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My monthly (first Sunday) Food Matters column in the San Francisco Chronicle appears today.  This time, it’s about the fuss over front-of-package labels.

Q: I’m completely confused by all of the little check marks and squares on food packages telling me they are healthy. Do they mean anything?

A: The Food and Drug Administration feels your pain. It sponsored two studies by the Institute of Medicine to rationalize front-of-package nutrition ranking systems.

The institute released its second report last month; it advises the FDA to allow front-of-package labels to state nothing but calories and nutrients to avoid: saturated and trans fat, sodium and sugar (go to sfg.ly/sUptQR).

The institute’s proposal gives products one point for not containing too much of each of these nutrients. It suggests displaying the points like Energy Stars on home appliances with zero to three stars, depending on how well the product meets nutritional criteria.

This is a simple system, instantly understandable. I think it is courageous. The institute’s proposal benefits consumers. It does not help companies sell junk food.

Selling or educating?

No food company wants to display nutrients to avoid. For the food industry, the entire point of front-of-package labels is to market products as healthy or “better for you” no matter what they contain. Front-of-package labels are a tool for selling, not buying. They make highly processed foods look healthier.

Will companies accept a voluntary labeling scheme that makes foods seem worse? Doubtful.

Nutrition ranking symbols began appearing on food packages in the mid-1990s, when the American Heart Association got companies to pay for displaying its HeartCheck.

Food companies then established their own systems for identifying “better-for-you” products. PepsiCo, for example, developed its own nutritional standards and proclaimed hundreds of its snacks and drinks as “Smart Choices Made Easy.”

In an attempt to bring order to this chaos, food companies banded together to develop an industry-wide system. Unfortunately, their joint Smart Choices checkmark appeared first on Froot Loops and other sugary cereals. The ensuing ridicule and legal challenges forced the program to be withdrawn.

At that point, the FDA, backed by Congress and other federal agencies, asked the Institute of Medicine for help.

The institute released its first report last year. It revealed inconsistencies in the 20 existing ranking schemes from private agencies, food companies and supermarket chains. Toasted oat cereal, for example, earned two stars in one system, a score of 84 (on a scale of 100) in another, and a score of 37 in a third.

The report said labels should display only calories and to-be-avoided nutrients. Labels should not display “good-for-you” nutrients – protein, fiber, and certain vitamins and minerals – because these would only confuse consumers and encourage companies to unnecessarily add nutrients to products for marketing purposes.

Although the FDA was waiting for the second institute report before taking action, the food industry wasted no time. The Grocery Manufacturers Association and Food Marketing Institute introduced their own system.

Complicated approach

They got their members to agree to a more complicated system, “Nutrition Keys,” based on nutrients to avoid but also including up to two “good-for-you” nutrients.

Food companies immediately put Nutrition Keys’ symbols – well established to be difficult for consumers to understand – on package labels where you can see them today. Now called Facts Up Front, the symbols are backed by a $50 million “public education” campaign.

The reasons for the industry’s preemptive strike are obvious. The second Institute of Medicine report gives examples of products that qualify for stars – toasted oat cereal, oatmeal, orange juice, peanut butter and canned tomatoes, among them.

It also lists the kinds of products that would not qualify for stars, including animal crackers, breakfast bars, sweetened yogurt and chocolate milk.

So the industry argues that consumers “want simple and easy to use information and should be trusted to make decisions for themselves and their families … rather than have government tell them what they should and should not eat.”

But why, you ask, does any of this matter? I view front-of-package labels as a test of the FDA’s authority to regulate and set limits on any kind of food industry behavior. If the FDA cannot insist that food labels help the public choose healthier foods, it means the public has little recourse against any kind of corporate power.

Perhaps Facts Up Front will arouse the interest of attorneys general – just as the Smart Choices program did.

In the meantime, the industry’s pre-emption of FDA labeling initiatives is evidence that voluntary schemes don’t work. Labeling rules need to be mandatory.

Let’s hope the FDA takes the Institute of Medicine’s advice and starts rule-making right away.

Marion Nestle is the author of “Food Politics” and “What to Eat,” among other books, and is a professor in the nutrition, food studies and public health department at New York University. E-mail comments to food@sfchronicle.com.

I’ve just gotten an urgent plea from Margo Wootan at the Center for Science in the Public Interest (CSPI).

Please encourage everyone to write to President Obama, First Lady Michelle Obama, and federal agencies to support the nutrition standards for marketing foods to kids.

As I’ve discussed previously, these were created jointly by the Interagency Working Group (IWG) of four federal agencies—CDC, FDA, FTC, and USDA.

Under intense pressure from the food and entertainment industries and their friends in Congress, the IWG’s proposed guidelines—voluntary, no less—are in danger of being withdrawn.

Doing that might help corporate health but would do nothing for public health.

CSPI organized 75 researchers (including me) to send a letter to the President urging support of the voluntary guidelines and expressing dismay at the campaign of disinformation aimed at getting them withdrawn.

Junk-food advertisers, in the guise of the Sensible Food Policy Coalition, have attacked the voluntary guidelines as an assault on the First Amendment, a point debunked by top Constitutional experts, and claimed that adopting the voluntary guidelines would result in job losses, based on a flimsy industry “study.”

….It would be a real setback for children’s health if the Administration backed down on strong guidelines for food marketing to children, especially given the transparently specious arguments of junk-food advertisers….Denying the science on food marketing and childhood obesity is like denying the science on global warming or evolution.

But the food industry is dug in on this one.  For example, a reader sent me this letter from Tom Forsythe, Vice President, Corporate Communications, General Mills (excerpts follow with my comments in brackets):

Your email notes that we have lobbied against the Interagency Working Group (IWG) proposal.  That is correct.  We have serious concerns about the IWG proposal.

Our most advertised product is cereal – and we stand behind it.   Cereal is one of the healthiest breakfast choices you can make….If it is a General Mills cereal, it will also be a good or excellent source of whole grains.

Childhood obesity is a serious issue – and General Mills wants to be part of the solution.  But if the issue is obesity, cereal should perhaps be advertised more, not less.

…You can be assured than food and beverage companies have studied every letter, comma and period in the proposal.  We know what it says, and what it does not.

For example, we know that 88 of the 100 most commonly consumed foods and beverages could not be marketed under the IWG guidelines.  The list of “banned” items under the guidelines would include essentially all cereals, salads, whole wheat bread, yogurt, canned vegetables, and a host of other items universally recognized as healthy [Note: I’m not at all sure this is true–MN].

Despite the characterizations used to advance them, the IWG guidelines would not be voluntary, in our view.  The IWG guidelines are advanced by two of the agencies most responsible for regulating the food industry, as well as the agency most responsible for regulating advertising.  Ignoring their “voluntary guidance” would not be an option for most companies.

Regulation has already been threatened (even demanded) should companies choose not to comply – and litigation would inevitably follow.

The IWG guidelines also conflict with most existing government programs and definitions relative to food.  For example, many products that meet the U.S. Food and Drug Administration’s current definition of “healthy” could not be advertised under the IWG guidelines [It would be interesting to see examples].

Many products included in the U.S. Department of Agriculture’s Supplemental Nutrition Assistance Program fail the IWG standards, as do most products encouraged and subsidized under the USDA’s Women, Infants and Children Feeding Program (WIC) [If so, this is a sad commentary on what we encourage low-income mothers and children to eat].

Finally, your email suggests companies should focus on providing feedback via public comment.  We agree.  We have reviewed every detail of the IWG proposal – and we remain opposed, as our public comment explains.

My interpretation: if food companies are this upset, the guidelines must be pretty good.

Companies have the right to sell whatever they like.  But they should not have the right to market it as healthy or to kids.

Tell the IWG you support their guidelines.  Tell the White House to protect the guidelines.  Now, please.

The FTC has imposed new advertising restrictions on Kellogg because of the Immunity claim on Rice Krispies.  The company is not to make claims about “any health benefit of any food  unless the claims are backed by scientific evidence and not misleading.”

Under a previous order dealing with Frosted Mini-Wheats, Kellogg was not supposed to make claims about benefits to cognition on any of its cereals or snack foods unless the company could prove that the claims were backed by real science. This new decision extends that ruling to include any claim at all.

OK, but I’m confused about several aspects of this decision:

• How come the FTC is doing this and not the FDA?  At some point years ago, regulatory responsibility was split between FDA and FTC.  Since then, the FDA regulates claims on food package labels, whereas the FTC regulates advertising claims.  I realize that food labels are a form of advertising, but it’s unusual and surprising for the FTC to get involved in FDA-regulated matters.
• As FoodNavigator also wonders, why didn’t the FTC fine the company and, instead, write a harsh letter? [see update below]
• Why is the FTC doing this?  Kellogg agreed months ago to withdraw its Immunity claim ( see my November 5 post about the withdrawal).  The Immunity boxes gradually disappeared from supermarket shelves and I haven’t seen one for a long time.

So what’s going on here?  Is the FTC getting serious about regulation (and about time, too)?  Or is FDA sitting back and letting the FTC do its enforcement work?

Could this be why the FDA hasn’t sent a warning letter to Mead-Johnson, the maker of the chocolate toddler formula with three health claims aimed at kids ages 1 to 3.  I posted about this product on April 26, but haven’t heard whether the FDA is doing anything about it.  Can the FTC be on this case but waiting for investigations to be completed before taking action?

Kellogg, it seems, is under fire on all fronts.  CSPI’s Margo Wootan sent me the recent decision by the Children’s Advertising Review Unit of the Better Business Bureau that Kellogg must stop advertising Pop-Tarts to kids:

CARU was concerned that the product packaging, which features berries and states “Made with Real Fruit” for several of Kellogg’s Pop-Tarts®  products that have fruit in their names, impliedly represents to children that the products contain substantial amounts of fruit.

In fact, according to CARU, Pop-Tarts contain less than 6% fruit and less than 2% of the fruit shown in the advertising. Kellogg claimed that its marketing was not aimed at kids, but lost that one.

It’s great that regulatory agencies like FTC and FDA (and voluntary agencies like CARU) are regulating but it’s hard to keep track of who is doing what.   Nothing to do but wait and see what happens next.  Stay tuned.

Update, June 8: CSPI’s Margo Wootan writes that FTC can’t impose fines because it does not have the authority to issue civil penalties.  Ted Mermin of Public Good Law concurs.  He says:

Companies fight hard to make FTC (and similar) orders as narrow as possible, in large part to avoid precisely the situation in which they are held responsible for violating an existing injunction/order.  Since (in the Commission’s view, at least) Kellogg hadn’t violated an existing order, the FTC did not have the authority to fine them without first going to the US Department of Justice to get DOJ to take the case (a matter of a 45 day delay, if DOJ takes it at all).  The burden of that delay (and of needing to get authority from DOJ in the first place) is precisely what is driving the congressional charge for enhanced FTC authority as part of the financial reform legislation.

If the House version of financial reform legislation had been in effect, the FTC would have had the authority to seek civil penalties (i.e., fines) and the outcome here might have been different.  As it was, the fact that Kellogg had stopped the practice…kept the Commission (at least the three commissioners in the “majority”) from focusing on any remedy other than injunctive relief–that is, a broadening of the existing order from the Mini-Wheats case, with the threat of that $16,000 per violation (and an expanded area of prohibited activity) running into the future.

Update, June 11: In an editorial titled “Snake oil for breakfast,” the New York Times explains why health claims matter so much.  If you can’t believe health claims, what part of the food label can you believe?:

Businesses have been making dubious claims about their products at least since the 17th century, when the British clergyman Anthony Daffy sold Daffy’s Elixir as a cure for scurvy as well as agues, gout, rheumatism, rickets, worms and other ailments. Hucksterism — no matter how implausible the claim — lives on…[for example] POM Wonderful claimed its pomegranate juice helps treat, prevent or cure hypertension, diabetes and cancer.  This might be par for the course for an era of swift-boating political ads and a torrent of television commercials plumping for myriad wonder drugs (sudden death may result). It leaves the consumer in a quandary: what part of the label can be believed?

Thanks to my NYU Medical Center colleague, Dr. Melissa Bender for the alert about the blogosphere fuss over Cascadian Farm Purely O’s cereals.  Apparently, Cascadian Farm, now owned by Big Food General Mills:

quietly changed the recipe for its “Purely O’s” cereal — previously an unsweetened favorite among children/toddlers – to include three times the sugar, as well as new fillers/sweeteners such as corn meal and tapioca syrup. They did this with no announcement on the label, taking advantage of those who trusted the brand for its previous simplicity. Loyal customers, particularly parents who had chosen this product because it was one of the few unsweetened options available, are outraged by this secretive yet major reformulation. Many discovered the change when their children spat out the cereal (myself included).

Her note sent me right to the largest of the three Whole Foods stores within walking distance of my Manhattan apartment.  Purely O’s: 3 grams of sugars, 3 grams of fiber, and 160 mg sodium per serving.

Oops: low-sugar, yes, but only medium-fiber and high in sodium.  Even with 0 grams of sugar, it’s not all that great.  Neither, for that matter, is its non-organic analog Cheerios (1 gram sugar, 3 grams fiber, 190 mg sodium).

At 3 grams of sugar per serving, Purely O’s is still lower in sugar than practically every other cereal in Whole Foods.  Whole Foods does not sell Big Food non-organics, so it does not carry Cheerios.  I had to look hard to find the only cereal lower in sugar than the reformulated Purely O’s: Arrowhead Mills Shredded Wheat, Bite Size (2 grams of sugar, 6 grams of fiber, and only 5 mg sodium).  That one, it seems to me, is a much better choice to begin with, pretty much in the same category as oatmeal (1 gram of sugar, 4 of fiber, and 0 mg sodium).  When it comes to cereal, more fiber the better.  Fiber is the point of breakfast cereal.

So I can’t get too upset about the reformulation of Purely O’s.  It’s simply a business decision, entirely to be expected from Big Food.  Cascadian Farms started out with “humble beginnings” as a maker of organic products, none of them cereals.  It was successful enough to be bought first by Small Planet Foods, and later by General Mills, which wanted to get in on the organic market.  Hence: organic Purely O’s.

General Mills is in business to sell cereal, and Purely O’s just didn’t make it past focus groups, as reported in the Boston Globe earlier this year.  General Mills must think there are too few of its deeply loyal customers to matter.  According to a business school case study, it has a history along these lines.  So chalk this one up to corporate imperatives.

Dr. Bender wrote to General Mills and received a reply that said as much:

Our goal is to give consumers quality products at a good value. Prior to introducing any product, extensive consumer testing is done. We conduct market research and product testing continuously to obtain consumer reaction to existing products and to changes being considered. Only when we feel confident that a product change will broaden its appeal will we alter a product’s formulation. We are sorry that you do not agree that the recent change in Cascadian Farm organic Purely O’s cereal was for the better.

If the bloggers are looking for a replacement, try oatmeal or those cute little bite-sized shredded wheat things.

My latest column in the San Francisco Chronicle deals with the immunity health claim on boxes of Kellogg Cocoa Krispies (see previous posts).  I’ve been writing the column for the last year at irregular intervals of about once every three weeks.  Beginning in January 2010, it has its own slot and will appear on the first Sunday of the month.  Here’s this one:

Q: It’s great that San Francisco City Attorney Dennis Herrera put a stop to the absurd “immunity” claim on Kellogg’s Cocoa Krispies, but how do companies get away with this?

A: I confess; I’m a health-claims junkie. I snatched up the immunity-claiming box of Cocoa Krispies the minute I saw it in a supermarket last August. I consider it a treasure: “Now helps support your child’s IMMUNITY.”

How does Cocoa Krispies perform this miracle? The cereal contains 25 percent of the daily value of antioxidant vitamins A, B, C and E per serving instead of the old 10 percent. Vitamins, Kellogg points out, play an important role in immunity.

Of course they do. All nutrients are involved in immune function. But is it remotely possible that Cocoa Krispies might protect your child against colds or swine flu? I wish.

Antioxidants present an unparalleled marketing opportunity. Kellogg does not have to prove that its cereals are protective. Immunity claims fall into a Food and Drug Administration regulatory gray area. “Supports immunity” is a “structure-function” claim, so called because it promises to support a structure or function of the human body. However you might interpret such claims, they do not really promise to prevent, treat or cure disease.

Congress expressly authorized structure-function claims when it deregulated dietary supplements in 1994. But that law did not apply to foods. Food companies wanted to use these claims, too. At first the FDA balked. When faced with further legislation and court overturns, the FDA gave up. Now it merely says that structure-function claims on supplements must be truthful and not misleading. The FDA says nothing about structure-function claims on food products. It mostly looks away when they appear.

“Misleading” is inevitably in the eye of the beholder. Herrera turns out to be a skeptic.

“The Immunity claims,” he said, “may falsely suggest to parents that cereals like Cocoa Krispies are more healthy for their children than other breakfast foods … [and] mislead parents into believing that serving this sugary cereal will actually boost their child’s immunity.” Kellogg, he said, must produce the evidence or have the claim subject to “immediate termination or modification.”

Faced with this threat and with ridicule in the press, Kellogg wisely decided to phase out the immunity-labeled Cocoa Krispies packages. Consider them collectors’ items.

Much is at stake. Ready-to-eat cereals produce more than $8 billion a year in sales. Kellogg spent about $32 million in 2008 to promote Rice Krispies cereals, and $4 million of that amount went to advertise Cocoa Krispies alone.

Shoppers care about health. If cereals can be advertised with special health benefits, more boxes will fly off the shelves. Food companies consider health claims essential for marketing their products.

This explains why so many companies are adding omega-3 fats, probiotics and antioxidants to so many foods. These ingredients make foods “functional,” meaning that the foods contain something beyond their usual nutritional value. Although little evidence shows that functional foods make healthy people healthier, companies can use functional ingredients to make health claims, no matter how far-fetched. These days, functional foods are about the only processed foods with increasing sales.

Kellogg has plenty of company with functional ingredients and health claims. See, for example, the claims on Nestlé (no relation) Juicy Juice products targeted to toddlers. One product adds antioxidants to “help support immunity.” The other adds omega-3s to “aid brain development.”

Think about it: Will feeding your toddler a sugary juice product really make her smarter? Face it. You are not supposed to think about it. You are supposed to buy – and feel good about doing so.

Absent the FDA, Herrera stepped into the breach. He does not care whether the claims are on Kellogg cereals or Juicy Juice cartons. If companies make such claims, he insists that they produce the evidence for them.

This will not be easy to do. It is one thing to find evidence that specific nutrients are involved in immune function. It is quite another to show that people who eat sweetened cereals or juices containing such nutrients are healthier than those who do not.

That is why the European Food Standards Agency denied hundreds of company petitions for health claims. The agency cannot find much evidence for the health benefits of foods with added functional ingredients. Its decisions have put European food marketers into crisis. How are they supposed to sell products without health claims?

As I keep saying, health claims are about marketing, not health. If it were up to me, I would remove all health claims from food packages. Foods are not drugs. Health claims cannot help but mislead.

So let’s congratulate Herrera for filling a regulatory gap. His colleagues – and the press – are doing their job on this one. FDA: Get to work!

Now that the Smart Choices program is on hold, it’s time to take a look at what else is on food packages these days.  My current favorite example is the huge IMMUNITY banner across Kellogg’s Cocoa Krispies.

I don’t know how you interpret this but my mind boggles at the very idea that eating Cocoa Krispies might protect kids against swine flu.

Apparently, the minds of the San Francisco attorney general’s staff are equally boggled.  They just sent a warning letter to Kellog:

“Specifically, the Immunity Claims may falsely suggest to parents that cereals like Cocoa Krispies are more healthy for their children than other breakfast foods that are not high in sugar and not highly processed.  The Immunity Claims  may also mislead parents into believing that serving this sugary cereal will actually boost their child’s immunity, leaving parents less likely to take more productive steps to protect their children’s health.”

The city attorneys are asking Kellogg to provide copies of all of the consumer and scientific research the company used to establish this claim, or else.  If they don’t get these documents, they will “seek an immediate termination or modification of the advertising claim….”

Good idea.  I can’t wait to see how Kellogg’s – ever at the leading edge of advertising claims – will respond.

But wait!  Shouldn’t the FDA be taking this on?