Food Politics

by Marion Nestle
Nov 10 2015

Two reports: Who is Obese? How to Curb Global Sugar?

The first report is from the UK.   Fat Chance? Exploring the Evidence on Who Becomes Obese is a curious example of what happens when a sugar company (AB Sugar) partners with a health organization (2020 Health) to produce a policy document.

The report examines the role of age, gender, socioeconomic factors, the built environment, mental health and disability, sleep, bullying and child abuse, smoking, ethnicity, and religion as factors in obesity—everything except diet and activity levels.

The press release for the report gives key findings, among them:

  • Obesity rates are rising rapidly among the poor as well as other groups who experience social instability.
  • Uncertainty seems to be a significant factor for weight gain.
  • Fast food outlets near working environments have a significant impact on the BMI of men; the lack of green space has an impact on obesity rates particularly among girls.
  • Half of all people suffering with psychosis are obese.
  • Parental obesity, especially in mothers, is a far more predictive factor in childhood obesity than is ethnicity.

Its authors write:

What is particularly highlighted in recent research, though rarely explicitly stated, is that obesity rates seem to be deeply influenced by social change (not just influences within static social categories). The studies we have compiled for this review show a subtle trend that has become increasingly evident over the last decade. It is highlighted in economic mobility, rising rates of mental illness, technological habits and engagements, and rapidly shifting urban ground. Argued here, broadly speaking, is that many of these categories strongly hint to a meta-structure that remains profoundly under-researched and largely ignored. This is the structure of uncertainty, a type of habitus that influences the terms of emotional engagement between an individual and their daily life. Insidiously, it undermines health seeking behaviour by making daily decision processes cognitively intolerable and emotionally taxing.

They conclude:

…approaches to obesity that recognise and incorporate complexity might impact a host of rising health problems that affect communities across Britain. The same interventions that encourage healthy BMI may improve energy levels through metabolic process and sleeping habits, while reducing risk of mental health problems, diabetes and a range of other comorbidities not discussed in this report.

But they don’t say what those interventions might be.

Could they possibly have something to do with removing sugary drinks and foods from local environments?

For doing just that, the World Cancer Research Fund International has produced Curbing Global Sugar Consumption: Effective Food Policy Actions to Help Promote Healthy Diets & Tackle Obesity.

Examples of actions which have had these effects include school nutrition standards in Queensland, Australia; a vending machine ban in France; a front-of-package symbol that led to product reformulation in the Netherlands; soda taxes in France and Mexico; a programme targeting retail environments in New York City, USA; a programme promoting increased water consumption in schools in Hungary; school fruit and vegetable programmes in Netherlands and Norway; a healthy marketing campaign in Los Angeles County, USA and a comprehensive nutrition and health programme in France.

The first report asks us to solve problems of poverty, instability, and mental health before taking action to prevent obesity, even when actions are known to be effective.  The second calls for such actions now.

Could AB Sugar’s sponsorship possibly have something to do with this difference?

Nov 9 2015

University of Colorado returns Coca-Cola funding for Global Energy Balance Network

On Friday, the University of Colorado School of Medicine announced that it was giving back the $1 million that Coca-Cola had donated to fund the Global Energy Balance Network.

This is the group of scientists funded by Coca-Cola who were promoting activity as the best way to prevent obesity, but playing down any contribution of soft drinks and junk food to weight gain (see my post on this).

This is the fourth impressive result of the investigative report by Anahad O’Connor in the New York Times in August that revealed Coca-Cola’s funding of such initiatives.

  1. Coke’s chief executive, Muhtar Kent, disclosed that the company had spent almost $120 million since 2010 to pay for partnerships with medical and community health groups, and promised that the company would be more transparent.
  2. Coca-Cola set up a transparency website where it revealed the list of funded organizations.
  3. Coke ended its relationships with the Academy of Nutrition and Dietetics, the American Academy for Pediatrics, and the American Academy of Family Practice (or these groups pulled out—everyone seems to want to credit).
  4. Now this. Coke says it will donate the returned money to the Boys & Girls Clubs of America.

I am quoted in this story:

Marion Nestle, a professor of nutrition, food studies and public health at New York University, called the network “a front group” for Coca-Cola intended to promote the message that obesity is primarily caused by a lack of exercise, not by overconsumption of junk food.

On Friday, Dr. Nestle, the author of “Soda Politics,” said she was pleased that the university had returned the money.

“Both deserve congratulations for making a difficult but necessary decision,” said Dr. Nestle. “Let’s hope other groups also decide to do the right thing and end such financial relationships.”

Next?

Nov 6 2015

Weekend reading: Yael Raviv’s Falafel Nation

Yael Raviv.  Falafel Nation: Cuisine and the Making of National Identity in Israel.  University of Nebraska Press, 2015.

Yael Raviv is an adjunct instructor in my department at NYU and has been researching and working on this book since I have known her.

The cuisine of Israel is trendy right now, something that Raviv could not possibly have guessed when she began this project.

Although her book focuses on the years from the Zionist immigration wave beginning in 1905 (the Second Aliya) and the 1967 Six-Day War, it deals with older and more recent ways in which food affected and was affected by the complexities and contradictions of religion, ethnicity, nationalism, and subsequent waves of immigration in this country.

Raviv is not claiming that food can solve the political problems of the region, but her book demonstrates that food can help us understand them.

Nov 4 2015

Does eating eggs raise blood cholesterol levels?

The Physicans Committee for Responsible Medicine (PCRM), a group advocating against use of animals in research but for vegetarian and vegan diets, has started a campaign to restore egg-and-cholesterol recommendations to the Dietary Guidelines for Americans.

Eggs are the largest source of cholesterol in American diets.

The campaign involves billboards like this one, in six locations in Texas:

egg-facts

It also involves a new organization (truthaboutegg.org) with an interactive website on a dozen issues related to egg production and consumption.

The one that particularly caught my eye was #5.

A 2013 review suggested that high-cholesterol foods have only a modest effect on blood cholesterol. Of the 12 studies it relied on, 11 were industry-funded.

In a letter to Congressman K. Michael Conaway (Rep-TX), Dr. Neal Barnard, PCRM’s president, wrote:

This week, billboards near your Texas offices will alert you to the dangers Americans face if cholesterol warnings are removed…Eggs are the leading source of cholesterol in the American diet.  A report (which I’ve included for your review) in the autumn 2015 Good Medicine magazine finds that this recommendation may have been influenced by egg-industry-funded cholesterol research. America’s heart disease and diabetes epidemics will continue unabated if the egg industry succeeds in its efforts to get cholesterol warnings out of the guidelines.

The 2015 Dietary Guidelines Advisory Committee (DGAC) said this about dietary cholesterol.

Cholesterol. Previously, the Dietary Guidelines for Americans recommended that cholesterol intake be limited to no more than 300 mg/day. The 2015 DGAC will not bring forward this recommendation because available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol, consistent with the conclusions of the AHA/ACC report.2,35 Cholesterol is not a nutrient of concern for overconsumption.

The DGAC based its unconcern about dietary cholesterol on two references:

2.  Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S76-99. PMID: 24222015. Its conclusion:

There is insufficient evidence to determine whether lowering dietary cholesterol reduces LDL–C.

35.  Shin JY, Xun P, Nakamura Y, He K. Egg consumption in relation to risk of cardiovascular disease and diabetes: a systematic review and meta-analysis. Am J Clin Nutr. 2013;98(1):146-59. PMID: 23676423. This study, which was also independently funded, concluded:

compared with those who never consume eggs, those who eat 1 egg per day or more are 42% more likely to develop type 2 diabetes. Among diabetic patients, frequent egg consumers (ie, > 1 egg/d) are 69% more likely to have CVD comorbidity…This meta-analysis suggests that egg consumption is not associated with the risk of CVD and cardiac mortality in the general population. However, egg consumption may be associated with an increased incidence of type 2 diabetes among the general population and CVD comorbidity among diabetic patients.

Were these references based largely on studies funded by the egg industry?  If so, PCRM is correct in arguing that the question of egg consumption and blood cholesterol levels merits much closer scrutiny and analysis than it is currently receiving.

What does a study funded by the egg industry look like?  Here are two one from my recent collection:

The effect of a high-egg diet on cardiovascular risk factors in people with type 2 diabetes: the Diabetes and Egg (DIABEGG) study—a 3-mo randomized controlled trial, by Nicholas R Fuller, Ian D Caterson, Amanda Sainsbury, Gareth Denyer, Mackenzie Fong, James Gerofi, Katherine Baqleh, Kathryn H Williams, Namson S Lau, and Tania P Markovic.  Am J Clin Nutr 2015; 101:705-713.

  • Conclusion: High egg consumption did not have an adverse effect on the lipid profile of people with T2D [type 2 diabetes] in the context of increased MUFA [monounsaturated fatty acid] and PUFA [polyunsaturated fatty acid] consumption. This study suggests that a high-egg diet can be included safely as part of the dietary management of T2D, and it may provide greater satiety.
  • Sponsor: Australian Egg Corporation

Dietary cholesterol and cardiovascular disease: a systematic review and meta-analysis. Berger, S., Raman, G., Vishwanathan, R., Jacques, P.F., Johnson, E.J., 2015. Am J Clin Nutr ajcn100305. doi:10.3945/ajcn.114.100305.  Am J Clin Nutr August 2015
vol. 102 no. 2 276-294

  • Conclusion: Reviewed studies were heterogeneous and lacked the methodologic rigor to draw any conclusions regarding the effects of dietary cholesterol on CVD risk.  [Implication: suggestions that eggs might raise cardiovascular risk are unwarranted]
  • Sponsor: Supported by USDA agreement 1950-51000-073 and the American Egg Board, Egg Nutrition Center.  The funders did not have a role in the study selection, quality assessment, data synthesis, or manuscript preparation.
Nov 3 2015

Food-Navigator-USA’s roundup of articles on bakery and snack trends

Snacks are trending.  As Food-Navigator-USA’s analysts see it, “there are new opportunities in gluten-free, ethnic breads and gourmet bakery items, while snack makers are tapping into consumer demand for ancient grains and seeds, plant-based proteins, and bean, pea and lentil-based ingredients….Americans are increasingly abandoning three square meals a day for serial snacking.”

Nov 2 2015

WHO clarifies meat-and-cancer report

The World Health Organization has issued a statement of clarification of the significance of its International Agency for Research on Cancer (IARC) report on the increased risk for colorectal cancer from eating processed and red meat (see my post on this).

The latest IARC review does not ask people to stop eating processed meats but indicates that reducing consumption of these products can reduce the risk of colorectal cancer.

Got that?

The New York Times explains the meaning of this increased risk.  To understand it, you need to know the risk of colorectal cancer among people who never eat processed or red meat.

The main problem with the public health messages put out by the W.H.O. is that the agency did a poor job of explaining what its risk-ranking system really means…it’s based only on the strength of the overall research, not on the actual danger of a specific product…Even the most strident anti-meat crusader knows that eating bacon is not as risky as smoking or asbestos exposure. Smoking raises a person’s lifetime risk of developing lung cancer by a staggering 2,500 percent. Meanwhile, two daily strips of bacon, based on the associations identified by the W.H.O., would translate to about a 6 percent lifetime risk for colon cancer, up from the 5 percent risk for people who don’t enjoy bacon or other processed meats.

My interpretation: Can processed and red meats be included in healthful diets?  Yes, of course.  But for many reasons, people and the planet would be healthier if these foods were consumed in smaller portions, less often.

Oct 30 2015

Clean Water rules: Will Congress just say no?

Today’s Politico Morning Agriculture report has this brief note:

SENATE TO TAKE UP WOTUS FIX: The Clean Water Rule’s days could be numbered. The Senate could as early as next week take up a bill from Sen. John Barrasso to require the EPA to withdraw its Clean Water Rule and re-draft the measure with the help of states and other affected groups…The bill has the backing of 46 senators…Given that the House has already passed a similar measure, a “yea” vote from the Senate could signal a quick demise for the rule.

This sent me to try to understand what the Clean Water Rule is about and why so many groups want to get rid of it.

In June, the Environmental Protection Agency (EPA) published a final rule defining the Waters of the United States (WOTUS) covered by its regulations. This, as far as I can tell, extends regulatory protection beyond large streams to the small streams that flow into them.

On its website devoted to this rule, the EPA says “The rule ensures that waters protected under the Clean Water Act are more precisely defined, more predictably determined, and easier for businesses and industry to understand.”

Maybe so, but I’m having a hard time understanding how the new rules would require agricultural producers to clean up the waste they discharge into local streams.

The agricultural implications are particularly contentious—think of the huge volumes of animal waste delivered to streams by Confined Animal Feeding Operations (CAFOs) or of pesticides and herbicides running off from mega-farms.

But the EPA insists that there are no changes to the current rules that exempt agriculture from having to protect local water supplies.

Agricultural producers evidently do not believe this. They have done everything possible to block the rules and apparently will succeed in this effort.

The strength of the opposition—farm organizations, golf course groups, municipalities—suggests that somewhere in these rules must be restrictions on discharges into water supplies.    If so, the Clean Water rules deserve plenty of support.

I wish I could find a clear, straightforward explanation of what the WOTUS rules would do.  If the rules are overturned, which it looks like they will be, I’m wondering if this is because only lobbyists can understand the details and implications.

This document from the American Water Works Association has useful diagrams illustrating which streams are affected by the EPA’s rules.

Are any groups supporting the WOTUS rules?  If so, they are very quiet.

Addition

The National Resources Defense Council (NRDC)’s position paper on the failings of the Clean Water Rule

Oct 29 2015

Another 5 industry-funded nutrition studies with results favorable to the sponsor. The score: 75:6

I’ve managed to collect another five industry-sponsored studies with results that the funder must love, bringing the total to 75 since mid-March.  As always, please keep your eye out for industry-funded studies that are contrary to the sponsor’s interests.  I’ve only managed to find 6 so far.

Dairy products consumption and metabolic syndrome in adults: systematic review and meta-analysis of observational studiesGuo-Chong Chen, Ignatius M. Y. Szeto, Li-Hua Chen, Shu-Fen Han, Yan-Jie Li, Rina van Hekezen, and Li-Qiang Qin.. Science Reports. 2015; 5: 14606. Published online 2015 Sep 29. doi:  10.1038/srep14606

  • Conclusions: Higher dairy consumption significantly reduced MetS [metabolic syndrome] by 17% in the cross-sectional/case-control studies…and by 14%…in cohort studies….Our findings suggest an inverse dose-response relationship between dairy consumption and risk of MetS.
  • Funding: This study was supported by Yili Innovation Center, Inner Mongolia Yili Industrial Group Co., Ltd. The funding source had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.
  • Comment: The Yili Group is a privately owned Chinese company headquartered in Hohhot, Inner Mongolia, engaged in processing and manufacturing milk products, including ice-cream, powdered milk, milk tea powder, sterilized milk and fresh milk.

Energy compensation following consumption of sugar‑reduced products: a randomized controlled trial.  Oonagh Markey · Julia Le Jeune · Julie A. Lovegrove  Eur J Nutr First online: 09 September 2015 DOI 10.1007/s00394-015-1028-5.

  • Conclusion: Consumption of sugar-reduced products, as part of a blinded dietary exchange for an 8-week period, resulted in a significant reduction in sugar intake. Body weight did not change significantly, which we propose was due to energy compensation.
  • Conflict of interest. This work was supported by Sugar Nutrition UK; however, the sponsor had no input into the study hypothesis and design, data analysis and interpretation.
  • Comment: It is in the interest of sugar trade associations to demonstrate that eating less sugar has no effect on body weight. 

Trends in Sugar-Sweetened Beverages: Are Public Health and the Market Aligned or in Conflict?  William Shrapnel.  Nutrients 2015, 7(9), 8189-8198; doi:10.3390/nu7095390.

  • Conclusions: drinks containing non-nutritive sweeteners enable the “small change” in health behaviour that individuals are willing to consider…Among those who currently consume carbonated beverages, the “small change” involved in moving from a sugar-sweetened beverage to a similar sugar-free beverage appears to be one that some consumers are willing to accept.  Facilitating this change may be a more productive public health strategy than advocacy for taxation of sugar-sweetened beverages.
  • Author disclosure: William Shrapnel was paid a consultancy fee by the Australian Beverage Council Ltd. to prepare this paper…The authors declare no conflict of interest.

Dietary Intervention for Overweight and Obese Adults: Comparison of Low-Carbohydrate and Low-Fat Diets. A Meta-Analysis.  Jonathan Sackner-Bernstein, David Kanter,  Sanjay Kaul.  PLoS One, October 20, 2015.  DOI: 10.1371/journal.pone.0139817.

  • Conclusions: In conclusion, this trial-level meta-analysis of 17 randomized controlled trials shows that both LoCHO and LoFAT diets are effective in reducing weight. However, LoCHO diet appears to achieve greater weight loss and reduction in predicted risk of ASCVD [atherosclerotic cardiovascular disease] events compared with LoFAT diet. On the basis of these results, we suggest that dietary recommendations for weight loss should be revisited to consider this additional evidence of the benefits of LoCHO diets.
  • Funding: The study was supported by Atkins Nutritionals….Jonathan Sackner-Bernstein owns and may receive compensation from ExVivos, LLC. ExVivos, LLC provided payment to authors (DK and SK) for their role as contractors to ExVivos, LLC.
  • Comment: ExVivos, LLC has one employee—Jonathan Sackner-Bernstein.  Atkins Nutritionals markets a low-carbohydrate diet plan.

Breast-feeding and postpartum maternal weight trajectories.  Laura Mullaney, Amy C O’Higgins, Shona Cawley, Rachel Kennedy, Daniel McCartney and Michael J Turner.

  • Conclusions: There are many reasons why breast-feeding should be strongly promoted but we found no evidence to support postpartum weight management as an advantage of breast-feeding.
  • Financial support: This project was supported by the UCD Centre for Human Reproduction and was partially funded by an unlimited educational grant from Danone Nutricia Early Life Nutrition for the first author.
  • Comment: Food companies often provide scholarships for doctoral research.  This particular arrangement raises some tough questions: Should dissertation research supervisors allow their students to accept such funding?  Or does accepting such an award run the risk of compromising the integrity of the student’s work?
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