Food Politics

by Marion Nestle
Oct 24 2016

Rethinking nutrition policy in developing countries

I recently coauthored an editorial on international development.  It appeared first in French, and now in English in Ideas for Development, a blog coordinated by the French Agency for Development.

Rethinking nutritional policies in developing countries taking into account the double burden of malnutrition

By , Marion Nestle, and

The world now experiences two forms of malnutrition which may seem contradictory: “undernutrition” (which includes micronutrient deficiencies) and “overnutrition” (obesity and its health consequences).The problem of malnutrition in developing countries is approached by most aid bodies (donors, international organisations and NGOs) and governments solely from the angle of undernutrition. And yet in these countries, the complex and multi-faceted challenge which malnutrition now presents can justifiably be called the double burden of malnutrition. In addition to the continuing problem of undernutrition there are now major issues linked to overnutrition and its associated illnesses.

Rapid nutrition transition

The stereotyped image of skeletal young children with protruding bellies saved by souls of goodwill in sub-Saharan Africa is still too widespread. Severe acute malnutrition still persists of course, especially among the victims of extreme poverty, natural catastrophes and wars. Naturally, this deadly disease must continue to be addressed and treated, as numerous NGOs are doing.

The treatment of malnutrition should focus not only on severe malnutrition in children. Less severe malnutrition, going back to life in the foetus and resulting from malnutrition in women even prior to their pregnancy, continues to contribute to stunting, which affects 23.8% of all children under the age of 5 throughout the world.

In parallel with acute and chronic undernutrition, the “nutrition transition” in low-income countries, driven by globalisation, urbanisation and technological progress and linked to “overnutrition,” leads to a swift increase in obesity and other chronic diseases – mainly diabetes and cardiovascular diseases. Nutrition transition is the term used to describe the progressive Westernisation of eating patterns, typified by a sharp increase in the consumption of animal fats and processed foods all over the world, combined with an increasingly sedentary lifestyle. It is easy to see how this transition encourages the increase in overweight and obesity.

Today, undernutrition alone is not the major issue; the greatest problem is the double burden of undernutrition and overnutrition. According to estimates from 129 countries with available data, 57 experience serious problems of both undernutrition in children and overweight in adults[i]. And Africa is not exempt from this double burden where undernutrition and overweight are undeniably linked. In West Africa, 50% of women of child-bearing age are anemic while at the same time 38% are overweight and 15% are obese. For the whole of sub-Saharan Africa, 40% of children have stunted growth characteristic of chronic undernutrition, while 7.5% of adults suffer from obesity. Malnutrition early in life increases the subsequent risk of chronic diseases in places where obesity is encouraged by the environment. Obesity is now on the increase among children in all developing countries. The World Health Organization (WHO) reports that between 1990 and 2015 the number of overweight or obese African children doubled from 5 to 10 million. 

The responsibilities of the industrial food system

It is often said that communication aimed at changing food habits is the best way to prevent obesity, a problem reserved for rich people in low-income countries. This cliché contains three errors:

  • The first is the claim that preventing nutrition-related chronic relies entirely on the capacity of individuals to make appropriate choices regarding food, physical activity or lifestyle. This claim ignores the well-documented effects of the food system and the socio-cultural factors which play a determining role and which influence the choice of individuals.
  • The second error is to believe that significant changes cannot be made to the eating practices of limited-income groups in the absence of an increase in resources. Yet several studies show the opposite, whether they are about exclusive breastfeeding for the first six months of life and improved complementary feeding, or else hygiene measures and supplies of drinking water.
  • The third error is to consider that obesity continues to be only a problem of the rich in low-income countries. Obesity is escalating and affecting growing numbers of not so well-off people, particularly in cities.

When analysing the impact of the food system, it is necessary to account for the agri-food industry (Big Food). On a world-wide scale Big Food is primarily responsible for the nutrition transition” towards processed food. “Globalised” industrial food is gradually replacing traditional cooking and locally produced foods, with ultra-processed foods’ (food-like substances as Michael Pollan calls some of them) undeniable appeal for city-dwellers and young people as these products are strongly associated with Western-style fast food and heavily promoted by the media. This appeal is reflected in profound changes in consumption trends in developing countries. Global sales of highly processed foods increased by 44% from 2000 to 2013, but only by 2% in North America as opposed to 48% in Latin America and 71% in Africa and the Middle East.

So what is the problem? Industrial food products (and drinks) are often a nutritional disaster: rich in calories, sugar, fat and salt, but low in essential nutrients and fiber. Even more, these products are relatively inexpensive, often less expensive than more nourishing local food products.

Changing the food environment

What is the explanation for the popularity of these “globalized” food products? Part of the answer lies in extremely effective advertising. Anyone travelling in Africa, for example, will see campaigns to promote salty stock cubes to replace traditional spices and vegetables. “Social marketing” efforts to change eating behaviour must be as forceful as these adverts, with commensurate budgets.

One idea is to impose a tax on soft drinks or other highly processed foods and use the revenues to finance cutting-edge nutrition education campaigns. This is what the United Kingdom has recently decided to do by taxing soft drinks.

It is especially important to rethink the nutrition programs created by NGOs and financed by international aid. Correcting the nutrition of malnourished mothers or children is only part of the problem.

A wider vision is needed to recognize the threat to world health posed by nutrition-related chronic diseases.

To cope with this new challenge, it will be important to address many determinants of health – education, social disparities, housing, and culture – as well as the food environment. The latest report on global nutrition1 points out the excellent return on investment of nutrition interventions (16 for 1), and challenges governments and decision-makers to identify and implement strategies that target the double burden of malnutrition. If this is not done, it will be difficult to reach the nutrition objectives set by the WHO for 2025 (see below). Solutions do exist, however, as can be seen from places such as Ghana, Brazil, or the state of Maharashtra in India, which have had encouraging results in fighting malnutrition in all its forms.

Global nutrition targets for 2025

  • Reduce the number of children with stunted growth by 40%
  • Reduce and keep the prevalence of acute malnutrition in under-five children (low weight) under 5%
  • Avoid any increase of overweight in children
  • Reduce the prevalence of anemia in women of child-bearing age by 50%
  • Increase exclusive breastfeeding for babies less than 6 months old by 50%
  • Reduce low birth weights by 30%
  • Avoid any increase in the prevalence of overweight, obesity and diabetes in adults.

The opinions expressed on this blog are those of the authors and do not necessarily reflect the official position of their institutions or of AFD.

[i] Global Nutrition Report 2016 www.globalnutritionreport.org
Oct 21 2016

Weekend reading: a how-to for sustainable food systems

Darryl Benjamin and Lyndon Virkler.  Farm to Table: The Essential Guide to Sustainable Food Systems for Students, Professionals, and Consumers.  Chelsea Green, 2016.

 

Oct 19 2016

Coca-Cola Europe’s policy agenda, courtesy of WikiLeaks

Ninjas for Health posts this graphic from someplace in the emails leaked to DCLeaks (it’s good they are going through them so we don’t have to).  

The Ninjas point out that Coke divides the policies into three categories based on likelihood of happening and impact on sales:

  • Fight back
  • Monitor
  • Prepare

The policy with the biggest impact greatest likelihood of materializing?  Increased soda taxes.

No wonder soda companies are fighting back against them.

Nancy Huehnergarth pointed out in an email that a ban on advertising to children under the age of 12 shows up in the “Prepare” category, even though soda companies insist that they do not advertise to young children.

It’s interesting to see what Coca-Cola thinks has a high likelihood of happening: Protectionism against sugar imports, mandatory environmental labels, emission reduction targets, and the mysterious “provisions for lobbying.”

The company has a lot to worry about, apparently.

Oct 18 2016

Pepsi to reduce sugar in its drinks? Really?

PepsiCo, yesterday, announced that it had launched its sustainability report with an agenda for 2025. 

The sustainability promises look good, but reporters called me for comments only on the first goal in its Products agenda:

  1. At least two-thirds of Pepsi’s global beverage portfolio volume will have 100 calories or fewer from added sugars per 12-ounce serving.

For the record, the other Product goals are:

  1. At least three-quarters of its global foods portfolio volume will not exceed 1.1 grams of saturated fat per 100 calories.
  1. At least three-quarters of its global foods portfolio volume will not exceed 1.3 milligrams of sodium per calorie.

The reporters’ questions assumed that Pepsi plans to reduce the sugar in its full-sugar beverages.

Maybe, but that’s not clear from the press release or the report.

Here’s what I want to know:

  1. The baseline: What proportion of Pepsi drinks already have fewer than 100 calories per 12 ounces?  Pepsi makes loads of beverages that meet that target—Gatorade, bottled waters, diet sodas.
  2. The marketing plan: Will the marketing dollars shift from full-sugar to lower-sugar options?

I ask, because Pepsi’s track record on sugar reduction is not encouraging.  In 2009, Pepsi set a goal to reduce the average amount of added sugars in its drinks by 25% by 2020.

The result?  An increase in average sugars of 4% so far (Pepsi got into trouble with investors who wanted marketing focused on full-sugar beverages).

Pepsi’s sustainability report says the company is working hard to find ways to reduce sugars and “these efforts could yield significant progress.”   Let’s hope they do.

The report also explains how the company plans to reach its lower-sugar goal:

  • Reformulating
  • Creating new low-and no-calorie drinks
  • Making smaller sizes
  • Boosting promotion of lower-calorie drinks

I hope the company does these things, despite its unfortunate record on sugar promises.  We need to wait and see whether the company delivers on this one.

But I’m thinking: Surely this announcement must be designed to head off the ongoing soda tax initiatives.  Pepsi is pouring millions of dollars into fighting the taxes directly and through its membership in the American Beverage Association.

Pepsi wants to have things both ways: to appear to promote healthier beverages while it is fighting public health measures to reduce soda intake.

Let’s give the company the benefit of the doubt and hope it delivers on its promises—while doing everything we can to get those taxes passed.

Here’s one of the articles that quotes me:

The last time Pepsi tried to position itself as doing something for health, its investors got very upset,” Marion Nestle, a professor in the Department of Nutrition, Food Studies & Public Health at New York University, said in an email. In 2012, investors got mad at PepsiCo CEO Indra Nooyi for focusing on getting revenue from healthy products, Business Insider reported.

“[PepsiCo] will continue to do everything it can to promote its most profitable products,” Nestle said. “These, alas, tend to be the ones with full sugar.”

Oct 17 2016

The FDA’s new strategic plan: open for public comment

I am late getting to the FDA’s July announcement of the release of its work plan for the next ten years, Foods and Veterinary Medicine (FVM) Program’s Strategic Plan for fiscal years 2016-2025.

The FDA organized the plan under goals for:

  • Food safety
  • Nutrition
  • Animal health
  • Organizational excellence

The FDA based the plan on basic principles:

  1. Public health is the first priority
  2. Partnerships are the key to success
  3. Scientific expertise and research are the foundation
  4. The program is committed to operating openly and transparently

Comments can be submitted on the strategic plan at any time.  Instructions for how to do so are here.

One possibility is to ask for further details.  The plan does not say how the FDA will accomplish the objectives, how much it will cost to achieve them, or whether it has adequate funding for everything it does (hint: it doesn’t).

Some of what it wants to do is puzzling.  For example, one Nutrition objective is this:

2.1: Provide and support accurate and useful nutrition information and education so consumers can choose healthier diets consistent with the Dietary Guidelines for Americans and other evidence-based recommendations.

I assume this refers to Nutrition Facts labels and menu labels, but one of its sub-objectives is:

Strategy 2.1d: Promote collaboration with stakeholders, including industry, consumer, and public health groups, to enhance consumer nutrition education directed towards age and demographic groups with specific needs.

I wish the report said more about this.  Surely the FDA is not suggesting that the food industry take responsibility for nutrition education?  I hope not.

The documents:

 

Oct 14 2016

Weekend reading: Restaurants that changed the way Americans eat

Paul Freedman.  Ten Restaurants that Changed America.  Liveright/WW Norton, 2016.

Image result for ten restaurants that changed america

I was happy to be asked for a blurb for this fascinating, entertaining, and beautifully produced (color illustrations!) volume.  Here’s what I said:

Is it even remotely possible that ten restaurants—from Delmonico’s to Howard Johnson, Sylvia’s, and Chez Panisse—could change the way America eats?  Paul Freedman draws on deep historical research, analysis of contemporary sources, and interviews with surviving players to give us an elegantly written, fascinating, and, dare I suggest, gossipy account of the individuals and social trends that made these restaurants famous.   Whether or not you’ve ever eaten in any of these restaurants, you will have a wonderful time reading this book and will gain unexpectedly delightful insights into modern American life.

I particularly enjoy Freeman’s writing.  Here is an excerpt from his chapter on Le Pavillion (page 336) on what it’s like to get into a high-end restaurant these days:

[I]t is hardly as if American high-end restaurants have become that much more democratic.  Although it is customary to begin any account of the modern restaurant boom by conjuring up the bad old days of damask tablecloths, dress code, leather-covered menus and haughty maîtres-d’-hôtel, restaurants today impose distinctions that would never have occurred to Henri Soulé: near-impossible reservations, no reservations, the speakeasy restaurant type with no visible sign, special telephone lines for favored customers, or forcing clients to pay in advance of their meal.  The model is no longer the nightclub of the Copacabana or El Morocco type, but the culinary version of a dance club complete with velvet rope and line of suppliants, lacking only a bouncer.

Freedman sprinkles wonderfully gossipy digressions throughout.  Here’s one from his chapter on the Four Seasons (page 372):

President John F. Kennedy’s forty-fifth birthday on May 19, 1962, was celebrated there.  Guests, who contributed $1,000, had a rather modest meal of baked crab, chicken broth with spring wheat, beef medallions and birthday cake.  Kennedy had spent so much time chatting with each table, had time only for cream of asparagus soup and a beer before going off to Madison Square Garden where Marilyn Monroe sang him a rather suggestive version of “Happy Birthday.

That comment ought to take you right to YouTube, where you can the “suggestive version” for yourself.

Oct 13 2016

I’ve been Wikileaked!

I’ve been following the story of Hillary Clinton’s Wikileaked e-mails (which John Podesta says the Russians released to sway the election)  but never dreamed that I would turn up in them.

But Crossfit’s Russ Greene sent me his blog post yesterday and there I am [the photo comes from an article in the Sydney Morning Herald].

Coke’s Surveillance of Marion Nestle

Strangely, the DC Leaks database does not include any Coca-Cola emails from August 2015, the month that the New York Times first exposed the Global Energy Balance Network. Nonetheless, it does reveal that Coke sent a representative to attend and take notes on Dr. Marion Nestle’s speech at Sydney University in January.

Dr. Nestle, an NYU professor who most recently published “Soda Politics,” spoke on conflicts of interest in health science and government food policy. She mentioned the GEBN as a case study in soda-influenced science.

Nestle moderately concerned Coke. They mentioned the need to “Monitor social media,” but stated that Nestle achieved “very limited pick up from yesterday’s presentation – #sodapolitics.”

Of course the pick up was limited.  This was a private, invitation-only meeting with Sydney nutritionists deliberately kept small so as not to compete with my subsequent public lectures (see below for the media list).

Who was the Coca-Cola note taker?   I have no idea but the notes seem fine.

Coke’s Surveillance of CSPI

I also turn up in the e-mails related to Center for Science in the Public Interest (CSPI).  Evidently, Coca-Cola was tracking the social media response to a CSPI report on its marketing to children.

The most shared tweet was this one – https://twitter.com/CSPI/status/732239510138949633, which was mainly because Marion Nestle re-tweeted it.

By now I assume that someone from Coca-Cola is taking notes at every talk I give and reporting in to headquarters.

What does all this have to do with Hillary Clinton’s campaign?

As Russ Greene explains, the emails reveal that Capricia Marshall, who is working on the Clinton campaign, is also working for Coca-Cola’s communications team.

The evidence that Marshall is working on Hillary Clinton’s presidential campaign is extensive and undeniable. HillaryClinton.com features her prominently at Clinton campaign events.

Just to make things easy for Coca-Cola, here’s my Australia media list

March 10 ABC 7:30, TV interview with Sarah Whyte on Coca-Cola’s funding of research: Sweet Talk

March 2 ABC-FM interview with Margaret Throsby, Classic FM, on Soda Politics

March 1 Lecture to Sydney Ideas: Soda Politics: Lessons from the Food Movement, U. Sydney

March 1 ABC News radio and print interview with David Taylor, on Soda Politics

Feb 29  Interview (online) with ABC Sydney on Soda Politics

Feb 27  “At Lunch With” column in the Sydney Morning Herald: “the powerful foodie”

Feb 24  Podcast of lecture on Soda Politics at the University of Melbourne

Feb 22 Lecture at symposium at Deakin University, Melbourne (this is an mp4 file requiring a lengthy download)

Feb 19 Radio interview with Mark Colvin, ABC News (Sydney) on Soda Politics

Feb 19 Podcast interview with Colvinius, ABC News (Sydney) on Soda Politics

Oct 12 2016

WHO takes action against sugary drinks, urges taxes

The World Health Organization took two actions yesterday to encourage people to cut down on consumption of sugar-sweetened beverages.

It issued a report urging national governments to consider taxes: “Taxes on sugary drinks: Why do it?  

Governments can take a number of actions to improve availability and access to healthy foods and have a positive influence on the food people choose to consume. A major action for comprehensive programmes aimed at reducing consumption of sugars is taxation of sugary drinks. Just as taxing tobacco helps to reduce tobacco use, taxing sugary drinks can help reduce consumption of sugars.

It defines sugar drinks as products that contain added sugar, corn or fruit-juice concentrates and include carbonates, fruit drinks, sports drinks, energy and vitamin water drinks, sweetened iced tea, and lemonade.

It also took immediate action to remove sugary drinks from its Geneva headquarters

The agency explained this action:

The move signifies how seriously WHO is taking its leadership role in implementing policies to improve public health…By implementing this policy WHO is setting a positive example for Member States, other organizations and visitors…WHO vending machines, restaurants and coffee shops will continue to sell water, fizzy water, and unflavoured milks with different fat contents, teas and coffees, and beverages with non-sugar sweeteners (such as diet and zero calorie drinks). Sugar packets for use with tea and coffee will continue to be served.

These actions are getting plenty of attention.

The Guardian pointed out that:

Battle lines are being drawn in Colombia, where a consumer movement is pressing the case for a sugary drinks tax and the industry is fighting back…Last month, the Asociación Educar Consumidores – the consumer organisation which, like its Mexican equivalent, has backing from Bloomberg Philanthropies in the US – produced an educational video to be broadcast on television, warning that drinking too many sugary drinks can lead to diabetes and other diseases.

But after a complaint from Postobón, the Colombian beverage giant, the government’s regulatory agency charged with consumer protection banned any showing of the video on TV, saying it was inaccurate and could confuse the public.

Michael Bloomberg, now a global ambassador for WHO issued a statement.

A growing number of cities and countries – including Mexico – are showing that taxes on sugary drinks are effective at driving down consumption. The World Health Organization report released today can help these effective policies spread to more places around the world, and that will help save many lives.

The International Council of Beverages Associations (ICBA) issued a statement:

ICBA is disappointed that this technical committee’s report advocates the discriminatory taxation solely of certain beverages as a ‘solution’ to the very real and complex challenge of obesity. We strongly disagree with the committee’s recommendation to tax beverages, as it is an unproven idea that has not been shown to improve public health based on global experiences to date.

Healthy Food America says the soda industry has spent $30 million to fight soda taxes, just this year.

WHO has just given its blessing to soda taxes.  Will countries respond?  How much more is the soda industry willing to spend to stop taxes?

Stay tuned.

Other accounts:

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