Posts dated: June2012

The Supreme Court ruling that the Affordable Care Act (ACA) is indeed constitutional means that Americans will now have greater access to health care as well as to services to help prevent disease.

The American Public Health Association summarizes the benefits: 

• 31 million Americans are projected to gain health coverage by 2019
• 54 million U.S. families have additional benefits, including greater access to preventive health care services
• 2.5 million young adults up to age 26 are able to stay on their parents’ health insurance plans;
• nearly 18 million children with pre-existing conditions are protected from insurance coverage denials;
• seniors can access preventive services

Let’s add menu labeling to the list.  The ACA takes menu labeling national.  The FDA proposed the rules for this process more than a year ago, with no further action.

The Supreme Court says go for it. 

FDA: No more excuses.  Get busy!

The online, open-access journal Public Library of Science – Medicine, better known as PLoS Medicine, is doing a series of articles on Big Food.  I’m its co-editor, with David Stuckler in the U.K.

Here’s what’s online so far. 

Editorial: PLoS Medicine Series on Big Food: The Food Industry Is Ripe for Scrutiny, by the PLoS Medicine Editors, PLoS Medicine, 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001246

Essay: Big Food, Food Systems, and Global Health, by David Stuckler, Marion Nestle, PLoS Medicine, 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001242 

Essay: Food Sovereignty: Power, Gender, and the Right to Food, by Rajeev C. Patel, PLoS Medicine, 26 Jun 2012 | info:doi/10.1371/journal.pmed.1001223

Policy Forum: Soda and Tobacco Industry Corporate Social Responsibility Campaigns: How Do They Compare?, by Lori Dorfman, Andrew Cheyne, Lissy C. Friedman, Asiya Wadud, Mark Gottlieb, PLoS Medicine, 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001241

Policy Forum: Manufacturing Epidemics: The Role of Global Producers in Increased Consumption of Unhealthy Commodities Including Processed Foods, Alcohol, and Tobacco, by David Stuckler, Martin McKee, Shah Ebrahim, Sanjay Basu, PLoS Medicine, 26 Jun 2012 |info:doi/10.1371/journal.pmed.1001235

Twitter chat: To follow the Twitter chat that took place on June 27, search for #plosmedbigfood.

More next week.  Stay tuned.

As the co-author of a recent book called Why Calories Count: From Science to Politics, I am well aware of how difficult it is to lose weight.

The problem

• When you are dieting and losing weight, you require fewer calories to maintain and move your smaller body, and your metabolism and muscle activity—and, therefore, your total energy expenditure–slow down.
• To maintain the weight loss, you need to eat less than you did before you began dieting.

But what would happen if you could adjust your diet to keep your energy expenditure from slowing down?

Enter Ebbeling et al in JAMA, with a comprehensive study to address precisely that question.  The results of the study and editorial comments on the findings demonstrate how complicated and difficult it is to obtain definitive answers to questions about diet composition and calorie balance.

• The investigators asked whether calorie-controlled diets containing varying amounts of carbohydrate, fat, and protein, and varying in glycemic load (a measure of rapidly absorbable carbohydrates in foods) affected total energy expenditure in obese people who had just lost 10% to 15% of their weight, but were still obese.
• They found that the diet lowest in carbohydrate did not slow down energy expenditure as much as did the low-glycemic index diet, or the one lowest in fat.
• They concluded: “The results of our study challenge the notion that a calorie is a calorie from a metabolic perspective.”

This study took years and involved a very large number of state-of-the-art physiological measurements.

But I want to focus on the question of whether calories from all sources are metabolically equivalent.   Here’s my understanding of the study.

The methods

Ebbeling et al started by offering $2500 to obese volunteers to participate in a 7-month weight-loss trial.   In my view, the 21 subjects who finished the study worked hard for that money.

They had to participate sequentially in a:

• Weight-monitoring phase for 4 weeks, during which they ate their typical diets while the investigators monitored their weight.
• Weight-loss phase for 12 weeks, during which they were fed pre-prepared diets calculated to contain about 60% of their usual calorie intake so they would lose about 2 pounds a week.  The average weight loss over 12 weeks was an impressive 14.3 kg (31.5 pounds).
• Weight-stabilization phase for 4 weeks, during which they were fed pre-prepared diets that provided the reduced number of calories needed to maintain their newly reduced weights.
• Testing phase of 4 weeks on each of three pre-prepared test diets (total: 12 weeks).  All three test diets provided the number of calories needed to maintain the reduced weight.  During each of the 3 testing periods, investigators measured—not estimated—the subjects’ total daily energy expenditure (resting metabolism plus activity).

The composition of the diets

Note that whenever one component of a diet gets changed, the other two components change too.   Because protein usually occurs in foods in relatively low amounts, a low-fat diet is necessarily a high-carbohydrate diet, and vice versa.

The results

• The weight-loss part of this study showed that when overweight people were allowed to eat only calorie-controlled pre-prepared diets, they lost weight quickly and maintained the weight loss.
• The test-diet part of the study showed that the diet lowest in carbohydrate (and, therefore, highest in fat) had the least effect in slowing down total energy expenditure.   The diet that slowed down overall energy expenditure the most was the one lowest in fat.

If these results are correct, people eating high-fat, low-carbohydrate diets are likely to have the easiest time maintaining weight loss.  In contrast, people on low-fat, high-carbohydrate diets are likely to have a harder time maintaining weight loss.

But does this mean that calories from different sources have different effects on metabolism?  Proponents of the Atkins (high-fat, low carb) diet say yes, according to an account in USA Today (in which I am also quoted).

I’m still skeptical.  The subjects in this study lost and maintained weight under highly controlled, calorie-restricted conditions, in which the calories came from a relatively low-fat, moderate-carbohydrate, high-protein diet (average diets contain 10% to 15% protein).

The accompanying editorial notes that heat losses are greater for protein than for carbohydrate or fat, and also raises questions about whether physical activity declined more with the low-fat (high-carb) diet than the others.  It also notes:

Each diet was consumed for only 4 weeks. A weight stabilization protocol…may not have adequately accounted for changing energy needs associated with readjustment to new diets.

These provocative results…emphasize the current incomplete knowledge base regarding the importance of dietary macronutrients and energy expenditure, especially after weight loss.

Under the relatively short, highly controlled feeding conditions of this study, the composition of the diet may indeed matter to metabolism.  But does diet composition matter for weight maintenance in the real world?

Other longer term studies of “free-living” people out and about in their communities show little difference in weight loss or maintenance between one kind of diet and another.

More research needed!

The bottom line

• If you want to lose weight, eat less (it worked well for the subjects in this study).
• It may help to avoid excessive consumption of sugars and easily absorbed carbohydrates.
• Once you’ve lost weight, adjust your calorie intake to maintain the weight loss.
• And understand that science has no easy answers to the weight-loss problem.

Dr. Karen Sokal-Gutierrez, a pediatrician I know who teaches in the UCSF-Berkeley Joint Medical Program, is involved in a health program in El Salvador that among other things focuses on the dental health of urban and rural kids.

As she explains, when she was a Peace Corps volunteer thirty years ago, the kids had perfect teeth and beautiful smiles.  She has a collection of photographs to prove it (she sent me this one).

Today, kids’ teeth are rotted to the roots as a result of the introduction of sugary drinks and snacks.  She and her students are working to educate parents to take care of their kids’ teeth but also to feed their kids healthier foods.

PBS NewsHour has just done a segment on her program (it’s a bit over 7 minutes).

This is well worth watching as a case study of:

• The efforts of junk food and soda companies to sell products in developing countries.
• The effects of junk foods and sodas on kids’ health.
• The hard work that Dr. Sokal-Gutierrez and her colleagues must do to counteract these effects.
• The investigative and production skills of recent journalism school graduates.

The segment is also worth watching for the priceless comments of Coke and Pepsi (these come at  about 4.3 minutes).

Coke: “With basic dental hygiene practices, people have enjoyed our products for decades without risk to their dental health.”

Pepsi: “We believe that parents should decide what their children eat and drink…Any food and beverage with sugars and starches, including some of our beverages can contribute to the development of cavities.”

Those of us who have access to fluoridated water, toothbrushes, and dental care don’t usually think of severe dental disease as a consequence of drinking sodas.

We should.

Addition:  Dr. Sokal-Gutierrez asked that I also post a photograph of what the kids’ teeth look like.  Happy to oblige.

Two queries from readers (see Feedback):

#1: I would love to hear your comments as to why you think the AMA came out in support of “not” labeling GMO foods. Do they have ties to big agriculture or biotech companies? How can they ask for safety testing and then not want the untested products already on the market not labeled? How can we as consumers monitor the effects of GMO’s if they’re not even label? Am I missing something here?

#2: I was also wondering why the American Medical Association would not support labeling genetically engineered foods. This just does not make sense to me. I would love to hear your thoughts on this. Thank you.

I can’t find the AMA statement online but I first read a report about it from Monica Eng in the Chicago Tribune.   Fortunately, Rosie Mestel reproduced much of the statement in her account in the Los Angeles Times.

Apparently, AMA delegates said they support mandatory FDA premarket safety assessments of GM foods “as a preventive measure to ensure the health of the public.”  They also urge the FDA “to remain alert to new data on the health consequences of bioengineered foods.”

The AMA says that policies on GM foods:

should continue to be science-based and guided by the characteristics of the plant or animal, its intended use, and the environment into which it is to be introduced, not by the method used to produce it, in order to facilitate comprehensive, efficient regulatory review.

And it says,

there is no scientific justification for special labeling of bioengineered foods, as a class, and that voluntary labeling is without value unless it is accompanied by focused consumer education.

Mestel quotes a statement e-mailed to her from AMA board member Dr. Patrice Harris:

The science-based labeling policies of the FDA do not support special product labeling without evidence of material differences between bioengineered foods and their traditional counterparts. The AMA adopted policy supporting this science-based approach, recognizing that there currently is no evidence that there are material differences or safety concerns in available bioengineered foods.

In the first chapter of my book Safe Food: The Politics of Food Safety, I explain what this is about.  I distinguish between two approaches to food hazards in general and to GM foods in particular.  These are:

• Science-based.  Translation: if the food is safe, it is acceptable.  GM foods are presumed safe; therefore, they are acceptable and any criticism of them is irrational.
• Value-based.  Translation: even if GM foods are safe, they are not necessarily acceptable for reasons of precaution, ethics, religion, culture, or concerns about corporate control of the food supply.  Science-based approaches are insufficient; they also need to address such concerns.

The two ways of looking at GM foods are so vastly different that it is hard to know where a compromise might exist.  If you have trouble believing this, take a look at the comments on my most recent post on GM foods.  These are classic examples of both positions.

The FDA took a strictly science-based approach when it approved GM foods in 1994.  The AMA is trying to do the same.

Here’s what surprises me: in recommending premarket safety testing, which is not now required, the AMA appears to be raising serious questions about the safety of GM foods.

If such doubts exist, shouldn’t GM foods be labeled so the public has a choice?

Many value-based concerns about GM foods could be alleviated if the products were labeled.  People who didn’t want to buy them wouldn’t have to.  Isn’t that what consumer choice is all about?

As I interpret what I’ve seen of the AMA statement, it provides further evidence for the need to label GM foods.

Other countries have no trouble labeling such foods.  We could too, and easily, as I have explained previously.

Update, June28: RosieMestel sends the complete AMA policy statement.

It’s difficult to know what to say about a 1010-page bill that affects literally hundreds of programs, some big, some small, at such astronomical cost—an expected $97 billion per year.  The bill is so big and so complex that it is unreasonable to expect legislators to understand it well enough to vote on it intelligently.  Think of it as a prime example of special interests in action.

I’ve been collecting e-mailed responses from various groups.  From these, it’s seems that the food movement scored a few wins along with plenty of losses.

First the wins.  The United Fresh produce association is happy that the bill provides for:

• Specialty Crop Block Grants funded at $70 million per year
• Specialty Crop Research Initiative funded at $25 million in FY13; $30 million in FY14-15; $65 million in FY16; $50 million in FY17
• Plant Pest and Disease Program funded at $60 million in FY13-16 and $65 million in FY17
• Market Access Program and Technical Assistance for Specialty Crops fully funded at 2008 Farm Bill levels
• Fresh Fruit and Vegetable Program fully funded at 2008 Farm Bill levels
• Hunger-Free Communities Grant Program for fruit and vegetable SNAP incentives
• Farmers Market and Local Food Promotion Program
• Section 32 specialty crop purchases funded at 2008 Farm Bill levels
• DoD Fresh program fully funded at $50 million per year consistent with 2008 levels

Oxfam likes two things:

• It converts the 2008 pilot program to study the effectiveness of purchasing food aid locally and regionally to a full program funded at $40 million per year.
• It tries to reduce dumping of food aid on developing country markets.

Everyone else is mixed or skeptical:

• From Food and Water Watch: “Today, the U.S. Senate passed a farm bill that left the largest agribusiness and food processing companies firmly in control of America’s food system.”
• From the National Sustainable Agriculture Coalition: “While the bill includes historic commodity payment limit reforms and renewed investments in a variety of sustainable farm and food programs…[it] would benefit greatly from more agriculture reform, a greater local and regional food focus, and a much greater commitment to economic development and jobs…We are also disappointed with the $3.7 billion cut to conservation programs on working farms and ranches.”
• From the Environmental Working Group: “While we do not support this bill, we applaud the provisions that require farmers who receive crop insurance subsidies to carry out basic environmental protections on their farms and to reduce insurance subsidies for the largest and most successful agribusinesses.”

The debates over the farm bill hold some interesting lessons.

• The historic “logrolling” alliance between rural states favoring commodity support and urban states protecting food assistance programs (SNAP, food stamps) may soon come to an end.  Senator Ron Johnson’s (Rep-WI) motion to separate SNAP benefits from farm supports was allowed four minutes of discussion.  It failed on a vote of 59 to 40 (all Republicans).  Forty?  That seems like a lot.
• Labeling of genetically engineered foods remains an issue in American politics and not likely to go away.  The Senate voted down an amendment to allow states to decide for themselves whether to label such foods.  How will this affect the California “lets label it” initiative?
• Crop insurance will be the new focus of consumer advocacy.  As Politico puts it, “the bill reflects a major shift of resources to crop insurance, which emerges as a new political powerhouse for agriculture — and what’s left of the safety net promised farmers. Midwest corn and soybean producers — riding high with good prices and a federal ethanol mandate — helped drive this change. But the result is a real and lasting split with Southern rice, peanuts and wheat growers reflected in the final vote.”
• The food movement has to get its act together. Ken Cook of the Environmental Working Group said “When conservationists stood our ground and fought, we won against the supposedly invincible crop insurance industry. Too many in the conservation community didn’t fight at all…As a consequence, conservation funding took the largest proportionate hit in this bill. For the “food movement”, the Senate farm bill has been another, rather sobering reminder that until we develop political muscle to match our passion for a sustainable food system, we’ll continue to see billions of dollars misspent on industrial agriculture.”

This is a call to action.  The House is about to take up its version in the coming weeks.  Advocates: get to work!

In the vote-a-rama of the last couple of days, the Senate passed these farm bill amendments with roll-call votes (other amendments were passed or rejected by voice votes):

• No. 2439; To limit the amount of premium subsidy provided by the Federal Crop Insurance Corporation on behalf of any person or legal entity with an average adjusted gross income in excess of $750,000 with a delayed application of the limitation until completion of a study on the effects of the limitation.
• No. 2438; To establish highly erodible land and wetland conservation compliance requirements for the Federal crop insurance program.
• No. 2363 As Modified; To ensure that extras in film and television who bring personal, common domesticated household pets do not face unnecessary regulations and to prohibit attendance at an animal fighting venture.
• No. 2295; To increase the amounts authorized to be appropriated for the designation of treatment areas.
•  No. 2454; To prohibit assistance to North Korea under title II of the Food for Peace Act unless the President issues a national interest waiver.
•  No. 2293; To limit subsidies for millionaires.
• No. 2382; To require the Federal Crop Insurance Corporation to provide crop insurance for organic crops under similar terms and conditions to crop insurance provided for other crops.
• No. 2309; To require a study into the feasibility of an insurance product that covers food safety recalls. No. 2238; To require more frequent dairy reporting.
• No. 2370; To encourage the purchase of pulse crop products for school meals programs.
• No. 2445; To strengthen rural communities and foster the next generation of farmers and ranchers.
• No. 2167; To provide payment limitations for marketing loan gains and loan deficiency payments.
• No. 2190 As Modified; To require Federal milk marketing order reform.

I won’t go through all of the rejected amendments, but did notice this one:

• No. 2289; To reduce funding for the market access program and to prohibit the use of funds for reality television shows, wine tastings, animal spa products, and cat or dog food.

Now why would the Senate vote to retain market access program funds for such things?   Taxpayer support of promotion of cat and dog food?  How did we miss that one when when my co-author and I were writing Feed Your Pet Right, our analysis of the pet food industry.

And wine tastings, anyone?

But to get to a more important rejection: Senator Gillibrand’s amendment to protect SNAP from budget cuts:

• No. 2156 As Modified; To strike a reduction in the supplemental nutrition assistance program and increase funding for the fresh fruit and vegetable program, with an offset that limits crop insurance reimbursements to providers.

The rejection of this proposal gets us into issues related to the cozy arrangement between anti-hunger advocates and pro-commodity advocates to vote for each other’s funding (translation: logrolling).   Does this rejection mean that the arrangement is breaking down under budget-cutting pressures?  Or does it simply reflect an agreement that a reduction in SNAP is the quid pro quo for removing direct payments and setting some caps on commodity benefits?

Senator Ron Johnson (Rep-Wisconsin) has an interesting take on the logrolling questions.  He filed a motion to send the farm bill back to committee to divide it into two separate bills, one for food assistance and the other for farm supports.

When Congress debates legislation to spend nearly $1 trillion, we need to be honest with the American people about what we’re doing. This isn’t a farm bill. It’s a welfare bill…We should be clear about how much we are spending and why we are spending it – and we ought to give Senators the opportunity for a straight up or down vote on two different proposals that have little in common.

…If Senators want to spend $800 billion on Food Stamps, or nearly $200 billion on farm programs, let them say so with a clean vote – rather than combining them into an all-or-nothing package that passes with a minimum of debate and scrutiny.

Want to take bets on how far his motion gets? [Not far: the Senate rejected the motion this morning, 59 to 40]

The Senate is voting on more amendments today.  More to come.

I’m trying to keep track of the Senate votes on the farm bill amendments, with help from Michael Bulger, Senate Floor Monitor @SenGOP_Floor, @ObamaFoodorama, and the  Senate’s official list online.

The list below comes from Farm Bill Primer, where you can read the details of the amendments.

The heartbreak: the defeat yesterday of Senator Gillibrand’s amendment to restore full funding for SNAP.

Senate Amendments for Vote 6-19-12

• Daniel Akaka, D-Hawaii #2440 (highly fractionated tribal lands);  PASSED
• Daniel Akaka, D-Hawaii #2396 (tribal relations office); PASSED
• Max Baucus, D-Mont., #2429 (livestock); PASSED
• Jeff Bingaman, D-N.M., #2364 (multi-state aquifers); WITHDRAWN
• Sherrod Brown, D-Ohio, #2445 (rural development); PASSED
• Maria Cantwell, D-Wash., #2370 (pulse pilot); PASSED
• Robert Casey, D-Pa., #2238 (technical/study -federal milk marketing) PASSED
• Christopher Coons, D-Del., #2426 (poultry insurance study); PASSED
• Dianne Feinstein, D-Calif., #2422 (conservation innovation grants); PASSED
• Dianne Feinstein, D-Calif., Feinstein #2309 (insurance recall); PASSED
• Kirsten Gillibrand, D-N.Y., #2156 (SNAP); DEFEATED
• Kay Hagan, D-N.C., #2366 (crop insurance plain language); PASSED
• John Kerry, D-Mass., #2187 (commercial fishermen); PASSED
• Mary Landrieu, D-La., #2321 (rural development loans); PASSED
• Olympia Snowe, R-Maine, #2190 (milk marketing order reform); PASSED
• Kelly Ayotte, R-N.H., #2192 (value added grants); DEFEATED
• Chuck Grassley, R-Iowa, #2167 (pay cap marketing loans); PASSED
• Jeff Sessions, R-Ala., #2174 (SNAP); DEFEATED
• Jeff Sessions, R-Ala., #2172 (SNAP); DEFEATED
• Rand Paul, R-Ky., #2181 ($250,000 income limit); DEFEATED
• Lamar Alexander, R-Tenn., #2191 (wind loans); DEFEATED
• John McCain, R-Ariz., #2199 (catfish); PASSED
• Patrick Toomey, R-Pa., #2217 (organic/AMA); DEFEATED
• Jim DeMint, R-S.C., #2263 (broadband funding); DEFEATED
• Jim DeMint, R-S.C., #2262 (SoS Free MKT); PASSED
• Jim DeMint, R-S.C., #2276 (checkoffs); DEFEATED

For what’s happening today, see the Senate list for June 20.

At some point, I’ll try to make sense of all this.  For the moment, it’s food politics happening in real time.