Food Politics

That same commenter had a second question: “What’s your take on all the diet books that are out there these days?”

I’m not sure which ones you mean in particular, but it doesn’t matter. They are all pretty much the same. They promise that if you just do this one thing, weight will pour off. All of them work–for some people, for some period of time. All of them say they are easy to follow and are a breakthrough, and all provide a semblance of biological rationale (some better than others). Whatever the gimmick–low fat, low carbohydrate, high volume of fruits and vegetables, low glycemic index, whatever–all have to be based on some method to reduce calories. Calories count. That’s why it matters to eat less and move more. Diets that suggest “eat more” fruits, vegetables, and whole grains, however, do make sense. But the ones that suggest eating more fat usually don’t (because fat has more concentrated calories). Whatever the diets suggest, they are unlikely to be harmful for a few weeks.

The Robert Wood Johnson report on climbing rates of obesity awards the prize to Mississippi as the first state to reach 30% of the population as overweight. The most distressing finding: rates are rising in one-fourth of the states, with the highest rates in the south. What to do? “Make healthy choices easy choices,” says the report. Good idea: make it easier for everyone to eat less or better and to move more.

And here’s what the New York Times had to say about this.

Today’s New York Times has a front page story by Gina Kolata, who seems to make a career of taking contrary positions on commonly held ideas about health matters. This time, she takes on common understanding of type 2 diabetes. Her article appears to argue that people with type 2 diabetes do not need to worry nearly as much about high blood sugar as they do about high blood cholesterol, that they need a mountain of drugs to stay healthy, that obesity isn’t really related to this condition (genetics counts more), and that rates of type 2 diabetes are not increasing, anyway (it’s just being diagnosed more frequently). Statisticians are unlikely ever to agree on the numbers but type 2 diabetes is the best reason I can think of to follow my “eat less, move more” mantra. Type 2 diabetes is a largely preventable condition. Yes, only small percentage of overweight individuals will develop type 2 diabetes, but the probability of getting it increases with increasing body weight. And if you look at the body weights of people who have been diagnosed with type 2 diabetes, most of them–95% in some studies–are overweight. It doesn’t take much of eating less and moving more to prevent or resolve symptoms. And that works for high blood cholesterol, as well.  Doesn’t doing that seem better than being tied to a lifetime of pharmaceuticals? And what about type 2 diabetes in young children? Isn’t type 2 diabetes something that everyone ought to be trying to prevent? I wrote about these issues in an editorial in the American Journal of Public Health a couple of years ago. Read the references to it and see how they compare to the this-won’t-work attitude expressed in Gina Kolata’s article. Will her article help clear up public confusion about how to approach chronic diseases related to diet and activity levels? Do weigh in on this one.

A most unusual presidential panel on cancer prevention, sponsored by the National Cancer Institute, has just weighed in with a report asking for better policies to make it easier for people to eat more healthfully. The Washington Post views the report as taking on the food industry (also tobacco). It quotes the chair of the panel as saying that the country has a moral obligation to protect the health of Americans. Indeed it has, but it is surprising that a panel reporting to this president puts so much of the responsibility for healthful eating on the food industry. The report itself is worth reading for its strikingly candid comments–”Ineffective policies, in conjunction with limited regulation of sales and marketing in the food and beverage industry, have spawned a culture that struggles to make healthy choices – a culture in dire need of change”–and its emphasis on the need to eat less and move more (my philosophy, precisely). The committee had only three members: it’s chair, Dr. LaSalle Leffall of Howard University, Margaret Kripke (M.D. Anderson Cancer Center, University of Texas), and none other than Lance Armstrong.

A comment posted yesterday under the Label category asks whether it is possible to rank foods: “The idea that I’m trying to express is some measure that shows that 100 calories of, say, broccoli sauteed in olive oil is healthier than 100 calories of shortbread cookies or 100 calories of potato chips, even if they happend to have the same number of fat grams.”

I have philosophical as well as practical problems with this kind of approach. First, the practical: Foods contain 40 to 50 components known to be required in the human diet and hundreds more (antioxidants, for example) that are not considered essential but have effects on health. All foods except sugar–which has calories but no nutrients–have lots of different nutrients, but in different proportions. Once you get beyond soft drinks, the situation gets really complicated. Many groups have taken this on: Center for Science in the Public Interest, Hannaford supermarkets, the Australian Heart Foundation, for example. I think they are way too complicated and the cut points set up a slippery slope. If you rank foods high because they contain vitamins, all companies have to do is add vitamins to their products to make them rank higher.

Philosophically, I much prefer the “eat less, move more, eat lots of fruits and vegetables, and don’t eat too much junk food” approach. Because there are so many different nutrients to keep track of, and because foods have nutrients in different proportions, eating lots of different kinds of relatively unprocessed foods takes care of nutritional needs. Keeping junk foods (highly processed by definition) to a minimum means that you don’t have to worry about the nutritional details and can enjoy what you eat.

Thanks for asking!