower, PhD
JAMA. 2012;308(11):1103 doi:10.1001/2012.jama.10762
Association Between Urinary Bisphenol A Concentration and Obesity Prevalence in Children and Adolescents
Leonardo Trasande, MD, MPP; Teresa M. Attina, MD, PhD, MPH; Jan Blustein, MD, PhD
JAMA. 2012;308(11):1113 doi:10.1001/2012.jama.11461
Health Benefits of Gastric Bypass Surgery After 6 Years
Ted D. Adams, PhD, MPH; Lance E. Davidson, PhD; Sheldon E. Litwin, MD; Ronette L. Kolotkin, PhD; Michael J. LaMonte, PhD; Robert C. Pendleton, MD; Michael B. Strong, MD; Russell Vinik, MD; Nathan A. Wanner, MD; Paul N. Hopkins, MD, MSPH; Richard E. Gress, MA; James M. Walker, MD; Tom V. Cloward, MD; R. Tom Nuttall, RRT; Ahmad Hammoud, MD; Jessica L. J. Greenwood, MD, MSPH; Ross D. Crosby, PhD; Rodrick McKinlay, MD; Steven C. Simper, MD; Sherman C. Smith, MD; Steven C. Hunt, PhD
JAMA. 2012;308(11):1122 doi:10.1001/2012.jama.11164
Health Care Use During 20 Years Following Bariatric Surgery
Martin Neovius, PhD; Kristina Narbro, PhD; Catherine Keating, MPH; Markku Peltonen, PhD; Kajsa Sjöholm, PhD; Göran Ågren, MD; Lars Sjöström, MD, PhD; Lena Carlsson, MD, PhD
JAMA. 2012;308(11):1132 doi:10.1001/2012.jama.11792
Surgical vs Conventional Therapy for Weight Loss Treatment of Obstructive Sleep Apnea: A Randomized Controlled Trial
John B. Dixon, MBBS, PhD, FRACGP; Linda M. Schachter, MBBS, PhD; Paul E. O’Brien, MD, FRACS; Kay Jones, MT&D, PhD; Mariee Grima, BSc, MDiet; Gavin Lambert, PhD; Wendy Brown, MBBS, PhD, FRACS; Michael Bailey, PhD, MSc; Matthew T. Naughton, MD, FRACP
JAMA. 2012;308(11):1142 doi:10.1001/2012.jama.11580
Dysfunctional Adiposity and the Risk of Prediabetes and Type 2 Diabetes in Obese Adults
Ian J. Neeland, MD; Aslan T. Turer, MD, MHS; Colby R. Ayers, MS; Tiffany M. Powell-Wiley, MD, MPH; Gloria L. Vega, PhD; Ramin Farzaneh-Far, MD, MAS; Scott M. Grundy, MD, PhD; Amit Khera, MD, MS; Darren K. McGuire, MD, MHSc; James A. de Lemos, MD
JAMA. 2012;308(11):1150 doi:10.1001/2012.jama.11132
Editorial
Progress in Filling the Gaps in Bariatric Surgery
Anita P. Courcoulas, MD, MPH
JAMA. 2012;308(11):1160 doi:10.1001/jama.2012.12337
Progress in Obesity Research: Reasons for Optimism
Edward H. Livingston, MD; Jody W. Zylke, MD
JAMA. 2012;308(11):1162 doi:10.1001/2012.jama.12203
On the plastic bottle front, much is happening.
BPA plastics are banned from the European market, only to be replaced by other plastics that seem to have their own problems. These are detailed in three articles in Food Additives and Contaminants dealing with the migration of chemicals from baby bottles.
In response to such concerns, soft drink companies are engaging in the latest form of “cola wars,” this time the race to greener bottles. As the New York Times puts it,
Over their decades of competition, the battle between Coca-Cola and PepsiCo has taken on many colors — brown (cola), orange (juice), blue (sport drinks) and clear (water).
Now, they are fighting over green: The beverage rivals are racing to become the first to produce a plastic soda bottle made entirely from plants.
Coca-Cola has signed up with three biotechnology companies to produce materials for 100% plant-based bottles. It already has some recyclable PlantBottles, but these are only 30% plant-based (mono-ethylene glycol, MEG). The other 70% is purified terephthalic acid, PTA. Coke says it will go to 100% plant-based by 2020.
PepsiCo says it is doing the same thing, only faster.
OK, plant-based. But from what?
Coke says it is experimenting with Brazilian sugarcane, molasses, and other plant residue materials but might also use crops grown specifically for plastic production. Pepsi says it will use agricultural waste products, such as corn husks, pine bark or orange peels.
What about corn? Corn has already been used to produce plastics, but doing this is just like growing food crops for biofuels, causing land conversion, higher food prices, and heavy fertilizer use.
It will be good to get the harmful chemicals out of drink bottles.
But soft drinks are inherently wasteful of natural resources. All the greenwashing in the world can’t hide that.
My once-a-month, first Sunday Food Matters column in the San Francisco Chronicle is about the difficulty of figuring out the health effects of food chemicals consumed in low doses.
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Taking steps on food chemicals
Editor’s note: Nutrition and public policy expert Marion Nestle answers readers’ questions in this monthly column written exclusively for The Chronicle. E-mail your questions to food@sfchronicle.com, with “Marion Nestle” in the subject line.
Q: I don’t understand why the FDA does not ban aspartame, food colors, BPA, pesticides and all those other nasty chemicals in food. I can’t believe they are good for us.
A: I can’t, either. But the Food and Drug Administration is required to make decisions on the basis of science, not beliefs.
You eat these chemicals in tiny amounts – parts per billion or trillion. Whether doses this low cause harm is hard to assess for two reasons: science and politics. Scientists cannot easily measure the health effects of exposure to low-dose chemicals. And the industries that make and use these chemicals don’t want to give them up.
Food chemicals elicit plenty of public dread and outrage. But are they harmful?
Controlled clinical trials at normal levels of intake would require vast numbers of subjects over decades. Nobody would fund them.
Instead, researchers use animals consuming much higher doses. I can remember how the diet soda industry ridiculed studies suggesting that saccharine caused bladder cancer in rats: the doses were equivalent to drinking 1,250 12-ounce diet sodas a day.
The difficulties of doing research on low-dose chemicals – and the food industry’s insistence that such doses are safe – explains the FDA’s reluctance to act.
Some examples illustrate the problem.
Aspartame
Some studies suggest that aspartame might cause cancer in rats when consumed at levels typical of diet soft drinks, as well as other problems. But researchers performing better controlled studies have given aspartame a clean bill of health.
Despite public concerns, the FDA’s assessment of the evidence “finds no reason to alter its previous conclusion that aspartame is safe as a general purpose sweetener in food.”
Food dyes
These have been considered a possible cause of hyperactivity in children since the 1970s. Some studies show improved behavior among children placed on additive-free diets. But behavior is difficult to judge objectively, and even controlled studies gave mixed results.
A recent study funded by the British Food Standards Agency is typical. It found most children to be unaffected by removing additives. But a small percentage seemed to get better.
The FDA can only conclude that there is not enough science to decide whether food dyes cause hyperactivity.
BPA (Bisphenol A)
BPA is a component of hard plastic used to make baby bottles and food and beverage cans. It is also an endocrine disrupter. Last year, the FDA concluded that BPA is safe at current exposure levels.
At the same time, the FDA advised children and pregnant women to reduce exposure to BPA. It advised the infant formula and soda industries to find ways to replace it.
The California Legislature has passed AB1319 banning BPA from baby bottles and sippy cups; it’s awaiting Gov. Jerry Brown’s signature.
Recent studies raise concerns about BPA’s effects on the brain and behavior of fetuses, infants and young children, and on cancer, obesity and infertility in adults. Some studies suggest that exposure to BPA is higher than previously estimated. Just last week, the Breast Cancer Fund released a study finding BPA in canned foods designed for children.
Studies by university scientists tend to find harm from BPA at low doses, whereas those by government regulatory agencies and the food industry do not. In the absence of compelling science, regulators have two choices: exercise the “precautionary principle” and ban the chemical until it can be proven safe, or approve it until it can be shown to be harmful.
The United States and European safety agencies – and the food industry, of course – prefer the latter approach.
Pesticides
Research clearly demonstrates that pesticides harm farmworkers exposed to high doses. But recent studies report slightly lower IQ levels in children born to urban women with higher blood levels of pesticides. Although these studies did not control for socioeconomic and other variables that might influence IQ, they raise the possibility that even low levels might be harmful.
What to do?
While waiting for the science to evolve, you can take both personal and political action.
You don’t want potentially harmful chemicals in your foods? Read labels and don’t buy foods with artificial sweeteners or food colors. Kids don’t need them anyway.
Consumer action has already induced baby bottle makers to get rid of BPA. This strategy can work for food colors, too.
Don’t stop eating fruits and vegetables. Their known health benefits greatly outweigh the potential harm of pesticides. Don’t stop eating them.
Buy organic. Pesticides, invisible and unlabeled as they are, constitute a good reason to do so.
Get political. Let your congressional representatives know that more research is needed, but you don’t want to wait for it. You want industry to find healthier alternatives.
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Marion Nestle is the author of “Food Politics” and “What to Eat,” among other books, and is a professor in the nutrition, food studies and public health department at New York University. E-mail comments to food@sfchronicle.com.
This article appeared on page G – 10 of the San Francisco Chronicle
According to FoodProductionDaily.com, a new report says that consumer concerns are driving companies to take bisphenol A (BPA) out of their packaging. BPA, you may recall from previous posts, is an estrogen disrupting chemical in plastic containers and the linings of food cans. Although the harm it causes is not well established, many groups have been working to get rid of it on the theory that estrogen disruption is not a good idea.
The USA Today account says
Some retailers say they’re working hard to go BPA-free. Last year, only 7% of companies had timeliness to phase out BPA. This year, 32% have set timelines, the report says. Most large baby bottle makers already have stopped using BPA.
It quotes the author of the report as saying that consumers are “voting with their shopping carts….This is definitely a story about consumers having a lot of power with the big companies….Investors and shareholders have a big impact, as well.”
In other words, getting BPA out of plastics is good for business.
And sometimes, consumer choice really works.
At current exposure levels, is BPA toxic or not? The question turns out to be difficult to answer for two reasons: science and politics. Science does not have an easy way to determine the health effects of exposures to very low doses of chemicals, and the plastics industry does everything it can to minimize risks.
A recent study says that human exposure to BPA is much higher than previously estimated, not least because many of the sources of this estrogen disrupting chemical have not yet been identified. The authors of the study, according to FoodQualityNews, want the chemical registered so that exposures can be assessed. They also call for immediate action to reduce exposures.
In contrast, FoodProductionDaily reports that the European Food Safety Authority (EFSA) has just ruled that current exposure levels are safe. Its expert panel reviewed hundreds of studies of BPA’s effects over a six-month period. The committee could find no new evidence for setting a lower level for the Tolerable Daily Intake, now established at 0.05 mg/kg/body weight. But at least one member of the committee disagreed and viewed the evidence as less certain. As FoodProductionDaily explains:
Bisphenol A is a chemical used as a monomer in polycarbonate plastic and epoxy resins – two food contact materials used in the manufacture of baby bottles and food and drink can linings respectively. Its continued use is a matter of fierce debate, with scientific evidence divided on the issue. In January 2010, the US Food and Drug Administration (FDA) said the substance was safe at current exposure levels. It also recommended that children and pregnant women reduce their exposure to the substance and that industry should seek to develop BPA-free materials for use in food contact materials.
As might be expected, the plastics industry is delighted with the EFSA decision. FoodProductionDaily quotes a representative of the chemical industry:
Consumers around the world can be reassured that EFSA’s intense scientific scrutiny continues to reaffirm the safety of BPA in food contact applications, and again concludes that established safe intake levels for BPA provide a sufficient margin of safety for protection of consumers, including for infants and young children.
Aren’t you reassured by this?
Glass baby bottles, anyone?
Update, October 4: France and Denmark say that unless EFSA requires lifting their bans on BPA, they intend to keep the bans.
Yesterday’s Science section of the New York Times carried a story by Denise Grady summarizing the present status of the arguments over the safety of the estrogen-disrupting chemical in plastics, bisphenol A (BPA).
Who knew that supposedly scientific decisions about whether BPA is safe or not would be mired in deadlocked partisan politics of the Republican vs. Democrats type? As Grady explains,
Environmental groups and many Democrats want BPA banned, blaming it for an array of ills that includes cancer, obesity, infertility and behavior problems….Many Republicans, anti-regulation activists and the food-packaging and chemical industries insist that BPA is harmless and all but indispensable to keeping canned food safe by sealing the cans and preventing corrosion, and to producing many other products at reasonable prices.
Dianne Feinstein (Dem-CA) tried to get a ban on BPA inserted into the pending food safety bill. Her plan
to ban BPA from baby bottles, sippy cups, baby food and formula was blocked by partisan battling. She had hoped that the ban would be included in the food safety bill, not merely in an amendment to be considered separately. But after months of wrangling, she gave up. The food industry, mostly supportive of the food bill, threatened to oppose it if the BPA provision got in. So did many Republican senators.
The scientific questions about BPA safety are complicated and difficult to answer, mainly because the doses are so low. Here too, politics intervenes. The article quotes Dr. Linda Birnbaum, director of the National Institute of Environmental Health Sciences. She and other scientists say that
studies by university labs tended to find low-dose effects, and studies by government regulatory agencies and industry tended not to find them. The split occurs in part because the studies are done differently. Universities, Dr. Birnbaum said, “have moved rapidly ahead with advances in science,” while regulators have used “older methods.” Some researchers consider the regulatory studies more reliable because they generally use much larger numbers of animals and adhere to formal guidelines called “good laboratory practices,” but Dr. Birnbaum described those practices as “good record-keeping” and said, “That doesn’t mean the right questions were being asked.”
In the absence of firm science, regulators have two choices: exercise caution and ban the chemical until it can be proven safe (the precautionary principle) or approve it until it can be proven harmful. In this case, I’m in favor of caution (see previous posts), not least because alternatives to BPA are available.
Your preference?
A coalition of public health and environmental groups, collectively known as the National Workgroup for Safe Markets, has produced a report on the amounts of Bisphenol A (BPA) in canned foods: No Silver Lining: An Investigation into Bisphenol A in Canned Foods.
What did it find? BPA in 92% of the foods sampled. Most canned foods are lined with BPA plastic, and it leaches into the foods.
I’ve discussed concerns about the health effects of BPA in previous posts. Here is an update on attempts to get rid of it.
To put all this in context, take a look at Jerome Groopman’s New Yorker article, The Plastic Panic: How Worried Should We Be About Everyday Chemicals? He isn’t exactly sure, but points out how difficult it is to test the health effects of any one of many chemicals in our environment–flame retardants and plastics among them–and how far regulation lags in dealing with this problem. He concludes:
How do we go forward? Flame retardants surely serve a purpose, just as BPA and phthalates have made for better and stronger plastics. Still, while the evidence of these chemicals’ health consequences may be far from conclusive, safer alternatives need to be sought. More important, policymakers must create a better system for making decisions about when to ban these types of substances, and must invest in the research that will inform those decisions. There’s no guarantee that we’ll always be right, but protecting those at the greatest risk shouldn’t be deferred.
Given the evidence brought forth to date on BPA, I’d call this an understatement.
Americans these days don’t want artificial and unsustainably produced ingredients in the food they buy and eat. For the makers of highly processed foods – ultraprocessed in today’s terminology – there isn’t a lot that they can do to make the products appear fresh and natural.
But Campbell’s is certainly trying. A few months after announcing that it will phase out genetically modified organisms (GMOs), the iconic soup company said on Friday that it will remove Bisphenol-A (BPA) from its cans by next year.
BPA, you will recall, is a chemical typically used in polycarbonate plastic containers and in the epoxy linings of food cans. It’s also an endocrine disrupter, which means it can interfere with the work our hormones are doing. Some research finds BPA to have effects on childhood development and reproduction.
Although the FDA doesn’t believe evidence of potential harm is sufficient to ban BPA from the food supply, the agency discourages use of BPA-polycarbonate or epoxy resins in baby bottles, sippy cups or packaging for infant formulas. For the past year or so, other retailers have been working hard to phase out BPA and to reassure customers that their cans and packages are safe.
All of these companies sell highly processed foods in an era when the public is demanding – and voting with their dollars – for fresh, natural, organic, locally grown and sustainably produced ingredients.
They can’t provide those things, but they can tout the bad, or unpopular, things that aren’t part of their product, the “no’s”: no unnatural additives, no artificial colors or flavors, no high fructose corn syrup, no trans fat, no gluten and, yes, no GMOs or BPA.
Let me add something about companies labeling their products GMO-free. In my view, the food biotechnology industry created this market – and greatly promoted the market for organics, which do not allow GMOs – by refusing to label which of its products contain GMOs and getting the FDA to go along with that decision. Whether or not GMOs are harmful, transparency in food marketing is hugely important to increasing segments of the public. People don’t trust the food industry to act in the public interest; transparency increases trust.
Vermont voted last year to mandate GMO labeling in the state – the US Senate rejected a bill in mid-March attempting to undermine it – and food conglomerates such as Campbell’s, General Mills, ConAgra, Kellogg and Mars have committed to labeling their products as containing GMO.
In addition to removing BPA from packaging and GMO from products, at least 11 other companies have announced recently that say they are phasing out as many artificial additives as possible, as quickly as they can.
Taco Bell, for example, will get rid of Yellow Dye #6, high fructose corn syrup, palm oil and artificial preservatives, and replace them with “natural” ingredients. Huge food companies such as Kraft, Nestlé (no relation) and General Mills are heading in the same direction.
All this may well benefit consumers to an extent. It also makes perfect sense from a business perspective: the “no’s” sell. But what everyone needs to remember is that foods labeled “free from” still have calories and may well contain excessive salt and sugars. The healthiest diets contain vegetables and lots of other relatively unprocessed foods. No amount of subtraction from highly processed foods is going to change that.