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Earlier this week I received a 3-page, single-spaced letter—plus 4 pages of charts and figures–from Andrew Briscoe III, the President and CEO of the Sugar Association.

I opened it with some trepidation because the last letter I got from the Sugar Association threatened to sue me (to read it, click here and scroll down to the Controversies section).

Whew.  This one merely expresses general concerns about:

the misinformation reported on added sugars consumption and the overstatement of added sugars contribution to increased caloric intakes.  Americans do not consume 25 percent of their calories from added sugars. We write to provide you with accurate data….

I don’t think I ever said that the average American consumes 25% of calories from sugars (although some surely do) but I have complained that the Institute of Medicine’s “safe” level of intake of sugars is 25% of calories.  This is higher than public health recommendations to restrict sugars to 10% of calories or less.  It is meant as an upper limit, but is often interpreted as a license to eat this much.

One quarter of daily calories from sugars is too high for something that provides no additional nutritional value.

The letter concludes:

The Sugar Association is committed to ensuring that all advice consumers receive regarding sugar intake is based on the best available scientific evidence and related data.  The American consumer will be better served by dietary advice that is science-based, practical and accurate, no matter the issue.

Can’t argue with that.  But as with all matters concerning nutrition, the issue is which science you choose to cite and how you interpret it.

Mr. Briscoe uses the term sugars, plural, because sucrose, HFCS, syrups, honey, and other such things are all sugars.

How much do Americans actually consume?  Mr. Briscoe was kind enough to provide USDA tables that address this question.  These describe the availability of sugars in the food supply, not necessarily what people are actually eating.

My interpretation of the tables is that they say:

• Sugars comprise 17% of total calorie availability.
• Adjusted for waste, the availability of sugars is about 27.5 teaspoons per day per capita (meaning everyone:  men, women, and tiny babies).
• Translating this into calories: 27.5 teaspoons x 4 grams per teaspoon x 4 calories per gram = 440 calories per day per capita.
• On a 2000 calorie diet, that’s 22% of total energy intake, although it will be lower for people who take in more calories.

The CDC has just released a summary of intake of added sugars among children and adolescents, in calories per day.

At 4 calories a gram, 400 calories is 100 grams or 3.5 ounces.  Can these calories contribute to weight gain or other health problems?

You bet.

As Mark Bittman put it in his New York Times column this week,

Let me state the obvious: there is no nutritional need for foods with added sugar.

All of this is part of the bigger question: How do we regulate the consumption of dangerous foods? As a nation, we’ve accepted the need to limit the marketing and availability of tobacco and alcohol. The first is dangerous in any quantity, and the second becomes dangerous when overconsumed.

And added sweeteners, experts increasingly argue, have more in common with these substances than with fruit.

No wonder the Sugar Association uses its own interpretation of the science to suggest that current levels of intake are benign and that no level of intake poses a risk.  Mr. Briscoe’s letter says:

No authoritative scientific body that has conducted a major systematic review of the scientific literature has a found a public health need to set an Upper Level (UL) for total or added sugars intake.  Every comprehensive review of the scientific literature concludes that, with the exception of dental caries, no causal link can be established between the intake of sugars and lifestyle diseases, including obesity.

I’m glad he mentioned dental caries.  Karen Sokal, a physician in California, has been tracking the onset of tooth decay among children in Latin America who are now consuming sodas and candy on a daily basis.  She writes:

Mark Bittman’s excellent editorial, “Regulating our Sugar Habit,” (Feb 27) concludes that eating too much sugar has become “the biggest public health challenge facing the developed world.”  Indeed, it poses a big health challenge for the entire world, especially developing countries.

In my 30 years of global health work, I have seen an explosion in the marketing and consumption of non-nutritious foods and beverages followed by a dramatic rise in childhood tooth decay and obesity. Quarterly business reports praise the food and beverage industry’s increased profits based on increased sales in “emerging markets.” The NY Times article on Kellogg’s purchase of Pringles (Feb 12) stated, “The snack business is growing faster and has greater appeal internationally,” which analysts noted “appears somewhat out of sync with the trends toward better-for-you snacking.”

Governmental regulations to ensure the production and marketing of healthful food and beverages must be applied worldwide and protect the health of the world’s most vulnerable populations.

Indeed, they must.  The Sugar Association has much to answer for in its opposition to public health recommendations to eat less sugar.

The amazing New York City Health Department, almost unique in its interest in public health and willingness to do what it can to improve the health of New Yorkers, adds another campaign to its collection of hard hitters.  This one is on the need to reduce portion sizes.

The subway campaign posters in Spanish and English.  Here’s an example in Spanish.

I especially like this campaign because much of the work on increasing portion sizes in the food supply was launched by my former doctoral student, now Dr. Lisa Young.  See:

• Young LR, Nestle M, The contribution of expanding portion sizes to the US obesity epidemic. American Journal of Public Health, 2002. 92(2): p. 246-9.
• Young LR, Nestle M, Expanding portion sizes in the US marketplace: implications for nutrition counseling. Journal of the American Dietetic Association, 2003. 103(2): p. 231-4.

Larger portions do three things:

• They have more calories, obviously.
• They induce people to eat more calories
• They induce people to underestimate the number of calories they are eating

All of these induce people to eat more than they need or should.

The expansion of portion sizes alone is sufficient to explain rising rates of obesity.

The Health Department’s campaign makes sense.  Let’s hope it helps.

Update, January 10: The American Beverage Association doesn’t like the ads much, according to Crain’s:

Portion control is indeed an important piece of the solution to obesity,” said said Stefan Friedman, New York spokesman for the American Beverage Association, in a statement. “But instead of utilizing scare tactics, the beverage industry is offering real solutions like smaller portioned containers and calorie labels that show the number of calories in the full container, right up front, to help people chose products and sizes that are right for them and their families.

And if you think the New York City ads are tough and hard-hitting, try these “Strong4Life ads from the state of Georgia.  Shocking people out of complacency?  Or just shocking?

Update, January 25: The New York Times reports that the shocking photograph of an overweight man with a leg amputation was “photoshopped” from a stock photo.

This is unfortunate, as it opens the Health Department up to unnecessary criticism:

The American Beverage Association, which opposes the city’s efforts against sodas and fast food, called the advertisement overwrought. “This is another example of the ‘What can we get away with?’ approach that shapes these taxpayer-funded ad campaigns,” Chris Gindlesperger, the association’s director of communications, said in a statement.

In what Obama Foodorama calls “a fundamental shift in the Let’s Move campaign” Michelle Obama announced in a speech last week that she will now focus on getting kids to be more active.

Apparently, she has given up on encouraging food companies to make healthier products and stop marketing junk foods to kids.

This shift is troubling.  Here’s why:

1.  The shift is based on faulty biology.

To lose weight, most people have to eat less whether or not they move more.   For example, it takes about three miles of walking to compensate for the calories in one 20-ounce soda.

Activity is important for health, but to lose or maintain weight, kids also need to eat less.  Sometimes they need to eat much less.  And discouraging them from drinking sugary sodas is a good first step in controlling body weight.

But eating and drinking less are very bad for business.  Food companies do all they can to oppose this advice.

2.  It undercuts healthy eating messages.

On the one hand, Mrs. Obama says that she disagrees with this assumption: “kids don’t like healthy food, so why should we bother trying to feed it to them.”

But her speech implies that kids won’t eat healthfully unless forced to:

I want to emphasize that last point — the importance of really promoting physical activity to our kids…This isn’t forcing them to eat their vegetables. (Laughter.) It’s getting them to go out there and have fun.

3.  It declares victory, prematurely.

Mrs. Obama says:

Major food manufacturers are cutting sugar, salt and fat from their products. Restaurants are revamping kids’ menus and loading them with healthier, fresher options. Companies like Walgreens, SuperValu, Walmart, Calhoun’s Grocery are committing to build new stores and to sell fresh food in underserved communities all across this country.

Congress passed historic legislation to provide more nutritious school meals to millions of American children. Our schools are growing gardens all over the place. Cities and towns are opening farmers markets. Congregations are holding summer nutrition programs for their kids. Parents are reading those food labels, and they’re rethinking the meals and the snacks that they serve their kids.

So while we still have a long way to go, we have seen so much good progress. We’ve begun to have an impact on how, and what, our kids are eating every single day.  And that is so important. It’s so important.

Really?  I’d say we’ve seen promises from food companies but remarkably little action.

Mrs. Obama’s speech fails to mention what I’m guessing is the real reason for the shift: “Move more” is not politically loaded.  “Eat less” is.

Everyone loves to promote physical activity.  Trying to get the food industry to budge on product formulations and marketing to kids is an uphill battle that confronts intense, highly paid lobbying.

You don’t believe this?  Consider recent examples of food industry opposition to anti-obesity efforts:

• Soda companies successfully defeated efforts to impose taxes on soft drinks.
• Food companies successfully defeated efforts by four federal agencies to set voluntary standards for marketing foods to children.
• Food companies successfully lobbied Congress to pass a law forbidding the USDA from setting standards for school meals regarding potatoes, tomato sauce, and whole grains.  The result?  Pizza tomato sauce now counts as a vegetable serving.
• McDonald’s and  Burger King evaded San Francisco’s new rules restricting toys with kids meals by selling the toys separately for ten cents each.

The political cost of fighting the food industry is surely the reason for the change in Mrs. Obama’s rhetoric.  Now, she agrees that kids won’t eat vegetables unless forced to.

But in March 2010 Mrs. Obama warned Grocery Manufacturers Association:

We need you…to entirely rethink the products that you’re offering…, the information that you provide about these products, and how you market those products to our children….This isn’t about finding creative ways to market products as healthy.

The food industry understood those as fighting words.  It fought back with weapons at its disposal, one of which is to deflect attention from food by focusing on physical activity.   It now has White House endorsement of this deflection.

I’m all for promoting physical activity but the refocusing is a loss, not a win, in the fight against childhood obesity.

In what Bloomberg News terms an “epidemic battle,” food companies are doing everything they can to prevent the United Nations from issuing a statement that says anything about how food marketing promotes obesity and related chronic diseases.

The U.N. General Assembly meets in New York on September 19 and 20 to develop a global response to the obesity-related increase in non-communicable, chronic diseases (cancer, cardiovascular disease, respiratory disease, type 2 diabetes) now experienced by both rich and poor countries throughout the world.

As the Bloomberg account explains,

Company officials join political leaders and health groups to come up with a plan to reverse the rising tide of non- communicable diseases….On the table are proposals to fight obesity, cut tobacco and alcohol use and expand access to lifesaving drugs in an effort to tackle unhealthy diets and lifestyles that drive three of every five deaths worldwide. At stake for the makers of snacks, drinks, cigarettes and drugs is a market with combined sales of more than $2 trillion worldwide last year.

Commenting on the collaboration of food companies in this effort:

“It’s kind of like letting Dracula advise on blood bank security,” said Jorge Alday, associate director of policy with World Lung Foundation, which lobbies for tobacco control.

The lobbying, to understate the matter, is intense.  On one side are food corporations with a heavy financial stake in selling products in developing countries.  Derek Yach, for example, a senior executive of PepsiCo, argues in the British Medical Journal that it’s too simplistic to recommend nutritional changes to reduce chronic disease risk.  [Of course it is, but surely cutting down on fast food, junk food, and sodas ought to be a good first step?]

On the other side are public health advocates concerned about conflicts of interest in the World Health Organization.  So is the United Nations’ special rapporteur for  the right to food, Olivier De Schutter.  Mr. De Schutter writes that the “chance to crack down on bad diets must not be missed.”

On the basis of several investigative visits to developing countries,  De Schutter calls for “the adoption of a host of initiatives, such as taxing unhealthy products and regulating harmful food marketing practices…Voluntary guidelines are not enough. World leaders must not bow to industry pressure.”

If we are serious about tackling the rise of cancer and heart disease, we need to make ambitious, binding commitments to tackle one of the root causes – the food that we eat.

The World Health Organization’s (WHO) 2004 Global Strategy on Diet, Physical Activity and Health must be translated into concrete action: it is unacceptable that when lives are at stake, we go no further than soft, promotional measures that ultimately rely on consumer choice, without addressing the supply side of the food chain.

It is crucial for world leaders to counter food industry efforts to sell unbalanced processed products and ready-to-serve meals too rich in trans fats and saturated fats, salt and sugars. Food advertising is proven to have a strong impact on children, and must be strictly regulated in order to avoid the development of bad eating habits early in life.

A comprehensive strategy on combating bad diets should also address the farm policies which make some types of food more available than others…Currently, agricultural policies encourage the production of grains, rich in carbohydrates but relatively poor in micronutrients, at the expense of the production of fruits and vegetables.

We need to question how subsidies are targeted and improve access to markets for the most nutritious foods.…The public health consequences are dramatic, and they affect disproportionately those with the lowest incomes.

In 2004, the U.N. caved in to pressures from food companies and weakened its guidelines and recommendations.  The health situation is worse now and affects people in developing as well as industrialized countries.  Let’s hope the General Assembly puts health above politics this time.

Readers Robyn and Will sent me a link to an ABC News story about Yum! Brands efforts to get more states to authorize the use of food stamp (SNAP) benefits in fast food restaurants.

Michigan, California, Arizona, and Florida already do this.  Yum!, the parent company of KFC, Taco Bell, and Pizza Hut, wants it to go national.

They write:

We believe that food stamps should be used to buy nutritious food for kids and families, not junk food! This nonsense has to stop!  This is a government program–it should not be a means for corporations to sell products that will eventually lead to ever-increasing health problems–obesity, heart issues, diabetes, etc. What can we do to be heard?

USA Today did a story on this last week.  It elicited more than 1,000 comments.  I’m not surprised.

The issue thoroughly divides the food advocacy community.   Public health and anti-hunger advocates sharply disagree on this issue, as they do on the question of whether sodas should be taxed.

USA Today quoted Kelly Brownell, director of Yale’s anti-obesity Rudd Center:

It’s preposterous that a company like Yum! Brands would even be considered for inclusion in a program meant for supplemental nutrition.

But then the article quoted Ed Cooney, executive director of the Congressional Hunger Center and a long-time anti-hunger advocate:

They think going hungry is better?…I’m solidly behind what Yum! is doing.

Of course he is.  Want to take a guess at who funds the Congressional Hunger Center?

Yum! is listed as a “Sower,” meaning that its annual gift is in the range of $10,000.   I’m guessing Yum! is delighted that it is getting such good value at such low cost.

USA Today was negligent in not mentioning Mr. Cooney’s financial ties to Yum! and other food brands.  Such ties matter, and readers deserve to know about them.

But Mr. Cooney’s argument worries me on grounds beyond the evident conflict of interest.

For one thing, it smacks of elitism.  “Let them eat junk food” argues that it’s OK for the poor to eat unhealthfully.  I think the poor deserve to be treated better.

For another, promoting use of SNAP benefits for fast food and sodas makes it and other food assistance programs vulnerable to attack.

Rates of obesity are higher among low-income groups, including SNAP recipients, than in the general population.

Anti-hunger and public health advocates need to work a lot harder to find common ground if they want food assistance programs to continue to help low-income Americans.

Let’s be clear about what’s at stake here.  SNAP is an entitlement program, meaning that anyone who qualifies can get benefits.

In June 2011 alone, according to USDA, 45 million Americans received an average of $133 in benefits at a total cost to taxpayers of more than $6 billion.

That’s a lot of money to spend on fast food.  Yum!’s interest in getting some of that money is understandable.

If you think low-income Americans deserve better:

• Complain to Congress for permitting the legal loophole that allows this.
• Insist to USDA that SNAP benefits be permitted only for real food.
• Get your city to recruit farmers’ markets, grocery stores, and other sources of healthy food to low-income areas.
• Let your congressional representatives know that you want a safety net for people who are out of work that enables people to eat healthfully.
•  And tell the Congressional Hunger Center and similarly inclined anti-hunger groups that you think conflicts of interest interfere with their ability to help the clients they are supposedly trying to serve.

It used to be that the “soda wars” referred to Coke vs. Pepsi.  No more.  Today’s soda wars are fought on the health front, as more and more evidence links sugary drinks to obesity and other health problems.

The current issue of the New Yorker has an article by John Seabrook (in which I am briefly quoted) about Pepsi’s attempt to “health up” its snacks and drinks.

Seabrook’s article, “Snacks for a fat planet,” describes the extraordinary amount of money and effort Pepsi is spending to try to tweak its products to make them seem healthier.  His article doesn’t exactly give Pepsi a pass (as some of my readers have complained), but it does not really come to grips with how sugary drinks and snacks affect health or how Pepsi is marketing its products in developing countries.

That, no doubt, is why Pepsi has sent out a press release to reports that enclosed the complete article and suggested that reporters might be “interested in the company’s focus on its innovative approach to:”

• Reduce salt, fat and sugar across the portfolio – the New Yorker feature explains PepsiCo’s effort to re-shape natural salt so that it has more surface area, and, in turn, is perceived as “saltier” on the tongue – meaning they can maintain all the salty flavor in Lay’s but reduce overall sodium content
• Scale more drinks and snacks made with whole grains, fruit, vegetables and dairy to new markets – e.g. bringing vegetable-based gazpacho (perhaps with an edible whole grain spoon) to the U.S.
• Test new ingredients brought back from “treks” around the world – e.g. using a state-of-the-art robot in PepsiCo’s new Hawthorne, NY research lab to test botanicals and other natural ingredients from near and far – e.g. even secluded villages in the far East – to determine their impact on taste and viability for use in PepsiCo snacks and drinks (Do they intensify sweetness? Can they be a substitute for sugar? Do they have a particular healthful function?)

Score this one as a win for Pepsi.

Along with such pledges, Pepsi is aggressively marketing sodas to teenagers.  The San Francisco Chronicle reports on Pepsi’s new “social marketing” vending machines.

At a trade show in Chicago this week, PepsiCo rolled out a prototype interactive soda machine that lets you send a drink as a gift to a friend or a random stranger.

“Our vision is to use innovative technology to empower consumers and create new ways for them to engage with our brands, their social networks and each other at the point of purchase,” Mikel Durham, PepsiCo Foodservice’s chief innovation officer, said in a press release.

“Social Vending extends our consumers’ social networks beyond the confines of their own devices and transforms a static, transaction-oriented experience into something fun and exciting they’ll want to return to, again and again.”

But these kinds of marketing pushes are not confined to Pepsi.   Advertising Age reports that Joe Tripodi, Coke’s chief marketing officer of Coca-Cola explains the company’s growth strategy: focus on teenagers:

The company sees huge opportunities to grow colas, and the business as a whole, around the world in the next decade. Teen recruitment will be particularly important, as the company follows demographic trends.

“There was a time [a decade ago] when we walked away from teen recruitment and probably lost a generation of drinkers,” Mr. Tripodi said. “Parts of the world lost confidence in cola as the engine of growth. We’ve gotten that back in a big way. …When you look at the massive opportunity in so many huge countries in the world, that’s what energizes us and why we believe cola is still at its very early stages.”

And then there are partnership strategies. The latest is Sonic drive-ins’ campaign for Limeades for Learning. The campaign encourages eaters to vote for school projects like those that support physical activity.  Sonic promises to fund the projects with the most votes. The Limeades, by the way, are 620 calories (for a medium) or 950 calories (for a large).

Finally, for now, the Boston Globe reports that most Massachusetts voters support a sales tax on sodas if the money is used for some useful purpose.  But:

The American Beverage Association has been aggressively fighting taxes on soda, as cities and states across the country look for new tools to counter an obesity epidemic and raise revenue amid squeezed budgets. It has spent millions fighting initiatives that impose product-specific excise taxes on sugar-sweetened beverages and has been successful in nearly every attempt.

Expect more such public relations efforts superimposed on fundamental marketing techniques aimed at kids and fighting back on taxes and other attempts to limit soda intake.

How does this comport with the spanking new advertising guidelines to children or any of the previous pledges? Is sending a soda to a friend an activity or marketing? Or both?

http://www.sfgate.com/cgi-bin/blogs/techchron/detail?entry_id=87904

Among the many thoughtful comments on yesterday’s post is one from the Director of Oxfam America’s Private Sector Department, Chris Jochnick, who writes that I did not “quite capture the scope and intent of this project.”

As part of our work, Oxfam has a responsibility to engage with global corporations, through both collaboration and campaigns, in order to have constructive dialog on their business practices.

….Throughout the work, Oxfam has maintained complete independence including the ability to undertake advocacy against either company if the situation warranted. The Coca-Cola Company and Oxfam America shared the costs of the collaboration roughly in the proportion of 2:1, with The Coca-Cola Company contributing two-thirds of the costs (US $400,000) and Oxfam America contributing one-third of the costs in kind including staff time.

Unrelated to the study, The Coca-Cola Company made an earlier donation of $2,500,000 to Oxfam between 2008-2010 for humanitarian work in Sudan, with an emphasis on work related to water, sanitation and hygiene.

….Our independent voice keeps Oxfam’s approach to private sector collaborations dynamic and honest.

Let me add a bit more about what I think is wrong with this picture.

The goal of Coca-Cola is to sell more Coca-Cola.  The goal of Oxfam is to address world poverty.  I’m having trouble understanding how these goals could be mutually compatible.

Coke sales in the United States are flagging.  Last year, three quarters of Coke’s revenue derived from sales outside of North America in emerging economies where rates of obesity are increasing rapidly.

Sugary beverages like Coke are increasingly associated with obesity and its health consequences, problems now rampant in developing economies.

In the past year, Coke has embarked on an aggressive campaign of contributions to potentially critical groups such as the American Academy of Family Physicians, the Children’s Hospital of Philadelphia, Save the Children, and now Oxfam.

These groups are now highly unlikely to advise their constituents to cut down on sugary sodas.  If nothing else, sponsorship buys silence.

Oxfam may have done the work of its Poverty Footprint Report without company interference.  It is what is not in the report that is so much in Coke’s interest.

For just under $3 million, Coke has purchased an endorsement from Oxfam of its “anti-poverty” practices and silence on the role of sugary drinks in obesity.  This kind of public relations is well worth the price.

What does Oxfam get in this bargain?  The money, of course, but at the cost of serious questions about the credibility of its report and its independence.  Perhaps these are tolerable, but what about loss of respect?

I score this as a win for Coca-Cola.

My monthly Food Matters column for the San Francisco Chronicle:

Food is cheap at market, but costs a lot elsewhere

Q: I pay a lot for food, and more each day, but then people like you say our food is cheap because its real costs are “externalized.” Huh? What’s that supposed to mean?

A: Food prices are indeed going up, and I can hardly keep track of the possible causes: natural disasters, crop failures, commodity speculation, corn used for biofuels, lack of research in agriculture, the declining value of the U.S. dollar and just plain greed.

But we Americans still pay relatively less for food than anywhere else because so many of the costs of industrialized food production are “externalized.” We pay for them, but not at the grocery store.

Human costs

I was reminded of externalized food costs when reading about the remarkable efforts of a Salinas teacher to educate children of itinerant farmworkers. The kids are trying to learn under disrupted, impoverished, crowded living conditions. If their parents were paid and housed better, we would pay more for food.

Last summer I visited fish canneries at the far end of the Alaskan peninsula. The fish packers were women from the Philippines, working round the clock for months to send money home to their children and families.

The canneries used to hire Alaskan high school students at wages high enough to put them through college. But to keep prices competitive, the companies reduced wages and imported labor. That money disappeared from the community.

The CEO of a large U.S. meat company told me that if he raised wages by $3, he could hire locals and not have to deal with immigrant labor. But then he would have to raise the price of his meat by 3 cents per pound (I’m not kidding). That amount, he claimed, would price him out of competitiveness.

Environmental costs

Twenty billion dollars of our tax money goes to subsidies for industrial food production every year. Additional tax money is required to clean up the mess created by that system – polluted drinking water, infertile soil, ocean dead zones and overall misery in the surrounding areas.

While driving to give a talk at a college in rural Minnesota last year, I passed within a mile or so of an industrial pig farm. The overpowering smell – an externalized cost – was still on my clothes hours later.

Safety costs

Food safety is one casualty of a food system devoted to low cost. Companies save money by cutting corners on oversight and overlooking safety violations. The Centers for Disease Control and Prevention (CDC) says food pathogens cause 48 million illnesses, 128,000 hospitalizations and 3,000 deaths each year.

Some experts say unsafe food costs Americans $152 billion annually – $1,850 for each case in health care and lost wages. Severe illnesses from E. coli O157:H7 can generate more than $1 million in health care costs alone, and ruin lives forever.

To these amounts must be added the costs to food producers of product recalls, continued loss of sales, lawsuits and ruined reputations. Sales of spinach, for example, are only now returning to levels reported before the huge E. coli outbreak in 2006.

Here again, the cost of prevention is minimal for large companies producing large volumes of food. Officials of one vegetable-packing company told me that the impressively comprehensive food safety system they instituted in the wake of recalls raised the cost of their products by only one penny a case (I’m not kidding about this, either).

Despite ample evidence from surveys that consumers are willing to pay more to guarantee safe food, large food producers perceive those few pennies as competitive barriers.

Health care costs

Let’s count obesity as another externalized result of a cheap food system. The cheapest foods are high in calories and low in nutritional value – “junk” foods. When food is cheap, people eat more of it.

Abundant cheap food leads companies to aggressively market their products to be eaten any time, any place and in very large amounts – all of which promote biologically irresistible overeating.

Current estimates of the costs of obesity and its consequent illnesses in health care and lost productivity approach $147 billion annually, almost the same as the cost of unsafe food.

Accurate or not, such numbers provide ample evidence for the need to bring agricultural policy in line with health policy.

To pick just one example: Dietary guidelines say to eat more fruits and vegetables, and cut down on sodas. But the indexed cost of fruits and vegetables has increased by about 40 percent since the early 1980s, whereas that of sodas has decreased by about 20 percent.

The high externalized cost of our present food system is a good reason to reconsider current policies when the Farm Bill comes up for renewal in 2012. Now is the time to start working toward food system policies that will better promote health, safety and human welfare.

Marion Nestle is the author of “Food Politics,” “Safe Food,” “What to Eat” and “Pet Food Politics,” and is a professor in the nutrition, food studies and public health department at New York University. E-mail her at food@sfchronicle.com, and read her previous columns at www.sfgate.com/food.

This article appeared on page H – 4 of the San Francisco Chronicle