Apr
24
2015
Food politics: the Lancet policy infographic
As part of its series on obesity, the Lancet has produced this chart to illustrate why it is so important to create a food environment that makes healthy choices easy. Nice!
by Marion Nestle
Currently browsing posts about: Obesity-policy
Apr
1
2015
Interview with Columbia University Public Health Students
For tonight’s Grand Rounds at Columbia University, I did an interview with FPOP (Food Policy and Obesity Prevention).
Food Policy Expert Marion Nestle on the Heinz-Kraft Deal, GMOs, and the Secret Ingredients to Healthy School Lunches
March 31, 2014—Years before the Reagan Administration decreed that ketchup was a vegetable, Marion Nestle saw the connections between the dinner table and politics. Nestle, the nation’s leading advocate for good nutrition, will address the Mailman School in a Grand Rounds talk tomorrow and kick-off Public Health Fights Obesity, a month-long series of lectures and special events, including an April 16 symposium on preventing childhood obesity.
Nestle, a professor and founder of the department of Nutrition, Food Studies, and Public Health at New York University, is the author of acclaimed books, includingFood Politics: How the Food Industry Influences Nutrition and Health, and most recently, Why Calories Count: From Science to Politics.
In anticipation of her Grand Rounds talk, the student group Food Policy and Obesity Prevention interviewed Nestle about everything from attempts to regulate Big Soda, GMO labeling, to school lunches done right.
The federal Dietary Guideline Advisory Committee recently published recommendations that for the first time considered issues of food sustainability. There has been a lot of controversy.
The guidelines have always been controversial, but never anything like this. I think this is an example of how worried the food industry is about the pushback about diet and health in America. Sustainability is the “S word” in Washington. The guidelines committee is trying to do is what I’ve been advocating for a very long time, which is to bring agricultural policy in line with health policy. Right now the policies are completely divorced.
At the same time you have Heinz and Kraft joining forces.
The food industry is in a defensive position because food and health advocates have been enormously successful in changing the market and changing people’s views. The fastest growing segment of the food industry is organics. The makers of processed foods are in retreat. Warren Buffett must think there’s plenty of money to be made in selling junk foods. I hope he’s wrong.
Is Big Food increasingly eyeing opportunities overseas?
If you can’t sell it here, you sell it there. The best example of this is the soda industry, which is the subject of my next book. There has been a 10- to 15-year decline in sales of carbonated sweetened beverages in the United States. It’s one of the great successes of health advocacy. To compensate, Coke and Pepsi are increasingly focusing their efforts overseas. Expect obesity and its consequences to follow.
Speaking of global commerce, should we be concerned about trade agreements like the Transpacific Partnership?
Food and Water Watch called it “NAFTA on steroids.” It’s very hard to know what’s going on because the negotiations are being done in secret. People are worried that a lot of the protections we have against bad things in food will be taken away on the basis of violations of trade agreements.
Poster supporting a soda tax in Berkeley
Closer to home, here in New York we’ve heard a lot about attempts to legislate on soda with failed attempt to limit portion sizes. Other areas have had more luck—
Not luck—skill! The only place in the United States where a soda tax has been successful is Berkeley. They did everything about advocacy right. Instead of framing it as a health argument, they framed it as an argument against corporate power: Berkeley versus Big Soda. And there was an enormous grassroots effort to engage the entire community. Community organizing is classic public health. Nobody does it very often. But when it’s done, it works!
Another issue people have been talking about is GMO labeling.
I was on the FDA food advisory committee in 1994 when they were in the process of approving GMOs. Those of us who were consumer representatives told the FDA that it had to require labeling. I’m surprised it’s taken this long for there to be a major national uproar. From the beginning, the question was: if they don’t want labels, what are companies like Monsanto trying to hide?
Speaking of Monsanto, there was news this week that a chemical in their Round Up herbicide is a likely a carcinogen.
RoundUp also induces weed resistance, which has become an enormous problem for the industry. And most of it is used on GMOs. It’s a plant poison! Why would anyone think it would be good for health?
Are GMOs always bad?
The papaya that’s engineered to resist ring spot seems like a reasonable use of biotechnology to me. It saved the Hawaiian papaya industry. That’s the only example I can think of that’s beneficial. Most of the technology has been applied to commodity crops.
What about food insecurity? Can GMOs help?
If you want to help food-insecure nations, you need to empower them to do their own agriculture. That agriculture needs to be sustainable. GMO crops are not sustainable. They require seeds, fertilizer, and pesticides, every year.
President Obama signs the Healthy Hunger-Free Kids Act in 2010
According to a new Rudd Center study, more kids are eating fruit at school. At the same time, there’s a lot of pushback against healthy foods at school.
In 2010, Congress passed the Healthy Hunger-Free Kids Act. That was bipartisan. Today, bipartisan seems out of the question. The Republicans want to roll the Act back. There’s no question it’s working in most schools that have people committed to it. There are huge advances being made in school food that carry over to food outside school. Kids come home and they want different foods because they see that eating healthy foods is valued.
How much is this change tied to school leaders compared to funding?
More funding would help. But some of the poorest schools have cafeterias where you walk in and the food smells good. They’re making it happen by cooking onsite with USDA commodity foods, which are unprocessed and cheap. Someone who knows how to cook can turn USDA surpluses into good meals. But not every school does that. I’ve been in schools where the food was terrible, the kids weren’t eating it, and the plate-waste was astronomical. If the food service workers know the names of the kids, it’s a good sign the food will be good too.
For students interested in food and health, what sectors offer the most opportunity? Government? Nonprofit?
It depends on what you like. We need good people in government. It’s really important to have public health professionals work from within to make agencies like the FDA and Department of Agriculture do useful work. Everybody loves NGOs. It doesn’t matter which. Just do it!
Attend Marion Nestle’s Grand Rounds talk on April 1, 4:00-5:30 p.m., at Alumni Auditorium, 650 West 168th Street, or watch it on LiveStream.
Jul
22
2014
Rest in Peace Mickey Stunkard
The Times’ obituary for Dr. Albert J. (“Mickey”) Stunkard, who died last week at the age of 92, describes his work on the genetics of obesity and quotes Dr. Walter Willett’s comment that genetics accounts for only a small part of the “legions of the obese.”
Stunkard was writing about the lifestyle and environmental determinants of weight gain, long before most of us had a clue.
I learned this in 2000 when Michael Jacobson and I were writing a paper on public health policy approaches to obesity prevention.[i] We were arguing that policies aimed at preventing weight gain focused almost entirely on personal behavior but needed to focus on fixing the environment of food choice.
A peer reviewer scolded us for missing Stunkard’s work.
At last, we discovered Stunkard’s groundbreaking work. In the published paper, we wrote:
The most notable exception [to the focus on personal responsibility] was the report of a 1977 conference organized by the National Institutes of Health (NIH) to review research and develop recommendations for obesity prevention and management.
In one paper, A.J. Stunkard thoroughly reviewed social and environmental influences on obesity.[ii] As a result, the conference report included an extraordinarily broad list of proposals for federal, community, and private actions to foster dietary improvements and more active lifestyles.
These ranged from coordinated health education and model school programs to changes in regulations for grades of meat, advertising, taxes, and insurance premiums. Some of the proposals cut right to the core of the matter: “Propose that any national health insurance program…recognize obesity as a disease and include within its benefits coverage for the treatment of it.” “Make nutrition counseling reimbursable under Medicare.” And “Fund demonstration projects at the worksite.”[iii]
He was far ahead of his time and will be greatly missed.
References
[i] Nestle M, Jacobson MF. Halting the obesity epidemic: A public health policy approach. Public Health Reports 2000;115:12-24.
[ii] Stunkard AJ. Obesity and the social environment: current status, future
prospects. In: Bray GA, editor. Obesity in America. Washington:
Department of Health, Education, and Welfare (US); 1979. NIH Pub.
No.: 79-359.
[iii] Stunkard A. The social environment and the control of obesity. In:
Stunkard AJ, editor. Obesity. Philadelphia: WB Saunders; 1980. p. 438-
Apr
4
2014
Government policies to reduce obesity: suggestions for action
Thanks to all who commented on my April 1 (not a joke) post on inadvertant government policies that promote obesity.
Thanks in particular to Joshua De Voto who forwarded a link to the Sean Faircloth article that kicked off this discussion.
What’s remarkable about the list of items is that they constitute a policy agenda for health promotion. Just turn them around:
- Subsidize development of trails and sidewalks in cities and communities.
- Pass zoning laws that encourage foot and bicycle traffic.
- Provide nutrition information in fast food and other restaurants (fingers crossed that the FDA will eventually get on this).
- Require physical education, nutrition, and cooking classes in schools.
- Ban marketing of junk foods to children.
- Ban marketing of junk foods in schools (USDA is trying to do this).
- Subsidize production of fresh fruits and vegetables.
- Subsidize healthy foods in programs for poor people.
- Eliminate corporate tax deductions for marketing.
- Permit lawsuits against food companies.
I can think of other policies well worth promoting.
Please add to the list!
Apr
1
2014
Call for ideas: Do government policies promote obesity? How?
Nicholas Kristof of the New York Times recently devoted a column to an analysis of who really gets welfare in the United States. He listed policies that favor not only the wealthy, but the fabulously wealthy:
- Subsidies for private airplanes via tax write-offs and deductions
- Tax deductions for private yachts
- Tax deductions for hedge funds and private equity
- Bank rescues
- Incentives to operate locally
His column reminded me of one written in 2005 by Sean Faircloth, then a Maine State representative, “Six ways government promotes obesity and what to do about it.”
No government, Faircloth said, could have devised more effective policies for reducing physical activity and promoting junk food. Taxpayers, he pointed out:
- Subsidize oil companies and cars to the detriment of trails and sidewalks.
- Make it impractical to get basic information in foods and restaurants (menu labeling regulations: where are you?).
- Give large corporations free reign to market to children.
- Allow soda and snack-food companies to market products in schools (USDA is trying to change this).
- Direct billions in subsidies toward processed foods while neglecting fresh produce.
- Promote high-calorie foods in programs for poor people.
I thought this was an interesting way of thinking about obesity policy and over the years have added these:
- Allowing marketing costs to be deducted from taxes as business expenses
- Bans on lawsuits against food companies
- Ambiguous and obfuscating dietary guidelines (e.g. SoFAS in the 2010 edition)
No doubt there are others.
Can you think of any others? Thanks.
Dec
13
2012
Good news: cities report declines in childhood obesity
I don’t get many fan letters (as you can tell from reading the comments to posts). When I do, they mean a lot. Here’s an especially lovely one from a reader this week:
I cannot help but think of you and the work that you do having a great impact on the first signs of child/youth obesity declining. Although the “researchers” indicate they are not sure of the reasons for the decline, I think many within the food / food politics community know that the work you do, the awareness you spread and the advertising you expose, greatly affects the way we feed our children. As a real food advocate and parent, thank you for the work you do.
Thanks but I can take no credit (much as I would love to).
The writer is referring to a front-page, right-hand column story—the most important of the day—in the December 11 New York Times. The article said that several cities are reporting drops in childhood obesity rates.
The drops may be small, just 3% to 5%, but any reversal in obesity trends is excellent news.
Last September, the Robert Wood Johnson Foundation first reported such drops.
It noted that the declines were occurring in places that had taken comprehensive action to address childhood obesity.
New York City, for example, has engaged in major efforts to make healthy dietary choices the easy choices. Health Commissioner Tom Farley recently reported a 5.5% decline in childhood obesity.
The Foundation says that Philadelphia:
has undertaken a broad assault on childhood obesity for years. Sugary drinks like sweetened iced tea, fruit punch and sports drinks started to disappear from school vending machines in 2004. A year later, new snack guidelines set calorie and fat limits, which reduced the size of snack foods like potato chips to single servings. By 2009, deep fryers were gone from cafeterias and whole milk had been replaced by one percent and skim.
Broad policies like these are exactly what the Institute of Medicine recommends (me too).
And now, it seems, these actions are actually having the intended effect.
That’s the best news ever.
And I don’t care who gets credit for it.
Sep
24
2012
Do sugar-sweetened beverages promote obesity? Yes, say papers in the New England Journal.
The New England Journal of Medicine has just published a series of articles on sugar-sweetened beverages to coincide with presentations at The Obesity Society’s annual meeting. Here are links to the articles. I’ve extracted brief quotes from some of them. And here’s a summary in the New York Times.
Perspective: J.L. Pomeranz and K.D. Brownell, Portion Sizes and Beyond — Government’s Legal Authority to Regulate Food-Industry Practices.
Regulations that affect “ordinary commercial transactions” (such as the sale of a product) are presumed to be constitutional if they have a rational basis and if the government body enacting them has the appropriate knowledge and experience to do so.
In the case of New York City’s portion-size restrictions, for example, the health department is an expert public health body that reviewed relevant scientific evidence on the health hazards associated with consumption of sugar-sweetened beverages and the effect of portion sizes on consumption patterns. The proposed policy thus has a rational basis….
Original Article: Q. Qi and Others, Sugar-Sweetened Beverages and Genetic Risk of Obesity
The study concludes: “the genetic association with adiposity appeared to be more pronounced with greater intake of sugar-sweetened beverages.”
Original Article: J.C. de Ruyter and Others, A Trial of Sugar-free or Sugar-Sweetened Beverages and Body Weight in Children
We conducted an 18-month trial involving 641 primarily normal-weight children from 4 years 10 months to 11 years 11 months of age. Participants were randomly assigned to receive 250 ml (8 oz) per day of a sugar-free, artificially sweetened beverage (sugar-free group) or a similar sugar-containing beverage that provided 104 kcal (sugar group). Beverages were distributed through schools….Masked replacement of sugar-containing beverages with noncaloric beverages reduced weight gain and fat accumulation in normal-weight children.
Original Article: C.B. Ebbeling and Others, A Randomized Trial of Sugar-Sweetened Beverages and Adolescent Body Weight
We randomly assigned 224 overweight and obese adolescents who regularly consumed sugar-sweetened beverages to experimental and control groups. The experimental group received a 1-year intervention designed to decrease consumption of sugar-sweetened beverages, with follow-up for an additional year without intervention….Among overweight and obese adolescents, the increase in BMI was smaller in the experimental group than in the control group after a 1-year intervention designed to reduce consumption of sugar-sweetened beverages, but not at the 2-year follow-up
Editorial: S. Caprio, Calories from Soft Drinks — Do They Matter?
These randomized, controlled studies — in particular, the study by de Ruyter et al. — provide a strong impetus to develop recommendations and policy decisions to limit consumption of sugar-sweetened beverages, especially those served at low cost and in excessive portions, to attempt to reverse the increase in childhood obesity.
Clinical Decisions: T. Farley, D.R. Just, and B. Wansink, Regulation of Sugar-Sweetened Beverages
This one is a point/counterpoint. On the basis of the evidence just presented, should government regulate sugary drinks?
New York City Health Commissioner Tom Farley says yes:
If a harmful chemical in schools were causing our children to get sick, people would demand government regulation to protect them. It is therefore difficult to argue against a government response to an epidemic of obesity that kills more than 100,000 persons a year in the United States and has an environmental origin.7
Federal, state, and local governments already regulate the food system, from farm to retail, in many ways and for many purposes, ranging from support of agriculture to prevention of foodborne illness. The question is not whether we should regulate food, but rather whether we should update food regulations to address this new epidemic.
David Just and Brian Wansink say no:
We must also recognize that the universe of foods that contribute to childhood obesity is much larger than sugar-sweetened beverages. Such a narrowly defined approach would have minimal chance for overall success. Rather, we must consider approaches that will involve parents, schools, and pediatricians in leading children toward more healthful eating habits and increased physical activity. In truth, we cannot hope to create regulations that restrict behavior holistically.
I’d say we now have plenty of evidence that habitual use of soft drinks raises risks for obesity, and plenty of evidence for the need for regulation.
Yes, it would be nice if “leading children to eat better” worked, but parents, teachers, and everyone else needs lots of help in coping with today’s food environment.
The New England Journal has done a great public service in publishing these papers as a series, and the authors all deserve much praise for taking on these difficult research projects.
OK city agencies: get to work!
Sep
19
2012
JAMA publishes theme issue on obesity
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
