Food Politics

by Marion Nestle
Mar 10 2013

Daily News Op-Ed: Bloomberg’s soda ‘ban’ should be only the beginning

My double-page op-ed in today’s New York Daily News:

Liberty from big soda: Why Bloomberg’s ‘ban’ should be only the beginning of a public health revolution

 

 

 

Barring any late legal surprises, Mayor Bloomberg’s 16-ounce cap on sugary sodas goes into effect on Tuesday, March 12. After that, restaurants, movie theaters, sports venues and food carts will not be permitted to sell extra-large portions of sugar-packed drinks.

Stay calm. This does not signal the end of democracy in America. This is not the nanny state gone out of control.

If we want Americans to be healthy, we are going to have to take actions like this – and many more – and do so soon. It’s long past time to tax sugar soda, crack down further on what gets sold in our schools, tackle abusive marketing practices, demand a redesign of labels – and extend the soda cap, no matter how controversial it may seem. This must be the beginning, not the end, of efforts toward a healthier America.

In short, we need a series of serious changes to make the healthy choice the easy choice. The soda size cap is a nudge in that direction. You will still be able to drink all the soda, and down all the sugar, that you want. The cap on soda size makes it just a tiny bit harder for you to do so.

That “tiny bit harder” is its point. If you have to order two sodas instead of one, maybe you won’t. If you have to add sugar to your coffee drink yourself, maybe you will only add one or two teaspoons instead of the 10 or more someone else put in there for you.

For a public health nutritionist like me, the soda size cap is a terrific idea. Unlike other foods, sodas are a unique target for intervention. They contain sugars – and sugar calories – but nothing else of nutritional value. They are candy in liquid form. Candy has a place in healthy diets, but a small one. So it should be for sodas.

It’s no surprise that people who drink large amounts of liquid candy have worse diets, are heavier, and have more health problems than those who do not. And it looks like the body doesn’t compute the calories from liquid sugars as accurately as it does for sugars in foods.

On top of that, big sizes make the problems worse. To state the obvious, larger portions have more calories. If an 8-ounce soft drink provides 100 calories, then a 16-ounce drink provides 200, a 32-ounce drink provides 400 and a 64-ounce drink provides 800.

But big sizes also have other effects. They induce people to eat and drink more than they would if given smaller portions. Big sizes confuse people into underestimating the number of calories consumed.

Most people eat whatever size is in front of them – the “default,” in public health-speak – and are content with that amount. So a reasonable goal of public health intervention is to change the default drink to a smaller size. Hence: Bloomberg’s 16-ounce size cap.

From my nutritionist’s perspective, a 16-ounce soda is still generous. Just one contains the equivalent of 12 packets of sugar. Just one provides 10% of the daily calorie needs of someone who typically eats 2,000 calories a day. Just one contains the upper limit of sugar intake that health officials recommend for an entire day. Once you down a 16-ounce soda, it’s best to stop right there.

You may find this hard to believe, but the original Coca-Cola was 6.5 ounces, smaller than any size available today. In the 1950s, Coke advertised its 16-ounce bottle as large enough to serve three.

Times have changed. The sizes of foods and drinks have expanded, and so have waistlines. This is no coincidence. On the basis of calories alone, larger portions are all you need to explain why Americans are putting on pounds.

City officials concerned about the health of their citizens, as those in New York most definitely are, want to do everything they can to prevent obesity and the illnesses that go with it. Their rationale is humanitarian, but also fiscal. Poor health is expensive for both individuals and society. You don’t believe that excessive weight is an issue? Just ask the military.

We can thank Big Soda – Coca-Cola, Pepsi and their trade association, the American Beverage Association – for the contribution of big sodas to weight gain. Soda companies have spent fortunes to create demand, to make drinking large amounts seem normal, to market sodas as essential for health and happiness and, these days, to fight Bloomberg’s soda cap and take the city to court over it.

Soda companies may make things you like to drink, but they are not social service agencies. Their job is to get you to buy more soda to satisfy the financial demands of investors. They are about business. They are not about fun or happiness or personal choice – and they certainly are not about health.

The soda industry may profess to care more about your well-being these days, but it ultimately will not do anything to promote health if doing so harms sales.

So-called “nanny-state” measures – like bans on driving while drunk, smoking in public places and, now, selling absurdly large sugary drinks – help to level the playing field. Such measures are about giving everyone an equal opportunity to live a safer and healthier life.

At the moment, it is up to you to make healthier choices, but that’s not easy in the face of relentless soda marketing. Governments have a responsibility to provide healthier environments for their citizens.

Here are some additional actions New York City should take, if only it were allowed to.

Close the loopholes. The city does not have jurisdiction over sales of sodas in convenience stores and supermarkets. The state does. Gov. Cuomo denied Mayor Bloomberg’s request to extend the size cap to those stores, not on principle but because he hadn’t thought about it. He should, right now. Let’s keep all sugary drinks to 16 ounces or less.

Fix the price differential. A 7.5-ounce can of soda costs twice as much per ounce as a two-liter bottle, and you can’t buy just one; it comes in an 8-pack. Price determines sales. If a 16-ounce soda costs a dollar, a 32-ounce soda should cost two dollars.

Tax sodas. Most people wouldn’t dream of eating candy all day, but soda companies have made it seem normal to drink sodas from morning to night. Raising the price of sodas would discourage sales, especially among young people most susceptible to marketing efforts and most vulnerable to weight gain. A one-cent tax per ounce should do the trick and raise plenty of needed revenue besides.

Remove vending machines from schools. Yes, the Beverage Association only puts “better-for-you” drinks in school vending machines, but sugar-filled sports drinks are still liquid candy. And kids should not have to pay for water in schools.

Restrict marketing of sodas to children. Soda companies market extensively to children and adolescents, especially those in low-income neighborhoods. Just look at billboards, celebrity photos on soda cans and Pepsi’s $50 million dollar deal with Beyoncé. They should not be permitted to market to kids this way. We already have restrictions on cigarette and alcohol marketing to kids. It breaks no new ground to add sodas to the list.

Don’t let SNAP (food stamp) benefits be used for sodas. Bloomberg tried this, but the federal Department of Agriculture said no. There is absolutely no reason that taxpayer-subsidized food assistance for low-income people should go toward junk with no nutritional value. He should try again.

Show full calories on the front of containers. The current way calories are tallied, in a measure called “calories-per-serving,” is confusing because the servings are unrealistically small and people don’t do the math. Soda cans already give the full calories in tiny type on the Nutrition Facts label, but I want to see the full calories in big type on the front.

Actions like these will evoke ferocious opposition from the soda industry, and it will spare no expense to make sure such things never happen. We would surely hear more and more howls of “nanny-state” from those who insist Bloomberg has led us to the brink of a public health police state. Polls say that many New Yorkers oppose the 16-ounce cap and would oppose measures like this, too.

But I can’t tell whether the opposition comes from genuine concern about limits on personal choice or because soda companies have spent millions of dollars to protect their interests and gin up histrionic, misinformed opposition.

Come Tuesday, the 16-ounce soda is the new default size in New York City. While waiting for the court decision and for politics to play out, why not give it a chance? Maybe it will help you live a healthier and longer life.

 

Mar 8 2013

Happy Birthday, Food Politics!

Food Politics is celebrating a birthday this year with the publication of a tenth anniversary edition in May.  Today is actually its eleventh birthday.  My department celebrated the occasion with a birthday cake!

Mar 7 2013

Lancet series on chronic diseases, many of them diet-related

The Lancet has just published a series of articles on non-communicable diseases (NCDs) the collective term for heart disease, type 2 diabetes, and other chronic conditions caused in large part by poor diets, lack of physical activity, or cigarettes or alcohol.

Since food politics is a big part of this discussion, these papers are worth a look.  For example, as editor Richard Horton explains in his editorial:

So where are the global conferences on NCDs, the research meetings, the task forces, the grand challenges initiated by funders and foundations? They don’t exist. We, the global health community, understand that chronic diseases are a present danger to the health of our societies. Yet we are unable to translate that understanding into real political action. We cannot quite bring ourselves to put heart disease, stroke, cancer, chronic respiratory disease, diabetes, or mental ill-health, together with their associated risk factors, on an equal footing with childhood pneumonia and diarrhoea, preventable maternal death, or epidemics of AIDS, tuberculosis, and malaria. The disconnect between the reality of people’s lives in countries and the concerns of professional and political leaders has rarely been greater.

Here are the papers in this series.  Read them and ponder.

Independent global accountability for NCDs

Robert Beaglehole, Ruth Bonita, Richard Horton

Full Text | PDF

NCDs: a challenge to sustainable human development

Helen Clark

Full Text | PDF

Embedding non-communicable diseases in the post-2015 development agenda

George Alleyne, Agnes Binagwaho, Andy Haines, Selim Jahan, Rachel Nugent, Ariella Rojhani, David Stuckler, for The Lancet NCD Action Group

Summary | Full Text | PDF

Country actions to meet UN commitments on non-communicable diseases: a stepwise approach

Ruth Bonita, Roger Magnusson, Pascal Bovet, Dong Zhao, Deborah C Malta, Robert Geneau, Il Suh, Kavumpurathu Raman Thankappan, Martin McKee, James Hospedales, Maximilian de Courten, Simon Capewell, Robert Beaglehole, on behalf of The Lancet NCD Action Group

Summary | Full Text | PDF

Inequalities in non-communicable diseases and effective responses

Mariachiara Di Cesare, Young-Ho Khang, Perviz Asaria, Tony Blakely, Melanie J Cowan, Farshad Farzadfar, Ramiro Guerrero, Nayu Ikeda, Catherine Kyobutungi, Kelias P Msyamboza, Sophal Oum, John W Lynch, Michael G Marmot, Majid Ezzati, on behalf of The Lancet NCD Action Group

Summary | Full Text | PDF

Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries

Rob Moodie, David Stuckler, Carlos Monteiro, Nick Sheron, Bruce Neal, Thaksaphon Thamarangsi, Paul Lincoln, Sally Casswell, on behalf of The Lancet NCD Action Group

Summary | Full Text | PDF

Promotion of access to essential medicines for non-communicable diseases: practical implications of the UN Political Declaration

Hans V Hogerzeil, Jonathan Liberman, Veronika J Wirtz, Sandeep P Kishore, Sakthi Selvaraj, Rachel Kiddell-Monroe, Faith N Mwangi-Powell, Tido von Schoen-Angerer

Summary | Full Text | PDF

Improving responsiveness of health systems to non-communicable diseases

Rifat Atun, Shabbar Jaffar, Sania Nishtar, Felicia M Knaul, Mauricio L Barreto, Moffat Nyirenda, Nicholas Banatvala, Peter Piot

Summary | Full Text | PDF

Mar 5 2013

Let’s Move! Celebrates its 3rd Birthday–At Walmart’s

Last week, First Lady Michelle Obama did a national tour to celebrate the third anniversary of her Let’s Move! campaign to end childhood obesity within a generation.  

As explained in the White House press release, the tour was to focus on school lunches, physical activity, and getting businesses involved—“Healthy Families, Thriving Businesses.”

To that end, she visited a Walmart in Springfield, Missouri to congratulate the company on its pledge to open 300 stores in communities with limited access to affordable healthy foods, to reduce salt and sugars in its products, to make healthier food more affordable, and to put front-of-package logos on healthier foods.

As the press release explained (and as Walmart says in its own):

Walmart is one of many businesses across the country that is making healthy changes to support their customers, because they recognize that what’s good for their customer’s health is also good for their business. Following the tour, Mrs. Obama will deliver remarks about how supporting the health of American families is also good for business, and remind consumers that it’s up to them to continue demanding healthier options.

Did this mean that the new emphasis of Let’s Move! would be on personal responsibility?  Mrs. Obama explained further in the Wall Street Journal:

Take the example of Wal-Mart. In just the past two years, the company reports that it has cut the costs to its consumers of fruits and vegetables by $2.3 billion and reduced the amount of sugar in its products by 10%. Wal-Mart has also opened 86 new stores in underserved communities and launched a labeling program that helps customers spot healthy items on the shelf.

The best reported account of this visit is by Eddie Gehman Kohan at Obamafoodorama.  She points out that this particular Walmart is not located in an underserved community.  She also did the math and calculated that the savings in the cost of fruits and vegetables work out to 16 cents per week per customer.

At this point, I thought it was time for a field trip.

I was in Ithaca, NY over the weekend and checked out its Walmart to see what its Let’s Move!-inspired actions looked like on the ground.  I particularly wanted to see how its “Great for You” labeling program was working out.   This, you may recall, identifies healthy products with this logo:

Although the labeling program was announced a year ago, I had to search hard to find any examples.  Here are a couple in the produce section.

 

 

 

 

 

 

 

 

Only a few bins of produce were marked with those labels.  There’s a tiny one in the picture below in front of some clementines from Honduras, but none of the other foods in that section had labels.

 

 

 

 

 

 

 

 

I could not find another such label anywhere else in the store.

How else was this Walmart promoting healthier eating?  Its big in-store promotion that day was right along the produce section: a large display of Oreo Mega Stuf cookies (the ones with twice the filling and twice the calories of regular Oreos).  A man was handing out free samples and dollar-off coupons.  When I picked up a package to read the label he said “Don’t do that. Treat yourself.”

The Ithaca Walmart is a quarter of a mile from Wegmans, so I did some comparison shopping.  I was surprised to find that the prices were remarkably close—about the same or only slightly higher (explaining why the Walmart price advantage is only a couple of cents a day).

But the people who shopped in Wegmans looked more affluent and healthier than Walmart shoppers.

Although the prices are similar—and the fresh foods at Wegmans are of higher quality—that Walmart is much less crowded, sparsely staffed by poorly paid employees,  and somehow makes it more comfortable for very poor people to shop there.

My conclusions:

  • Walmart makes produce available at market prices to people who don’t feel comfortable going to Wegmans.  
  • Walmart promises to open stores in low-income areas where Wegmans will not.

On this basis, does Walmart deserve this high level of White House praise and attention?

I don’t get it. 

Mar 3 2013

Food Matters: Horsemeat scandal has eaters nervous

My monthly (first Sunday) column in the San Francisco Chronicle is now out, this time on the horsemeat scandal.

Q: It makes me sick to think that anyone could eat horsemeat. I don’t see how it could get into so many foods. Tell me how I can be sure I’m not eating it.

A: From this side of the Atlantic, the discovery of horsemeat in European hamburger and frozen dinners is the most riveting of scandals, replete with DNA technology, veterinary drugs, impossible-to-trace supply chains, smuggling, organized crime and outright fraud – not to mention the usual finger-pointing, cover-ups and protestations of shock that accompany food crises.

It is easy to explain how horsemeat got into vast amounts of hamburger and prepared meals. Horses are expensive to house and feed. Something has to be done with them when they are no longer wanted for farming, transport, racing or recreation. Horsemeat is edible, even delicious to some, and costs less than beef.

Complications

In Europe, the supply chains are exceptionally complicated, involving countless companies in more than 21 countries that process, transport or sell horses or horsemeat. The complexity makes it relatively easy to use horses to smuggle people or drugs, to label horsemeat as beef or to slip it into hamburger.

This would just be a matter of economic fraud if people didn’t care whether they ate horsemeat. But some Europeans, and most Americans, care very much. Like you, many people are appalled at the idea of eating any companion animal, let alone one symbolic of the rugged West.

Beyond cultural prohibitions, there are other reasons to avoid eating meat from horses not raised for food. Horses are routinely treated with veterinary drugs, legal and not. The drug traces found in European horsemeat may be too low to cause harm, but hardly seem likely to promote human health.

How long horsemeat has been passed off as European beef is unknown, as is why officials in Ireland decided to do DNA tests on supermarket meals in the first place. Whether done as routine testing or because of a tip, the results were startling. More than one-third of the tested “beef” samples contained horsemeat. Later tests in Great Britain identified “beef” meals made entirely from horsemeat.

This, as the Guardian’s writer Felicity Lawrence wrote in her guide to the scandal, can only be “industrial scale adulteration.”

The ensuing crisis forced many food companies and retailers to recall vast numbers of products, some intended for school meals. Nestlé (no relation) recalled pasta meals, but issued assurances that such products do not leave Europe and that none of its American products contains horsemeat-laden European beef.

What to make of this? In our food studies programs at New York University, we discuss food as a marker of cultural identity. People in other nations eat horsemeat. But like you, about 80 percent of Americans are appalled at the idea of eating horsemeat and oppose slaughtering horses for food or any other reason.

Yet horsemeat used to be eaten by Americans (and still is, by some), and even more so by pets. As Malden C. Nesheim and I wrote in our book about the pet food industry, “Feed Your Pet Right,” horse slaughterhouses created pet food companies to dispose of the meat. Through the 1940s, nearly all domestic horsemeat ended up in pet food.

Under pressure from horse lovers and animal welfare advocates, pet food companies replaced horsemeat with meat from other animals. Although horsemeat is permitted in pet food, and in theory could show up in rendered byproducts and meals, no American company would knowingly use it as an explicit item in an ingredient list. One can only imagine the uproar if it did.

Inspection issues

In 2007, Congress blocked the Department of Agriculture from inspecting slaughterhouses, effectively banning their use. As unintended consequences, the 140,000 or so unwanted horses each year had to be transported to slaughterhouses in Canada or Mexico, and populations of neglected and abandoned horses increased. As a result, Congress permitted horse slaughterhouses to reopen last year, but the USDA has yet to authorize inspectors to work in them.

Could American beef be contaminated with horsemeat? We had a similar scandal in the 1950s. But if U.S. officials are testing hamburger for horsemeat DNA these days, they aren’t saying.

Because horsemeat is not produced here, it won’t be in butcher shops or supermarkets – unless the stores imported it or acquired contaminated products before the recalls, or unless the USDA assigns inspectors and allows horse slaughterhouses to reopen. Right now, without DNA testing, you can’t be sure.

You find this alarming? Short of going vegetarian, you have an option: Buy kosher meat. Jewish dietary laws prohibit horsemeat – horses are not ruminants and do not have cloven hooves – and kosher slaughterhouses are diligent about excluding forbidden animals.

This gives the horsemeat scandal one clear winner: Sales of kosher meat are booming.

Mar 1 2013

Does sugar cause diabetes? Is a calorie a calorie?

I spent a lot of time last week talking to reporters about the widely publicized study in PloS One that correlates sugar and diabetes.

The study is based on an econometric model of data food availability and diabetes prevalence in many countries.  Such data are not particularly reliable, but the authors did the best they could with what they had.  They are quite forthcoming about the limitations of their model and the data on which it is based [see addition below].

Their principal conclusion: for every 150 kcal/person/day increase in sugar availability (about one can of soda/day), diabetes prevalence increases by about 1%.

Because no other dietary, weight, or behavioral factor shows this kind of effect in their model, it is tempting to interpret the study as demonstrating that sugar is a risk factor for diabetes independent of calorie intake or body weight.

I’m not so sure.  Take a look at the summary figures and decide for yourself.

Figure 1.  Relationship between obesity and worldwide prevalence of diabetes.

Figure 1 Relationship between obesity and diabetes prevalence rates worldwide.

Despite outliers, this figure shows an obvious and strong correlation between obesity and diabetes.  Compare this to Figure 2.

Figure 2.  Relationship of sugar availability to worldwide diabetes prevalence.

Figure 2 Adjusted association of sugar availability (kcal/person/day) with diabetes prevalence (% adults 20–79 years old).

The correlation here is much less obvious.  Without statistical tests, you could just as easily draw the line straight across the graph.  The statistical significance is much weaker than that in Figure 1.

This means that these data cannot easily distinguish between several possibilities:

(a) Calories –> Obesity –> Diabetes

(b) Sugar –> Diabetes

(c) Sugar –> Calories –> Obesity –> Diabetes

While waiting for science to clarify these distinctions, the bottom line is the same for all of them.

As I explained in yesterday’s post, everyone would be healthier eating less sugar.

Addition: The authors have posted detailed comments about their methods.

Feb 28 2013

Let’s Ask Marion: What’s The Recommended Daily Allowance of Sugar?

Here’s another one of those occasional queries from Kerry Trueman.  This one, posted at Huffington, is about FDA regulations for labeling sugars.

Trueman: I’ve just begun to sink my teeth into Michael Moss’s extraordinary food industry exposé, Salt Sugar Fat: How the Food Giants Hooked Us, a book you’ve rightly lauded as a “breathtaking feat of reporting.” As Moss points out, the FDA is happy to give us guidelines on how much salt and fat to include in our daily diets, but–as a glance at any nutritional label shows–they’ve declined to make any recommendation at all about sugar.

Does this mean that:

(a) It’s OK to eat as much sugar as you like, or:

(b) There may be an unsafe level of sugar consumption, but the FDA just doesn’t have the resources to figure out what that level is, or:

(c) The FDA knows how much sugar we can eat without harming our health, but the food industry won’t let them tell us.

How is the average American supposed to interpret this absence of information?

Nestle: Whoa. Slow down. Let’s back up a minute. The FDA sets nutritional standards for food labels, but the Institute of Medicine (IOM) sets nutritional standards for dietary intake. To understand what’s happening with the FDA and food labels, we have to talk about what the IOM used to call the Recommended Dietary Allowances (RDAs) but now calls Dietary Reference Intakes (which, confusingly, include RDAs and other standards, such as Upper Limits).

In 2002, the IOM set standards for total carbohydrates–sugars and starches (which are converted to sugars in the body). In its review of the evidence, the IOM set the RDA for total carbohydrates at 130 grams a day (roughly 4 ounces) to meet the needs of the brain for fuel. This amount is much less than typically consumed by adults.

As for sugars, the IOM noted that the average intake of sugars among adolescent males was 143 grams per day, and that the heaviest users were consuming 208 grams per day–much more than the amount of total carbohydrate needed.

Since sugars are not required nutrients, the IOM could not set an RDA. And although it did not have enough evidence to set an Upper Limit, the IOM suggested that the maximum level of intake of added sugars (as opposed to those naturally present in foods) should be a whopping 25% or less of calories.

Americans typically consume around 20% of calories from added sugars. Taken at face value, the IOM suggestion made it sound as if current intake levels were just fine. The sugar industry happily viewed 25% as a recommendation, not a maximum.

Before the sugar industry got after them, many countries recommended an upper level of sugar intake at 10% of calories. That’s what the U.S. Pyramid did in 1992.

The sugar industry does not like the 10% recommendation. It means, for example, that just one of Mayor Bloomberg’s 16-ounce sodas takes care of recommended sugar intake for the day.

Robert Lustig, who is largely concerned about what too much fructose does to us, thinks that 50 grams of sugar (sucrose or HFCS) is a reasonable Upper Limit for most people. This would provide 25 grams of fructose, which the body can handle with relative ease. What’s interesting about his cut point is that it means 200 calories a day, or 10% of calories for a 2000 calorie diet. So there we are at 10% of calories again.

If the FDA wanted to be helpful, it could do two things.

1. Require companies to list added sugars under the carbohydrate category on food labels.

2. Set a DV for sugars at 50 grams.

In the meantime, everyone would be healthier eating less sugar. 

Feb 27 2013

Oxfam’s new corporate accountability initiative: Behind the Brands

Oxfam America announced a new initiative this week—an accountability project it’s calling Behind the Brands. 

Oxfam is an international relief and development organization.  It is concerned about what the top ten global food companies—Associated British Foods, Coca Cola, Danone, General Mills, Kellogg, Mars, Mondelez, Nestlé, Pepsico and Unilever—are doing about social and environmental policies to:

  • Ensure the rights of the workers and farmers who grow their ingredients
  • Protect women’s rights
  • Manage land and water use
  • Prevent climate change
  • Ensure the transparency of their supply chains
  • Ensure the transparency of their policies and operations.

Oxfam finds the Big Ten companies to rank from so-so to poor on these measures.  The overall results? 

  • None of the companies are committed to women’s rights throughout their supply chains.
  • None have adequate policies to protect local communities from land and water grabs.
  • All are overly secretive about their agricultural supply chains.
  • Few have policies in place to limit their impact on local water sources.
  • All have taken steps to reduce greenhouse gas emissions.
  • None are committed to pay a fair price to farmers (only Unilever has specific supplier guidelines).

Oxfam intends to monitor companies’ responses and to adjust scores accordingly.  It will have plenty of work to do.

Does Oxfam think companies will voluntarily take actions that might reduce their bottom lines?  Will its scorecard encourage voluntary action?  I’m not optimistic.  

The first company to respond, Associated British Foods, terms Oxfam’s charges “ridiculous.” 

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