Currently browsing posts about: Noncommunicable diseases

The FDA has announced its 2025  Priority Deliverables for the Human Food Program.

These cover the microbial and chemical safety of foods, but I am especially interested in what the FDA is and is not doing about nutrition and chronic disease prevention—something mentioned by FDA Commissioner Robert Califf as a priority for American public health.

Based on FDA’s Nutrition Initiatives, the deliverables begin with:

FDA’s Role in Empowering Consumers to Build Nutritious Diets that Support Health and Wellness

Using a risk management approach, we focus our efforts in FY 2025 on labeling and other initiatives to help consumers make more informed choices about the food they eat, and, for those who rely on certain critical foods, such as infant formula, as their sole source of nutrition, we work to make sure those products are safe, properly labeled, and nutritionally sound.

As for the Human Food Program’s priority policy initiatives:

• Update FDA’s Nutrient Content Claim “Healthy”
• Propose Front-of-Package Nutrition Labeling:
• Support Reductions in Sodium in the Food Supply
• Increase the Resiliency of the U.S Infant Formula Market

The deliverables do mention diet-related chronic disease in the contexts of sodium and research.

• We will also collaborate with our federal partners and engage with key stakeholders to enhance sodium-related data sharing and learnings, as part of these efforts to help reduce diet-related chronic diseases and deaths associated with high sodium intake, such as hypertension and stroke.
• We will continue to collaborate with other federal agencies on developing and advancing a nutrition research agenda, including accelerating high-quality research to better understand the mechanisms between ultra-processed foods and poor health outcomes.

Despite Commissioner Califf’s statements, it looks like the Human Food Program is not particularly interested in chronic disease prevention or policy approaches to improving the environment of food choice.

Instead, its policies put the burden of responsibility on you as an individual to make healthier choices—not to find ways to counter the food industry’s marketing imperatives.

The FDA’s Human Food Program is all about empowering consumers.  Good luck with that.

Yes, the FDA is grossly underfunded and handicapped in what it can do, and yes, addressing environmental determinants of chronic disease would encounter opposition from vested interests.

But the FDA is an agency of the Public Health Service.  It needs to do better.

The Human Food Program should be taking the lead in addressing Commissioner Califf’s stated concerns

• The big issue is chronic disease, on which we are “doing terribly.”
• We have to deal with the marketing of ultra-processed foods designed to make you hungry for more.

These issues are consistent with the new administration’s Make America Healthy Again campaign.  Let’s hope that works.

I saw this on Twitter (X):

For the video, click here.

I’m for all three actions.  I’ve argued for years for getting rid of conflicts of interest and focusing resources on preventing chronic disease.

I can’t wait to find out how the new administration plans to accomplish these goals.   We all need to hold it accountable for delivering on these promises.

The current Dietary Guidelines Advisory Committee has produced its draft recommendations.  These, as I discuss tomorrow, are mostly banal, much the same as all guidelines since 1980.

But this year there are two rather shocking exceptions, both having to do with what is not recommended.

Incredible non-recommendation #1.  Reduce the focus of the Dietary Guidelines on reduction of chronic disease risk.

What???  The entire purpose of the Dietary Guidelines is to reduce the risk of diet-related disease.  Chronic diseases—obesity, type-2 diabetes, heart disease, cancer, etc—are the leading causes of death and disability among U.S. adults.

Maybe this was a typo?  Surely this committee means to say “Recommend increasing the focus of the Dietary Guidelines on chronic disease risk reduction.

The current wording is a travesty.  I’m not the only one who thinks so.  See Jerry Mande’s Tweet (X).

Update: I gather the uproar over this did some good and the committee is changing the wording.

Incredible non-recommendation #2.  Say nothing about ultra-processed foods.

The committee made it clear that they were not going to say a word about ultra-processed foods.  At least not now.  Why not?

Scientific experts tasked with advising federal officials drafting the 2025-2030 Dietary Guidelines for Americans said the data were far too limited to draw conclusions…Ultra-processed foods don’t have a recognized definition or a robust body of scientific literature that has studied them, they said, so guidelines would be premature.

Another travesty.  An overwhelming body of observational research suggests harm from diets high in ultra-processed foods.  OK, these studies only demonstrate association, not causation.

But—not one, but two well-controlled clinical trials demonstrate that ultra-processed foods induce people to consume more calories than they would otherwise: 500 more in one trial and more than 800 in the second.  These are enormous differences.

Yes, it would be great to know why, exactly.  And yes, the definition of ultra-processed can be fuzzy with respect to a few—remarkably few—foods.

But what more do you need to know?  Isn’t this enough to tell people that if they want to keep caloric intake under control, a good way to do that would be to limit consumption of ultra-processed foods?

But this committee chose to ignore the controlled trials because they didn’t last long enough.

As I explain in that link, the committee’s hands are tied by having to make “science-based” recommendations.  But in nutrition, most of the science is observational, which is why those controlled trials, short in duration as they are, matter so much.

The committee needs to revisit this decision.  If the guidelines do not include a recommendation to limit intake of ultra-processed foods, they will be ignoring the science and will be behind the times.

Worse, the guidelines will not help Americans reduce their risks for chronic disease.

See: Stat News:  5 questions about the next U.S. dietary guidelines, and the ‘impossible restriction’ on them: Difficulty of nutrition research leaves problems like ultra-processed foods largely unaddressed. 

Tomorrow: the banality of the latest recommendations.

At the insistence of Jerry Mande, I watched the meeting of the President’s Council of Advisors on Science and Technology (PCAST) to learn about the Federal Vision for Advancing Nutrition Science in the United States.

This Vision derives from last year’s White House Conference on Hunger, Nutrition, and Health and its pillar on enhancing nutrition research.

Cathie Woteki, who introduced the report, made a forceful case for the importance of chronic disease prevention.  Her committee was shocked  that the majority of Americans are overweight or obese, and at a cost of $500 billion annually.  She pointed out the lack of focus and coordination of 200 existing programs that ought to be addressing this issue.

The conclusion: not enough research on chronic disease and more funding needed.

No question about that.  Yes, we need more nutrition research and more funding for it.  A lot more.

But the White House request for the Office of Nutrition Research is only $1.3 million (see p. 26).  Surely this  is some kind of joke?  It’s hardly even a rounding error in federal terms.

As for the PCAST report’s efforts needed:  That’s all?

Yes we can use more data and research on personal eating habits and individual behavior, but what about the food environment?

Maybe PCAST is under political constrainsts but this sure does feel like a lost opportunity.

The report —as yet unpublished—appears to say nothing about:

• The effects of ultra-processed foods on individual food choices and weight. (the word “ultra-processed” was not mentioned)
• The need to change the food environment to make it easier and less expensive for individuals to make healthier food choices.
• Policies to requirie food companies to produce healthier foods and reduce serving sizes.
• Policies to stop the food industry from marketing ultra-processed foods to kids.
• Programs to achieve the existing 2030 health objectives to prevent obesity and chronic disease (these were not mentioned).

The committee said it consulted widely to produce this report.  Not widely enough, I’d say.

Compare this to what the UK House of Lords is doing in its hearings on  Food, Diet and Obesity.  Take a look at who they are listening to.

If the PCAST committee talked to any of these people, their comments are not showing up.

PCAST has a real opportunity here to push for a strong research and policy agenda to address obesity and its related chronic diseases.

What kind? Here are my suggestions.

Jerry Mande, a co-founder of Nourish Science wrote me to urge support for a national action plan to reduce obesity—and the chronic diseases for which it raises risks. (Note: he also has an op-ed in The Hill on NIH research and leadership needs).

Here is what we should do. It’s time for a new federal nutrition goal. For decades it’s been some variation of “access to healthier options and nutrition information.” Jim Jones [the new head of food and nutrition at FDA] used that last week in his vision for the new human foods program. It’s in USDA FNS’s mission too. The WaPo reporting on life expectancy, fatty liver disease, & Lunchables in school meals reveals that goal has failed and needs to be replaced.

The goal should be updated to: ensuring that every child reaches age 18 at a healthy weight and in good metabolic health. Cory Booker proposed making it the U.S. goal in his attached letter to Susan Rice on the WHC [White House Conference]. It’s part of the Nourish Science vision.

It’s doable.  USDA has the necessary power, reach, and resources. Over half of infants are on WIC, 1/3 of children in CACFP [Child and Adult Care Feeding Program], virtually all in school meals, and almost ½ of SNAP recipients are under 18. If we leveraged those programs to achieve the new goal and with FDA’s & CDC’s help, we could make substantial progress. For example, USDA was able to raise school meal HEI [Healthy Eating Index] scores from failing U.S. average of 58 to an acceptable 82 in just three years.

We have a successful blueprint in FDA regulation of tobacco. When we began our FDA investigation in 1993 1/3 of adults and ¼ of kids smoked cigarettes. Today we have a $700M FDA tobacco center and 11% of adults and only 2% of high school students smoke cigarettes.

We should set the new goal in the upcoming Farm Bill. We should change USDA’s name to the U.S. Department of Food and Agriculture and state the new goal.

The only needed ingredient to make this happen is an effective federal nutrition champion. That’s how tobacco happened.

I’m optimistic. We can do this.

I like the vision.  I’m glad he’s optimistic.  Plenty of work to do to get this on the agenda.

Some background

• The CDC on how nearly 70% of American adults are overweight or have obesity.
• My report on the White House Conference, a year ago
• Politico (Helena Bottemiller Evich, now at Food Fix)  on how diet- and obesity-related diseases are a huge public health problem, especially for COVID-19, but no government program exists to prevent them.
• Politico (Catherine Boudreau and Helena Bottemiller Evich) on how federal research on prevention of diet- and obesity-related diseases hardly exists.

The World Obesity Atlas 2023, published by World Obesity Federation, predicts that unless preventive interventions succeed, by 2035:

• The global economic impact of overweight and obesity will reach $4.32 trillion annually and constitute nearly 3% of global GDP.
• The majority—51% or more than 4 billion people—will be living with overweight or obesity.
• One in four people—nearly 2 billion—will have obesity.
• The economic impact of overweight and obesity is estimated to be over $370 billion a year in low and lower-middle income countries alone.
• Childhood obesity could more than double.

Here’s the prediction for the U.S.

In the report, the World Obesity Federation:

• Notes that member states of WHO committed to halt the increase in obesity rates at 2010 levels by 2025. No country is on track to meet these targets.
• Calls on governments to develop national action plans.
• Calls on governments to improve health care.
• Calls for building on the ROOTS framework for tackling obesity: Recognising the root causes, monitoring Obesity data, investing in Obesity prevention, ensuring access to Treatments, and adopting a Systems-based approach.

The documents:

• The press release
• The World Obesity Atlas 2023  (this includes predictions for WHO member nations) 

Comment

This is a global problem requiring global solutions., and actions by every government, including ours.   We need a national obesity prevention plan focused on strategies like to work (reduction of food insecurity, improved health care, better education, restrictions on marketing junk food, etc).

Otherwise,  we are all headed to Wall-E, which will turn out to be prescient, rather than dystopian.

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The Task Force on Hunger, Nutrition, and Health released its comprehensive report yesterday.

The report’s purpose is to inform the upcoming White House Conference on Hunger, Nutrition, and Health.  If so, it’s going to leave the White House in a quandary.

The report has lots of useful information, beautifully presented, and does all it should on adddressing hunger.

But as I read it, the report, titled Ambitious, Actionable Recommendations to End Hunger, Advance Nutrition, and Improve Health in the United States,” is not nearly ambitious enough when it comes to nutrition and health.

It makes far too many recommendations—30.  That’s always a bad sign (too many to do).  .

Really, only 2 recommendations are needed.  These should establish or expand federal agriculture, food, and nutrition policies to ensure:

1.  Adequate, affordable food and nutrition for everyone.
2.  Healthy diets for everyone, meaning those that follow Dietary Guidelines and are largely plant-based, balanced in calories, and low in undesirable fats, sugars, and salt (i.e., ultra-processed foods).

The hunger recommendations do the job: they call for ensuring benefits sufficient to meet households’ basic needs.

But the second?  A mess.

Here is the most obvious example [my comments follow] .

Recommendation #9: “Reduce the marketing of foods that do not align with the latest DGA and increase the marketing of foods that align with the latest DGA to children and populations with disproportionate rates of diet-related chronic conditions” [Good! But not through the recommended voluntary methods by industry.  That won’t work; it requires legislation]

But here’s Recommendation #25: “Increase the ability of food companies to communicate with consumers about the evidence for healthfulness of certain food products and nutrients.”  [Uh oh]

This comes with three action items:

1. FDA should expeditiously update its definition of the word “healthy” [good] and incentivize food companies to use the terminology and/or associated symbol in their food packaging and marketing [Yikes!] and increase the proportion of products on the market that meet the “healthy” definition [OK, as long as they are not gaming the system].
2. Congress and/or FDA should improve and streamline the process for application, review, approval, and use of health claims and qualified health claims on food packages. [No!  If it’s one thing we don’t need, it’s more misleading health claims]. 
3. Congress and/or FDA should create a new process for communicating about foods, nutrients, and other bioactive ingredients that may prevent or treat disease through label claims. [No!  We do not need more claims for the benefits of ultra-processed food products].

What’s missing from this report?

• Anything about ultra-processed foods and their effects on calorie intake and overall health.  The term is mentioned once, but only in the context of ‘more research needed’ (Recommendation #19).
• A clear statement of the benefits of soda taxes in reducing consumption of sugar-sweetened beverages.  Why isn’t there one?  A box explains: “Task Force members voiced diverse perspectives on this topic.”
• A clear statement about making SNAP align with Dietary Guidelines.  This is mentioned, but only in the context of pilot research (recommendation #2), and therefore contradicts recommendations #3 and #5.  #3:  Increase nutrition security by promoting dietary patterns that align with the latest Dietary Guidelines for Americans (DGA) through federal nutrition programs.  #5:  Leverage the federal nutrition programs’ power in economic stimulus to support food systems that promote foods that align with the latest DGA.”
• Firm calls on Congress to pass legislation to do what is needed.

What happened?  One member of the committee explained to me that its membership included everyone from anti-hunger advocates to food industry representatives, and too many vested interests were at stake.  Members could not agree on anything that would make a real difference to policy.  Anything substantive met strong resistance.

When it comes to public health policy, which this most definitely is, the food industry has no business being at the table.

This was a recommendation of the 2019 Lancet Commission on the Global Syndemic of Obesity, Undernutrition, and Climate Change.  Read that report.  It explains why including the food industry in policy recommendations that might reduce sales is not a good idea.

If I had been a member of this Task Force, I would have called for a minority report on policies for reducing consumption of sugary drinks and ultra-processed foods.  But that, of course, is why I’m no longer appointed to such committees.

• Read the Executive Summary
• Read the Full Report
• Read the Press Release
• Register here for the Webinar hosted by the co-chairs: Wednesday, Aug. 31 at 2:00 p.m. ET.

In response to my post last week about problems at the FDA, I received an emailed note from Jerry Mande, whom I met years ago when he was at USDA, and is now a visiting fellow at the Harvard School of Public Health.

Terrific piece today, but you should have called for the need for FDA to focus much more on the chronic disease risks of food. It’s catastrophic that they have taken only one truly regulatory action (banning trans fat) to improve diet and health…Commissioner Califf needs to put the F back in FDA only 7% of CFSAN’s budget is used for improving diet quality and nutrition, which accounts for 99%+ of food related poor health…The bottom line, as you know better than anyone, is there are more deaths every day due to poor quality diets than in a year due to acute illnesses…I urge you to consider that when you write more on this topic. You could start by featuring our op-ed in your blog. Thx!

The op-ed is indeed worth a read.

But, in fact, this topic has been on my mind since Politico’s Helena Bottemiller Evich wrote Diet-related diseases pose a major risk for Covid-19.  But the U.S. overlooks them, back in October.

Her article, which focused on the lack of government attention to the risks posed by obesity for chronic disease and COVID-19, inspired me to write an editorial for the American Journal of Public Health.  I’m told it’s going online tonight (if it does, I will post it tomorrow).