Search results: public health strategies

The Access to Nutrition Initiative (ATNI) has released its latest Index report on the progress of the 11 largest U.S. food and beverage companies on their commitments to make, market and sell healthy food and drinks.

The report’s dismal conclusion:

While all companies have placed a greater focus on nutrition in their corporate strategies since the first index was released in 2018, their actual products have not become healthier, and they are not making sufficient efforts to safeguard children from the marketing of unhealthy products.

Collectively, these copanies have sales of about $170 billion annually and account for nearly 30% of all U.S. food and beverage sales.

The report’s overall findings (the Index is a composite on a scale of 10):

Specific findings:

• Only 30% of their products meet criteria for “healthy,” 70% do not. This is only marginally better than in 2018 (see link to my post on this below).
• Companies say they have a greater focus on nutrition and health, but are not doing much about it.
• Only four companies are trying to improve the affordability of their healthier products.
• Companies say they are trying to protect children from the harmful effects of marketing unhealthy products, but they are not doing much about it.

ATNI recommends that companies fix these problems and that the government “support such changes by introducing more effective and enforceable standards and legislation that prevent the marketing of unhealthy products and push companies to apply reformulation strategies on their products.

I like this recommendation, despite its being couched as “encourage,” rather than as a demand:

Companies are encouraged to actively support (and commit to not lobby against) public policy measures in the US to benefit public health and address obesity as enshrined in the National Strategy on food, hunger, nutrition, and health

Comment: Results liket these come as no surprise.  To repeat: food companies are not social service or public health agencies; they are businesses with stockholders who demand returns on investment as the first priority.

Expecting companies to change products to make them less attractive or to stop marketing to children means asking them to go against their business interests.

Until companies are rewarded for focusing on social values, public health, and environmental sustainability, ATNI’s evaluations are unlikely to have much of an impact on corporate behavior.

Documents

• The press release
• ATNI US Index Executive Summary
• My post on the 2018 ATNI release
• Note: ATNI is funded by the Robert Wood Johnson Foundation

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I can hardly believe it but we are going to have to endure another round of dietary guidelines, these for 2025-2030.

Why endure?

Because they have basically said the same things since 1980:

• Eat more fruits and vegetables
• Balance calories
• Don’t eat too much of foods high in saturated fat, salt, and sugar

As I am fond of quoting Michael Pollan: “Eat food.  Not too much.  Mostly plants.”

The wording changes from edition to edition.  The editions get longer and longer.  And the basic problems—nutrients as euphemisms for the foods that contain them, more and more obfuscation–stay the same.

But maybe not this time?

ODPHP, the Health and Human Service Office of Disease Prevention and Health Promotion (of which I am an alum) has just announced “Proposed Scientific Questions to Inform the Development of the Dietary Guidelines for Americans, 2025-2030: Available for Public Comment April 15 to May 16!”

The questions whose answers will form the research basic of the forthcoming guidelines are listed here.

Several break new or necessary ground:

• What is the relationship between consumption of dietary patterns with varying amounts of ultra-processed foods and growth, size, body composition, risk of overweight and obesity, and weight loss and maintenance?  Comment: This was one of my big criticisms of the 2020-2025 guidelines; the word “ultraprocessed” was never mentioned, yet I consider it the most important nutrition concept to come along in decades.  So this is a big step forward.
• What is the relationship between beverage consumption (beverage patterns, dairy milk and milk alternatives, 100% juice, low- or no-calorie sweetened beverages, sugar-sweetened beverages, coffee, tea, water) and growth, size, body composition, risk of overweight and obesity, and weight loss and maintenance? risk of type 2 diabetes?  Comment: it will be good to have this clarified.
• What is the relationship between food sources of saturated fat consumed and risk of cardiovascular disease?  Comment: This is an old issue but one under attack as being irrelevant.  Let’s get it settled, if that is possible.
• What is the relationship between specific food-based strategies during adulthood and body composition, risk of overweight and obesity, and weight loss and maintenance?  Comment: With luck, this will resolve the diet wars over low-carb v. low-fat, etc.  My prediction: they all work for some people.
• What is the relationship between specific food-based strategies during adulthood and body composition, risk of overweight and obesity, and weight loss and maintenance?  Comment:  Finally, an unambiguous demand for research on diet and obesity (as opposed to euphemisms).

What’s missing here?  I think they should have a question on meat, since evidence on risk/benefit is also controversail.  OK, saturated fat is a euphemism for meat, but let’s stop using euphemisms.

What’s being ducked, at least in the guidelines?

There are two topics not on the list of questions to be examined by the 2025 Dietary Guidelines Advisory Committee that will be addressed in separate processes.

• Alcoholic beverages remain a high priority topic, but because it requires significant, specific expertise and has unique considerations, it will be examined in a separate effort led by HHS Agencies that support work on this topic.
• Sustainability and the complex relationship between nutrition and climate change is an important, cross-cutting, and high priority topic that also requires specific expertise. HHS and USDA will address this topic separate from the Committee’s process to inform work across the Departments.

Want to weigh in on this (please do!):  here’s how (read and follow the directions carefully to have maximum impact)

As usual ConscienHealth has interesting things to say about all this.  I particularly enjoyed:

So it’s both unsurprising and unimpressive to hear that people with strong views about nutrition believe the process is rife with conflicts of interest. A group that is disenchanted with the last output from this process lays it out with a new paper in Public Health Nutrition. But Tamar Haspel made the same point much more efficiently in a recent tweet:

“I think they should just let me write the Dietary Guidelines and call it a day.”

This also reminds me about the need to select a scientific committee as free of conflicted interests as possible.  The last committee was rife with them.  HHS/USDA ought to be starting the committee selection process fairly soon.  Stay tuned.

The Intergovernmental Panel on Climate Change (IPCC) has released its 6th report.  

The news gets worse with each successive report.

Human-induced climate change is causing dangerous and widespread disruption in nature and affecting the lives of billions of people around the world, despite efforts to reduce the risks. People and ecosystems least able to cope are being hardest hit…The world faces unavoidable multiple climate hazards over the next two decades with global warming of 1.5°C (2.7°F). Even temporarily exceeding this warming level will result in additional severe impacts, some of which will be irreversible. Risks for society will increase, including to infrastructure and low-lying coastal settlements.

One paragraph (C.2.2) deals with the effects of agriculture on climate change, and the strength of the associations.

• Effective adaptation options, together with supportive public policies enhance food availability and stability and reduce climate risk for food systems while increasing their sustainability (medium confidence).
• Effective options include cultivar improvements, agroforestry, community-based adaptation, farm and landscape diversification, and urban agriculture (high confidence).
• Institutional feasibility, adaptation limits of crops and cost effectiveness also influence the effectiveness of the adaptation options (limited evidence, medium agreement).
• Agroecological principles and practices, ecosystem-based management in fisheries and aquaculture, and other approaches that work with natural processes support food security, nutrition, health and well-being, livelihoods and biodiversity, sustainability and ecosystem services (high confidence).
• These services include pest control, pollination, buffering of temperature extremes, and carbon sequestration and storage (high confidence).
• Trade-offs and barriers associated with such approaches include costs of establishment, access to inputs and viable markets, new knowledge and management (high confidence) and their potential effectiveness varies by socioeconomic context, ecosystem zone, species combinations and institutional support (medium confidence).
• Integrated, multi-sectoral solutions that address social inequities and differentiate responses based on climate risk and local situation will enhance food security and nutrition (high confidence).
• Adaptation strategies which reduce food loss and waste or support balanced diets (as described in the IPCC Special Report on Climate Change and Land) contribute to nutrition, health, biodiversity and other environmental benefits (high confidence).

Here are the documents:

• Summary for policymakers
• Figures for policymakers
• Technical summary
• Full report

The previous IPCC reports

• The Overview of the First Assessment Report (1990)
• The IPCC Second Assessment Report Synthesis of Scientific-technical Information Relevant to Interpreting Article 2 of the UNFCCC (1995)
• The Synthesis Report of the Third Assessment Report (2001)
• The Synthesis Report of the Fourth Assessment Report (2007)
• The Synthesis Report of the Fifth Assessment Report (2014)

Here’s a report from the World Health Organization on the effects of taxing sugar-sweetened beverages.

The study:

Consumption of SSBs is associated with increased risk of overweight and obesity (5), cardiovascular events (6), hypertension (7) and diabetes (8). There is now substantial evidence that SSB taxes can both discourage consumption and encourage reformulation (9,10). SSB taxes have also been found to have positive impacts on population weight and to potentially have greater health benefits among lower socioeconomic populations (11,12)….This study takes a policy analysis lens to studying SSB tax adoption and implementation in the WHO European Region. The focus was on the politicoeconomic and stakeholder dynamics in cross-sectoral policy-making, as well as considering adaptation in policy design.

https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/publications/2022/sugar-sweetened-beverage-taxes-in-the-who-european-region-success-through-lessons-learned-and-challenges-faced-2022

https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/publications/2022/sugar-sweetened-beverage-taxes-in-the-who-european-region-success-through-lessons-learned-and-challenges-faced-2022

• Be adapted to a country’s legislative, fiscal, economic and health context.
• Be designed and implemented through collaboration between finance and health policy-makers.
• Take revenues into consideration.
• Expect opposition from industry.

On this last point, the report says:

SSB taxes were strongly opposed by actors in the food and beverage industry in all the study countries, before and after  implementation. Industry made strong public statements regarding the negative economic impact that the tax would have on industry, particularly in relation to employment. In Finland, France, Hungary, Ireland and Portugal, they also argued that the tax would be regressive and, therefore, have a negative impact on consumers. In Belgium, Finland, France and Hungary (notably, these were earlier taxes), industry actors raised concerns that the tax singled out beverages and/or the beverage industry for differential taxation. Industry actors also presented a range of arguments regarding the taxes being ineffective and poorly designed.

Soda tax advocates need strategies to counter this opposition.  Plenty are available.  See the toolkit at Healthy Food America, for example.

The World Health Organization has just published “Food marketing exposure and power and their associations with food-related attitudes, beliefs and behaviours: a narrative review”

This is an update of a review WHO published in 2009 on the extent, nature and effects of food marketing.

The update includes a review of studies from 2009 to 2020 of

• Where food marketing occurs
• How much there is,
• Which brands and products are marketed
• How they are marketed
• How consumers react to food marketing

The report, which covers digital and social media,  concludes

Food marketing remains prevalent

• It is especially prevalent where children are and what they watch on TV
• It predominantly promotes “fast food”, sugar-sweetened beverages, and chocolate and confectionery
• It uses a wide range of creative strategies  aimed at young audiences (celebrity/sports endorsements, promotional characters, games)
• Its exposure is positively associated with habitual consumption of marketed foods or less healthy foods

The report confirms what advocates have been saying for years

• Food marketing is pervasive
• Food marketing is persuasive
• Food marketing is bad for health

The bottom line: Food marketing, especially to children, must be stopped

Let’s start 2022 off with a review sent to me by a reader who wishes to remain anonymous.

The review: Implementing the 2020–2025 Dietary Guidelines for Americans: Recommendations for a path forward. Sanders, L. M., Allen, J. C., Blankenship, J., Decker, E. A., Christ-Erwin, M., Hentges, E. J., Jones, J. M., Mohamedshah, F. Y., Ohlhorst, S. D., Ruff, J., &Wegner, J. (2021). J Food Sci. 86:5087–5099.  https://doi.org/10.1111/1750-3841.15969

Method: Based on a workshop aimed at developing strategies to promote adoption of dietary guideline recommendations.

Workshop funding: a grant from USDA with contributions from the Institute of Food Technologists.

Conflicts of interest: Mary Christ-Erwin is President and Owner of MCE Food and Agriculture Consulting and received an honorarium from the grant for moderating the meeting and panel and roundtable discussions. Julie M. Jones is a Scientific Advisor to USA Rice, Grain Foods Foundation, and the Quality Carbohydrate Coalition. John Ruff is an Investment Committee Member for Sathguru Catalyser Advisors Private Limited, the Asset Management Company of Innovation in Food and Agriculture Fund (IFA Fund) that invests in innovation-driven growth enterprises in the Food and Agriculture sectors, based in India. He is reimbursed for meeting fees and expenses related to attending committee meetings but has no investments in the fund. Lisa M. Sanders [Note: First author who wrote original draft] is the owner of Cornerstone Nutrition, LLC, a consultancy which has received funding from Kellogg Company, PepsiCo, and The Coca-Cola Company. Dr Sanders receivedwriting fees fromthe grant for development of this manuscript. JillWegner is an employee of Nestle. Jonathan C. Allen, Jeanne Blankenship, Eric A. Decker, Eric J.Hentges, Farida Y. Mohamedshah, and Sarah D. Ohlhorst have no conflicts to declare.

Comment: This workshop reflects a food industry perspective on the dietary guidelines.  Some of its reocmmendations make sense.  Others raise eyebrows, or should.

• The first recommendation: “Emphasize health benefits…gained through cooking at home.
• My favorite recommendation: “Leverage the current interest in science to debunk myths about food processing by demonstrating the similarity of techniques used to make foods at home and at scale in food industry, to show how food processing can contribute to the solution.”

This review is an excellent example of why the food industry needs to firmly excluded from nutrition policy discussions (for details on why, see my book, Unsavory Truth).

My strongest criticism of the 2020 dietary guidelines is that they fail to say anything about the health benefits of reducing consumption of ultra-processed foods (the junk food category strongly associated with excessive calorie intake, weight gain, and poor health).

Yet here we have a published review in a food science journal arguing for debunking “myths” about food processing.

They are not myths.  Evidence is abundant.

See, for example:

• Monteiro CA, Cannon G, Levy RB, et al.  Ultra-processed foods: what they are and how to identify them.  Public Health Nutr; 2019;22(5):936–941.
• Lawrence MA, Baker PI.  Ultra-processed food and adverse health outcomes.  BMJ. 2019 May 29;365:l2289.  doi: 10.1136/bmj.l2289.
• Hall KD, Ayuketah A, Brychta R, et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake [errata in Cell Metab. 2019;30(1):226 and Cell Metab. 2020;32(4):690]. Cell Metab. 2019;30(1):67–77.e3. doi: 10.1016/j.cmet.2019.05.008.

Fruit drinks, as opposed to 100% fruit juice, are a no-brainer.  They are heavily sugar-sweetened, and best consumed in very small amounts or not at all.

They are difficult to distinguish from 100% fruit juice.  Their labels make them look fruity and juicy.

So do their ingredient lists:

But these are juice concentrates and require translation: added sugars.  In this case, 11 out of the 13 grams per serving.

Public health advocates want to discourage parents from buying sugary beverages for their kids.  Here are the results of one such attempt.

• The study:  Countermarketing About Fruit Drinks, Alone or With Water Promotion: A 2019 Randomized Controlled Trial in Latinx Parents.  James Krieger, Taehoon Kwon, Rudy Ruiz, Lina Pinero Walkinshaw, Jiali Yan and Christina A. Roberto.  American Journal of Public Health, 28 Oct 2021.
• Method: Online messaging via Facebook groups using “countermarketing”—focusing on industry strategies rather than health messages.
• Result: A nearly 14% reduction in choosing fruit drinks.

As the accompanying editorial, Warning: Don’t Let the Beverage Industry Harm Your Kids, explains, 

Unlike general social marketing or other communications campaigns, countermarketing is designed “to reduce the demand for unhealthy products by exposing the motives of their producers and portraying their marketing activities as outside the boundaries of civilized corporate behavior”…Let’s put this good news to use by placing responsibility at the feet of the platforms and companies profiting from directly and incessantly targeting children with marketing the food and drink they should avoid.

If you would like to know how this works, here’s a toolkit for campaigns against fruit drinks.

One additional observation was a reduction in purchases of 100% juice, probably because it is so hard to tell the difference without careful scrutiny of labels (hint: look for 100%).

100% juice is a better option than fruit drinks (fruit is the best option), but still sugary because so many pieces of fruit go into it.

The juice industry is plenty worried about decreasing sales.  Marketing materials sent to dietitians reveal the concerns.  Guess who paid for these messages—and the studies.

Hot summer temperatures combined with a population eager to get outside and get moving means risk of dehydration is high. In addition to water, consider including 100% juice as a healthy, nutrient dense beverage option. In addition to rehydration and increasing fruit intake, two new studies show 100% juice has many other health benefits.

1. A recent UK study published in Nutrients found moderate consumption of 100% fruit juice, which aligns with the US Dietary Guidelines, does not increase the risk of obesity, type 2 diabetes, cardiovascular disease or poor glycemic control. Furthermore, regular daily consumption of 100% juice, may confer health benefits related to vascular function and reduced blood pressure. Emerging evidence shows there may even be a positive impact on cognitive health. [Funding: This research was funded by an unrestricted grant from the Fruit Juice Science Centre].
   [Funders: a consortium of orange producers, juice manufacturers and packaging companies based in Europe and Brazil under the umbrella of the European Fruit Juice Association (AIJN)].

2. A second review study, published in Frontiers in Immunology, found that citrus juice, contains key nutrients and bioactive substances that help our immune system to work efficiently and reduce inflammation. [Funders: a consortium of orange producers, juice manufacturers and packaging companies based in Europe and Brazil under the umbrella of the European Fruit Juice Association (AIJN)].

And how do we know this is all about marketing?  Try this Infographic: Squeeze More Profits From Juices.

Reference: For a summary of research on the “funding effect”—the observations that research sponsored by food companies almost invariably produces results favorable to the sponsor’s interests and that recipients of industry funding typically did not intend to be influenced and do not recognize the influence—see my book, Unsavory Truth: How Food Companies Skew the Science of What We Eat.

In a press release, the USDA says it is going to take action against Salmonella contamination of poultry in order to get closer to the national target of a 25% reduction in Salmonella illnesses.

Despite consistent reductions in the occurrence of Salmonella in poultry products, more than 1 million consumer illnesses due to Salmonella occur annually, and it is estimated (PDF, 1.4 MB) that over 23% of those illnesses are due to consumption of chicken and turkey…USDA intends to seek stakeholder feedback on specific Salmonella control and measurement strategies, including pilot projects, in poultry slaughter and processing establishments. A key component of this approach is encouraging preharvest controls to reduce Salmonella contamination coming into the slaughterhouse.

The North American Meat Institute says its members are happy to assist (Salmonella is a problem for poultry, not beef).

The National Chicken Council also pledged to assist with the pilot projects, but then put the onus of responsibility squarely on you.

Even with very low levels of pathogens, there is still the possibility of illness if a raw product is improperly handled or cooked. Increased consumer education about proper handling and cooking of raw meat must be part of any framework moving forward. Proper handling and cooking of poultry is the one thing that will eliminate any risk of foodborne illness. All bacteria potentially found on raw chicken, regardless of strain, are fully destroyed by handling the product properly and cooking it to an internal temperature of 165°.

The newly formed Coalition for Poultry Food Safety Reform, led by Center for Science in the Public Interest, welcomes the USDA’s announcement, but insists that USDA’s food safety oversight needs to extend from farm to fork.

Comment: The USDA’s jurisdiction starts at the slaughterhouse, but chickens coming into the plant are already contaminated with Salmonella.  This means prevention has to start on the farm, and poultry producers would have to institute procedures to keep their flocks free of Salmonella. They would much rather you cooked your chicken properly.

The latest big Salmonella outbreak is due to onions, an FDA-regulated food.

FDA’s traceback investigation is ongoing but has identified ProSource Produce, LLC (also known as ProSource Inc.) of Hailey, Idaho, and Keeler Family Farms of Deming, New Mexico, as suppliers of potentially contaminated whole, fresh onions imported from the State of Chihuahua, Mexico.

Keeler Family Farms issued a voluntary recall.   ProSource Produce LLC also issued a voluntary recall.

The CDC has the statistics:

Comment: I wrote about a previous onion recall last year.   Food safety lawyer Bill Marler asks: What did we learn – or not – from the 2020 Salmonella Outbreak linked to onions?  That investigation, as he emphasizes, identified probable causes:

• potentially contaminated sources of irrigation water;
• sheep grazing on adjacent land;
• signs of animal intrusion, including scat (fecal droppings), and large flocks of birds that may spread contamination; and
• food contact surfaces that had not been inspected, maintained, or cleaned as frequently as necessary to protect against the contamination of produce.

The FDA lists all the products that have been recalled so far.  It also displays their labels.  If you have onions from these companies, treat them like biosafety hazards.  If you can’t bear to throw them out, at least boil them and sterilize everything they could have contacted.