The Times’ obituary for Dr. Albert J. (“Mickey”) Stunkard, who died last week at the age of 92, describes his work on the genetics of obesity and quotes Dr. Walter Willett’s comment that genetics accounts for only a small part of the “legions of the obese.”

Stunkard was writing about the lifestyle and environmental determinants of weight gain, long before most of us had a clue.

I learned this in 2000 when Michael Jacobson and I were writing a paper on public health policy approaches to obesity prevention.[i]   We were arguing that policies aimed at preventing weight gain focused almost entirely on personal behavior but needed to focus on fixing the environment of food choice.

A peer reviewer scolded us for missing Stunkard’s work.

At last, we discovered Stunkard’s groundbreaking work.  In the published paper, we wrote:

The most notable exception [to the focus on personal responsibility] was the report of a 1977 conference organized by the National Institutes of Health (NIH) to review research and develop recommendations for obesity prevention and management.

In one paper, A.J. Stunkard thoroughly reviewed social and environmental influences on obesity.[ii]  As a result, the conference report included an extraordinarily broad list of proposals for federal, community, and private actions to foster dietary improvements and more active lifestyles.

These ranged from coordinated health education and model school programs to changes in regulations for grades of meat, advertising, taxes, and insurance premiums. Some of the proposals cut right to the core of the matter: “Propose that any national health insurance program…recognize obesity as a disease and include within its benefits coverage for the treatment of it.” “Make nutrition counseling reimbursable under Medicare.” And “Fund demonstration projects at the worksite.”[iii]

He was far ahead of his time and will be greatly missed.

References

[i] Nestle M, Jacobson MF.  Halting the obesity epidemic: A public health policy approach.  Public Health Reports 2000;115:12-24.

[ii] Stunkard AJ. Obesity and the social environment: current status, future

prospects. In: Bray GA, editor. Obesity in America. Washington:

Department of Health, Education, and Welfare (US); 1979. NIH Pub.

No.: 79-359.

[iii] Stunkard A. The social environment and the control of obesity. In:

Stunkard AJ, editor. Obesity. Philadelphia: WB Saunders; 1980. p. 438-

Sheldon Krimsky and Jeremy Gruber, eds.  The GMO Deception: What You Need to Know about the Food, Corporations, and government Agencies Putting Our Families and Our Environment at Risk.  Skyhorse Publishing, 2014.

I did a blurb for this one:

GMO Deception brings together essays by specialists in a wide range of fields united in skepticism about the benefits of GMOs for reasons grounded in in biology, social science, politics, and ethics.  If you do not understand why there is so much opposition to GMOs, nationally and internationally, this book is the place to start.

Politico ProAg’s Helena Bottemiller Evich has been reporting on the School Nutrition Association (SNA) meeting in Boston this week (and see the video conversation with her editor, Jason Huffman, about the meeting).

One of her points: from the kinds of junk-food products exhibited, you would never know that the SNA was at war with the White House over USDA’s nutrition standards for school meals (see my previous posts).

As she explains, food companies have had no problem coming up with look-alike products that meet USDA standards:

More than 400 exhibitors showed off their innovations designed to meet the Department of Agriculture’s new regulations…PepsiCo, which owns Tropicana, Quaker and Lays, has a long list of products that meet the new rules, including Reduced Fat Doritos and Cheetos, Stacy’s Pita Chips and Munchies. Windsor Foods, which specializes in food service, has come up with whole grain-rich egg rolls that the company says kids love.

General Mills displayed a modified version of Chex Mix, a whole grain Betty Crocker cookie and a Cinnamon Toast Crunch cereal bar: “Snacks so good, kids won’t know they’re nutritious,” according to the marketing flyers.

…while the changes to lunch standards may be giving many school nutrition professionals fits, the food manufacturing industry is drooling over the opportunity to gain more sales inside what has been described as the nation’s largest restaurant: The school lunch program serves 30 million kids each day and represents a $30 billion per year market for the food industry, according to the Center for Science in the Public Interest.

…SNA benefits from the food industry’s enthusiasm in school lunches. The largest chunk of the group’s revenue is generated at its annual conference, which brought in $4.7 million in 2012. The association charges $15,000 to sponsor an education session track featuring a company representative and $20,000 to put company logos on hotel key cards.

Evich quotes Michele Simon, who also attended the meeting.

Walking through that hall, it’s very hard to see where the changes are,” she said. “It’s still pretty appalling to see the types of junk food that can pass as acceptable food for school meals. It seems like there’s a disconnect between the uproar over the improved guidelines and all these vendors who seem to have no problem meeting them.”

Michele sent me a photo of one such product.

For photos of other such items, see Michele Simon’s other images on Time Magazine’s site, and Nancy Huehnergarth’s collection of what she calls “The Good, the Bad and The Ugly Food Exhibits.”

To understand what this is about, take a look at the Public Health Advocacy Institute’s report on Copycat Snacks in Schools.  The “better for you” versions are sold in schools, but you can hardly tell the difference between those and the “not so good for you” commercial versions from the nearly identical packages.

How can food and beverage companies get away with this?  This is the result of USDA’s setting nutrient-based, rather than food-based standards for school meals.  Setting nutrient standards allows food companies to tweak the formulas to give the USDA what it requires.

Is a slightly “better for you” option necessarily a good choice?  Surely, schools can do better.

The FDA is taking comments on its proposals to revamp the food label until August 1, 2014.

It has two sets of proposed changes:

• Nutrition and Supplement Facts Labels
• Serving Sizes

Here is the first of my comments on several food label items.  Feel free to copy, edit, or file your own (see directions below).

July 16, 2014

TO:  FDA

FROM:  Marion Nestle, Professor, New York University

RE:  Nutrition Facts panel: ADDED SUGARS

1.  Retain the line for Sugars but call it Total Sugars

2.  Add a line for Added Sugars

Rationale:

• Excessive intake of dietary sugars is well established to raise the risk of obesity and type-2 diabetes.[i]
• Americans on average twice as much as is generally recommended.[ii]
• The amount typically consumed comes close to the upper limit recommended by the Institute of Medicine on the basis of increased risk of nutrient deficiencies.[iii]
• Sugars intrinsic to foods are accompanied by nutrients; added sugars are not.
• Although there is no biochemical difference between intrinsic and added sugars, food and beverage companies know exactly how much sugar they add as part of the recipes for their products.
• Listing the amount of added sugars on food labels would inform consumers about how much sugars are added to the foods they buy.
• Randomized, controlled clinical trials to test the hypothesis that added sugars increase disease risk would violate ethical standards and, therefore, are impossible to conduct.

3.  Establish a Daily Reference Value for Added Sugars of 10% of total calories

Rationale:

• Since the 1977 Dietary Goals, health officials have consistently recommended an upper limit of 10 percent of calories from added sugars.[iv]
• The 1992 USDA Food Guide Pyramid suggested an upper limit of 6, 12, and 18 teaspoons of sugars, respectively, for daily diets of 1,600, 2,200, and 2,800 calories, respectively.  This works out to 7, 10, and 13 percent of calorie intake, respectively, for an average of 10 percent.[v]
• By 1992, health officials in several European countries had recommended much the same.[vi]
• The Institute of Medicine’s 2002 upper safety limit of 25% of calories was based on risk for nutrient deficiencies, not obesity and chronic disease.[vii]
• In 2009, the American Heart Association recommended that women consume no more than 100 calories per day from added sugars (25 grams), and men no more than 150 calories per day (38 grams).  These come to 5 percent and 7.5 percent, respectively, of a 2000-calorie daily diet.[viii]
• The 2010 Dietary Guidelines for Americans state that no more than 5 to 15 percent of calories should come from a combination of solid fats and added sugars.  This implies that added sugars should be less than 10% of calories.^[ix]
• Dr. Robert Lustig says that a “dose” of added sugars up to 50 grams a day poses little risk for metabolic or chronic disease.  This amounts to 200 sugar calories and 10% of a 2,000-calorie daily diet (he says twice that much, the amount commonly consumed by Americans, is toxic.[x]
• The World Health Organization in 2014 said that added sugars should make up less than 10 percent of total calories per day, and less than 5 percent would be even better,[xi] based on two research reviews, one on sugars and obesity[xii]  and one on sugars and tooth decay.[xiii]
• Added sugars as 10% of calories represents about half the amounts currently consumed and comes close to consensus.

References

[i] Te Morenga L, Mallard S, Mann J. Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohttp://steinhardt.nyu.edu/nutrition/hort studies. BMJ 2012;345:e7492.  doi: 10.1136/bmj.e7492.

[ii] USDA.  Loss-adjusted food availability documentation.  March 11, 2014.  http://www.ers.usda.gov/data-products/food-availability-(per-capita)-data-system/loss-adjusted-food-availability-documentation.aspx#.UzlzcfldU6w.   USDA.  Food availability documentation: added sugar and sweeteners.  http://www.ers.usda.gov/data-products/food-availability-(per-capita)-data-system/food-availability-documentation.aspx#sugar.   The tables used to construct figure 3D are at: Refined Sugar, Corn Syrup, Other Sweeteners.

[iii] Institute of Medicine (IOM) of the National Academies. “Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients), Chapter 6: Dietary Carbohydrates: Sugars and Starches”, Washington, DC: National Academies Press; 2002.

[iv] U.S. Senate Committee on Nutrition and Human Needs.  Dietary Goals for the United States, December 1977.

[v] USDA.  Food Guide Pyramid, 1992.

[vi] Cannon G:  Food and Health: The Experts Agree.  London:  Consumers’ Association, 1992.

[vii] USDA.  Is intake of added sugars associated with diet quality?  Nutrition Insights, Insight 21, October 2000.

[viii] Johnson RK, Appel LJ, Brands M, et al.  Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association.  Circulation. 2009;120(11):1011-1120.  doi: 10.1161/CirculationAHA.109.192627.

[ix] USDA and USDHHS.  Dietary guidelines for Americans, 2010.  http://www.cnpp.usda.gov/dgas2010-policydocument.htm.

[x] Lustig RH.  Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease.  Hudson Street Press, 2012.

[xi] WHO.  Draft guideline: Sugars intake for adults and children, March 2014. http://www.who.int/nutrition/sugars_public_consultation/en/.

[xii] Te Morenga L, Mallard S, Mann J. Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ 2012;345:e7492 doi: 10.1136/bmj.e7492.

[xiii] Moynihan PJ, Kelly SAM.  Effect on Caries of Restricting Sugars Intake. Systematic Review to Inform WHO Guidelines.  JDR 2014;93:8-18.  doi:10.1177/0022034513508954.

The FDA makes it easy to file comments. It provides:

• All necessary information in one place.
• A short guide and checklist
• Nutrition and Supplement Facts Label: Docket FDA-2012-N-1210  Comment here now
• Serving Sizes: Docket FDA-2004-N-0258  Comment here now

I know I live on another planet, and my kids are long grown, but is there really a void in the market that has to be filled by a half-juice, half-herbal tea drink in a box for kids?

According to Food Navigator, the CEO of Drazil (lizard spelled backwards) Kids Tea thinks this product

pinpoint[s] a void in the kids’ beverage marketplace for a naturally healthy, reduced-sugar ready-to-drink beverage line as US consumers started falling out of love with 100% juice….There’s a huge need for healthy beverages that actually appeal to kids, so I thought, why not tea?…“I’ve studied how habits are formed when doing product development,” she said. “How do you get more adult tea drinkers? You get them to start drinking it regularly when they’re young. Tea is perfect because it’s relatively inexpensive to brew, so healthy—all those antioxidants, nutrients. Why not develop those habits young?”

OK.  The concept is adorable.

But is tea really loaded with antioxidants and nutrients?  Not like fruit juices.  This product is a juice drink that dilutes juice and its nutrients by half.   Yes, it also dilutes the fruit sugars by half but the boxes are 6.75 ounces and that much 100% juice is not unreasonable for school-age kids.

What ever happened to tap water?

This product is about marketing, and marketing to kids and hooking them early at that.

As I said, I live on another planet.

Authors employed by the Food Packaging Forum Foundation, funded by the packaging industry but working “independently of donors’ special interests,” have produced a surprising analysis of chemical in food packaging that comes into contact with food during production, handling or storage.

Why surprising?  Because the results are indeed against donors’ special interests.

Such chemicals, the authors say, can contaminate food through migration from the packaging.  About 6000 such substances exist, some of which are associated with disease.  These are Chemicals of Concern (COCs).

This study identified chemicals used in packaging that are considered to be COCs.  It found 175 such chemicals in use.  Of these, 54 are “candidates for Substances of Very High Concern.”

From a consumer perspective, it is certainly unexpected and undesirable to find COCs [chemicals of concern] being intentionally used in FCMs [food contact materials], and thus it seems appropriate to replace substances case by case with inherently safer alternatives.

This comes from people in the industry.  I hope makers of packing materials—and food safety regulators—pay close attention.

I received a press release last week announcing the release of a new meta-analysis of more than 300 studies comparing organically produced foods to those produced conventionally.  The results show that organic foods have:

• Less pesticides: this is to be expected as they are not used in organic production.
• Less cadmium: this also is to be expected as sewage sludge, a probable source of cadmium, is not permitted in organic production.
• More antioxidants: this is news because some previous studies did not find higher levels of nutrients in organic foods.

I was interviewed by the New York Times about this study:

Even with the differences and the indications that some antioxidants are beneficial, nutrition experts said the “So what?” question had yet to be answered.

“After that, everything is speculative,” said Marion Nestle, a professor of nutrition, food studies and public health at New York University. “It’s a really hard question to answer.”

Dr. Nestle said she buys organic foods, because she believes they are better for the environment and wants to avoid pesticides. “If they are also more nutritious, that’s a bonus,” she said. “How significant a bonus? Hard to say.”

She continued: “There is no reason to think that organic foods would be less nutritious than conventional industrial crops. Some studies in the past have found them to have more of some nutrients. Other studies have not. This one looked at more studies and has better statistics.”

Two additional comments:

1. The study is not independently funded.   One of the funders is identified as the Sheepdrove Trust, which funds research in support of organic and sustainable farming.

This study is another example of how the outcome of sponsored research invariably favors the sponsor’s interests.  The paper says “the  Trust  had  no  influence  on  the  design  and management of the  research  project  and  the  preparation  of publications  from the project,” but that’s exactly what studies funded by Coca-Cola say.  It’s an amazing coincidence how the results of sponsored studies almost invariably favor the sponsor’s interests.  And that’s true of results I like just as it is of results that I don’t like.

2.  The purpose of the study is questionable.  The rationale for the study is “Demand for organic foods is partially driven by consumers’ perceptions that they are more nutritious.”  The implication here is that research must prove organics more nutritious in order to market them.  But most people who buy organics do so because they understand that organics are about production values.  As I said, if they are more nutritious, it’s a bonus, but there are plenty of other good reasons to prefer them.

Other resources:

• Supplementary data from the study
• Q and A on the study
• Washington State University press release
• The Guardian story that broke the embargo [nobody was supposed to write about it until July 15]
• The Organic Trade Association’s statement

Courtney White, Grass, Soil, Hope: A Journey through Carbon Country.  Chelsea Green, 2014.

Courtney White, whom I do not know but would like to, describes himself as a former archaeologist and Sierra Club activist who became a producer of grass-fed beef, thereby catching on to the importance of grass for restoring nutrients to soil, reducing climate change, and feeding the planet.  Carbon, he says, is key and we can achieve all this with low-tech methods.

He visits a bunch of “new agrarians” who are managing carbon-conserving agriculture, from farms to rooftops.

We’re all carbon.  We live in a carbon universe.  We breathe carbon, eat carbon, use carbon products, profit from the carbon cycle, and suffer from the carbon poisoning taking place in our atmosphere…We could, for example, find ways to support the 2 percent of Americans who actively manage the soil portion of the carbon cycle.  There are a million ways to help them, starting with the power of the purchasing dollar.  Seek out the new agrarians and buy their products.  Better yet, get involved yourself.

He writes well, and convincingly.