Currently browsing posts about: Label-scoring-systems

Front-of-Package Labels: The FDA is hard at work trying to do something about public understanding of food labels.  What with the fuss about the Smart Choices program (now withdrawn), FDA wants to get the front-of-package labeling under control.  It is considering various formats for giving a quick overview of the nutritional quality of food products.  FDA is asking for public comment on the various formats (see Federal Register notice).

The FDA chose five versions (plus variations) for comment:

1. A mini Nutrition Facts version called Nutrition Tips
2. A UK traffic lights version
3. A version like Hannaford’s Guiding Stars
4. A version like the discontinued Smart Choices
5. One that just highlights calories/servings

I rather like this one, a variation of #1 (colorful, easy to understand, not too cluttered, and makes calories clear).

The Nutrition Facts Panel: The FDA also is taking another look at the Nutrition Facts panel on the back of food packages.  It is seeking public comment on  a plan for consumer research to test understanding of elements on the Nutrition Facts panel.  Here’s the Federal Register notice with all the information about what’s going on and where to file comments.

What’s interesting about this is that the FDA has great social science researchers on staff.  They’ve been kept under wraps the last eight years and apparently are being let loose again.  Even so, they don’t get to just go out and do studies like we academics do (with human subjects approval, of course).  Oh no.  First, they have to announce that they plan to do the studies (which they did some time ago) and get comments on the idea.  Then they do the research plan and have to ask for further comments on the research design.  That’s what this notice is about.  Once they deal with these comments, they can finally get to work.    It’s a miracle if they do anything at all.  Keep them busy: send comments!

Agency Transparency: The Association of Health Care Journalists (ACHJ) and ten other journalism organizations have filed a complaint.  The FDA, they say, is still requiring journalists to obtain permission from an agency official in order to conduct interviews with staff members.  This is a leftover from the Bush administration.  Time to get rid of it.

Blogging: It is especially time to open up to reporters because Michael Taylor, who is now senior advisor to the FDA commissioner, is now blogging on the Atlantic Food Channel (which also reprints my posts).  If he can blog, FDA staff can talk to reporters.

Addendum: Beverages pretending to be dietary supplements: The FDA has just issued guidance to the beverage industry to stop putting herbal supplements into beverages and calling them dietary supplements so they can get around food rules on health claims.  If a beverage is consumed as a food, it should be labeled as a food.  Guidance, of course, is non-binding but I see this as a warning that the FDA is going to be enforcing its own rules.  Good show!

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 FDA just announced in the Federal Register that it plans to take a good hard look at public understanding of what’s currently on food labels.  It says it will do an Internet survey of 43,000 people to:

• Identify attitudes and beliefs to do with health, diet and label usage
• Determine relationships between these attitudes and beliefs, demographics, and actual label use
• Look at the relevance of these attitudes
• Identify barriers to label use

I hope they ask me!

What is this about?  Let me take a wild guess: Health claims?  Smart Choices labels?  Anything that makes people think highly processed foods are good for them?  Or distracts from the Nutrition Facts panel?

The FDA is required to allow 60 days for comment.   Tell the FDA you think the more research it does on food labels, the better!

Earlier this week, I received a phone call from Dr. Celeste Clark, Kellogg’s senior vice president for global nutrition, corporate affairs and chief sustainability officer.

She had seen my previous blog post on the Smart Choices program, and wanted me to know that Froot Loops has been reformulated to contain 3 grams of fiber, not less than 1 gram, as I had posted, and that  in all fairness, I ought to post the new version.  Sure.  Happy to.  Here it is.

This higher fiber product, of course, gets us into the philosophical question:  Is a somewhat-better-for-you, highly processed food really a good choice?  Does the additional 2.5 grams of fiber convert this product to a health food?  Whether Froot Loops really is a better choice than a doughnut as the Smart Choices program contends, seems debatable.

If I read the Nutrition Facts and ingredient list correctly, Froot Loops cereal contains:

• No fruit
• Sugar as the first ingredient (meaning the highest in weight–41%)
• Sugar as 44% of the calories
• Partially hydrogenated vegetable oil and, therefore, trans fat (although less than half a gram per serving so the label can read zero)

But with an implied endorsement from the American Society of Nutrition, which is managing the Smart Choices program, I guess none of that matters.  Or maybe the added fiber cancels all that out?

I pointed out to Dr. Clark that I had just bought the fiberless Froot Loops at a grocery store in midtown Manhattan, which means the old packages must still be on the market.

I discussed this and other such products with William Neuman of the New York Times whose reporting on the Smart Choices program appears on the front page of today’s business section under the title, “For your health, Froot Loops.  Industry-backed label calls sugary cereal a ‘Smart Choice.'”

According to his well reported account, Kellogg’s and other participating companies pay up to $100,000 for that seal.  No wonder the American Society of Nutrition and everyone else involved in the program want to set nutrition standards so loosely that they can encompass as many products as possible.   The more products that qualify for the Smart Choices logo, the more money the program gets.  I’d call that a clear conflict of interest.

Neuman managed to find nutritionists who defend the program.  I am not one of them.

Update September 6: CBS did a story on Smart Choices (I’m interviewed in it)

Update September 9: The American Society of Nutrition must be getting a bit defensive about the negative publicity, as well it should be.  It has issued an explanation to members.

At last, the American Heart Association (AHA) has done something useful.  It advises eating less sugar.  Americans eat way too much, it says, a whopping 22 teaspoons a day on average.  Let’s work this out.  A teaspoon is 4 grams.  A gram is 4 calories.  So the 275 calories in that default 20-ounce soda you picked up from a vending machine come from nearly 17 teaspoons of sugar – close to the average right there.  If you have trouble maintaining weight, soft drinks are an obvious candidate for “eat less” advice.  Neither the Wall Street Journal (in which I am quoted) nor the New York Times say much about how soft drink manufacturers are reacting to this recommendation, but it isn’t hard to guess.

Here, for example, is what the industry-sponsored American Council on Science and Health (ACSH) has to say:

The study targets added sugars as the main culprit of dietary excess, but since “U.S. labels on packaged foods do not distinguish between naturally occurring or added sugars,” it is difficult to tell the difference. However, “our bodies can’t tell the difference either,” says ACSH’s Jeff Stier. “Natural and added sugars are nutritionally the same. Added sugar causes obesity as much as the orange juice promoted by the American Heart Association causes obesity [e-mail newsletter, August 25, 2009].

This is the first time the AHA has seriously weighed in on sugar.  I find this especially interesting because the AHA has a long history of endorsing sugary cereals (as I discuss in Food Politics and also in What to Eat).  In this example, the AHA’s endorsement is in the lower left corner.  This product has sugars of one kind or another listed 9 times in the ingredient list.

The AHA gets paid for such endorsements.  Let’s hope the new recommendation encourages the AHA to stop doing this.

Update August 27: I really don’t know what to say about the ACSH’s Jeff Stier.  he is acting more like the Center for Consumer Freedom’s Rick Berman every day.   Today’s e-mail newsletter from ACSH contains this statement:

In her blog in The Atlantic, NYU Professor of Nutrition Dr. Marion Nestle has fallen into the habit of suggesting that ACSH is incapable of objective analysis of public health concerns because we are, in her distorted view, “thoroughly industry-sponsored.”

ACSH’s Jeff Stier wrote to her editors: “Like many of the country’s top non-profits, Dr. Nestle’s NYU included, we accept corporate donations, with no strings attached. But we also receive significant support from individuals and foundations. Her misleading description of us suggests that we represent industry. We do not. We are advised by some of the nation’s leading scientists and represent consumers.

“By way of this email, I ask for a conspicuous and fair correction. We are happy to engage on the issues Dr. Nestle writes about, but her attacks on us are below someone of her stature. We’d prefer an informed and enlightening discussion of the issues, not underhanded and unfounded attacks on credibility.”

“Apparently, Dr. Nestle believes that your opinions are irrelevant, since they diverge from her ideological agenda,” says Stier. “We represent you, consumers, who want science rather than ideology informing public health decisionmaking. Does she really think that consumers are so monolithic that they either agree with her or are put up to it by some sinister entity?”

Readers: Does anyone know what is going on with this group?  It sounds so much like the Center for Consumer Freedom that I can’t help but wonder.

You may recall my previous posts about the new Smart Choices program.  This program was developed by food processors to identify products that are ostensibly “better for you”  because they supposedly contain more good nutrients and fewer bad ones.  This program is about marketing processed foods and I wouldn’t ordinarily take it seriously except that several nutrition professional associations are involved in this program and the American Society of Nutrition is managing it.  In effect, this means that nutritionists are endorsing products that bear the Smart Choices logo.

So what products are nutritionists endorsing?  I went grocery shopping last week and bought my first Smart Choice product: Froot Loops!

Froot Loops

Look for the check mark in the upper right of the package.  Frosted Flakes also qualifies for this logo, and do take a look at what else is on the approved list.

A close look a the Nutrition Facts label of Froot Loops shows that it has 12 grams of added sugars in a 110-calorie serving.  That’s 44% of the calories (12 times 4 calories per gram divided by 110).  The usual program maximum for sugar is 25% of calories but it makes an exception for sugary breakfast cereals.  Note that the fiber content is less than one gram per serving, which makes this an especially low-fiber cereal.

OK.  I understand that companies want to market their processed foods, but I cannot understand why nutrition societies thought it would be a good idea to get involved with this marketing scheme.  It isn’t.  The American Society of Nutrition gets paid to manage this program.  It should not be doing this.

But, you may well ask, where is the FDA in regulating what goes on package labels?

Good news: I am happy to report that our new FDA is on the job!  FDA officials have written a letter to the manager of the program.  Although the letter is worded gently, I interpret its language as putting the program on high alert:

FDA and FSIS would be concerned if any FOP [Front of Package] labeling systems used criteria that were not stringent enough to protect consumers against misleading claims; were inconsistent with the Dietary Guidelines for Americans; or had the effect of encouraging consumers to choose highly processed foods and refined grains instead of fruits, vegetables, and whole grains [my emphasis].

Update August 25: I received an interesting e-mail message from a member of the Keystone group that developed the Smart Choices program.  The message confirms that this program is a scheme to make junk foods look healthy.  It says:

Glad to see your posting about Froot Loops! The negotiations over criteria were interesting. Lots of good debate on various points, but when the companies put their foot down, that was it; end of discussion. And sugar in cereals was one such point. Others included the non-necessity for breads, etc. to contain half or more whole grains and the acceptance of fortification to meet the nutrient requirement.

In other words, some people in the group argued that breads needed to contain at least half a serving of whole grains to quality and that added vitamins and minerals should not count toward qualification.  Too bad for them.  I guess the companies put down feet.  But why didn’t they speak up then?  And why aren’t they speaking up now?

Last week, I posted correspondence regarding the American Society of Nutrition’s (ASN) partnership with the industry-sponsored Smart Choices program.  This program places a check mark on food products that meet its nutrient standards.  I am concerned about ASN’s involvement in this project as it puts the society in conflict of interest.  Several other food rating systems are under development, among them the traffic-light system used in Great Britain.  How can the ASN objectively evaluate the relative merits of these systems if it is paid for administering – and, therefore, endorsing – Smart Choices?  I much prefer the traffic light system, have concerns about the entire approach, and think some of the standards overly generous, particularly the upper limits of 25% of calories from added sugars and 480 mg sodium per serving.  Several people who commented on my post asked to see the ASN’s response.  Here it is:

From: John E. Courtney, Ph.D., Executive Officer, American Society of Nutrition
Sent: Tuesday, May 12, 2009 10:24 AM
Subject: Sunday, May 10, 2009 10:36 AM email to Katrina Dunn

Importance: High

Dear Dr. Nestle,

Thank you for your comments on ASN and the Smart Choices program. We value feedback from our members and I’d like to take this opportunity to address some of your concerns and amend a few of the points you made. First, The Smart Choices Program is not an industry-initiated plan. The Smart Choices idea was facilitated by the Keystone Center, which works with a broad array of stakeholders to develop solutions to complex health and social problems. The Smart Choices front-of-pack symbol was developed through a series of plenary meetings over two years and intensive work groups with academics, food manufacturers, public health organizations, and with observers from federal agencies.  This unique process with a broad array of stakeholders along with the fact that the program is completely transparent sets it apart from other programs that have been developed. In the fall of 2008, Keystone Center issued a RFP for organizations interested in administering the program. The ASN Executive Board was briefed on the program, discussed and evaluated it, and approved moving forward. ASN partnered with NSF to administer the program and was selected. ASN’s role will primarily be one of oversight and facilitation of the program governance, and the Society will be responsible for maintaining the scientific integrity in the Smart Choices program. This program was discussed at the ASN Volunteer Member Leadership Summit in January and most recently at the ASN Scientific Sessions and Annual Meeting at Experimental Biology in New Orleans, LA in April, 2009.

Perhaps most exciting for the Society and consistent with its mission is that ASN will be coordinating a rigorous evaluation of the program as well as consumer research to determine the effectiveness of the program. Perhaps most importantly, ASN neither “owns” the program nor are we making any profit from the program. The funds generated from company participants will be reinvested into the program.  ASN is the pre-eminent society for nutrition researchers and practitioners and encourages scientific debate and transparency and is looking forward to evaluating the effectiveness of this program in helping consumers.

Thank you again for your comments and for your commitment to advancing nutrition research and practice.

Over the weekend, I received a letter from the American Society of Nutrition (ASN) nominating me to join the Board of Directors of the Smart Choices program.  Smart Choices, you may recall from my previous posts on this program as well as on other such systems, is a food industry-initiated plan to put a check mark – a stamp of approval – on processed food products that meet certain nutritional criteria.  Apparently, the ASN Board agreed to administer (and, implicitly, endorse) this program without discussing the matter with the membership.  I think involvement of independent nutrition researchers with Smart Choices represents a conflict of interest and the ASN should not be involved in this effort.  Here is what I told Katrina Dunn, the ASN Program Coordinator:

Dear Katrina—

Thank you for inviting me to join the Board of Directors of the Smart Choices program.  I regret that I cannot accept.  Participating in Smart Choices represents a serious conflict of interest for nutrition educators who wish to maintain independence from the influence of the food industry on nutrition advice.

But participation also represents a serious conflict of interest for the American Society of Nutrition (ASN).  I am dismayed that the ASN—an organization devoted to the highest standards of nutrition research–is involved in this project.  I think the ASN should reconsider this involvement and withdraw immediately.

The ostensible purpose of Smart Choices is to guide the public to select more healthful foods.  I am unaware of a research basis indicating that the program is likely to succeed in this goal.

Evidence does, however, support two additional goals of the program.  The first is to provide a basis for marketing highly processed food products.  I think we would all agree that highly processed foods are, in general, demonstrably nutritionally inferior to whole or minimally processed foods.

The second is to stave off federal regulations requiring a traffic-light food rating system such as that in use in the United Kingdom.   Preliminary research indicates that consumers prefer this system to numerical scores and understand the colors to mean that they should choose green-lighted foods and avoid red-lighted foods.

The cut points selected for the Smart Choices program may meet criteria of the Dietary Guidelines, but their health benefits are debatable (the sodium cut point is particularly generous).  Surely, a great deal more research is needed before ASN directly or indirectly endorses specific processed foods simply because they meet arbitrary nutrient cut points.

These concerns all address questions of intellectual conflict of interest.  But I am also concerned about financial conflicts of interest.  If ASN receives payment for its endorsement and administration of this program, the organization—and its members—risk losing intellectual independence.

I appreciate the invitation but I believe the entire program is ill advised and I urge ASN to extricate as quickly as possible.

Sincerely yours,

Marion Nestle
Paulette Goddard Professor of Nutrition, Food Studies, and Public Health
New York University