by Marion Nestle

Currently browsing posts about: Food-policy

Nov 2 2023

Toward a national campaign to prevent weight-related chronic disease

Jerry Mande, a co-founder of Nourish Science wrote me to urge support for a national action plan to reduce obesity—and the chronic diseases for which it raises risks. (Note: he also has an op-ed in The Hill on NIH research and leadership needs).

Here is what we should do. It’s time for a new federal nutrition goal. For decades it’s been some variation of “access to healthier options and nutrition information.” Jim Jones [the new head of food and nutrition at FDA] used that last week in his vision for the new human foods program. It’s in USDA FNS’s mission too. The WaPo reporting on life expectancy, fatty liver disease, & Lunchables in school meals reveals that goal has failed and needs to be replaced.

The goal should be updated to: ensuring that every child reaches age 18 at a healthy weight and in good metabolic health. Cory Booker proposed making it the U.S. goal in his attached letter to Susan Rice on the WHC [White House Conference]. It’s part of the Nourish Science vision.

It’s doable.  USDA has the necessary power, reach, and resources. Over half of infants are on WIC, 1/3 of children in CACFP [Child and Adult Care Feeding Program], virtually all in school meals, and almost ½ of SNAP recipients are under 18. If we leveraged those programs to achieve the new goal and with FDA’s & CDC’s help, we could make substantial progress. For example, USDA was able to raise school meal HEI [Healthy Eating Index] scores from failing U.S. average of 58 to an acceptable 82 in just three years.

We have a successful blueprint in FDA regulation of tobacco. When we began our FDA investigation in 1993 1/3 of adults and ¼ of kids smoked cigarettes. Today we have a $700M FDA tobacco center and 11% of adults and only 2% of high school students smoke cigarettes.

We should set the new goal in the upcoming Farm Bill. We should change USDA’s name to the U.S. Department of Food and Agriculture and state the new goal.

The only needed ingredient to make this happen is an effective federal nutrition champion. That’s how tobacco happened.

I’m optimistic. We can do this.

I like the vision.  I’m glad he’s optimistic.  Plenty of work to do to get this on the agenda.

Some background

Jul 21 2023

Why ultra-processed foods matter: the state of world hunger

The Food and Agriculture Organization of the U.N. released its annual State of Food Security and Nutrition in the World report last week.  Its conclusions are sobering.

Global hunger is still far above pre-pandemic levels. It is estimated that between 690 and 783 million people in the world faced hunger in 2022. This is 122 million more people than before the COVID-19 pandemic. Nonetheless, the increase in global hunger observed in the last two years has stalled and, in 2022, there were about 3.8 million fewer people suffering from hunger than in 2021. The economic recovery from the pandemic has contributed to this, but there is no doubt that the modest progress has been undermined by rising food and energy prices magnified by the war inUkraine. There is no room for complacency, though, as hunger is still on the rise throughout Africa, Western Asia and the Caribbean.

Ultra-processed foods are a critical part of this story.  The word “processed” comes up 264 times in this report; “highly processed” comes up 99 times .  Some examples:

  • Healthy diets are essential for achieving food security goals and improving nutritional outcomes. A healthy diet…is based on a wide range of unprocessed or minimally processed foods, balanced across food groups, while it restricts the consumption of highly processed foods and drink products…Eating a healthy diet throughout the life cycle is critical for preventing all forms of malnutrition, including child stunting and wasting, micronutrient deficiencies and overweight or obesity. It also helps reduce the risk of non-communicable diseases (NCDs) such as cardiovascular diseases, diabetes and certain types of cancer.
  • The unfinished agendas to reduce stunting, wasting and micronutrient deficiency, along with rising overweight and obesity, represent the current challenge to address multiple forms of malnutrition. Malnutrition in all its forms is related to poor diets, the rise of low-cost
    nutrient-poor foods and the increasing availability of highly processed foods in rural areas.
  • Supply-side factors, including globalized technology in food production, transportation and marketing, coupled with an increase in demand for readily available foods, have contributed to a substantial expansion of supermarkets, hypermarkets, food deliveries and other convenience retailers. However, these are also associated with increased supply and spread of energy-dense and highly processed foods.
  • However, urbanization has also contributed to the spread and consumption of processed and highly processed foods, which are increasingly cheap, readily available and marketed, with private sector small and medium enterprises (SMEs) and larger companies often setting the nutrition landscape. Cost comparisons of individual food items and/or food groups from existing studies indicate that the cost of nutritious foods – such as fruits, vegetables and animal source foods – is typically higher than the cost of energy-dense foods high in fats, sugars and/or salt, and of staple foods, oils and sugars.
  • The dynamics of supply and demand for processed foods, however, are complex. There has been a surge on the supply side, with small and medium enterprises and large private companies alike making massive aggregate investments in all types of processed foods (from minimally to highly processed) in response to demand. At the same time, aggressive marketing and relatively low pricing – and even interference in policies to curb consumption of highly processed foods and sugar-sweetened beverages – are driving up consumption.

The report emphasizes the importance of food processing in contributing to poor diets and health.

What is to be done?  From the Brief summary:

Leveraging connectivity across the rural–urban continuum will require adequate governance mechanisms and institutions to coordinate coherent investment beyond sectoral and administrative boundaries. To this end, subnational governments can play a key role in designing and implementing policies beyond the traditional top-down approach. Approaches to agrifood systems governance should ensure policy coherence among local, regional and national settings through the engagement of relevant agrifood systems stakeholders at all levels.

I read this as saying what’s need is community-based, bottom up approaches at the local level.  That’s a great place to start.  Go for it.

Resources

 

Jan 27 2023

Weekend reading: Lobbying

The Access to Nutrition Initiative (ATNI) published a report, Spotlight on Lobbying 2022 just in time for Christmas.  I am just getting to it.

ATNI has been commissioned to benchmark the world’s 25 largest F&B companies’ lobbying-related commitments, management systems, and disclosure against the Responsible Lobbying Framework (RLF). The RLF was developed to help organizations adopt corporate practices that ensure their lobbying activities are legitimate, transparent, consistent, and accountable, while providing the opportunity for other, more resource-constrained groups, to lobby in the public
interest.

Note that this report focuses on corporate promises and internal practices.  It does not evaluate what the companies are actually doing to influence nutrition policy.

The results?  No surprise, “current practice is far from the standard set in the RLF.”

Of course it is.  Why would companies want to stop lobbying when it is so effective in protecting their profits.

The report mentions the major issues:

  • Taxes on unhealthy foods
  • Marketing restrictions, particularly to children
  • Mandatory front-of-package labels
  • Food-based (rather than nutrient-based) dietary guidelines.

I hope its next lobbying report will document how these companies are fighting every one of these public health initiatives.

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Jun 21 2022

The UK’s Government Food Strategy: no there there?

The UK government has just published its long-awaited food strategy to almost universal disappointment.

But first, some background. Nearly a year ago, I wrote about the UK’s strategy proposals.  These had been commissioned from Henry Dimbleby, a restaurateur with a deep interest in food policy (the British version of Jose Andres?).

To summarize what I said in July 2021.

Henry Dimbleby described the UK’s National Food Strategy as  a “bit of a labour of love.”  It came a slide deck of 175 items.

A separate document. summarizes the report’s 14 recommendations.  Most of the recommendations dealt with school feeding and feeding programs for the poor.  Others:

Recommendation 1. Introduce a sugar and salt reformulation tax.  This came with a separate report on the impact of such a tax; it recommended using revenues to help get fresh fruit and vegetables to low income families.

Recommendation 11. Invest £1 billion in innovation to create a better food system.

Recommendation 13. Strengthen government procurement rules to ensure that taxpayer money is spent on healthy and sustainable food.

So, does the strategy do any of these things?  I have to confess finding the report unreadable.  It is extremely wordy and imprecise, talks a lot about objectives, but says almost nothing specific.  Here is just one example:

The strategy comes at a time of significant increases in food prices, largely because of energy prices and exacerbated by events in Ukraine, which is very challenging for people across the country. We are engaging closely with the food industry to understand price impacts and any mitigating measures, including through our Food Industry Resilience Forum and UK Agricultural Market Monitoring Group. We are also working closely with third sector organisations to understand challenges related to food access.

One section gives action items (I have edited these for clarity):

  • Keep producing domestic food at current levels
  • Promote job training for the agri-food industry.
  • Reduce childhood obesity by half by 2030; reduce diet-related disease; increase healthier food
  • Reduce greenhouse gas (GHG) emissions and the environmental impacts of the food system
  • Export £1 trillion of food annually by 2030
  • Maintain high standards for food consumed in the UK

How?  It doesn’t really say.  The one action item I could locate is to create a Food Data Transparency Partnership.

The partnership will champion consumer interests, providing people with the information they need to make more sustainable, ethical, and healthier food choices, and incentivise industry to produce healthier and more ethical and sustainable food….This partnership will join up with existing work across government to promote healthier food choices, so that government can speak with one voice to industry. It will also support further measures to strengthen incentives to reformulate food, promote healthier food and turn the trend on the overconsumption of calories to tackle obesity.

Unsurprisingly, reactions have been fierce: not a strategy, disappointing, nothing concrete about obesity , health, or reducing meat as a means to address climate change.  If those things are there, I couldn’t find them.

I also couldn’t find The Guardian’s most amusing criticism of the report:

Among its few policy proposals are the suggestion there could be more fish farming, which is environmentally controversial, and an increase in the use of “responsibly sourced wild venison”.

Is that in the report?  I can’t find any reference to venison or deer, however sourced.

Other critiques in The Guardian are here and here.

This is a lost opportunity, and a big one.  Disappointing, indeed.

May 10 2022

Exciting news: White House Conference on Hunger, Nutrition, and Health

On May 4, I was sent this press release from Tufts University : White House Announces Historic Conference on Hunger, Nutrition, and Health.

Today, the Biden-Harris administration announced that it will hold a historic White House Conference on Hunger, Nutrition, and Health this September…This will require bringing together diverse stakeholders, and raising the voices of people with lived experiences in food and nutrition insecurity, hunger, and diet-related disease…

To inform and help achieve these goals…[we]are announcing the formation of the Task Force on Hunger, Nutrition, and Health (Task Force), along with an accompanying Strategy Group on Hunger, Nutrition, and Health to advise the Task Force.

The Task Force brings together a diverse, non-partisan group of stakeholders to inform the goals of the White House Conference. This effort is not organized or endorsed by the White House, but represents an independent effort to convene voices from across the nation to help solve the issues at the heart of the Conference’s focus.

The official White House announcment makes clear that this conference is about both food insecurity and dietary determinants of chronic disease and COVID risk.

Millions of Americans struggle with hunger. Millions more struggle with diet-related diseases—like heart disease and diabetes—which are some of the leading causes of death and disability in the U.S.

The toll of hunger and these diseases is not distributed equally, disproportionately impacting underserved communities, including Black, Hispanic, and Native Americans, low-income families, and rural Americans.

This is exciting news.  As I wrote in a previous post, if you are old enought or up on the history of US nutrition policy, you might remember the 1969 White House Conference on Food, Nutrition, and Health.  This led to the creation and strengthening of many nutrition programs, SNAP among them.

Tufts held a 50th anniversary conference at which I spoke (videos of the talks are here–I was on Panel 3 starting at about 17 minutes in).

And now for the questions.

Mine is this: What will be the balance between the conference focus on food insecurity (not controversial except for the cost) and the greatly needed fbut highly controversial focus on poor diets and their consequences for chronic disease and COVID risk?

Food safety lawyer Bill Marler asks: What about food safety? 

Let this sink in: The CDC estimates 48 million people get sick, 128,000 are hospitalized, and 3,000 die from foodborne diseases each year in the United States.  It is not that I do not think a Conference on Hunger, Nutrition, and Health is important and necessary, but could ya throw a bone to those sickened by foodborne illnesses?

E&E News notes: Biden nutrition conference may fire up climate debate on meat

Of all the food and agriculture interests bound to be represented in the Biden administration’s discussions, meat — and especially beef — may have the biggest messaging challenge, extolling its value in the diet against charges that Americans already eat too much and that raising and sending livestock to market contributes to climate change.

“We look forward to being a part of this important conversation and sharing the science-based, data-driven research regarding the immense environmental and nutritional benefits from cattle and beef production,” the National Cattlemen’s Beef Association, a producers’ trade group, told E&E News.

I suspect we will have many opportunities to weigh in on this.

I, for one, will be watching the progress on this conference with great interest.  Stay tuned.

Resources

Apr 5 2022

Good news: Another White House Conference on Food

If you are plenty old, or up on your history of US nutrition policy, you might remember the 1969 White House Conference on Food, Nutrition, and Health.

Tufts held a 50th anniversary conference at which I spoke (videos of the talks are here–I was on Panel 3 starting at about 17 minutes in).

In early December 1969, President Richard M. Nixon convened the first and only White House Conference on Food, Nutrition and Health to “put an end to hunger in America for all time” and improve the nutritional well-being of all Americans at a time when malnutrition was of urgent national concern. The agenda of the Conference was to draft recommendations that could be implemented by a bipartisan coalition into national nutrition policy.

The conference was notable for Nixon’s amazing speech kicking off the conference.

We see, then, that the problem of hunger and malnutrition is, really, two separate problems. One is to insure that everyone is able to obtain an adequate diet. The second is to insure that people actually are properly fed, where they have the ability to obtain the adequate diet.

On the one hand, we are dealing with problems of income distribution. On the other hand, with problems of education, habit, taste, behavior, personal preferences-the whole complex of things that lead people to act the way they do, to make the choices they do.

Look at what Nixon was proposing:

For the first time–Mr. Moynihan [Counsellor to the President] please notice–for the first time, this new family assistance plan would give every American family a basic income, wherever in America that family may live. For the first time, it would put cash into the hands of families because they are poor, rather than because they fit certain categories. When enacted, this measure alone will either supplement the incomes or provide the basis for the incomes of 25 million American men, women, and children.

The conference was also notable for its hundreds of recommendations—among them, free food stamps, cash income supports, transfer of food assistance out of the USDA.  We didn’t get the Universal Basic Income but we did get food stamps (now SNAP), school meals,and other useful policies.

The Tufts program kicked off demands for another White House Conference, and it looks like we may actually get that.

Congress allotted $2.5 million for a White House Conference on Food, Nutrition, Health, and Hunger in the FY22 omnibus spending package (see page 112), as part of efforts to end hunger.

The conference should be developed using a whole-of-government approach- in partnership with the Executive Office of the President, the Department of Agriculture, and other Federal agencies-and in consultation with State, territories, local, and Tribal officials, and a diverse group of interested parties from across the country, including anti-hunger, nutrition, and health experts; the private sector; and people with lived experience of hunger and nutrition insecurity. The conference should examine why hunger and nutrition insecurity persist and how they affect health, including their role in the high prevalence of chronic disease. It should also review existing and crossdepartmental strategies and consider new approaches to improve health by eliminating hunger, reducing the prevalence of chronic disease, and improving access to and consumption of nutritious foods in accordance with Dietary
Guidelines for Americans.

The conference was called for in bills S. 3064 sponsored by Senator Cory Booker (D, NJ) and Mike Braun (R, IN) and H.R. 5724 sponsored by House Rules Chair Jim McGovern (D, MA) and Jackie Walorski (R, IN).

HHS is to work with other federal agencies to “report initial findings” to the Hill about conference plans probably by late July.

This is great news.  Can’t wait to see how this develops.

Feb 23 2022

The plight of small dairy farmers: a difficult dilemma

Lorraine Lewandrowski, a dairy farmer and lawyer who works with small dairies in Herkimer County, NY, is a frequent correspondent.  I am always happy to hear from her because I learn a lot from her and respect her knowledge about small dairies and passion for doing something to help them.  With her permission, here is what she wrote me.

Is there really any hope for the region’s dairy farmers for the future?  It seems that each day we read of NYC officials condemning us and the food we produce, fresh milk, yogurt, soft cheeses, hard cheeses as “ruining the planet” and “bad for health.”  With Mayor Adams having literally  called for a shut down of NY’s dairy farms when he was Brooklyn Borough President, and now calls for VEGAN food as “saving the planet,” why should many of us even go on?

I am working with farmers who are considering suicide, young farmers who tried to farm, but are now locked into a lifetime of debt to pay off the failed farm, and this now….the steady stream of hate directed at us emanating from the city.  Speakers who talk  only “plant based” while trashing all animal ag without any nuance.

Should I just plain tell the people who struggle to live up here on the millions of acres of Upstate grasslands to forget it. Sell it out and go work somewhere.  Or, if you are working a second job to support the farmland taxes as so many do, just sell the land for sprawl or move to another state as several farmers I know have done.

Is it even worth it to try when I don’t see even one urban group standing up for the regional dairy farms?  I’m a lawyer for scores of farmers and hearing the same message from all of them. Why go on?  Personally, I will NEVER work to organize trailers of free milk into NYC again.  Our reward for trying to feed people was a resounding slap in the face from the City and those urban food groups who I had thought supported us upstate.

Lorraine sent the same message to Nevin Cohen, Director of the CUNY Urban Food Policy Institute at the CUNY School of Public Health.  His response to her is also worth reading (also reproduced with permission):

Thanks so much for writing about the challenges facing dairy farmers in NYS. As the descendent of a Catskill dairy farmer – my grandfather owned a small dairy farm in White Lake, NY, and my dad milked cows until he left home for the Army – I empathize with the struggles of today’s dairy farmers.

New York’s farmers, and other farmers throughout the region, have tried to remain profitable in the face of competition from agribusiness, insufficient transportation, processing, and distribution infrastructure, and federal policies that have essentially subsidized large producers. This is particularly true for dairy, a sector that is facing overproduction nationally, consolidation by large corporations operating massive feedlots, and outdated federal policies like the Federal Milk Marketing Order not providing support for small dairies. I understand the enormous financial and emotional strain this places on farmers, and why so many choose to sell their land.

In my opinion, though, the battle is with big ag and USDA, not vegans. Corporate power and an inadequate federal response, combined with development pressures within the region, are far more to blame for falling profits and the pressure farmers face to sell their land than movements to encourage people to eat more fruits and vegetables. Eric Adams’ rhetoric about veganism may appeal to some (though likely an even smaller number since he was “caught” enjoying a fish dinner the other week), but it isn’t the most important factor driving the drop in US milk consumption or over-production by the massive CAFOs out west. A recent USDA study, for example, found that the growth in nut and soy “milks” over the past decades has been much smaller than the decrease in milk consumption. The perceived health halo around non-milk beverages may drive some consumers but other factors, including competition from beverage manufacturers and demographic changes, are at play.

Dairy farmers in the Catskill provide enormous benefits to New York City and the region, not the least of which is protecting our unfiltered drinking water supply from development and providing high quality fresh, local food. We clearly need to focus more on policies to make dairy farming profitable and to make the point that regenerative agriculture with livestock and produce is healthy and resilient. I would be interested in your thoughts about Sen. Gillibrand’s legislation to require changes to the federal milk marketing order, or whether you have other ideas for policy change. The CUNY Urban Food Policy Institute has monthly forums to address important issues like this. We would be interested in hosting a panel to raise awareness of the obstacles farmers face and identify policies that NYC groups can advocate for.

Lorraine Lewandrowski’s response to Nevin Cohen:

In 1939, it was possible to organize upstate dairy farmers to fight the big-3 milk companies that had a stranglehold on the NYC milk market. Today the battle is in Washington and also against multinational companies like Danone, which just last summer terminated its contracts with organic dairy farmers throughout the NY region…Today, Mayor Adams, talks veganism.

In his Daily News Op Ed two years ago, he called for a shut down of our state’s dairy farms, citing a farmer in CA who plowed up the pastures to plant almond groves.  He urged us to “go plant based.”   Over time, I have come to recoil from the word, “VEGAN.”  Vegans have called my office telling my secretary that my throat should be slit.  At the last in-person conference that a group of us farmers attended, vegans defaced and trashed our table, leaving photos of almond milk plastered on our handouts.  It’s even acceptable for leadership to simply call for death to our farms.  A new member of the NYS Senate Agriculture Committee, Jabari Brisport, led a rally in the City calling for Death to Dairy.  No one says a word and he gets a coveted spot on the Senate Ag Committee.

Senator Hinchey tried to talk “equity” to Mayor Adams last week concerning the watershed farmers, but I don’t think he grasped what she was saying when he said he would direct his departments to look at purchasing more “healthy” food from Upstate.  Is one person the arbiter now?

Lastly, Nevin, as to your question on Senator Gillibrand.  For years, farmers have asked for hearings on the milk price formula, but it never happened.  We are at the point where you can drive for miles up here and see nothing but emptied out farms, a bleak landscape.   There will likely be a new look at the formula. Secretary Vilsack has stated that the farm groups need to come up with a unified proposal.  The small scale farms of the Northeast generally feel that the proposal will be crafted for the larger farms of other regions, as we see now with environmental incentives (digesters for the big guys).  But, we are doing our best to input.

My comment on this exchange:

I too am concerned about the plight of upstate New York dairy farmers (and small dairies in general) and about Danone’s abandonment of them.  But when it comes to vegans, I’m with Nevin Cohen: “the battle is with big ag and USDA, not vegans.”

Vegan and vegetarian diets are healthy and I’m all for them if that’s what people want to do.  Personally, I like and eat dairy foods and think they have a place in healthy diets.  I also think small dairies have a place in healthy environments and that it’s the government’s role to make sure they survive in the face of Big Dairy and its discontents.

No question, dairying can be done in ways that are better for cows and better for the environment.  That’s where we need to focus—on policies that will allow farmers to use better practices and to make a living doing so.

I thank Lorraine and Nevin for raising these issues.  I hope this conversation stimulates serious thinking about how policies can best promote healthful diets and protect the environment.

Feb 1 2022

At last some love for nutrition

Last week was a busy time for high-level thinking about nutrition.

I’ll start with this from Chef José Andrés.

For the rest, I am indebted to Politico Morning Ag for gathering all this in one place.

Nutrition research: Last week, Sens. Cory Booker (D-N.J.) and John Cornyn (R-Texas) appeared at an event focused on “sustainable nutrition science” hosted by the Union of Concerned Scientists and Tufts University’s Friedman School of Nutrition Science and Policy.  The are sponsors of the Food and Nutrition Education in Schools Act.  I watched Booker’s remarkably inspiring talk and wish I could find a video or transcript of it.

Booker held hearings on nutrition last year.  I have a transcript of his opening remarks.  Here is an excerpt:

Now let’s be clear about something: the majority of our food system is controlled by a handful of big multinational companies. These big food companies carefully formulate and market nutrient-poor, addictive, ultra-processed foods — ultra-processed foods which now comprise 2/3 of the calories in children and teen diets in the U.S — and then these companies want us to believe that diet related diseases such as obesity and diabetes are somehow a moral failing, that they represent a lack of willpower or a failure to exercise enough.
That is a lie.
It is not a moral failing, it is a policy failure.

Food is Medicine: Food and Society at the Aspen Institute and Harvard’s Center for Health Law and Policy Innovation released a Food is Medicine Research Action Plan, a lengthy report detailing recommendations for how to bolster nutrition interventions in health care.

Food is the leading cause of poor health in the United States. Over half of American adults suffering from at least one chronic, diet-related disease. This health crisis has devastating effects for individuals and their and families and places an immense burden on our health system and economy. Though food is the culprit, it can also be the cure. Food and nutrition interventions can aid in prevention and management, and even reverse chronic disease. Introduced at large scale, proven interventions could save millions of lives and billions in healthcare costs each year.

Universal free school meals: The Bipartisan Policy Center released recommendations from its Food and Nutrition Security Task Force.   The report has recommendations for strengthening nutrition education and security in and out of school.  For example:

  • Ensure all children, regardless of household income, have access to nutritious foods to allow them to learn and grow by providing school breakfast, school lunch, afterschool meals, and summer meals to all students at no cost.
  • Make Summer EBT a permanent program and allow students to access EBT benefits during school breaks, holidays, closures, and other emergencies.
  • Maintain and, if possible, strengthen nutrition standards for all programs to better align them with the latest Dietary Guidelines for Americans.

Pandemic EBT program: The Government Accountability Office recommended that USDA do a better job on nutrition assistance during emergencies and of implement the Pandemic-EBT program, which was supposed to give eligible school children charge cards for buying foods, but never worked well.