by Marion Nestle

Search results: public health strategies

Aug 9 2022

My latest publication: Preventing Obesity

JAMA Internal Medicine has just published an editorial I wrote: Preventing Obesity—It Is Time for Multiple Policy Strategies

As it explains, it is a commentary on a research article by Joshua Petimar, et al, Assessment of Calories Purchased After Calorie Labeling of Prepared Foods in a Large Supermarket Chain  

Both papers are behind paywalls, but here are the key points of the supermarket article:

Question  Was calorie labeling of prepared foods in supermarkets associated with changes in calories purchased from prepared foods and potential packaged substitutes?

Findings  In this longitudinal study of 173 supermarkets followed from 2015 to 2017, calories purchased from prepared bakery items declined by 5.1% after labeling, and calories purchased from prepared deli items declined by 11.0% after labeling, adjusted for prelabeling trends and changes in control foods; no changes were observed among prepared entrées and sides. Calories purchased from similar packaged items did not increase after labeling.

Meaning  Calorie labeling of prepared supermarket foods was associated with overall small declines in calorie content of prepared foods without substitution to similar packaged foods.

I was really interested in this study because the “large supermarket chain” that supplied reams of data was so obviously Hannaford, which has long been ahead of the curve in trying to encourage customers to make healthier food choices.

In 2005, Hannaford initiated a Guiding Stars program that ranked–and still ranks–products by giving them zero to three stars depending on what they contain.

I wrote about the first-year evaluation of this program way back in 2006.  It did help customers to make better choices.

Now, all these years later, the FDA is contemplating doing some kind of front-of-package label.  As I said, Hannaford is way ahead.

But the point of my editorial is that single interventions rarely do better than what this study found.

I argue here for trying multiple strategies at once:

My interpretation of the current status of obesity prevention research is that any single policy intervention is unlikely to show anything but small improvements.

Pessimists will say such interventions are futile and should no longer be attempted.

Optimist that I am, I disagree.  We cannot expect single interventions to prevent population-basedweight gain ontheirown,but they might help some people—and might help even more people if combined simultaneously with other interventions.

….Widespread policy efforts to reduce intake of ultraprocessed foods through a combination of taxes, warning labels, marketing and portion-size restrictions, dietary guidelines, and media education campaigns, along with policies for subsidizing healthier foods and promoting greater physical activity, should be tried; they may produce meaningful effects.

Politically difficult? Of course. Politically impossible? I do not think so.

Unless we keep trying to intervene—and continue to examine the results of our attempts—we will be settling for the normalization of overweight and the personal and societal costs of its health consequences.

Here’s Ted Kyle’s commentary on my commentary on ConscienHealth.

Jul 1 2022

Weekend reading: Discouraging breastfeeding: digital strategies

Here’s a recent report from WHO: Scope and impact of digital marketing strategies for promoting breastmilk substitutes

 

The report’s findings:

Why should we care?  Because it is so easy to discourage breastfeeding, and digital marketing does just that.

Here are some comments on this report:

And here are links to the first WHO report and to other reports on digital marketing.

Jun 24 2021

Do product reformulation strategies make any nutritional difference?

That’s my question when I see what food companies are trying to do to reduce the content of sugar and salt in their ultra-processed junk food products.

To put it another way, does making an ultra-processed food or beverage slightly better for you convert it to a good choice?

We can argue about this, but companies really are trying hard, as this collection of articles from FoodNavigator.com indicates.

Special Edition: Nutrition and reformulation strategies

Most shoppers say they want to reduce consumption of products that are high in fat, salt and sugar. But many struggle to cut HFSS foods and beverages from their diets and reformulation efforts often face the headwind of perceived quality issues. Meanwhile, the fortified food market in Europe is expected to see a CAGR of 5.2% through to 2025. While reformulation efforts take out the ‘baddies’ is there also an opportunity to add positive nutrients through fortification?

Nov 19 2020

Retailers should promote health eating: Here’s how.

I was sent a press release announcing a set of research papers on retail strategies to improve healthy eating.  Most people buy food at supermarkets, but supermarkets are not public health agencies.  They are businesses with one purpose: to make money for owners and stockholders.  As I discussed in my book, What to Eat, they are designed to keepyou in the store as long as possible so you will have plenty of time to impulse-buy.  These papers in the  International Journal of Environmental Research and Public Health discuss ways retail food stores could help diets get healthier.

They come with a new report outlining a research agenda for retailers.  All of this was funded by Healthy Eating Research, a national program of the Robert Wood Johnson Foundation in partnership with the Center for Science in the Public Interest (CSPI), the Johns Hopkins Bloomberg School of Public Health, and The Food Trust.

The full issue of the journal is here.

Special issue: Retail Strategies to Support Healthy Eating

Jul 24 2019

At last: attention to sugar’s role in dental health

I included a chapter on sugar and dental disease in my 2015 book, Soda Politics: Taking on Big Soda (and Winning), because billions of people have decayed teeth and other dental problems that could have been kept intact by dental hygiene, fluoride treatment, or—consuming less sugar or sugary drinks.

But:

  • Dental disease has a long history of being overlooked as a public health problem.
  • Sugar has a long history of being ignored as a cause of dental disease.

This may now be changing.

The Lancet has a new series on oral health:

Radical action on oral health will benefit from harnessing a clear global health mandate. Because oral diseases share the main risk factors of other non-communicable diseases (NCDs)—sugar consumption, tobacco use, and harmful alcohol use—oral health should have a stronger place on the global NCDs agenda.

  • Oral diseases: a global public health challenge: Marco A Peres, Lorna M D Macpherson, Robert J Weyant, Blánaid Daly, Renato Venturelli, Manu R Mathur, Stefan Listl, Roger Keller Celeste, Carol C Guarnizo-Herreño, Cristin Kearns, Habib Benzian, Paul Allison, Richard G Watt.  The Lancet, Vol. 394No. 10194.  

Among this article’s key messages:

  • Oral conditions share common risk factors with other non-communicable diseases, which include free sugar consumption, tobacco use, and harmful alcohol consumption, as well as the wider social and commercial determinants of health
  • Of particular concern is the effect of free sugar consumption on the prevalence of caries and overweight or obesity, and associated conditions such as diabetes
  • Recognition is increasing of the influence, power, and effect of the global sugar industry as a threat to public health, which requires tighter regulation and legislation by governments
  • Ending the neglect of global oral health: time for radical action: Richard G Watt, Blánaid Daly, Paul Allison, Lorna M D Macpherson, Renato Venturelli, Stefan Listl, Robert J Weyant, Manu R Mathur, Carol C Guarnizo-Herreño, Roger Keller Celeste, Marco A Peres, Cristin Kearns, Habib Benzian.  The LancetVol. 394No. 10194

In this Series paper, we focus on the need to reduce sugar consumption and describe how this can be achieved through the adoption of a range of upstream policies designed to combat the corporate strategies used by the global sugar industry to promote sugar consumption and profits. At present, the sugar industry is influencing dental research, oral health policy, and professional organisations through its well developed corporate strategies. The development of clearer and more transparent conflict of interest policies and procedures to limit and clarify the influence of the sugar industry on research, policy, and practice is needed. Combating the commercial determinants of oral diseases and other NCDs should be a major policy priority.

A check of dental research organisation websites shows that corporate members of ORCA include Cloetta, a Nordic confectionery company; Unilever, a global consumer goods company that sells ice cream and sugary beverages; and Mars Wrigley Confectionery, a leading manufacturer of chewing gum, chocolate, mints, and fruity confections (through its Wrigley Oral Healthcare Program). Corporate members of the International Association for Dental Research (IADR) include Unilever and Mondelēz International, one of the world’s largest snack companies, whose products include cookies, chocolate, and confectionery. These financial ties are slightly less shocking given the oral health-care products these companies sell: xylitol chewing gum and pastilles (Cloetta), sugar-free gum with xylitol (Mondelēz, Mars Wrigley), and toothbrushes and fluoridated toothpaste (Unilever). Nonetheless, as the dental research community comes to terms with its neglect of sugars intake, these relationships with industry are ripe for scrutiny.  [I’ve written previously about Kearns’ discovery of links between sugar trade associations and dental professional organizations].

Two key strategic aims for a global oral health movement will be to ensure that oral health treatment and prevention services are central to UHC [universal health coverage] and to support global efforts to limit the damage caused by the sugar industry…There is fragmented global action for reducing the damage of the sugar industry and some progress has been made in a number of cities and countries, especially with the introduction of taxes on sugary drinks.  However, there is no united global movement against sugar, as there is against the tobacco industry.

  • Perspective:  Richard Watt: time to tackle oral diseases: Rachael Davies.  The Lancet, Vol. 394No. 10194.  “The mouth really is a marker of people’s social position and future disease risk…and oral diseases are a canary in the coal mine for inequality.”
  • Perspective: Polished smiles and porcelain teeth.  Richard Barnett.  The Lancet, Vol. 394No. 10194. 
This is a history of George Washington’s teeth and the later development of the dental profession, ending with this thought: “in the early 21st century, the great global divide in dentistry remains—as it was in Washington’s day—between the rich and the poor.”

It’s great that The Lancet has finally taken this on.

Here’s The Guardian’s Account.  There should be a lot more press coverage.  Dental conditions affect billions of people throughout the world.

Jun 27 2013

World Health Organization takes on the food industry

I’ve just been sent a copy of  the opening address given by the Director-General of the World Health Organization, Dr Margaret Chan, to a Global Conference on Health Promotion in Helsinki on June 10.

Here is an excerpt from her extraordinary remarks:

Today, getting people to lead healthy lifestyles and adopt healthy behaviours faces opposition from forces that are not so friendly.  Not at all.

Efforts to prevent noncommunicable [chronic] diseases go against the business interests of powerful economic operators.

In my view, this is one of the biggest challenges facing health promotion…it is not just Big Tobacco anymore.  Public health must also contend with Big Food, Big Soda,and Big Alcohol.

All of these industries fear regulation, and protect themselves by using the same tactics.

Research has documented these tactics well. They include front groups, lobbies, promises of self-regulation, lawsuits, and industry-funded research that confuses the evidence and keeps the public in doubt.

Tactics also include gifts, grants, and contributions to worthy causes that cast these industries as respectable corporate citizens in the eyes of politicians and the public.

They include arguments that place the responsibility for harm to health on individuals, and portray government actions as interference in personal liberties and free choice.

This is formidable opposition. Market power readily translates into political power…

Not one single country has managed to turn around its obesity epidemic in all age groups.  This is not a failure of individual will-power. This is a failure of political will to take on big business…

I am deeply concerned by two recent trends.

The first relates to trade agreements. Governments introducing measures to protect the health of their citizens are being taken to court, and challenged in litigation. This is dangerous.

The second is efforts by industry to shape the public health policies and strategies that affect their products. When industry is involved in policy-making, rest assured that the most effective control measures will be downplayed or left out entirely. This, too, is well documented, and dangerous.

In the view of WHO, the formulation of health policies must be protected from distortion by commercial or vested interests.

Dr. Chan was courageous to say this so clearly.  Would that our health officials would be as brave.

Dec 6 2012

New books take a fresh look at public health

If I were teaching public health nutrition right now, here’s what I’d want students to read:

Geof Rayner and Tim Lang, Ecological Public Health: Reshaping the Conditions for Good Health, Routledge Earthscan, 2012.

Our case is that public health is an interdisciplinary project, and not merely the preserve of particular professionals or titles.  Indeed, one of the themes of the book is that public health is often improved by movements and by people prepared to challenge conventional assumptions and the status quo…In these cynical academic times, when thinking is too often set within narrow economistic terms—What can we afford? What is the cost-benefit of health action?—and when the notion of the ‘public’ is often replaced by the ‘individual’ or the ‘private,’ this book offers an analysis of public health which is unashamedly pro bono publico, for the public good.

David Stuckler and Karen Siegel, eds.  Sick Societies: Responding to the Global Challenge of Chronic Disease, Oxford University Press, 2011.

Sick Societies argues that we are building environments that are poorly designed for our boides: we create societies where tobacco, alcohol, and foods containing high levels of salt, sugar, and fats are the easiest, cheapest, and most desirable choices, while fruits, vegetables, and exercise are the most expensive, inaccessible, and inconvenient options.  The rise in chronic diseases is the result of a model of societal development that is out of control: a model that puts wealth before health.

Wilma Waterlander, Put the Money Where the Mouth Is: The Feasibility and Effectiveness of Food Pricing Strategies to Stimulate Healthy Eating, Vrije Universiteit, Amsterdam, 2012.

This one is for policy wonks and change agents.  This is Waterlander’s doctoral dissertation done as a published book but it is written clearly and forcefully.  Her conclusions:

The studies presented in this thesis show that the healthy choice is the relatively expensive choice; that price fundamentally affects food choice and may even form a barrier for low SES consumers in selecting healthier foods.  These findings make pricing strategies a justifiable tool to stimulate healthier choices…making healthier foods cheaper was found to be the most feasible pricing strategy to implement.

Mar 7 2012

U.N. Special Rapporteur: Five Ways to Fix Unhealthy Diets

Olivier de Schutter, the United Nations Special Rapporteur on the Right to Food, has issued five recommendations for fixing diets and food systems:

  • Tax unhealthy products.
  • Regulate foods high in saturated fats, salt and sugar.
  • Crack down on junk food advertising.
  • Overhaul misguided agricultural subsidies that make certain ingredients cheaper than others.
  • Support local food production so that consumers have access to healthy, fresh and nutritious foods.

De Schutter explains:

One in seven people globally are undernourished, and many more suffer from the ‘hidden hunger’ of micronutrient deficiency, while 1.3 billion are overweight or obese.

Faced with this public health crisis, we continue to prescribe medical remedies: nutrition pills and early-life nutrition strategies for those lacking in calories; slimming pills, lifestyle advice and calorie counting for the overweight.

But we must tackle the systemic problems that generate poor nutrition in all its forms.

Governments, he said:

have often been indifferent to what kind of calories are on offer, at what price, to whom they are accessible, and how they are marketed…We have deferred to food companies the responsibility for ensuring that a good nutritional balance emerges.

…Heavy processing thrives in our global food system, and is a win-win for multinational agri-food companies…But for the people, it is a lose-lose…In better-off countries, the poorest population groups are most affected because foods high in fats, sugar and salt are often cheaper than healthy diets as a result of misguided subsidies whose health impacts have been wholly ignored.

Much to ponder here.  Let’s hope government health agencies listen hard and get to work.

For further information, the press release adds these links: