by Marion Nestle

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Mar 7 2013

Lancet series on chronic diseases, many of them diet-related

The Lancet has just published a series of articles on non-communicable diseases (NCDs) the collective term for heart disease, type 2 diabetes, and other chronic conditions caused in large part by poor diets, lack of physical activity, or cigarettes or alcohol.

Since food politics is a big part of this discussion, these papers are worth a look.  For example, as editor Richard Horton explains in his editorial:

So where are the global conferences on NCDs, the research meetings, the task forces, the grand challenges initiated by funders and foundations? They don’t exist. We, the global health community, understand that chronic diseases are a present danger to the health of our societies. Yet we are unable to translate that understanding into real political action. We cannot quite bring ourselves to put heart disease, stroke, cancer, chronic respiratory disease, diabetes, or mental ill-health, together with their associated risk factors, on an equal footing with childhood pneumonia and diarrhoea, preventable maternal death, or epidemics of AIDS, tuberculosis, and malaria. The disconnect between the reality of people’s lives in countries and the concerns of professional and political leaders has rarely been greater.

Here are the papers in this series.  Read them and ponder.

Independent global accountability for NCDs

Robert Beaglehole, Ruth Bonita, Richard Horton

Full Text | PDF

NCDs: a challenge to sustainable human development

Helen Clark

Full Text | PDF

Embedding non-communicable diseases in the post-2015 development agenda

George Alleyne, Agnes Binagwaho, Andy Haines, Selim Jahan, Rachel Nugent, Ariella Rojhani, David Stuckler, for The Lancet NCD Action Group

Summary | Full Text | PDF

Country actions to meet UN commitments on non-communicable diseases: a stepwise approach

Ruth Bonita, Roger Magnusson, Pascal Bovet, Dong Zhao, Deborah C Malta, Robert Geneau, Il Suh, Kavumpurathu Raman Thankappan, Martin McKee, James Hospedales, Maximilian de Courten, Simon Capewell, Robert Beaglehole, on behalf of The Lancet NCD Action Group

Summary | Full Text | PDF

Inequalities in non-communicable diseases and effective responses

Mariachiara Di Cesare, Young-Ho Khang, Perviz Asaria, Tony Blakely, Melanie J Cowan, Farshad Farzadfar, Ramiro Guerrero, Nayu Ikeda, Catherine Kyobutungi, Kelias P Msyamboza, Sophal Oum, John W Lynch, Michael G Marmot, Majid Ezzati, on behalf of The Lancet NCD Action Group

Summary | Full Text | PDF

Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries

Rob Moodie, David Stuckler, Carlos Monteiro, Nick Sheron, Bruce Neal, Thaksaphon Thamarangsi, Paul Lincoln, Sally Casswell, on behalf of The Lancet NCD Action Group

Summary | Full Text | PDF

Promotion of access to essential medicines for non-communicable diseases: practical implications of the UN Political Declaration

Hans V Hogerzeil, Jonathan Liberman, Veronika J Wirtz, Sandeep P Kishore, Sakthi Selvaraj, Rachel Kiddell-Monroe, Faith N Mwangi-Powell, Tido von Schoen-Angerer

Summary | Full Text | PDF

Improving responsiveness of health systems to non-communicable diseases

Rifat Atun, Shabbar Jaffar, Sania Nishtar, Felicia M Knaul, Mauricio L Barreto, Moffat Nyirenda, Nicholas Banatvala, Peter Piot

Summary | Full Text | PDF

Dec 6 2012

New books take a fresh look at public health

If I were teaching public health nutrition right now, here’s what I’d want students to read:

Geof Rayner and Tim Lang, Ecological Public Health: Reshaping the Conditions for Good Health, Routledge Earthscan, 2012.

Our case is that public health is an interdisciplinary project, and not merely the preserve of particular professionals or titles.  Indeed, one of the themes of the book is that public health is often improved by movements and by people prepared to challenge conventional assumptions and the status quo…In these cynical academic times, when thinking is too often set within narrow economistic terms—What can we afford? What is the cost-benefit of health action?—and when the notion of the ‘public’ is often replaced by the ‘individual’ or the ‘private,’ this book offers an analysis of public health which is unashamedly pro bono publico, for the public good.

David Stuckler and Karen Siegel, eds.  Sick Societies: Responding to the Global Challenge of Chronic Disease, Oxford University Press, 2011.

Sick Societies argues that we are building environments that are poorly designed for our boides: we create societies where tobacco, alcohol, and foods containing high levels of salt, sugar, and fats are the easiest, cheapest, and most desirable choices, while fruits, vegetables, and exercise are the most expensive, inaccessible, and inconvenient options.  The rise in chronic diseases is the result of a model of societal development that is out of control: a model that puts wealth before health.

Wilma Waterlander, Put the Money Where the Mouth Is: The Feasibility and Effectiveness of Food Pricing Strategies to Stimulate Healthy Eating, Vrije Universiteit, Amsterdam, 2012.

This one is for policy wonks and change agents.  This is Waterlander’s doctoral dissertation done as a published book but it is written clearly and forcefully.  Her conclusions:

The studies presented in this thesis show that the healthy choice is the relatively expensive choice; that price fundamentally affects food choice and may even form a barrier for low SES consumers in selecting healthier foods.  These findings make pricing strategies a justifiable tool to stimulate healthier choices…making healthier foods cheaper was found to be the most feasible pricing strategy to implement.

Sep 11 2012

A nice compliment from J Public Health Policy

Most of you probably don’t read the Journal of Public Health Policy, but I’m on its editorial committee.  Nevertheless, this editorial came as a surprise.*   I thought I would share it with you.  Enjoy!  (I did).

Big food

Anthony Robbins M.D., M.P.A.Co-Editor

I first encountered Marion Nestle in the late 1990s when I edited Public Health Reports, the scientific journal of the US Public Health Service. We published a provocative piece of hers about the marketing by Proctor and Gamble of Olestra, a zero calorie fat substitute. Marion taught me a great deal about how the food industry markets its products that are tasty, convenient, and relatively inexpensive. It markets intensively to children and continues to do so long after overeating and obesity have been shown to have deadly health consequences. Sound familiar? Perhaps like the tobacco industry.

In 2003, I invited Marion to Public Health Grand Rounds to describe the obesity epidemic to my public health students at Tufts Medical School. To follow Marion, I invited Richard Daynard from Northeastern Law School, who had litigated extensively against the tobacco industry. Dick carefully noted the differences between tobacco, which has no healthy use, and food. But he suggested that the anti-health behavior of the two industries might be similar: continuing to market products in a way that certainly harmed health.

When the public health faculty at Tufts and the law faculty at Northeastern joined forces to establish the Public Health Advocacy Institute, one of our first projects was Legal Approaches to the Obesity Epidemic1, a symposium published in the Journal of Public Health Policy, in 2004. It attracted a great deal of attention and JPHP became a favorite place to publish research on obesity.

But I was not entirely pleased, because although the research was usually methodologically sound, it often missed Marion’s point and the focus of the PHAI symposium. Most submissions concentrated on individual behavior and personal responsibility. In 2010, I asked Marion, who was on the JPHP editorial board to join me in writing an Editorial: ‘Obesity as collateral damage: a call for papers on the Obesity Epidemic’.2 We had ‘come to believe that research studies concentrating on personal behavior and responsibility as causes of the obesity epidemic do little but offer cover to an industry seeking to downplay its own responsibility’. We urged ‘authors to submit articles that consider how to understand and change the behavior of the food industry’.

Imagine our pleasure in learning that starting this June, PLoS Medicine will publish a series of articles exploring the food industry’s involvement in health with Marion Nestle as a guest editor. To PLoS Medicine, we say bravo!

References

  1. Journal of Public Health Policy (2004) Special section: Legal approaches to the obesity epidemic. 25(3&4): 346–434.
  2. Robbins, A. and Nestle, M. (2011) Obesity as collateral damage: A call for papers on the Obesity Epidemic. Journal of Public Health Policy 32(2): 143-145.

 *Journal of Public Health Policy (2012) 33, 285–286. doi:10.1057/jphp.2012.25

Aug 28 2012

PepsiCo donates $100,000 to National Association of Hispanic Journalists

A blog post from Fernando Quintero on the Berkeley Media Studies Group’s site alerted me to PepsiCo’s latest example of corporate social responsibility: an additional $50,000 donation for scholarships and internships to the National Association of Hispanic Journalists bringing the total to $100,000.

Hispanic populations in the United States have higher than average rates of obesity, type 2 diabetes, and other chronic conditions associated with overconsumption of sodas and snacks.

Such generosity raises questions about what Pepsi is buying from this group.

The NAHJ says:

We are thrilled to have PepsiCo as a new partner committed to building a stronger Latino community,” said Ivan Roman, Executive Director for NAHJ. “The company’s support as we get more Hispanics into journalism to tell our stories is key to making sure our communities are represented fairly in the news media, while giving them a louder voice in the civic dialogue.

Why do I think that journalists in this Association are unlikely to be telling stories like these:

  • The relationship of soda and snack consumption to obesity and type 2 diabetes in Hispanic communities
  • The relationship of soda and snack consumption to Hispanic childhood obesity
  • How soda intake among Hispanic children leads to dental decay
  • Soda company marketing practices in Hispanic communities
  • The effects of soda and snack marketing on dietary practices and health in countries in Latin America

Pepsi says:

As part of La Promesa de PepsiCo, the company is building relationships with the community, strengthening its strategic partnerships, and sponsoring national Hispanic organizations like: CHCI (Congressional Hispanic Caucus Institute), HACR (Hispanic Association on Corporate Responsibility), LULAC (League of United Latin American Citizens), NAHJ (National Association of Hispanic Journalists), and NCLR (National Council of La Raza) among others.

A page from the tobacco-industry playbook, no?

Jul 6 2012

A food politics thought for the weekend: treatment vs. prevention

I’ve been at meetings in London and Geneva on non-communicable (what we call chronic) diseases and how to prevent them. 

On the way to Europe, I did some catching up on reading past issues of The Lancet and ran across this letter from Sally Casswell of the School of Public Health at Massey University in Auckland. 

Professor Casswell was responding to an article arguing that a major priority in chronic disease prevention should be to strengthen the capacity of countries to deliver primary care services.

Yes, professor Casswell writes, primary care is important.  But it is even more important to focus prevention efforts on the environmental factors that influence the behavior of individuals and cause them to need primary care services in the first place.

Do we really want to continue to live in a world where the oversupply and marketing of tobacco, alcohol, unhealthy processed foods, and soft drinks is tolerated simply to allow continuing profits for the shareholders of the transnational corporations producing and distributing them, while the taxpayer funds the health services and pharmaceutical response to the ensuing disease and injury?

This is a refreshing way to look at this problem, and one well worth pondering.

Jul 4 2012

PLoS Medicine series on Big Food: the papers are now online

The third part of the PLoS Medicine series on Big Food (which I co-edited with David Stuckler) is now out.  Happy Fourth of July!

Here’s the entire PLoS collection of papers on this topic:

Editorial: PLoS Medicine Series on Big Food: The Food Industry Is Ripe for Scrutiny, The PLoS Medicine Editors, PLoS Medicine: Published 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001246

Essay: Big Food, Food Systems, and Global Health, David Stuckler, Marion Nestle, PLoS Medicine: Published 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001242

Essay: Food Sovereignty: Power, Gender, and the Right to Food, Rajeev C. Patel, PLoS Medicine: Published 26 Jun 2012 | info:doi/10.1371/journal.pmed.1001223

Essay: The Impact of Transnational “Big Food” Companies on the South: A View from Brazil, Carlos A. Monteiro, Geoffrey Cannon, PLoS Medicine: Published 03 Jul 2012 | info:doi/10.1371/journal.pmed.1001252

Perspective: Thinking Forward: The Quicksand of Appeasing the Food Industry, Kelly D. Brownell, PLoS Medicine: Published 03 Jul 2012 | info:doi/10.1371/journal.pmed.1001254

Policy ForumSoda and Tobacco Industry Corporate Social Responsibility Campaigns: How Do They Compare?, Lori Dorfman, Andrew Cheyne, Lissy C. Friedman, Asiya Wadud, Mark Gottlieb, PLoS Medicine: Published 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001241

Policy Forum: Manufacturing Epidemics: The Role of Global Producers in Increased Consumption of Unhealthy Commodities Including Processed Foods, Alcohol, and Tobacco, David Stuckler, Martin McKee, Shah Ebrahim, Sanjay Basu, PLoS Medicine: Published 26 Jun 2012 | info:doi/10.1371/journal.pmed.1001235

Policy Forum: “Big Food,” the Consumer Food Environment, Health, and the Policy Response in South Africa, Ehimario U. Igumbor, David Sanders, Thandi R. Puoane, Lungiswa Tsolekile, Cassandra Schwarz, Christopher Purdy, Rina Swart, Solange Durão, Corinna Hawkes, PLoS Medicine: Published 03 Jul 2012 | info:doi/10.1371/journal.pmed.1001253

Jun 28 2012

PLoS Series on Big Food: Weeks #1 and #2

The online, open-access journal Public Library of Science – Medicine, better known as PLoS Medicine, is doing a series of articles on Big Food.  I’m its co-editor, with David Stuckler in the U.K.

Here’s what’s online so far. 

Editorial: PLoS Medicine Series on Big Food: The Food Industry Is Ripe for Scrutiny, by the PLoS Medicine Editors, PLoS Medicine, 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001246

Essay: Big Food, Food Systems, and Global Health, by David Stuckler, Marion Nestle, PLoS Medicine, 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001242 

Essay: Food Sovereignty: Power, Gender, and the Right to Food, by Rajeev C. Patel, PLoS Medicine, 26 Jun 2012 | info:doi/10.1371/journal.pmed.1001223

Policy ForumSoda and Tobacco Industry Corporate Social Responsibility Campaigns: How Do They Compare?, by Lori Dorfman, Andrew Cheyne, Lissy C. Friedman, Asiya Wadud, Mark Gottlieb, PLoS Medicine, 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001241

Policy Forum: Manufacturing Epidemics: The Role of Global Producers in Increased Consumption of Unhealthy Commodities Including Processed Foods, Alcohol, and Tobacco, by David Stuckler, Martin McKee, Shah Ebrahim, Sanjay Basu, PLoS Medicine, 26 Jun 2012 |info:doi/10.1371/journal.pmed.1001235

Twitter chat: To follow the Twitter chat that took place on June 27, search for #plosmedbigfood.

More next week.  Stay tuned.

Mar 2 2012

How much sugar(s) do you eat?

Earlier this week I received a 3-page, single-spaced letter—plus 4 pages of charts and figures–from Andrew Briscoe III, the President and CEO of the Sugar Association.

I opened it with some trepidation because the last letter I got from the Sugar Association threatened to sue me (to read it, click here and scroll down to the Controversies section).

Whew.  This one merely expresses general concerns about:

the misinformation reported on added sugars consumption and the overstatement of added sugars contribution to increased caloric intakes.  Americans do not consume 25 percent of their calories from added sugars. We write to provide you with accurate data….

I don’t think I ever said that the average American consumes 25% of calories from sugars (although some surely do) but I have complained that the Institute of Medicine’s “safe” level of intake of sugars is 25% of calories.  This is higher than public health recommendations to restrict sugars to 10% of calories or less.  It is meant as an upper limit, but is often interpreted as a license to eat this much.

One quarter of daily calories from sugars is too high for something that provides no additional nutritional value.

The letter concludes:

The Sugar Association is committed to ensuring that all advice consumers receive regarding sugar intake is based on the best available scientific evidence and related data.  The American consumer will be better served by dietary advice that is science-based, practical and accurate, no matter the issue.

Can’t argue with that.  But as with all matters concerning nutrition, the issue is which science you choose to cite and how you interpret it.

Mr. Briscoe uses the term sugars, plural, because sucrose, HFCS, syrups, honey, and other such things are all sugars.

How much do Americans actually consume?  Mr. Briscoe was kind enough to provide USDA tables that address this question.  These describe the availability of sugars in the food supply, not necessarily what people are actually eating.

My interpretation of the tables is that they say:

  • Sugars comprise 17% of total calorie availability.
  • Adjusted for waste, the availability of sugars is about 27.5 teaspoons per day per capita (meaning everyone:  men, women, and tiny babies).
  • Translating this into calories: 27.5 teaspoons x 4 grams per teaspoon x 4 calories per gram = 440 calories per day per capita.
  • On a 2000 calorie diet, that’s 22% of total energy intake, although it will be lower for people who take in more calories.

The CDC has just released a summary of intake of added sugars among children and adolescents, in calories per day.

At 4 calories a gram, 400 calories is 100 grams or 3.5 ounces.  Can these calories contribute to weight gain or other health problems?

You bet.

As Mark Bittman put it in his New York Times column this week,

Let me state the obvious: there is no nutritional need for foods with added sugar.

All of this is part of the bigger question: How do we regulate the consumption of dangerous foods? As a nation, we’ve accepted the need to limit the marketing and availability of tobacco and alcohol. The first is dangerous in any quantity, and the second becomes dangerous when overconsumed.

And added sweeteners, experts increasingly argue, have more in common with these substances than with fruit.

No wonder the Sugar Association uses its own interpretation of the science to suggest that current levels of intake are benign and that no level of intake poses a risk.  Mr. Briscoe’s letter says:

No authoritative scientific body that has conducted a major systematic review of the scientific literature has a found a public health need to set an Upper Level (UL) for total or added sugars intake.  Every comprehensive review of the scientific literature concludes that, with the exception of dental caries, no causal link can be established between the intake of sugars and lifestyle diseases, including obesity.

I’m glad he mentioned dental caries.  Karen Sokal, a physician in California, has been tracking the onset of tooth decay among children in Latin America who are now consuming sodas and candy on a daily basis.  She writes:

Mark Bittman’s excellent editorial, “Regulating our Sugar Habit,” (Feb 27) concludes that eating too much sugar has become “the biggest public health challenge facing the developed world.”  Indeed, it poses a big health challenge for the entire world, especially developing countries.

In my 30 years of global health work, I have seen an explosion in the marketing and consumption of non-nutritious foods and beverages followed by a dramatic rise in childhood tooth decay and obesity. Quarterly business reports praise the food and beverage industry’s increased profits based on increased sales in “emerging markets.” The NY Times article on Kellogg’s purchase of Pringles (Feb 12) stated, “The snack business is growing faster and has greater appeal internationally,” which analysts noted “appears somewhat out of sync with the trends toward better-for-you snacking.”

Governmental regulations to ensure the production and marketing of healthful food and beverages must be applied worldwide and protect the health of the world’s most vulnerable populations.

Indeed, they must.  The Sugar Association has much to answer for in its opposition to public health recommendations to eat less sugar.