by Marion Nestle

Search results: smart choices

Nov 16 2021

The American Heart Association’s new and groundbreaking dietary guidelines

The American Heart Association (AHA) has just issued its latest set of dietary guidelines aimed at preventing the leading cause of death in the United States: 2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association.

Because AHA guidelines apply not only to coronary heart disease but also to all other chronic disease conditions—and sustainability issues—influenced by dietary practices, they deserve special attention.

Most of these repeat and reinforce the 2020-2025 Dietary Guidelines for Americans.

The two big differences in the recommendations:

  • Clarifying protein recommendations: these include all sources but emphasize plant sources (#4)
  • Including a new one: minimize ultra-processed foods (#6)

These recommendations are way ahead of the US Dietary Guidelines in recognizing how much ultra-processed foods contribute to poor health, and how important it is to minimize their intake.

Also unlike the US guidelines, these are unambiguous and easily summarized.

 

The statement is worth reading for its emphasis on two other points.

  • This dietary pattern addresses problems caused by other chronic conditions and also has a low environmental impact.
  • Following this dietary pattern requires much more than personal responsibility for food choices.  It requires societal changes as well.

The press release summarizes the problems in society that make following healthy diets so difficult, if not impossible:

  • Widespread dietary misinformation from the Internet;
  • A lack of nutrition education in grade schools and medical schools;
  • Food and nutrition insecurity – According to references cited in the statement, an estimated 37 million Americans had limited or unstable access to safe and nutritious foods in 2020;
  • Structural racism and neighborhood segregation, whereby many communities with a higher proportion of racial and ethnic diversity have few grocery stores but many fast-food outlets; and
  • Targeted marketing of unhealthy foods and beverages to people from diverse racial and ethnic backgrounds through tailored advertising efforts and sponsorship of events and organizations in those communities.

As the statement concludes: “Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.”

Amen to that.

Comment: From my perspective, this statement thoroughly supersedes the 2020-2025 Dietary Guidelines for Americans, which—because they say nothing about ultra-processed foods , differential protein sources, sustainability, or doing anything to counter societal determinants of poor diets—were out of date the instant they appeared.

Some of the details of the AHA statement will be debated but its overall approach should not be.

The committee that put these guidelines together deserves much praise for basing its advice on today’s research and most pressing societal needs.

Additional AHA Resources:

Feb 17 2016

The strange story of my accepted but then unpublished commentary on a Disney-sponsored study

Last summer, Brian Wansink, a friend and Cornell colleague and the editor of the new Journal of the Association for Consumer Research, asked me to write a commentary on a paper to be published in its inaugural issue.

The paper turned out to be by a group of authors, among them John Peters and Jim Hill, both members of the ill-fated Global Energy Balance Network, the subject of an investigation by the New York Times last August.

Titled “Using Healthy Defaults in Walt Disney World Restaurants to Improve Nutritional Choices,” the paper described the benefits of improving the composition of kids’ meals at Disney World.

The healthy defaults reduced calories (21.4%), fat (43.9%) and sodium (43.4%) for kid’s meal sides and beverages sold in the park. These results suggest that healthy defaults can effectively shift food and beverage selection patterns toward healthier options.

The authors explain:

This work was supported by the Walt Disney Company and by the National Institutes of Health…The Walt Disney Company and the National Institutes of Health had no role in the design, analysis, or writing of this article. Full disclosure: JH is a consultant for the Walt Disney Company and for McDonalds; KA is a consultant for the Walt Disney Company.”

I thought Disney’s sponsorship of this research and its withholding of critical baseline and sales data on kids’ meals that the company considered proprietary did indeed deserve comment, and wrote my piece accordingly.  Brian Wansink soon accepted it for publication but to my surprise, gave it to Peters et al. for rebuttal.  They filed a lengthy response.  I was then given the opportunity to respond, and did so, briefly.

The paper by Peters, et al. did was published in the journal’s first issue.   This issue also includes several commentaries on other papers (none of which are accompanied by rebuttals).

My commentary—and the back-and-forth—however, were omitted.

After some discussion, the journal published my commentary online.  You have to scroll down to find it.  The site provides no links to it in the table of contents or in the article by Peters et al.

Is it possible that Disney or the authors’ contractual relationships with Disney could have had anything to do with the omission of my accepted-for-publication commentary?  Brian Wansink says no, they just ran out of room (despite room for others).

Whatever.

Here’s what I wrote:

Dietary nudges for obesity prevention: They work, but additional policies are also needed

In 2006, the Walt Disney Company announced a new initiative to improve the nutritional quality of meals served to children at its theme parks. The company would be changing the default kids’ meals—the components that come without having to be ordered separately–to include low-fat milk, juice, or water rather than soft drinks, and sides such as apple sauce or carrots rather than French fries. Parents who wanted sodas or fries for their children would have to ask for them, something many might not bother to do. Health groups had long advocated for this policy change (Wootan 2012).

As I commented to a reporter at the time, “going to Disney World is an excuse for eating junk food…Disney or its advisers must be feeling they have some responsibility” (Horovitz and Petrecca 2006). Indeed, the healthier defaults were part of a larger effort by Disney to deal with its contribution to obesity in America. After ticket prices, food is the second greatest source of revenue at Disney World. Although reducing the amount of food consumed at the parks might help create a less “obesogenic” food environment, revenues might fall. But the default change might be revenue neutral. By 2008, Disney could report that two-thirds of U.S. customers ordering kids’ meals had accepted the default, with no loss in sales. In Hong Kong Disney parks, nearly all customers accepted the default. The report, however, did not include data on the numbers or proportions of customers ordering kids’ meals (Walt Disney Company 2008).

Disney’s more recent summary of its child health initiatives states that it is funding investigators at the University of Colorado to conduct a more formal evaluation of use of the default options (Walt Disney Company 2015). The paper by Peters et al. (2016) in this issue of the Journal presents the results of that research. Their work confirms the ongoing effectiveness of the strategy. Nearly half the customers ordering kids’ meals accepted the healthy default side dishes and two-thirds accepted the healthier beverages. These choices resulted in significant reductions in the calories, fat, and sodium in purchased kids’ meals, but not sugar (Peters et al 2016).

The authors argue that gentle nudges changes like these are preferable to more coercive policies that smack of nanny statism. Such reductions help, but are they enough to make a real difference? To answer this question, it would help to know what else the children were eating along with the drink and side dishes. Although the authors were given raw sales data, Disney did not permit them to use this information as part of the overall analysis. The company also refused to provide information about the number of children who visited the park or the number of kids’ meals sold.

These missing pieces raise red flags because this is a Disney-funded study that produced results that Disney can use to advertise itself as a company that cares about kids’ health, and to deflect attention from Disney World’s’ reputation as a junk-food paradise. Corporate funding of research introduces conflicts of interest and reduces the credibility of the results, not least because the biases inherent in such research are largely unconscious, unintentional, and unrecognized (Moore et al 2005) The results of this study merit especially careful scrutiny. Taking them at face value, the default strategy worked well for the drink, but the sides are still a problem, and so are the sugars. They do not reveal much about what kids eat in a day at Walt Disney World

Nudges like this default are an important part of strategies to counter childhood obesity. But are they enough to deal with the public health problem? To make a real difference, they need to be accompanied and supported by a range of policy approaches. Current thinking about such approaches recommends combining insights from behavioral research, economics, and public health to establish a food environment far more conducive to making the healthy choice not only easy choice, but also the preferred choice. Doing so is likely to require multiple actions—for example, regulation of nutrient content and marketing; incentives such as subsidies of healthier foods; disincentives such as taxes, warning labels, and nutritional rating systems for unhealthier foods; and education of adults and children (Hawkes et al 2015). Disney’s voluntary default is a small step in the direction of such policies, but many more are needed if we are to make real progress in reducing the prevalence of childhood obesity.

  • Margo G. Wootan. Children’s meals in restaurants: families need more help to make healthy choices.   Childhood Obesity 2012;8(1):31-33.
  • Bruce Horovitz and Laura Petrecca.  Disney to make food healthier for kids.  USA Today, October 17, 2006.
  • Walt Disney Company. Walt Disney Company—2008 Corporate Responsibility Report. 2008.
  • Walt Disney Company.  Magic of Healthy Living brochure.  2015. https://thewaltdisneycompany.com/sites/default/files/MOHL_Brochure.pdf.
  • John C. Peters, Jimikaye Beck, Jan Lande, Zhaoxing Pan, Michelle Cardel, Keith Ayoob, and James Hill. Using healthy defaults in Walt Disney World restaurants to improve nutritional choices.  J Assoc Consumer Res., 2016;1:1.
  • Don A. Moore, Daylian M. Cain, George Loewenstein, and Max H. Bazerman, editors.  Conflicts of Interest: Challenges and Solutions in Business, Law, Medicine, and Public Policy.  Cambridge University Press, 2005.
  • Corinna Hawkes, Trenton G Smith, Jo Jewell, Jane Wardle, Ross A Hammond, Sharon Friel, Anne Marie Thow, Juliana Kain.  Smart food policies for obesity prevention. The Lancet 2015;385:2410–2421.

And here’s my response to the rebuttal by Peters et al.

The response from Peters and Hill still fails to acknowledge the severity of the problems posed by Disney’s sponsorship of their research—the company’s failure to produce data essential for proper interpretation of study results, and the level to which sponsorship by food companies biases such interpretations.  At one point, Disney boasted of the results of this research, confirming its benefit to marketing goals.  The threat of industry sponsorship to research credibility has received considerable press attention in recent months, as must surely be known to these authors.1,2 

1  Anahad O’Connor.  Coca-Cola funds scientists who shift blame for obesity away from bad diets.  New York Times, August 9, 2015. http://well.blogs.nytimes.com/2015/08/09/coca-cola-funds-scientists-who-shift-blame-for-obesity-away-from-bad-diets/

2  Candice Choi.  AP Newsbreak: Emails reveal Coke’s role in anti-obesity group.  US News, November 24, 2015.  http://www.usnews.com/news/business/articles/2015/11/24/apnewsbreak-emails-reveal-cokes-role-in-anti-obesity-group

Sep 26 2014

Weekend reading: Brian Wansink’s Slim by Design

Brian Wansink.  Slim by Design: Mindless Eating Solutions for Everyday Life.  William Morrow, 2014.

In his new book, Wansink, the author of Mindless Eating (Amazon’s #1 Best Seller in Eating Disorders, Self-Help) and guru of Cornell’s Food and Brand Lab, promotes the idea that small changes in the food environment will encourage healthier eating.

Wansink, of course, is the behavioral economist who conducts clever and revealing experiments proving this point: the bottomless soup bowl (people eat and eat and eat), the Super Bowl study (students eat more from larger containers), the organic aura hypothesis (people perceive foods with health claims as having fewer calories), the stale popcorn study (if it’s there, people will eat it).

His studies are fun and I especially like his work because it shows how much environmental factors influence food choice.  If so, we need policies to change the environment to make the healthy choice the easy choice.

Wansink, however, usually interprets his work as suggesting what you—as an individual—can do to counter the environmental forces: pay attention, use smaller plates, snack-proof your house.

He does that in this book too, but also has suggestions for actions that restaurants, supermarkets, and food makers can take to sell healthier foods and still make money.   If you are a fast-food restaurant, for example, you can:

Make it motivating

  • Start a Healthy Habits loyalty card—five punches and the sixth healthy item is free.
  • Give 5 percent off the healthier combo version: diet versus regular, baked versus fried.

He says:

Give away a sixth meal?  Give a 5 percent discount?  On a $5 meal that’s a 25-cent loss.  Think of it instead as a $4.75 gain, because diners could have easily otherwise gone somewhere else.  And it’s a $9.50 gain if they brought a friend.

Could this start a movement?

In an e-mail, Wansink writes:

My goal is for this book to ignite a Slim by Design Movement that transforms restaurants, grocery stores, workplaces, schools into healthier places that guide us to make smarter, healthier choices. The book tells people exactly what they can ask their favorite restaurant or grocery store to do, and the web site allows them to complete abbreviated scorecards and post them to Facebook and Twitter to show people there are simple, scalable, solutions that can make all of us Slim by Design.

Policy change, anyone?

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Apr 28 2014

Act now: support USDA’s wellness policies for schools

Now is the time to tell USDA you support its proposed guidelines for nutrition education, physical activity, and junk food marketing in schools:

The bipartisan Healthy, Hunger-Free Kids Act of 2010 mandated that the USDA set guidelines for what needed to be included in local school wellness policies in areas such as setting goals for nutrition education and physical activity, informing parents about content of the policy and implementation, and periodically assessing progress and sharing updates as appropriate. As part of local school wellness policies, the proposed guidelines would ensure that foods and beverages marketed to children in schools are consistent with the recently-released Smart Snacks in School standards. Ensuring that unhealthy food is not marketed to children is one of the First Lady’s top priorities; that is why it is so important for schools to reinforce the importance of healthy choices and eliminate marketing of unhealthy products.

Here are two easy ways to make sure USDA follows through on the guidelines:

Center for Science in the Public Interest (CSPI) has a website set up for quick letters:

While many schools have adopted policies over the past few years to support healthy eating and physical activity, implementation has not been uniformly strong. USDA’s proposed updates will strengthen implementation, help parents be better informed about the policies, and provide schools with more tools and resources.

The Campaign for a Commercial-Free Childhood (CCFC) asks for signatures on a letter urging the USDA to ban all advertising in schools:

The USDA is urging schools only to limit junk food marketing. By attempting to set a ceiling that prohibits advertising for unhealthy foods, the USDA may set a floor that opens the floodgates for many other types of marketing in schools, setting a dangerous precedent that goes far beyond food.

Now is the time….

 

Mar 9 2011

New York City’s successful school food initiatives

I was pleased to see the article in last Sunday’s New York Times about New York City’s efforts to improve school food.   The story focused on PS 56, a school that serves low-income kids in Brooklyn.

The article  describes the food revolution that is taking place in New York City schools, one described in an excellent report by Hunter College faculty.

In singling out PS 56, the writer chose a good example.

I visited there a year or so ago, and wrote about it at the time under the title “School food: it can be done!”  Its cafeteria is an astonishing place.  The food smelled good.  It tasted good.  The staff cared whether the kids ate what they cooked.

When I asked whether this school was typical, the answer was “not exactly.”  How come it worked?  Everyone pointed to the principal, Deborah Clark-Johnson, who believes it’s important to feed kids well and who totally supported the cafeteria staff.

So one way to improve school food is to recruit caring staff.

Another, for older kids, is to encourage them to make better choices.  An article in the Boston Globe discusses Cornell professor Brian Wansink’s work in this area:

But it turns out that students are susceptible to the same marketing strategies that grocery stores have been using for years. Several experiments have shown that children will be more likely to eat items if they see them early in the lunch line and find them attractive and convenient to pick up. Putting fruit in a good-looking bowl works. So does putting a salad bar in a prominent place. Calling your carrots “X-ray vision carrots” can double sales.

I’ve discussed Professor Wansink’s work on lunch line redesign in an earlier post.  It raises an interesting question: is this the right strategy, or should schools just serve healthy food in the first place?

This is worth discussion.  Want to weigh in?

Dec 21 2009

Food labeling: yet another update

The FTC Forum last week got everyone going about food labels.  Here are the latest items to hit my inbox:

Traffic light front-of-package labels may do some good after all: As I explained in a previous post, British investigators did a study showing that the green-yellow-red traffic light dots on food packages do not necessarily help people make healthier choices.  Now, another British scientist argues that the study showed no such thing; at best, it showed that more research is needed to see how consumers interpret and act on those signals.

European Food Safety Authority (EFSA) approves some (weak) omega-3 claims: Under great pressure from food companies desperate to make claims for omega-3 fatty acids, EFSA is allowing three, if somewhat grudgingly:

  • DHA intake can contribute to normal brain development of the foetus, infant and young children
  • DHA intake can contribute to normal development of the eye of the foetus, infant and young children
  • DHA intake can contribute to the visual development of the infant

“Can,” I suppose, is a bit less conditional than “may,” but these are not strong claims.  And they say nothing at all about making kids smarter.  Under these rules, that  “brain development” claim on Nestlé’s omega-3-fortified Juicy Juice drink (the one I find so absurd), would be OK.  But anything more specific, the EFSA committee said, would have to be backed by further science.

FDA food labeling rules: if after all the fuss about serving sizes at the FTC Forum, you want to know what FDA really says about them,  you can find the details on the FDA food labeling website.  On that site, click on Label Formats/Graphics to find the current rules on serving sizes.  Good luck making sense of them.

That’s more than enough about food labels for the moment.  It’s the holidays and time to talk about something cheerier.  Stay tuned.


Dec 12 2008

What to Eat

Order from your local independent bookstore or Amazon or Barnes & Noble

Summary

What To Eat What to Eat is a book about how to make sensible food choices. Consider that today’s supermarket is ground zero for the food industry, a place where the giants of agribusiness compete for your purchases with profits—not health or nutrition—in mind. This book takes you on a guided tour of the supermarket, beginning in the produce section and continuing around the perimeter of the store to the dairy, meat, and fish counters, and then to the center aisles where you find the packaged foods, soft drinks, bottled waters, baby foods, and more. Along the way, it tells you just what you need to know about such matters as fresh and frozen, wild and farm-raised, organic and “natural,” and omega-3 and trans fats. It decodes food labels, nutrition and health claims, and portion sizes, and shows you how to balance decisions about food on the basis of freshness, taste, nutrition, and health, but also social and environmental issues and, of course, price. Note to Readers: I cannot begin to tell you how much fun this book has been to research and write. It turned out to be as challenging a project as any I have ever undertaken, but also a lot more entertaining. Every time I walked into a supermarket, I discovered something new and often unsuspected. The most seemingly mundane products (eggs! bottled water!) led me to discoveries I had not even imagined possible. I found something astonishing—and often quite amusing—in every section of the store. I hope that you are just as amazed and amused reading this book as I was while writing it. I also hope that you put it to immediate use. Enjoy, eat well, and change the world (for the better, of course).

Reviews and Commentary

Oct 28 2008

New food rating label: a step forward?

Big Food companies have gotten together and agreed on a scoring system to identify “better-for-you” packaged foods (see below).  Thanks to my colleague in Copenhagen, Morten Strunge Meyer (MortenCopenhagen), for sending the link to the qualifying crieteria.  As is true of scoring systems in general, these are complicated and constitute a slippery slope.  Take sodium, for example.  The allowance is particularly generous (junk foods don’t taste good without it) – 480 mg per serving.  That means 479 mg qualifies and that’s still nearly half a gram.

Having one checkmark instead of the various ones run by PepsiCo, Kraft, and Unilever seems useful if – and only if – the criteria are stringent (which this one is not for sodium), and this symbol replaces all of the others.  Even so, this looks like preemption.  It’s voluntary and seems designed to head off a mandatory traffic light system (red, yellow, green)  that would warn people away from the worst junk foods.  It also preempts the FDA proposal to display the full number of calories per package.  Alas, this is a standard food industry tactic: preempt with something that seems better than what is currently available to stave off something that could be worse.

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