While I’m on the topic of sugars (see yesterday’s post), the World Health Organization (WHO) has just called for public comment on proposed new guidelines for intake of “free” (added) sugars:

• Added sugar intake should be less than 10% of total calories per day (50 grams for a 2000 calorie-a-day diet)
• Intake below 5% of calories would confer additional benefits (25 grams)

Although the announcement casually mentions that the draft guidelines reaffirm a previous WHO sugar guideline from 2002, it just as casually fails to mention what happened to that guideline.

I, however, have perfect recall, particularly because I wrote about these events in the Afterword to the 2013 edition of Food Politics:

In the early 2000s, the World Health Organization (WHO) began work on a global strategy to reduce risk factors for chronic disease, obesity among them. In 2003, it published a research report that advised restricting intake of “free” (added) sugars to 10% or less of daily calories. Although this percentage was similar to that embedded in the USDA’s 1992 Pyramid (7–13% of calories, depending on total intake), sugar industry groups strenuously objected, enlisted senators from sugar-growing states to pressure the DHHS secretary to withdraw funding from WHO, and induced the DHHS chief counsel to send a critique of the report to WHO that had essentially been written by industry lobbyists. When released in 2004, WHO’s Global Strategy on Diet, Physical Activity, and Health omitted any mention of the background report or the 10% sugar recommendation.

“Strenuously objected” vastly understates what happened.

Why was the sugar industry so concerned?  One 12-ounce Coke or Pepsi contains about 40 grams of sugars.  Have one, and you’ve just about done your added sugars for the day.

WHO must either think that the research basis of the 10% sugar guideline is much stronger now (see references below), or that the political landscape has shifted so far in the direction of reducing sugar intake that governments will ignore industry groups this time.

I’m not so sure.  I think WHO needs all the help it can get with this one.

Submit comments here.  Now!

References

Reports commissioned by WHO

• Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies
• Effect on caries of restricting sugars intake: Systematic review to inform WHO guidelines

What happened to the previous guideline

• Waxman A. The WHO Global Strategy on Diet, Physical Activity and Health: the controversy on sugar. Development 2004;47:75–82
• Zarocostas J. WHO waters down draft strategy on diet and health. Lancet 2004;363:1373.
• Kaiser J.  The man behind the memos.  Science 2004;305:1552-1553.

After my post earlier this week about the USDA’s final rules for the WIC program, I heard from Tracy Fox, who heads a food and nutrition policy consulting firm in Washington, DC.

She wrote: “Did you see the amount of total sugar they are allowing in the yogurt provision?  Up to 40 grams per 8 ounces.”

Oops.  She’s right.

The sugar rules for WIC yogurt

The rules say:

As recommended by the IOM, yogurt must conform to the standard of identity for yogurt as listed in Table 4 of 7 CFR 246.10(e)(12) and may be plain or flavored with ≤ 40 grams of total sugar per 1 cup of yogurt.

The IOM reference is to the Institute of Medicine’s 2005 report, WIC Food Packages: Time for a Change.  On page 221, this report says:

Yogurt (must conform to FDA standard of identity…plain or flavored with ≤ 17 g of total sugars per 100 g yogurt.

Let’s do the math

The standard serving size for yogurt in these rules is 8 ounces, or 226 grams.  At 17 grams of sugar per 100 grams, this allows for 38.4 grams of sugar per 8 ounces.  USDA must have rounded this up to 40.

But plain yogurt is already sweet.  It contains 16 grams of lactose sugar in 8 ounces.

The rules allow for an additional 24 grams of sugar per 8 ounces—6 teaspoons!

But most yogurt comes in 6 ounces containers

In 2003, yogurt makers shrunk the package size to 6 ounces as a cost-saving measure.

A 6-ounce yogurt contains 12 grams of lactose. 

So the rules allow for 18 grams of added sugars in 6 ounces—4.5 teaspoons.

The new Nutrition Facts label may help

• It requires listing the amount of added sugars.
• This may discourage government agencies from buying highly sweetened yogurts.
• It may encourage yogurt makers to cut the sugar.

In the meantime, what to do?

• Encourage the WIC program to buy plain yogurt.
• Ask USDA to amend the regulations.
• Make sure added sugars stays on the FDA’s proposed rules (file comments here)

 

Over the weekend, Politico announced that the Grocery Manufacturers Association (GMA) and Food Marketing Institute (FMI) were finally going to launch their long-threatened $50 million campaign to promote voluntary “Facts Up Front” labels on food packages.

In case you never noticed these labels—and I doubt most people do—here is an example:

GMA and FGI conducted their own survey.  This—no surprise—found that people love Facts Up Front labels, but I find that hard to believe.  Neither do others, according to Politico reporters.

For what $50 million will buy, see yesterday’s Washington Post, page A5 (thanks Politico).

Recall the history

Facts Up Front (formerly known as Nutrition Keys), was originally launched as an end run around what the FDA was then trying to do with front-of-package labeling initiatives.  This happened early in 2011.

The GMA/FMI ploy brought the FDA’s initiatives to a halt—despite the agency’s investment in two Institute of Medicine (IOM) studies to establish a research basis for front-of-package labels.

These, in turn, followed on the heels of the food industry’s ill-fated Smart Choices—an attempt to promote highly processed foods as healthy.

GMA/FMI’s goal was to head off any possibility that the FDA would mandate red, yellow, and green traffic light signals.

Red signals might discourage consumers from buying products made by the companies GMA and FMI represent.

The food industry had cause to worry.  The IOM was considering—and eventually published—a front-of-package scheme similar to traffic lights.  It used checks or stars to evaluate the content of calories, saturated and trans fat, sodium, and sugars, all nutrients to watch out for.

GMA/FMI got its much more complicated—and, therefore, harder to understand—Nutrition Keys out first.  This preempted the IOM recommendations.

The FDA gave up.  The two IOM reports went into a drawer and the FDA has done nothing with them.

Why is GMA/FMI doing this now?

Surely, it is no coincidence that GMA/FMI is rolling out this campaign on the heels of Let’s Move!’s triumphant release of the FDA’s new food labeling proposals.

They must be worried that the FDA will unearth the two IOM reports, adopt the IOM recommendations, and start rulemaking for front-of-package labeling.

One sign of the food industry’s strategy comes from Bruce Silverglade, who for years was head counsel for the Center for Science in the Public Interest (CSPI), but has now revolved to a Washington, DC law firm that represents food companies.  He told Politico:

The general view in the industry is that nutrition information has really moved to the front of the pack. What FDA is doing is essentially proposing a new model of an old dinosaur.

As Michele Simon tweeted: “that comment…is rich coming from ex-@cspi lawyer who fought for label.”

What’s wrong with Facts Up Front? 

Plenty.

The IOM recommended that front-of-package labels be:

• Simple: easy to understand
• Interpretive: putting judgments in context
• Scaled: indicating good, better, and best

Facts Up Front does none of the above.

Facts Up Front is a tool for selling, not buying.

Its purpose is to make highly processed foods look healthier, whether or not they really are.

Whether slightly better-for-you processed foods will help anyone make better food choices and be healthier remain open questions.

What should happen now?

With Let’s Move! really moving, this seems like a great time to urge the FDA to pull out those IOM reports and get busy on a front-of-package labeling method that will really help the public make healthier dietary choices.

On Friday afternoon (that slow news moment), Let’s Move! and the USDA announced the release of the long-awaited Final Rules governing foods eligible for purchase by participants in WIC–The Special Supplemental Food Program for Women, Infants, and Children.

These are the first such revisions since 1980.  The rules:

• Increase the dollar amount for purchases of fruits and vegetables.
• Expand whole grain options.
• Allow for yogurt as a partial milk substitute.
• Allow parents of older infants to buy fresh produce instead of jarred infant food
• Give states and local WIC agencies more flexibility in meeting the nutritional and cultural needs of WIC participants.

These are good moves but the big news is that the USDA stood up to lobbyists for the potato industry who have pushed the White House and Congress to allow participants to buy white potatoes with their WIC funds.

As I noted in an earlier post, the exclusion of white potatoes follows recommendations of the Institute of Medicine based on observations that WIC mothers already buy plenty of them.

Potato lobbyists got Congress to insert language in the 2014 Agriculture Appropriations bill urging the USDA to allow white potatoes in the package.

The USDA responded by asking the Institute of Medicine to reexamine the WIC food package in time for reauthorization of child nutrition programs in 2015.  This is now underway.

Although WIC is a small program relative to SNAP, it still provides about $7 billion a year for its nearly 9 million participants.

Food companies fight fiercely to ensure that their products are eligible to be purchased with WIC funds.  The potato lobbyists got Congress to intervene in USDA rules on school meals.

They must have thought they could win this one too.

It’s encouraging when public health wins out over industry lobbying.

But this one is small potatoes.  How about a few wins against Big Food?

Release of the FDA’s proposals for revisions of the Nutrition Facts label got, to say the least, lots of attention.

A few items need some follow up.

The politics

The best discussion of the First Lady’s involvement in the new food label comes from Helena Bottemiller Evich at Politico:

• On yesterday’s release
• On Mrs. Obama’s emerging role in nutrition policy
• On the likely effects of the new label on the food industry

The reaction of the Grocery Manufacturers Association (GMA)

How’s this for a brilliant response?

We welcome First Lady Michelle Obama’s announcement of the proposed updates to the Nutrition Facts panel and thank her for her leadership on this and broader health issues.  The nation could not ask for a more thoughtful, effective or passionate advocate than Michelle Obama.

For 20 years, the Nutrition Facts panel has been an invaluable tool to help consumers build more healthful diets for themselves and their families, and the time is right for an update.

Diets, eating patterns and consumer preferences have changed dramatically since the Nutrition Facts were first introduced.  Just as food and beverage manufacturers have responded by creating more than 20,000 healthier product choices since 2002, and by providing tools like Facts Up Front front-of-pack labels, the FDA is responding with a thoughtful review of the Nutrition Facts panel.

We look forward to working with the FDA and other stakeholders as these proposed updates to the Nutrition Facts label make their way through the rule making process.

It is critical that any changes are based on the most current and reliable science.  Equally as important is ensuring that any changes ultimately serve to inform, and not confuse, consumers.

How you can file comments

A frustrated reader complains that he can’t find information on the FDA’s website about how to file comments.     That’s because the proposals haven’t been published yet.

They are scheduled for publication in the Federal Register on March 3.  Look for instructions then.  After that, the FDA will collect comments for 90 days.

Two sets of proposed rules will be open for comment:

• Food Labeling: Revision of the Nutrition and Supplement Facts Label  (367 pages)
• Serving Sizes of Foods that can Reasonably be Consumed at One-Eating Occasion; Dual-Column Labeling; Updating, Modifying, and Establishing Certain Reference Amounts Customarily Consumed; Serving Size for Breath Mints; and Technical Amendments (145 pages)

Start drafting comments now!

The FDA is proposing an updated food label today.  How’s this for a surprise? I like it!

First, consider the old one that went into effect 20 years ago:

In developing this label, the FDA tested several designs.  The public could not understand any of the prototypes, so the FDA picked this one because it was the best of a bad lot (the least worst).

If you think it should be easy to revise, consider that its explanation required about 900 pages in the Federal Register of January 6, 1993.

Now take a look at the FDA’s proposed changes:

The FDA also proposes an alternate design that clarifies which Daily Values are floors (“eat more”) and which are ceilings (“eat less”):

Another improvement: updating of portion sizes.  The old ones were based on serving sizes reported in the 1970’s and 1980’s.  The new label recognizes that portion sizes are much larger than they used to be.

The ice cream example: A serving used to be a laughable half cup.  Now it’s a cup.

The soda example: A serving used to be 8 ounces.  Now it’s a more realistic 12—or 20—ounces.

The other significant changes:

• Require listing “added sugars.”   Yes!
• For packages that are likely to be eaten at one time, require “dual column” labels to indicate both “per serving” and “per package” information.  
• Require the declaration of potassium and vitamin D.  Vitamins A and C can be listed voluntarily.
• Revise some Daily Values to reflect recent science.
• Remove “calories from fat” (the kind of fat matters more than the amount).
• Emphasize calories, serving sizes and Percent Daily Value.

The details will come in a Federal Register notice to be released today (see links below).

My take?  These changes should make the label easier for everyone to understand and use.

My preference?  I like the Alternate Proposal, and can’t wait to see if anyone else does.

The FDA will be collecting comments for 90 days.  Weigh in!  The food industry certainly will.

In the meantime, congratulations to the FDA for a job well done and to Let’s Move! for inspiring the changes and moving them along.

FDA Resources

• Proposed Changes to the Nutrition Facts Label
• Federal Register: Food Labeling: Revision of the Nutrition and Supplement Facts Label  
• Federal Register: Serving Sizes of Foods that can Reasonably be Consumed at One-Eating Occasion; Dual-Column Labeling; Updating, Modifying, and Establishing Certain Reference Amounts Customarily Consumed; Serving Size for Breath Mints; and Technical Amendments 

The biggest story—front page, right column—in the New York Times today is CDC’s report of a 43% drop in obesity among children ages 2 to 5 in the last decade.

• 2003-2004: 14%
• 2011-2012:   8%

A change this large is highly unusual.

The data come from a report in JAMA which found no change in overall obesity prevalence in that decade among infants and toddlers, youth ages 2 to 19, or adults.  When looking at the data for subgroups, however, the authors found two exceptions:

• The big decline in obesity among children ages 2 to 5
• A big increase in obesity among women ages 60 and older (oops)

What to make of this?

The decline in obesity among young children is consistent with previous reports, although these showed a smaller change.

To examine what the data show, it helps to look at an illustration.  The JAMA paper does not provide one, but a reporter sent me this:

The lower curve is for children ages 2 to 5.  It shows a sharp uptick in 2003-2004 (what was that about?), followed by a decline in 2007-2008.  The new data extend the decline a little further.

Any decline in the rising prevalence of obesity is cause for celebration.  So is the no change in a decade among almost everyone else.

The reasons?  I can only speculate but the “eat less junk food and move more” message must be getting out.

Let’s Move! is making several sensational announcements today.

Announcement #1: Universal school meals

This one is extraordinary: Schools with 40% or more of children eligible for free or reduced-price meals will be able to serve free breakfasts and free lunches to every student in the school, regardless of family income.

This means an end to:

• USDA paperwork requirements for ensuring eligibility.
• Parents having to fill out complicated eligibility forms.
• Schools having to monitor to make sure kids’ families have turned in the paperwork or paid.
• Schools turning away kids whose families haven’t paid.
• Schools destroying the meals of kids whose families haven’t paid.
• Students knowing who gets free meals, and who does not.

Guess what:  This program, which will affect 22,000 U.S. schools and 9 million children, is cost-neutral.

How is this possible?

• No more tedious, labor-intensive, expensive paperwork and monitoring.
• More student participation means more reimbursement.

This is just what school food advocates have been saying for years (see, for example, Janet Poppendieck’s Free For All: Fixing School Food in America).

For this alone, Let’s Move! deserves enthusiastic congratulations.

Announcement #2: limits on marketing junk foods and sodas in schools

As discussed in ObamaFoodorama today, USDA’s new rules will:

• Ban the marketing of unhealthy foods to children on school grounds.
• Phase out on-campus advertising for sodas and junk foods at schools during the school day.
• Apply the ban to places such as scoreboards on football fields and in gymnasiums, on vending machines, and on menu posters, cups and plates in cafeterias.

This is good news and a terrific step in the right direction, even though there are plenty of loopholes:

• Scoreboards with Coke logos, for example, can be phased out over time.
• After-school fundraisers and concessions at sports events are exempt.
• Schools can opt out.

These announcements are a tribute to the persistent work of school food advocates over a great many years.

But there is still plenty of room for more advocacy:

• Universal meals for all public schools.
• Closing the loopholes on junk food marketing to kids.
• Ensuring compliance with school meal standards.

The relevant documents

• The White House announcement
• School wellness backgrounder
• USDA Federal Register notice on school wellness policies
• After-school program commitments
• Childcare program commitments
• The Washington Post Account (with video)