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I’ve just had a book review published in the American Journal of Public Health: “Public health nutrition deserves more attention.”

It’s for a textbook on public health nutrition but doing it gave me the opportunity to say some things I want public health professionals to know.  I started the review like this:

Public Health Nutrition deserves more attention

Food and nutrition deserve much more attention from public health professionals.  On the grounds of prevalence alone, diet-related conditions affect enormous numbers of people.  Everybody eats.  Everybody is at risk of eating too little for health or survival, or too much to the point of weight gain and increased prevalence of non-communicable diseases (NCDs).  By the latest count, nearly 700 million people in the world do not get enough to eat on a daily basis, a number that has increased by tens of millions over the past five years and will surely increase by many millions more as a result of the Coronavirus pandemic.[i]   At the same time, about two billion adults are overweight or obese, and few countries are prepared to deal with the resulting onslaught of type 2 diabetes and heart disease.[ii]  Beyond that, food production, distribution, consumption, and disposal—collectively food systems—are responsible for a quarter or more of greenhouse gas emissions; climate change affects the health of everyone on the planet.[iii]

The same social, behavioral, economic, and structural determinants that affect health also affect nutritional health, and it is no accident that food choices are flash points for arguments about culture, identity, social class, inequity, and power, as well as about the role of government, private enterprise, and civil society in food systems.   From a public health standpoint, everyone–regardless of income, class, race, gender, or age—should have the power to choose diets that meet nutritional needs, promote health and longevity, protect the environment, and are affordable, culturally appropriate, and delicious.

Nutrition in 2021

For people in high-income countries, dietary prescriptions for health and sustainability advise eating less meat but more foods from plant sources.[iv]  Optimal diets should minimize consumption of ultra-processed foods, those that are industrially produced, bear little resemblance to the basic foods from which they were derived, cannot be prepared in home kitchens, and are now compellingly associated with NCD risk and mortality.[v]  We now know that ultra-processed foods encourage people to unwittingly take in more calories and gain weight.[vi]

Agenda for 2021

Today, a book for researchers and practitioners of public health nutrition needs to emphasize coordinated—triple-duty—recommendations and interventions to deal with hunger and food insecurity, obesity and its consequences, and the effects of food production and dietary choices on the environment.  Such approaches, as described by a Lancet Commission early in 2019,⁴ should encourage populations of high-income countries to eat less meat but more vegetables, those in lower- and middle-income countries (LMICs) to consume a greater variety of foods, and everyone, everywhere to reduce intake of ultra-processed foods.  As that Commission argued, public health nutritionists must recognize that attempts to improve diets, nutritional status, nutritional inequities, and food systems face daunting barriers from governments captured by corporations, civil society too weak to demand more democratic institutions, and food companies granted far too much power to prioritize profits at the expense of public health.  Nutritionists need knowledge and the tools to resist food company marketing and lobbying, to advocate for regulatory controls of those practices, and to promote civil society actions to demand healthier and more sustainable food systems.[vii]

I then go on to talk about the book itself, which alas, did not have much to say about this agenda.

References to the first part of this review

[i] The World Bank.  Brief: Food Security and COVID-19. December 14, 2020. https://www.worldbank.org/en/topic/agriculture/brief/food-security-and-covid-19#:~:text=In%20November%202020%2C%20the%20U.N.,insecure%20people%20in%20the%20world. Accessed January 2, 2021.

[ii] WHO.  Obesity and overweight: Key facts.  Geneva: WHO.  April 1, 2020. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed January 2, 2021.

[iii] International Panel of Experts on Sustainable Food Systems. COVID-19 and the crisis in food systems: symptoms, causes, and potential solutions. IPES-Food, April 2020. www.ipesfood.org/pages/covid19. Accessed January 2, 2021.

[iv] Swinburn BA, Kraak V, Allender S, et al. The global syndemic of obesity, undernutrition, and climate change: The Lancet Commission report. Lancet. 2019;393:791–846.

[v]  Monteiro CA, Cannon G, Levy RB, et al.  Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019;22(5):936–941.

[vi] Hall KD, Ayuketah A, Brychta R, et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell Metab. 2019;30, 67–77.

[vii]  Jayaraman S, De Master K, eds.  Bite Back: People Taking On Corporate Food and Winning.  Oakland, CA: University of California Press; 2020.

 

 

Michael Moss.  Hooked: Food, Free Will,and How the Food Giants Exploit Our Addictions.  Random House, 2021.

This follows Michael Moss’s Salt Sugar Fat which was about how food companies used these ingredients to hook us on junk food.  The new book focuses on the “addictive” qualities of junk foods—what we are now calling “ultra-processed.”  I put addictive in quotes because his definition is looser than others I’ve seen: habits that are hard to quit.

By this definition, his book provides convincing evidence for what food companies do to make their products irresistible—remember Frito Lay’s “You can’t eat just one?”

The book starts by going into the physiology of addiction:

When we taste sugar, the taste buds on our tongue send the signal.  By contrast, the signal for fat gets transmitted by the trigeminal nerve that extends from the roof of the mouth to the brain.  Food that has both sugar and fat will activate these two different paths, sending to separate alerts, and thus doubling the arousal of a brain that appears to place a high value on information for information’s sake [62].

No wonder we like ice cream so much.

In speaking about how the food environment sets us up for overeating, he says:

…we simply haven’t had anywhere near the time we would need, vis-à-vis evolution, to catch up with the dramatic changes in food and our eating habits of the past forty years.  As a result, we are fundamentally mismatched to the food of today.  Small [Dana Small, an expert Moss interviewed] puts it this way: “It’s not so much that food is addictive, but rather that we by nature are drawn to eating, and the companies have changed the food [p. 99].

Moss is a terrific writer and tells a compelling story.  Even if you don’t have a problem resisting fast food, sodas, or chocolate, this book has a lot to say about why so many people have put on pounds during the Covid-19 pandemic.

Mark Bittman.  Animal, Vegetable, Junk: A History of Food, from Sustainable to Suicidal.  Houghton Mifflin Harcourt, 2021.

This book comes with more than three pages of blurbs, starting with Al Gore and Leah Penniman and ending with José Andrés and Bryant Terry, so many and so glittery that I’m feeling a little left out that I wasn’t asked to do one.

I would have.  It’s a good book.  Bittman read a lot, is generous in citing sources (mine among them), and has done a thorough synthesis of the key events that transformed our food system from one that was healthy and sustainable (if hard on farmers) to today’s unsustainably industrialized system that is mainly set up to feed animals and fuel cars, and to encourage us to consume ultra-processed diets.   We pay the externalized costs of this system in overweight and chronic diseases that increase our vulnerability to COVID-19 and in environmental degradation and climate change.

Here are a few excerpts:

And while Deere & Co. [the tractor company] showed good will toward struggling farmers, its success in financially bonding those farmers virtually ensured that creditors remained profitable in the long run.  It’s also among the chief reasons why industrial agriculture is so difficult to change today.  Today, the company’s margins are almost four times as great from providing credit as they are from sales…Its 2019 profits were eleven billion dollars, a bit more than ten percent of the comb8ined profits of all two million-plus farms in the United States that same year [pp. 107-108]

In fact, the worse you were treated by American policy in the eighteenth and nineteenth centuries, the worse you were treated in the twentieth.  For example, the Social Security Act of 1935 and the Fair Labor Standards (sic!) Act of 1938 both excluded agricultural and domestic, thanks to influential southern Democrats who refused to protect the Black people working in those sectors.  This meant that the New Deal disproportionately excluded people of color from the most vital government protections….[p. 120].

You will hear, “The food system is broken.”  But the truth is that it works almost perfectly for Big Food.  It also works well enough for about a third of the world’s people, who have the money to demand and have at a moment’s notice virtually any food in the world.  But it doesn’t work well enough to nourish most of humanity, and it doesn’t work well enough to husband our resources so that it can endure,  Indeed the system has created a public health crisis (one whose effects have, in turn, exacerbated the deadly effects of COVID-19), and, perhaps even more crucially, it’s a chief contributor to the foremost threat to our species: the climate crisis.  The way we produce food threatens everyone, even the wealthiest and cleverest [p. 243].

Paul B. Thompson and Patricia E. Norris.  Sustainability: What Everyone Needs to Know.  Oxford University Press, 2020.

“Sustainability” is one of those terms that everyone uses but if you ask people to define it, you get a million different answers.  This book addresses that precise point, and I thought it was worth a blurb:

Sustainability is the hot buzzword these days.  Does it take a whole book to explain what it means?  Yes and how lucky we are to have it.  This is a book about how to think about what it takes to keep systems going.  The Q and A format makes difficult and contested concepts especially easy to follow.

As an example, here is an excerpt from the authors’ answer to the question, “Is sustainability just a passing fad?”

The solution to this problem [of thinking that sustainability goals are morally mandatory] is to recall the complexity created by interacting systems.  While an action can increase sustainability by making for efficient use of some resource, that action can have rebound effects that do just the opposite.  Sometimes the rebound is in systems (like the global climate system) that most of us do not understand in the first place.  Seeking sustainability requires you to remain faithful to the objective, even while you remain open to the possibility that any particular strategies might provide to be less effective than you originally thought, and sometimes they are just wrong altogether….”Sustainability is about being nimble, not being right”.  Put another way, we all, every one of us, still have a lot to learn.

Nick Freudenberg.  At What Cost: Modern Capitalism and the Future of Health.  Oxford University Press, 2021.   

I did a blurb for this terrific book:

At What Cost is a must-read for anyone who wants to understand why food insecurity, low-wage work, chronic disease, and environmental degradation are such widespread and seemingly intractable problems.  Capitalism may not be their only cause, but it is common to all of them.  This important book provides compelling evidence for the need to join together to change this system to one better for people and the planet.

Here are a few excerpts to give you the idea:

…how capitalism has evolved now undermines health, widens inequality, worsens climate change, and erodes democracy.  Food, education, healthcare, labor, transportation, and social relationships constitute the most basic necessities of life.  Converting them into commodities that must bring profits to their producers if they are to be offered imposes a cost on human and planetary well-being (p. 15).

[Goals for food justice require] changing the dominant corporate system of food and agriculture.  Focusing on the separate goals of each strand rather than the common overarching ones has made the food movement less powerful, less able to win concessions from the highly organized alliance of food and agriculture businesses, and more vulnerable to co-optation by trade groups who offer some factions grants or a seat at the policy table (p. 274).

Corporate-controlled globalization, financialization, deregulation, monopoly concentration, and the corporate capture of new technologies, the defining characteristics of twenty-first-century capitalism, are fundamental causes of multiple and growing threats to well-being.  This commonality justifies a sharp focus on the system that is the underlying cause (p. 277).

To fix food system problems, means fixing capitalism.  That’s the problem that needs our focused attention.  He’s got some ideas about that too.

Sonja Stummerer & Martin Hablesreiter.   Food Design Small: Reflections on Food, Design and Language.  De Gruyter 2020.

Their other books are bigger:  Food Design XL (2009) and Eat Design (2014).

These are unusual, to say the least, and great fun.

For one thing, the authors do not take themselves too seriously: They like to be known as honey and bunny, lower case.

For another, they think of food primarily as a design object. Of vegetables cut into small cubes, for example, they say:

Whether the design of frozen vegetables into small cubes is simple, functional, appropriate for the product and timeless, and of greater or lesser practical use, cannt be answered withoiut an adequate reference system (value system, ideology).  From today’s perspective, the answer would probaly be negative even though there is undeniably a certain timelessness about the product.

They point out that specific shapes convey specific associations.

Food in the shape of a triangle is actually rather unusual: psychologically because it always has an acute angle pointing at the consumer; ergonomically (especially with small objects such as chocolates) because it fits poorly in the mouth; and technically because (industrially) triangles are not easy to produce, stack and package.  One exception is the Toblerone….

And they are very much into semiotic theories, which, they say, can illuminate our lives and help solve environmental problems.

The photographs are in black and white but give the idea of how honey and bunny use food and dining as design objects (the photos are bigger, better, and more colorful in the XL version).

If you like this sort of thing—and I most definitely do—this is a quirky book that encourages thinking about food in entirely different ways.

Great fun indeed.

As to why it matters, let me quote from the introduction to the book by my NYU colleague Fabio Parasecoli:

What is important to me is nt so much elaboratig a univocal and final definition of food design, but rather understanding why we are even talking about food design, how and why it emerged, how it connects to the developments within design at large, and why it is emerging at this specific historical point in time.  There may not be any firm answers yet, but it is quite likely that food design is a manifestation of the overall growing interest in food and the acknowledgment of its centrality to huma life.

Saray Stancic.  What’s Missing From Medicine: Six Lifestyle Changes to Overcome Chronic Illness.  Hierophant Publishing, 2021.

I don’t usually recommend books about topics other than food politics, but this one has dietary changes at its core and although I have never met the author, I greatly admire her and her work.

I first heard about Dr. Stancic, who has a practice in New Jersey, when I was invited to watch a documentary film about her, Code Blue.   I was interested to see it because I was told I appeared in it, which I did for about 10 seconds.  I don’t remember meeting her or filming it (I tend not to remember such things), but the film is impressive and well worth seeing.

It tells her personal story of how she was able to get control of her formerly debilitating multiple sclerosis with a plant-based diet and exercise—good advice for everyone.  The film goes beyond the personal and talks about why she never understood the importance of diet: lack of nutrition education in medical schools, media confusion, inadequate government policies, and the overwhelming influence of drug, food, and beverage companies.   The film moves quickly and I thought it was much better than most documentaries of this type.

What made it work for me is Stancic, who comes across as committed, but sane and likable.  I would send anyone who has MS to see her in a shot.  She’s my kind of doctor—one who listens to patients and works with them.  The film’s message leans toward veganism, but without ideology and pushed only softly even by the strongest proponents she interviewed.

The book makes the same points.  It’s great strength is that it makes lifestyle changes seem possible for anyone.

Here’s what drove her to healthier eating:

My physicians warned me that it was irresponsble to wean myself off of the ten to twelve medications I was taking daily (and that were making my life unbearable) and solely manage my MS with an “unproven lifestyle change” [i.e., diet]…I adoped a whole foods, plant-based diet becasue the overwhelming body of scientific literature pointed to those foods as the best diet for optimal health for all people.  At that point, I knew I could not face a lifetime of living as I was—with a huge pillbox, cane, diapers, and the other physical and psychological burdens of MS [p. 36].

Her advice about how to eat more plant foods is sensible and easy to follow.  I particularly like her lack of dogmatism.  In a section on common food myths, she has two about meat:

Myth 1: We need to eat meat and dairy to be healthy.  FALSE [p. 57].

Myth 2. Eating animal products of any kind is bad for your health.  FALSE [p. 59]

Most of the book is about other changes that  can help everyone cope with chronic disease: movement, stress management, sleep, avoiding substances, human connections.  All of these messages are aimed at giving us the power to control our own health, and to make doing so seem entirely possible.

I found the book inspiring.  Her wish for us:

May we eat well, relish physical and mental challenges, enjoy restorative sleep, and connect deeply with others [p. xxxiii].

This is good advice for all of us these days.

Stefano Castriota (Translated from the Italian by Judith Turnbull).  Wine Economics.  MIT Press, 2020.  

Wine isn’t something that I pay a lot of attention to academically, so I had no idea there was a field of economics devoted to these products until MIT Press sent me this book.  It reviews the literature on lots of issues I’ve never thought about:

• Why you pay more for some wines than others even when the cost of producction is the same.
• The role of expertise: can they really tell the difference between one wine and another, and how does expertise affect price.
• What market forces affect wine consumption.
• The external costs of wine production and consumption.

This is a serious but well written review of the academic literature and a convenient way to dig into these topics all at once.  The book is full of charts, impenetrable (to me) economic diagrams, and figures.  Here’s one I copied (badly).  It’s per capita consumption of alcohol by type in the U.S. from 1934 (post-Prohibition) to 2014.  Wine is the dotted line at the bottom.  This is why this industry is pushing you to drink more wine.

The pushing is one reason why I am interested in the economic externalities of wine production and consumption.

Castriota is convinced by his reading of the literature that moderate wine consumption is associated with improved health.  I’d say the jury is still out on this one, but in any case positive health externalities depend on what’s meant by “moderate.”

But there are definitely other positive externalities: gorgeous countryside, land preservation, wine tourism, conviviality, cultural value.

The negative externalities of excessive alcohol consumption are well known: poor physical and mental health, accidents, violence, fetal damage.  These add up to enormous costs to society.  How much of that is due to wine consumption?  Hard to say.

This industry wants to sell more wine.  To do so, Castriota suggests:

• Make wines of better quality.
• Change the tax system to promote quality.
• Clarify the classification system.
• Support small wineries.
• Keep prices competitive.
• Promote wine culture among consumers.