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Lots of people take supplements in the hope that they will help with body weight.  This is a big market.  Drug companies want in on it.  Most drugs don’t work, or have deal-breaking side effects.  In June,  The FDA approved Novo Nordisk’s Semaglutide for obesity management.

I subscribe to the Obesity and Energetics newsletter, which sends out weekly lists of research, articles, and commentary on those topics—a great way to stay up on current literature.

On July 2, it featured:

• From the Obesity Society: “Health care providers should be aware of the lack of evidence and deficiencies in regulatory oversight of dietary supplements marketed for weight loss.”  

This referred to: Perspective: Dietary supplements and alternative therapies for obesity: A Perspective from The Obesity Society’s Clinical Committee.  Srividya Kidambi, John A. Batsis, William T. Donahoo, Ania M. Jastreboff, Scott Kahan, Katherine H. Saunders, Steven B. Heymsfield.  Obesity 23 June 2021.

Our recommendation to clinicians is to consider the lack of evidence for non-FDA-approved dietary supplements and therapies and guide their patients toward tested weight management approaches…we call on regulatory authorities to critically examine the dietary supplement industry, including their role in promoting misleading claims and marketing products that have the potential to harm patients.

I am with the Obesity Society on this one, but what caught my interest was that several of the authors report financial tied to drug companies with interests in pharmacologic approaches to obesity treatment.

Conflicts of interest: SK serves as Medical Editor for TOPS Magazine (TOPS Inc. nonprofit weight loss club) and as Director for the TOPS Center for Metabolic Research at the Medical College of Wisconsin supported by TOPS Inc. JAB’s research reported in this publication was supported in part by the National Institute on Aging of the National Institutes of Health (NIH) under Award Number K23AG051681. JAB reports equity in SynchroHealth LLC. AMJ’s research is supported by the NIH/NIDDK, the American Diabetes Association, Novo Nordisk, and Eli Lilly; she serves as a consultant for Novo Nordisk, Eli Lilly, and Boehringer Ingelheim. SKa has served as a consultant for Novo Nordisk, Vivus, Gelesis, and Pfizer. KHS reports an ownership interest in Intellihealth. SBH reports his position on the Medical Advisory Board of Medifast Corp.

The newsletter also featured the article referred to in the Perspective.

• Systematic Review: Dietary Supplements and Alternative Therapies for Weight Loss.

When I clicked on this link, it took me to the page where I could download the pdf.  I got the paper at this site.   But before I could read it, I had to see an ad for Novo Nordisk’s drug, Semaglutide.  Then I scrolled down to get the study:  A Systematic Review of Dietary Supplements and Alternative Therapies for Weight Loss.  John A. Batsis, John W. Apolzan, Pamela J. Bagley, Heather B. Blunt, Vidita Divan, Sonia Gill, Angela Golden, Shalini Gundumraj, Steven B. Heymsfield, Scott Kahan, Katherine Kopatsis … Obesity (2021) 29, 1102-1113

Study conclusion: “There is weak evidence for the efficacy of dietary supplements and alternative therapies.”

Authors’ disclosure: JAB reports equity in SynchroHealth LLC. AG reports consulting with Novo Nordisk and Unjury. SH reports personal fees from Medifast. SKa reports personal fees from Novo Nordisk, Pfizer, Vivus, and Gelesis. DR reports consulting and speaking fees for Novo Nordisk and Astra Zeneca. KHS has a relationship with Intellihealth Inc. SK is the medical director for TOPS Center for Metabolic Health at the Medical College of Wisconsin, which is supported by TOPS Inc. SBH reports his position on the Medical Advisory Board of Medifast Corp.

I much prefer dietary approaches to weight management and policy strategies to make healthy diets the easy choice.

I am almost never in favor of supplements.  The evidence that they do much beyond placebo effects is usually pretty weak.

The ad gives the side effects for Semiglutide; it has to.

My point: all of this seems to be about marketing Semiglutide.

The Pan-American Health Organization (PAHO) has developed a Nutrient Profile Model, which it describes as “a tool to classify processed and ultra-processed food and drink products that are in excess of critical nutrients such as sugars, sodium, total fat, saturated fat and trans-fatty acids.”

To understand how it works, go to the website.  Watch the video.

Its purpose, as explained in the print publication is to help governments to identify unhealthy products and use public policies to discourage the consumption of those products.

The Expert Consultation Group described in this report was commissioned to develop a Nutrient Profile Model for the Pan American Health Organization – the PAHO NP Model – to be used as a tool in
the design and implementation of various regulatory strategies related to the prevention and control of obesity/overweight, including the following:
• Restriction in the marketing of unhealthy food and beverages to children
• Regulation of school food environments (feeding programs and food and beverages sold in schools)
• Use of front-of-package (FOP) warning labels
• Definition of taxation policies to limit consumption of unhealthy food
• Assessment of agricultural subsidies
• Identification of foods to be provided by social programs to vulnerable groups.

The criteria for ultra-processed foods to be avoided or eaten in small amounts:

It’s a start.

PAHO produces its  Nutrient Profile Tool in Spanish, of course: Perfil de Nutrientes – OPS/OMS | Organización Panamericana de la Salud (paho.org)a

It also has a report listing ultra-processed foods in Latin America, and many other useful documents.

As for me, I rather like the broader definition of ultra-processed foods described by the Brazilian public health academics who defined the term:

A practical way to identify an ultra-processed product is to check to see if its list of ingredients contain…either food substances never or rarely used in kitchens (such as high-fructose corn syrup, hydrogenated or interesterified oils, and hydrolysed proteins), or classes of additives designed to make the final product palatable or more appealing (such as flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents).

All of these are great resources for food policy in Latin America.

Let’s hope governments respond.

As I mentioned yesterday, everyone seems to be doing reports on food systems—a deluge.  Here are the most recent ones I’ve collected.

Food and Water Watch: Well-Fed:  A Roadmap To A Sustainable Food System That Works For All

The report outlines the alarming degree of corporate consolidation in the food industry and its impact on consumers and small farms. For example:

• 83 percent of all beef is produced by just four processing companies;
• 65 percent of consumer grocery market share is held by just four retailers; and
• 67 percent of crop seed market share is held by just four corporations.

Global Alliance for the Future of Food: Beacons of Hope: Stories of Food Systems Transformation During COVID-19

Building on a program of work launched in 2019 — “Beacons of Hope: Stories of
Transformation” — this short report shares stories of food systems initiatives and the
people who responded to the COVID-19 pandemic with creativity, adaptability, and resilience.

Global Alliance for the Future of Food:  How to Transform Food Systems: 7 Calls to Action

The Global Alliance advocates for increased systems-based research into the future of food and positive food environments that are adapted to meet regional conditions and cultural contexts. We also call for transformed governance and decision-making, with additional investment and support for agroecology and regenerative approaches, and excluding harmful subsidies and incentives.

World Resources Institute: Food Systems at Risk: Transformative Adaptation for Long-Term Food Security

Food security, people, climate. These three words are inextricably linked; changes to one will inevitably affect the others. As climate change threatens food-producing regions, what changes are needed to feed a growing population? How can we shift food systems to better adapt to the changing climate? More explicitly, how can policymakers help hundreds of millions of small-scale agricultural producers to enhance food security and improve livelihoods despite the challenges that climate change brings?

OECD (Organisation for Economic Co-operation and Development): Agricultural Policy Monitoring and Evaluation 2021: Addressing the Challenges Facing Food Systems

Food systems is the hot new term, referring as it does to everything that happens to a food from production to processing to consumption to waste.  Reports about food systems constitute a deluge.  This one deserves special mention.  Others follow tomorrow.

FAO announces a new report on indigenous people’s food systems:

Nearly 500 million people in more than 90 countries self-identify as Indigenous Peoples, with unique traditional knowledge offering rich opportunities for food security and biosecurity preservation.  Eight Indigenous Peoples’ food systems are examined in depth and revealed to be among the most sustainable in the world in terms of efficiency, no waste, seasonality and reciprocity.

The 420-page (!) report is here.

It is enormously detailed about foods, climate, geography, sustainability, resilience, and needs of the people in each community studied.

The eight groups studied:

• Forest-based Baka of South-eastern Cameroon
• Reindeer herding Inari Sámi of Nellin, Finland
• Fishing and gathering Khasi of Meghalaya, India
• Fishing and agroforestry Melanesians of Solomon Islands
• Pastoralist Kel Tamasheq of Aratène Mali
• Agro-pastoralist and gathering Bhotia and Anwal of Uttarakhand, India
• Fishing, chagra, and forest Tikuna, Cocama, and Yagua of Puerto Nariño, Colombia
• Milpa practicing Maya Ch’orti’ of Ciquimula, Guatemala

For each group, the report gives detailed information about food sources, production methods, sustainability, resiliency, problems, and issues.

And example from the Baka:

This is an astonishing resource and FAO deserves much praise for doing a deeply scholarly report like this.

Michael Pollan.  This is Your Mind on Plants.  Penguin, 2021.

This book is a great read: informative, smart, hilariously funny on occasion, and wonderfully written, as is only to be expected from anything Pollan produces.

The book is about three plants that are sources of mind-altering drugs, poppies (opium), tea and coffee (caffeine), and peyote cactus (mescaline).

The tea and coffee bring it into the realm of food politics, and I’ll stick to them for the moment (but the poppies chapter is particularly riveting, tough, and timely).

An excerpt beginning on page 99:

Most of the various plant chemicals, or alkaloids, that people have used to alter the textures of consciousness are chemicals originally selected for defense. Yet even in the insect world, the dose makes the poison, and if the dose is low enough, a chemical made for defense can serve a very different purpose: to attract, and secure the enduring loyalty of pollinators.  This appears to be what’s going on between bees and certain caffeine-producing plants, in a symbiotic relationship that may have something important to tell us about our own relationship to caffeine…[in an experiment] even at concentrations too small for the bees to taste, the presence of caffeine helped them to quickly learn and recall a particular scent and to favor it…Actually we don’t know whethe the bees feel anything when they ingest caffeine, only that the chemical helps them to remembe–which, as we will see, caffeine appears to do for us, too.

Another from page 145:

Would people have ever discovered coffee or tea, let alone continued to drink them for hundreds of years, if not for caffeine?  There are countless other seeds and leaves that can be steeped in hot water to make a beverage, and some number of them surely taste better than coffee or tea, but where are the shrines to those plants in our homes and offices and shops?  Let’s face it: The rococo structures of meaning we’ve erected atop those psychoactive molecules are just culture’s way of dressing up our desire to change consciousness in the finery of metaphor and association.  Indeed, what really commends these beverages to us is their association not with wood smoke or stone fruit or biscuits, but with the experience of well-being—of euphoria—they reliably give us.

Let’s hear it for USDA.  It’s asking tough questions about its programs and paying attention to what it’s finding out.

It has just issues a report on barriers to eating healthfully on SNAP (formerly, Food Stamps).

The press release summarizes the report.

The study, Barriers that Constrain the Adequacy of Supplemental Nutrition Assistance Program Allotments, conducted in 2018, finds that 88% of participants report encountering some type of hurdle to a healthy diet. The most common, reported by 61% of SNAP participants, is the cost of healthy foods. Participants who reported struggling to afford nutritious foods were more than twice as likely to experience food insecurity. Other barriers range from a lack of time to prepare meals from scratch (30%) to the need for transportation to the grocery store (19%) to no storage for fresh or cooked foods (14%).

An infographic displays this information.

The report comes in three parts:

• Summary
• Survey Findings from more than 5,000 SNAP participants between May and November 2018. 
• In-depth Interview Findings

From the interviews (page 52)

Overview

More broadly, processed foods—both those purchased at stores for home consumption and those eaten out—were seen as cheaper than healthier options…This perception was the same whether participants lived in urban or rural areas, had children or elderly in the household, or spoke Spanish or English.

Two interview excerpts

Just kind of life circumstances and it makes no sense to me that it is terribly cheap to eat like crap. Eating at [fast food ] every day is going to cost me $5 today and I would eat every day $5 a day but if I tried to go to [store] or some place that had good food and buy good food for a day, even just for myself, for $5, not going to happen. It’s going to be triple that or quadruple that or 10 times that depending on where you go.

Oh, just not processed. Not processed, not frozen. And I don’t really think carbs are very healthy myself, like breads and pastas, I don’t find necessary really. That’s mostly what you can afford, is the cheapest, for some stupid reason in stores, you know?

Policy options seem pretty obvious.  I hope USDA gives them a try.

That’s my question when I see what food companies are trying to do to reduce the content of sugar and salt in their ultra-processed junk food products.

To put it another way, does making an ultra-processed food or beverage slightly better for you convert it to a good choice?

We can argue about this, but companies really are trying hard, as this collection of articles from FoodNavigator.com indicates.

Special Edition: Nutrition and reformulation strategies

Most shoppers say they want to reduce consumption of products that are high in fat, salt and sugar. But many struggle to cut HFSS foods and beverages from their diets and reformulation efforts often face the headwind of perceived quality issues. Meanwhile, the fortified food market in Europe is expected to see a CAGR of 5.2% through to 2025. While reformulation efforts take out the ‘baddies’ is there also an opportunity to add positive nutrients through fortification?

• What reformulation really looks like in 2021: ‘Reformulated products need to be better nutritionally and equally tasty, if not tastier’: With calls to reformulate food and drink products to reduce fat, sugar and salt, we explore: What influences prompt brands to reformulate? What does the process really entail? And can it be done successfully during a global pandemic?.. Read
• ‘No added sugar’: Fibre and stevia predicted to ‘shake up’ sugar reduction:  Fibre and next-generation stevia are expected to play key roles in sugar reduction as a growing number of manufacturers seek out ‘no added sugar’ claims, according to Mintel… Read
• How UK brands are reformulating to avoid the HFSS ad ban:  UK food brands are currently digesting planned government legislation coming next year which will prevent marketing and advertising of HFSS being shown on TV (pre-9pm) and online from 2022 and limit where these products can be placed in bricks and mortar stores… Read
• What does the future hold for reformulation?  With the impending publication of part two of the National Food Strategy in the UK, IGD convened major retailers, manufacturers, food service companies and members of the National Food Strategy team to discuss reformulation, the challenges, and opportunities. Here Hannah Pearse, Head of Nutrition and Scientific Affairs at IGD, shares an overview of the conversations from a series of roundtable discussions… Read
• Kellogg cuts sugar and salt across Europe and UK: ‘The process is trial and error’:  The Kellogg Company has pledged to remove at least 10% of sugars and 20% of salt from its children’s cereals across European and UK brands… Read
• Does the UK’s proposed junk food ad ban reduce the motivation to reformulate?  The Food and Drink Federation says UK plans to restrict in-store promotions of foods high in fat, salt and sugar will deter companies from developing lower sugar and fat alternatives… Read
• Cereal Partners Worldwide talks breakfast renovation: ‘Innovation can be less, rather than more’:  The joint venture between Nestlé and General Mills is taking a ‘dual strategy’ approach to cereal renovation that is ‘both reductionist and increasing’, says Gharry Eccles, Vice President UK and Oceania of Cereal Partners Worldwide… Read
• Snack sector looks to lentils, beans and insects as ‘health by stealth’ hits limit:  As the snack sector reaches its technological limits in cutting salt and fat from products, European manufacturers are accelerating reformulating efforts using lentils, beans, other vegetables — and even insects — as a way of meeting consumer demand for healthier snacking options… Read

The USDA’s Economic Research Service, back on the job, has the latest statistics on the availability of sugars in the U.S. food supply.

Availability means the amount produced plus imports less exports, per year, per capita.

It is not the same as consumption (availability is likely to be higher), but it is an accurate indicator of trends.

The chart shows:

• Availability of sugars peaked in about 1999 and has been going down ever since.
• The increase was almost entirely in corn sweeteners—high fructose corn syrup (HFCS) and the like.
• The rise in HFCS was due to its substitution for sucrose (the sugar in beets and cane), in soft drinks starting in the late 1970s.  Soft drinks account for close to half of available sugars.
• Cane and beet sugar (sucrose) fell with substitution of HFCS, but started to increase again as HFCS got a bad reputation.
• Total availability of all sugars is now around 120 pounds per person per year.

What does 120 pounds per capita per year mean?

• Calculation: 120 pounds per capita x 454 grams per pound divided by 365 days per year = 149 grams per day per capita (approaching 40 teaspoons)
• This means about 600 calories available from sugars per day per person (which, in turn, refers to every man, woman, child, and infant in the country).  This is a lot of sugars.

Current Dietary Guidelines say sugars should not exceed 10% of daily calories.  For diets of 2000 calories a day, that means no more than 50 grams of sugars (one gram of sugar = about 4 calories).

Therefore, the U.S. food supply provides at least three times the upper amount of sugars recommended.

Pretty much everyone would be healthier eating less sugar, if for no other reason than that they provide calories but minimal or no nutrients.

Their lack of nutritional value applies to sugars of all kinds, refined and unrefined, no matter their source: beets, cane, honey, sorghum, or maple trees.

The downward trend is in the right direction.