by Marion Nestle

Search results: added sugar

Jan 4 2017

SNAP to Health launches new website, resources

I was a member of the commission that developed the SNAP to Health report.  We recommended getting more information about what foods SNAP participants purchase with their benefits and conducting pilot studies or taking sugary drinks out of the eligible items.

Now SNAP to Health has redesigned its website as a a virtual town hall for information and resources regarding food insecurity, obesity prevention, and the current state of federal food assistance programs.  It has also added sections for WIC resources.

Here’s the press release about the new site.

And here’s one more item about SNAP

Pushing for drug testing of SNAP recipients: Wisconsin Gov. Scott Walker is still trying to do this in his state.  According to Politico

Wisconsin U.S. District Court Judge Charles Clevert threw out a lawsuit the state had filed against USDA in July 2015 that sought to prevent the department from blocking the state from implementing a drug-testing requirement for recipients of Supplemental Nutrition Assistance Program benefits. Clevert said Wisconsin filed suit too soon, because it did not allow USDA to formally reject the state’s new requirement. Normally, states request waivers from USDA when they want to add their own SNAP requirements, but Wisconsin filed its suit preemptively — leading Agriculture Secretary Tom Vilsack to suggest shortly after the suit was filed that it was a political move by Walker, since he was a GOP candidate in the 2016 presidential race. (Walker ended his campaign in September 2015.)

“The reason why [Walker] hasn’t requested a waiver is because he knows it’s not going to be granted because the law is pretty clear,” Vilsack said at the time.

This is a bad idea.  I hope he forgets it.

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Nov 17 2016

FoodNavigator-USA’s Special Edition: Food allergy and intolerance

FoodNavigator.com does occasional “special editions” in which they collect articles on particular topics from the perspective of their food-industry audience.  This one is on food allergies and intolerances, about which remarkably little is known.  If you are allergic or intolerant, the best you can do is hope for an accurate allergy test or do everything you can to avoid the food that triggers reactions.  Good luck with that since allergies are hard to diagnose and allergenic ingredients sneak into a great many foods and are not always revealed on labels.

FoodNavigator begins with Food allergy 101: Are you up to speed?

Food allergy is on the rise in many countries, but how many people are impacted in the US? We’ve collected some facts and figures from Food Allergy Research and Education (FARE), the world’s largest private source of funding for food allergy research; the CDC (Centers for Disease Control and Prevention); and NIAID, the lead institute at the National Institutes of Health conducting research on food allergy… Display [this site has basic statistics on prevalence and basic definitions of terms]

The lowdown on food allergy and intolerance: In conversation with Dr Steven TaylorMost researchers agree that the prevalence of food allergies is increasing in the US. Yet the amount of money spent on finding out why is surprisingly low, says one food allergy expert… Read

Soup-To-Nuts Podcast: Is low-FODMAP the new gluten-free? For the 45 million Americans who suffer from irritable bowel syndrome, identifying food that they can safely eat without triggering a flare up is a source of deep frustration that also could be a sizable market opportunity for innovative food and beverage companies that can provide an easy solution… Listen now

Allergen-friendly, free-from claims offer marketing potential beyond conventional food, beverageWith the number of Americans with food allergies and sensitivities increasing, free-from claims have become du jour in the conventional food and beverage space, but they remain relatively rare in the supplement segment and as such offer manufacturers a powerful tool to set their products apart. .. Read

Leadbetter’s realigns to focus on allergy-friendly manufacturing: ‘Our growth curve is very steep’San Francisco-based Leadbetter’s Bake Shop has stopped making English muffins, its flagship product, and changed its name to Better Bakeries as it focuses on building an allergy-friendly food manufacturing and co-packing business designed to bridge the gap between Mom & Pop scale operators and the big guns in gluten-free… Read

Elevation Brands CEO: Gluten-free bakery is saturated, but there’s a ton of white space in other allergy-friendly categoriesThe world will probably keep turning without another gluten-free cookie or cracker, but there is a ton of white space for allergy-friendly foods in other parts of the store, and untapped opportunities in c-stores, club stores, schools, and in Mexico, where the gluten-free retail market is set to “explode,” says the CEO of Elevation Brands, the parent company of Ian’s. .. Read

‘First’ entirely gluten-free dining hall opens on US college campusKent State University claims to have opened the first certified gluten-free dining hall on a college campus… Read

Gluten-free products are evolving to be more nutritious, flavorful, Firebird Artisan Mills saysThe gluten free market in the US remains hot, but as the category becomes more crowded, manufacturers must offer products with added appeal to stay competitive – such as a protein boost from pulses or an added dose of fiber and flavor with ancient grains, according to experts… Watch now

PepsiCo rolling out gluten-free Quaker oatmeal range across US retailNational distribution under way following limited launch in selected stores late last year… Read

Enjoy Life Foods: Dedicated allergy-friendly sets in the natural aisle are the best way to merchandise free-from foodsWith one in 13 children diagnosed with a food allergy in the US*, ‘allergy-friendly’ foods are now infiltrating every category in grocery. But right now, it still makes sense for most retailers to merchandise them in a dedicated set rather than spreading them around the store, unless you have very clear signage, says Enjoy Life Foods… Watch now

Early introduction of allergens reduces food allergies, suggests studyResearchers say they have “moderate certainty” that introducing allergenic food such as peanuts or egg at an early age reduces risk of developing allergies… Read

Digestive issues attributed to lactose intolerance may be caused by A1 beta-casein protein, suggests study funded by a2 MilkNew clinical research – funded by the a2 Milk Company – lends credence to its claims that many consumers who believe they can’t tolerate lactose (milk sugar) should really be blaming their digestive discomfort on the A1 beta casein protein in milk products instead. However, more human data is needed before this moves beyond the realm of theory into fact, says the National Dairy Council… Read

Quinn Snacks removes more than gluten from pretzels, shows consumers its supply lineHistorically consumers who wanted a gluten-free alternative to a wheat-based product had to sacrifice nutrition, taste or accept the presence of other common allergens in the ingredient list. .. Read

60-second interview, Beneo: Is rice still the first choice in gluten-free recipe formulation? Rice flours and starches dominated the first generated of gluten-free goods, particularly in the bakery segment, but are they still the #1 choice in formulators’ toolkits? FoodNavigator-USA caught up with Pierre Donck, regional product manager at rice ingredients specialist Beneo Inc, to find out… Read

Aug 29 2016

Yes! The Berkeley soda tax is doing what it is supposed to

Jennifer Falbe and other investigators from Kristin Madson’s group at UC Berkeley have just produced an analysis of the effects of the Berkeley soda tax on consumption patterns.

They surveyed people in low-income communities before and after the tax went into effect.  The result: an overall 21% decline in reported soda consumption in low-income Berkeley neighborhoods versus a 4% increase in equivalent neighborhoods in Oakland and San Francisco.

The Los Angeles Times breaks out these figures: 

In Oakland and San Francisco, which have not yet passed a tax, sales of regular sodas went up by 10%.

Other findings, as reported by Healthy Food America:

  • During one of the hottest summers on record, Berkeley residents reported drinking 63 percent more bottled water, while comparison cities saw increases of just 19 percent.
  • Only 2 percent of those surveyed reported crossing city lines to avoid the tax.
  • The biggest drops came in consumption of soda (26%) and sports drinks (36%).

Agricultural economist Parke Wilde at Tufts views this study as empirical evidence for the benefits of taxes.  He writes on his US Food Policy blog that it’s time for his ag econ colleagues to take the benefits of taxes seriously:

There is a long tradition in my profession of doubting the potential impact of such taxes…Oklahoma State University economist Jayson Lusk, who also is president of the Agricultural and Applied Economics Association (AAEA), has blogged several times about soda taxes, agreeing with most of the Tamar Haspel column  in the Washington Post, and concluding stridently: “I’m sorry, but if my choice is between nothing and a policy that is paternalistic, regressive, will create economic distortions and deadweight loss, and is unlikely to have any significant effects on public health, I choose nothing” (emphasis added).

Wilde points out that Lusk has now modified those comments in a blog post.

All that said, I’m more than willing to accept the finding that the Berkeley city soda tax caused soda consumption to fall. The much more difficult question is: are Berkeley residents better off?

Yes, they are.

The Berkeley study is good news and a cheery start to the week.  Have a good one.

Addition

Politico adds up the “piles of cash” being spent on the soda tax votes in San Francisco, Oakland, and Alameda and analyzes the soda industry’s framing of the tax as a “grocery tax.”

May 5 2016

More on corporate funding of nutrition research: exchange of letters

In January this year, JAMA Internal Medicine published my Viewpoint on corporate funding of nutrition research: science or marketing.

Richard Kahn, former chief scientist and medical officer of the American Diabetes Association, wrote a letter in reply (see below for more about him**).  The journal published his letter, along with my response, in its current issue.  Here’s what I said.

In Reply Dr Kahn requests evidence that nutrition research funded by food companies is of lesser quality than studies funded by independent agencies or performed by investigators with nonfinancial conflicts of interest. Concerns about such issues are relatively recent; few published studies address them directly. Instead, concerns about industry sponsorship of nutrition research derive from comparisons with the results of studies of funding by tobacco, chemical, drug, or medical device companies. This research typically finds industry-sponsored studies to report results more favorable to the products of the sponsor than studies not funded by industry. It identifies subtle rather than substantive differences in the quality of this research; industry-funded studies are more likely to underreport unfavorable results and interpret neutral results more positively.1 When results are negative, they are less likely to be published.2

Between March 2015 and March 2016, I identified 166 industry-funded nutrition research studies and posted and discussed them on my blog.3 Of these, 154 reported results favorable to the interest of the sponsor; only 12 reported contrary results. The few studies systematically examining the influence of industry funding on nutrition research tend to confirm results obtained from other industries. For example, a systematic review comparing industry-funded and nonindustry-funded trials of probiotics in infant formula reported no association of funding source with research quality. Industry-funded studies, however, seemed more likely to report favorable conclusions unsupported by the data.4

Dr Kahn states that sponsored studies often specify that the funder had no role in the study. Only recently have some journals required such statements, and I am unaware of research on the extent of this practice or authors’ adherence to it. Among the 166 industry-funded studies that I reviewed, few disclosed involvement of a sponsor.

Dr Kahn asks whether industry funding is any more biasing than career self-interest or intellectual passion. Unlike industry funding, self-interest and passions are intrinsic to every scientist who conducts research, are a matter of public record, cannot be eliminated, and have not been shown to consistently bias research results in the same ways as industry funding.5 Fortunately, nutrition societies and research institutions are developing policies to manage financial relationships with industry.6 Such policies hold promise for preventing financial conflicts of research in nutrition research.

1. Lundh  A, Sismondo  S, Lexchin  J, Busuioc  OA, Bero  L.  Industry sponsorship and research outcome. Cochrane Database Syst Rev. 2012;12:MR000033. PubMed

2. Rising  K, Bacchetti  P, Bero  L.  Reporting bias in drug trials submitted to the Food and Drug Administration: review of publication and presentation. PLoS Med. 2008;5(11):e217. PubMed   |  Link to Article

3. Nestle  M. Food Politics Blog. https://foodpolitics.com/. Accessed March 2, 2016.

4. Mugambi  MN, Musekiwa  A, Lombard  M, Young  T, Blaauw  R.  Association between funding source, methodological quality and research outcomes in randomized controlled trials of synbiotics, probiotics and prebiotics added to infant formula: a systematic review. BMC Med Res Methodol. 2013;13:137. PubMed   |  Link to Article
5. Bero  L.  What is in a name? Nonfinancial influences on the outcomes of systematic reviews and guidelines. J Clin Epidemiol. 2014;67(11):1239-1241. PubMed   |  Link to Article 
6. Charles Perkins Centre. Engagement with Industry Guidelines 2015. University of Sydney, 2015. https://intranet.sydney.edu.au/perkins/research-support/engaging-with-industry.html. Accessed March 2, 2016.
**Richard Kahn is infamous in my circles for supporting the positions of the sugar and soda industries while with the American Diabetes Association and now.  I wrote about what he said in an interview with Corporate Crime Reporter in my book What to Eat (pages 355-356).  Recently, The Russells (of CrossFit) had a lot more to say about Kahn’s ongoing opposition to public health measures.
Nov 3 2015

Food-Navigator-USA’s roundup of articles on bakery and snack trends

Snacks are trending.  As Food-Navigator-USA’s analysts see it, “there are new opportunities in gluten-free, ethnic breads and gourmet bakery items, while snack makers are tapping into consumer demand for ancient grains and seeds, plant-based proteins, and bean, pea and lentil-based ingredients….Americans are increasingly abandoning three square meals a day for serial snacking.”

Oct 6 2015

Two rare industry-funded studies with results that must have disappointed the funders

Consumption of Honey, Sucrose, and High-Fructose Corn Syrup Produces Similar Metabolic Effects in Glucose-Tolerant and -Intolerant Individuals.  Susan K Raatz, LuAnn K Johnson, and Matthew J Picklo.  J. Nutr. 2015; 145:2265-2272 doi:10.3945/jn.115.218016 

  • Conclusions: Daily intake of 50 g carbohydrate from honey, sucrose, or HFCS55 for 14 d resulted in similar effects on measures of glycemia, lipid metabolism, and inflammation. All 3 increased TG [triglyceride] concentrations in both GT [glucose tolerant] and IGT [glucose intolerant] individuals and elevated glycemic and inflammatory responses in the latter.
  • Funding: Supported by a grant from the National Honey Board and by the USDA Agricultural Research Service.
  • Comment.  The authors hypothesized that honey would result in improved glycemia and insulin sensitivity compared with sucrose and HFCS.  But they found that their “data do not support the contention that the consumption of honey vs. HFCS or sucrose provides an added health benefit for maintenance of glucose homeostasis and other cardiometabolic outcomes because all 3 sugars evaluated exerted similar metabolic effects.”

Sugar-sweetened beverage consumption and incident hypertension: a systematic review and meta-analysis of prospective cohortsViranda H Jayalath, Russell J de Souza, Vanessa Ha, Arash Mirrahimi, Sonia Blanco-Mejia, Marco Di Buono, Alexandra L Jenkins, Lawrence A Leiter, Thomas MS Wolever, Joseph Beyene, Cyril WC Kendall, David JA Jenkins, and John L Sievenpiper.  Am J Clin Nutr 2015; 102:914-921 doi:10.3945/ajcn.115.107243.

  • Conclusions: SSBs were associated with a modest risk of developing hypertension in 6 cohorts. There is a need for high-quality randomized trials to assess the role of SSBs in the development of hypertension and its complications.
  • Funding: “The Canadian Institutes of Health Research…through the Canada-wide Human Nutrition Trialists’ Network and by the Diet, Digestive Tract, and Disease (3D) Centre, which is funded through the Canada Foundation for Innovation.  The Ministry of Research and Innovation’s Ontario Research Fund provided the infrastructure for the conduct of this project.”  Some of the investigators also received funds from other Canadian government agencies or health associations.  This, therefore is actually an independently funded study.
  • Authors’ funding disclosures: RJdS has received research support from the Calorie Control Council and the Coca-Cola Company…ALJ is a part owner, vice president, and director of research of Glycemic Index Laboratories, Toronto, Canada….JB has received research support from the Calorie Control Council and The Coca-Cola Company…CWCK has received research support from the Calorie Control Council, the Coca-Cola Company (investigator initiated, unrestricted grant), Hain Celestial, Kellogg, Kraft, Loblaw Companies Ltd., Solae, and Unilever…DJAJ has received research grants from Loblaw Companies Ltd., Unilever, the Coca-Cola Company… JLS has received research support from the Calorie Control Council and the Coca-Cola Company…travel funding, speaker fees, or honoraria from the Calorie Control Council, the Canadian Sugar Institute, World Sugar Research Organization, White Wave Foods, Abbott Laboratories, Dairy Farmers of Canada, Dr. Pepper Snapple Group, The Coca-Cola Company, and the Corn Refiners Association….
  • Comment: In this study, a group of investigators, some—but not all— of whom typically receive funding from food companies, participated in a study funded by Canadian government and health agencies.  If nothing else, this study is evidence for the importance of independent funding of nutrition research.

The score, for those of you following this saga, is now 65 studies with results favoring the sponsor to 5 with unfavorable results.  But I will soon be posting another 5 of the former kind.

Aug 14 2015

Let’s Ask Marion: Can Exercise Balance Out Soda Drinking?

This is the latest in a series of Q & A’s written by .   It appeared on Civil Eats, August 12, 2015.  And please note references added at the end.

Civil Eats: Your next book, Soda Politics: Taking on Big Soda (and Winning), documents the history of how this sugary beverage gave rise to some of our most powerful corporations and has lately become Public Enemy Number One in the war on obesity.

With sales on the decline, the New York Times recently reported that Coca-Cola is pouring millions of dollars into a ‘science-based’ campaign to convince the public that the secret to achieving and maintaining a healthy weight is not avoiding excess calories, but getting more exercise. What’s the science on more exercise versus fewer calories?

Marion Nestle: When it comes to studies about the health effects of sugary drinks, the science, alas, depends on who pays for it. Studies paid for by government or private health foundations show that if you want to prevent obesity, [a combination of] eating less and moving more works every time.

You can lose weight by eating less on its own. But you will have a much harder time doing that by increasing physical activity. This is because it takes lots of effort to compensate for excess calories. Eat two little Oreo cookies—100 calories—and you have to walk a mile to work them off. Drink a 20-ounce soda and you need to cover nearly three miles. This was the point of the New York City health department’s subway current poster campaign, which shows that you need to walk from Union Square in Manhattan to downtown Brooklyn to burn off 275 calories.

The soda industry would love you to believe that the principal cause of obesity is lack of physical activity, and they put tons of money into research to discourage other ideas. They much prefer you to believe that all of their products can be part of an active, healthy lifestyle that includes balanced diets, proper hydration, and regular physical activity. I call the idea the “physical activity diversion.” It deflects attention from what really counts in obesity prevention: not eating huge amounts of junk foods, snack foods, and sodas.

Mind you, I’m greatly in favor of physical activity for its many benefits: physiological, social, psychological, and health. But there is a good reason for the outraged reaction to Coca-Cola’s video seemingly suggesting that all you have to do to burn off the 140 “happy calories” in a 12-ounce soft drink is to laugh out loud for 75 seconds. This is so far from the reality of calorie balance that several countries actually banned the commercial [in 2013].

Soda companies promote the primacy of physical activity in other clever ways. The Coca-Cola Foundation says that about one-third of its philanthropic contributions go to organizations working to counter obesity, especially through promotion of physical activity.

Both Coca-Cola and PepsiCo invest heavily in sponsorship of international sports teams. They put fortunes into recruiting sports celebrities as spokespersons. These investments accomplish two purposes: they influence fans to buy the products and shift the focus to physical activity. Obesity, these imply, is about what you do, not what you eat or drink. Public health advocates complain about how frequently young people—especially those of color or in low-income families—are exposed to advertising by professional athletes. The sponsored programs and celebrities never suggest that drinking less soda might be a useful health-promotion strategy.

As a nutritionist and co-author of a book titled Why Calories Count, I thoroughly agree that balance, variety, and moderation are fundamental principles of healthful diets, and that weight gain is a result of calorie imbalance.

But soda companies distort these principles to distract from their marketing of sugary drinks and how overconsumption of these drinks overrides normal physiological controls of hunger and satiety. Independently funded research makes it abundantly clear that avoiding sodas is one of the best things you can do for your health.

Sponsorship of research or research investigators by Coca-Cola or the American Beverage Association is reason alone for skepticism.

References: I am grateful to Richard Cooper for forwarding his paper on the relative contributions to obesity of diet and exercise.  From his review of the literature, you must reduce calories to lose weight.

He also pointed me to rebuttals by  Blair and Hill, the investigators featured in the New York Times article cited above.

The rebuttal by Steven Blair and colleagues.

  • Funding: Drs. Blair, Archer, and Hand are funded via unrestricted research grants from The Coca-Cola Company for analyses of dietary trends and for an energy balance study.
  • Conflict of interest: None declared [Evidently, these investigators do not perceive funding by Coca-Cola as a conflict]

The rebuttal from James Hill and John Peters:

  • Conflict of interest: J.H. receives research grants from the American Beverage Association and serves on advisory boards for McDonalds, General Mills and McCormicks. J.P. receives research funding from the American Beverage Association.

 

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Mar 12 2015

New Scientist: Cigarettes get plain packets – will junk food be next?

Here is the online version of my commentary in New Scientist, March 14, 2015:24-25.

I submitted an illustration with it, which the editors did not use.  It’s from the Ontario Medical Association.

OMA

Cigarettes get plain packets – will junk food be next?

The tobacco industry is fighting moves to sell cigarettes in plain packs by claiming food manufacturers will be hit next. Will they?

ANTI-SMOKING advocates will be delighted. MPs have today voted in favour of introducing uniform packaging for cigarettes in the UK. That plain wrappers will undoubtedly further reduce smoking, especially among young people, is best confirmed by the tobacco industry’s vast opposition to this government measure and positive evidence from Australia, the first country to adopt it.

Along with lobbying and appeals to the World Trade Organization, the tobacco industry, when under attack, inevitably wheels out well-worn arguments about the nanny state, personal freedom, lack of scientific substantiation, and losses in jobs and tax revenues.

So to perk up its tired and thoroughly discredited campaign, the tobacco folks have added a new argument. Requiring plain wrappers on cigarettes, they say, is a slippery slope: next will be alcohol, sugary drinks and fast food. This argument immediately raises questions. Is it serious or just a red herring? Should the public health community lobby for plain wrappers to promote healthier food choices, or just dismiss it as another tobacco industry scare tactic?

Let me state from the outset that foods cannot be subject to the same level of regulatory intervention as cigarettes. The public health objective for tobacco is to end its use. So for cigarettes the rationale for plain wrappers is well established. Company logos, attractive images, descriptive statements, package colours and key words all promote purchases. Plain wrappers discourage buying, especially along with other measures such as bans on advertising, smoke-free policies, taxes and health warnings.

Australia’s pioneering law specified precise details of pack design, warning images and statements. The result: cigarette brands all look much alike. Most reports say plain packaging boosts negative perceptions of cigarettes among smokers and increases their desire to quit. Australia expects plain packaging to further reduce its smoking rate, which, at 12.8 per cent, is already among the world’s lowest. Along with the UK, New Zealand and Ireland are well on the way to adding plain packaging to their anti-smoking arsenal. More nations are considering it.

Which is all bad news for the tobacco industry. So it ramps up the slippery slope argument, hoping the food industry will support its fight against plain wrappers. It cites examples such as the regulation of infant formula in South Africa, where pictures of babies on labels are forbidden; that’s a big problem for the Gerber food brand – Gerber’s company logo is a smiling baby.

But those peddling the slippery slope idea ignore the fact that the health message for tobacco is simple: stop smoking. But beyond tobacco, it is more complex. For alcohol it is a little more nuanced: drink moderately, if at all. For food it is much more nuanced. Food is not optional; we must eat to live. Nutritional quality varies widely. Foods are spread across a spectrum from unhealthy to healthy, from soft drinks (no nutrients) to carrots or fish (many nutrients). Most fall somewhere in between. What’s more, an occasional soft drink is fine; daily guzzling is not. So the advice is to choose the healthy and avoid or eat less junk, both in the context of calorie intake and expenditure.

Is there any evidence that plain packaging for unhealthy foods would reduce demand? Research has focused on marketing’s effect on children’s food preferences, demands and consumption. Brands and packages sell foods and drinks, and even very young children recognise and desire popular brands. When researchers compare the responses of children to the same foods wrapped in plain paper or in wrappers with company logos, bright colours or cartoon characters, kids invariably prefer the more exciting packaging.

But the problem is deciding which foods and beverages might call for plain wrappers. For anything but soft drinks and confectionery, the decisions look too vexing. Rather than having to deal with such difficulties, health advocates prefer to focus on interventions that are easier to justify – scientifically and politically.

We know that some regulations and market interventions –analogous to, if not the same as those aimed at smoking cessation – are essential for reducing the damage from harmful products. If not plain packaging, then what? Studies suggest small benefits from a long list of interventions such as taxes, caps on portion size, front-of-package traffic-light labels, nutrition standards for school meals, advertising restrictions, and elimination of toys from fast food meals and cartoons from packaging. Rather than dealing with the impossible politics of plain wrappers on foods, health advocates increasingly favour warning labels.

These first appeared on cigarette packs in the 1960s and have been considered for food products since the early 1990s. Heart disease researchers suggested that foods high in calories and fat should display labels such as: “The fat content of this food may contribute to heart disease.” More recently, health advocates in California and New York proposed warning labels on sugary drinks. The Ontario Medical Association takes a similar view: “To stop the obesity crisis, governments must apply the lessons learned from successful anti-tobacco campaigns.” It has mocked up examples of warnings on foods.

Although no warning label law has passed so far, such messages are the logical next step in promoting healthy food choices, in the same way that plain wrappers are the next logical step for all cigarette packages. Health advocates should recognise the slippery slope argument for the typical tobacco ploy that it is.