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A press release from the World Health Organization announces recommendations on the use of artificial, non-nutritive (meaning no-calorie) sweeteners: WHO advises not to use non-sugar sweeteners for weight control in newly released guideline.

The recommendation is based on the findings of a systematic review of the available evidence which suggests that use of NSS does not confer any long-term benefit in reducing body fat in adults or children. Results of the review also suggest that there may be potential undesirable effects from long-term use of NSS, such as an increased risk of type 2 diabetes, cardiovascular diseases, and mortality in adults.

The recommendation not to use artificial sweeteners for weight control or chronic disease prevention applies to:

all synthetic and naturally occurring or modified non-nutritive sweeteners that are not classified as sugars. Common NSS include acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives.

The guideline document notes:

The recommendation in this guideline was made based on evidence that suggests that there may be health effects associated with NSS use irrespective of which NSS is being used – that is, NSS as a class of compounds, despite individual NSS having different chemical structures, may have an impact on health…individual NSS have different sweetness intensities and organoleptic properties, and are processed differently by the body. Although limited  evidence suggests that individual NSS may also differ in some of their physiological effects in humans, the evidence is currently insufficient to make
recommendations for individual NSS.

Overall, the evidence summarized in the document shows benefits from short-term studies but not ones that last longer than three months or so.  After that, use of non-nutritive sweeteners is associated with potential harm.

At issue, of course, is the mechanism.  These remain speculative: calorie compensation? mainenance of taste preference?  microbiome?

Much of the research into biological mechanisms has been carried out in in vitro and rodent models, and further research is needed to determine whether observations in non-human models translate to humans.  Although there are as yet no conclusive mechanistic links between NSS use and many of the associations observed in prospective cohort studies, that plausible mechanisms have been identified, tested and in some cases validated (albeit mostly in non-human models) reinforces the seriousness with which the associations observed in prospective cohort studies should be considered and highlights the need for further exploration of possible mechanisms with additional research.

Until then, it seems best to avoid them (I don’t like their taste anyway).

• View the press release here
• Access the guideline here

Questions?

• Please email any questions to: NFS@who.int 

The latest review of sugars and health has created quite a stir.

• The study:  Dietary sugar consumption and health: umbrella review.  BMJ 2023; 381 doi: https://doi.org/10.1136/bmj-2022-071609 (Published 05 April 2023).
• Method:  The authors evaluated 73 meta-analyses that included 8601 studies, most of them observational (meaning they indicate associations but not necessarily causation).
• Findings: Significant harmful associations between dietary sugar consumption and 18 endocrine/metabolic outcomes, 10 cardiovascular outcomes, seven cancer outcomes, and 10 other outcomes (neuropsychiatric, dental, hepatic, osteal, and allergic) were detected.
• Implications: Low-quality evidence linked each additional serving of a sugar-sweetened beverage per week with a 4% higher risk of gout. Each extra cup per day of a sugar-sweetened drink was associated with a 17% and a 4% higher risk of coronary heart disease and all-cause mortality, respectively.
• Recommendations: (1) Reduce the consumption of free sugars or added sugars to below 25 g/day (this translates to about 6 teaspoons daily). (2) Limit sugar-sweetened beverages to less than 1 a week.

Here’s the headline about the stir:

Experts recommend 6-teapsoon limit to added sugar following BMJ review, industry weighs in:  Recently published research in The BMJ is providing fresh concerns about sugar consumption levels, as some industry stakeholders disagree with the conclusion and CPG brand look to innovate in the low- and no-sugar space…. Read more

And one of the quotes from an industry representative:

…This is a review of existing evidence, and even a well-executed systematic review is only as good as the studies that are inputted. Essentially, garbage in equals garbage out, and it is known that added sugars literature suffers from significant variability when it comes to definitions, intake measurements and control of energy and other diet and lifestyle variables.

Comment: The six-teaspoon recommendation is consistent with World Health Organization guidelines to reduce daily intake of free sugar to less than 10% of their total energy intake, and preferably 5 percent.  The authors admit the evidence is not strong.  But there’s just so much of it, and it’s not going away.

When it comes to sugars, less is better, alas.

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Here’s a recent report from WHO: Scope and impact of digital marketing strategies for promoting breastmilk substitutes

 

The report’s findings:

Why should we care?  Because it is so easy to discourage breastfeeding, and digital marketing does just that.

Here are some comments on this report:

• WHO report urges curbs to ‘aggressive’ code-flouting baby formula marketing:  Parents and pregnant women around the world are exposed to aggressive marketing for baby formula milk, according to a report launched jointly by the World Health Organization (WHO) and UNICEF…. Read more
• Second WHO report identifies formula firms’ social media use in targeting mums-to-be:  A World Health Organization (WHO) report claims that pregnant women and mothers are being targeted online by formula milk companies with personalised social media content…. Read more

And here are links to the first WHO report and to other reports on digital marketing.

• February 16, 2022 WHO report on food marketing
• November 4, 2021  What’s up with digital marketing?  Plenty.
• November 24, 2020  Digital marketing to children: two reports

The World Health Organization has just published “Food marketing exposure and power and their associations with food-related attitudes, beliefs and behaviours: a narrative review”

This is an update of a review WHO published in 2009 on the extent, nature and effects of food marketing.

The update includes a review of studies from 2009 to 2020 of

• Where food marketing occurs
• How much there is,
• Which brands and products are marketed
• How they are marketed
• How consumers react to food marketing

The report, which covers digital and social media,  concludes

Food marketing remains prevalent

• It is especially prevalent where children are and what they watch on TV
• It predominantly promotes “fast food”, sugar-sweetened beverages, and chocolate and confectionery
• It uses a wide range of creative strategies  aimed at young audiences (celebrity/sports endorsements, promotional characters, games)
• Its exposure is positively associated with habitual consumption of marketed foods or less healthy foods

The report confirms what advocates have been saying for years

• Food marketing is pervasive
• Food marketing is persuasive
• Food marketing is bad for health

The bottom line: Food marketing, especially to children, must be stopped

The World Health Organization is about to publish a report on how the palm oil industry is promoting obesity and chronic disease as well as environmental degradation as integral parts of its business model.

The draft report gets right to the point.

We highlight the industry’s mutually profitable relationship with the processed food industry and its impact on human and planetary health, including detrimental cultivation practices that are linked to respiratory illnesses, deforestation, loss of biodiversity and pollution. This analysis illustrates many parallels to the contested nature of practices adopted by the alcohol and tobacco industries.

The research behind the report supports the analytical framework for examining industry’s effects on health.

The report documents how the palm oil industry, working with the food industry, acts to maximize profits at the expense of health and the environment, through marketing, supply chain management, lobbying, and corporate “citizenship.”

The report calls for

• More research on the effects of palm oil on health
• Actions to mitigate industry influences to protect producers and sellers from needed regulations
• Use of the Sustainable Development Goals to aid these actions

You don’t get why palm oil raises health and environmental concerns?  Read this.  Now.

 

Nobody should be surprised by the results of the latest WHO report on the lack of progress in curbing the marketing of highly processed junk foods to children.

 

The report looks at marketing policies across WHO Europe’s member countries.  The data show that while about half the countries have taken some steps to limit junk food marketing to kids, even these steps do not go nearly far enough.

Actions focus mainly on

• Advertising but ignore other methods for reaching children.
• Children up to age 12 or 13, but not others.

The report notes the need for more consistent definitions and regulations across the various countries, especially with respect to digital media.

The report documents the negative effects of highly processed foods on kids’ health.  It also documents the uphill nature of addressing this problem.

From the standpoint of the food industry, marketing to children in the line in the sand.  They cannot stop marketing to kids and still sell junk foods aimed at kids.

The report provides plenty of evidence for food companies’ prioritizing profit over public health.

By this time, you have no doubt heard about the Trump Administration’s attempts to stop the World Health Organization from promoting breastfeeding.  Incredible but true.

Here is a brief timeline of how this story got out.

May 25   Lucy Sullivan, executive director o 1000 Days (the first 1000 days of life are critical to an infant’s survival) sent out a tweet warning of a battle brewing over breastfeeding at WHO’s World Health Assembly, where countries are negotiating a resolution on infant and young child feeding.

June 7   Amruta Byatnal writes about “A Moment of Reckoning for Nutrition Advocates at the WHA” [World Health Assembly: “Nutrition advocates have accused the U.S. of siding with private sector interests, sparking a controversy over what they assumed would be a routine effort to provide advice on breastfeeding and the use of breast milk substitutes.”

July 8  The New York Times takes the story national: “Opposition to Breast-Feeding Resolution by U.S. Stuns World Health Officials.”  The Guardian also publishes an account.   These make it clear that the Trump Administration threatened Ecuador to drop its support of breastfeeding.  As the Times put it,

The Americans were blunt: If Ecuador refused to drop the resolution, Washington would unleash punishing trade measures and withdraw crucial military aid. The Ecuadorean government quickly acquiesced….The confrontation was the latest example of the Trump administration siding with corporate interests on numerous public health and environmental issues.

Ironically, Russia stepped in and introduced the measure, which passed despite US attempts to block it.

July 9  President Trump sends out a tweet:

July 9  Alex Azar, Secretary of Health and Human Services, also sends out a tweet, supporting the President: “America has a long history of supporting mothers and breastfeeding around the world and is the largest bilateral donor of such foreign assistance programs. Those unable to breastfeed shouldn’t be stigmatized; they should be equally supported with info and access to alternatives.”

July 9  The New York Times publishes an editorial: “Why Breast-Feeding Scares Donald Trump.”  Its answer: “It comes down to public health abroad could hurt American companies’ profits.”

What this is about

Infant formula works for babies, but breastfeeding is demonstrably better.  This is especially true for women who cannot afford formula, do not have clean water to dilute the powder properly, or lack refrigeration to store formula properly.

But breastfeeding has a serious political problem: it does not make money for formula companies.  As I explained in Waht to Eat:

Infant formulas cause controversy and are endlessly contentious for three important reasons.  Formulas are (1) largely unnecessary (most mothers can breast feed their infants), (2) not as perfect as breast milk for feeding babies, and (3) more expensive than breast feeding.  Breast milk is nutritionally superior to formula, but from a marketing standpoint it has one serious disadvantage: it is free.   Beyond one-time purchases of breast pumps, storage bottles, or special clothing, nobody makes money from it.

Formula companies are happy to pay lip service to “breast is best,” as long as policies do not promote breastfeeding over formula.

This is not the first time the US has taken this position.  In 1981, when the United Nations developed the International Code of Marketing of Breast-Milk Substitutes, all of its member countries agreed to abide by the Code except for the United States and South Africa.  Eventually, South Africa signed on.  The U.S. was the last hold out and did not agree to abide by the Code until 1994.  Why not?  Because the Code could set a precedent that might adversely affect U.S. corporations.

The Washington Post (“US efforts”) and The Atlantic (“epic battle”) review this history.

The formula industry’s problem

As I also explained in What to Eat, only about 4 million babies are born in the US each year, meaning that the formula market is limited and static.  That is why formula companies work so hard to convince mothers that breastfeeding is too difficult, unsanitary, inefficient, and ineffective to continue, and that they would be better off switching to formulas and staying on formulas long past the time when babies should be eating solid foods.

The reactions

My favorites are from

• Georges Benjamin, executive director of the American Public Health Association (in an interview with Food Chemical News).

• From the American Public Health Association
• From medical experts interviewed in the New York Times
• From Vox

Add this to the growing list of ways the Trump Administration favors corporate interests over public health. Alas.

Additions

Maplight reports:

Three of the largest infant formula companies — U.S.-based Abbott Laboratories, Swiss-based Nestle, and U.K.-based Reckitt Benckiser — have spent $60.7 million lobbying U.S. lawmakers and officials during the last decade….While the New York Times reported that the formula manufacturers didn’t play a visible role in the debate over the WHO resolution, lobbying records show they have a significant Capitol Hill presence that often extends beyond infant nutrition.

Stephen Colbert’s take

 

The AP reports that the reason the WHO committee on preventing noncommunicable diseases (NCDs) did not recommend soda taxes is that the US representative vetoed the idea.

The Trump administration has torpedoed a plan to recommend higher taxes on sugary drinks, forcing a World Health Organization panel to back off the U.N. agency’s previous call for such taxes as a way to fight obesity, diabetes and other life-threatening conditions.

The move disappointed many public health experts but was enthusiastically welcomed by the International Food and Beverage Alliance — a group that represents companies including Coca-Cola, PepsiCo. and Unilever.

The WHO committee’s report appeared in The Lancet last week.  About soda taxes, it said:

The Commissioners represented rich and diverse views and perspectives. There was broad agreement in most areas, but some views were conflicting and could not be resolved. As such, some recommendations, such as reducing sugar consumption through effective taxation on sugar-sweetened beverages and the accountability of the private sector, could not be reflected in this report, despite broad support from many Commissioners.

It did not include soda taxes in its tax recommendation:

Implement fiscal measures, including raising taxes on tobacco and alcohol, and consider evidence-based fiscal measures for other unhealthy products.

This omission is striking in view of WHO’s strong previous positions on the need to reduce NCDs as part of the agency’s Sustainable Development Goals for 2030, and on reducing sugars and taxing sodas as a means to achieve those goals:

• In 2015, WHO recommended  that sugars be consumed at less than 10% of calories.
• In 2016, WHO recommended taxes on sugary drinks as a way to reduce sugar intake and prevent NCDs.

Again a US veto?  Recall the infamous incident in 2003 when the US blocked the agency from recommending a reduction in sugar intake.

The US should not be holding WHO hostage to public health measures.

WHO should not be caving in to US threats.

NCDs are the major cause of worldwide death and disability and we need worldwide efforts to prevent them.  This calls for cooperation, not blackmail.

Shame.