by Marion Nestle

Search results: the corporation not me

Feb 3 2022

The coming influx of hard soda

As if we don’t have enough trouble with alcohol in this country, it’s now being added to sodas.  In states that allow such things, expect to see them taking up more and more room in supermarket aisles.

The business press is interested in this trend; there is much money to be made on drinks of any kind.

See, for example, Bud Light to Launch Hard Soda.

Bud Light Seltzer Hard Soda will have no sugar or caffeine. Anheuser-Busch describes it as ‘light like a seltzer and bold like soda pop.’ Each can will contain 100 calories and 5% alcohol.

This comes in cola, cherry cola, orange and lemon-lime flavors.

Consumer demand has soared over the past few years for nonalcoholic seltzers such as LaCroix and alcoholic ones such as White Claw that are low on calories and offer just a hint of flavor. Now some consumers are migrating toward stronger flavors, industry experts say, and brewers are trying out new fizzy drinks.

This, then, is about market share.

Lots of other companies are getting into this act.

Given all that, what are we to make of this piece of news?

  • Alcohol and COVID-19: Good news for red wine drinkers, but blow for beer boozers?  People who consume red wine between one to more than five glasses a week had a 10 to 17% lower risk in contracting COVID-19, but beer drinkers had a heightened risk, according to a recent study…. Read more
  • Here’s the study: COVID-19 Risk Appears to Vary Across Different Alcoholic Beverages.
  • Here’s the caveat: Association does not equal causation.  Drinkers of red wine have different lifestyles than beer drinkers, perhaps?
  • And here are the study’s sensible conclusions:  The COVID-19 risk appears to vary across different alcoholic beverage subtypes, frequency, and amount…Consumption of beer and cider and spirits and heavy drinking are not recommended during the epidemics. Public health guidance should focus on reducing the risk of COVID-19 by advocating healthy lifestyle habits and preferential policies among consumers of beer and cider and spirits.

Amen.

 

Nov 12 2021

Weekend reading: Food and Inequality

Priya Fielding-Singh.  How the Other Half Eats: The Untold Story of Food and Inequality in America.  Little, Brown Spark, 2021.

I did a blurb for this book (some of it ended up on the cover)

How the Other Half Eats is a must-read for anyone who has ever wondered why Americans don’t eat more healthfully. Fielding-Singh achieved something remarkable in gaining the trust of families who then let her observe their daily food choices. Her book is a thoughtful, riveting, compassionate, and utterly compelling account of why eating healthfully is so difficult, especially for the poor. What’s more, she offers a superb example of why on-the-ground field research is invaluable for gaining a deep and nuanced understanding of the ways that our industry-driven and highly inequitable food environment affects real people on a daily basis.

What I found so amazing about this book was that Fielding-Singh actually talked to people about how they feel about their diets—and listened.  Her analysis is exceptionally thoughtful.  Some examples:

From page 253

It is one thing to be able to find and afford a head of cauliflower.  But it is another to want to buy that cauliflower, to choose to spend one’s money on that cauliflower (at the expense of other purchases), to have the time and tradition to cook that cauliflower, and to possess the patience to weather one’d child’s complaints and pleas for macaroni and cheese and soldier on to feed that cauliflower to one’s child.  Only a handful of parents I met had all of these things.

From page 255

Personal responsibility has never solved a public health problem or remedied an inequity.  Food is no exception…Many of the families I met had either done so or were trying to figure out how to eat more nutritiously with the resources they had.  But, largely due to the structures implemented by the food industry and federal government, most felt like they were fighting an uphill battle—and losing.

Page 259

Banning marketing to kids would give moms a fighting chance of being able to feed their kids what they want rather than what corporations push on them.  Currently, only those families with the most money, time, and bandwidth have a shot at prevailing against the industry—and even those families often struggle and even fail.  Protection from the food industry should be right granted to all families, not a privilege reserved for the few.

Nov 4 2021

What’s up with digital marketing? Plenty.

Digital marketing, especially when targeted to children, is a rising source of concern and for well-documented reasons.

Two reports provide the data.  The big issue?  Digital marketing promotes unhealthful eating.

I.  From the World Health Organization’s Regional Office in Europe: Digital Food Environments Factsheet

Digital technologies are becoming integrated to varying degrees into everyday life across the 53 countries of the WHO European Region. The increase in digital technologies can increase the convenience of food and prepared meals. A recent unrepresentative survey of 10 European countries found that every fifth meal was consumed outside of the home, with 80% from commercial outlets. The influence of digitalization on dietary behaviour, however, is not well understood, raising questions about its influence on the health and nutrition of adults and children.

II.  From the U.S. Center for Digital Democracy comes Big Food, Big Tech, and the Global Childhood Obesity Pandemic

The full report

Some of the largest food and beverage corporations—including Coca-Cola, McDonald’s, and Pepsi—have, in effect, transformed themselves into Big Data businesses, acquiring specialist firms, establishing large in-house operations, and hiring teams of data scientists and technology experts to direct these systems. With these enhanced capabilities, they can more effectively engage in ad targeting—whether on the leading platforms or through their own mobile apps.

The Executive Summary

A growing body of academic research has documented the increasing presence of unhealthy food promotion in digital media, as well as clear patterns of youth engagement with major brands, and influences on health behaviors.

The Press Release

Tech platforms especially popular with young people—including Facebook’s Instagram, Amazon’s Twitch, ByteDance’s TikTok, and Google’s YouTube – are working with giant food and beverage companies, such as Coca Cola, KFC, Pepsi and McDonald’s, to promote sugar-sweetened soda, energy drinks, candy, fast food, and other unhealthy products across social media, gaming, and streaming video. The report offers fresh new analysis and insight into the most recent industry practices.

Comment: All this calls for regulation, of course.  Any chance of that coming our way?

Sep 10 2021

Weekend reading: Break up Big Ag

Two articles on similar themes have come out recently.

Is It Time to Break Up Big Ag? — The New Yorker

Nationally, the four largest dairy co-ops now control more than fifty per cent of the market. They’ve been able to grow so big, in part, because of a 1922 law called the Capper-Volstead Act, which provides significant exemptions from antitrust laws for farmer-owned agricultural coöperatives. “The agricultural industry is different than other industries because Capper-Volstead allows them to combine in ways that other individuals would go to jail for,” Allee A. Ramadhan, a former Justice Department antitrust attorney who led an investigation into the dairy industry, told me.

The law’s protections were intended to give small, independent farmers the right to collectively bargain prices for processing and selling their goods, but many large co-ops, such as D.F.A., have increasingly come to resemble corporations.

Break Up Big Chicken — The New York Times

Most chicken that Americans eat is processed by a handful of big companies because, in recent decades, the government gave its blessing to the consolidation of poultry processing, along with a wide range of other industries. The unsurprising result: In recent years, the surviving companies took advantage of their market power to prop up the price of chicken, overcharging Americans by as much as 30 percent.

Evidence of the industry’s misconduct became so blatant — thanks in part to lawsuits filed by wholesale poultry buyers — that regulators were roused from complacency. Beginning in 2019, the government has filed a series of charges against the companies and their executives.

And while we are at it, let’s not forget Philip Howard’s work, which I’ve written about previously.

Aug 13 2021

Weekend reading: A call to the UN Food Systems Summit: Ultra-processed foods

I am a co-author on a paper published recently by BMJ Global Health 2021;6:e006885.  The need to reshape global food processing: a call to the United Nations Food Systems Summit.  Authors: Carlos Augusto Monteiro, Mark Lawrence, Christopher Millett, Marion Nestle, Barry M Popkin, Gyorgy Scrinis, Boyd Swinburn.

Because this paper is open access, I reproduce its text below.  The link is to the pdf.

Summary box

  • In the modern, globalised food system, useful types of industrial food processing that preserve foods, enhance their sensory properties and make their culinary preparation easier and more diverse, have been and are being replaced by food ultra-processing.

  • The main purpose of food ultra-processing is to increase profits by creating hyperpalatable and convenient food products that are grossly inferior imitations of minimally processed foods and freshly prepared dishes and meals.

  • In the last decades, obesity, type 2 diabetes and related diseases have become global epidemics, leading the health systems of many countries to or beyond breaking point.

  • Taken together, the totality of evidence summarised here shows beyond reasonable doubt that increased consumption of ultra-processed foods is a major contributor to the pandemic of obesity, type 2 diabetes and related diseases.

  • The 2021 UN Food System has a unique opportunity to urge countries to implement policy interventions required to reduce ultra-processed food production, distribution and consumption, while simultaneously making fresh or minimally processed foods more available, accessible and affordable.

Introduction

The UN Food Systems Summit is taking place later this year at a crucial time. Food systems are manifestly failing to enhance human health, social equity or environmental protection. One symptom is the pandemic of obesity and related non-communicable diseases with their vast consequences. As we show here, one of the main drivers of this pandemic is the transformation in food processing. In the modern, globalised food system, useful types of food processing that preserve foods, enhance their sensory properties and make their culinary preparation easier and more diverse, have been and are being replaced by deleterious types of processing whose main purpose is to increase profits by creating hyperpalatable and convenient products that are grossly inferior imitations of minimally processed foods and freshly prepared dishes and meals. The Summit has a unique opportunity to confront this calamitous change, and to recommend effective policies and actions to UN agencies and member states.

Processing and industry

The key issue here is the nature, purpose and extent of food processing. It is not processing as such. General criticism of food processing is too unspecific to be helpful. Most foods are processed in some way, and culinary preparations of fresh foods are usually made using processed ingredients. Some types of food processing contribute to healthful diets, but others do the opposite.1

At one extreme are minimal processes which mostly preserve or enhance whole foods, such as drying grains, pulses and nuts, grinding grains into flour and pasta, chilling or freezing fruits and vegetables, pasteurising milk and fermenting milk into yoghurt.

At the other extreme are industrial processes that convert food commodities such as wheat, soy, corn, oils and sugar, into chemically or physically transformed food substances, formulated with various classes of additives into generally cheap to make, long duration substitutes to minimally processed foods and freshly prepared dishes and meals. The result is brand-named sugary, fatty and/or salty food and drink products which typically contain little or no whole food, are designed to be ready-to-consume anytime, anywhere and are highly attractive to the senses or even quasi-addictive. These products, including sweet and flavoured drinks, sweet or savoury snacks, reconstituted meat products and shelf-stable or frozen ready meals and desserts, are identified as ultra-processed foods.2

Criticisms of the food industry as a whole are also a mistake. Most of the very many millions of food farming, growing, rearing, making, distributing, selling and catering businesses throughout the world, notably in Asia, Africa and Latin America, deal solely or largely in fresh and minimally processed foods. These businesses and the foods they produce need to be encouraged, defended and supported.

By contrast, ultra-processed foods are mostly enabled, produced and sold by a small number of transnational corporations, some of whose turnovers exceed the revenues of many countries and make annual profits of US$ billions.3 These corporations use their power to formulate, mass manufacture, distribute and aggressively market their products worldwide.4

These corporations shape scientific findings by funding in-house and university-based research, so as to defend and promote ultra-processed foods.5 They also exercise political power by intensive lobbying, donations and sponsorships, and until now have dissuaded most governments from adequately regulating their products and practices.6

Time-series food sales data indicate the explosive growth in manufacturing and consumption of ultra-processed foods worldwide.7 National dietary surveys show that ultra-processed foods already make up 50% or more of total dietary energy intake8 in high-income countries, with even higher consumption among children and adolescents.9 In middle-income countries, they now represent between 15% and 30% of total energy intake8 but sales of ultra-processed foods are increasing fastest in these countries.10

The pandemic of obesity and related diseases and its link with ultra-processing

According to WHO, worldwide prevalence of obesity has nearly tripled since the mid-1970s, and now over 650 million adults are obese, and 1.9 billion adults and over 370 million children and adolescents are overweight or obese (https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight). No country has yet reversed these increases. Closely driven by the increase in obesity is a doubling of worldwide type 2 diabetes prevalence since 1980, now affecting about 420 million people (https://www.who.int/news-room/fact-sheets/detail/diabetes). Obesity, type 2 diabetes and related non-communicable diseases, including cardiovascular diseases and some common cancers, have become pandemics. Pre-COVID-19, health systems in most countries did not have the capacity to effectively treat diet-influenced diseases. Now, many health systems are at or beyond breaking point struggling with COVID-19, the severity of which is significantly higher in people with obesity and related diseases.

Evidence of the general healthfulness of dietary patterns based on fresh and minimally processed foods and culinary preparations, and their protection against all forms of malnutrition, ‘is noteworthy for its breadth, depth, diversity of methods, and consistency of findings’.11

But only in the last decade, with the advent of the NOVA food classification system that distinguishes ultra-processed foods from minimally processed or processed foods,1 has the link between changes in types of food processing and the pandemic of obesity and related diseases been revealed. Evidence here includes:

  • Three meta-analyses of findings from epidemiological studies, including large, long-duration, carefully conducted cohort studies, show dose-response associations between consumption of ultra-processed foods and obesity, abdominal obesity, type 2 diabetes, dyslipidaemias, metabolic syndrome, depression, cardio and cerebrovascular diseases and all-cause mortality.12–14

  • Analysis of national dietary or food purchase surveys in middle-income or high-income countries shows that the higher the dietary share of ultra-processed foods, the higher the obesogenic dietary nutrient profiles. These are characterised by higher energy density, free sugars, unhealthy fats and sodium, and lower protein and dietary fibre.8

  • Epidemiological and experimental studies indicate that ultra-processed foods may increase risks for obesity and related diseases in other ways beyond their nutritional composition. These include structural and physical properties that blunt satiety signalling, organoleptic characteristics associated with higher energy intake rate, neo-formed substances and migrated packaging materials that are endocrine disruptors, additives that promote pro-inflammatory microbiome, and reduced thermic effect that decreases total energy expenditures.12–14

  • A randomised controlled cross-over trial shows that consuming a high ultra-processed diet causes a highly significant increase in ad libitum calorie intake and consequent weight gain. Over a 2-week period, 20 young adults following a diet with 83% of energy from ultra-processed foods consumed approximately 500 more kcal per day than when they followed a diet with no ultra-processed foods. Participants gained 0.9 kg at the end of the 2 weeks with the ultra-processed diet and lost 0.9 kg at the end of the non ultra-processed diet, mostly of body fat.15

  • A longitudinal ecological study of 80 countries from 2002 to 2016 shows a direct association between changes in annual per capita volume sales of ultra-processed foods and corresponding changes in population adult body mass index.16

Taken together, the totality of evidence summarised here shows beyond reasonable doubt that increased consumption of ultra-processed foods is a major contributor to the pandemic of obesity and related diseases. There is also mounting evidence of the harmful effects of the ultra-processed food industry on the planet, through its global demand for cheap ingredients that destroy forests and savannah, its displacement of sustainable farming, and its resource-intensive manufacturing and packaging.17

Policy responses

To begin with, the UN Food Systems Summit should urge international and national health and food and nutrition authorities to review their dietary guidelines to emphasise preference for fresh or minimally processed foods and avoidance of ultra-processed foods, in line with guidelines developed, for example, by the WHO/Pan American Health Organization,18 and issued in several Latino-American countries, and now also in France, Belgium, and Israel.

At the same time, national governments should be urged to use fiscal measures, marketing regulations, bold mandatory front-of-pack labelling schemes and food procurement policies, all designed to promote the production, accessibility and consumption of a rich variety of fresh or minimally processed foods, and to discourage the production, distribution and consumption of ultra-processed foods, as now done in several countries.19

Current food and nutrition policies are mostly intended to encourage food manufacturers to reformulate their products by reducing the use of salt, sugar or unhealthy fats. There is a role for strong regulations that effectively limit the levels of these components, but reformulation alone will not turn ultra-processed products into healthy foods,20 as in effect recently acknowledged in one internal document from one leading ultra-processed food corporation – “some of our categories and products will never be ‘healthy’ no matter how much we renovate” (https://www.ft.com/content/4c98d410-38b1-4be8-95b2-d029e054f492). Policies should instead stimulate the entire manufacturing industry to maintain, develop or improve processing methods that prolong the duration of whole foods, enhance their sensory properties and make their culinary preparation easier and more diverse. Ultra-processed foods should be replaced by processed foods with limited levels or absence of added salt, sugar or unhealthy fats or, preferably, by minimally processed foods.20

Conclusions

Food systems are failing. This is most clearly shown by what are now the pandemics of obesity and type 2 diabetes, of which ultra-processed food is a main contributor. The UN Food Systems Summit should urge member states to implement multiple policy interventions to reduce ultra-processed food production, distribution and consumption, while simultaneously making fresh or minimally processed foods more available, accessible and affordable.

Data availability statement

All data relevant to the study are included in the article.

Ethics statements

Acknowledgments

This paper expands a one-page submission made by the authors to the UN Food Systems Summit within Solution Cluster 2.2.1 (food environment).

References

 

Footnotes

  • Twitter @CMonteiro_USP

  • Contributors All authors contributed to the ideas presented in the manuscript. CAM wrote the manuscript. All authors contributed to redrafting and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

Jul 14 2021

The UN Summit on Food Systems 2: The Critique

Yesterday, I posted information about the forthcoming UN Summit on Food Systems (UNFSS) and its Pre-Summit.  The Summit has been heavily criticized on the grounds that it:

  • Sets agenda themes determined by corporate entities such as The World Economic Forum and the Gates Foundation.
  • Favors corporate technological solutions to food system problems.
  • Ignores agroecology, organic farming, and indigenous knowledge.
  • Excludes meaningful representation from people most affected by food system transformation.
  • Promotes corporate control of food systems.
  • Ignores the conflicted interests of its organizers.
  • Is fundamentally undemocratic.

These criticisms are so severe that The Civil Society and Indigenous Peoples’ Mechanism for Relations with the UN (CSM) is organizing counter events July 25 to July 27.

Much has been written to document such concerns.

Civil Society and Indigenous Peoples Mechanism, North America: UN Food System Summit “Dialogue” events spark renewed concerns of corporate capture in North American food system and rural economies globally

In March 2020, 550 civil society organizations sent an open letter to the United Nations (UN) Secretary-General condemning the involvement of the World Economic Forum in the UNFSS, the appointment of Ms. Agnes Kalibata as UNFSS Special Envoy due to her links to corporate agribusiness, the failure of the UNFSS to elevate the primacy and indivisibility of human rights frameworks as foundational to the governance of food systems, and the necessity of civil society organizations to have an autonomous, self-organized, and equal ‘seat at the table.’ These concerns have not been addressed despite numerous CSM interactions with UNFSS organizers.

The International Panel of Experts on Sustainable Food Systems (IPES): An IPCC [Intergovernmental Panel on Climate Change] for Food?”  How the UN Food Systems Summit is being used to advance a problematic new science-policy agenda.

Behind what sounds like a technocratic question is in fact a high-stakes battle over different visions of what constitutes legitimate science and relevant knowledge for food systems. This, in turn, is part of a broader battle over what food systems should look like and who should govern them.

Matthew CanfieldMolly D. Anderson and Philip McMichael.  UN Food Systems Summit 2021: Dismantling Democracy and Resetting Corporate Control of Food Systems.  Front. Sustain. Food Syst., 13 April 2021. [Note: this paper has an especially useful historical account of attempts to establish global food system governance]

Although few people will dispute that global food systems need transformation, it has become clear that the Summit is instead an effort by a powerful alliance of multinational corporations, philanthropies, and export-oriented countries to subvert multilateral institutions of food governance and capture the global narrative of “food systems transformation”…It elaborates how the current structure and forms of participant recruitment and public engagement lack basic transparency and accountability, fail to address significant conflicts of interest, and ignore human rights.

Independent scientists:  Open letter to policy makers: No new science-policy interface for food systems.

We call on governments and policymakers to…Support participatory processes that actively and meaningfully include plural perspectives and voices in food system governance. Farmers and other citizens need inclusive, participatory, and safe spaces within the CFS-HLPE process to co-create the knowledge necessary to govern food systems at global, national and local levels.

Maywa Montenegro, Matthew Canfield, and Alastair IlesWeaponizing Science in Global Food Policy.

Nobody disputes the need for urgent action to transform the food system. But the UNFSS has been criticized by human rights experts for its top-down and non-transparent organization. Indigenous peoples, peasants, and civil society groups around the world know their hard-won rights are under attack. Many are protesting the summit’s legitimacy and organizing counter-mobilizations.

Scientists are also contesting a summit because of its selective embrace of science, as seen in a boycott letter signed by nearly 300 academics, from Brazil to Italy to Japan.

Through the Summit, “science” has been weaponized by powerful actors not only to promote a technology-driven approach to food systems, but also to fragment global food security governance and create institutions more amenable to the demands of agribusiness.

ScientistsAn open letter from scientists calling for a boycott of the 2021 Food Systems Summit.

Some critics of the UNFSS have suggested ways that the process could become less problematic: (1) it could incorporate a human rights framing into all of its “action tracks”; (2) it could create an action track led by the CSM on the corporate capture of food systems; and (3) it could designate the UN Committee on World Food Security as the institutional home to implement recommendations coming out of the summit.

Nisbett N, et al.  Equity and expertise in the UN Food Systems Summit.  BMJ Global Health. 2021;6:e006569.

…time is not late to take action in rebalancing powers and enabling a greater diversity of knowledge, not simply among a multiplicity of voices in multiple public forums, but explicitly engaged at the summit’s top table of expertise and summit leadership. It is also not late to adopt mechanisms that limit the engagement of those actors whose primary interests have driven our food systems to
become unhealthy, unsustainable and inequitable, so the voices of the people can be clearly heard..

An alternative: The Global People’s Summit on Food Systems

The People’s Summit is composed primarily of movements of landless peasants, agricultural workers, fisherfolk, indigenous people, rural women, and youth—or small food producers who produce 70% of the world’s food, yet remain among the world’s poorest and food insecure.  “The issue of landlessness and land grabbing is not on the agenda of the UNFSS.  Nowhere in its so-called Action Tracks do discussions highlight critical trends such as on land concentration and reconcentration in the hands of big agribusiness firms and their network of local landlords and compradors, nor on the massive displacement of rural communities to give way to big private investments and large development projects,” said Chennaiah Poguri, chairperson of the Asian Peasant Coalition (APC).

Additions

 

Apr 12 2021

Industry-funded opinon of the week: eggs and cholesterol

Nutritional Viewpoints on Eggs and Cholesterol. by Michihiro Sugano and Ryosuke Matsuoka.  Foods 202110(3), 494; https://doi.org/10.3390/foods10030494

Opinion:  This review says that although Japanese people eat more eggs than Americans, they may be protected against higher cholesterol levels due to the differences in everything else they eat (more seafood, for example?).

Conclusion: “Although randomized controlled trials with long-term follow-up are required to evaluate the association between consumption of eggs and human health, available information, at least from the nutritional viewpoint, suggests that egg is a healthy and cost-efficient food worldwide.”

Conflicts of interest: “M.S. declares no conflicts of interest, and R.M. is an employee of Kewpie Corporation. There are no other patents, products in development, or marketed products to declare. Kewpie Corporation has no conflicts of interest with this research.”

Comment: Really?  No conflicts of interest?  But Kewpie is Japan’s #1 mayonaise companyKewpie says that it “uses about four billion eggs a year. Recognizing that eggs contain all the necessary ingredients for creating life, we continually study ways of effectively utilizing such ingredients and manufacture fine chemicals for use in a broad range of food, cosmetic, and pharmaceutical applications.”

One of those ways, apparently, is to get its employees to write opinion pieces like this.

With that said, concerns about eggs and cholesterol have diminished in recent years.  The 2020 Dietary Guidelines for Americans says not a word about eggs and cholesterol; it just recommends eggs as a source of protein.  A study in the American Heart Association Journal finds no association between eggs and heart disease mortality.

The American Heart Association notes that eggs are the leading source of dietary cholesterol but their negative effects may be confounded by the fact that they are so often eaten with bacon and sausage.  The AHA egg recommendations:

  • Vegetarians (lacto-ovo) who do not consume meat-based cholesterol-containing foods may include more dairy and eggs in their diets within the context of moderation discussed herein.
  • Patients with dyslipidemia, particularly those with diabetes mellitus or at risk for heart failure, should be cautious in consuming foods rich in cholesterol.
  • For older normocholesterolemic patients, given the nutritional benefits and convenience of eggs, consumption of up to 2 eggs per day is acceptable within the context of a heart-healthy dietary pattern.

And even with that said, the authors should have disclosed Kewpie’s evident conflicted interests.

Mar 24 2021

My latest publication: a book review

I’ve just had a book review published in the American Journal of Public Health: “Public health nutrition deserves more attention.”

It’s for a textbook on public health nutrition but doing it gave me the opportunity to say some things I want public health professionals to know.  I started the review like this:

Public Health Nutrition deserves more attention

Food and nutrition deserve much more attention from public health professionals.  On the grounds of prevalence alone, diet-related conditions affect enormous numbers of people.  Everybody eats.  Everybody is at risk of eating too little for health or survival, or too much to the point of weight gain and increased prevalence of non-communicable diseases (NCDs).  By the latest count, nearly 700 million people in the world do not get enough to eat on a daily basis, a number that has increased by tens of millions over the past five years and will surely increase by many millions more as a result of the Coronavirus pandemic.[i]   At the same time, about two billion adults are overweight or obese, and few countries are prepared to deal with the resulting onslaught of type 2 diabetes and heart disease.[ii]  Beyond that, food production, distribution, consumption, and disposal—collectively food systems—are responsible for a quarter or more of greenhouse gas emissions; climate change affects the health of everyone on the planet.[iii]

The same social, behavioral, economic, and structural determinants that affect health also affect nutritional health, and it is no accident that food choices are flash points for arguments about culture, identity, social class, inequity, and power, as well as about the role of government, private enterprise, and civil society in food systems.   From a public health standpoint, everyone–regardless of income, class, race, gender, or age—should have the power to choose diets that meet nutritional needs, promote health and longevity, protect the environment, and are affordable, culturally appropriate, and delicious.

Nutrition in 2021

For people in high-income countries, dietary prescriptions for health and sustainability advise eating less meat but more foods from plant sources.[iv]  Optimal diets should minimize consumption of ultra-processed foods, those that are industrially produced, bear little resemblance to the basic foods from which they were derived, cannot be prepared in home kitchens, and are now compellingly associated with NCD risk and mortality.[v]  We now know that ultra-processed foods encourage people to unwittingly take in more calories and gain weight.[vi]

Agenda for 2021

Today, a book for researchers and practitioners of public health nutrition needs to emphasize coordinated—triple-duty—recommendations and interventions to deal with hunger and food insecurity, obesity and its consequences, and the effects of food production and dietary choices on the environment.  Such approaches, as described by a Lancet Commission early in 2019,4 should encourage populations of high-income countries to eat less meat but more vegetables, those in lower- and middle-income countries (LMICs) to consume a greater variety of foods, and everyone, everywhere to reduce intake of ultra-processed foods.  As that Commission argued, public health nutritionists must recognize that attempts to improve diets, nutritional status, nutritional inequities, and food systems face daunting barriers from governments captured by corporations, civil society too weak to demand more democratic institutions, and food companies granted far too much power to prioritize profits at the expense of public health.  Nutritionists need knowledge and the tools to resist food company marketing and lobbying, to advocate for regulatory controls of those practices, and to promote civil society actions to demand healthier and more sustainable food systems.[vii]

I then go on to talk about the book itself, which alas, did not have much to say about this agenda.

References to the first part of this review

[i] The World Bank.  Brief: Food Security and COVID-19. December 14, 2020. https://www.worldbank.org/en/topic/agriculture/brief/food-security-and-covid-19#:~:text=In%20November%202020%2C%20the%20U.N.,insecure%20people%20in%20the%20world. Accessed January 2, 2021.

[ii] WHO.  Obesity and overweight: Key facts.  Geneva: WHO.  April 1, 2020. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed January 2, 2021.

[iii] International Panel of Experts on Sustainable Food Systems. COVID-19 and the crisis in food systems: symptoms, causes, and potential solutions. IPES-Food, April 2020. www.ipesfood.org/pages/covid19. Accessed January 2, 2021.

[iv] Swinburn BA, Kraak V, Allender S, et al. The global syndemic of obesity, undernutrition, and climate change: The Lancet Commission report. Lancet. 2019;393:791–846.

[v]  Monteiro CA, Cannon G, Levy RB, et al.  Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019;22(5):936–941.

[vi] Hall KD, Ayuketah A, Brychta R, et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell Metab. 2019;30, 67–77.

[vii]  Jayaraman S, De Master K, eds.  Bite Back: People Taking On Corporate Food and Winning.  Oakland, CA: University of California Press; 2020.