by Marion Nestle

Currently browsing posts about: Noncommunicable diseases

Sep 21 2021

At last, a call for leadership to prevent diet-related chronic disease

Chronic (“noncommunicable”) diseases—heart disease, cancer, and diabetes—account for half of annual deaths in the United States at enormous physical and economic cost to individuals and to society.  These conditions are related to diet; obesity is a risk factor for all three.

Despite the widespread prevalence of obesity (the CDC says 73.6% of American adults are overweight or severely overweight) and its associated chronic conditions, no concerted government effort is aimed at prevention.

This is also true on the international level.  The UN’s Sustainable Development Goals barely mention reduction of noncommunicable diseases.  You have to go to the fourth sub-goal of SDG 3, Good Health and Well-Being, to find:

By 2030, reduce by one third premature mortality from non-communicable disaeases through prevention and treatment and promote mental health and well-being.

Why is so little attention focused on diet-related conditions?  To prevent them, people have to eat more of healthier foods and less of unhealthier foods—public health measures strongly opposed by the food industry.  [For detailed evidence on this point, see Swinburn BA, et al.  The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission reportLancet. 2019;393:791-846].

Representatives Rosa DeLauro and Tim Ryan have the same question.  They asked the Government Accountability Office (GAO) to look into government efforts to prevent chronic disease.

The result: Chronic Health Conditions:Federal Strategy Needed to Coordinate Diet-Related Efforts.

It’s not that the US government ignores chronic disease; on the contrary.  The GAO identified an astounding 200 federal efforts to reduce these conditions—but fragmented among an even more astounding 21 federal agencies.

Most of these are focused on research.

These programs are all over the place, and nobody is in charge.

Agency Officials Say They Lack Authority to Lead a Federal Strategy on Diet:  Despite their support for a federal strategy to coordinate diet-related efforts, no agency officials we interviewed asserted that their agencies had the authority to lead a federal strategy that would have reasonable assurance of being sustained across administrations. Officials from six agencies said they would not have the authority, and officials from the remaining 10 agencies said they did not know or were not in a position to comment. Some officials stated that they would have the authority to lead a strategy for their agency alone but not for the entire federal government.

The GAO came to the obvious conclusion.

Congress should consider identifying and directing a federal entity to lead the development and implementation of a federal strategy to coordinate diet-related efforts that aim to reduce Americans’ risk of chronic health conditions. The strategy could incorporate elements from the 2011 National Prevention Strategy and should address outcomes and accountability, resources, and leadership.

Leadership!  Here’s my list.

  • Say what a healthy diet is in plain English.
  • Tell the public to avoid or minimize ultra-processed foods.
  • Establish policies—from agriculture to public health—to promote healthful diets and discourage unhealthful diets.

This will take courage.  Hence: Leadership.

Sep 17 2020

Food companies’ exploitation of Covid-19 for marketing purposes: new report

The NCD [Non-Communicable Disease] Alliance has issued a press release for its latest report, Signalling Virtue, Promoting Harm – Unhealthy Commodity Industries and COVID-19

As the press release explains, the

new report details hundreds of examples of unhealthy commodity industries, led by Big Alcohol, Big Food, and Big Soda, leveraging the COVID-19 pandemic for commercial gain. This report raises concerns of corporate capture during the pandemic by the very industries that are fuelling the burden of NCDs worldwide and putting people at greater risk of severe COVID-19 outcomes.

The Alliance released the report in conjunction with the  Global Week for Action on NCDs and the theme of accountability.

The report includes hundreds of case studies submitted from more than 90 countries of business responses to Covid-19, in these categories.

The report illustrates dozens of examples, and it’s hard to choose the most egregious from among so many possibilities.  I particularly appreciated this one.

This report is well worth a close look.  I found it highly instructive.

Jan 28 2015

WHO versus noncommunicable (chronic) disease: where’s the sugar target?

The World Health Organization (WHO) released two reports within the last week aimed at preventing noncommunicable diseases.  Although the second is all about reducing sugar intake, the first report is about everything but.

1.  The Global Status Report on Noncommunicable Diseases, 2014.* 

The WHO press release points out that the report calls for:

more action to be taken to curb the epidemic, particularly in low- and middle-income countries, where deaths due to NCDs are overtaking those from infectious diseases. Almost three quarters of all NCD deaths (28 million), and 82% of the 16 million premature deaths, occur in low- and middle-income countries.

How?  By working to achieve 9 targets:

  • Target 1: A 25% relative reduction in risk of premature mortality from CVDs, cancer, diabetes, chronic respiratory diseases.
  • Target 2: At least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context.
  • Target 3: A 10% relative reduction in prevalence of insufficient physical activity.
  • Target 4: A 30% relative reduction in mean population intake of salt/sodium.
  • Target 5: A 30% relative reduction in prevalence of current tobacco use in persons aged 15+ years.
  • Target 6: A 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure, according to national circumstances.
  • Target 7: Halt the rise in diabetes and obesity.
  • Target 8: At least 50% of eligible people receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes.
  • Target 9: An 80% availability of the affordable basic technologies and essential medicines, including generics, required to treat major NCDs in both public and private facilities.

Don’t dietary sugars have something to do with diabetes and obesity?  How come no specific target?  This is especially odd in light of the second report.

2. Guideline: Sugars Intake for Adults and Children [see updated, revised publication released March 2015]

The WHO makes three recommendations about intake of added (“free”) sugars:

  • A reduced intake of free sugars throughout the lifecourse (strong recommendation).
  • Reducing the intake of free sugars to less than 10% of total energy intake (strong recommendation).
  • A further reduction of the intake of free sugars to below 5% of total energy intake (conditional recommendation)

Why no target for sugar reduction to 10% of energy  in the first report?

The omission is glaring.  Could politics be involved?  It’s hard to think of any other explanation.

WHO needs to speak with one voice on NCD targets, guidelines, and recommendations.

* Along with the NCD target report, WHO also released:

**Thanks to Dr. Karen Sokal-Gutierrez for alerting me to the lack of a sugar target.