Food Politics

by Marion Nestle
Jan 18 2013

Should sugar-sweetened beverages be regulated? NEJM readers vote yes.

As part of an interactive case study and point-counterpoint on regulation of sugar-sweetened beverages, the New England Journal of Medicine (NEJM) conducted a poll of its U.S. and international readers.  The poll elicited responses from 1290 readers from 75 countries.

Overall, 68% of respondents favored government regulation.

High as this percentage is, the average is much lower than percentages from most countries as a result of one outlier—the United States.

Only 58% of U.S. voters in the poll favored regulation.  Everywhere else in the world, the percent in favor averaged 84%.

These results reminded me of change-in-sales figures from a few years ago:

Americans have reduced soft drink consumption, causing soda companies to focus their marketing efforts overseas.  Trends like these explain Coca-Cola’s new obesity ad campaign and Pepsi’s $50 million deal with Beyoncé. 

In America these days, 58% is an impressive majority.  NEJM readers are likely to be physicians, scientists, and health and health policy professionals. I suspect we will be hearing more about this idea.  Stay tuned for this one too.

Jan 17 2013

The FTC says no to POM Wonderful’s health claims

The Federal Trade Commission (FTC) just ruled that POM Wonderful’s claims for the health benefits of its pomegranate juices and products are indeed deceptive.

The FTC also said POM cannot claim that its products do anything special for heart disease, prostate cancer, and erectile dysfunction—unless it produces convincing evidence for these claims through two randomized, controlled clinical trials.

POM

The dispute over POM’s health claims has gone on for more than two years.  The FTC says POM has not proved that drinking its juice will cheat death.

POM says it has spent $35 million on peer-reviewed research proving that the antioxidants in pomegranate products promote health.

Of course they do.  Antioxidants in all fruits and vegetables promote health.

Maybe POM should resort to the defense used by Coca-Cola against charges that Vitamin Water makes deceptive health claims.

As Stephen Colbert reports, Coca-Cola’s argues: “No consumer could reasonably be misled into thinking Vitaminwater was a healthy beverage.”

Once again: health claims are about marketing, not health.

Expect POM to take the FTC to court over this ruling.  Stay tuned.

Jan 16 2013

Coca-Cola fights obesity? Oh, please.

In case you missed all the publicity about Coca-Cola’s new ad campaign positioning the company as a force for public health, take a look at its new two-minute TV ad.

The video—how much do these things cost?—argues that the company is producing lower-calorie products in smaller sizes and promoting community activity, that all calories count, and that it’s up to you to fit Coke into your healthy active lifestyle.

The ad is an astonishing act of chutzpah, explainable only as an act of desperation to do something about the company’s declining sales in the U.S. and elsewhere.

If Coke really wanted to help prevent obesity, it would STOP:

  • Targeting its “drink more Coke” marketing to kids.
  • Targeting marketing to low-income minorities.
  • Lobbying and spending a fortune to defeat soda taxes and caps on soda sizes.
  • Fighting attempts to remove vending machines from schools.
  • Pricing drinks so the largest sizes are the best value.
  • “Bribing” health professions organizations to shut up about research linking sugar-sweetened beverages to poor diets and weight gain.
  • Pushing Coke sales in developing countries where rates of obesity and related conditions are skyrocketing.

Instead, it’s doing all these things, but not talking about them in videos.

The company is supposed to be releasing a second video tonight, explaining how to work off the “140 happy calories” in a soda by dog-walking, dancing, or laughing. If only.

I can’t wait.

Addition, January 18:  Someone who calls himself John Pemberton has gone to the trouble of presenting the 2-minute commercial with a somewhat different narrative—the real story about Coca-Cola and obesity.  If that link doesn’t work, try this one.

Jan 15 2013

Reading food and food politics

I’m also catching up on reading.

This just in:

Wenonah Hauter.  Foodopoly: The Battle Over the Future of Food and Farming in America.  The New Press, 2012.

Hauter heads up Food and Water Watch, a tough-minded advocacy group in Washington DC working to preserve and ensure a safe, accessible, and sustainable food supply.  Foodpoly is her manifesto.  She has a lot to say about the problems with food policy, food chains, the organic-industrial complex, the food safety system, factory farms, and corporate control of the food supply.  She urges: “eat and act your politics.”  I’m using it as required reading in my food advocacy course this spring at NYU.

And here are a couple of others I’ve been saving up:

Bee Wilson, Consider the Fork: A History of How We Cook and Eat, Basic Books, 2012.

I blurbed this one:

Consider the Fork is a terrific delve into the history and modern use of kitchen tools so familiar that we take them for granted and never give them a thought.  Bee Wilson places kitchen gadgets in their rich cultural context.  I, for one, will never think about spoons, measuring cupts, eggbeaters, or chopsticks in the same way again.

W.A. Bogart, Permit But Discourage: Regulating Excessive Consumption, Oxford University Press, 2011.

I blurbed this one too:

Permit But Discourage is an engagingly written examination of a hugely important question: How can laws best be used to protect individuals and societies against out-of-control consumption of such things as alcohol, junk foods, sodas, and other unhealthy indulgences, without doing more harm than good?  The book clearly and compellingly argues for a mix of laws that permit consumption but discourage excesses, and for finding that mix through trial and error.  This fascinating book is as must read for anyone who cares about promoting health as well as human rights in a market-driven economy.

Jan 14 2013

FDA issues food safety rules–at long last

I’m catching up with events that occurred while I was out of the country.  One was the release by FDA of two of its long-awaited proposals for food safety rules.

These go into the Federal Register on January 16. But they were announced on January 4, perhaps to commemorate the two-year anniversary of President Obama’s signing the Food Safety Modernization Act authorizing these rules.

The two massive sets of proposed rules, 680 and 547 pages, respectively, are:

Still to come: proposed rules for

  • Food importers
  • Preventive controls for animal feed
  • Accreditation of third-party auditors

Notice that all of these are proposals.  Terrific as it is to have them released, no breath-holding is in order.

Once the proposals appear in the Federal Register, interested parties will have 120 days to comment.  It will probably take a year for the FDA to write final rules.   For the produce standards at least, larger farms get 2 years before implementation kicks in.  Smaller farms get 3 or 4 more years to figure out how to comply.

Some farms, such as those bringing in less than $500,000 per year, are exempt.  Chalk that up to successful lobbying by small farmers.

The FDA estimates that the new rules will cost large farms about $30,000 a year, and small farms $13,000.   It says that following the rules will prevent 1.75 million cases of foodborne illness a year and save more than $1 billion in costs.

The rules for produce focus on prevention of contamination through:

  • Agricultural water
  • Biological soil amendments
  • Poor worker hygiene
  • Domesticated and wild animals
  • Equipment, tools and buildings.

All food producers will need to develop, submit, and follow a written food safety plan that includes:

  •  A hazard analysis
  • Preventive controls
  • Monitoring procedures
  • Corrective action procedures
  • Verification procedures
  • A recall plan

That’s the basic outline.  The devil is in the details and in this case there are plenty of them (I have much sympathy for whoever has to write these things).  The proposals devote hundreds of pages to definitions.  Here, for example, is FDA’s summary of its definition of farm and farm activities.  Hint: RAC = Raw Agricultural Commodity.

  • The basic purpose of farms is to produce RACs and RACs are the essential products of farms.
  • Activities that involve RACs and that farms traditionally do for the purposes of growing their own RACs, removing them from the growing areas, and preparing them for use as a food RAC, and for packing, holding and transporting them, should all be within the definition of “farm” in §§ 1.227 and 1.328.
  • Activities should be classified based in part on whether the food operated on is a RAC or a processed food, and on whether the activity transforms a RAC into a processed food.
  • Activities farms may perform on others’ RACs should appropriately be classified as   manufacturing/processing, packing, or holding in the same manner as these activities are classified off-farm when the RACs are to be distributed into commerce.
  • Manufacturing/processing, packing, or holding food– whether RACs or processed foods, from any source–for consumption on the farm should remain within the farm definition.

I include this example to illustrate what food producers are up against.  It explains why practically every group commenting on the proposals said the same things: “we are glad they are out but must reserve comment until we—and our lawyers—have a chance to go over the rules in detail.”

My guess is that we will be hearing plenty more about these reactions when they do.

In the meantime, the elephant in the room issue is funding.  The FDA’s budget is already overstressed.  How can it possibly add monitoring and enforcement responsibilities without additional staff and funding?  How can it get new resources from this Congress?

Recall: the FDA gets its funding from congressional agriculture appropriations committees, not health committees.

The FDA addresses the funding issue in a website Q and A:

G.5.  Does FDA have sufficient funding to implement the new rule?  The funding we have available through the annual budget cycle and fees impacts the number of FTEs we have and will be a factor in the way that FDA handles its significant and far-ranging activities, including the way that this legislation is implemented… Without additional funding, FDA will be challenged in implementing the legislation fully without compromising other key functions. We look forward to working with Congress and our partners to ensure that FDA is funded sufficiently to achieve our food safety and food defense goals.

Indeed.

To submit a comment:

  • Go to http://www.regulations.gov.
  • Refer to Docket No. FDA-2011-N-0920.
  • Do it by May 16.
Jan 11 2013

The Leanwashing Index: Yes!

I was unfamiliar with the Leanwashing Index, but am delighted to learn about it.  EnviroMedia launched it in 2012 to discourage advertisers from using absurdities to push products.

EnviroMedia explains the inspiration for the Index: the appearance of the word “Superfood” on Lake Superior State University’s 38th annual List of Words to be Banished.

Here’s the 2013 Leanwashing list:

  • Natural
  • Made With
  • Whole Grains
  • Light
  • 100 Calorie

Away with all of them!  (I can think of plenty more.  Send your suggestions to the site.)

Here’s a prime example:

And while we are on the subject of whole grains, you might want to take a look at Colbert’s latest “Thought for Food.”

Enjoy the weekend!

Jan 10 2013

Predictions for 2013 in food politics

For my monthly (first Sunday) Food Matters column in the San Francisco Chronicle, I devote the one in January every year to predictions.  Last year I got them all pretty much on target.  It didn’t take much genius to figure out that election-year politics would bring things to a standstill.  This year’s column was much harder to do, not least because the FDA was releasing blocked initiatives right up to the printing deadline.

 Q: I just looked at your 2012 crystal ball column. Your predictions were spot on. But what about 2013? Any possibility for good news in food politics?

A: Food issues are invariably controversial and anyone could see that nothing would get done about them during an election year. With the election over, the big question is whether and when the stalled actions will be released.

The Food and Drug Administration has already unblocked one pending decision. In December, it released the draft environmental assessment on genetically modified salmon – dated May 4, 2012. Here comes my first prediction:

The FDA will approve production of genetically modified salmon: Because these salmon are raised in Canada and Panama with safeguards against escape, the FDA finds they have no environmental impact on the United States. The decision is now open for public comment. Unless responses force the FDA to seek further delays, expect to see genetically modified salmon in production by the end of the year.

Pressures to label genetically modified foods will increase: If approval of the genetically modified salmon does nothing else, it will intensify efforts to push states and the FDA to require GM labeling.

Whatever Congress does with the farm bill will reflect no fundamental change in policy: Unwilling to stand up to Southern farm lobbies, Congress extended the worst parts of the 2008 farm bill until September. Don’t count on this Congress to do what’s most needed in 2013: restructure agricultural policy to promote health and sustainability.

The FDA will start the formal rule-making process for more effective food safety regulations: President Obama signed the Food Safety Modernization Act in January 2011. Two years later, despite the FDA’s best efforts, its regulations – held up by the White House – have just been released for public comment. Lives are at stake on this one.

The FDA will issue rules for menu labels: The Affordable Care Act of 2010 required calorie information to be posted by fast-food and chain restaurants and vending machines. The FDA’s draft applied to foods served by movie theaters, lunch wagons, bowling alleys, trains and airlines, but lobbying led the FDA to propose rules that no longer covered those venues. Will its final rules at least apply to movie theaters? Fingers crossed.

The U.S. Department of Agriculture will delay issuing nutrition standards for competitive foods: When the USDA issued nutrition standards for school meals in January 2012, the rules elicited unexpected levels of opposition. Congress intervened and forced the tomato sauce on pizza to count as a vegetable serving. The USDA, reeling, agreed to give schools greater flexibility. Still to come are nutrition standards for snacks and sodas sold in competition with school meals. Unhappy prediction: an uproar from food companies defending their “right” to sell junk foods to kids in schools and more congressional micromanagement.

The FDA will delay revising food labels: Late in 2009, the FDA began research on the understanding of food labels and listed more relevant labels as a goal in its strategic plan for 2012-16. Although the Institute of Medicine produced two reports on how to deal with front-of-package labeling and advised the FDA to allow only four items – calories, saturated and trans fat, sodium and sugars – in such labels, food companies jumped the gun. They started using Facts Up Front labels that include “good” nutrients as well as “bad.”

Will the FDA insist on labels that actually help consumers make better choices? Will it require added sugars to be listed, define “natural” or clarify rules for whole-grain claims? I’m not holding my breath.

Supplemental Nutrition Assistance Program participation will increase, but so will pressure to cut benefits: Demands on Snap – food stamps – reached record levels in 2012 and show no sign of decline. Antihunger advocates will be working hard to retain the program’s benefits, while antiobesity advocates work to transform the benefits to promote purchases of healthier foods. My dream: The groups will join forces to do both.

Sugar-sweetened beverages will continue to be the flash point for efforts to counter childhood obesity: The defeat of soda tax initiatives in Richmond and El Monte (Los Angeles County) will inspire other communities to try their own versions of soda tax and size-cap initiatives. As research increasingly links sugary drinks to poor diets and health, soda companies will find it difficult to oppose such initiatives.

Grassroots efforts will have greater impact: Because so little progress can be expected from government these days, I’m predicting bigger and noisier grassroots efforts to create systems of food production and consumption that are healthier for people and the planet. Much work needs to be done. This is the year to do it.

And a personal note: In 2013, I’m looking forward to publication of the 10th anniversary edition of “Food Politics” and, in September, my new editorial cartoon book with Rodale Press: “Eat, Drink, Vote: An Illustrated Guide to Food Politics.”

Jan 9 2013

Let’s Ask Marion: Can It Really Be Healthier To Be Overweight?

Every now and then, Kerry Trueman challenges me with a difficult question about some current topic.  Our most recent exchange, published yesterday in the Huffington Post, is about the so-called “obesity paradox” (defined below).

Trueman: There’s a brouhaha in the blogosphere over Paul Campos’ NY Times op-ed in which he claims that our current definition of what constitutes a ‘healthy weight’ is dead wrong. Campos cites a new analysis from The Journal of the American Medical Association claiming that overweight or obese individuals have a lower mortality rate than people whose weight is ‘normal.’

He speculates that our obsession with obesity is a misguided and manufactured controversy foisted on us by the multibillion dollar weight loss industry and Big Pharma. Marion, you’ve been called a lot of things over the years, but have you ever been accused of being in cahoots with Jenny Craig and Eli Lilly?

Nestle. I love it when people invoke conspiracy theories to deny that obesity raises disease risks.

Paul Campos is a lawyer. He views matters of diet and health from a legal perspective. From that viewpoint, if a statistical analysis shows little effect of obesity on mortality except among very obese people, then nobody need be concerned about weight gain except at the extreme.

If only the science of diet and health were that simple. Scientists, alas, must struggle with a number of vexing questions about such studies:

  • Does a finding of statistical significance necessarily imply clinical or biological significance?
  • Do statistical findings based on populations necessarily count for individuals?
  • Do statistical associations provide guidelines for behavior?
  • Are the methods used in statistical studies adequate to draw conclusions about behavior?

We are talking here about a huge meta-analysis of 97 studies of obesity and mortality carried out by Katherine Flegal and her colleagues at the National Center for Health Statistics.

When I read papers by excellent statisticians published in prestigious, peer-reviewed journals, I start by taking the results at face value. Then I ask critical questions about what the results might mean.

I found the figures in the paper difficult to follow so I’ve summarized the results below:

RELATIONSHIP OF WEIGHT CATEGORY TO THE RISK OF MORTALITY.

WEIGHT CATEGORY BMI RANGE MORTALITY RISK (RELIABILITY)
Normal 18.5 – 25 1.00
Overweight 25 – 30 0.94 (95% CI, 0.91-0.96)
Obesity, Grade 1 30 – 35 0.95 (95% CI, 0.88-1.01)
Obesity, Grades 2 and 3 >35 1.29 (95% CI, 1.18-1.41)

My interpretation: Compared to people with BMI’s in the normal range, those with BMI’s considered overweight or somewhat obese display no increased risk of mortality. Indeed, those in the obesity grade 1 category may have a slightly reduced risk. The study only finds an increased risk of mortality—by 29%—when the BMI exceeds 35.

My first reaction? This is not news.

Since this is a study of previous studies, we’ve seen results like this before. Flegal herself published a similar analysis in JAMA in 2005. In that paper, she presented the results in a way that is easier to visualize:

RELATIONSHIP OF BMI TO MORTALITY AT VARIOUS AGES

2013-01-08-BMI1.png

2013-01-08-BMI2.png

These earlier results show what is called a “J-shaped” curve, meaning that the risk of mortality increases at BMI’s below as well as above the normal range.

The new study is consistent with these earlier—and equally controversial—results.

But the earlier results point to some of the difficulties in interpretation.

  • What’s going on at the lower end of these curves?
  • Are mortality results skewed by people who are ill and weigh less?
  • Is BMI an adequate indicator of health status?

At the moment, there is no way to answer these questions at a level of precision that might satisfy legal thinkers.

What we do know is that obesity above the normal range sometimes—never always—raises the risk for chronic diseases like type 2 diabetes, heart disease, and others. Risk is about probability. Risk never implies legal certainty.

It seems clear that for some people—perhaps many—having a chronic disease does not cause a decrease in lifespan. Since 1970, people throughout the world have gained slightly more than ten years of life expectancy overall, but are now spending many more years living with injury, illnesses, and disabilities—conditions caused by cigarette smoking, excessive alcohol consumption, and poor diet.

With respect to overweight, this is sometimes called the “obesity paradox,” understood as the survival benefits of modest overweight and obesity for people who already have a specific medical condition.  For them, many studies—not all—show that survival is modestly better at higher weights.

The Flegal study deals only with the statistical significance of the mortality survival component of the paradox. It does not deal with issues related to the effects of obesity on quality of life.

As a result, some of my colleagues have made harsh comments about the study, calling it “a pile of rubbish.”

I wouldn’t go that far. The study is what it is—a statistical meta-analysis. It’s up to scientists and clinicians to figure out whether statistics like these have meaning in the real world.

In the real world, it doesn’t take much overweight to induce type-2 diabetes in susceptible individuals, and many people—not all—with type-2 diabetes can completely eliminate symptoms by losing a few pounds.

Campos may be willing to let his weight go to where it will and take his chances that statistics are on his side. That’s his choice.

As for me, I’d prefer to avoid weight-related illnesses for as long as I can. I’m hedging my bets and continuing to watch my weight.

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