by Marion Nestle

Search results: public health strategies

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:

Feb 1 2012

Survey result: low-income families want to eat healthfully too

I was invited yesterday to a press event to announce the results of a survey conducted by Share Our Strength’s Cooking Matters program.  The program and the survey, It’s Dinnertime: A Report on Low-Income Families’ Efforts to Plan, Shop for and Cook Healthy Meals, are sponsored by the ConAgra Foods Foundation.

I went because I was interested in the survey and also because I admire the work of chef Sara Moulton who, among many other things, works with Share Our Strength on this program.

Cooking Matters is part of Share Our Strength’s No Kid Hungry Campaign.  Its goal is to help low-income families increase access to public food resources (food assistance benefits, farmers’ market coupons) and produce healthy meals at low cost.  It does this through a 6-week course that teaches shopping strategies, meal planning, and cooking.

The research produced some important findings, perhaps obvious:

  • 8 out of 10 low-income families cook at home at least 5 times per week, more if they are poorer.
  • 85% of low-income families consider eating healthy meals to be important and realistic.
  • Low-income families struggle to put healthy meals on the table: food costs and preparation time are big barriers.
  • Low-income families are eager for cooking and budgeting tips and tools.

Where does ConAgra fit in?

ConAgra owns countless food product brands that pack the center aisles of supermarkets.

Working under the premise that it takes more than food to fight hunger, the ConAgra Foods Foundation, a national sponsor of Cooking Matters, funded It’s Dinnertime as part of its ongoing strategy to find sustainable solutions to help surround kids with the nourishment they need to flourish.

The ConAgra Foods Foundation is funded solely by ConAgra Foods.  One of the study’s conclusions is very much in ConAgra’s interest.

A better understanding of the health benefits of frozen and canned fruits and vegetables could also put more healthy options in reach for low-income families: While 81 percent of low-income parents rated fresh produce as extremely healthy, that rating drops down to 32 percent when it comes to frozen fruits and vegetables and 12 percent with canned fruits and vegetables.

The program works to improve the image of frozen and canned fruits and vegetables among low-income families.

Ordinarily, food industry-sponsored programs make me squirm.  This one makes me squirm less than most even though Sara Moulton was cooking with at least one ConAgra product: Wesson Oil.

But the program worked with 18,000 families last year and its goals make sense.

Canned and frozen fruits and vegetables really do retain much of the nutritional value of fresh produce unless they are loaded with salt and sugars.  Sara was cooking with low-salt products and the dishes she made were easy, inexpensive, nutritious, and quite delicious.

I’m impressed with how this program teaches families to fend for themselves in today’s tough environment.

Now, if ConAgra would just get busy promoting policies to improve access to healthy foods for everyone….

 

Jul 13 2011

Google’s impressive healthy food program

I’m just back from judging Google’s first Science Fair for kids 13 to 18 at its corporate headquarters in California (yes, those are tomatoes growing in the foreground).

Google’s famous food program: Why famous?  It is:

  • Available 24/7
  • Totally free
  • Varied and delicious
  • Designed to promote health as well as environmental values (local, organic, sustainable)

On this last point, the recycling program is comprehensive and the campus is planted with organic vegetables, free for the picking:

But what about the “freshman 15″?

If free food is available 24/7, isn’t Google creating a classic “obesogenic” environment?  Do new Google employees gain weight?

Indeed, they do, and this creates a dilemma for the food team.  I met with Joe Marcus, Google’s food program manager, and executive chef Scott Giambastiani.  Free and very good food, they explain, is an important recruiting perk for Google.   Employees learn to manage it.  And those who are eating healthy food for the first time in their lives find that they actually lose weight.

Google’s food labeling program

Google labels its snacks, drinks, and the foods prepared in its 25 or so cafeterias with traffic lights: green (eat anytime), yellow (once in a while), or red (not often, please).  It bases the decisions about which food goes where on the Harvard School of Public Health’s healthy eating pyramid.   It labels foods at the top of the Harvard pyramid red, the ones in the middle yellow, and those at the bottom green.

In theory this makes sense as a starting point.  In practice, it tends to seem a bit like nutritionism—reducing the value of the foods to a few key nutrients.

The difficulties are most evident in the snack foods, freely available from kiosks all over the campus.   Products are displayed on shelves labeled red, yellow, or green.  For example:

GREEN: Sun chips, 1.5 oz, 210 kcal, 10 g fat, 180 mg sodium, 3 g sugar, 4 g fiber

YELLOW: Lentil chips, 1 oz, 110 kcal, 3 g fat, 170 mg sodium, 1 g sugar, 3 g fiber

YELLOW: Walnuts, 0.8 oz, 150 kcal, 15 g fat, 0 g sodium, 1 g sugar, 2 g fiber

RED:  Luau BBQ chips, 1.5 oz, 210 kcal,  14 g fat, 158 mg sodium, 2 g sugar, 1 g fiber

Note: the weights of the packages are not the same, so the amounts are not really comparable, but the ranking scheme seems to give most credit for fiber.

As for these and the foods cooked in cafeterias, Google uses other strategies to promote healthier choices.  It:

  • Puts the healthiest products at eye level
  • Uses small plates
  • Tries to include vegetables in everything
  • Makes healthier options available at all times
  • Uses the smallest sizes of snack foods (packages of 2 Oreos, rather than 6)
  • Makes it easy to be physically active (Google bicycles!)

The only place on the campus where employees pay for food is from a vending machine.  The pricing strategy is based on nutrient content, again according to the Harvard pyramid plan.  For the vended products, you pay:

  • one cent per gram of sugar
  • two cents per gram of fat
  • four cents per gram of saturated fat
  • one dollar per gram of trans fat

On this basis, Quaker Chewy Bars are 15 cents each, Famous Amos cookies re 55 cents, and an enormous Ghirardelli chocolate bar is $4.25.  Weights don’t count and neither do calories.  The machine is not run by Google.  Whoever does it has a sense of humor.

Impressive, all this.  Not every company can feed its nearly 30,000 employees like this but every company can adopt some of these strategies.  It might save them some health care costs, if nothing else.

Nov 25 2008

Publications

This page lists books and articles. Books start under the first photo, and articles under the second.

Witt Program on Activism, DeWitt Clinton High School, Bronx NY, 12-8-09

BOOKS: For more information on books, click here

  • 2013: Nestle M. FOOD POLITICS: HOW THE FOOD INDUSTRY INFLUENCES NUTRITION AND HEALTH, 10th Anniversary Edition with a Foreword by Michael Pollan. University of California Press.
  • 2012: Nestle M, Nesheim M. WHY CALORIES COUNT: FROM SCIENCE TO POLITICS, University of California Press.
  • 2010: Nestle M. SAFE FOOD: THE POLITICS OF FOOD SAFETY, revised and expanded edition, University of California Press.
  • 2010: Nestle M, Nesheim MC. FEED YOUR PET RIGHT, Free Press/Simon & Schuster.
  • 2008: Nestle M. PET FOOD POLITICS: THE CHIHUAHUA IN THE COAL MINE, University of California Press. Paperback, 2010.
  • 2007: Nestle M. FOOD POLITICS: HOW THE FOOD INDUSTRY INFLUENCES NUTRITION AND HEALTH, revised and expanded edition, University of California Press.
  • 2006: Nestle M. WHAT TO EAT, North Point Press/Farrar, Straus and Giroux. Paperback, 2007. Hebrew edition, 2007.
  • 2004: Nestle M, Dixon LB, eds. TAKING SIDES: CLASHING VIEWS ON CONTROVERSIAL ISSUES IN NUTRITION AND FOOD, McGraw Hill/Dushkin.
  • 2003: Nestle M. SAFE FOOD: BACTERIA, BIOTECHNOLOGY, AND BIOTERRORISM. University of California Press. Paperback, 2004. Chinese edition, 2004. Japanese edition, 2009. Revised edition, 2010 (see above).
  • 2002: Nestle M. FOOD POLITICS: HOW THE FOOD INDUSTRY INFLUENCES NUTRITION AND HEALTH, University of California Press. Paperback, 2003. Chinese edition, 2004. Japanese edition, 2005. Revised edition, 2007; 10th anniversary edition with a Foreword by Michael Pollan (see above).
  • 1985: Nestle M. NUTRITION IN CLINICAL PRACTICE. Greenbrae CA: Jones Medical Publications. Asian edition, 1986. Greek edition, 1987.Dr. Nestle at FAO 082

ARTICLES (SELECTED): For the most part, these are columns, professional articles, book chapters, letters, and book reviews for which links or pdf’s are available (or will be when I get time to find or create them). Additional publications are listed in the c.v. link in the About page.

2014

Nestle M.  Foreword.  Cognard-Black J, Goldthwaite MA, eds.  Books That Cook: The Making of a Literary Meal.  New York University Press, 2014:xv-xviii.

Nestle M. Foreword. Poppendieck J. Breadline Knee-Deep in Wheat: Food Assistance in the Great Depression. University of California Press, 2014:ix-xii.

Nesheim MC, Nestle M. Advice for fish consumption: challenging dilemmas. American Journal of Clinical Nutrition. 2014;99:973-974.

Nestle M, Baron RB. Nutrition in Medical Education: From Counting Hours to Measuring Competence. JAMA Intern Med. Published online April 14, 2014. doi:10.1001/jamainternmed.2014.440.

Nestle M. Next, Cut the Soda and Junk Food. New York Times, Room for debate: What other unhealthy products should CVS stop selling? February 7, 2014

2013

Blumenthal SJ, Hoffnagle EE, Leung CW, Lofink H, Jensen HH, Foerster SB, Cheung LWY, Nestle M, Willett WC. Strategies to improve the dietary quality of supplemental nutrition assistance program (SNAP) beneficiaries: An assessment of stakeholder opinions. Public Health Nutrition 2013. doi:10.1017/S1368980013002942.

Nestle M. A push for policies for sustainable foods systems. Perspectives, FAO, October 9, 2010.

Nestle M. Conflict of interest in the regulation of food safety: a threat to scientific integrity. JAMA Internal Medicine 2013; Online: doi:10.1001/jamainternmed.2013.9158.

Nestle M. Mediterranean diet month memory—day 26: Marion Nestle remembers a lasting legacy. Oldways, May 26, 2013.

Nestle M, Cohen L, Waters R. Twinkie insanity hits the House. Politico, May 3, 2013.

Nestle M. Food is a political issue. World Nutrition May 2013, 4,5, 270-295.

Nestle M. Doctors should stress food variety, minimal processing, and moderation. In: Hunnicutt S, ed. At Issue: Is the Western Diet Making the World Sick? Greenhaven Press, 2013:71-75.

Gussow J, Kirschenmann F, Uauy R, Schell O, Nestle M, Popkin B, Cannon G, Monteiro C.
The American genius. [Appraisals]. World Nutrition 2013;4:150-170.

Nestle M. School meals: A starting point for countering childhood obesity. JAMA Pediatrics. 2013;():1-2. doi:10.1001/jamapediatrics.2013.404

Nestle M. Liberty from big soda. New York Daily News, March 10, 2013.

Leung C, Blumenthal S, Hoffnagle E, Jensen H, Foerster S, Nestle M, Cheung L, Mozaffarian D, Willett W. Associations of Food Stamp Participation with Obesity and Dietary Quality among Low-income Children. Pediatrics 2013;131:463–472.

Nestle M, Nesheim MC. To Supplement or Not to Supplement: U.S. Preventive Services Task Force Recommendations on Calcium and Vitamin D. Annals of Internal Medicine 2013;158(9):701-702.

Nestle M. Today’s “eat more” environment: the role of the food industry. In: Pringle P, ed. A Place at the Table: The Crisis of 49 Million Hungry Americans and How to Solve It. PublicAffairs, 2013;95-106.

Nestle M. Food safety and food security: a matter of public health. In: Estes CL, et al, eds. Health Policy: Crisis and Reform, 6th ed. Jones and Bartlett Learning, 2013:125-130.

Nestle M. Politics. In: Smith AF, ed. The Oxford Encyclopedia of Food and Drink in America. Vol 3, Pike-Zomb. Oxford University Press, 2013:28-37.

2012

Nestle M. Foreword to Fairfax SK et al. California Cuisine and Just Food. MIT Press, 2012:xii-xiv.

Nestle M. Waistline or bottom line. New Scientist, November 24, 2012:28-29.

Young LR, Nestle M. Reducing portion sizes to prevent obesity: A call to action. American Journal of Preventive Medicine 2012;43(5):565-68.

Nestle M. Marion Nestle on the Early Nutritionists. In: Taylor MJ, Wolf C, eds. 100 Classic Cookbooks, 501 Classic Recipes. Rizzoli, 2012:46-47.

Nestle M. Cookbooks and food studies canons. Foreword to Taylor MJ, Wolf C, eds. 100 Classic Cookbooks, 501 Classic Recipes. Rizzoli, 2012:8-9.

Nesheim M, Nestle M. Is a calorie a calorie? Nova ScienceNow, September 20, 2012.

Nestle M. Online debate: What role should government play in combating obesity? Wall Street Journal, September 18, 2012.

Nestle M. Online debate: Buying organics is a personal choice. New York Times, September 10, 2012.

Temple N, Nestle M. Population Nutrition and Health Promotion. In: Temple NJ, Wilson T, Jacobs DR, eds. Nutritional Health: Strategies for Disease Prevention, 3rd ed. Humana Press, 212:373-450.

Nestle M, Wilson T. Food Industry and Political Influences on American Nutrition. In: Temple NJ, Wilson T, Jacobs DR, eds. Nutritional Health: Strategies for Disease Prevention, 3rd ed. Humana Press, 2012:477-490.

Stuckler D, Nestle M. Big food, food systems, and global health. PLoS Medicine 2012;9(6):e1001242 (4 pages).

Nestle M. Nanotechnology: No One Is Evaluating the Risks! Mother Earth News, April/May 2012:18.

Nestle M. Better Information and Better Options. Room for Debate: Do We Need More Advice About Eating Well? New York Times online, April 16, 2012.

Nestle M. Utopian Dream: A New Farm Bill. Dissent 2012:Spring:15-19.

Joseph M, Nestle M. Food and Politics in the Modern Age: 1920 – 2012. In: Bentley A, ed. A Cultural History of Food in the Modern Age, Vol. 6. Berg, 2112:87-110.

Isoldi KK, Dalton S, Rodriguez DP, Nestle M. Classroom “cupcake” celebrations: observations of foods offered and consumed. Journal of Nutrition Education and Behavior 2012;44:71-75.

2011

Nestle M. World’s first “fat tax”: what will it achieve? New Scientist, October 23, 2011:30-31 (Obesity’s Match).

Nestle M. Food stamps for fast food? No: what the poor need is healthy food. Milwaukee Wisconsin Journal Sentinal, September 24, 2011.

Nestle M. School food, public policy, and strategies for change. In: Robert SA, Weaver-Hightower MB, eds. School Food Politics: The Complex Ecology of Hunger and Feeding in Schools Around the World. New York: Peter Lang, 2011:143-46.

Robbins A, Nestle M. Obesity as collateral damage: a call for papers on the obesity epidemic [editorial]. Journal of Public Health Policy 2011;32:143-45.

Csete J, Nestle M. Global nutrition: complex aetiology demands social as well as nutrient-based solutions. In: Parker R, Sommer M, eds. Routledge Handbook in Global Public Health, Routledge, 2011:303-13.

2010

2009

2008

2007

2006

2005

  • Nestle M. Preventing childhood diabetes: The need for public health intervention (editorial). American Journal of Public Health 2005;95:1497-1499.
  • Nestle M. Increasing portion sizes in American diets: more calories, more obesity (commentary). Journal of the American Dietetic Association 2003;103:39-40.
  • Berg J, Nestle M, Bentley A. Food studies. In: Katz SH, Weaver WW, eds. The Scribner Encyclopedia of Food and Culture, Vol 2. New York: Charles Scribner’s Sons, 2003:16-18.

  • Nestle M. The ironic politics of obesity (editorial). Science 2003:299:781.

  • Nestle M. Not good enough to eat (commentary). New Scientist 2003;177 (February 22):25.

  • Nestle M. Hearty Fare? Review of Faergeman, O. Coronary Heart Disease: Genes, Drugs, and the Agricultural Connection. Amsterdam: Elsevier, 2003. Nature 2003;425:902.
  • Nestle M. Thinking about food (letter). Wilson Quarterly Autumn 2003 [27(4)]:4.

  • Young LR, Nestle M. The contribution of expanding Portion Sizes to the U.S. obesity epidemic. American Journal of Public Health 2002;92:246-249.
  • Mahabir S, Coit D, Liebes L, Brady MS, Lewis JJ, Roush G, Nestle M, Fay D, Berwick M. Randomized, placebo-controlled trial of dietary supplementation of a-tocopherol on mutagen sensitivity levels in melanoma patients: a pilot trial. Melanoma Research 2002;12:83-90.
  • Byers T, Nestle M, McTeirnan A, Doyle C, Currie-Williams A, Gansler T, Thun M, and the American Cancer Society 2001 Nutrition and Physical Activity Guidelines Advisory Committee. American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention: Reducing the Risk of Cancer with Healthy Food Choices and Physical Activity. CA Cancer Journal for Clinicians 2002;52:92-119.
  • Fried EJ, Nestle M. The growing political movement against soft drinks in schools (commentary). Journal of the American Medical Association 2002;288:2181.

2001

  • Nestle M. Genetically engineered “golden” rice unlike to overcome vitamin A deficiency (letter). Journal of the American Dietetic Association 2001;101:289-290.
  • Nestle M. Nutrition and women’s health: the politics of dietary advice [editorial]. Journal of the American Medical Women’s Association 2001;56:42-43.

  • Kumanyika SK, Morssink CB, Nestle M. Minority women and advocacy for women’s health. American Journal of Public Health 2001;91:1383-1388.

  • Nestle M. Food company sponsorship of nutrition research and professional activities: A conflict of interest? Public Health Nutrition 2001;4:1015-1022.
  • Nestle M. Review of: Bendich A, Deckelbaum RJ, eds. Primary and Secondary Preventive Nutrition (Totowa, NJ: Humana Press, 2001). American Journal of Clinical Nutrition 2001;74:704.

2000

1999

  • Nestle M. Hunger in America: A Matter of Policy. Social Research 1999;66(1): 257-282.
  • Nestle M. Commentary [dietary guidelines]. Food Policy 1999;24(2-3):307-310.
  • Nestle M. Meat or wheat for the next millennium? Plenary lecture: animal v. plant foods in human diets and health: is the historical record unequivocal? Proceedings of the Nutrition Society 1999;58:211-218 (online here).
  • Nestle M. Heart disease’s decline (letter). New York Times, August 12, 1999:A18.
  • Nestle M. Dietary supplement advertising: a matter of politics, not science. Journal of Nutrition Education 1999;31:278-282.

1998

1987-1997

  • Nestle M.Broccoli sprouts as inducers of carcinogen-detoxifying enzyme systems: clinical, dietary, and policy implications [Commentary].Proceedings of the National Academy of Sciences, USA 1997;94:11149-11151.

  • Nestle M.The role of chocolate in the American diet: nutritional perspectives.In: Szogyi A, ed.Chocolate, Food of the Gods.Westport, CN: Greenwood Press, 1997:111-124.
  • Nestle M. Allergies to transgenic foods–questions of policy [editorial]. New England Journal of Medicine 1996;334:726-728 (Note: it’s the 3rd one in the pdf).
  • Nestle M.Epidemiologists’ Paradise.Junshi C, Campbell TC, Junyao L, Peto R.Diet, Life-style, and Mortality in China: A Study of the Characteristics of 65 Chinese Counties.NY: Oxford University Press, 1990 [book review].BioScience 1991;41:725-726.

  • Nestle M. National nutrition monitoring policy: the continuing need for legislative intervention. J Nutrition Education 1990;22:141-144.
  • Nestle M, Porter DV. Evolution of federal dietary guidance policy: from food adequacy to chronic disease prevention.Caduceus: A Museum Journal for the Health Sciences 1990;6(2):43-67.

  • McGinnis JM, Nestle M. The Surgeon General’s report on nutrition and health: policy implications and implementation strategies. American Journal of Clinical Nutrition1989;49:23-28.
  • Department of Health and Human Services, Public Health Service. The Surgeon General’s Report on Nutrition and Health. Publ. No. (PHS) 88-50210. Washington DC: U.S. Government Printing Office, 1988, 712 pages [Managing Editor]. Reprint: Prima Publishing, 1989. Reprint: Warner Books, 1989.

  • Nestle M. Promoting health and preventing disease: national nutrition objectives for 1990 and 2000. Food Technology 1988;42(2):103-107.
Dec 17 2013

The FDA issues guidance on animal antibiotics–voluntary, alas, but still a major big deal

I was in Washington DC last week when the FDA announced  that it was taking significant steps to address antibiotic resistance, a problem caused by overuse in raising animals for food.

The FDA called on makers of animal antibiotics to:

  • Voluntarily stop labeling medical important antibiotics as usable for promoting animal growth or feed efficiency (in essence, banning antibiotics from these uses).
  • Voluntarily notify the FDA of their intent to sign on to these strategies within the next three months.
  • Voluntarily put the new guidance into effect within 3 years.
  • Agree to a proposed rule to require a veterinarian’s prescription to use antibiotics that are presently sold over the counter (the proposal is open for public comment for 90 days at www.regulations.gov.   Docket FDA-2010-N-0155).

Voluntary is, of course, a red flag and the Washington Post quoted critics saying that the new guidance falls far short of what really is needed—a flat-out ban on use of antibiotics as growth promoters.

  • Consumers Union is concerned about the long delay caused by the 3-year window.
  • CSPI is worried about all the loopholes.
  • NRDC thinks the FDA is pretending to do more than it’s really doing and “kicks the can significantly down the road.”
  • Mother Jones points out that the meat industry can still “claim it’s using antibiotics ‘preventively,’ continuing to reap the benefits of growth promotion and continue to generate resistant bacteria.”
  • Civil Eats reminds us that the Pew Commission on Industrial Farm Animal Production (on which I served) recommended a ban on nontherapeutic use of all antibiotics.

Yes, the loopholes are real, but I view the FDA’s guidance as a major big deal.  The agency is explicitly taking on the antibiotic problem.  It is sending a clear signal to industrial farm animal  producers that sooner or later they will have to:

  • Stop using antibiotics as growth promoters.
  • Stop using antibiotics indiscriminately, even for disease treatment.

I think the FDA is dead serious about the antibiotic problem.  If the FDA seems to be doing this in some convoluted fashion, I’m guessing it’s because it has to.  The FDA must not have been able to find any other politically viable way to get at the antibiotics problem.

I see this as a first step on the road to banning antibiotics for any use in animals other than the occasional treatment of specific illnesses.

As the New York Times puts it,

This is the agency’s first serious attempt in decades to curb what experts have long regarded as the systematic overuse of antibiotics in healthy farm animals, with the drugs typically added directly into their feed and water. The waning effectiveness of antibiotics — wonder drugs of the 20th century — has become a looming threat to public health. At least two million Americans fall sick every year and about 23,000 die from antibiotic-resistant infections.

Still not convinced antibiotics are worth banning for promoting growth?

The best explanation is the Washington Post’s handy guide to the antibiotic-perplexed.  Here, for example, is its timeline of development of microbial resistance to antibiotics.  The bottom line: the more widespread the use of antibiotics, the greater the onset and prevalence of resistance.  And it takes practically no time for bacteria to develop resistance to antibiotic drugs.

nchembio.2007.24-F1

Resources from FDA

Jun 13 2013

The endless debates about salt: Don’t worry. Eat (real) food

Since 1980, U.S. dietary guidelines have advised eating less sodium (salt is 40% sodium, 60% chloride).  Although sodium is an essential nutrient, most Americans consume way more than they need or is good for them—around 3,400 milligrams a day.

The 2010 guidelines advised healthy people to consume no more than 2,300 mg per day (~6 grams, or 1.5 teaspoons).  They advised even less, 1,500 mg, for people with or at high risk for high blood pressure.  Since blood pressure increases with age in countries with high salt intake, this applies or will apply to just about everyone.  

In 2011, the Institute of Medicine said it was imperative to find effective strategies to lower salt intake.  This means dealing with processed and restaurant foods, because that’s where most of the salt comes from, as can be seen from this list of major food sources

Because consumers have no choice about the amount of salt in processed and restaurant foods, education cannot be enough to achieve salt reduction.  Scientists in Australia have just proved this point.

As I explained to a reporter,

Why anyone would think that nutrition education alone would change behavior is beyond me. By this time everyone should know that to change behavior requires not only education, but a food environment—social, political, economic—that supports and promotes the behavior change.

Most dietary sodium comes from processed foods, restaurant foods, and other pre-prepared foods.  All the label can do is say ‘don’t eat me’ It can’t help with what people can eat.

The easiest and most effective way to help people reduce sodium intake is to require food producers and food preparers to use less of it. Good luck with that. I’m not optimistic, particularly given the conflicting and confusing science. 

Ah yes.  The conflicting science.  The IOM now says that there’s no evidence one way or the other that reducing sodium below 2,300 mg per day, or even to 1,500 per day, does much good, and that low sodium intakes could be harmful (but this too is controversial).

Yes, they could, but as Mark Bittman blogs,    

It may be true that there are no benefits in an ultra-low-salt diet, but almost no one is eating an ultra-low-salt diet. It’s not quite like worrying about whether we get “enough” sugar, but it’s nearly as ridiculous.

And now, as Food Navigator explains, the IOM committee is complaining that its report has been badly misinterpreted.  All they said was:

As to whether we should cut back to 1,500 mg or to 2,300 mg sodium a day, meanwhile, the jury is out, says the IOM, not because consuming 1500 mg/day is dangerous, but because there is just not enough data on the benefits of consuming such low levels to support a firm conclusion.

IOM committee members were so bothered by misleading press accounts that they wrote an op-ed to JAMA to clarify:

Rather than focusing on disagreements about specific targets that currently affect less than 10% of the US population (ie, sodium intake of <2300 mg/d vs <1500 mg/d),  the IOM, AHA, WHO, and DGA are congruent in suggesting that excess sodium intake should be reduced, and this is likely to have significant public health effects. Accomplishing such a reduction will require efforts to decrease sodium in the food environment….

The bottom line, Bittman says (and I enthusiastically agree), is that

Salt intake — like weight, and body mass index — is a convenient baseline for public policy people to talk about. If you focus on eating less salt — and, indeed, less sugar — you will inevitably eat less processed food, fast food, junk food (it’s all the same thing.) If you eat less processed food (etc.) you eat more real food. If you eat more real food, not only are you healthier, but you probably don’t have to pay attention to how much salt you’re eating. Wowie zowie. 

Page 1 of 41234