Food Politics

by Marion Nestle
Sep 19 2012

JAMA publishes theme issue on obesity

Yesterday, JAMA released a theme issue on obesity with several articles of particular interest, starting with New York City Health Commissioner Tom Farley’s Viewpoint.  About portion sizes, Dr. Farley notes:

As publicly traded companies responsive to the interests of their shareholders, food companies cannot make decisions that will lower profits, and larger portion sizes are more profitable because most costs of delivering food items to consumers are fixed….The sale of huge portions is driven by the food industry, not by consumer demand….The portion-size studies strongly suggest that, with a smaller default portion size, most consumers will consume fewer calories.  This change will not reverse the obesity epidemic, but it can have a substantial effect on it.

Lots of interesting food for thought here.  Take a look:


Viewpoint

The Role of Government in Preventing Excess Calorie Consumption:  The Example of New York City
Thomas A. Farley, MD, MPH
JAMA. 2012;308(11):1093 doi:10.1001/2012.jama.11623

The Next Generation of Obesity Research:  No Time to Waste
Griffin P. Rodgers, MD; Francis S. Collins, MD, PhD
JAMA. 2012;308(11):1095 doi:10.1001/2012.jama.11853

FDA Approval of Obesity Drugs:  A Difference in Risk-Benefit Perceptions
Elaine H. Morrato, DrPH, MPH; David B. Allison, PhD
JAMA. 2012;308(11):1097 doi:10.1001/jama.2012.10007

Cardiovascular Risk Assessment in the Development of New Drugs for Obesity
William R. Hiatt, MD; Allison B. Goldfine, MD; Sanjay Kaul, MD
JAMA. 2012;308(11):1099 doi:10.1001/jama.2012.9931

Original Contribution

Exercise Dose and Diabetes Risk in Overweight and Obese Children:  A Randomized Controlled Trial
Catherine L. Davis, PhD; Norman K. Pollock, PhD; Jennifer L. Waller, PhD; Jerry D. Allison, PhD; B. Adam Dennis, MD; Reda Bassali, MD; Agustín Meléndez, PhD; Colleen A. Boyle, PhD; Barbara A. Gower, PhD
JAMA. 2012;308(11):1103 doi:10.1001/2012.jama.10762

Association Between Urinary Bisphenol A Concentration and Obesity Prevalence in Children and Adolescents
Leonardo Trasande, MD, MPP; Teresa M. Attina, MD, PhD, MPH; Jan Blustein, MD, PhD
JAMA. 2012;308(11):1113 doi:10.1001/2012.jama.11461

Health Benefits of Gastric Bypass Surgery After 6 Years
Ted D. Adams, PhD, MPH; Lance E. Davidson, PhD; Sheldon E. Litwin, MD; Ronette L. Kolotkin, PhD; Michael J. LaMonte, PhD; Robert C. Pendleton, MD; Michael B. Strong, MD; Russell Vinik, MD; Nathan A. Wanner, MD; Paul N. Hopkins, MD, MSPH; Richard E. Gress, MA; James M. Walker, MD; Tom V. Cloward, MD; R. Tom Nuttall, RRT; Ahmad Hammoud, MD; Jessica L. J. Greenwood, MD, MSPH; Ross D. Crosby, PhD; Rodrick McKinlay, MD; Steven C. Simper, MD; Sherman C. Smith, MD; Steven C. Hunt, PhD
JAMA. 2012;308(11):1122 doi:10.1001/2012.jama.11164

Health Care Use During 20 Years Following Bariatric Surgery
Martin Neovius, PhD; Kristina Narbro, PhD; Catherine Keating, MPH; Markku Peltonen, PhD; Kajsa Sjöholm, PhD; Göran Ågren, MD; Lars Sjöström, MD, PhD; Lena Carlsson, MD, PhD
JAMA. 2012;308(11):1132 doi:10.1001/2012.jama.11792

Surgical vs Conventional Therapy for Weight Loss Treatment of Obstructive Sleep Apnea:  A Randomized Controlled Trial
John B. Dixon, MBBS, PhD, FRACGP; Linda M. Schachter, MBBS, PhD; Paul E. O’Brien, MD, FRACS; Kay Jones, MT&D, PhD; Mariee Grima, BSc, MDiet; Gavin Lambert, PhD; Wendy Brown, MBBS, PhD, FRACS; Michael Bailey, PhD, MSc; Matthew T. Naughton, MD, FRACP
JAMA. 2012;308(11):1142 doi:10.1001/2012.jama.11580

Dysfunctional Adiposity and the Risk of Prediabetes and Type 2 Diabetes in Obese Adults
Ian J. Neeland, MD; Aslan T. Turer, MD, MHS; Colby R. Ayers, MS; Tiffany M. Powell-Wiley, MD, MPH; Gloria L. Vega, PhD; Ramin Farzaneh-Far, MD, MAS; Scott M. Grundy, MD, PhD; Amit Khera, MD, MS; Darren K. McGuire, MD, MHSc; James A. de Lemos, MD
JAMA. 2012;308(11):1150 doi:10.1001/2012.jama.11132

Editorial

Progress in Filling the Gaps in Bariatric Surgery
Anita P. Courcoulas, MD, MPH
JAMA. 2012;308(11):1160 doi:10.1001/jama.2012.12337

Progress in Obesity Research:  Reasons for Optimism
Edward H. Livingston, MD; Jody W. Zylke, MD
JAMA. 2012;308(11):1162 doi:10.1001/2012.jama.12203

Sep 18 2012

Today’s debate: The Wall Street Journal asks who’s responsible for preventing obesity?

Betsy McKay of The Wall Street Journal organized and moderated a debate on this question.  I was a participant along with Brian Wansink , the John S. Dyson professor of marketing at Cornell University and Michael D. Tanner, senior fellow at the Cato Institute.

The debate is lengthy—you can read all of it online—but here are my initial responses to the two questions asked of me.

WSJ: What role should government play in addressing the obesity epidemic?  

DR. NESTLE: The government is up to its ears in policies that promote obesity. To name only a handful: supporting production of food commodities, but not of fruits and vegetables; permitting food and beverage companies to deduct marketing expenses from taxes; permitting SNAP benefits [food stamps] to be used on any food, thereby encouraging food companies to market directly to low-income groups.

Research on the prevalence of obesity shows that after decades of remaining at the same level, it began to increase sharply in the early 1980s. Our sense of personal responsibility did not change then. What did change was the food environment, transformed by food industry imperatives to increase sales, to one that increasingly urged people to “eat more” by making it socially acceptable to eat anywhere, anytime, and in very large amounts. In this kind of food environment, all but the most mindful eaters overeat. Few of us are in that category.

The food, beverage and restaurant industries collectively spend roughly $16 billion a year to promote sales through advertising agencies, perhaps $2 billion of that targeted at children. Marketing to children is well established to encourage kids to want advertised products, pester their parents for them, and believe that those products are what they are supposed to be eating. The “I am responsible” argument does not work for children (I’m not aware of evidence that it works well for adults either). Because regular consumption of junk foods and sugary drinks is linked to obesity in children, marketing these products to them is overtly unethical.

To expect food and beverage companies, whose sole purpose is to increase sales and report growth in sales every quarter, to voluntarily stop marketing to children makes no sense. On ethical grounds alone, government intervention is essential.

Given the personal and economic costs of obesity—currently estimated at $190 billion a year—governments have many reasons to promote the health of their populations. Just ask the military.

WSJ: Let’s talk about some specific initiatives. Will Mayor Bloomberg’s cap on soda sizes reduce soda consumption? What about the proposed municipal tax of a penny an ounce on sugary drinks in Richmond, Calif.?

DR. NESTLE: If only education and personal responsibility worked to improve eating behavior. Brian Wansink’s research clearly shows that his own students, diligently educated to understand the effect of large food portions on eating behavior, will still eat more when given more food—and, more seriously, they will underestimate the amount they have eaten.

Education must be backed up by a supportive environment. So why not create a food environment that makes it easier for people to eat less? Mayor Bloomberg’s idea of capping soda sizes at 16 ounces is an interesting approach to doing just that. A 16-ounce soda is not exactly abstemious. It is two standard servings, 50 grams of sugar and 200 calories.

To suggest that food laws will not change behavior makes little sense. For one thing, anti-obesity initiatives have scarcely been tried. For another, the history of anti-smoking interventions suggests quite the opposite. Attempts to get smokers to quit by invoking personal responsibility made little headway. Smokers quit when the government made smoking so inconvenient and expensive that it became easier to stop than to continue.

The intense response of soda companies to Mayor Bloomberg’s cap on soda size is testimony to the effectiveness of regulatory approaches. The companies would not be putting this kind of effort or spending millions to oppose an action they expected to fail.

Sep 17 2012

The New York Times’ online debate about organics

I participated last week in a New York Times blog debate on this question:

Is organic food worth the expense?

A recent study by scientists at Stanford University found that fruits and vegetable labeled organic are, on average, no healthier than less expensive conventional produce, although they have lower levels of pesticide residue.

Are there other benefits that outweigh the cost of organic food? Is there a place for organic farming in a world with severe food shortages and rising food prices?

My answer: Buying organic is a personal choice.

Marion Nestle

Marion Nestle, the Paulette Goddard professor in the Department of Nutrition, Food Studies and Public Health at New York University, is the author of “Why Calories Count: From Science to Politics.” She blogs at FoodPolitics.com and is on Twitter.

Questions about organic food raise three issues: productivity, benefits and costs. Productivity is easy. Since the early 1980s, careful productivity studies conclude that organic yields are only slightly lower than conventional yields, and organic production leaves soils in much better shape — boding well for future productivity. The yield difference is too small to have much of an effect on world food supplies.

Next, benefits. If crops are grown without pesticides, they won’t contaminate soil and water, foods will contain fewer pesticides, and people who eat organic foods will have lower levels in their bodies. The Stanford study and others confirm all this. Critics of organics say: “So what. Pesticides are safe.” They point out that nobody has ever died from eating industrially produced broccoli. Although science does not presently demonstrate long-term harm from eating pesticide-treated vegetables, pesticides are demonstrably harmful to farm workers and to “nontarget” wildlife, and they accumulate in soils for ages. If pesticides were all that benign, the government wouldn’t need to regulate them, but it does.

The Stanford study made a big deal about nutrients, but nutrients are not the point. The point of organic production is its effects on the health of people and the planet. The investigators did not examine the overall health impact of organics, no doubt because such studies are difficult to conduct and interpret. For one thing, people who buy organics tend to be better educated and wealthier — characteristics that track with good health anyway.

That leaves the cost question. Organics cost more because they require greater amounts of hand labor. Are they worth it? Personally, I prefer not to be a guinea pig in a long-term pesticide experiment. I’m also fortunate to have the choice.

We should be doing all we can to give everyone else the same choice.

Here are the other debaters

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Sep 14 2012

Maker of “pink slime” sues everyone who calls it that

You have to hand it to BPI (Beef Products Inc), the producer of  “Lean Finely Textured Beef (LFTB)”—a.k.a. “pink slime.”  The company deserves a prize for chutzpah (translation: outrageous audacity).

It has just filed a defamation (“veggie libel”) lawsuit for $1.2 billion (!) against an amazing cast of characters:

  • ABC News (owned by Disney)
  • TV news anchor Diane Sawyer
  • ABC correspondent Jim Avila
  • ABC correspondent David Kerley
  • Gerald Zirnstein , former USDA employee who invented the term “pink slime”
  • Carl Custer, former USDA employee
  • Kit Foshee, whistleblower former BPI employee

South Dakota, apparently, has a veggie libel law to protect companies making food products from people who say mean things about them (recall: the Texas cattlemen vs. Oprah Winfrey).  Nobody has ever tested the constitutionality of veggie libel laws but I don’t know anyone who thinks they will stand up in court—free speech and all that.

BPI says the company lost 80% of its sales, a loss of $20 million per month, following news broadcasts about “pink slime.”  It had to close three facilities—in Texas, Kansas, and Iowa—and fire 650 workers at those places as well as 85 others at the company’s headquarters in South Dakota.

As I’ve written before, I see the “pink slime” episode as reflecting a lack of transparency in the beef industry and BPI’s efforts to defend its products as an example of power politics in action.

BPI is fighting back, hard.

The responses:

ABC News says, “The lawsuit is without merit. We will contest it vigorously.”

Bill Marler, the Seattle attorney who specializes in representing victims of food poisonings, has taken on this case and is representing Custer and Zirnstein.

Marler points out:

  • You can buy a lot of Pink Slime for $1.2 billion.
  • Someone should have told BPI’s lawyer it is not a great PR move to repeat the same charge that your client is now claiming harmed them in the first place.
  • The lawsuit is without merit.
  • We intend to defend this bogus, unwarranted and frivolous claim brought by BPI against these two former FSIS public employees.
  • We are also contemplating filing a counter-claim against PBI.

Let the charges and countercharges begin!

This one will be almost as much fun to watch as the equally absurd legal squabbles between the Sugar Association and the Corn Refiners Association over what to call High Fructose Corn Syrup.  I’ll do a post on that next week sometime.

Sep 13 2012

McDonald’s will post calorie info on menus. Won’t it have to anyway?

I’m puzzled by the huge media attention to McDonald’s announcement that it will post calories on menu boards.

McDonald’s will have to do this sooner or later.  By doing it now, it gets a public relations bonus.

Why will it have to?  Because the Affordable Care Act takes menu labeling national (see my previous post on this).

When the Supreme Court ruled that the Affordable Care Act is constitutional, it made menu labeling constitutional.

The FDA wrote proposed rules for menu labeling early in April.  These, you may recall, contain exemptions for movie theaters and other venues.  Note: There is still time to file complaints about the exemptions.

Implementation of the rules can’t begin until the White House Office of Management and Budget releases them.  It’s had them—along with food safety and other regulations—under consideration for months.

Presumably, OMB will act eventually.

McDonald’s looks like a champion getting out in front on this one.

Other fast food places will have to post calories too.  The only question is when.

Sep 11 2012

A nice compliment from J Public Health Policy

Most of you probably don’t read the Journal of Public Health Policy, but I’m on its editorial committee.  Nevertheless, this editorial came as a surprise.*   I thought I would share it with you.  Enjoy!  (I did).

Big food

Anthony Robbins M.D., M.P.A.Co-Editor

I first encountered Marion Nestle in the late 1990s when I edited Public Health Reports, the scientific journal of the US Public Health Service. We published a provocative piece of hers about the marketing by Proctor and Gamble of Olestra, a zero calorie fat substitute. Marion taught me a great deal about how the food industry markets its products that are tasty, convenient, and relatively inexpensive. It markets intensively to children and continues to do so long after overeating and obesity have been shown to have deadly health consequences. Sound familiar? Perhaps like the tobacco industry.

In 2003, I invited Marion to Public Health Grand Rounds to describe the obesity epidemic to my public health students at Tufts Medical School. To follow Marion, I invited Richard Daynard from Northeastern Law School, who had litigated extensively against the tobacco industry. Dick carefully noted the differences between tobacco, which has no healthy use, and food. But he suggested that the anti-health behavior of the two industries might be similar: continuing to market products in a way that certainly harmed health.

When the public health faculty at Tufts and the law faculty at Northeastern joined forces to establish the Public Health Advocacy Institute, one of our first projects was Legal Approaches to the Obesity Epidemic1, a symposium published in the Journal of Public Health Policy, in 2004. It attracted a great deal of attention and JPHP became a favorite place to publish research on obesity.

But I was not entirely pleased, because although the research was usually methodologically sound, it often missed Marion’s point and the focus of the PHAI symposium. Most submissions concentrated on individual behavior and personal responsibility. In 2010, I asked Marion, who was on the JPHP editorial board to join me in writing an Editorial: ‘Obesity as collateral damage: a call for papers on the Obesity Epidemic’.2 We had ‘come to believe that research studies concentrating on personal behavior and responsibility as causes of the obesity epidemic do little but offer cover to an industry seeking to downplay its own responsibility’. We urged ‘authors to submit articles that consider how to understand and change the behavior of the food industry’.

Imagine our pleasure in learning that starting this June, PLoS Medicine will publish a series of articles exploring the food industry’s involvement in health with Marion Nestle as a guest editor. To PLoS Medicine, we say bravo!

References

  1. Journal of Public Health Policy (2004) Special section: Legal approaches to the obesity epidemic. 25(3&4): 346–434.
  2. Robbins, A. and Nestle, M. (2011) Obesity as collateral damage: A call for papers on the Obesity Epidemic. Journal of Public Health Policy 32(2): 143-145.

 *Journal of Public Health Policy (2012) 33, 285–286. doi:10.1057/jphp.2012.25

Sep 10 2012

California judge: Richmond cannot require anti-soda tax group to disclose donors

I’m following the soda tax initiative in Richmond, CA with rapt attention.  Richmond, as I explained last week, is a low-income city with a lot of obesity-related chronic disease and high soda consumption.

Residents will vote on its soda tax initiative in November.  In the meantime, the American Beverage Association has gone to work to spin the science, attack critics, and fund “community coalition” groups to oppose the initiative.

Richmond requires such groups to disclose their top donors on political mailings.  The soda-industry funded “Coalition” went to court to block this requirement on First Amendment grounds.

Now, according to Robert Rogers, the terrific reporter for the Contra Costa Times who has been working on this story, a federal judge in San Francisco issued a temporary restraining order doing just that.

Complete victory for our side,” said coalition spokesman Chuck Finnie. “(Judge Charles Breyer) indicated he doesn’t think (the ordinance) applies to us because we are not engaged in independent expenditures. (Breyer) indicated a city can’t require a campaign to publish political arguments under the guise of claiming it is a disclosure.

This will be back in court on September 18.

In the meantime, “Big Soda” is expected to spend more than a million dollars in Richmond to make its efforts look like a local campaign.

Here is the Statement on Ruling on Richmond Mailer Ordinance.

And here are related Contra Costa Times stories on the soda tax initiative.

Sep 7 2012

Weekend food image: Lake Geneva

Thanks to Juan Pablo Peña-Rosas of the World Health Organization for sending this photo.

It’s of Lake Geneva in front of Nestlé’s (no relation) food museum in Vevey.

The museum’s current exhibit is called COLLECTIONNEZ-MOI!  It includes thousands of such things as sardine cans, fruit wrapping papers, soft drink bottles, and—my favorite—sugar cubes obsessively accumulated by private collectors, and well worth the visit (I was there a month or so ago).

And the fork!

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