By MIKE STOBBE (AP)
ATLANTA — Where would you start if you were charged with keeping the nation healthy? Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, has chosen six priorities — winnable battles, he calls them.
They are smoking, AIDS, obesity/nutrition, teen pregnancy, auto injuries and health care infections. These are long-standing, major challenges that get a lot of attention already.
But elevating a handful of problems above dozens of others is a bold move for a public health official. So far, it's been received like a bucket of cold water — invigorating some, infuriating others.
Many advocates, legislators and others in public health have devoted their lives to problems that did not make Frieden's short list. So there are complaints.
A CDC employee blog is peppered with postings like, "I guess climate change is not a battle worth winning," and "Don't we still owe the patients of tomorrow an investment in things that may not pay off immediately?"
Some advocates wonder aloud just how targeted federal public health dollars are going to be. A particular point of concern is hepatitis C, a long under-recognized liver-destroying virus which has infected more than 3 million Americans. Some experts consider the issue a ticking time bomb and have called for the government to step up efforts to prevent it and better diagnose and treat people who already are infected.
Hepatitis B and C already are "badly neglected" by the CDC, and their omission from Frieden's winnable battles list is more bad news, said Bruce Burkett, past president of the National Hepatitis C Advocacy Council.
"I was very disappointed that it wasn't on there. This is going to affect millions by not being on there," he said.
Frieden, who took over CDC in June last year, already had a reputation as something of a public health maverick. When he started his previous job as New York City's health commissioner in 2002, he began by identifying the city's most pressing health issues. He led campaigns to ban smoking in the workplace, tax soda, cut salt in processed foods, and ban artificial trans fats in restaurants.
It's no surprise that he is boldly painting targets at the CDC, said Dr. Jo Ivey Boufford, president of the New York Academy of Medicine. She's a fan of Frieden's who worked with him as a member of an advisory council to the city health department.
Frieden's CDC job, ironically, does not provide the same kind of power he had in New York City to engineer bans or tax increases. But Frieden calls his new short list "winnable battles" because, he says, proven programs can save lives and reduce harm from each of these health problems. He believes government can make dramatic improvements if available money and manpower are focused."In each of these areas we know what to do to make a difference and we need to do it to a much greater extent," he said in an interview. Frieden, with a low-key demeanor, has said relatively little about this to the public, though he seems to be building support within the public health community.There is some nervousness about how far Frieden's going to take this.
"I think everyone is going to be cautious in how the focus on winnable battles is balanced against other areas" that are also deemed important but may not be as easy to dent, said Jeff Levi, who heads Trust for America's Health, a research group.
Top CDC officials have been quick to say they have no intention of walking away from other public health missions. They couldn't even if they wanted to, because much of the agency's funding is directed to certain causes by Congress. According to one estimate, less than one-tenth of 1 percent of CDC's $6.6 billion budget is discretionary money that can be channeled into the winnable battles campaign. Indeed, the agency has been asking for more flexibility.
But there's power in perception, especially concerning CDC's grant money to states. Nearly a quarter of that is targeted at the six battle areas, which already were major areas of interest. State health officers say they're acutely aware of Frieden's priorities and want him to know it when they apply for CDC money.
"We're in the position of focusing pretty much on what we can get federal funds for," said Will Humble, director of the Arizona Department of Health Services.
Humble and several other public health leaders applaud Frieden's priorities as an overdue attempt to narrow the public health message and better market health improvement to Americans.
"You can't market if your message is too diffuse," Humble said. "If we're all on the same page and working in the same direction, we can get a lot more momentum."
This isn't how many public health officials traditionally operate, partly because they tend to worry about alienating employees, legislators and advocates, observed Stanton Glantz, a University of California-San Francisco expert on the health effects of smoking.
Other top federal health officials have not been as specific. U.S. Surgeon General Dr. Regina Benjamin, the government's chief health educator, has made the broader themes of prevention and wellness her focus.
But Frieden clearly has the blessing of his Obama administration bosses to set clear targets. "Getting focused, and getting some quick wins under your belt, is terribly important," said Victor Strecher, a University of Michigan health behavior expert.
Progress in these areas has long been measured by health statistics. What exactly will constitute a win? Frieden hasn't said yet.
___
Online:
CDC Web page describing winnable battles: http://bit.ly/bCd8Lr
Thursday, September 30, 2010
Healthy School Lunch Bill Stalled by Food Stamp Politics
Tasty and nutritious, but don't expect to find it in the school cafeteria. The push to bring more nutritious school lunches to the nation's students has stalled in the House of Representatives. A large group of Democrats objected to plans to use cuts in food stamp money to pay for the bill:"It's just plain wrong," said Rep. Jim McGovern (D-Mass.), a longtime advocate for childhood nutrition programs. "The way you are going to pay for a child nutrition bill is by dipping into people's food stamps? Give me a break."First Lady Michelle Obama has made the passage of the child nutrition bill a centerpiece of her Let's Move campaign to get kids eating better and participating in sports and fitness activities.Obama has lobbied Capitol Hill Democrats extensively to pass the bill this year.
House members balked at further cuts to food stamp funding to pay for the first lady's passion project.
In August, House leadership proposed voting on a Senate-passed version of the child nutrition bill that used the food stamp money to cover its cost. Members had already voted to slash food stamp allocations by 13.6 percent to pay for the President's Medicaid and education funding bill for the states.
106 House Democrats sent a letter to Speaker Nancy Pelosi saying they would not support the Senate version, and urged her to take up their own House bill, which does not contain the food stamp cuts.
Lawmakers adjourned for the midterm elections Wednesday without taking up the bill. The earliest it could now be considered is during this winter's lame duck session.
If passed, the child nutrition bill would require a nutritious makeover for lunchroom food, and would expand food programs for low-income students.
Hamburgers, for example, would need to be made with leaner meat and whole wheat buns. High-calorie soft drinks would vanish from school vending machines.
URL: http://www.takepart.com/news/2010/09/30/healthy-school-lunch-bill-stalled-in-congress
House members balked at further cuts to food stamp funding to pay for the first lady's passion project.
In August, House leadership proposed voting on a Senate-passed version of the child nutrition bill that used the food stamp money to cover its cost. Members had already voted to slash food stamp allocations by 13.6 percent to pay for the President's Medicaid and education funding bill for the states.
106 House Democrats sent a letter to Speaker Nancy Pelosi saying they would not support the Senate version, and urged her to take up their own House bill, which does not contain the food stamp cuts.
Lawmakers adjourned for the midterm elections Wednesday without taking up the bill. The earliest it could now be considered is during this winter's lame duck session.
If passed, the child nutrition bill would require a nutritious makeover for lunchroom food, and would expand food programs for low-income students.
Hamburgers, for example, would need to be made with leaner meat and whole wheat buns. High-calorie soft drinks would vanish from school vending machines.
URL: http://www.takepart.com/news/2010/09/30/healthy-school-lunch-bill-stalled-in-congress
Tuesday, September 28, 2010
Nestlé to take on pharmaceutical sector
Nestlé to take on pharmaceutical sector
By Haig Simonian and Louise Lucas in Lausanne
Published: September 27 2010 08:48 | Last updated: September 27 2010 19:20
Nestlé is challenging the global drugs industry with plans to invest SFr500m ($510m) over the next decade to support the creation of a standalone health science business to tackle obesity and chronic disease.The Swiss food group, which announced the move on Monday, appointed Luis Cantarell, one of its most experienced executives, to "pioneer a new industry between food and pharma" that will develop products to combat diabetes, heart problems and Alzheimer's. Pharmaceutical groups including Pfizer, GlaxoSmithKline and Sanofi-Aventis have placed increasing emphasis on consumer health products sold over the counter, in an effort to diversify away from high-risk traditional drug development. Nestlé recently completed the divestment of Alcon, its specialist eyecare business, to Novartis.
The new health science division, to open in January, will include the group's existing healthcare nutrition business, which had sales of SFr1.6bn last year. By setting up a standalone subsidiary, the group may avoid perceived conflicts between core products, such as chocolate, and obesity – which now affects a sixth of the world's population.
Some analysts are sceptical about a food company's ability to break into this area, citing the time it has taken arch rival Danone of France, which has invested heavily in recent years, to see a significant payback.
Regulators, including the European Food Safety Authority, have begun imposing tougher standards to ensure any health-related claims are backed by science.
However, Nestlé said it was no newcomer and already had a pet food that holds back Alzheimer's in dogs. The group says its Pro Plan Senior is "the first and only dog food to contain ANTI AGE – a nutrient blend proven to improve cognitive function and mental alertness in senior dogs." Mr Brabeck said the division would grow via acquisitions, licensing and integration of start up companies, some already associated via Nestlé venture capital funds.
Medical nutrition has been built up steadily through acquisitions – notably of Novartis's medical nutrition business in 2007. Many analysts expect Nestlé to acquire further, with Mead Johnson, a big US health nutrition group, widely tipped.
The latest changes also mark unusual management volatility for a group known for its stability. The departure of Mr Cantarell from his current job heading the Americas, will mean the appointment of a the fifth new boss in six years to what has become Nestlé's biggest division.
Mr Cantarell will be succeeded by Chris Johnson, an American credited with the introduction of the group's highly successful information technology system, and a fast riser in Nestlé's ranks.
Additional reporting by Andrew Jack in London
By Haig Simonian and Louise Lucas in Lausanne
Published: September 27 2010 08:48 | Last updated: September 27 2010 19:20
Nestlé is challenging the global drugs industry with plans to invest SFr500m ($510m) over the next decade to support the creation of a standalone health science business to tackle obesity and chronic disease.The Swiss food group, which announced the move on Monday, appointed Luis Cantarell, one of its most experienced executives, to "pioneer a new industry between food and pharma" that will develop products to combat diabetes, heart problems and Alzheimer's. Pharmaceutical groups including Pfizer, GlaxoSmithKline and Sanofi-Aventis have placed increasing emphasis on consumer health products sold over the counter, in an effort to diversify away from high-risk traditional drug development. Nestlé recently completed the divestment of Alcon, its specialist eyecare business, to Novartis.
The new health science division, to open in January, will include the group's existing healthcare nutrition business, which had sales of SFr1.6bn last year. By setting up a standalone subsidiary, the group may avoid perceived conflicts between core products, such as chocolate, and obesity – which now affects a sixth of the world's population.
Some analysts are sceptical about a food company's ability to break into this area, citing the time it has taken arch rival Danone of France, which has invested heavily in recent years, to see a significant payback.
Regulators, including the European Food Safety Authority, have begun imposing tougher standards to ensure any health-related claims are backed by science.
However, Nestlé said it was no newcomer and already had a pet food that holds back Alzheimer's in dogs. The group says its Pro Plan Senior is "the first and only dog food to contain ANTI AGE – a nutrient blend proven to improve cognitive function and mental alertness in senior dogs." Mr Brabeck said the division would grow via acquisitions, licensing and integration of start up companies, some already associated via Nestlé venture capital funds.
Medical nutrition has been built up steadily through acquisitions – notably of Novartis's medical nutrition business in 2007. Many analysts expect Nestlé to acquire further, with Mead Johnson, a big US health nutrition group, widely tipped.
The latest changes also mark unusual management volatility for a group known for its stability. The departure of Mr Cantarell from his current job heading the Americas, will mean the appointment of a the fifth new boss in six years to what has become Nestlé's biggest division.
Mr Cantarell will be succeeded by Chris Johnson, an American credited with the introduction of the group's highly successful information technology system, and a fast riser in Nestlé's ranks.
Additional reporting by Andrew Jack in London
Sunday, September 26, 2010
Told to Eat Its Vegetables, America Orders Fries
Heather Ainsworth for The New York Times
The baby-carrot industry tried to reposition its product as junk food, starting a $25 million advertising campaign whose defining characteristics include heavy metal music, a phone app and a young man in a grocery cart dodging baby-carrot bullets fired by a woman in tight jeans.
On the East Side of Manhattan, crates of heirloom vegetables with names like Lady Godiva squash were auctioned for $1,000 each at Sotheby’s, where the wealthy are more accustomed to bidding on Warhols and Picassos than turnips and tomatoes.
Both efforts, high and low, are aimed at the same thing: getting America to eat its vegetables.
Good luck. Despite two decades of public health initiatives, stricter government dietary guidelines, record growth of farmers’ markets and the ease of products like salad in a bag, Americans still aren’t eating enough vegetables.
This month, the Centers for Disease Control and Prevention issued a comprehensive nationwide behavioral study of fruit and vegetable consumption. Only 26 percent of the nation’s adults eat vegetables three or more times a day, it concluded. (And no, that does not include French fries.)
These results fell far short of health objectives set by the federal government a decade ago. The amount of vegetables Americans eat is less than half of what public health officials had hoped. Worse, it has barely budged since 2000.
“It is disappointing,” said Dr. Jennifer Foltz, a pediatrician who helped compile the report. She, like other public health officials dedicated to improving the American diet, concedes that perhaps simply telling people to eat more vegetables isn’t working.
“There is nothing you can say that will get people to eat more veggies,” said Harry Balzer, the chief industry analyst for the NPD Group, a market research company.
This week, the company released the 25th edition of its annual report, “Eating Patterns in America.” The news there wasn’t good, either. For example, only 23 percent of meals include a vegetable, Mr. Balzer said. (Again, fries don’t count, but lettuce on a hamburger does.) The number of dinners prepared at home that included a salad was 17 percent; in 1994, it was 22 percent.
At restaurants, salads ordered as a main course at either lunch or dinner dropped by half since 1989, to a mere 5 percent, he said. The nation has long had a complicated relationship with vegetables. People know that vegetables can improve health. But they’re a lot of work. In refrigerators all over the country, produce often dies a slow, limp death because life becomes too busy.“The moment you have something fresh you have to schedule your life around using it,” Mr. Balzer said.In the wrong hands, vegetables can taste terrible. And compared with a lot of food at the supermarket, they’re a relatively expensive way to fill a belly.
“Before we want health, we want taste, we want convenience and we want low cost,” Mr. Balzer said.
Melissa MacBride, a busy Manhattan resident who works for a pharmaceuticals company, would eat more vegetables if they weren’t, in her words, “a pain.”
“An apple you can just grab,” she said. “But what am I going to do, put a piece of kale in my purse?”
No one really wants to admit that they don’t eat vegetables. A nurse who works at the Hospital for Special Surgery on the Upper East Side openly acknowledges that vegetables make her gag. Still, she begged to not be publicly identified because she is in the health care field and knows that she should set a better example.
David Bernstein, who lives in Greenpoint, Brooklyn, is sheepish about the lack of vegetables in his diet. He waits tables at the hip M. Wells restaurant in Long Island City, Queens, and knows his way around the Union Square Greenmarket. But his diet consists largely of bacon, yogurt and frozen stuffed chicken breasts.
“It’s just like any other bad habit,” he said. “Part of it is just that vegetables are a little intimidating. I’m not afraid of zucchinis, but I just don’t know how to cook them.”
The food industry has tried to make eating vegetables easier. Sales of convenience vegetables, like packages of cut broccoli designed to go right into the microwave, are growing. Washed, ready-to-eat bagged salads are a $3-billion-a-year business.
http://www.nytimes.com/2010/09/25/health/policy/25vegetables.html
Promoting Carrots Like Junk Food
Carrot Talk
By ROB WALKER
Published: September 24, 2010, New York Times
We know junk food when we see it, and maybe we know something else, too: It’s delicious! Feel free to reject that point of view if you like, but farmers who grow carrots have decided to embrace it. As a group, they hired an advertising agency that has landed on a strategy of promoting the root vegetable as if it were junk food. Most notably, they sell baby carrots in plastic bags that explicitly reference processed snacks, like Doritos. Related tongue-in-cheek TV spots end by pointing out that baby carrots now come in “junk-food packaging.”
The campaign is aimed at kids and young adults and even includes the installation of some carrot vending machines in schools. Some observers have dismissed this strategy as an insult to the intelligence of children, or argued that even if it works, kids will be let down when carrots turn out to be distinctly unlike salty chips. Still, while it’s hard to believe that carrotmania is going to sweep youth culture anytime soon, the campaign’s attempt to leech off the power of junk-food branding isn’t completely disconnected from reality.
In 2007, the journal Archives of Pediatrics and Adolescent Medicine published some interesting research on the subject of packaging and the grub kids crave. In the study, children from the ages of 3 to 5 tasted five pairs of identical foodstuffs (including, as it happens, carrots). In each pair, one item was offered in plain, unmarked packaging — and the other was in McDonald’s packaging. The kids, on average, said they preferred the stuff they thought came from the fast-food chain, which of course is one of the most recognizable brands in the world. They thought McDonald’s fries tasted better with branded packaging than without it; they preferred milk in a McDonald’s cup to milk in a plain cup.
This, the study noted, “was true even for carrots,” a food they are unlikely to have experienced at the fast-food chain. The researchers argued, then, that branding has a measurable impact on the taste perceptions of young children.
Yes, that’s depressing. But if it’s true, then maybe junk-food-branded vegetables make some sort of perverse sense. Certainly the tactic was praised by most of those commenting at The Dieline, a popular package-design blog. “How your snack looks makes a big impact,” one designer argued, specifically citing the taste-perception research, on whether “a kid is willing to bring a ‘nerdy snack’ like veggies to school or not (I know; I have kids).”
Thomas Robinson, a doctor and professor of pediatrics at Stanford University who was the lead researcher on the 2007 study, is skeptical that the strategy will have much impact. He’s all for creative efforts to get kids to eat more vegetables, but the carrot farmers are reportedly spending about $25 million on their effort; the combined marketing dollars pushing actual junk food runs well into the billions. “It really is an unfair playing field,” Robinson wrote to me in an e-mail. “I would greatly prefer restrictions on marketing to children rather than trying to compete with junk-food marketing.”
The carrot campaign, of course, feeds off the prevalence of junk-food marketing. The television ads (made by the agency Crispin Porter & Bogusky, whose clients include Burger King and Domino’s Pizza) satirize snack-industry tropes — the sexy-chic girl in baby-carrot ecstasy, the extreme dude performing a harebrained stunt and so on. They’re amusing and join a tradition of ads mocking advertising that stretches back to at least the early 1960s. (There’s also a baby-carrot iPhone app and a Twitter feed.) An assessment on Salon called the spots “reverse-reverse psychology” meant to “convince teens and 20-somethings to eat carrots because it’d be ironic and funny and they’d be in on the joke.”
But it’s hard to say who gets the last laugh here. The makers of Doritos aren’t exactly complaining. (“We’re happy to serve as inspiration,” a Frito-Lay spokesman told USA Today.) And the reality is that marketers have long since recognized and accepted that “how your snack looks” makes a difference, to kids in particular. Thus the many decades of cartoon figures and kids’-entertainment character tie-ins used to sell all manner of sweet or salty items — and, on occasion, packaged vegetables, like SpongeBob carrots, for instance. (As it happens, McDonald’s offered a “Shrek”-themed Happy Meal with a fruit-and-vegetable option earlier this year.) And another study involving children sampling food , conducted at the Rudd Center for Food Policy and Obesity at Yale University and published in the journal Pediatrics this summer, found that kids liked various snacks better when a character like Dora the Explorer appeared on the packaging.
That involves a brand borrowing positive meaning from a widely recognized cultural creation. What’s noteworthy about the carrot campaign is that, satirical or not, the widely recognized cultural creations it’s built around are snack brands. Maybe that’s why the snack companies don’t seem particularly threatened by this particular marketplace challenge. The carrot ads might poke fun at the overwhelming prevalence and effectiveness of “junk food” branding, but in the process, they’re also confirming it.
http://www.nytimes.com/2010/09/26/magazine/26fob-consumed-t.html?_r=1&scp=2&sq=food&st=cse
By ROB WALKER
Published: September 24, 2010, New York Times
We know junk food when we see it, and maybe we know something else, too: It’s delicious! Feel free to reject that point of view if you like, but farmers who grow carrots have decided to embrace it. As a group, they hired an advertising agency that has landed on a strategy of promoting the root vegetable as if it were junk food. Most notably, they sell baby carrots in plastic bags that explicitly reference processed snacks, like Doritos. Related tongue-in-cheek TV spots end by pointing out that baby carrots now come in “junk-food packaging.”
The campaign is aimed at kids and young adults and even includes the installation of some carrot vending machines in schools. Some observers have dismissed this strategy as an insult to the intelligence of children, or argued that even if it works, kids will be let down when carrots turn out to be distinctly unlike salty chips. Still, while it’s hard to believe that carrotmania is going to sweep youth culture anytime soon, the campaign’s attempt to leech off the power of junk-food branding isn’t completely disconnected from reality.
In 2007, the journal Archives of Pediatrics and Adolescent Medicine published some interesting research on the subject of packaging and the grub kids crave. In the study, children from the ages of 3 to 5 tasted five pairs of identical foodstuffs (including, as it happens, carrots). In each pair, one item was offered in plain, unmarked packaging — and the other was in McDonald’s packaging. The kids, on average, said they preferred the stuff they thought came from the fast-food chain, which of course is one of the most recognizable brands in the world. They thought McDonald’s fries tasted better with branded packaging than without it; they preferred milk in a McDonald’s cup to milk in a plain cup.
This, the study noted, “was true even for carrots,” a food they are unlikely to have experienced at the fast-food chain. The researchers argued, then, that branding has a measurable impact on the taste perceptions of young children.
Yes, that’s depressing. But if it’s true, then maybe junk-food-branded vegetables make some sort of perverse sense. Certainly the tactic was praised by most of those commenting at The Dieline, a popular package-design blog. “How your snack looks makes a big impact,” one designer argued, specifically citing the taste-perception research, on whether “a kid is willing to bring a ‘nerdy snack’ like veggies to school or not (I know; I have kids).”
Thomas Robinson, a doctor and professor of pediatrics at Stanford University who was the lead researcher on the 2007 study, is skeptical that the strategy will have much impact. He’s all for creative efforts to get kids to eat more vegetables, but the carrot farmers are reportedly spending about $25 million on their effort; the combined marketing dollars pushing actual junk food runs well into the billions. “It really is an unfair playing field,” Robinson wrote to me in an e-mail. “I would greatly prefer restrictions on marketing to children rather than trying to compete with junk-food marketing.”
The carrot campaign, of course, feeds off the prevalence of junk-food marketing. The television ads (made by the agency Crispin Porter & Bogusky, whose clients include Burger King and Domino’s Pizza) satirize snack-industry tropes — the sexy-chic girl in baby-carrot ecstasy, the extreme dude performing a harebrained stunt and so on. They’re amusing and join a tradition of ads mocking advertising that stretches back to at least the early 1960s. (There’s also a baby-carrot iPhone app and a Twitter feed.) An assessment on Salon called the spots “reverse-reverse psychology” meant to “convince teens and 20-somethings to eat carrots because it’d be ironic and funny and they’d be in on the joke.”
But it’s hard to say who gets the last laugh here. The makers of Doritos aren’t exactly complaining. (“We’re happy to serve as inspiration,” a Frito-Lay spokesman told USA Today.) And the reality is that marketers have long since recognized and accepted that “how your snack looks” makes a difference, to kids in particular. Thus the many decades of cartoon figures and kids’-entertainment character tie-ins used to sell all manner of sweet or salty items — and, on occasion, packaged vegetables, like SpongeBob carrots, for instance. (As it happens, McDonald’s offered a “Shrek”-themed Happy Meal with a fruit-and-vegetable option earlier this year.) And another study involving children sampling food , conducted at the Rudd Center for Food Policy and Obesity at Yale University and published in the journal Pediatrics this summer, found that kids liked various snacks better when a character like Dora the Explorer appeared on the packaging.
That involves a brand borrowing positive meaning from a widely recognized cultural creation. What’s noteworthy about the carrot campaign is that, satirical or not, the widely recognized cultural creations it’s built around are snack brands. Maybe that’s why the snack companies don’t seem particularly threatened by this particular marketplace challenge. The carrot ads might poke fun at the overwhelming prevalence and effectiveness of “junk food” branding, but in the process, they’re also confirming it.
http://www.nytimes.com/2010/09/26/magazine/26fob-consumed-t.html?_r=1&scp=2&sq=food&st=cse
Friday, September 24, 2010
OECD says governments must fight fat
"This new OECD report, Obesity and the Economics of Prevention: Fit not Fat, examines the current obesity epidemic, giving new comparative data, trends and projections across OECD countries and outlining causes and costs.
It also notes ways in which the private sector and governments encouraged obesity and makes recommendations for ways they can contribute to combating it. Since the 1980s, obesity has spread at an alarming rate.
Changes in food supply and eating habits, combined with a dramatic fall in physical activity, have made obesity a global epidemic. Across OECD countries, one in 2 adults is currently overweight and 1 in 6 is obese.
The rate of overweight people is projected to increase by a further 1% per year for the next 10 years in some countries."
It also notes ways in which the private sector and governments encouraged obesity and makes recommendations for ways they can contribute to combating it. Since the 1980s, obesity has spread at an alarming rate.
Changes in food supply and eating habits, combined with a dramatic fall in physical activity, have made obesity a global epidemic. Across OECD countries, one in 2 adults is currently overweight and 1 in 6 is obese.
The rate of overweight people is projected to increase by a further 1% per year for the next 10 years in some countries."
Tuesday, September 21, 2010
Taxing Caloric Sweetened Beverages To Curb Obesity
"Obesity among the U.S. population has increased markedly over the past three decades. Two-thirds of U.S. adults are now either overweight or obese, and growing numbers of children are overweight as well. Studies by nutritionists and epidemiologists suggest that consuming beverages sweetened with sucrose (sugar) and/or high-fructose and other corn syrups is linked to risks for obesity and diabetes.
Many public health advocates are calling for taxes on these caloric sweetened beverages as a way to reduce consumption and raise revenue for obesity-prevention programs. USDA's Economic Research Service researchers analyzed the effects of a hypothetical tax on caloric sweetened soft drinks, fruit drinks, powdered mixes, and energy and sports drinks.
The researchers found that a 20-percent tax on these beverages purchased at grocery stores and restaurants could trigger changes in consumption that would result in an average reduction of 37 calories a day for adults, which translates into a loss of 3.8 pounds of body weight over a year. The estimated decreases for children averaged 43 calories a day, or 4.5 pounds over a year."
Taxing Caloric Sweetened Beverages To Curb Obesity, Travis A. Smith, Biing-Hwan Lin, Rosanna Mentzer Morrison, September 2010
URL: http://www.ers.usda.gov/AmberWaves/September10/PDF/TaxingCaloricBeverages.pdf
Many public health advocates are calling for taxes on these caloric sweetened beverages as a way to reduce consumption and raise revenue for obesity-prevention programs. USDA's Economic Research Service researchers analyzed the effects of a hypothetical tax on caloric sweetened soft drinks, fruit drinks, powdered mixes, and energy and sports drinks.
The researchers found that a 20-percent tax on these beverages purchased at grocery stores and restaurants could trigger changes in consumption that would result in an average reduction of 37 calories a day for adults, which translates into a loss of 3.8 pounds of body weight over a year. The estimated decreases for children averaged 43 calories a day, or 4.5 pounds over a year."
Taxing Caloric Sweetened Beverages To Curb Obesity, Travis A. Smith, Biing-Hwan Lin, Rosanna Mentzer Morrison, September 2010
URL: http://www.ers.usda.gov/AmberWaves/September10/PDF/TaxingCaloricBeverages.pdf
Wednesday, September 15, 2010
How to Inform the American Consumer of Healthy Food Choices
Are 'Smart Food Labels' The Proper Tool to Achieve this Goal?
Roseann B. Termini
Widener University - School of Law
Nicole Stanzione
Widener University - School of Law
Food and Drug Law Institute Update, No. 4, p. 18, July/August 2010
Abstract:
Obesity in the United States continues as a growing epidemic and has the distinction as the second largest cause of premature death. Nearly 129 million adults and nine million children have been considered overweight and obese. Health costs associated with obesity range from “$69 billion dollars to $117 billion dollars on an annual basis.” Should the federal government step up and implement regulations that support the health and welfare of its citizens or should the consumer figure this out?
Apparently, the time is more than ripe for the federal government to establish specific rules that address how to accurately and clearly present label information concerning healthy food choices. The Food and Drug Administration (“FDA”) should develop these rules to assure that food manufacturers depict accurate non-misleading and informative labeling. The FDA was established to protect the public health “by assur[ing] the safety, effectiveness and security of… our nation’s food supply.” The continued role of this federal agency is to ensure that the public obtains “accurate, science-based information they need [in order] to use… foods to improve their health.”
DOWNLOAD: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1673528
Roseann B. Termini
Widener University - School of Law
Nicole Stanzione
Widener University - School of Law
Food and Drug Law Institute Update, No. 4, p. 18, July/August 2010
Abstract:
Obesity in the United States continues as a growing epidemic and has the distinction as the second largest cause of premature death. Nearly 129 million adults and nine million children have been considered overweight and obese. Health costs associated with obesity range from “$69 billion dollars to $117 billion dollars on an annual basis.” Should the federal government step up and implement regulations that support the health and welfare of its citizens or should the consumer figure this out?
Apparently, the time is more than ripe for the federal government to establish specific rules that address how to accurately and clearly present label information concerning healthy food choices. The Food and Drug Administration (“FDA”) should develop these rules to assure that food manufacturers depict accurate non-misleading and informative labeling. The FDA was established to protect the public health “by assur[ing] the safety, effectiveness and security of… our nation’s food supply.” The continued role of this federal agency is to ensure that the public obtains “accurate, science-based information they need [in order] to use… foods to improve their health.”
DOWNLOAD: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1673528
what's on your plate?
what's on your plate? is a witty and provocative documentary produced and directed by award-winning Catherine Gund about kids and food politics.
Filmed over the course of one year, the film follows two eleven-year-old multi-racial city kids as they explore their place in the food chain. Sadie and Safiyah take a close look at food systems in New York City and its surrounding areas. With the camera as their companion, the girl guides talk to each other, food activists, farmers, new friends, storekeepers, their families, and the viewer, in their quest to understand what’s on all of our plates.
The girls address questions regarding the origin of the food they eat, how it’s cultivated, how many miles it travels from the harvest to their plate, how it’s prepared, who prepares it, and what is done afterwards with the packaging and leftovers. They visit the usual supermarkets, fast food chains, and school lunchrooms. But they also check into innovative sustainable food system practices by going to farms, greenmarkets, and community supported agriculture programs.
They discover that these programs both help struggling farmers to survive on the one hand and provide affordable, locally-grown food to communities on the consumer end, especially to lower-income urban families. In WHAT’S ON YOUR PLATE?, the two friends formulate sophisticated and compassionate opinions on the state of their society, and by doing so inspire hope and active engagement in others.
See http://www.whatsonyourplateproject.org/
Filmed over the course of one year, the film follows two eleven-year-old multi-racial city kids as they explore their place in the food chain. Sadie and Safiyah take a close look at food systems in New York City and its surrounding areas. With the camera as their companion, the girl guides talk to each other, food activists, farmers, new friends, storekeepers, their families, and the viewer, in their quest to understand what’s on all of our plates.
The girls address questions regarding the origin of the food they eat, how it’s cultivated, how many miles it travels from the harvest to their plate, how it’s prepared, who prepares it, and what is done afterwards with the packaging and leftovers. They visit the usual supermarkets, fast food chains, and school lunchrooms. But they also check into innovative sustainable food system practices by going to farms, greenmarkets, and community supported agriculture programs.
They discover that these programs both help struggling farmers to survive on the one hand and provide affordable, locally-grown food to communities on the consumer end, especially to lower-income urban families. In WHAT’S ON YOUR PLATE?, the two friends formulate sophisticated and compassionate opinions on the state of their society, and by doing so inspire hope and active engagement in others.
See http://www.whatsonyourplateproject.org/
Tuesday, September 14, 2010
Voices of Federal Food Safety Scientists and Inspectors
Survey: FDA and USDA Scientists (2010)
Download: Driving the Fox from the Henhouse - 2010 Food Safety Report | Food Safety Survey Brochure
Unsafe food can lead to illness and death, and disproportionately harms the most vulnerable members of society. While Americans are fortunate to enjoy a food supply among the safest in the world, there is significant room for improvement. Barely a month goes by without a recall of tainted food.
To evaluate how well the government uses science to protect the food supply, the Union of Concerned Scientists (UCS), working with researchers at Iowa State University, sent a 44-question survey to nearly 8,000 food safety employees at the FDA and U.S. Department of Agriculture (USDA), which together oversee our food system. More than 1,700 employees responded.
The results reveal a food safety system where special interests and public officials all too often inhibit the ability of government scientists and inspectors to protect the food supply.
The August 2010 recall of shell eggs due to Salmonella contamination, as well as the 2006 outbreak of illness due to Escherichia coli in spinach, has brought the topic of food safety into the public spotlight. Roughly 76 million Americans still suffer from foodborne illnesses each year.
While many of these illnesses are mild, they result in more than 300,000 hospitalizations and some 5,000 deaths annually (Mead et al. 1999). A recent study by a former Food and Drug Administration (FDA) economist puts the total pricetag of foodborne illness related to produce in the United States at $152 billion annually (Scharf 2010).
Because of globalization and the complexity of our food supply chain, foodborne disease outbreaks today are more widespread and difficult to isolate than in the past. Food policy experts agree that the market cannot regulate itself. Some food producers prioritize profits over public health, and consumers typically do not have the ability to identify contaminated food by sight or smell.
Reforms aimed at restoring scientific integrity are needed to combat the political and corporate interference at the FDA and USDA. The laws governing the system badly need to be updated to meet twenty-first-century challenges.
Congress should give the FDA and USDA the authority to mandate food recalls, establish a science-based system for detecting harmful pathogens in the food supply, require food manufacturers to disclose more information to the government, and increase government surveillance of food imports. Congress also should provide adequate resources to more effectively police the food supply. Only then can the frequency and scale of disease outbreaks decline.
Download: Driving the Fox from the Henhouse - 2010 Food Safety Report | Food Safety Survey Brochure
Unsafe food can lead to illness and death, and disproportionately harms the most vulnerable members of society. While Americans are fortunate to enjoy a food supply among the safest in the world, there is significant room for improvement. Barely a month goes by without a recall of tainted food.
To evaluate how well the government uses science to protect the food supply, the Union of Concerned Scientists (UCS), working with researchers at Iowa State University, sent a 44-question survey to nearly 8,000 food safety employees at the FDA and U.S. Department of Agriculture (USDA), which together oversee our food system. More than 1,700 employees responded.
The results reveal a food safety system where special interests and public officials all too often inhibit the ability of government scientists and inspectors to protect the food supply.
The August 2010 recall of shell eggs due to Salmonella contamination, as well as the 2006 outbreak of illness due to Escherichia coli in spinach, has brought the topic of food safety into the public spotlight. Roughly 76 million Americans still suffer from foodborne illnesses each year.
While many of these illnesses are mild, they result in more than 300,000 hospitalizations and some 5,000 deaths annually (Mead et al. 1999). A recent study by a former Food and Drug Administration (FDA) economist puts the total pricetag of foodborne illness related to produce in the United States at $152 billion annually (Scharf 2010).
Because of globalization and the complexity of our food supply chain, foodborne disease outbreaks today are more widespread and difficult to isolate than in the past. Food policy experts agree that the market cannot regulate itself. Some food producers prioritize profits over public health, and consumers typically do not have the ability to identify contaminated food by sight or smell.
Reforms aimed at restoring scientific integrity are needed to combat the political and corporate interference at the FDA and USDA. The laws governing the system badly need to be updated to meet twenty-first-century challenges.
Congress should give the FDA and USDA the authority to mandate food recalls, establish a science-based system for detecting harmful pathogens in the food supply, require food manufacturers to disclose more information to the government, and increase government surveillance of food imports. Congress also should provide adequate resources to more effectively police the food supply. Only then can the frequency and scale of disease outbreaks decline.
- Survey Brochure (pdf)
- Survey: FDA and USDA (2010) (pdf)
- Survey Methodology (pdf)
- Selected Essay Excerpts (pdf)http://www.ucsusa.org/assets/documents/scientific_integrity/food-safety-survey-essay-excerpts.pdf
- Solutions and Recommendations (pdf)http://www.ucsusa.org/
- Frequently Asked Questionshttp://www.ucsusa.org/scientific_integrity/abuses_of_science/food-safety-FAQs.html
- Food Safety Outbreaks and Responses
Dietary Guidelines in the 21st Century--a Time for Food
JAMA -- Dietary Guidelines in the 21st Century--a Time for Food, August 11, 2010, Mozaffarian and Ludwig 304 (6): 681
Dietary Guidelines in the 21st Century—a Time for Food
Dietary Guidelines in the Age of Chronic Disease
By the 1970s, the contribution of diet to the increasing burdens of cardiovascular disease, diabetes, obesity, and cancer was known. In response, the goals of dietary guidelines evolved to include prevention of not only nutrient deficiencies but also chronic diseases. For implementation, this new emphasis borrowed heavily from precedent. Accordingly, the Dietary Guidelines for Americans of 1980 remained primarily nutrient-focused, including advice to "avoid too much fat, saturated fat, cholesterol," "eat foods with adequate starch and fiber," "avoid too much sugar," and "avoid too much sodium." International guidelines were similarly nutrient-focused,3 and advances in nutritionalscience paralleled and reinforced emphasis on individual nutrients.
Despite its initial appeal, attempts to extend the nutrient deficiency–based approach for prevention of chronic diseases have been problematic. The RDAs are methodologically and conceptually inappropriate for this purpose,1 necessitating formulation of other measures such as adequate intakes and acceptable macronutrient distribution ranges. However, these newer nutrient-based metrics are hampered by imprecise definitions and inconsistent usage. Moreover, translation of nutrient-based targets to the public has proven difficult. Few individuals can accurately gauge daily consumption of calories, fats, cholesterol, fiber, or salt.
Nutritional science has advanced rapidly, and the evidence now demonstrates the major limitations of nutrient-based metrics for prevention of chronic disease. The proportion of total energy from fat appears largely unrelated to risk of cardiovascular disease, cancer, diabetes, or obesity.4-6 Saturated fat—targeted by nearly all nutrition-related professional organizations and governmental agencies—has little relation to heart disease within most prevailing dietary patterns.7 Typical recommendations to consume at least half of total energy as carbohydrate, a nutrient for which humans have no absolute requirement, conflate foods with widely divergent physiologic effects (eg, brown rice,white bread, apples). Foods are grouped based on protein content (chicken, fish, beans, nuts) despite demonstrably different health effects. With few exceptions (eg, omega-3 fats, trans fat, salt), individual compounds in isolation have small effects on chronic diseases.8 Thus, little of the information found on food labels' "nutrition facts" panels provides useful guidance for selecting healthier foods to prevent chronic disease.
The Need for a New Approach
In contrast with discrete nutrients, specific foods and dietary patterns substantially affect chronic disease risk, as shown by controlled trials of risk factors and prospective cohorts of disease end points.9 Fruits, vegetables, whole grains, and nuts are consistently associated with lower risk of disease. Fish consumption reduces risk of cardiac mortality, belying categorization with other protein sources. Conversely, processed meats, packaged and fast foods, and sugar-sweetened beverages increase chronic disease risk. The effects of foods likely reflect complex, synergistic contributions from and interactions among food structure, preparation methods, fatty acid profile, carbohydratequality (eg, glycemic index, fiber content), protein type, micronutrients, and phytochemicals. Healthy eating patterns share many characteristics, emphasizing whole or minimally processed foods and vegetable oils, with few highly processed foods or sugary beverages. Such diets are also naturally lower in salt, trans fat, saturated fat, refined carbohydrates, and added sugars; are higher in unsaturated fats, fiber, antioxidants, minerals, and phytochemicals; and are more satiating. Thus, a focus on foods increases the likelihood of consuming more healthy nutrients and fewer calories and decreasing chronic disease risk, whereas the opposite has arguably occurred through decades of nutrient-focused guidelines.
The nutrient-based approach may foster dietary practices that defy common sense. Countless highly processed products are now marketed in which refined carbohydrate replaces fat, providing an aura of healthiness but without actual health benefits. School nutrition guidelines specify a minimum number of total calories but a maximum proportion of fat calories, and foods like gelatin desserts and sugar-sweetened low-fat milk have been used to achieve these nutrient targets. Based primarily on considerationof a few nutrients, a national obesity prevention program categorizes whole-milk yogurt and cheese with donuts and french fries as foods to eat occasionally; sautéed vegetables and tuna canned in vegetable oil with processed cheese spread and pretzels as foods to eat sometimes; and fresh fruits and vegetables with trimmed beef and fat-free mayonnaise as foods to eat almost anytime.10 Taking the nutrient approach to self-serving extremes, the food industry "fortifies" highly processed foods, like refinedcereals and sugar-sweetened beverages, with selected micronutrients and recharacterizes them as nutritious. These marketing ploys provide little public health benefit and could potentially produce harm.8
Recently, dietary guidelines have begun to advocate fruits and vegetables based on evidence of their intrinsic health benefits rather than nutrient targets per se.2-3Otherwise, the process of formulating dietary guidelines still principally begins with multiple nutrient targets and then attempts to translate these targets to food-based recommendations. A major shift is needed to novel, evidence-based strategies in which foods comprise the principal dietary targets.
A transition to food-based guidelines does not mean abandoning decades of nutritional science. Biological nutrient requirements should not be ignored but, rather, used to inform application of food-based guidelines, especially in special populations or regions with endemic food shortages or clinical nutrient deficiencies. Much also remains to be discovered regarding the biological effects of specific nutrients, alone and in combination, and such scientific research should continue.
The prevailing nutrient-focused approach has broad consequences, influencing food-labeling priorities, school lunch and low-income food assistance policies, industry and restaurant product formulations, and public perceptions of healthier vs unhealthy foods. This focus contributes to confusion, distracts from more effective strategies, and promotes marketing and consumption of processed products that nominally meet selected nutrient cut points but undermine overall dietary quality. The relatively recent focuson nutrients parallels an increasing discrepancy between theory and practice: the greater the focus on nutrients, the less healthful foods have become. As national and international organizations update dietary guidelines, nutrient targets should largely be replaced by food-based targets. Such change would facilitate translation to the public, correspond with scientific advances in chronic disease prevention, mitigate industry manipulation, and remedy widespread misperceptions about what constitutes healthful diets.
Although this approach may seem radical, it actually represents a return to more traditional, time-tested ways of eating. Healthier food-based dietary patterns have existed for generations among some populations. Modern nutritional science now provides substantial evidence for how foods and food-based patterns affect health, guiding the design of more effective approaches for the prevention of chronic disease.
AUTHOR INFORMATION
Corresponding Author: Dariush Mozaffarian, MD, DrPH, 665 Huntington Ave, Bldg 2-319, Boston, MA 02115 (dmozaffa@hsph.harvard.edu).Financial Disclosures: Dr Mozaffarian reports receiving honoraria or travel reimbursement from the US Food and Drug Administration, World Health Organization, Food and Agricultural Organization of the United Nations, International Life Sciences Institute, Aramark, Unilever, SPRIM, and Nutrition Impact for speaking at scientific conferences and consulting on dietary topics; royalties from UpToDate; grants from GlaxoSmithKline, Sigma Tau, Pronova, and the National Institutes of Health for an investigator-initiated trial of fish oil; and grants from the National Institutes of Health for diet-related research and mentoring. Dr Ludwig reports receiving royalties from a book about childhood obesity and grants from foundations and the National Institutes of Health for obesity-related research, mentoring, and patient care.
Funding/Support: Dr Ludwig is supported in part by career award K24DK082730 from the National Institute of Diabetes and Digestive and Kidney Diseases.
Role of the Sponsors: The funding sources had no role in the preparation, review, or approval of the manuscript.
Disclaimer: The content of this Commentary is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Additional Contributions: We thank Walter Willett, MD, DrPH, Department of Nutrition, Harvard School Public Health, and Marion Nestle, PhD, MPH, Department of Nutrition, Food Studies, and Public Health, New York University, for their critical reading of an earlier version of the manuscript. Neither received compensation for their contributions.
REFERENCES
1. Harper AE. Evolution of recommended dietary allowances—new directions? Annu Rev Nutr. 1987;7:509-537. WEB OF SCIENCE | PUBMED
2. US Department of Health and Human Services. Dietary guidelines for Americans. http://www.health.gov/dietaryguidelines/. Accessed April 21, 2010.
3. World Health Organization; Food and Agricultural Organization. Diet, Nutrition and the Prevention of Chronic Diseases: Report of a Joint WHO/FAO Expert Consultation (Report 916). Geneva, Switzerland: World Health Organization; 2003.
4. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective. Washington, DC: American Institute for Cancer Research; 2007.
5. Tinker LF, Bonds DE, Margolis KL; et al, Women's Health Initiative. Low-fat dietary pattern and risk of treated diabetes mellitus in postmenopausal women. Arch Intern Med.2008;168(14):1500-1511. FREE FULL TEXT
6. Sacks FM, Bray GA, Carey VJ; et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med. 2009;360(9):859-873.FREE FULL TEXT
7. Mozaffarian D, Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat. PLoS Med. 2010;7(3):e1000252. FULL TEXT |PUBMED
8. Bjelakovic G, Nikolova D, Gluud LL; et al. Mortality in randomized trials of antioxidant supplements for primary and secondary prevention. JAMA. 2007;297(8):842-857.FREE FULL TEXT
9. Heidemann C, Schulze MB, Franco OH; et al. Dietary patterns and risk of mortality from cardiovascular disease, cancer, and all causes in a prospective cohort of women.Circulation. 2008;118(3):230-237. FREE FULL TEXT
10. National Heart, Lung, and Blood Institute. We Can! Ways to Enhance Children's Activity and Nutrition.http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/downloads/go-slow-whoa.pdf. Accessed April 30, 2010.
JAMA. 2010;304(6):681-682. doi:10.1001/jama.2010.1116
The discovery of specific dietary insufficiencies as the cause of human disease played a central role in the development of modern nutritional science. In 1753, one of the first clinical trials showed that citrus fruit could prevent scurvy in sailors, leading to the identification of vitamin C as essential for health. By the mid-20th century, protective effects of many nutrients for deficiency diseases had been shown, including thiamine (beriberi), niacin (pellagra), vitamin D (rickets), vitamin A (night blindness), iron (anemia), and iodine (goiter).
Early population-wide dietary guidelines therefore emphasized prevention of nutrient deficiencies. This emphasis assumed special urgency with the food shortages of the Great Depression and World War II, impelling the League of Nations, British Medical Association, and US Department of Agriculture to create new minimum requirements for calories, protein, calcium, phosphorus, iron, and various vitamins.1 Consequently, the first recommended dietary allowances (RDAs) were formulated in 1941, establishing a scientific basis for modern dietary guidelines.2 These efforts set a precedent, followed to this day, for the creation of guidelines by first considering nutrient targets and then translating these targets into food recommendations.
Dietary Guidelines in the Age of Chronic Disease
 | |
By the 1970s, the contribution of diet to the increasing burdens of cardiovascular disease, diabetes, obesity, and cancer was known. In response, the goals of dietary guidelines evolved to include prevention of not only nutrient deficiencies but also chronic diseases. For implementation, this new emphasis borrowed heavily from precedent. Accordingly, the Dietary Guidelines for Americans of 1980 remained primarily nutrient-focused, including advice to "avoid too much fat, saturated fat, cholesterol," "eat foods with adequate starch and fiber," "avoid too much sugar," and "avoid too much sodium." International guidelines were similarly nutrient-focused,3 and advances in nutritionalscience paralleled and reinforced emphasis on individual nutrients.
Despite its initial appeal, attempts to extend the nutrient deficiency–based approach for prevention of chronic diseases have been problematic. The RDAs are methodologically and conceptually inappropriate for this purpose,1 necessitating formulation of other measures such as adequate intakes and acceptable macronutrient distribution ranges. However, these newer nutrient-based metrics are hampered by imprecise definitions and inconsistent usage. Moreover, translation of nutrient-based targets to the public has proven difficult. Few individuals can accurately gauge daily consumption of calories, fats, cholesterol, fiber, or salt.
Nutritional science has advanced rapidly, and the evidence now demonstrates the major limitations of nutrient-based metrics for prevention of chronic disease. The proportion of total energy from fat appears largely unrelated to risk of cardiovascular disease, cancer, diabetes, or obesity.4-6 Saturated fat—targeted by nearly all nutrition-related professional organizations and governmental agencies—has little relation to heart disease within most prevailing dietary patterns.7 Typical recommendations to consume at least half of total energy as carbohydrate, a nutrient for which humans have no absolute requirement, conflate foods with widely divergent physiologic effects (eg, brown rice,white bread, apples). Foods are grouped based on protein content (chicken, fish, beans, nuts) despite demonstrably different health effects. With few exceptions (eg, omega-3 fats, trans fat, salt), individual compounds in isolation have small effects on chronic diseases.8 Thus, little of the information found on food labels' "nutrition facts" panels provides useful guidance for selecting healthier foods to prevent chronic disease.
The Need for a New Approach
|
In contrast with discrete nutrients, specific foods and dietary patterns substantially affect chronic disease risk, as shown by controlled trials of risk factors and prospective cohorts of disease end points.9 Fruits, vegetables, whole grains, and nuts are consistently associated with lower risk of disease. Fish consumption reduces risk of cardiac mortality, belying categorization with other protein sources. Conversely, processed meats, packaged and fast foods, and sugar-sweetened beverages increase chronic disease risk. The effects of foods likely reflect complex, synergistic contributions from and interactions among food structure, preparation methods, fatty acid profile, carbohydratequality (eg, glycemic index, fiber content), protein type, micronutrients, and phytochemicals. Healthy eating patterns share many characteristics, emphasizing whole or minimally processed foods and vegetable oils, with few highly processed foods or sugary beverages. Such diets are also naturally lower in salt, trans fat, saturated fat, refined carbohydrates, and added sugars; are higher in unsaturated fats, fiber, antioxidants, minerals, and phytochemicals; and are more satiating. Thus, a focus on foods increases the likelihood of consuming more healthy nutrients and fewer calories and decreasing chronic disease risk, whereas the opposite has arguably occurred through decades of nutrient-focused guidelines.
The nutrient-based approach may foster dietary practices that defy common sense. Countless highly processed products are now marketed in which refined carbohydrate replaces fat, providing an aura of healthiness but without actual health benefits. School nutrition guidelines specify a minimum number of total calories but a maximum proportion of fat calories, and foods like gelatin desserts and sugar-sweetened low-fat milk have been used to achieve these nutrient targets. Based primarily on considerationof a few nutrients, a national obesity prevention program categorizes whole-milk yogurt and cheese with donuts and french fries as foods to eat occasionally; sautéed vegetables and tuna canned in vegetable oil with processed cheese spread and pretzels as foods to eat sometimes; and fresh fruits and vegetables with trimmed beef and fat-free mayonnaise as foods to eat almost anytime.10 Taking the nutrient approach to self-serving extremes, the food industry "fortifies" highly processed foods, like refinedcereals and sugar-sweetened beverages, with selected micronutrients and recharacterizes them as nutritious. These marketing ploys provide little public health benefit and could potentially produce harm.8
Recently, dietary guidelines have begun to advocate fruits and vegetables based on evidence of their intrinsic health benefits rather than nutrient targets per se.2-3Otherwise, the process of formulating dietary guidelines still principally begins with multiple nutrient targets and then attempts to translate these targets to food-based recommendations. A major shift is needed to novel, evidence-based strategies in which foods comprise the principal dietary targets.
A transition to food-based guidelines does not mean abandoning decades of nutritional science. Biological nutrient requirements should not be ignored but, rather, used to inform application of food-based guidelines, especially in special populations or regions with endemic food shortages or clinical nutrient deficiencies. Much also remains to be discovered regarding the biological effects of specific nutrients, alone and in combination, and such scientific research should continue.
The prevailing nutrient-focused approach has broad consequences, influencing food-labeling priorities, school lunch and low-income food assistance policies, industry and restaurant product formulations, and public perceptions of healthier vs unhealthy foods. This focus contributes to confusion, distracts from more effective strategies, and promotes marketing and consumption of processed products that nominally meet selected nutrient cut points but undermine overall dietary quality. The relatively recent focuson nutrients parallels an increasing discrepancy between theory and practice: the greater the focus on nutrients, the less healthful foods have become. As national and international organizations update dietary guidelines, nutrient targets should largely be replaced by food-based targets. Such change would facilitate translation to the public, correspond with scientific advances in chronic disease prevention, mitigate industry manipulation, and remedy widespread misperceptions about what constitutes healthful diets.
Although this approach may seem radical, it actually represents a return to more traditional, time-tested ways of eating. Healthier food-based dietary patterns have existed for generations among some populations. Modern nutritional science now provides substantial evidence for how foods and food-based patterns affect health, guiding the design of more effective approaches for the prevention of chronic disease.
AUTHOR INFORMATION
|
Corresponding Author: Dariush Mozaffarian, MD, DrPH, 665 Huntington Ave, Bldg 2-319, Boston, MA 02115 (dmozaffa@hsph.harvard.edu).Financial Disclosures: Dr Mozaffarian reports receiving honoraria or travel reimbursement from the US Food and Drug Administration, World Health Organization, Food and Agricultural Organization of the United Nations, International Life Sciences Institute, Aramark, Unilever, SPRIM, and Nutrition Impact for speaking at scientific conferences and consulting on dietary topics; royalties from UpToDate; grants from GlaxoSmithKline, Sigma Tau, Pronova, and the National Institutes of Health for an investigator-initiated trial of fish oil; and grants from the National Institutes of Health for diet-related research and mentoring. Dr Ludwig reports receiving royalties from a book about childhood obesity and grants from foundations and the National Institutes of Health for obesity-related research, mentoring, and patient care.
Funding/Support: Dr Ludwig is supported in part by career award K24DK082730 from the National Institute of Diabetes and Digestive and Kidney Diseases.
Role of the Sponsors: The funding sources had no role in the preparation, review, or approval of the manuscript.
Disclaimer: The content of this Commentary is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Additional Contributions: We thank Walter Willett, MD, DrPH, Department of Nutrition, Harvard School Public Health, and Marion Nestle, PhD, MPH, Department of Nutrition, Food Studies, and Public Health, New York University, for their critical reading of an earlier version of the manuscript. Neither received compensation for their contributions.
Author Affiliations: Division of Cardiovascular Medicine and Channing Laboratory, Brigham and Women's Hospital and Harvard Medical School (Drs Mozaffarian and Ludwig), Departments of Epidemiology (Dr Mozaffarian) and Nutrition (Drs Mozaffarian and Ludwig), Harvard School of Public Health, and Optimal Weight for Life Program, Children's Hospital (Dr Ludwig), Boston, Massachusetts.
REFERENCES
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1. Harper AE. Evolution of recommended dietary allowances—new directions? Annu Rev Nutr. 1987;7:509-537. WEB OF SCIENCE | PUBMED
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Monday, September 13, 2010
Nonprofit Groups: Tons of Foods Recalled and Thousands Sickened as Senate Stalls on Food Safety
Center for Science in the Public Interest:
"As the nation reels from the impact of a massive egg recall that has sickened well over 1,500 people, survivors of foodborne illness and consumer advocates say that antiquated laws and poor enforcement are to blame.
According to a new report, the massive egg recall is only the latest—but largest—of 85 recalls that companies made while food safety reform legislation has been pending in the Senate, and since similar legislation passed the House in July of 2009. All told, at least 1,850 people have been sickened from foods subject to a recall, according to a report issued today by three consumer groups. And since foodborne illness is dramatically under reported, the actual toll of illness is almost certainly in the tens of thousands."
"As the nation reels from the impact of a massive egg recall that has sickened well over 1,500 people, survivors of foodborne illness and consumer advocates say that antiquated laws and poor enforcement are to blame.
According to a new report, the massive egg recall is only the latest—but largest—of 85 recalls that companies made while food safety reform legislation has been pending in the Senate, and since similar legislation passed the House in July of 2009. All told, at least 1,850 people have been sickened from foods subject to a recall, according to a report issued today by three consumer groups. And since foodborne illness is dramatically under reported, the actual toll of illness is almost certainly in the tens of thousands."
Friday, September 10, 2010
How Does Obesity in Adults Affect Spending on Health Care?
How Does Obesity in Adults Affect Spending on Health Care?
September 8, 2010, Economic and Budget Issue Brief
"Over the past two decades, the adult population in the United States has, on average, become much heavier. From 1987 to 2007, the fraction of adults who were overweight or obese increased from 44 percent to 63 percent; almost two-thirds of the adult population now falls into one of those categories. The share of obese adults rose particularly rapidly, more than doubling from 13 percent to 28 percent. That sharp increase in the fraction of adults who are overweight or obese poses an important public health challenge. Those adults are more likely to develop serious illnesses, including coronary heart disease, diabetes, and hypertension. As a result, that trend also affects spending on health care.
This Congressional Budget Office (CBO) issue brief examines changes over time in the distribution of adults among four categories of body weight: underweight, normal, overweight, and obese."
URL: http://cbo.gov/ftpdocs/118xx/doc11810/09-08-Obesity_brief.pdf
September 8, 2010, Economic and Budget Issue Brief
"Over the past two decades, the adult population in the United States has, on average, become much heavier. From 1987 to 2007, the fraction of adults who were overweight or obese increased from 44 percent to 63 percent; almost two-thirds of the adult population now falls into one of those categories. The share of obese adults rose particularly rapidly, more than doubling from 13 percent to 28 percent. That sharp increase in the fraction of adults who are overweight or obese poses an important public health challenge. Those adults are more likely to develop serious illnesses, including coronary heart disease, diabetes, and hypertension. As a result, that trend also affects spending on health care.
This Congressional Budget Office (CBO) issue brief examines changes over time in the distribution of adults among four categories of body weight: underweight, normal, overweight, and obese."
URL: http://cbo.gov/ftpdocs/118xx/doc11810/09-08-Obesity_brief.pdf
Wednesday, September 8, 2010
Do School Lunches Plump Up Poor Kids?
September 1, 2010
A program to ensure all American children get at least one good meal a day may lie behind their expanding waistlines. Oddly, a breakfast program does not.
By Emily Badger
URL: http://www.miller-mccune.com/health/do-school-lunches-plump-up-poor-kids-21822/?utm_source=Newsletter125&utm_medium=email&utm_content=0907&utm_campaign=newsletters
Students who participate in the National School Lunch Program are more likely to come from lower-income families or families with two working parents who don’t have time to pack a brown-bag lunch the night before. Those same students, as a quick glance around many school cafeterias this fall will show, are also more likely to be overweight.
The challenge for researchers and policymakers has been to sort out the relationship between the two.
“When you just look at those groups [who participate in school lunch], those are groups also more likely to not be the healthiest kids,” said Daniel Millimet, an economist at Southern Methodist University. “Then there’s a question of whether or not there’s actually something causal going on, or does the perception just reflect people who are self-selecting into the program?”
In other words: Does the National School Lunch Program make children obese, or are obese children simply more likely to sign up for the program in the first place?
This riddle is deeply relevant for policymakers trying to mine a solution to the country’s obesity epidemic – an epidemic that may even have national security implications — in the school cafeteria.
Millimet, alongside Georgia State economist Rusty Tchernis and Muna Husain of Kuwait University, now believe school lunches are partly to blame.
“When we try to isolate causal effect,” Millimet said, “it’s surprising that there’s still something there.”
In their paper “School Nutrition Programs and the Incidence of Childhood Obesity,” published in the Journal of Human Resources, the authors rely on data on 13,500 students taken from the Early Childhood Longitudinal Study, which tracked children who entered kindergarten in the fall of 1998 through the eighth grade. The survey includes annual data on height and weight, which the researchers used to calculate body mass indexes (they define obesity as above the 95th percentile in BMI).
The original survey also asked parents for data on the birth weight of their children, allowing the researchers to assess weight gains from birth through kindergarten, isolating the health status of children before they entered the school lunch program. The researchers also accounted for the likely meals children received from their parents at home.
Controlling for those two factors, they found that children who participate in the school lunch program are more likely to become obese than those who don’t. In a surprising twist, though, the federally subsidized School Breakfast Program has the opposite effect. (And children who eat both school breakfast and lunch are less heavy than those who participate in neither program.)
Millimet has a few theories to explain this. Breakfast is, as nutritionists say, the most important meal of the day. “In general, even if breakfast weren’t in compliance with federal nutrition guidelines, even if they were close,” Millimet said, “I think a lot of nutritionists would argue that’s still a good thing.”
He also points to one difference between school breakfast and lunch – the latter has more a la carte options, which are not subject to the USDA nutrition guidelines because they are not reimbursable by the federal government.
The a la carte tray comes with a unique set of economics. Schools are reimbursed a set amount for each meal on the cafeteria line they sell.
“But then if on your way out, you pick up an extra ice cream sandwich, paying that out of pocket, the government doesn’t know about it, schools don’t get reimbursed,” Millimet said, “and whatever profit the schools earn on that is revenue they can spend on whatever they want.” Like teacher salaries or classroom supplies.
Schools may be conflicted in wanting — and needing — to offer the items kids will buy. And most kids, untethered from the benevolent influence of the grownup who dishes out the lunch tray, will go for the a la carte ice cream sandwich over the plate of broccoli. The answer may not be so simple as removing the a la carte tray.
“We need to think about how to make school lunches more healthy as well as profitable to schools,” Millimet said. “Health is important, but it’s only one issue that schools are dealing with. Before we go overboard one way or another, we have to think through the full ramifications.”
A program to ensure all American children get at least one good meal a day may lie behind their expanding waistlines. Oddly, a breakfast program does not.
By Emily Badger
URL: http://www.miller-mccune.com/health/do-school-lunches-plump-up-poor-kids-21822/?utm_source=Newsletter125&utm_medium=email&utm_content=0907&utm_campaign=newsletters
Students who participate in the National School Lunch Program are more likely to come from lower-income families or families with two working parents who don’t have time to pack a brown-bag lunch the night before. Those same students, as a quick glance around many school cafeterias this fall will show, are also more likely to be overweight.
The challenge for researchers and policymakers has been to sort out the relationship between the two.
“When you just look at those groups [who participate in school lunch], those are groups also more likely to not be the healthiest kids,” said Daniel Millimet, an economist at Southern Methodist University. “Then there’s a question of whether or not there’s actually something causal going on, or does the perception just reflect people who are self-selecting into the program?”
In other words: Does the National School Lunch Program make children obese, or are obese children simply more likely to sign up for the program in the first place?
This riddle is deeply relevant for policymakers trying to mine a solution to the country’s obesity epidemic – an epidemic that may even have national security implications — in the school cafeteria.
Millimet, alongside Georgia State economist Rusty Tchernis and Muna Husain of Kuwait University, now believe school lunches are partly to blame.
“When we try to isolate causal effect,” Millimet said, “it’s surprising that there’s still something there.”
In their paper “School Nutrition Programs and the Incidence of Childhood Obesity,” published in the Journal of Human Resources, the authors rely on data on 13,500 students taken from the Early Childhood Longitudinal Study, which tracked children who entered kindergarten in the fall of 1998 through the eighth grade. The survey includes annual data on height and weight, which the researchers used to calculate body mass indexes (they define obesity as above the 95th percentile in BMI).
The original survey also asked parents for data on the birth weight of their children, allowing the researchers to assess weight gains from birth through kindergarten, isolating the health status of children before they entered the school lunch program. The researchers also accounted for the likely meals children received from their parents at home.
Controlling for those two factors, they found that children who participate in the school lunch program are more likely to become obese than those who don’t. In a surprising twist, though, the federally subsidized School Breakfast Program has the opposite effect. (And children who eat both school breakfast and lunch are less heavy than those who participate in neither program.)
Millimet has a few theories to explain this. Breakfast is, as nutritionists say, the most important meal of the day. “In general, even if breakfast weren’t in compliance with federal nutrition guidelines, even if they were close,” Millimet said, “I think a lot of nutritionists would argue that’s still a good thing.”
He also points to one difference between school breakfast and lunch – the latter has more a la carte options, which are not subject to the USDA nutrition guidelines because they are not reimbursable by the federal government.
The a la carte tray comes with a unique set of economics. Schools are reimbursed a set amount for each meal on the cafeteria line they sell.
“But then if on your way out, you pick up an extra ice cream sandwich, paying that out of pocket, the government doesn’t know about it, schools don’t get reimbursed,” Millimet said, “and whatever profit the schools earn on that is revenue they can spend on whatever they want.” Like teacher salaries or classroom supplies.
Schools may be conflicted in wanting — and needing — to offer the items kids will buy. And most kids, untethered from the benevolent influence of the grownup who dishes out the lunch tray, will go for the a la carte ice cream sandwich over the plate of broccoli. The answer may not be so simple as removing the a la carte tray.
“We need to think about how to make school lunches more healthy as well as profitable to schools,” Millimet said. “Health is important, but it’s only one issue that schools are dealing with. Before we go overboard one way or another, we have to think through the full ramifications.”
Tuesday, September 7, 2010
Presidential Proclamation--National Childhood Obesity Awareness Month
"One of the greatest responsibilities we have as a Nation is to safeguard the health and well-being of our children.
We now face a national childhood obesity crisis, with nearly one in every three of America's children being overweight or obese.
There are concrete steps we can take right away as concerned parents, caregivers, educators, loved ones, and a Nation to ensure that our children are able to live full and active lives.
During National Childhood Obesity Awareness Month, I urge all Americans to take action to meet our national goal of solving the problem of childhood obesity within a generation.
Childhood obesity has been a growing problem for decades. While it has afflicted children across our country, certain Americans have been disproportionately affected. Particular racial and ethnic groups are more severely impacted, as are certain regions of the country.
In addition, obesity can be influenced by a number of environmental and behavioral factors, including unhealthy eating patterns and too little physical activity at home and at school."
We now face a national childhood obesity crisis, with nearly one in every three of America's children being overweight or obese.
There are concrete steps we can take right away as concerned parents, caregivers, educators, loved ones, and a Nation to ensure that our children are able to live full and active lives.
During National Childhood Obesity Awareness Month, I urge all Americans to take action to meet our national goal of solving the problem of childhood obesity within a generation.
Childhood obesity has been a growing problem for decades. While it has afflicted children across our country, certain Americans have been disproportionately affected. Particular racial and ethnic groups are more severely impacted, as are certain regions of the country.
In addition, obesity can be influenced by a number of environmental and behavioral factors, including unhealthy eating patterns and too little physical activity at home and at school."
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