Search results: food policy action

JAMA Internal Medicine invited me to comment on an article about the lack of nutrition education in medical schools.  This was written by Nathanial Morris, a second-year medical student at Harvard, who complains about the paucity of nutrition instruction in his curriculum.

Yet the course spanned just 3 afternoons, for a total of 9 hours of instruction…The course directors told us it would be the only time for dedicated nutrition education during our 4 years as medical students. There were no examinations nor interactions with patients. The 1 lecture on obesity lasted 45 minutes…As a medical student, I cannot fathom why medical schools continue to neglect nutrition education.

When I read his article, I didn’t know whether to laugh or cry.  I wrote almost identical articles in the 1980s based on my experience at UCSF (here’s one).

I asked a former UCSF colleague, Dr. Robert Baron, to co-author the commentary with me: Nutrition in Medical Education:  From Counting Hours to Measuring Competence.

Some help from Congress?

It is interesting in this context that various members of Congress are introducing bills to improve nutrition education for medical professionals, for example, the EAT for Health Act and the ENRICH Act.  Thanks to Jamie Berger for alerting me to this legislation and for sending some fact sheets about the bills: EAT for Health / ENRICH.

It’s been nearly 40 years since my involvement in this issue.  Ever optimistic, I’m happy to see some progress at last.

And this just in.

The current issue of the American Journal of Clinical Nutrition has papers from a symposium on nutrition in medical education.  The first was in 1962, so the half-century saga continues.

• Title page, program participants, and TOC:  Am J Clin Nutr 2014;99 1145S-1149S
• Introduction to Nutrition Education in Training Medical and Other Health Care Professionals. Penny M Kris-Etherton, Charlotte A Pratt, Edward Saltzman, and Linda Van Horn. Am J Clin Nutr 2014;99 1151S-1152S
• The need to advance nutrition education in the training of health care professionals and recommended research to evaluate implementation and effectiveness. Penny M Kris-Etherton, Sharon R Akabas, Connie W Bales, Bruce Bistrian, Lynne Braun, Marilyn S Edwards, Celia Laur, Carine M Lenders, Matthew D Levy, Carole A Palmer, Charlotte A Pratt, Sumantra Ray, Cheryl L Rock, Edward Saltzman, Douglas L Seidner, and Linda Van Horn. Am J Clin Nutr 2014;99 1153S-1166S
• Nutrition education in medical school: a time of opportunity. Robert F Kushner, Linda Van Horn, Cheryl L Rock, Marilyn S Edwards, Connie W Bales, Martin Kohlmeier, and Sharon R Akabas. Am J Clin Nutr 2014;99 1167S-1173S
• Residency and specialties training in nutrition: a call for action. Carine M Lenders, Darwin D Deen, Bruce Bistrian, Marilyn S Edwards, Douglas L Seidner, M Molly McMahon, Martin Kohlmeier, and Nancy F Krebs. Am J Clin Nutr 2014;99 1174S-1183S 
• Challenges and opportunities for nutrition education and training in the health care professions: intraprofessional and interprofessional call to action. Rose Ann DiMaria-Ghalili, Jay M Mirtallo, Brian W Tobin, Lisa Hark, Linda Van Horn, and Carole A Palmer. Am J Clin Nutr 2014;99 1184S-1193S
• Policy approach to nutrition and physical activity education in health care professional training. Matthew D Levy, Lisel Loy, and Laura Y Zatz.  Am J Clin Nutr 2014;99 1194S-1201S.

Nicholas Kristof of the New York Times recently devoted a column to an analysis of who really gets welfare in the United States.  He listed policies that favor not only the wealthy, but the fabulously wealthy:

• Subsidies for private airplanes via tax write-offs and deductions
• Tax deductions for private yachts
• Tax deductions for hedge funds and private equity
• Bank rescues
• Incentives to operate locally

His column reminded me of one written in 2005 by Sean Faircloth, then a Maine State representative, “Six ways government promotes obesity and what to do about it.”

No government, Faircloth said, could have devised more effective policies for reducing physical activity and promoting junk food.  Taxpayers, he pointed out:

• Subsidize oil companies and cars to the detriment of trails and sidewalks.
• Make it impractical to get basic information in foods and restaurants (menu labeling regulations: where are you?).
• Give large corporations free reign to market to children.
• Allow soda and snack-food companies to market products in schools (USDA is trying to change this).
• Direct billions in subsidies toward processed foods while neglecting fresh produce.
• Promote high-calorie foods in programs for poor people.

I thought this was an interesting way of thinking about obesity policy and over the years have added these:

• Allowing marketing costs to be deducted from taxes as business expenses
• Bans on lawsuits against food companies
• Ambiguous and obfuscating dietary guidelines (e.g. SoFAS in the 2010 edition)

No doubt there are others.

Can you think of any others?  Thanks.

Kristin Voigt, Stuart G. Nicholls, Garrath Williams.  Childhood Obesity: Ethical and Policy Issues.  Oxford University Press, 2014.

I gave this one a blurb:

A well-researched, highly critical, but carefully balanced examination of everyday assumptions about childhood obesity and its prevention from an intensely moral perspective.  Although the authors demonstrate that no intervention is without ethical complications or effective entirely on its own, they call for immediate actions to reduce the stigma of childhood obesity, support parents, and create food environments healthier for children, adults, and the environment.    

Once again, Congress—under pressure from lobbyists—is micromanaging USDA’s food assistance programs.

This time it’s the WIC program (Special Supplemental Program for Women, Infants, and Children).

The lobbying is coming from the National Potato Council, which wants—no surprise—white potatoes to be included the list of foods approved for purchase with WIC benefits (the “WIC Package”).

I love potatoes but they don’t need to be in WIC.

Here’s what this is about.

The WIC Food Package

This is designed to meet the special nutritional needs of at-risk low-income pregnant, breastfeeding, non-breastfeeding postpartum women, infants and children up to five years of age.  Rules published in the Federal Register in 2007 aimed to promote long-term breastfeeding by providing WIC participants with a wider variety of foods including fruits and vegetables and whole grains (see summary here).

Although the rules allow states considerable flexibility, they specifically exclude white potatoes.

The New York State WIC package, for example, allows any variety of fresh vegetables and fruits except white potatoes (sweet potatoes and yams are allowed).

These rules are the result of an Institute of Medicine study released in 2005.  This study found that WIC participants already ate plenty of white potatoes.  The report said it would be better for WIC to encourage consumption of a wider variety of vegetables.

Potato industry lobbying

For the last five years, the potato industry has been lobbying to include white potatoes in the WIC package.

Potato lobbyists are active these days.

For example, the Maine potato lobby succeeded in getting Congress to tell the USDA that it could not set any limits on the number of times per week that white potatoes could be served in school lunches.  That ploy worked and this one may work too.

The National Potato Council lobbyists induced Congress to add a clause to the 2014 omnibus appropriations bill.  When President Obama signed that bill on January 17, he directed the USDA to allow all varieties of fresh, whole, or cut vegetables to be included.  Translation: white potatoes, and French fries at that.

If the USDA fails to comply, Agriculture Secretary Tom Vilsack must submit a report to Congress explaining why not.

The National Potato Council makes this statement: “This action sends a clear message to USDA that it is obligated to base its nutritional policy on the latest nutritional science, which calls for an increase in starchy vegetable consumption for all Americans, including WIC mothers and children.”

It does?  I’m not aware of such science.

The Institute of Medicine is currently reviewing the WIC package and I seriously doubt that it will find a deficiency of starchy vegetables in American diets.

This is about getting potato growers a chunk of taxpayer money spent for the WIC program.

Why should anyone care?

If Congress caves in on white potatoes, it will open a Pandora’s box of pressures from lobbyists representing every food product currently excluded from the WIC package.

If lobbyists for white potatoes succeed, can those for “fruit”-flavored cereals and sports drinks be far behind?

The WIC program has always focused on encouraging recipients to consume foods that will best promote their own health and that of their children.

It would be better for WIC recipients—and a lot better for American democracy—if the potato industry stopped manipulating Congress and interfering with USDA nutrition programs.

I was in Washington DC last week when the FDA announced  that it was taking significant steps to address antibiotic resistance, a problem caused by overuse in raising animals for food.

The FDA called on makers of animal antibiotics to:

• Voluntarily stop labeling medical important antibiotics as usable for promoting animal growth or feed efficiency (in essence, banning antibiotics from these uses).
• Voluntarily notify the FDA of their intent to sign on to these strategies within the next three months.
• Voluntarily put the new guidance into effect within 3 years.
• Agree to a proposed rule to require a veterinarian’s prescription to use antibiotics that are presently sold over the counter (the proposal is open for public comment for 90 days at www.regulations.gov.   Docket FDA-2010-N-0155).

Voluntary is, of course, a red flag and the Washington Post quoted critics saying that the new guidance falls far short of what really is needed—a flat-out ban on use of antibiotics as growth promoters.

• Consumers Union is concerned about the long delay caused by the 3-year window.
• CSPI is worried about all the loopholes.
• NRDC thinks the FDA is pretending to do more than it’s really doing and “kicks the can significantly down the road.”
• Mother Jones points out that the meat industry can still “claim it’s using antibiotics ‘preventively,’ continuing to reap the benefits of growth promotion and continue to generate resistant bacteria.”
• Civil Eats reminds us that the Pew Commission on Industrial Farm Animal Production (on which I served) recommended a ban on nontherapeutic use of all antibiotics.

Yes, the loopholes are real, but I view the FDA’s guidance as a major big deal.  The agency is explicitly taking on the antibiotic problem.  It is sending a clear signal to industrial farm animal  producers that sooner or later they will have to:

• Stop using antibiotics as growth promoters.
• Stop using antibiotics indiscriminately, even for disease treatment.

I think the FDA is dead serious about the antibiotic problem.  If the FDA seems to be doing this in some convoluted fashion, I’m guessing it’s because it has to.  The FDA must not have been able to find any other politically viable way to get at the antibiotics problem.

I see this as a first step on the road to banning antibiotics for any use in animals other than the occasional treatment of specific illnesses.

As the New York Times puts it,

This is the agency’s first serious attempt in decades to curb what experts have long regarded as the systematic overuse of antibiotics in healthy farm animals, with the drugs typically added directly into their feed and water. The waning effectiveness of antibiotics — wonder drugs of the 20th century — has become a looming threat to public health. At least two million Americans fall sick every year and about 23,000 die from antibiotic-resistant infections.

Still not convinced antibiotics are worth banning for promoting growth?

The best explanation is the Washington Post’s handy guide to the antibiotic-perplexed.  Here, for example, is its timeline of development of microbial resistance to antibiotics.  The bottom line: the more widespread the use of antibiotics, the greater the onset and prevalence of resistance.  And it takes practically no time for bacteria to develop resistance to antibiotic drugs.

Resources from FDA

• Consumer Update: Phasing Out Animal Antibiotics
• FAQ on today’s action
• Final Non-Binding Guidance for Industry 213
• Veterinary Feed Directive
• Final Non-Binding Guidance for Industry 209

I am indebted to Farm Futures for the heads up about the USDA’s just-published request for public input on what it calls “enhancing agricultural coexistence.”

Agricultural coexistence, the USDA says,

refers to the concurrent cultivation of crops produced through diverse agricultural systems, including traditionally produced, organic, identity preserved (IP), and genetically engineered crops.  As the complexity and diversity of U.S. agriculture increases, so does the importance of managing issues that affect agricultural coexistence, such as seed purity, gene flow, post-harvest mixing, identity testing, and market requirements.

My translation: The USDA wants producers of traditional crops and organic foods to stop complaining that GMOs are contaminating their crops, and producers of GMO crops to stop complaining that they get prosecuted if they try to save seeds from year to year.

The USDA explains that it is doing this in response to recommendations from its Advisory Committee on Biotechnology & 21st Century Agriculture.  This committee recommended actions to promote agricultural coexistence in five areas:

1. Potential compensation mechanisms
2. Stewardship
3. Education and outreach
4. Research
5. Seed quality

How come the USDA is collecting input on #3 rather than the far-more-likely-to-be-controversial #1 and #2?

Early in 2011, I wrote about USDA Secretary Tom Vilsack’s use of Cold War rhetoric to promote détente between growers of organic and GMO foods.  I pointed out that while the USDA had no intention of backing down on support of GM agriculture, it was at least recognizing the threat to organic production.

I noted that the USDA was unlikely to get very far with this initiative because so many farm groups representing industrial agriculture so strongly objected to Vilsack’s coexistence proposal.  The groups argued that coexistence could “adversely impact all producers of biotech crops, as well as the integrity of the American agriculture system.”

If you can’t do anything about underlying structural problems, try communication.

Have something to say about what it will take to support all systems of agricultural production?  Now is a good time to weigh in.

I was a member of this Pew Commission, which produced a landmark report in 2008: Putting Meat on the Table: Industrial Farm Animal Production in America.

Our report’s conclusion: The current system of raising farm animals poses unacceptable risks to public health, to communities near Confined Animal Feeding Operations (CAFOs), and to the environment.

Our key recommendations:

1. Ban the nontherapeutic use of antimicrobials in food animal production.
2. Define nontherapeutic use of antimicrobials as any use in food animals in the absence of microbial disease or documented microbial disease exposure.
3. Implement new systems to deal with farm waste.
4. Phase out gestation crates, restrictive veal crates, and battery cages.
5. Enforce the existing environmental and anti-trust laws applicable to food animal production.
6. Expand animal agriculture research.

Recently, the Johns Hopkins Center for a Livable Future (CLF) did an in-depth analysis of what has happened with these recommendations.  Its dismal conclusion: The problems have only gotten worse.

Many hoped the release of the report, which occurred within a year of a change in the administration, would help trigger a sea change in the federal government’s approach to regulating the food animal production industry…Early administrative appointments to top regulatory posts held promise for meaningful changes.

CLF’s review of the policy-landscape changes in the five years since the release of the report paints a very different picture. Contrary to expectations, the Obama administration has not engaged on the recommendations outlined in the report in a meaningful way; in fact, regulatory agencies in the administration have acted regressively in their decision-making and policy-setting procedures.

In addition, the House of Representatives has stepped up the intensity of its attacks on avenues for reform and stricter enforcement of existing regulations, paving the way for industry avoidance of scrutiny and even deregulation, masked as protection of the inappropriately termed “family farmer.”

The assaults on reform have not been limited to blocking policies…Instead, the policy debate…has shifted to the implementation of policies such as “ag-gag”, agricultural certainty, and right-to-farm laws, all of which are designed to further shield unsavory industry practices from the eye of the public and the intervention of regulators.

This week, some of the Commission members answered questions from ProPolitico reporter Helena Bottemiller Evich.  Ralph Loglisci reports in Civil Eats on that meeting and his conversation with former Pew Commission director Robert Martin, who is now the Center for a Livable Future’s Director of Food System Policy:

I think issues are going to drive change at some point. You’ve got this big group of people who want to see change. The problems of antibiotic resistance are worsening–the problems of 500 million tons of (animal) waste we produce each year are worsening and the ground in many areas of the country is really saturated with phosphorous. You can’t transport the material, so you’ve got to disperse the animals. So, the problems are reaching really a crisis point. So that could really force action too.

Is there any hope?  It sounds like things will have to get worse before they get better.  But how much worse?

I wish there were better news.  Food safety, animal welfare, and environmental advocates: get together and get busy!

My monthly first Sunday Food Matters column in the San Francisco Chronicle:

Q: I hear that the Mexican government wants to increase taxes on sodas as a way to fight diabetes. The soda industry persuaded voters to defeat soda taxes in Richmond and El Monte last year. Won’t it do the same in Mexico?

A: It might. I’m just back from a lecture trip to Mexico City where I heard plenty about the proposed soda tax and the industry’s response to it.

Last month, the Mexican government proposed an additional soda tax of one peso (about 8 cents) per liter. The idea is to raise $1.5 million per year while discouraging soda consumption, thereby helping to reduce the country’s high prevalence of obesity and Type 2 diabetes.

Mexicans drink lots of soda. By some estimates, average per capita consumption is 50 gallons a year, the highest in the world. It’s no coincidence that more than 70 percent of Mexicans are overweight or obese, and around 15 percent have Type 2 diabetes, a prevalence that terrifies health officials. This type of diabetes, if undiagnosed and untreated, can lead to blindness or foot amputations.

‘Nutrition transition’

Mexico is a classic example of a country in “nutrition transition.” As the economy improves, people increasingly buy high-calorie ready-made foods, put on weight, and raise their risk for diabetes. Meanwhile, the poorer segments of the population continue to experience high levels of stunting, iron-deficiency anemia and vitamin A deficiency.

This makes obesity a relatively new problem in Mexico, one widely understood to result from the introduction of processed foods – especially sodas – into the Mexican food market.

I could easily see how deeply sodas are embedded in Mexico’s food culture. Sodas were advertised and available everywhere. And they come in enormous three-liter bottles that cost less than the price of bottled water – only 17 pesos ($1.35) each. Clean water is not always available, making sodas the easy choice.

Sodas are cheap because Mexico grows its own sugarcane and sells it at market prices. We, however, artificially support the higher price of U.S. sugar through tariffs and quotas. That’s why our sodas are made with high fructose corn syrup. We subsidize corn production so corn syprup costs less than sugar.

Some people think cane sugar tastes better than high fructose corn syrup, although controlled taste tests don’t always back this up. It’s ironic that U.S. supermarkets now carry, at highly inflated prices, Mexican Coca-Cola sweetened with cane sugar.

Industry efforts to defeat the Mexican soda tax have been ferocious, just as they were in Richmond and El Monte last year. Producers argue that if the tax really does decrease consumption, it will cause hundreds of thousands of jobs to be lost.

I saw a newspaper advertisement from the Mexican Beverage Association that not only attacked the science relating soft drinks to obesity, but extolled the health benefits of sodas: “Sugar is nutritious; it’s a carbohydrate. Carbohydrates are essential for life. Sugar is indispensable for the brain. Soft drinks hydrate and bring energy.”

An ad from the sugarcane industry also threatened job losses – “The tax will generate unemployment and discourage productivity and investment” – and noted that workers and the poor will bear most of its burden.

The big questions

As with any such initiative, the big questions are whether the tax is likely to reduce soda consumption, obesity and diabetes, and whether the revenue will be used for widely beneficial public health purposes. Mexico’s Congress will have to address these questions when it votes on the tax in the weeks ahead.

In the meantime, a coalition of consumer and health groups, in part funded by Bloomberg Philanthropies, has been putting posters in subway stations that illustrate the amounts of sugar in soft drinks. The groups are actively advocating for the soda tax and for using its funds to provide free potable water in schools – something that does not now exist. But TV stations have refused to carry their ads for fear of losing soda advertisers.

Like their U.S. colleagues, Mexican public health authorities are searching for effective ways to reverse obesity trends. Sugary drinks are an easy target. Taxing them might happen despite industry opposition – especially if the funds are earmarked for clean water.

Editor’s notes: Marion Nestle will discuss her new book, “Eat, Drink, Vote: An Illustrated Guide to Food Politics,” with Narsai David at the Commonwealth Club on Oct. 15 at 6 p.m., and at Book Passage in Corte Madera on Oct. 19 at 11 a.m.

She is also receiving the James Beard Foundation Leadership Award for her writing about how science and public policy influence what we eat. The award ceremonies are Oct. 21 at the Hearst Tower in New York.

Marion Nestle is the author of “Eat, Drink, Vote,” “Why Calories Count: From Science to Politics,” “Food Politics” and “What to Eat,” among other books. She is a professor in the nutrition, food studies and public health department at New York University, and blogs at www.foodpolitics.com. E-mail: food@sfchronicle.com