by Marion Nestle

Currently browsing posts about: WHO(World Health Organization)

Jul 16 2018

The Trump Administration’s support of infant formula v. breastfeeding

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

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

 

Jun 4 2018

US vetoes any mention of soda taxes in WHO committee report on preventing noncommunicable (chronic) disease

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:

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.

Nov 7 2016

WHO Europe takes on food marketing to children

The World Health Organization’s Europe branch has issued a brave new report: Tackling food marketing to children in a digital world: trans-disciplinary perspectives (2016)


I say brave because marketing to children is the food industry’s line in the sand.
Food and beverage companies will not stop marketing to children because doing so will hurt their bottom lines too much.

WHO Europe makes eight recommendations, all of them highly political:

1. Acknowledge States’ duty to protect children online with statutory regulation
2. Extend offline protections online
3. Define legal age, rather than leaving commercial interests to do so
4. Define marketing directed to children
5. Draw on existing legislation, regulation and regulatory agencies
6. Compel private Internet platforms to remove marketing of foods high in saturated fat, salt and/ or free sugars
7. Develop appropriate sanction and penalty mechanisms
8. Devise cross-border international responses

The report’s conclusion:

Children’s participation in digital media should not, however, be predicated on receiving digital HFSS [high in saturated fats, salt and/or free sugars] advertising. Digital marketing can amplify the power of earlier marketing practices by identifying and targeting more vulnerable populations with sophisticated analytics and creating engaging, emotion-focused, entertaining ways to reach children.

Nor should children’s digital participation be predicated on “devolving” consent to parents, which is akin to States expecting parents to completely prohibit their children from watching all television in order to avoid HFSS marketing, rather than implementing broadcast regulations.

Instead, States and supra-national actors should devise ways to allow children to participate in the digital world without being targeted by marketers with immersive, engaging, entertaining marketing of products that have been demonstrated to be injurious to their health.

Now if governments would just listen….

Mar 1 2016

PAHO issues nutrition standards for ultraprocessed foods. Beverage Associations object.

Cheers to the Pan American Health Organization/World Health Organization for releasing nutritional profile standards for making it easier for governments to distinguish fresh and minimally processed foods from ultraprocessed.  The idea here is to encourage populations to consume traditional diets (see press release).

Ultra-processed foods are defined as industrially formulated food products that contain substances extracted from foods (such as casein, milk whey, and protein isolates) or substances synthesized from food constituents (such as hydrogenated oils, modified starches, and flavors). Drawing on the best scientific evidence available, the model classifies processed and ultra-processed foods and beverages as having “excessive” amounts of sugar, salt and fat according to the following criteria:

  • Excessive sugar if the amount of added sugars is 10% or more of total calories
  • Excessive fat if the calories from all fats are 30% or more of total calories
  • Excessive saturated fat if calories from saturated fats are 10% or more of total calories
  • Excessive trans fat if calories from trans fats are 1% or more of total calories
  • Excessive sodium if the ratio of sodium (in milligrams) to calories (kcal) is 1:1 or higher.

PAHO’s point in setting these standards is to encourage governments to:

  • Restrict the marketing of unhealthy food and beverages to children (see PAHO Plan of Action for the Prevention of Obesity in Children and Adolescents)
  • Regulate school food environments (feeding programs and food and beverages sold in schools)
  • Use front-of-package (FOP) warning labels
  • Define taxation policies to limit consumption of unhealthy food
  • Assess agricultural subsidies
  • Identify foods to be provided by social programs to vulnerable groups.

Yes!

Alas, not everyone is as enthusiastic as I am about the profiles.  The International Council of Beverages Associations released this statement:

We agree that obesity is a global health challenge, and ICBA and its members welcome the opportunity to work with PAHO and other stakeholders to pursue effective and practical solutions. There are some areas, however, where we believe that use of PAHO’s Nutrient Profile Model may not provide helpful guidance to consumers.  There is not current scientific consensus in all areas that the Nutrient Profile Model addresses. It will not be useful if families find that nearly 80% of the foods and beverages in their grocery carts are unacceptable. Such a radical message is not likely to be followed by most individuals…we encourage governments and scientific bodies to offer food and dietary recommendations and national policies that are based on the totality of scientific evidence and provide realistic, positive encouragement to consumers to have a real impact promoting healthful diets and preventing obesity and non-communicable diseases.

 

The PAHO profiles may need tweaking, but they are a great first step.  Now let’s see how they get implemented.

Nov 2 2015

WHO clarifies meat-and-cancer report

The World Health Organization has issued a statement of clarification of the significance of its International Agency for Research on Cancer (IARC) report on the increased risk for colorectal cancer from eating processed and red meat (see my post on this).

The latest IARC review does not ask people to stop eating processed meats but indicates that reducing consumption of these products can reduce the risk of colorectal cancer.

Got that?

The New York Times explains the meaning of this increased risk.  To understand it, you need to know the risk of colorectal cancer among people who never eat processed or red meat.

The main problem with the public health messages put out by the W.H.O. is that the agency did a poor job of explaining what its risk-ranking system really means…it’s based only on the strength of the overall research, not on the actual danger of a specific product…Even the most strident anti-meat crusader knows that eating bacon is not as risky as smoking or asbestos exposure. Smoking raises a person’s lifetime risk of developing lung cancer by a staggering 2,500 percent. Meanwhile, two daily strips of bacon, based on the associations identified by the W.H.O., would translate to about a 6 percent lifetime risk for colon cancer, up from the 5 percent risk for people who don’t enjoy bacon or other processed meats.

My interpretation: Can processed and red meats be included in healthful diets?  Yes, of course.  But for many reasons, people and the planet would be healthier if these foods were consumed in smaller portions, less often.

Oct 27 2015

Some comments on the meat-is-carcinogenic report

Yesterday, the World Health Organization’s International Agency for Research on Cancer (IARC) issued a warning about the carcinogenic potential of processed and red meat.  This, as you might expect, caused a media flurry.  CNN News asked me for a written comment.  They titled it “The other benefit to eating less red meat.”  Here’s what I wrote:

The just-released report from the International Agency for Research on Cancer judging processed meat as clearly carcinogenic and red meat as probably carcinogenic has caused consternation among meat producers and consumers.

Meat producers do not like the “eat less meat” message. Consumers do not want to give up their bacon and hamburgers — delicious and also icons of the American way of life.

But these judgments should come as no surprise to anyone. Eating less processed and red meat has been accepted dietary advice since Ancel and Margaret Keys wrote their diet book for heart disease prevention, “Eat Well and Stay Well,” in 1959. Their advice: “restrict saturated fats, the fats in beef, pork, lamb, sausages …” They aimed this advice at reducing saturated fat to prevent heart disease. Federal committees and agencies have continued issuing such heart-disease advice to the present day.

Cancer entered the picture in the 1970s, when scientists began to link red meat — beef, pork, lamb — to the risk of cancers of the colon and rectum. Even after several decades of research, they had a hard time deciding whether the culprit in meat was fat, saturated fat, protein, carcinogens induced when meat is cooked to high temperatures or some other component.

In the mid-1990s, dietary guidelines committees advised eating lean meats and limiting intake of processed meats, still because of their high fat content. By the late 1990s, cancer experts said that red meat “probably” increases the risk of colorectal cancers, and “possibly” increases the risk of cancers of the pancreas, breast, prostate and kidney. The IARC report, based on more recent evidence, makes even stronger recommendations and favors carcinogens as the causative factors.

To put this in context: For decades, the meat industry’s big public relations problem has been that vegetarians are demonstrably healthier than meat eaters. People who do not eat red meat havemuch less of a chance of developing heart disease and bowel cancers than the average American.

More recently, the 2015 Dietary Guidelines Advisory Committee (DGAC) found diets “higher in red/processed meats…” to be associated with a greater risk of colorectal cancer, and it recommended dietary patterns and low in red and/or processed meats, but higher in vegetables, fruits, legumes, whole grains, lean meats/seafood and low-fat dairy — largely, but not necessarily exclusively, plant-based.

This is good advice for anyone.

Eating less red and processed meats has two benefits: a reduced risk for certain forms of cancer,and a reduced effect on climate change.

The DGAC deemed eating less red meat to be exceptionally beneficial to the environment as well as to human health. The IARC report strengthens the health component of the recommendation. The secretaries of USDA and Health and Human Services, however, have refused to allow environmental concerns to be considered in the 2015 dietary guidelines.

I mention the dispute over environmental “sustainability” in the dietary guidelines because largely plant-based diets are appropriate for all kinds of health concerns — obesity, type 2 diabetes, coronary heart disease and now, especially, colorectal cancer — as well as environmental concerns.

By eating less red and processed meats, you promote both your own health and that of the planet.

At issue then is how much red and processed meat is compatible with good health. The IARC commission ducked that question, although it cites evidence that as little as 100 grams (a quarter pound) of red meat a day, and half that much of processed meats, increases cancer risk by 15% to 20%.

Will an occasional hamburger or piece of bacon raise your risk that much? I don’t think so. But the evidence reviewed by IARC strongly suggests that if you do eat meat, eat less when you do, don’t eat meat every day, save processed meats for rare treats and be sure to eat plenty of vegetables.

Fortunately, this advice leaves plenty of room for delicious meals — just with meat taking up much less room on the plate.

Other comments

Mar 21 2015

WHO’s cancer working group: Roundup is “probably a human carcinogen”

The WHO’s International Agency for Research on Cancer (IARC) has just published a report from 17 experts from 11 countries who concluded that glyphosate (“Roundup”) is “probably carcinogenic to humans.”

The IARC Working Group found evidence that

Case-control studies of occupational exposure in the USA, Canada, and Sweden reported increased risks for non-Hodgkin lymphoma that persisted after adjustment for other pesticides…In male CD-1 mice, glyphosate induced a positive trend in the incidence of a rare tumour, renal tubule carcinoma. A second study reported a positive trend for haemangiosarcoma in male mice.  Glyphosate increased pancreatic islet-cell adenoma in male rats in two studies. A glyphosate formulation promoted skin tumours in an initiation-promotion study in mice.

Glyphosate has been detected in the blood and urine of agricultural workers, indicating absorption. Soil microbes degrade glyphosate to aminomethylphosphoric acid (AMPA). Blood AMPA detection after poisonings suggests intestinal microbial metabolism in humans. Glyphosate and glyphosate formulations induced DNA and chromosomal damage in mammals, and in human and animal cells in vitro. One study reported increases in blood markers of chromosomal damage (micronuclei) in residents of several communities after spraying of glyphosate formulations. Bacterial mutagenesis tests were negative. Glyphosate, glyphosate formulations, and AMPA induced oxidative stress in rodents and in vitro.

Organophosphate pesticides and herbicides have long been known to be toxic to mammals, but experts have been undecided about whether they cause cancer.

Glyphosate is the herbicide used in conjunction with glyphosate-resistant genetically modified crops.  These are widely planted in the United States (HT means herbicide tolerant).

In addition to causing widespread selection of resistant weeds, glyphosate may also cause cancer.

Add this to the list of scientific reasons for concern about widespread production of GMO crops.  Roundup is used on plants other than GMOs, but GMO corn, cotton, and soybeans use the most.

Note: The FDA has just approved new varieties of GMO apples and potatoes.  These do not use Roundup.

Next: watch Monsanto, the maker of Roundup, attempt to cast doubt on IARC’s scientific judgment.

Addition, March 22:  As an example of the level of the general discussion of GMOs and glyphosate, see this short video clip from French TV (in English) with Patrick Moore.  Mr. Moore, a former director of Greenpeace, has controversial views on climate change and GMOs.

Additions, March 23:

DTN/The Progressive Farmer quotes a Biotechnology Industry Organization representative as pointing out that IARC took the Séralini study seriously, immediately casting doubt on the quality of its literature review (but I can’t find any mention of this study in the IARC report).

Center for Science in the Public Interest urges the EPA to take this seriously.

Consumer Reports is concerned about the vast amounts of glyphosate used and thinks the government should monitor it.

Sep 9 2014

Canada’s Heart and Stroke Foundation weighs in on added sugars

Dr. Yoni Freedhoff sent me Canada’s Heart and Stroke Foundation’s  new position statement on Sugar, Heart Disease, and Stroke.

Its major recommendation is just like the one from the World Health Organization:

The Heart and Stroke Foundation recommends that an individual’s total intake of free sugars not exceed 10% of total daily calorie (energy) intake,and ideally less than 5%.

The Canadian government, the Foundation says, should:

  • Ensure clear and comprehensive nutrition labelling of the free sugars content in the Nutrition Facts table of all packaged foods, grouping all sugars together when listingingredients on product packaging, and standardized serving sizes on the Nutrition Facts table.
  • Restrict the marketing of all foods and beverages to children.
  • Educate Canadians about the risks associated with free sugars consumption through public awareness and education campaigns.

Shouldn’t we be doing that too?

As Dr. Freedhoff puts it, it’s “Amazing how forceful and sweeping public health organizations can be when they don’t need to worry about upsetting their industry partners.”