by Marion Nestle

Search results: myplate

Sep 11 2019

USDA’s Nutrition Education programs

I was astounded to learn that the USDA spends more than $900 million a year on nutrition education since I can hardly recall seeing any of it.

But now we have a Government Accountability Office (GAO) analysis of USDA’s expenditures on nutrition education.

The GAO says that USDA does not:

  • Coordinate its nutrition education efforts
  • Use the expertise of USDA nutritionists
  • Make nutrition education a priority
  • Have leadership with responsibility for nutrition education
  • Share information across sub-agencies and avoid duplicating efforts
  • Assign nutrition education experts to appropriate sub-agencies

No big surprise here—I’ve been hearing such complaints since I worked for the government in the late 1980s—but it’s good to see them documented.

Most of the report is about nutrition education for participants in WIC, SNAP, and other nutrition assistance programs.

Note that there is no line budget for promotion of the Dietary Guidelines for Americans, a statement of of federal nutrition policy, or for MyPlate, a food guide directed at the general public.  Funds to promote these documents have to be authorized by Congress.

Note also that while $900 million seems like a lot of money, it is considerably below what companies like McDonald’s and Coca-Cola each spend on advertising every year.

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Jun 11 2019

My latest publication: food and nutrition policy primer

This is an invited comment on a series of papers on food policy in the American Journal of Public Health, Vol. 109, No. 7 (July): 985-986.

Primer on US Food and Nutrition Policy and Public Health: Marion Nestle Comments

Marion Nestle PhD, MPH

Accepted: April 12, 2019
Published Online: June 05, 2019
The profound influence of food policies on public health is best illustrated by the vast number of people affected by these policies. All three of the most prevalent problems in worldwide public health—undernutrition, overnutrition, and climate change—have roots in dysfunctional food systems. Hunger and malnutrition affect more than 800 million people,1 more than two billion people are overweight and at risk for chronic disease,2 and all of us are subject to the impact of food production on climate change.3

How the US food system affects public health is a matter of intense current interest. “Food system” means the totality of processes through which food is produced, transported, sold, prepared, consumed, and wasted.4 Policies governing these processes emerged piecemeal over the past century in response to specific problems as they arose, with regulatory authority assigned to whatever agency seemed most appropriate at the time.5 Today, multiple federal agencies oversee food policies. For some policy areas, oversight is split among several agencies—the antithesis of a systems approach.

US food policies deal with eight distinct purposes, all of them directly relevant to public health:

  • Agricultural support: Overseen by the US Department of Agriculture (USDA), agricultural support polices are governed by farm bills passed every five years or so. These bills determine what crops are raised and grown, how sustainably, and the extent to which production methods contribute to pollution and greenhouse gas emissions.
  • Food assistance: The USDA also administers food assistance for low-income Americans through programs such as the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps), the Women, Infants, and Children program, and school meals.
  • Nutrition education: This policy is set forth in dietary guidelines revised every five years since 1980 (overseen jointly by the USDA and the US Department of Health and Human Services) and in the MyPlate food guide (USDA).
  • Food and nutrition research: The National Institutes of Health and the USDA fund studies of diet and disease risk.
  • Nutrition monitoring: The USDA and the Centers for Disease Control and Prevention are responsible for keeping track of the quantity and quality of the foods we eat and how diet affects our health.
  • Food product regulation: Rules about food labels, health claims, and product contents are overseen by three agencies: the USDA for meat and poultry; the Food and Drug Administration (FDA) for other foods, beverages, and dietary supplements; and the Federal Trade Commission for advertising.
  • Food safety: Regulation of food safety is split between the USDA for meat and poultry and the FDA for other foods.
  • Food trade: More than 20 federal agencies are involved in regulating the export and import of food commodities and products, among them are the FDA, the USDA, and the Department of Homeland Security.

This list alone explains why advocates call for a coordinated national food policy.6

The food policy primers in this issue of AJPH address the critical links between agricultural policies and health (Miller et al., p. 986) and key components of food assistance policies: direct food aid to the poor (Brownell et al., p. 988) and nutrition standards for school food (Schwartz et al., p. 989). Their authors are well-established policy experts whose thoughtful comments on the political opposition these programs face make it clear why food system approaches to addressing hunger, obesity, and climate change are essential.

Politics stands in the way of rational policy development, as the editorial by Franckle et al. (p. 992) suggests. Although its authors found substantial bipartisan support for introducing incentives to improve the nutritional quality of foods purchased by SNAP participants, congressional interest in this program remains focused almost entirely on reducing enrollments and costs. Please note that for a special issue of AJPH next year, I am guest editing a series of articles on SNAP that will provide deeper analyses of that program’s history, achievements, needs for improvement, and politics. Stay tuned.

In the meantime, how can US public health advocates achieve a systems approach to oversight of the eight food and nutrition policy areas? A recent report in the Lancet suggests a roadmap for action. It urges adoption of “triple-duty” policies that address hunger, obesity, and the effects of agricultural production on climate change simultaneously.7 For example, a largely—but not necessarily exclusively—plant-based diet serves all three purposes, and all federal food policies and programs, including SNAP, should support it. The primers and editorial should get us thinking about how to advocate a range of food system policies that do a better job of promoting public health. Read on.

CONFLICTS OF INTEREST: The author’s work is supported by New York University retirement funds, book royalties, and honoraria for lectures about matters relevant to this comment.

REFERENCES
1. IFAD, UNICEF, WFP and WHO. The State of Food Security and Nutrition in the World. Rome, Italy: Food and Agriculture Organization of the United Nations; 2018. Google Scholar
2. GBD 2015 Obesity Collaborators; Afshin A, Forouzanfar MH, Reitsma MB, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27. Crossref, Medline, Google Scholar
3. Vermeulen SJ, Campbell BM, Ingram JSI. Climate change and food systems. Annu Rev Environ Resour. 2012;37:195–222. Crossref, Google Scholar
4. Institute of Medicine; National Research Council; Nesheim MC, Oria M, Yih PT, eds. A Framework for Assessing Effects of the Food System. Washington, DC: National Academies Press; 2015. Google Scholar
5. Nestle M, Lee PR, Baron RB. Nutrition policy update. In: Weininger J, Briggs GM, eds. Nutrition Update. Vol 1. New York, NY: Wiley; 1983:285–313. Google Scholar
6. Bittman M, Pollan M, Salvador R, De Schutter O. A national food policy for the 21st century. 2015. Available at: https://medium.com/food-is-the-new-internet/a-national-food-policy-for-the-21st-century-7d323ee7c65f. Accessed March 17, 2019. Google Scholar
7. Swinburn BA, Kraak VI, Allender S, et al. The global syndemic of obesity, undernutrition, and climate change: the Lancet Commission report. Lancet. 2019;393(10173):791–846. Crossref, Medline, Google Scholar
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Nov 8 2018

Progress, of sorts, on the 2020 Dietary Guidelines

Remember the Dietary Guidelines?  Those pesky things that have to be revised every five years by order of Congress?

This time, the USDA is firmly in charge of the joint process with HHS.

It says the updating process is well underway.

The call has gone out for nominations of advisory committee members.  This is now closed and USDA expects to appoint the committee within the next few months.

And now it has put the official charter for the process out for comment.

It also has issued a Q and A.

And provides a schedule for public engagement.

A few aspects of this especially interest me:

  • Nothing has been said about a new food guide (MyPlate is left over from the 2010 guidelines).
  • USDA’s close control.  It says this is mandated by Congress.
  • The level of scrutiny of the process will be exceptional, giving the fuss about the 2015 guidelines.
  • Expect the process to be highly politicized.

This committee will have its work cut out for it.  Much appreciation to the brave souls willing to take this on.

I can’t wait to see who they are.

Stay tuned.

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May 25 2016

Guest blog for Scientific American: the new food label

Guest Blog

The FDA’s new rules for food labeling are finally here

The changes are a step toward better health and less obesity, especially in children

By Marion Nestle on May 24, 2016

The FDA’s announcement of final rules for its overhaul of labels on food packages is a signature accomplishment of Michelle Obama’s Let’s Move! campaign to end childhood obesity within a generation.

In 2010, in setting the agenda for Let’s Move!, the White House Task Force on Childhood Obesity called for improving the clarity, accuracy, and consistency of food package labels to enable parents and children to make healthier food choices.  The Task Force noted that more than half the adult public used food labels to decide what to buy, but that the current labels had hardly changed since the FDA’s regulations of 1993.

The FDA actually began work on revising the food label in 2005 with a request for public input on updating serving sizes, and it began formal rulemaking in 2008.  The FDA proposed rules and issued its last call for comments in 2014.

I attribute this nine-year process to details and politics.

First, the details. The Federal Register notice on the food label takes up 943 pages, and it takes another 170 pages to explain the changes in serving sizes.

FDA’s fact sheet on the changes explains the politics.  Most changes are relatively uncontroversial: the greater emphasis on calories, the removal of calories from fat, the requirement for “dual column” labels for “per serving” and “per package,” the updating of serving sizes to more closely reflect actual intake, and the rewording of the Daily Value footnote.  As Michelle Obama put it, ”you will no longer need a microscope, a calculator, or a degree in nutrition to figure out whether the food you’re buying is actually good for our kids.  So that’s a phenomenal achievement.”

Indeed it is, especially in light of a political climate in which the food industry and Congress do all they can to undermine public health measures in school food and child nutrition programs.

Mrs. Obama alluded to the ongoing political controversy: “most important of all, this label will tell you how much sugar in your snack was added during processing, and how much of it comes from ingredients like fruit.”

The new food label distinguishes between intrinsic sugars in food and those added in manufacturing; it also sets a Daily Value for the maximum amount of sugars recommended for diets of 2,000 calories a day.  I credit the Center for Science in the Public Interest for this accomplishment; it petitioned FDA for these changes in 2013 (its first added sugar petition was in 1999).

The Washington Post got right to the core of the controversy: “Why the sugar industry hates the FDA’s new Nutrition Facts label.” Americans consume roughly twice the amount of sugar recommended for good health, and sugars are rampant in processed foods.  All it takes is one 16-ounce soft drink to reach the 50-gram daily maximum.

The Sugar Association, the trade group for producers of sugar cane and sugar beets invokes science as the reason for its intense opposition: “We are concerned that the ruling sets a dangerous precedent that is not grounded in science, and could actually deter us from our shared goal of a healthier America.”

The Association argues, correctly, that the sugars that occur naturally in fruits are biochemically identical to those added in manufacturing.  But this argument misses how added sugars dilute the nutritional value of food products.  Much research supports the health benefits of eating fruit, whereas added sugars raise risks for obesity and other chronic conditions.

The Sugar Association does not really care about science.  It cares about what will happen to sales if people read labels and reject products with added sugars.  This, of course, is one of the purposes of Added Sugars on food labels.

The Association has reason to worry.  Since 1999, per capita consumption of sugars has fallen in the United States, although it still exceeds the 10 percent of calories recommended by the World Health Organization last year.  The new label should accelerate that downward trend.

An even greater worry is that labeling added sugars might encourage manufacturers to reduce the amounts in their products.  The FDA’s listing of trans-fatty acids on food labels in 2006 led to an immediate reductionin the use of hydrogenated oils as ingredients in food products.  I expect to see grams of sugars decline by the time these rules take effect in May 2018 (small food producers get until May 2019).

I see the new label as a political win for public health and Let’s Move!  But let’s keep this in perspective.  Healthful diets are based on foods, not food products.  We would all be healthier eating foods that do not come with Nutrition Facts panels, and saving most of those that do for once-in-a-while occasions.

The views expressed are those of the author(s) and are not necessarily those of Scientific American.

Recent Scientific American Articles by Marion Nestle

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Mar 29 2016

Some food guides are unafraid of sustainability

I’ve just heard about the new Netherlands food guide.  It emphasizes sustainability.  According to an article in National Geographic’s The Plate,

The Netherlands Nutrition Centre says  it is recommending people eat just two servings of meat a week, setting an explicit limit on meat consumption for the first time [but see added comment below].

Here’s what the Netherlands food guide looks like.

Capture

Google translator calls this a pyramid, and explains: “Moreover, the Pyramid helps you eat more environmentally friendly broadly.”

Ours, of course, looks like this.  I’m guessing the USDA is working on a new food guide in response to the 2015 Dietary Guidelines.  These do not mention sustainability at all—the S word.

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If you want to check out food guides m other countries, see FAO’s pages on food-based dietary guidelines.  You can search the site by regions and countries.  Fun!

Added comment: A reader from Amsterdam, who obviously speaks Dutch better than Google translator, and who also is well versed in the Dutch nutrition scene, writes:

Sustainability is indeed an important concern in the new Dutch food guide. However, the recommendation for meat is not ‘two servings per week’, but two servings of red meat and two servings of white meat (chicken), for a total of four per week. One serving is 100 gram or 3.5 oz. of meat. Diehards may add a third serving of red meat; 300 g of red meat (11 oz) plus 200 g of chicken (7 oz) per week is considered the absolute limit.

The fish advice has been reduced from twice to once a week because environmental concerns were thought to outweigh the small health benefit of a second weekly serving of fish.

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Jan 11 2016

The 2015 Dietary Guidelines’ hidden advice about sugary drinks: definitely there, but hard to find 

I’m indebted to Maria Godoy of NPR’s The Salt for pointing out where in the new 2015 Dietary Guidelines you can find advice about cutting down on sugary drinks.  As she puts it, this is easy to miss.

Here’s my wonky analysis.

In my post about the 2015 Dietary Guidelines, I noted that they are unambiguous about the need to reduce added sugars to 10% or less of calories.  But what they say about cutting down on sugary drinks—the leading source of sugars in US diets—is buried deep in the text.  Fortunately, Deborah Noble of slowfoodfast.com has performed a great public service by producing the 2015 Dietary Guidelines in a searchable pdf format.Here’s where to find advice about cutting down on sugary drinks:

The Executive Summary: See under “Cross-Cutting Topics of Public Health Importance:”

Similarly, added sugars should be reduced in the diet and not replaced with low-calorie sweeteners, but rather with healthy options, such as water in place of sugar-sweetened beverages.

Figure 2-10 explains:

The major source of added sugars in typical U.S. diets is beverages, which include soft drinks, fruit drinks, sweetened coffee and tea, energy drinks, alcoholic beverages, and flavored waters.

Reading the Figure tells you that beverages comprise a whopping 47% of added sugars (closer to half if you add in sweetened milks, teas, and coffees).  The text following the Figure says:

Shift to reduce added sugars consumption to less than 10 percent of calories per day: Individuals have many potential options for reducing the intake of added sugars. Strategies include choosing beverages with no added sugars, such as water, in place of sugar-sweetened beverages, reducing portions of sugar-sweetened beverages, drinking these beverages less often, and selecting beverages low in added sugars.

Strategies?  How about just saying: “Cut down on sugary drinks” or “Drink water instead of sugary drinks.”

Figure ES-1 in the Executive Summary illustrates the 2015-2020 Dietary Guidelines for Americans at a Glance.  All it says is:

Limit calories from added sugars…Consume an eating pattern low in added sugars…Cut back on food and beverages higher in these components to amounts that fit within healthy eating patterns.

Figure 3.2 shows Implementation of the Guidelines through MyPlate: “Drink and eat less…added sugars,” but nothing about sugary drinks.

This circumspection is weird.  Clear, straightforward advice to cut down on sugary beverages has plenty of historical precedent.

Both Figures ES-1 and 3.2 are most certainly derived from a USDA graphic on the MyPlate website (dated January 2016).  This says flat out:

Drink water instead of sugary drinks.

This statement, in turn, derives from:

  • The precepts issued with the 2010 Dietary Guidelines in January 2011
  • The statements issued with the MyPlate graphic in June 2011

myplate

  • The USDA’s May 2012 tip for making better beverage choices.

The 2015 DGAC (Dietary Guidelines Advisory Committee) repeatedly urged limits on consumption of sugar-sweetened beverages.  Statements like this one, for example, appear throughout the document:

To decrease dietary intake from added sugars, the U.S. population should reduce consumption of sugar-sweetened beverages.

Why did the USDA and HHS writing committee choose to waffle about his point?

This cannot be an accident.  It must be deliberate.  And it can have only one explanation: politics.

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Jan 7 2016

The 2015 Dietary Guidelines, at long last

The 2015 Dietary Guidelines are out.

Picture1

They are now online in a version that takes up dozens of screens with annoying drop-down boxes.  It’s hard to navigate, and if it’s searchable, I can’t figure out how (OK, it’s searchable but doesn’t work all that well).

First the good news.  These Dietary Guidelines—for the first time—attempt to focus on foods and dietary patterns:

Previous editions of the Dietary Guidelines focused primarily on individual dietary components such as food groups and nutrients. However, people do not eat food groups and nutrients in isolation but rather in combination, and the totality of the diet forms an overall eating pattern.

They almost succeed in this mission.  The Guidelines say:

  • Follow a healthy eating pattern across the lifespan [Pattern].
  • Focus on variety, nutrient density, and amount [Pattern].
  • Limit calories from added sugars and saturated fats and reduce sodium intake [Oops: Nutrients].
  • Shift to healthier food and beverage choices [Pattern].
  • Support healthy eating patterns for all [Pattern].

A healthy eating pattern, they say:

  • Includes foods from various groups [Pattern].
  • Limits saturated fats, trans fats, added sugars, and sodium [Oops: Nutrients].

As for (Oops) Nutrients:

  • Less than 10% of calories from added sugars [this is new, but consistent with many other reports such as the one from WHO]
  • Less than 10% of calories from saturated fats [in the Guidelines since 1990]
  • Less than 2,300 mg sodium [no change from 2010]

Why Oops?  Because these Dietary Guidelines, like all previous versions, recommend foods when they suggest “eat more.”   But they switch to nutrients whenever they suggest “eat less.”

In the 2015 Dietary Guidelines,

  • Saturated fat is a euphemism for meat.
  • Added sugars is a euphemism for sodas and other sugar-sweetened beverages.
  • Sodium is a euphemism for processed foods and junk foods.

If the Guidelines really focused on dietary patterns, they wouldn’t pussyfoot.  They would come right out and say:

  • Eat less meat [OK, they do but only under the euphemism of “protein” and only for males. “Some individuals, especially teen boys and adult men, also need to reduce overall intake of protein foods (see Figure 2-3) by decreasing intakes of meats, poultry, and eggs and increasing amounts of vegetables or other underconsumed food groups.”  But what about processed meats?  Not a word that I can find.
  • Cut down on sugary drinks [OK, it says “drink water instead of sugary drinks,” but good luck finding that statement without knowing where it is].
  • Eat less processed and junk food.

Why don’t they?  Politics, of course.

Recall that Congress weighed in with an Appropriations Bill that called for an investigation of the scientific basis of the Guidelines and granted $1 million to the National Academy of Medicine to take them over.

Recall also that the secretaries of USDA and HHS said that the Guidelines would not say anything about sustainability as a rationale for advising eating less meat.

So let’s count the 2015 Guidelines as a win for the meat, sugary drink, processed, and junk food industries.

Other concerns, nutritional and otherwise:

  • Calories: The Guidelines deemphasize calories.  They dropped the information about food sources of calories from the 2010 edition, even though calorie balance remains a—if not the—major public health nutrition problem (an Appendix gives calorie needs).
  • Portion sizes: the best way to control calorie intake is by eating smaller or moderate portions. If the Guidelines talk about portion size, it must be well hidden.
  • Cholesterol: the recommendation to limit cholesterol has been dropped, but the document says, confusingly, that “this change does not suggest that dietary cholesterol is no longer important to consider when building healthy eating patterns. As recommended by the IOM, individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern.”  Could the dropping of the limit have anything to do with egg-industry funding of research on eggs, the largest source of dietary cholesterol, and blood cholesterol?  The Physicians Committee for Responsible Medicine has just filed a lawsuit on that very point.
  • Protein: My pet peeve.  The Guidelines use this as yet another euphemism for meat.  “Protein” lumps meat together with seafood, poultry, eggs, nuts, seeds, and soy.  But grains and dairy also have protein, so using this term makes no nutritional sense and obfuscates the message to eat less meat.
  • Seafood: the document recommends 8 ounces a week of seafood high in omega-3s but low in methylmercury. That pretty much means salmon and sardines (anchovies are too salty).

I might have more to say when I can look at a document that is easier to read.

Full disclosure: I was a peer reviewer on an earlier version of this document.

Documents and commentary

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Oct 7 2015

The bizarre saga of the 2015 Dietary Guidelines: Continued

Two events yesterday:

#1.  USDA and HHS announce that sustainability will not be part of the Dietary Guidelines.

This year, we will release the 2015 edition, and though the guidelines have yet to be finalized, we know they will be similar in many key respects to those of past years. Fruits and vegetables, low-fat dairy, whole grains and lean meats and other proteins, and limited amounts of saturated fats, added sugars and sodium remain the building blocks of a healthy lifestyle.

…In terms of the 2015 Dietary Guidelines for Americans (DGAs), we will remain within the scope of our mandate in the 1990 National Nutrition Monitoring and Related Research Act (NNMRRA), which is to provide “nutritional and dietary information and guidelines”… “based on the preponderance of the scientific and medical knowledge.”  The final 2015 Guidelines are still being drafted, but because this is a matter of scope, we do not believe that the 2015 DGAs are the appropriate vehicle for this important policy conversation about sustainability.

OK, but see Michele Simon’s analysis of the legal issues related to sustainability in the guidelines, and My Plate My Planet’s analysis of the comments filed on the sustainability question.

As my analysis shows, the USDA and HHS would be well within its legal authority to include sustainability. In summary:

    • A plain reading of the statute does not preclude sustainability;
    • The Congressional intent was to further a broad agenda on health;
    • Previous DGA versions included issues beyond “nutrition and diet”.

And also see Kathleen Merrigan et al’s argument in favor of sustainable dietary guidelines in Science Magazine.

So this is about politics, not science.

#2.  A coalition of critics of the Dietary Guidelines is attempting to block their release.

Yesterday’s Hagstrom Report and, later, Politico (both behind paywalls) reported that this group is calling on  USDA and HHS to turn over the guidelines to a committee of the National Academy of Sciences Food and Nutrition Board for reexamination before releasing them to the public.

The issues?  The meat and beverage recommendations.

The group is funded by philanthropists Laura and John D. Arnold, who fund Nina Teicholz’s work.

Teicholz is on the board of the group as is Cheryl Achterberg, dean of the Ohio State University College of Education, and John Billings, who directs the Wagner School’s Health Policy and Management Program at NYU (why they agreed to do this is beyond me).

Hagstrom notes that coordinating support is coming from Beth Johnson, a former undersecretary for food safety at USDA who has her own consulting firm with clients apparently including the National Restaurant Association and the National Cattlemen’s Beef Association.

Other members of the advisory board include several scientists who do research funded by food companies.

The Coalition’s website is here.

This morning’s Politico Pro Agriculture has a long piece on the funding behind the coalition.

In the lead up to congressional hearings on the proposed 2015 dietary guidelines, the Arnolds are spending an initial $200,000 to communicate that critique and to advocate for changes that they say would improve the process. They have funded the new political action group, called The Nutrition Coalition, whose well-placed lobbyists have helped Teicholz score face-to-face meetings with top officials in Congress and the White House to push for an independent review of the guideline process. The team helped persuade lawmakers to insert language in the fiscal 2016 House agriculture spending bill to direct the National Academy of Medicine to conduct such a review.

Really? Eating fruits and vegetables and not overeating calories requires this level of lobbying?

This too is about politics.

The mind boggles.

Addition

The Hagstrom Report is keeping track of the testimony at today’s congressional hearing on the guidelines.

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