Search results: app

Unprocessed red meat in the dietary treatment of obesity: a randomized controlled trial of beef supplementation during weight maintenance after successful weight loss.  Faidon Magkos, Sidse I Rasmussen, Mads F Hjorth, Sarah Asping, Maria I Rosenkrans, Anders M Sjödin, Arne V Astrup, Nina R W Geiker. The American Journal of Clinical Nutrition, Volume 116, Issue 6, December 2022, Pages 1820–1830, https://doi.org/10.1093/ajcn/nqac152

Methods: In this 5-mo parallel randomized intervention trial, 108 adults with BMI 28–40 kg/m² (45 males/63 females) underwent an 8-wk rapid weight loss period, and those who lost ≥8% body weight (n = 80) continued to ad libitum weight maintenance diets for 12 wk: a moderate-protein diet with 25 g beef/d (B25, n = 45) or a high-protein diet with 150 g beef/d (B150, n = 35).

Conclusions: Healthy diets consumed ad libitum that contain a little or a lot of unprocessed beef have similar effects on body weight, energy metabolism, and cardiovascular risk factors during the first 3 mo after clinically significant rapid weight loss.

Funding: The study was supported by The Beef Checkoff (a program of the National Cattlemen’s Beef Association, CO, USA) and the Danish Agriculture & Food Council (Copenhagen, Denmark). Lighter Life (Essex, UK) sponsored very-low-calorie diet products for the weight-loss phase of the study. The sponsors had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

Conflicts of interest: NRWG has received funding from The Beef Checkoff program (National Cattlemen’s Beef Association, CO, USA) and the Danish Agriculture & Food Council (Copenhagen, Denmark) to conduct additional studies relevant to the role of meat in the diet. AVA is a member of the scientific advisory board for Weight Watchers, USA; congressional chairman for RNCP (Répertoire National des Certifications Professionnelles), France; co-owner of the University of Copenhagen spin-off Flax-Slim ApS; co-inventor on a pending provisional patent application for the use of biomarkers to predict responses to weight-loss diets; and co-inventor of other related patents and patent applications that are all owned by the University of Copenhagen, in accordance with Danish law. All other authors report no conflicts of interest.

Comment: The conclusion of this beef industry-funded study is that you can eat as much beef as you like without its having any effect on your body weight or metabolic risk factors, as long as you first lose weight and keep it off.  This is a perfect example of why looking at one food at a time makes no sense without also taking into consideration everything else you are eating and how much.  The Beef Checkoff got the answer it wanted, so money well spent.

The USDA is trying to improve nutrition standards for school meals.  I wish it the best of luck.

It is proposing over the next several years to:

• Limit added sugars in certain high-sugar products and, later, across the weekly menu;
• Allow flavored milk in certain circumstances and with reasonable limits on added sugars;
• Incrementally reduce weekly sodium limits over many school years; and
• Emphasize products that are primarily whole grain, with the option for occasional non-whole grain products.

This does not make it sound as if USDA is in much of a hurry.  Or that it is doing anything particularly radical.

Take the sugar proposals, for example.  Currently, the re are no limits on sugars in school meals, which means that any limits ought to be an improvement.  The USDA proposal sugar limits in two phases:

1. Product-based limits: Beginning in school year (SY) 2025-26, the rule proposes limits on products that are the leading sources of added sugars in school meals:
   1. Grain-based desserts (cereal bars, doughnuts, sweet rolls, toaster pastries, coffee cakes, and fruit turnovers) would be limited to no more than 2 ounce equivalents per week in school breakfast, consistent with the current limit for school lunch.
   2. Breakfast cereals would be limited to no more than 6 grams of added sugars per dry ounce. This would apply to CACFP [Child and Adult Care Food Program] as well, replacing the current total sugars limit.
   3. Yogurts would be limited to no more than 12 grams of added sugars per 6 ounces.
   4. Flavored milks would be limited to no more than 10 grams of added sugars per 8 fluid ounces for milk served with school lunch or breakfast. For flavored milk sold outside of the meal (as a competitive beverage for middle and high school students), the limit would be 15 grams of added sugars per 12 fluid ounces.
2. Overall weekly limit: Beginning in SY 2027-28, this rule proposes limiting added sugars to an average of less than 10% of calories per meal, for both school breakfasts and lunches. This weekly limit would be in addition to the product-based limits described above.

Sugary products will still be allowed.  And schools have 4-5 years to comply (by that time, today’s elementary school children will be in high school).

Why the pussy-footing?  The USDA must be expecting ferocious pushback, and for good reason.  Anything, no matter how small, that threatens sales of foods commonly sold in schools will incite fights to the death.

• The dairy industry is gearing up to complain about restrictions on chocolate milk, which accounts for substantial revenues.
• The industry-funded School Nutrition Association, which represents school food serrvice personnel, strongly opposes the proposals, deeming them “unachievable.”

This, of course, was  precisely the reaction to Obama Administration immprovements to school meals, most of which were implemented with little difficulty.  Even so, Congress yielded to lobbying pressure and caved in on rules about potatoes, ketchup (a vegetable!), and whole grains.

I will never understand why everyone isn’t behind healthier foods for kids, but I’m not trying to get them to eat junk food.

As for why school meals matter so much to kids’ health, see Healthy Eating Research: Rapid Health Impact Assessment on Changes to School Nutrition Standards to Align with 2020-2025 Dietary Guidelines for Americans.

• Download the full report here.
• Download the executive summary here.
• Read the Press Release.

As for the gory details of the USDA’s proposals, see:

• Details of the proposed standards
• Comparison Chart: Current Standards vs. Proposed Standards
• Infographic: Proposed Rule for School Meal Standards
• Infographic: Proposed Timeline for Implementation
• Infographic: The Road Ahead – Building Back Better with School Meals
• Media Toolkit

Care to say something about this? FNS encourages all interested parties to comment on the proposed school meal standards rule during the 60-day comment period that begins February 7, 2023.

*******

For 30% off, go to www.ucpress.edu/9780520384156.  Use code 21W2240 at checkout.

Last week I did a post on the FDA’s reorganization.   I should have made one other point: the long-standing inadequacy of FDA funding.  For decades, Congress has assigned tasks to the FDA but provided inadequate funding to do those tasks adequately (hence 1% of imported foods are inspected).  Congress also assigns the funding for specific purposes.

Yes, FDA ought to be doing more, but it is not up to the agency to decide how to deploy its funds.

One more point: For long-standing historical reasons, FDA funding comes from congressional Agriculture committees, even though it is an agency of the Public Health Service.  That is one reason why USDA’s food safety programs are funded at so much higher a level than FDA’s.

With that said, the FDA has come out with some recent initiatives of interest.

I.  Front-of-Package labels.  The FDA is proposing to research a front-of-package symbol: “an easy-to-understand, standardized system that is 1) mandatory, 2) nutrient-specific, 3) includes calories, and is 4) interpretive with respect to the levels of added sugars, sodium, and saturated fat per serving.”

It is doing this in response to a petition from the Center for Science in the Public Interest.

The comments that have come in so far are here.

It is examining the use of front-of-pack symbols in other countries.

It also plans to conduct research on consumer understanding of multiple designs.  Here are the prototype packages on which the designs will be tested.

None of these is likely to be as effective as the ones used in other countries.

Here is one of the better options, in my opinion.

To file comments, go here.  It’s important to do this because the Consumer Brand Association (formerly the Grocery Manufacturers Association) and other industry groups are unlikely to accept any labeling scheme that might discourage you from buying a product.

II.  Qualified health claim: cocoa flavanols.  The FDA has approved a qualified health claim for cocoa flavanols and reduced risk of cardiovascular disease.

This was in response to a petition from the Swiss chocolate company, Barry Callebaut.

Here’s what the FDA will allow.  Yes, this is absurd (look at what the FDA has to go through to get to this), but companies must think statements like this will sell their products.

• “Cocoa flavanols in high flavanol cocoa powder may reduce the risk of cardiovascular disease, although FDA has concluded that there is very limited scientific evidence for this claim.”
• “Cocoa flavanols in high flavanol cocoa powder may reduce the risk of cardiovascular disease. FDA has concluded that there is very limited scientific evidence for this claim.”
• “Very limited scientific evidence suggests that consuming cocoa flavanols in high flavanol cocoa powder, which contains at least 4% of naturally conserved cocoa flavanols, may reduce the risk of cardiovascular disease.”
• “Very limited scientific evidence suggests that consuming cocoa flavanols in high flavanol cocoa powder, which contains at least 4% of naturally conserved cocoa flavanols, may reduce the risk of cardiovascular disease. This product contains at least 4% of naturally conserved cocoa flavanols. See nutrition information for_____ and other nutrients.”

III.  GRAS panels.  The FDA has issued final guidance on best practices for panels deciding which ingredients can be Generally Recognized as Safe.

This lays out the guidelines for

• Identifying GRAS panel members who have appropriate and balanced expertise.
• Steps to reduce the risk of bias, or the appearance of bias, that may affect the credibility of the GRAS panel’s report, including assessing potential GRAS panel members for conflict of interest and the appearance of conflict of interest.
• Limiting the data and information provided to a GRAS panel to publicly available information.

A lot of this is headache-inducing.  FDA rulemaking takes forever.  Can’t wait to see how all this turns out.

*******

For 30% off, go to www.ucpress.edu/9780520384156.  Use code 21W2240 at checkout.

So many readers have asked me to comment on the American Academy of Pediatrics’ Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity that I thought I ought to say something about it.

The guideline report is so long and detailed that I cannot imagine anyone actually reading it.  I started with the introduction, which summarizes basic facts.

• 14.4 million children and adolescents are affected by obesity.
• Obesity is a chronic disease with potentially serious health consequences
• Childhood obesity is strongly affected by social determinants of health (poor education, poverty, racism, exposure to toxins, etc)
• Childhood obesity is stigmatized in ways that fail to acknowledge social determinants.

What got press attention—and the attention of readers of this blog—is the AAP’s endorsement of drug and bariatric surgical treatment of obese children.

I cut right to the chase and looked at Appendix I, which gives the AAP’s algorithm for deciding on treatment options.  

The report’s major conclusions expand on this chart (the report does not define KAS, but I think it means Knowledge, Attitudes, and Skills):

KAS 9.  Pediatricians and other PHCPs should treat overweight (BMI ≥ 85th percentile to <95th percentile) and obesity (BMI ≥ 95th percentile) in children and adolescents, following the principles of the medical home and the chronic care model, using a family-centered and nonstigmatizing approach that acknowledges obesity’s biologic, social, and structural drivers.

KAS 10.  Pediatricians and other PHCPs should use motivational interviewing (MI) to engage patients and families in treating overweight (BMI ≥ 85th percentile to <95th percentile) and obesity (BMI ≥ 95th percentile).

KAS 11.  Pediatricians and other PHCPs should provide or refer children 6 y and older (Grade B) and may provide or refer children 2 through 5 y of age (Grade C) with overweight (BMI ≥ 85th percentile to <95th percentile) and obesity (BMI ≥ 95th percentile) to intensive health behavior and lifestyle treatment. Health behavior and lifestyle treatment is more effective with greater contact hours; the most effective treatment includes 26 or more hours of face-to-face, family-based, multicomponent treatment over a 3- to 12-mo period.

KAS 12.  Pediatricians and other PHCPs should offer adolescents 12 y and older with obesity (BMI ≥ 95th percentile) weight loss pharmacotherapy, according to medication indications, risks, and benefits, as an adjunct to health behavior and lifestyle treatment.

KAS 13.  Pediatricians and other PHCPs should offer referral for adolescents 13 y and older with severe obesity (BMI ≥ 120% of the 95th percentile for age and sex) for evaluation for metabolic and bariatric surgery to local or regional comprehensive multidisciplinary pediatric metabolic and bariatric surgery centers.

What is not in this guideline is anything that addresses the social determinants of childhood obesity.  What we have here is a focus on treating the symptoms, but getting nowhere near the cause.

It is difficult for someone like me who is not affected by those determinants to even imagine how drugs and surgery could be thought even remotely acceptable for children, even those over the age of 12, but I am not treating these kids.

Providers who do treat obese children tell me they are relieved to be able to offer options that might help kids achieve healthier weights.

As I see it, these should be absolute last resorts if used at all. And this is without even getting into issues of cost or our dysfunctional health care system.

In public health terms, drugs and surgery are “downstream” solutions to a problem that began way upstream with all those societal determinants.

If ever we needed upstream approaches, chldhood obesity is a prime example.

Upstream means policy changes that make healthy eating more appealing, accessible, and affordable  That’s what pediatricians need to be calling for.

This AAP report deliberately separates treatment from prevention.  It promises a discussion of prevention in a subsequent report.  I hope it is as hard hitting as any AAP report has ever been.

If childhood obesity teaches us anything, it is that our society needs to change in ways that are healthier for our children.

Additional supporting documents

• Executive Summary: Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity
• Appraisal of Clinical Care Practices for Child Obesity Treatment. Part I: Interventions
• Appraisal of Clinical Care Practices for Child Obesity Treatment. Part II: Comorbidities

Thanks to all the people who wrote me about this.  Much appreciated.

*******

For 30% off, go to www.ucpress.edu/9780520384156.  Use code 21W2240 at checkout.

Last week, the FDA announced its proposed Redesign of Human Foods Program to Enhance Coordinated Prevention and Response Activities.   You can also watch this announcement on video.

This action comes in the wake of:

• The infant formula crisis [Contaminated formula made babies sick. The FDA was warned about food safety concerns at an Abbott plant but took no action.  Abbott recalled formulas,shut down the plant.  This led to empty shelves.  Abbott is now under criminal investigation].
• The FDA’s evaluation of its performance during the crisis [this didn’t say much about accountability]
• The evaluation of the FDA by the Reagan-Udall Foundation [it called for major structural changes]
• The resignation of Frank Yiannas, deputy FDA commissioner [which made clear needed changes were not going to happen]
• Bipartisan pressure from members of Congress to enact major reforms
• Pressure from Senators DeLauro and Durbin to enact reforms
• The Washington Post editorial calling for breaking up the FDA
• Pressure from food safety lawyer Bill Marler to put food back into the FDA and to make fundamental changes

The FDA proposal comes with a vision of how the redesign would work.

The complaints and pressures argued for appointing a senior FDA official in charge of all FDA food programs and units.  Instead, the FDA proposes to create a Human Foods Program encompassing some, but not all, FDA food units.

Most prominently missing is the Center for Veterinary Medicine which deals with food for farm animals and pets.  These, however, fully participate in the food system for humans; they eat most of US corn production and loads of byproducts of human food production.  The systems for humans and animals are inextricably linked.

The organizational chart will look like this.  It splits the food units and connects them with dotted lines.  Good luck with that.  That was precisely the problem with the previous organization.

This looks better than the previous organization chart but falls far short of the authority needed to solve the nation’s food safety problem.

What’s needed?

• Unification of food safety under a central authority that unites the functions of USDA and FDA (the Government Accountability Organization has been calling for that for decades).
• Short of that, high-level FDA authority over the entire food supply under its jurisdiction.
• And much more FDA attention to its public health as well as its safety functions.  It should be taking the lead on actions to prevent diet-influenced chronic diseases.

Hey, I can dream.

In the meantime, let’s see how the FDA’s new structure goes and who it hires into that key position in charge of human foods.

********

For 30% off, go to www.ucpress.edu/9780520384156.  Use code 21W2240 at checkout.

The Federal Trade Commission has issued a Health Products Compliance Guide.

This amazing publication takes on the Dietary Supplement Health and Education Act of 1994.  That act effectively removed the FDA from regulating dietary supplements.  It also allowed supplement labels to make “structure/function” claims that the supplement supported some structure or function of the body, whether or not there was much in the way of scientific evidence to back up those claims (in contrast, FDA-authorized claims must be scientifically substantiated).

Now the FTC is saying:

Marketers of health-related products, including dietary supplements, should be familiar with the requirements under both FDA law and FTC law that labeling and advertising claims be truthful, not misleading, and substantiated.  The FTC approach generally requires that health-related claims be backed by competent and reliable scientific evidence substantiating that the representations are true.

Marketers cannot suggest unsubstantiated benefits, safety, or other characteristics.

Example 4:  An ad for an infant formula states that an ingredient added to the formula can reduce the symptoms of colic.  The ad includes an unrelated chart from a pediatric journal showing that, as a general principle, the length of time that colicky babies cry tends to decrease over the first 12 weeks of life…Using the graph in an ad for the infant formula likely implies that the formula, rather than the babies’ ages, causes the decrease in crying time.

Claims have to be qualified.

Example 10:  An energy drink contains an ingredient that, when consumed daily over an extended period, can result in a significant increase in blood pressure.  Even absent any representation about the product’s safety, the marketer should disclose this potentially serious risk.

Qualifying information must be clear and straightforward.

Example 13:  A company has results from two studies suggesting that its supplement helps to maintain healthy cholesterol levels.  There are, however, significant limitations to each of the studies… The company makes a claim in advertising that “promising, preliminary scientific studies show that our product may be effective in reducing cholesterol.”  The use of the words “promising,” “preliminary,” and “may” is unlikely to sufficiently convey the limitations of the science.

Assertions about the strength of evidence must be accurate.

Example 16: An ad for a supplement includes the statement “Scientists Now Agree!” in discussing the product’s benefit.  This statement likely conveys to consumers that the state of science supporting the benefit has reached the level of scientific consensus.  Unless the advertiser possesses evidence demonstrating that scientists have reached that consensus, the claim is false.

Marketers must consider the totality of the science.

Example 30:  An advertiser wants to claim that a supplement will substantially reduce body fat.  The advertiser has two controlled, double-blind studies showing a modest but statistically significant loss of fat at the end of a six-week period.  However, there is an equally well-controlled, double-blind 12-week study showing no statistically significant difference between treatment and control groups.  Assuming other aspects of methodology are similar, the studies taken together suggest that, if the product has any effect on body fat, it would be very small and may not persist over time.  Given the totality of the evidence, the claim is unsubstantiated.

Here’s the press release. 

The bottom line:  The FTC is requiring evidence for health claims on supplements.

This will affect claims for thousands of supplement products.

Enforcement anyone?  This should be fun to watch.

********

For 30% off, go to www.ucpress.edu/9780520384156.  Use code 21W2240 at checkout.

All of this is enough to make me want to run out and eat some M&Ms.

You can’t make this stuff up.

********

For 30% off, go to www.ucpress.edu/9780520384156.  Use code 21W2240 at checkout.

I received an emailed announcement alerting me to today’s big event: It’s National Peanut Brittle Day, “a day dedicated to honoring one of our favorite uniquely American treats.”

Who knew?

The press release continues with some not-so-sweet news:  peanut brittle is yet another victim of inflation.

The chart shows the cost of the raw ingredients in peanut brittle has increased by nearly 18% — from just under $0.38 per pound in early 2021 to nearly $0.46 cents today.

Other cost increases: transportation, energy, labor add up to “a recipe for expensive candy!”

A strange press release, but an interesting commentary on what’s happening with prices.

********

For 30% off, go to www.ucpress.edu/9780520384156.  Use code 21W2240 at checkout.