Food Politics

by Marion Nestle
Jul 29 2014

Last call for comments on proposed food label: more on Added Sugars

August 1 is the deadline for filing comments on FDA’s food label proposals.

Two were released yesterday, one for and one against.

The Union of Concerned Scientists (UCS) organized a statement in support of listing added sugars signed by 280 scientists, physicians, and public health officials (including me).

The press release says:

In a letter submitted as a public comment for the agency’s first label update since 1994, the signatories point out that sugar overconsumption contributes to diabetes, cardiovascular disease and other ailments….Many food and beverage manufacturers add excessive amounts of sugar to their products, including those that they market as healthy options. In our current food environment, many people are unknowingly and unavoidably consuming excess sugar. Given our soaring rates of chronic diseases and the link between sugar and these diseases, citizens have a right to know how much sugar has been added to their foods.

People who signed the letter include many from Healthy Food Action, a national network of health professionals founded by Dr. David Wallinga.  I am a co-author of the statement with UCS staff and Dr. Robert Lustig.

In contrast, the American Society for Nutrition (ASN), an organization of nutrition scientists to which I belong, produced a strong statement against labeling added sugars.

ASN also has concerns that the inclusion of added sugars on the label may divert attention away from total calories and other important contributors to weight gain. The inclusion of added sugars on the label may confuse consumers and create the perception that naturally occurring sugars are somehow more beneficial because they are “natural” and do not have health effects similar to added sugars…There is no supporting evidence that indicates that the inclusion of added sugars on the food label will translate into the American public reducing caloric intake from added or total sugars or total energy intake…it is important to consider potential unintended consequences of  reformulation as well. When sugar is removed from a solid food product…The replacement is often fat and/or starch which could lead to a product with higher calories per serving. ASN encourages FDA to carefully consider potential adverse consequences of this proposed determination, including gaining input from food scientists…An investment in consumer education… is likely to be most productive for consumer understanding relative to added sugars, and would assure that consumers do not experience increased confusion, which they may encounter if added sugars are declared on the Nutrition Facts label.

These comments, which read as though written by sugar trade association groups, were signed by the chair of ASN’s public policy committee, although not by the other members.   The letter gives no indication of the process by which these comments were developed.

I wonder if  all the other members of the committee agreed with what is stated here.

I wonder if much of the membership agrees.   I certainly don’t.

 

Jul 28 2014

On deadline: comments on FDA’s food label proposals

The FDA is taking comments on its proposals to revamp the food label through August 1, 2014 (instructions are at bottom of post).

I’ve already filed comments on Added Sugars and on whether Vitamin D should be added to food labels.

And I just filed further comments on the FDA’s proposals for the Nutrition and Supplement Facts Labels.  If you would like to read what I said, click here.

I’ve also filed comments on the FDA’s Serving Size proposals.

These proposals are highly technical and tough to slog through, so I tried to deal with the big picture.

July 27, 2014

TO:                  FDA

FROM:           Marion Nestle, Professor of Nutrition, Food Studies and Public Health, New York University

RE:                  Comments: Serving size proposals, Docket No. FDA-2004-N-0258

In addressing the question of how to change serving size designations on food labels, FDA is faced with an impossible dilemma .  Serving sizes, which are supposed to be based on amounts typically consumed from packaged products, are invariably perceived as recommendations for dietary intake.

To comment on each of the bold-face, italicized points:

  • Typically consumed:  This information derives from dietary intake surveys which invariably underestimate actual intake, often by 30% to 40%.
  • Packaged foods: Food labels only appear on packaged foods.  RACC amounts on packaged foods are often much lower than amounts served in restaurants or fast-food places (pizza is an obvious example).  It is unclear whether amounts reported as consumed are from packages (with Nutrition Facts labels) or are from restaurants or fast-food places where portion sizes can be much higher than those for foods in packages.
  • Recommendation:  Substantial anecdotal information suggests that people view labeled serving sizes as what they should be eating.  They view the serving sizes as meaningless compared to the portion sizes of foods they are accustomed to eating.

What is well established is that overall calorie intake has increased since RACCs were established in 1993 and marketplace portion sizes have also increased.

Therefore, any increase in RACC runs the risk of being interpreted as a validation of current portion sizes and as a recommendation to eat more.

On the other hand, larger portions have more calories.  These must appear on the label.

To address this dilemma, FDA should:

  • Make dual-column labeling mandatory for all food and beverage packages likely to be consumed in one sitting.
  • Require total calories in the package to be displayed on the front of the package.
  • Include a footnote explaining that the serving size is not meant as a recommendation

INSTRUCTIONS FOR FILING COMMENTS

The FDA provides:

File comments here

Jul 25 2014

Weekend thinking: NutraIngredients-USA’s special edition on cognitive health 

The role of specific nutrients in brain health isn’t something I think about much.  I’m of the opinion that a reasonably healthy diet takes care of health.  Stop worrying, be happy.

But I’m always interested in what the food industry is cooking up based on current research, and here’s a good sampling to ponder.

For this Special Edition, NutraIngredients-USA has a long hard think about cognitive health…

Cognition spans the lifetime, from development in the womb right through to old age. So, which ingredients have the best science? How are companies approaching this sector and what claims can they make? What’s all this about the gut-brain axis? And what’s happening with botanicals in this space?

 

Jul 24 2014

FDA’s food label proposals: comments on Vitamin D

The FDA is taking comments on label proposals until August 1 (see info at end of post).  Here’s mine on voluntary vitamin D labeling.

July 17, 2014

TO:  FDA

FROM:  Marion Nestle, Professor, New York University

RE:  Proposed revision to Nutrition Facts Panel: VITAMIN D

This is to argue against permitting food companies to voluntarily label added “Vitamin” D on the Nutrition Facts panel.  Doing so will not promote—and may possibly harm–public health.

Rationale

  • “Vitamin” D is not a vitamin; it is a hormone synthesized by the action of sunlight on skin.  For this reason alone, it does not belong on the food label.
  • Vitamin D fortification must be understood as a form of hormone replacement therapy.   As such, it raises questions about efficacy, dose, and side effects that should be asked about all such therapies.
  • Fortification and supplementation provide hormone Vitamin D by the oral route.  This is not physiological.  Active vitamin D is synthesized in the body through a series of reactions that begin with the action of sunlight on skin.  Sunlight on skin produces ample Vitamin D, is regulated to promote synthesis as needed and avoid toxicity, and may lead to synthesis of other useful biological components; the unphysiologic oral route does not produce the same benefits.[i]
  • As a hormone, Vitamin D is found naturally in very few foods (e.g., fish); in them, it is present in small amounts.  It is present in most foods as a result of fortification.
  • Permitting Vitamin D to be listed on food labels will encourage fortification, undoubtedly of foods that would not otherwise necessarily be recommended.  To cite just one example: Yum Bunny Caramel Milk Spread fortified with vitamin D at 10% of the DV.  This product is half sugars by weight, marketed as “a good source of calcium and vitamin D,” and clearly aimed at children. See: http://www.yumbunny.com/about-us.   Whether such products should be considered “good sources” also deserves scrutiny.
  • The U.S. Preventive Services Task Force concludes that evidence is insufficient to determine how Vitamin D supplementation (and, therefore, fortification) affects fracture incidence.[ii],[iii],[iv] 
  • Data from the Women’s Health Initiative also are consistent with largely inconclusive findings about hormone Vitamin D supplements and bone health.[v]
  • The Institute of Medicine (IOM) does not consider deficiency of Vitamin D to be a serious problem in the United States, except among certain population groups.  Instead, because of widespread fortification and supplementation, it is concerned about the possibility of adverse consequences from overconsumption through supplementation or fortification.[vi]
  • Many scientific debates about hormone Vitamin D are as yet unresolved.[vii],[viii]  
  • The lack of compelling research has permitted Vitamin D to become “trendy.”  It is advertised on boxes of fortified cereals, has its own pro-supplement advocacy group, and generates millions in annual supplement sales.[ix]

In the absence of stronger evidence for benefit from fortification, and some evidence for possible adverse consequences, the FDA should not contribute to further commercialization of this misnamed hormone by permitting it to be listed on food labels.

References

[i] Wacker M, Holick MF.  Sunlight and Vitamin D: A global perspective for health. Dermato-Endocrinology 2013;5(1):51–108.

[ii] Cranney A, Horsley T, O’Donnell S, Weiler H, Puil L, Ooi D, et al.  Effectiveness and safety of vitamin D in relation to bone health. Evidence Report/Technology Assessment No. 158. Rockville, MD: Agency for Healthcare Research and Quality. 2007.  http://www.ncbi.nlm.nih.gov/books/NBK38410. Accessed February 5, 2013.

[iii] Chung M, Balk EM, Brendel M, Ip S, Lau J, Lee J, et al  Vitamin D and calcium: a systematic review of health outcomes. Evidence Report/Technology Assessment No. 183. Rockville, MD: Agency for Healthcare Research and Quality. 2009.  http://www.ncbi.nlm.nih.gov/books/NBK32603/. Accessed February 5, 2013.

[iv] Chung M, Lee J, Terasawa T, Lau J, Trikalinos T. Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155(12):827-38.

[v] Prentice RL, Pettinger MB, Jackson RD, Wactawski-Wende J, LaCroix AZ, Anderson GL, et al.  Health risks and benefits from calcium and vitamin D supplementation: Women’s Health Initiative clinical trial and cohort study.  Osteoporosis Int.  2013;24(2):567-580.

[vi] Institute of Medicine.  Dietary Reference Intakes: Calcium, Vitamin D.  Washington, DC: National Academies Press, 2011.

[vii] Rosen, Clifford J,  Abrams, Steven A,  Aloia John F. et al.  IOM Committee members respond to endocrine society vitamin D guideline. J Clin Endocrinol Metab. 2012;97:1146-1152.

[viii] Holick, Michael F,  Brinkley Neil C, Heike, A et al  Guidelines for preventing and treating vitamin D deficiency and insufficiency revisited.  J Clin Endocrinol Metab. 2012;97:1153-1158.

[ix] Much growth in vitamin sales driven by vitamin D.  Nutr Business J. 2009;14(6/7):5.

Here’s how to file comments:

The proposed revisions are to:

The FDA makes it very easy to file comments. It provides:

File comments here

Jul 23 2014

The White House says “Drink Up,” meaning water

Living in New York as I do, I miss the fun in Washington, DC, of which there was much yesterday related to the First Lady’s “Drink Up” campaign with the Partnership for a Healthier America.   Here’s one of ObamaFoodorama’s tweets on the event.

Screenshot 2014-07-23 07.58.20

Listen to what the First Lady is saying in these selected quotes, some of which deal with the current furor over school meals:

  • When the Drink Up campaign was launched last year, it had one simple goal – to get kids and families excited about drinking water.
  • As Drink Up encourages more people to drink more water, we also want to help make choosing water an easier choice…water for more people wherever they are, whenever they want it, however they want it – be it tap, filtered or bottled.
  • In a number of school districts, participation in the lunch program has actually risen. And there’s a simple reason for that: It’s because those districts actually put some effort into marketing the new meals to the kids. They didn’t just sit back and say, well, the kids like junk food so let’s just give them junk food.
  • Instead, they embraced higher standards and more nutritious options, and they worked hard to get the kids excited about them. They did taste tests. They came up with new recipes. They did everything they could to make healthy eating fun.
  • Today, we’re seeing the results, especially among younger kids…They’re getting used to healthier food, and they’re developing healthy habits early on that will stay with them for the rest of their lives. And that’s our job as adults… And no matter what, we don’t give up on our kids. And we don’t give up on their health and their futures.
  • We need to keep pushing to market healthy products to children and families. We need to keep working together within industries and across industries to help our kids lead healthier lives.

Even better, The California Endowment announced that it will increase community access to water in South Kern County and the Eastern Coachella Valley by installing hundreds of taps and dispensers to fill reusable water bottles in schools and public places.

Let’s have more tap-water initiatives, please.

The more people drink tap water, the greater will be public support for maintaining the quality of municipal water supplies.

Addition, July 24:  The School Nutrition Association wrote the First Lady to complain that it found her remarks offensive.

 

 

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-

 

Jul 21 2014

This week’s reading: The GMO Deception

Sheldon Krimsky and Jeremy Gruber, eds.  The GMO Deception: What You Need to Know about the Food, Corporations, and government Agencies Putting Our Families and Our Environment at Risk.  Skyhorse Publishing, 2014.

I did a blurb for this one:

GMO Deception brings together essays by specialists in a wide range of fields united in skepticism about the benefits of GMOs for reasons grounded in in biology, social science, politics, and ethics.  If you do not understand why there is so much opposition to GMOs, nationally and internationally, this book is the place to start.

Jul 18 2014

School Nutrition Association: junk foods galore (but they meet USDA’s nutrition standards)

Politico ProAg’s Helena Bottemiller Evich has been reporting on the School Nutrition Association (SNA) meeting in Boston this week (and see the video conversation with her editor, Jason Huffman, about the meeting).

One of her points: from the kinds of junk-food products exhibited, you would never know that the SNA was at war with the White House over USDA’s nutrition standards for school meals (see my previous posts).

As she explains, food companies have had no problem coming up with look-alike products that meet USDA standards:

More than 400 exhibitors showed off their innovations designed to meet the Department of Agriculture’s new regulations…PepsiCo, which owns Tropicana, Quaker and Lays, has a long list of products that meet the new rules, including Reduced Fat Doritos and Cheetos, Stacy’s Pita Chips and Munchies. Windsor Foods, which specializes in food service, has come up with whole grain-rich egg rolls that the company says kids love.

General Mills displayed a modified version of Chex Mix, a whole grain Betty Crocker cookie and a Cinnamon Toast Crunch cereal bar: “Snacks so good, kids won’t know they’re nutritious,” according to the marketing flyers.

…while the changes to lunch standards may be giving many school nutrition professionals fits, the food manufacturing industry is drooling over the opportunity to gain more sales inside what has been described as the nation’s largest restaurant: The school lunch program serves 30 million kids each day and represents a $30 billion per year market for the food industry, according to the Center for Science in the Public Interest.

…SNA benefits from the food industry’s enthusiasm in school lunches. The largest chunk of the group’s revenue is generated at its annual conference, which brought in $4.7 million in 2012. The association charges $15,000 to sponsor an education session track featuring a company representative and $20,000 to put company logos on hotel key cards.

Evich quotes Michele Simon, who also attended the meeting.

Walking through that hall, it’s very hard to see where the changes are,” she said. “It’s still pretty appalling to see the types of junk food that can pass as acceptable food for school meals. It seems like there’s a disconnect between the uproar over the improved guidelines and all these vendors who seem to have no problem meeting them.”

Michele sent me a photo of one such product.

Gatorade

 

For photos of other such items, see Michele Simon’s other images on Time Magazine’s site, and Nancy Huehnergarth’s collection of what she calls “The Good, the Bad and The Ugly Food Exhibits.”

To understand what this is about, take a look at the Public Health Advocacy Institute’s report on Copycat Snacks in Schools.  The “better for you” versions are sold in schools, but you can hardly tell the difference between those and the “not so good for you” commercial versions from the nearly identical packages.

How can food and beverage companies get away with this?  This is the result of USDA’s setting nutrient-based, rather than food-based standards for school meals.  Setting nutrient standards allows food companies to tweak the formulas to give the USDA what it requires.

Is a slightly “better for you” option necessarily a good choice?  Surely, schools can do better.

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