Michelle Obama, who has made elimination of “food deserts” a cornerstone of her campaign to end childhood obesity, announced this week that several supermarket and drug store chains—Walmart, SuperValue, and Walgreens among them—have committed to finding ways to put healthier foods into low-income areas.

The USDA issued a press release and a fact sheet on the initiative.

This week, the Food Marketing Institute released “Access to Healthier Foods: Challenges and Opportunities for Retailers in Underserved Areas.”  The report summarizes the risks and benefits of locating grocery stores, describes how to get local governments to provide incentives, and gives some examples of success stories.

Mrs. Obama’s event was thoroughly covered by ObamaFoodorama, which notes that recent research suggests only minimal benefits from putting grocery stores into low-income areas and observes that it’s going to take a lot more than just better access to encourage people in underserved areas to eat more healthfully.

Some advocates worry that the access issue is being used as an excuse for large retail corporations to get a foothold in inner cities than it is for residents to have better food choice, and that an influx of big chains will put small grocers out of business.

Maybe, but I’m guessing that people who live in areas without decent grocery stores will be more than delighted to have them nearby, especially if the stores keep their promises to provide fresh produce.

Just for the record, the research on food deserts (or swamps as some prefer) makes it clear why this is an important issue:

• Access to Affordable and Nutritious Food: Measuring and Understanding Food Deserts and Their Consequences. USDA, 2009 .
• “The Public Health Effects of Food Deserts: Workshop Summary.” Institute of Medicine, Washington, DC: National Academies Press (Washington, DC). 2009.
• Treuhaft, Sarah and Karpyn, Allison. “The Grocery Gap: Who Has Access To Healthy Food and Why It Matters.” Oakland, CA: Policy Link, 2010.

Read, think, advocate!

Center for Science in the Public Interest anounces its Xtreme Eating Awards and describes them in detail in the latest issue of Nutrition Action Healthletter.

Xtreme Eating gives the numbers for calories, saturated, fat and sodium (nicely summarized by  FoodNavigator), but let’s just look at calories.

• Denny’s Fried Cheese Melt  1,260
• The Cheesecake Factory Farmhouse Cheeseburger 1,530 (1,900 with fries)
• IHOP Bacon ’N Beef Cheeseburger 1,250 (plus 620 for onion rings)
• Cold Stone Creamery PB&C Shake 2,010
• Applebee’s Provolone-Stuffed Meatballs With Fettuccine  1,520
• The Cheesecake Factory Ultimate Red Velvet Cake Cheesecake 1,540
• The Steakhouse (Morton’s) Porterhouse Steak and mash 1,390 for the steak; 850 for the mash
• Great Steak extra large King Fries 1,500

These, it should be evident, are substantial fractions of the 2,000 to 3,000 calories most people need in a day.  And these numbers don’t include the additional calories from drinks and anything else that’s added.

CSPI gets sarcastic: “Let’s get one thing clear: Restaurants have nothing to do with the nation’s obesity epidemic. It’s not their fault that two out of three adults and one out of three children are either overweight or obese.”

Are the numbers accurate?  My July 20 JAMA hasn’t arrived yet but I hear that it has an article saying that the calorie numbers posted on restaurant menu boards seem close enough.

If an item says it’s 1,500 calories, it probably is.  Best to share with friends.

 

 

 

 

The mysterious ghostwriting episode I discussed earlier today (see below) is now explained.  Apologies to the Huffington Post.

I received a flurry of messages in response to the post, including an apology from Linda Gibbs, Deputy NYC Mayor for Health and Human Services. She reminds me that we spoke months ago (early May, as it turns out) about my willingness to edit and sign an op-ed about the proposed SNAP ban prepared by her staff that was to be submitted to the New York Times.

I vaguely remember reviewing such a piece and approving its submission.  When I heard that the Times had rejected the piece, I promptly forgot about it.

As far as I can tell from reviewing my sent and deleted messages from Linda Gibbs, none mentioned co-authorship with Geoffrey Canada, and the piece submitted to and published in the Huffington Post does not mention the involvement of the NYC health department.

The press director for Harlem Children’s Zone tells me that the piece was later submitted to two other publications that also turned it down. I was not cc’d on either of those submissions or on the one to the Huffington Post.

Hence my confusion.

For the record, I am happy to have the piece published with my name on it, to be working with the NYC health department and Linda Gibbs, and to be a co-author with Geoffrey Canada, who I very much look forward to meeting one of these days.

And here’s what all the fuss was about:

Does HuffPo use ghostwriters?  “My” piece with Geoffrey Canada!

A colleague congratulated me yesterday on my Huffington Post article—co-authored with Harlem Children’s Zone’s Geoffrey Canada—on SNAP (food stamp) benefits and sodas.

I was amazed to see it.  I don’t recall writing it and I don’t believe I have ever met Mr. Canada, although I would be delighted to do so.  The article does indeed reflect my views but does not read like something I wrote.

So I guess thanks are due to Mr. Canada or to the ghostwriter.  If anyone knows the story behind this, please tell!

Here’s the article:

NYC’s SNAP Sugary Beverage Ban Is the Right Idea

Marion Nestle and Geoffrey Canada

Posted at HuffingtonPost.com: 7/15/11 05:26 PM ET

New York City’s proposal for a two-year pilot to ban the use of food stamps to buy sugar-sweetened beverages is the right idea at the right time. It is a sound approach aimed at minimizing consumption of soda and other beverages stocked with added sugars at a time when we desperately need new interventions to combat the surge of obesity and diet-related disease across the country. A ban would also act as a counterweight to the soda industry’s efforts to solidify its products as part of the typical everyday diet. From our diverse perspectives — informed by a lifetime writing and teaching about food systems and policy, and decades spent helping kids in poverty beat the odds — we join together in a firm belief that this effort must be approved.

Increasingly strong evidence points to sugary drinks as major contributors to obesity and diabetes. The least-fortunate Americans suffer the most, evidenced by health disparities between rich and poor, white and non-white. For example, obesity and Type 2 diabetes are twice as prevalent in New York City’s poorest households as in the wealthiest. And these disparities persist nationwide. Overall, 44 percent of African Americans and 38 percent of Hispanics in the United States are obese, versus 32 percent of whites. Obesity itself increases the risk of diabetes, high blood pressure, cancer, high cholesterol and heart disease, all conditions that disproportionately affect the poor.

New York’s proposal for a two-year pilot project to remove sugar-sweetened beverages from allowable SNAP (Supplemental Nutrition Assistance Program, or food stamp) benefits is based not only on evidence linking these beverages to obesity, but also the fact that sugared drinks have absolutely no nutritional value. Considering that the SNAP program is, both in title and purpose, a nutrition assistance program aimed at combating food insecurity, this in itself is a compelling basis for excluding sugared drinks from the allowable purchases with SNAP dollars. The proposed ban, which would have to be approved by the United States Department of Agriculture (USDA), is in line with the SNAP program’s approach to other non-essential items: the federal government already prohibits use of SNAP benefits for alcoholic beverages, for example. And the WIC (Women, Infants and Children) program, which the USDA also runs, restricts benefits for low-income mothers to only a limited number of nutrient-rich foods.

Some have criticized New York City’s proposal as patronizing to SNAP recipients, but the ban would not stop SNAP recipients from buying sodas. They just wouldn’t be able to use SNAP benefits for them. And, more critically, we must begin to think creatively about mechanisms to change our food environment for the better. The rates of soda consumption in our poorest communities cannot be explained by individual consumer preferences alone, but rather are linked to broader issues of access and affordability of healthy foods in low-income neighborhoods, and to the marketing efforts of soda companies themselves. Four in 10 residents of high-poverty pockets of Harlem, Brooklyn and the South Bronx drink four or more sugary drinks daily, compared with one in 10 Upper West Side residents.*

Certainly, as the 2012 Farm Bill looms, a larger conversation about using federal policy to promote healthful eating is warranted. We should focus on ways to make healthful foods more available to low-income families — for instance, by doubling the value of SNAP benefits when used for fruits and vegetables, or promoting incentives to establish grocery stores and community gardens in inner-city areas. There is no reason that these ideas cannot work in tandem with a policy that eliminates the federal subsidy for soda.

Soda companies hate New York City’s proposal, of course. In 2010 Coca-Cola, Pepsi and the American Beverage Association lobbed $22 million at federal officials, according to the House of Representatives’ Office of the Clerk. This lobbying has killed soda tax initiatives and gotten the industry’s sugar-soaked products into schools (though not here in New York City schools, where they cannot be served). Soda companies reach millions more kids through targeted Internet and social media campaigns. As soda sales in the U.S. have declined, they are increasingly marketing their products to children and youth in low-income areas, and they have successfully co-opted health professional groups with partnerships, alliances and grants. As a result of these efforts, they have created an environment in which it is considered normal in many households to drink sugary drinks all day.

In 2010, SNAP benefits went to more than 40 million people at a total cost of more than $68 billion. According to USDA figures for 2009, approximately six percent of this funding — more than four billion dollars a year — is spent on sugar-sweetened beverages. Given this scale, and the potential health impacts of soda consumption, is time for policy makers to rethink the place of these beverages in a federally funded nutrition assistance program. We hope the USDA will approve New York City’s project.

*Alberti P and Noyes P. Sugary Drinks: How Much Do We Consume? New York, NY. New York City Department of Health and Mental Hygiene, 2011.

Follow Marion Nestle on Twitter: www.twitter.com/marionnestle

Update: 11:00 a.m.

Dear Dr. Nestle,

Apologies for your mistaken attribution in the Geoffrey Canada piece published on Friday. We received an email from the communications director of the Harlem Children’s Zone indicating you were to be bylined on this article. The link to the post now goes to a post bylined just by Mr. Canada.

Sincerely,

Claire Fallon, Associate Blog Editor

The Huffington Post

 

I complained to Scientific American about one of its blog posts about salt, which I viewed as rather one-sided.  The result was a conversation with Michael Moyer that ended up in the form of a Q and A.  I did not have a chance to review it before it was posted, so please see addendum at the end). 

The Salt Wars Rage On: A Chat with Nutrition Professor Marion Nestle

A researcher explains why there may never be a good study on whether excess dietary salt causes hypertension and heart disease

By Michael Moyer | Thursday, July 14, 2011

 Is salt bad for us? In just the past few months researchers have published seemingly contradictory studies showing that excess sodium in the diet leads to heart disease, reduces your blood pressure, or has no effect at all. We called Scientific American advisory board member Marion Nestle, a professor of Nutrition, Food Studies, and Public Health at New York University and the author of Food Politics, to help parse the latest thinking regarding salt and heart health.leads to heart disease, reduces your blood pressure, or has no effect at all. We called Scientific American advisory board member Marion Nestle, a professor of Nutrition, Food Studies, and Public Health at New York University and the author of Food Politics, to help parse the latest thinking regarding salt and heart health.

[An edited transcript of the interview follows.]

I understand this area is controversial.

Hugely.

Could you take us through some of the controversy?

If you talk to any kidney specialist or anybody working on hypertension they will tell you that the first thing they do is try to lower the amount of salt their patients are eating because it helps with blood pressure control. But if you do a clinical trial where you try to put large amounts of people on a low-salt diet, you just don’t see much difference between the people who say they eat a lot of salt and the people who say they don’t eat a lot of salt. In clinical trials the relationship doesn’t show up.

Why not?

Two reasons: One that it’s impossible to put a population of people on a low-salt diet. Roughly 80 percent of the salt in the American food supply is in foods before people eat them—either in processed food or in restaurant food. Because so much salt is added to the food supply and because so many people eat out, it’s impossible to find a population of people who are eating a low-salt diet. They basically don’t exist.

In the one comparative epidemiological study they did some years ago—the Intersalt study—they managed to find two populations of people in remote areas of the jungle someplace who weren’t eating a lot of processed foods and who weren’t eating in restaurants. They were on a low-salt diet, and they never developed hypertension.

So in that trial did they put one group on a high-salt diet and put one on a low-salt diet?

No, no, no. It wasn’t a comparative trial. They just looked at the amount of salt that populations were eating and the amount of hypertension that they had. Only in these two populations were there very low rates of hypertension. With everybody else the salt intake was so high that they couldn’t see any difference between high and higher.

So except for people living in the jungle somewhere, there aren’t any populations on Earth that are eating a low amount of salt?

Not anymore. Maybe we used to be, but not anymore. We have a global food supply, so it’s impossible to do a really careful study.

What’s the other issue?

Not everybody responds to a low-salt diet. There’s a proportion of people in the population who are sensitive to salt—if you lower their intake of salt, then their blood pressure goes down. There’s another (probably larger) percentage of the population who doesn’t respond. They are people who can eat as much salt as they want and still their blood pressure is low.

So you have this curious anomaly where whenever you do a clinical trial you get these complicated, difficult-to-interpret results that don’t show much of an effect. But everybody who works with patients who have hypertension think they do better [on a low-salt diet]. And every committee, body, and group that has ever in my lifetime considered whether salt has anything to do with hypertension says, “yes,” and has recommended salt reduction as a public health measure. That’s the curious situation that we are in.

There’s one other wrinkle and has to do with people’s taste for salt. Campbell’s soup, for example, just announced yesterday that can’t sell low-sodium soups and so they’re adding salt back. And part of the reason they can’t sell it is that if you’re on a high-salt diet, food that isn’t salty tastes terrible to you. And if you’re on a low-salt diet it takes three to six weeks to get accustomed to being on a low-salt diet and then everything you eat tastes salty. And so the more salt in the food supply the more salt people need to bring the flavor you associate with salt. That complicates things, too.

So from a public health standpoint, if you want to deal with the percentage of the population that seems to be extremely responsive to a low-salt diet what you want to do is get the sodium level in the food supply as low as you can. And that makes the people who sell salty food go nuts. And it makes the people who like salty foods go nuts. They think the food tastes bland. And so there are different stakeholders in this system who have very different views and that accounts for the level of passion, I think, in a situation where the science is murky.

Couldn’t you just make the case that people should eat fewer processed foods?

Well what about restaurants? I’m a food professional. I eat out professionally.

Well chefs need to make their food taste good—otherwise people won’t go to their restaurant.

No, they need to make the food taste good by their standard. And chefs, because they’re dealing with a great deal of salt in their food, tend to raise the sodium level. It just goes up and up and up and up. As they get more used to a certain level of salt taste it no longer tastes salty to them and they have to raise it. So the pressure is to raise the salt in the food supply. And reducing it is very difficult.

So you advocate regulation to limit the amount of salt in restaurants?

Yeah, I do. Certainly for processed food. I think everybody would be healthier if they ate less salt. You can always add salt if you don’t think it’s salty enough, whereas I can’t take it away if it’s presented to me. And that’s the dilemma. And the ferocity of the arguments gets into the whole question of personal responsibility and “nanny state” and all of these other enormous debates that really don’t get at the public health question. And the public health question is hard to resolve because the science is really difficult to do.

Couldn’t you imagine a study where you look at sodium levels in urine, which is a direct measure of salt intake, and correlate that with hypertension?

Yeah they’ve done that, and they don’t see any difference in hypertension rates. The reason is that the baseline [level of salt intake] is so high that it doesn’t make any difference. To suggest that people get down to 1,500 mg a day—the recommended level—would be really really hard, and that level may be too high. And it’s unclear that that’s the right level because you can’t do a really decent dose response, and because people vary so much.

Will there ever be a good study?

I don’t know!

Is it possible that this represents the limits of science? It’s black hole event horizons and salt intake?

It may be. It very well may be. Or the science that we have is completely adequate and we already have the answer. I was once at a sodium meeting at which there were a bunch of statisticians. And I left with the statisticians and they said that “anyone who thinks that salt has anything to do with hypertension is delusional.” And that was on the basis on the clinical trials that show so little. And yet every single committee that has dealt with this question says, “We really need to lower the sodium in the food supply.” Now either every single committee that has ever dealt with this issue is delusional, which I find hard to believe—I mean they can’t all be making this up—there must be a clinical or rational basis for the unanimity of these decisions.

But that’s the thing—these committees should be able to point to the evidence that supports their recommendations. But they seem to rely so much on anecdote and individual experience.

Or on some clinical trials that everybody argues about. Everybody argues about every clinical trial no matter what the conclusion. So I find the whole thing completely fascinating. I don’t think anybody can underestimate the difficulty of doing nutritional research. Because people aren’t eating just sodium. They’re eating sodium in food. And it may be that high-sodium diets are a marker for some other things in the food supply or it may be that the physiological differences are so profound that you just don’t get clean results. That human variation is so great. I don’t know the answer to that. I just know it works for me. That’s anecdotal. With an “n” of one.

Addendum

If I had been given the opportunity to review this before it was posted, I would have edited it carefully.  Yes, this is the way I talk but I don’t think what I said reads clearly in print.  In reading over this piece, I think it may give the wrong impression of my views on how expert committees decide on salt recommendations.  The piece may give the impression that committees make dietary recommendations basied on anecdotal evidence, not science.  That’s not true.  They base their recommendations on their interpretation of the experimental and clinical evidence, including that from clinical trials.

For example, the Advisory Committee for the 2010 Dietary Guidelines concluded that “a strong body of evidence has documented that in adults, as sodium intake decreases, so does blood pressure.”  Was this committee delusional in viewing the evidence as strong?  I don’t think so.

Today is the last day to comment on the federal Interagency Working Group’s (IWG) proposed nutrition standards for marketing food products to kids.  The IWG is a joint project of four federal agencies with at least some responsibility for public health: FTC, FDA, USDA, and CDC.

As I discussed back in April, I thought the IWG standards were generous and gave food companies plenty of room to market junk foods with impunity.  Maybe, but that’s not how food companies see it.  They think it will cause so much havoc with their marketing that they are fighting back, big time.

Large food companies joined together to create the “Sensible Food Policy Coalition.”  This entity paid for an economic assessment.  On July 8, the Coalition released Global Insight’s report of this assessment—a call to arms arguing that the “administration’s misguided ad restrictions would cost 74,000 American jobs.”

The report’s point is that restricting advertising would have unintended economic consequences, particularly losses in sales and revenues, and therefore jobs.  The report estimates an astonishing loss of $28.3 billion from manufacturing and retail sales, just in the first year, translating to “at least 74,000 lost jobs.”

This makes me think that the standards may have some merit.  Campbell Soup, for example, has just announced that because its low-salt soups aren’t selling, they are putting the salt back in.  Oh.

In any case, industry pushback seems to be having an effect.  As I discussed in my post a week or so ago, David Vladeck of the FTC used his blog to discuss industry mythology about the proposed standards.  I thought his statement backpedaled on even a hint of federal regulation of food marketing to kids.

MYTH #2: The Working Group’s proposal is regulation by the back door

….This is a report to Congress, not a rulemaking proceeding, so there’s no proposed government regulation. In fact, the FTC Act explicitly forbids the Commission from issuing a rule restricting food advertising to children. So the FTC couldn’t issue a rule on this subject if it wanted to, which it doesn’t. Simply put, a report like this can’t be a rule — whether it’s delivered to Congress by the front door, the back door, or the kitchen door.

The IWG is collecting comments on its proposals through close of business today.  If you need a rationale for filing a comment, read Larry Cohen’s piece in the Huffington Post.

Comments don’t have to be long or complicated.  Just say what you think.

Go to this site to file them.

Or go to the PreventObesity site for additional suggestions.

Do this today!

 

 

 

I’m just back from judging Google’s first Science Fair for kids 13 to 18 at its corporate headquarters in California (yes, those are tomatoes growing in the foreground).

Google’s famous food program: Why famous?  It is:

• Available 24/7
• Totally free
• Varied and delicious
• Designed to promote health as well as environmental values (local, organic, sustainable)

On this last point, the recycling program is comprehensive and the campus is planted with organic vegetables, free for the picking:

But what about the “freshman 15”?

If free food is available 24/7, isn’t Google creating a classic “obesogenic” environment?  Do new Google employees gain weight?

Indeed, they do, and this creates a dilemma for the food team.  I met with Joe Marcus, Google’s food program manager, and executive chef Scott Giambastiani.  Free and very good food, they explain, is an important recruiting perk for Google.   Employees learn to manage it.  And those who are eating healthy food for the first time in their lives find that they actually lose weight.

Google’s food labeling program

Google labels its snacks, drinks, and the foods prepared in its 25 or so cafeterias with traffic lights: green (eat anytime), yellow (once in a while), or red (not often, please).  It bases the decisions about which food goes where on the Harvard School of Public Health’s healthy eating pyramid.   It labels foods at the top of the Harvard pyramid red, the ones in the middle yellow, and those at the bottom green.

In theory this makes sense as a starting point.  In practice, it tends to seem a bit like nutritionism—reducing the value of the foods to a few key nutrients.

The difficulties are most evident in the snack foods, freely available from kiosks all over the campus.   Products are displayed on shelves labeled red, yellow, or green.  For example:

GREEN: Sun chips, 1.5 oz, 210 kcal, 10 g fat, 180 mg sodium, 3 g sugar, 4 g fiber

YELLOW: Lentil chips, 1 oz, 110 kcal, 3 g fat, 170 mg sodium, 1 g sugar, 3 g fiber

YELLOW: Walnuts, 0.8 oz, 150 kcal, 15 g fat, 0 g sodium, 1 g sugar, 2 g fiber

RED:  Luau BBQ chips, 1.5 oz, 210 kcal,  14 g fat, 158 mg sodium, 2 g sugar, 1 g fiber

Note: the weights of the packages are not the same, so the amounts are not really comparable, but the ranking scheme seems to give most credit for fiber.

As for these and the foods cooked in cafeterias, Google uses other strategies to promote healthier choices.  It:

• Puts the healthiest products at eye level
• Uses small plates
• Tries to include vegetables in everything
• Makes healthier options available at all times
• Uses the smallest sizes of snack foods (packages of 2 Oreos, rather than 6)
• Makes it easy to be physically active (Google bicycles!)

The only place on the campus where employees pay for food is from a vending machine.  The pricing strategy is based on nutrient content, again according to the Harvard pyramid plan.  For the vended products, you pay:

• one cent per gram of sugar
• two cents per gram of fat
• four cents per gram of saturated fat
• one dollar per gram of trans fat

On this basis, Quaker Chewy Bars are 15 cents each, Famous Amos cookies re 55 cents, and an enormous Ghirardelli chocolate bar is $4.25.  Weights don’t count and neither do calories.  The machine is not run by Google.  Whoever does it has a sense of humor.

Impressive, all this.  Not every company can feed its nearly 30,000 employees like this but every company can adopt some of these strategies.  It might save them some health care costs, if nothing else.

Every now and then, Kerry Trueman (“KAT”) poses a question, usually about something challenging.  Her challenge today:

Let’s Ask Marion: Is it Possible to Have an Unhealthy Obsession With Healthy Eating?

A few more for summer reading pleasure and enlightenment (for others see previous post):

Poisoned, Jeff Benedict, Mariner 2011: I blurbed this one: “In telling the entwined stories of childhood victims of food poisoning and the lawyers [Bill Marler et al!] wrangling over just compensation, Poisoned is a fast-paced thriller, a riveting illustration of how the political—in this case, the inadequate food safety system—becomes personal.”

The Sorcerer’s Apprentices, Lisa Abend, Free Press, 2011. What is a book about the celebated Spanish restaurant El Bulli doing on a food politics list?  Abend is a terrific reporter who spent a year observing how the place runs: almost entirely on the labor of dozens of food professionals who gave up their real jobs to work for six months at a time as unpaid volunteers.   The cooks are essentially piece workers.  They never see or taste the final dishes served in the restaurant.

State of the World, 2011, Worldwatch Institute. The 2011 annual report focuses on “Innovations that nourish the planet”—anti-hunger and farming projects throughout the world that are successfully improving the health of people and the planet.  Read and be inspired!

Tomatoland, Barry Estabrook, Andrews McMeel, 2011. This book is a welcome expansion of Estabrook’s stunning, prize-winning article in Gourmet.   Estabrook writes a compelling account of the injustices and social costs of industrial tomato farming to farm workers and to the environment.  We could and should do better, and Estabrook explains how.  Tomatoland scored a rave review in the New York Times, most deservedly.

…And for the under 2 set:

Rah, Rah, Radishes: A Vegetable Chant, April Pulley Sayre, Beach Lane, 2011:  It comes with gorgeous photographs of vegetables and could be fun to read to little kids:

Oh boy,

Bok choy!

Brussels sprout.

Broccoli, cauliflower.

Shout it out!