'Weight of the Nation' documentary explores costs of obesity

Nanci Hellmich, USA TODAY, April 29, 2012

John Hoffman isn't a doctor. He doesn't even play one on TV.But come May 14, he'll unveil a diagnosis, of sorts, for dealing with obesity as executive producer of The Weight of the Nation, a new four-part HBO documentary.

The production, done in conjunction with the Institute of Medicine, which provides independent advice on health, features dozens of top experts exploring the causes and solutions for obesity in the USA. 

"The aim is to sound a very loud alarm — to say, we have enough evidence about the terrible toll obesity is exacting on individuals, our communities and our society," Hoffman says. "The consequences of not acting, boldly, systemically and decisively, are dire."

HBO Documentary Films: The Weight of the Nation

Excess weight is linked to an increased risk of heart disease, type 2 diabetes, cancer and a host of other illnesses. The Weight of the Nation premieres with two back-to-back one-hour shows May 14 and two more May 15, beginning at 8 p.m. ET/PT each night. It has a companion book by the same name. 

The documentary, which also involved the Centers for Disease Control and Prevention and the National Institutes of Health, is being released in conjunction with a two-day CDC meeting, also called Weight of the Nation, May 7-8 in Washington, D.C. Hoffman offers his thoughts on the series and its message in this conversation:

Q: What is it going to take to reverse the obesity epidemic?

A: The obesity epidemic is not a natural disaster that we can't do anything about. This national crisis is completely preventable.

We live in a world where there's an abundance of cheap calories, and we have foods high in sugar and fat at arm's reach at almost all times.

Big decisions made by the food industry, agriculture and government have a huge impact on the little decisions we make about what we reach for when we're hungry and how long we sit at our desks and in our cars.

Q: What was the most surprising thing you learned?

A: Over the course of human evolution, there has never been any reason to limit our food intake. In fact, it's the opposite. Because we need food to survive, we are genetically programmed to love it. There may be as many as 100 genes that favor food-seeking behavior. And we evolved a system to favor fat deposition as a buffer against times of scarcity. … But in a world full of burger joints, pizza parlors and vending machines, our biological imperative to store fat whenever we can may instead pose a threat to our survival.

Q: If you could wave a magic wand and make a change, what would it be?

A: Remove all sugared beverages from our diet. Our bodies are not adapted for that rush of liquid calories. It's clear they're driving a lot of obesity and a contributor to diabetes.

Q: What else did you learn?

A: Even after 10 years of maintaining a significant weight loss, the body doesn't readjust. Your brain still thinks you're in a state of deprivation, and it manipulates your body in ways you don't even notice: You're hungrier, less easily satisfied, and more frequently tempted by sweet and fatty foods; you are less inclined to exercise.

Losing weight and keeping it off requires a renovation of your entire life for the remainder of your life.

Q: What actions/policies would help the most?

A: We need to work together to make some big changes to the systems that govern the food we grow; the economies that drive the food we manufacture; the policies that regulate what we market and serve, particularly to kids; the values we place on the overall quality of the schools to which we send our children; the design of our communities, parks and roads so they promote health; and the perspective of our health care system so that it's focused on preventing illness from happening, rather than just treating it once it develops.

USDA Regional Food Hub Guide: An Innovative Tool for Growing Local Food Systems

 USDA,  April 2012

"Last week, at the National Good Food Network (NGFN) Food Hub Collaboration Spring 2012 Conference in Chicago (sponsored by USDA and the Wallace Center at Winrock International), USDA released our new Regional Food Hub Resource Guide, a collection of information, resources and background on everything needed to develop or participate in a regional food hub.

The guide presents a series of key questions about the current state of food hub development and examples from operating food hubs. It also outlines the role that food hubs can play in regional food systems; their innovative business models; and their economic contributions to local communities. It describes funding opportunities and other resources, best practices, and additional strategies for anyone interested in developing regional food hubs."

Time to Revisit Food Deserts

David Bornstein, The New York Times, April 25, 2012

In last week’s Fixes column I reported on a variety of initiatives that New York and other cities are engaged in to increase the availability of healthy food for sale, particularly fresh produce, in low-income neighborhoods that are believed to have insufficient access. The efforts include bringing in green carts and green markets to serve these areas, as well as offering financial, zoning and other incentives to attract new supermarkets and improve the quality and quantity of fresh food offerings in bodegas and corner stores. The work is explicitly designed to address what the government and many health experts have dubbed the problem of “food deserts.” It has catalyzed new retail food vendors in low-income areas, many of which have become successful businesses.

As The Times also reported last week, however, some new studies have questioned whether food deserts are as pervasive a problem as the government and other researchers have long believed they are. The studies also challenge whether efforts to increase access to supermarkets in low-income areas will achieve the ultimate goal of these policies: reducing obesity and other diet-related diseases among the people who live there. When I wrote my column last week, I had not seen this new research. Since then, I read the studies, as well as a number of others, and spoke to more food experts. I’m still convinced that convenient access to fresh food remains a significant barrier for many low-income people around the country, but I have been persuaded that the standard way “food deserts” have been defined [1] may overemphasize — and in some cases mischaracterize — the problem of access and draw attention from other factors that influence what people buy and eat, like food prices, preparation time and knowledge, marketing, general levels of education, transportation, cultural practices and taste.

One of the advantages of a term like “food desert” is that it is simple and memorable. As such, the issue caught the attention of policy makers, funders and academics in a way that it would not have had it been defined as “inequitable access.” It has also tilted the debate heavily toward the question of how to stimulate new fresh food sources. But the big questions remain: Is access to healthy food a primary barrier to healthy eating? And, if so, will increasing it lead to better health outcomes?

The conventional answers have been yes to both questions. A literature review (pdf) conducted by two nonprofits, PolicyLink and The Food Trust (which focuses on food access) reviewed 132 studies and reported that a “large and consistent body of evidence” supported the contention that many residents of low-income, minority and rural communities lack sufficient opportunities to buy healthy and affordable food. However, one recent study, which looked at more detailed food industry categorizations than those of past studies, did not support this, at least not at the national level (it did not examine local-level variations). It found that low-income areas had more of all types of retail food vendors than higher income areas.

This study drew on a national survey that tracked children from kindergarten to fifth grade. One of its limitations was that, like many such surveys, the children who were unable to be tracked for the duration of the survey (about 60 percent) were more likely to be minorities and from urban areas, though the researcher used statistical methods to control for missing data. “I’m not saying food deserts don’t exist,” explained Helen Lee, a policy fellow at the Public Policy Institute of California, who conducted the study. “But I’m saying that if you compare wealthier neighborhoods to poor neighborhoods, you don’t see a systematic pattern in differences in availability.”

Much of the research on food access draws on business data sets, which include things like types of businesses, locations and sizes, but not information about, say, the quality or variety of food in a store. A number of social service workers I spoke with brought up this point. Joel S. Berg, the executive director of the New York City Coalition Against Hunger, said that the new studies reminded him of the quote from Chico Marx: Who are you going to believe, me or your own eyes?

“I spend a great deal of time in low-income neighborhoods,” Berg said. “And even where food stores exist on paper, their selection and quality is so low that I think most people would consider the areas food deserts.” (One of the advantages of green carts and farmers’ markets is thought to be the attractiveness and freshness of the produce.)

If access is a major problem, successful efforts to increase it should lead to better eating and better health. But it’s hard to find strong connections between food access (as determined by proximity and number of grocers) and health. If we’re talking about teenagers, some studies have found that greater access to supermarkets is associated with lower Body Mass Index (B.M.I.) and also that easier access to convenience stories is associated with a higher B.M.I. (Teenagers can walk to stores and buy their own snacks; schoolchildren can’t.) However, a longitudinal study published last year looking at young and middle-aged adults, found that while fast food consumption was associated with fast food availability for low-income people, consumption of fruits and vegetable and diet quality were not related to the availability of grocery stores.

There are a number of plausible explanations for this, and efforts to address obesity need to consider them. Parke E. Wilde, an associate professor at the Friedman School of Nutrition Science and Policy at Tufts University (who writes a blog on U.S. food policy) notes that the majority of Americans — including low-income Americans — do their grocery shopping by car, even if they don’t own one. This is a crucial detail that I failed to account for in my previous column. The U.S.D.A.’s 2009 study on food deserts reports that 5.5 percent of the nation’s households (about 5.8 million) live at least half a mile from a supermarket and are without access to a vehicle (pdf, p.19). Of those households, 2.5 million are within low-income areas. This is the group that seems most hard hit. The report also notes that 93 percent of people in low-income, low-access areas do their shopping with a vehicle, but the figure remains at 65 percent even when grocery stores are within walking distance. No doubt, price is a significant factor in the decision to drive to a big box store.

The question of access should take these patterns into account. It’s worth studying those who lack vehicle access and grocery stores within walking distance. Another question is whether people who need to do their shopping by car, especially if they don’t own a car, shop less frequently and, therefore, stock up on non-perishable foods. That was the situation I reported on in my previous column in Highland Falls, N.Y. (Perishable doesn’t always equate with healthier. Dr. Lee explained that frozen peas are healthier than fresh peas and they’re cheap and easy to find.) It’s also worth looking more closely at the shopping patterns of people who frequent inner city supermarkets that take pains to meet community needs like Jeffrey Brown’s ShopRite stores — stores that receive subsidies because of the increased start-up costs of serving low-income areas.

Second, the dominant constraint in the lives of low-income people is lack of money. From 1985 to 2000, the prices of fresh fruits and vegetables rose 40 percent while prices of fats and soft drinks decreased by about 15 and 25 percent, respectively, noted Arielle E. Traub, a Senior Systems Analyst at the New York City Health and Hospitals Corporation in a report she wrote for the Johns Hopkins Bloomberg School of Public Health. Researchers have found that energy-dense foods (those that contain the most calories per gram, which is to say sweets and starchy foods) — are far less expensive than low-energy and nutritious foods like fruits and vegetables. In fact, measured on a per-calorie basis, they are one tenth the price.

Third, as Abhijit V. Banerjee and Esther Duflo observe in their excellent book, “Poor Economics,” poor people “choose their foods not mainly for their cheap prices and nutritional values, but for how good they taste.” Being poor or near poor in the United States means being exposed to a million luxuries that are beyond your reach. Even simple things most Americans take for granted — like taking the kids to a movie — are unaffordable. But a tasty meal is not. Junk foods that combine fat, salt and sugar in proportions that make them highly desirable, maybe even addictive — foods that hit the so-called “bliss point” — are never too expensive or far from reach.

To make their point, Banerjee and Duflo quote George Orwell’s description of the life of poor British workers in his book “The Road to Wigan Pier”: “A millionaire may enjoy breakfasting off orange juice and Ryvita biscuits; an unemployed man does not… When you are unemployed you don’t want to eat dull wholesome food. You want to eat something a little tasty. There is always some cheap pleasant thing to tempt you.” In this context, it may indeed help to have more green carts on the sidewalks, where pedestrians can more easily make impulse purchases of oranges or strawberries instead of doughnuts or chips (to satisfy cravings for tasty treats).

Finally, just as the problem of obesity is connected to poverty; it is connected to education. One of the most consistent predictors of health, including reduced obesity, is higher maternal education. This has been found across cultures. There are many excellent educational initiatives that aim to teach young people about healthy eating — like the Healthy Schools Program and Cooking Matters. But if raising the level of education of mothers is one of the most reliable ways of improving family health, it may make sense to think of general educational efforts — like City Year’s In School & On Track, which reduces high school dropout rates, or College Summit’s college access programs for low-income youth — as effective health promotion, too.

As with so many problems, education seems to be the most reliable long-term answer. But nothing in the field of nutrition is straightforward. As soon as I had that thought, I came across yet another study, which looked at preschool children from 20 large American cities. Here, researchers found that obesity rates were considerably higher among Hispanics than blacks or whites — but that the disparities could not be attributed to differences in maternal education or household income. If they are related to cultural or genetic factors, what are the implications?

In May, the Institute of Medicine will release a report entitled “Accelerating Progress on Obesity Prevention.” I look forward to reading it and will continue to report on this issue. If you are aware of any pertinent research that sheds light on these matters, please write in.

FOOTNOTE

[1] The term “food desert” is often applied indiscriminately, but the government does have a standard definition: a census tract that contains concentrations of low-income people in which at least a third of the population lives more than a mile from a supermarket or large grocery store. (For rural areas, the distance is 10 miles.)

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Political Hot Potatoes

Jurek Martin, the Financial Times, April 21, 2012

There has never been a vegetable presidential election in American history, though some presidents may have acted like spinach. Bush the Elder once famously declared, “[now] I’m President of the United States … I’m not going to eat any more broccoli,” (or cauliflower, cabbage or Brussels sprouts, all of which he detested) but he left that comment until he was safely in the Oval Office and the broccoli lobby, famously powerful, could do nothing about it.

This year might prove the exception to the rule, not to the extent that veggies are up there with unemployment, foreign wars and the price of petrol as pivotal issues, but they are at least visible in the form of Michelle Obama’s campaign to persuade Americans to eat healthier, exercise more and thereby become less fat, which they undoubtedly are.

Even the US Supreme Court, lords of the law, now seems to have a vegetable complex. Last month, during oral arguments over the constitutionality of healthcare reform, Justice Antonin Scalia, the rock-ribbed conservative, wondered aloud why the government should not compel the people to eat broccoli if it also required them to buy health insurance. The judicial answer will be forthcoming in a couple of months.

Objectively, it is hard to argue with the First Lady and her “Let’s Move” campaign. Childhood obesity rates have tripled in the past 30 years, with nearly one in three kids seriously overweight, carrying that extra poundage into adulthood with the diabetic and cardiac problems that inevitably ensue, adding an estimated $147bn a year to the national health bill. 

Obesity is now one of the most common disqualifiers for military service.

And the government does have skin in the food game, as it were. 

It subsidises school lunches to the tune of $11bn a year and has to fight influential lobbies every step of the way to change what is on the daily menu. Last year, Congress blocked proposals to reduce the starchy content of school meals, placed no restrictions on servings of potatoes and insisted that tomato paste, even when thinly spread across a pizza base, remain classified as a vegetable. Government guidelines earlier this year to double the amount of fruit and vegetables served, to stipulate that all milk served be low fat and that more of the grains used be whole grains, will doubtless be challenged. The National Potato Council has already sniffed that spuds are considered “a second-class vegetable”.

Of course, politics is not an exercise in objectivity. To the legions on the right, Mrs Obama’s campaign is just another thin end of the wedge whereby the dreaded government is going to control every aspect of citizen life in a nanny state liberal utopia. As Mark Levin, a notorious rightwing radio ranter puts it, “You can’t sit down and have a meal without calorie counts being thrown in your face.” Rush Limbaugh, the king of conservative polemicists, rarely lets a day go by without uttering something similar along the lines that socialism and America are incompatible. To Sarah Palin, who likes to “field dress” (or disembowel on the spot) dead moose, Mrs Obama “is telling us she cannot trust parents to make decisions for their own children, for their own families, in what we should eat”. (That comment persuaded Jamie Oliver to call the former governor of Alaska a “froot loop”, but then he has his own campaign to improve school meals.)

Believe it or not, these are quite mild expressions of discontent. The outer reaches of the blogosphere are alive with reports of “Michelle Obama’s food police” handcuffing kindergarteners in the Carolinas for bringing to school insufficiently nutritious homemade lunches or of her pictured stuffing her face with hamburgers (which, taken with Dijon mustard, happen to be among her husband’s favourite meals) or serving deep-pan pizza with crisps at the White House Super Bowl party. When she visited a military base in Arkansas earlier this year to promote healthy eating among soldiers (“Don’t worry, you’ll be a vegetable guy soon,” she told one GI) she was assailed for undermining national security. 

Persuading Walmart, the retailing giant, to support her efforts was tantamount to putting dynamite under the private sector.

Her organic vegetable patch in the White House gardens is the subject of constant derision, though she is hardly the first First Lady to embark on such a project. In 1943, Eleanor Roosevelt dug one in the same place as a symbol of her wartime Victory Garden campaign, interestingly over the objections of the US Department of Agriculture which thought farmers might be adversely affected. For once, the bureaucrats were right; by the end of the war, some 20m home gardens supplied 40 per cent of the produce consumed in the country, but this was fine because the farmers were off in uniform fighting somewhere. And if Rosie the Riveter could keep America’s factories at full tilt in wartime, then Gertie the Gardener was doing her bit, too.

First Ladies are permitted to have their causes. Nobody objected when Betty Ford waged her war on addiction to prescription drugs or Laura Bush went around promoting literacy, or even when Jackie Kennedy patronised European haute couture, which led, after all, to an American fashion renaissance. But in a country as politically and socially polarised as America is today, Michelle Obama finds it harder than they did to get away with promoting healthy eating.

It so happens the Obamas do like to eat well, as affluent yuppies of their generation typically do, and have catholic tastes. In Washington they go out quite a lot to the better restaurants, as they did when they lived in Chicago, sometimes on date nights or with their daughters or friends, and, yes, sometimes with campaign donors, mostly specially chosen modest ones, not the fat cats. But the president was not above taking out his Russian counterpart, Dmitry Medvedev, to Ray’s Hell Burger, an excellent suburban spot serving the American national dish, or smooching at Ben’s Chili Bowl, a local institution renowned for the toppings on its hot dogs.

Presidential eating habits over the years have covered the full gamut. Thomas Jefferson was, naturally, a gourmet (he had lived in Paris) as was Chester Arthur, the first to recruit a real French chef to the White House, while William Howard Taft, the fattest president, was a true gourmand. John Kennedy, for all his style, was more of a clam chowder and sandwich man. 

Bill Clinton notoriously shovelled everything down, but now, after heart problems, says he is a near vegan. Bush the Elder fancied the Peking Gourmet Inn, a suburban Chinese place, for eating out but his son, though fond of Tex-Mex cooking, rarely ventured out, preferring to be tucked up by 9pm (he did once nearly choke on a pretzel though). Jimmy Carter’s peanuts and Ronald Reagan’s jelly beans added to the snack mix. Washington has only become a serious food town in the past 30 years, so most presidents, if they went out, were more likely to eat in private homes.

Campaigning to be president, also known as the rubber chicken circuit, is enough to turn anybody off food. It also has pitfalls for the unwary. In 1976, Gerald Ford memorably encountered his first tamale and ate the husk. The Iowa state fair, a mandatory pit stop for all politicians, features fried ice cream and innumerable things on a stick and coated in butter (there is even a life-sized cow carved in butter). Mitt Romney apparently gets by on a diet of chocolate milk, turkey breast, rice and, yes, broccoli, but he is a bland sort of chap anyway. 

Ron Paul’s addiction, according to his wife’s cook book, is to cheese soup made with Velveeta (a processed cheddar), plus Thousand Island dressing on everything, which does not sound very libertarian. Michele Bachmann chews celery constantly, which explains her thinness, though not her red meat politics.

It used not to be that bad, for candidates and the travelling press corps alike. We of the dirty raincoat brigade were not above planning our travels around restaurants as much as rallies (the old Benson Hotel in Portland for Pacific salmon, regardless of whether the Oregon primary was important; Joe’s Stone Crab restaurant in Miami Beach, for example, where “Tip” O’Neill, the legendary speaker of the House, liked to hang out). If our source for political intelligence was Willie Brown, the Nostradamus of California, we would take him out to whatever restaurant he fancied in San Francisco, where he had been mayor when not running the state legislature – and his taste was fancy. In the Deep South, there were certain unmissable barbecue joints, in Michigan in-season cherry pies. Party conventions in New Orleans were particularly popular with the press, for all the obvious reasons, those in Detroit less so.

But it is different now in the age of the cellphone and the insatiable demands of filing copy for the web around the clock. In a Facebook posting earlier this year, one reporter lamented that her typical campaign meal was a Subway sandwich eaten on her lap in her rental car. She wept when I told her how it sometimes used to be. 

Still, if President Obama is re-elected, much more will, and should be, heard about eating right, even if it is broccoli. If Mitt Romney wins, then chocolate milk rules. America faces an existential choice.

Jurek Martin is an FT commentator based in Washington

Studies Question the Pairing of Food Deserts and Obesity

Gina Kolata, The New York Times, April 18, 2012

It has become an article of faith among some policy makers and advocates, including Michelle Obama, that poor urban neighborhoods are food deserts, bereft of fresh fruits and vegetables.

But two new studies have found something unexpected. Such neighborhoods not only have more fast food restaurants and convenience stores than more affluent ones, but more grocery stores, supermarkets and full-service restaurants, too. And there is no relationship between the type of food being sold in a neighborhood and obesity among its children and adolescents. 

Within a couple of miles of almost any urban neighborhood, “you can get basically any type of food,” said Roland Sturm of the RAND Corporation, lead author of one of the studies. “Maybe we should call it a food swamp rather than a desert,” he said. 

Some experts say these new findings raise questions about the effectiveness of efforts to combat the obesity epidemic simply by improving access to healthy foods. Despite campaigns to get Americans to exercise more and eat healthier foods, obesity rates have not budged over the past decade, according to recently released federal data. 

“It is always easy to advocate for more grocery stores,” said Kelly D. Brownell, director of Yale University’s Rudd Center for Food Policy and Obesity, who was not involved in the studies. “But if you are looking for what you hope will change obesity, healthy food access is probably just wishful thinking.” 

Advocates have long called for more supermarkets in poor neighborhoods and questioned the quality of the food that is available. And Mrs. Obama has made elimination of food deserts an element of her broader campaign against childhood obesity, Let’s Move, winning praise from Democrats and even some Republicans, and denunciations from conservative commentators and bloggers who have cited it as yet another example of the nanny state. 

Speaking in October on the South Side of Chicago, she said that in too many neighborhoods “if people want to buy a head of lettuce or salad or some fruit for their kid’s lunch, they have to take two or three buses, maybe pay for a taxicab, in order to do it.” 

Mrs. Obama has also advocated getting schools to serve healthier lunches and communities to build more playgrounds. 

Her office referred questions about the food deserts issue to the Department of Agriculture. A spokesman there, Justin DeJong, said by e-mail that fighting obesity requires “a comprehensive response.” The federal effort, he added, includes not just improving access to healthy foods but also improving food in schools, increasing physical education time, and educating people on the importance of healthy diets. 

Some researchers and advocates say that further investigation is still needed on whether grocery stores and chain supermarkets in poor neighborhoods are selling produce that is too costly and of poor quality. “Not all grocery stores are equal,” said John Weidman, deputy executive director of the Food Trust, an advocacy group in Philadelphia. 

It was difficult to design a study that could rigorously answer the questions: Do poor urban neighborhoods lack places to buy fresh produce and is that contributing to obesity? But Helen Lee of the Public Policy Institute of California, a nonprofit, nonpartisan research organization, found a way. For data on where children lived and went to school and how much they weighed, she used a federal study of 8,000 children. For data on the location of food establishments, she used a data set that compiled all the businesses in the nation and included their sizes and locations. 

“I knew where the children lived, so let’s take the middle of that neighborhood,” Dr. Lee said. “What is the nearest grocery store? What is the nearest convenience store?” 

She used census tracts to define neighborhoods because they tend to have economically homogeneous populations. Poor neighborhoods, Dr. Lee found, had nearly twice as many fast food restaurants and convenience stores as wealthier ones, and they had more than three times as many corner stores per square mile. But they also had nearly twice as many supermarkets and large-scale grocers per square mile. Her study, financed by the institute, was published in the March issue of Social Science and Medicine. 

Dr. Sturm’s study, published in February in The American Journal of Preventive Medicine, had a different design. With financing from the National Institutes of Health, he used data on the self-reported heights, weights, and diets of more than 13,000 California children and teenagers in the California Health Interview Survey. The survey included the students’ addresses and the addresses of their schools. He used a different data set to see what food outlets were nearby. Dr. Sturm found no relationship between what type of food students said they ate, what they weighed, and the type of food within a mile and a half of their homes. 

He has also completed a national study of middle school students, with the same result — no consistent relationship between what the students ate and the type of food nearby. Living close to supermarkets or grocers did not make students thin and living close to fast food outlets did not make them fat. The study will be published soon in Public Health. 

It is unclear how the idea took hold that poor urban neighborhoods were food deserts but it had immediate appeal. There is even an Agriculture Department “food desert locator” and a “National Food Desert Awareness Month” supported by the National Center for Public Research, a charitable foundation.

But, Dr. Lee said, studies lending support to the idea tended to be limited by methodological difficulties. 

For example, some researchers looked at neighborhood food outlets but did not have data on how fat residents were. Others examined small areas, like part of a single city and extrapolated to the entire nation. Others had a different problem. They looked at much bigger areas like ZIP codes, which include people of diverse incomes, making it hard to know what happened in pockets of poverty within those regions. 

Some researchers counted only fast food restaurants and large supermarkets, missing small grocers who sold produce. Some tallied food outlets per 1,000 residents, which made densely populated urban areas appear to have fewer places per person to buy food. A more meaningful measure, Dr. Lee said, is the distance to the nearest stores. 

In one neighborhood in Camden, N.J., where 80 percent of children are eligible for a free school lunch, children bought empanadas, sodas and candy at a grocer, while adults said they had no trouble finding produce. Wedged in among fast food restaurants, convenience stores, sit-down restaurants, take-out Chinese and pizza parlors were three places with abundant produce: Pathmark and Save-A-Lot supermarkets and a produce stand.

The Challenge of Going Vegan

Tara Parker-Pope, the New York Times, April 16, 2012

From Bill Clinton to Ellen DeGeneres, celebrities are singing the benefits of a vegan diet. Books that advocate plant-based eating are best sellers. But is eliminating meat and dairy as simple as it sounds?

As countless aspiring vegans are discovering, the switch from omnivore to herbivore is fraught with physical, social and economic challenges — at least, for those who don’t have a personal chef. The struggle to give up favorite foods like cheese and butter can be made all the harder by harsh words and eye-rolling from unsympathetic friends and family members. 

Substitutes like almond milk and rice milk can shock the taste buds, and vegan specialty and convenience foods can cost two to three times what their meat and dairy equivalents do. And new vegans quickly discover that many foods in grocery stores and on restaurant menus have hidden animal ingredients.

“The dominant social-cultural norm in the West is meat consumption,” said Hanna Schösler, a researcher in the Institute for Environmental Studies at Vrije University in Amsterdam, who has studied consumer acceptance of meat substitutes. “The people who want to shift to a more vegetarian diet find they face physical constraints and mental constraints. It’s not very accepted in our society not to eat meat.”

Still, the numbers are substantial, according to according to a 2008 report in Vegetarian Times. Three percent of American adults, 7.3 million people, follow a vegetarian diet, and one million of them are vegans, who eat no animal products at all — no meat, fish, eggs, milk, cheese, even honey. (And 23 million say they rarely eat meat.)

No one knows how many people have tried and failed to switch to vegan or vegetarian diets, but the popularity of books like “The China Study” and the “Skinny Bitch” series suggests that interest is growing. New vegans often cite Robert Kenner’s 2008 documentary which offers an unsettling view of corporate farming and the toll it takes on animals, the environment and human health.

Megan Salisbury, 33, a social work student in Phoenix, says she prefers plant-based eating but can manage it only about 75 percent of the time. The vegan options at the campus cafeteria are limited and often expensive, and she has to drive 20 miles to find stores with vegan specialty foods for cooking.

“I really enjoy eating the way I do,” she said. “But even a box of Gardenburgers is $4 — which doesn’t seem expensive, but when you compare it to the meat counterparts, it’s so much more.”

Frustrating, too, is the lack of social support. When Ms. Salisbury baked vegan doughnuts to share with her family, “they said things like, ‘I’m going to go eat some eggs now,’ ” she said. “They were very condescending. They don’t understand and don’t make any effort to understand.”

New vegans say it’s hard to give up favorite foods and adjust to the taste of substitutes for butter and dairy products. For Linda Walsh of Wilmington, Vt., who was a vegetarian for 30 years before recently switching to a vegan diet, the toughest thing was giving up cheese. “I have become vegan anyway,” she said. “But I think a great vegan cheese alternative will make for many, many more converts.”

Giving up favorite foods is never easy, food scientists say, for it means overriding taste preferences imprinted on the brain during a lifetime of eating. “In most American adults, meat intake has been associated since childhood with pleasurable nutritional effects,” said France Bellisle, an eating behavior researcher in Paris. “Liking for meats has been learned and reinforced over years. Any substitute would have to mimic the total sensory experience elicited by meats.

“It always takes more motivation to change any type of behavior than to go on with old habits,” she added.

Dairy products are particularly difficult to replace, says Daniel Granato, a researcher at the Federal University of Paraná, Brazil, because the intrinsic attributes of dairy foods come from proteins and fats that are difficult to mimic in a nondairy substitute. And because people start consuming these foods in infancy, the taste preference is deeply ingrained.

“Usually dairy products made with milk fat are softer and present a very pleasant viscosity and texture,” Dr. Granato said. “Consumers do feel the difference between milk-based and soy-based products. And once their first reference is milk-based products, they tend to reject plant-based products made with oat and soy or other vegetable-based food.”

Vegan ingredients and cooking techniques can be overwhelming for beginners, even if the changes are relatively small. Substitutes like vegetarian margarine and nutritional yeast can impart an unaccustomed nutty or cheesy flavor. Another method for making vegan foods creamy or cheesy involves soaking and blending cashews.

“The one I found weird was miso paste,” Ms. Salisbury said. “I used it in stuffed shells, but I haven’t really mastered what it’s for, but I think it’s to help consistency.”

Despite the challenges of plant-based eating in a meat-based world, would-be vegans say they will keep trying. Mary Bandrowski, 50, of Bainbridge Island in Washington, says she has been eating mostly vegetarian for years, but in the past few weeks has been moving to veganism after reading “Eat to Live,” by Dr. Joel Fuhrman. She is also trying to push her family to eat fewer animal foods.

Antibiotics Off the Farm - NYTimes.com

The New York Times, April 15, 2012

Two important events in recent weeks — a regulatory guideline and a federal court decision — have raised hopes that progress can be made in curbing the widespread use of antibiotics to spur growth in cattle, chickens, pigs and other food animals.

The decades-long practice of feeding small doses of antibiotics continuously to entire herds or flocks has a high cost for human health. It has fostered the emergence of germs that are resistant to veterinary drugs and to the very similar drugs used to treat humans.

Last Wednesday, the Food and Drug Administration issued new regulatory guidelines, as part of an effort to get drug companies, animal producers and veterinarians to rein in indiscriminate use of antibiotics that are important for treating humans. There is a lot of reining in to do — about 80 percent of all antibiotics sold in the United States are used in animals, the vast majority to promote rapid weight gain, not to treat sick animals.

Under the F.D.A.’s approach, the drug makers would voluntarily change their labels on medically important drugs to eliminate growth promotion as an approved use in animals — a step that would make it illegal for animal producers to use the drugs for that purpose. The labels would also require that veterinarians supervise use of the drugs to treat or prevent disease. That would end the current unrestricted over-the-counter sales. Some advocacy groups wanted the F.D.A. to work for outright bans on use of medically important drugs to promote growth. But the Pew Campaign on Human Health and Industrial Farming endorsed what it said was a “sweeping” approach to the problem. Federal officials argue it will work because, they say, drug manufacturers have largely bought into the idea.

It will be critically important for the F.D.A. to monitor whether drug companies change their labels and whether use of the drugs on farms declines over the next few years. If those things don’t happen, the agency will need to take stronger action.

Meanwhile, a Federal District Court judge in New York issued an order last month requiring the F.D.A. to ban low-dose use of penicillin and two forms of tetracycline by animal producers to promote growth unless manufacturers can prove in hearings that such usage is safe for humans and is not promoting drug-resistant microbes.

That is the kind of case-by-case approach the agency was hoping to avoid with its new voluntary guidelines. Even so, it would be useful to proceed down both tracks at once to see which is most effective. Unless producers change their practices, more and more drugs won’t be able to protect humans against resistant germs.

Maryland set to become first state to ban arsenic in chicken feed

Darryl Fears,  The Washington Post, April 9, 2012

Maryland is about to become the first state to ban the use of additives containing arsenic in chicken feed, a practice already prohibited by Canada and the European Union.

The state’s House of Delegates and Senate approved the legislation last week and placed it before Gov. Martin O’Malley on Monday. The governor could sign it soon, said Del. Tom Hucker (D-Montgomery), who sponsored the House legislation.

“He congratulated me. He likes the bill. And he’s communicated with his staff about the bill,” Hucker said.

Arsenic occurs naturally in the environment but can also be a toxic carcinogen that contributes to diabetes and heart disease. Last year, the Food and Drug Administration tested 100 chickens by giving them feed that contained the additive roxarsone, an arsenic-based drug used to fight parasites in animals. Half the chickens later showed trace amounts of inorganic arsenic, a known carcinogen, in their livers.

The finding prompted Pfizer to suspend sales of roxarsone, which also makes the meat appear pinker and more plump by promoting growth in chickens’ blood vessels. Perdue Farms stopped using the additive years ago, and McDonald’s does not allow its suppliers to use it.

The United States produced 8.5 billion broiler chickens in 2009, according to the Agriculture Department. Georgia was the nation’s largest producer of broilers, turning out 1.3 billion. Maryland was 10th, with nearly 300 million that year, or about 1.4 billion pounds, generating 40 percent of the state’s farm revenue, according to the DelMarva Poultry Industry trade group.

Growers in Maryland, particularly on the Eastern Shore, continued to use stockpiles of the feed after Pfizer suspended it, feeding about 3 million chickens per year, according to Hucker and one of the bill’s supporters, Food & Water Watch. 

The chickens produced about a billion pounds of waste, often spread as fertilizer. Hucker said unknown levels of arsenic have seeped into the state’s soil since the product was first used in 1946 or have washed into waters that run into the Chesapeake Bay.

“We know arsenic causes cancer, heart disease and diabetes,” Hucker said. “We’ll never know how much is caused by arsenic in chicken, but we do know it’s highly avoidable.” 

“I would think it’s a huge marketing opportunity for Maryland chicken growers to let consumers know only Maryland chickens are guaranteed to be free of arsenic,” said Hucker, who is in discussions with lawmakers in other states who want to pass similar legislation. 

Saying Maryland poultry is arsenic-free “doesn’t amount to a hill of beans,” said Del. Charles J. Otto (R-Somerset), who opposed the legislation. “You don’t know where your chicken comes from.”

Otto argued that arsenic occurs naturally and shows up in extremely low amounts in chickens.

“It’s not an environmental threat or human health threat,” he said. Tying it to disease “is a scare tactic,” Otto said.

But scientists have seen growing evidence that organic arsenic can become toxic. In the FDA test, roxarsone widely used by farmers was fed to the chickens. 

“So we think the danger to public health and the environment was such that Maryland needed to take a major first step in eliminating this poison from our chicken,” said Jorge Aguilar, southern region director for Food & Water Watch.

The Myth of Sustainable Meat

James E. McWilliams, The New York Times, April 12, 2012

THE industrial production of animal products is nasty business. From mad cow, E. coli and salmonella to soil erosion, manure runoff and pink slime, factory farming is the epitome of a broken food system. 

There have been various responses to these horrors, including some recent attempts to improve the industrial system, like the announcement this week that farmers will have to seek prescriptions for sick animals instead of regularly feeding antibiotics to all stock. My personal reaction has been to avoid animal products completely. But most people upset by factory farming have turned instead to meat, dairy and eggs from nonindustrial sources. 

Indeed, the last decade has seen an exciting surge in grass-fed, free-range, cage-free and pastured options. These alternatives typically come from small organic farms, which practice more humane methods of production. They appeal to consumers not only because they reject the industrial model, but because they appear to be more in tune with natural processes. 

For all the strengths of these alternatives, however, they’re ultimately a poor substitute for industrial production. Although these smaller systems appear to be environmentally sustainable, considerable evidence suggests otherwise. 

Grass-grazing cows emit considerably more methane than grain-fed cows. Pastured organic chickens have a 20 percent greater impact on global warming. It requires 2 to 20 acres to raise a cow on grass. If we raised all the cows in the United States on grass (all 100 million of them), cattle would require (using the figure of 10 acres per cow) almost half the country’s land (and this figure excludes space needed for pastured chicken and pigs). A tract of land just larger than France has been carved out of the Brazilian rain forest and turned over to grazing cattle. Nothing about this is sustainable. 

Advocates of small-scale, nonindustrial alternatives say their choice is at least more natural. Again, this is a dubious claim. Many farmers who raise chickens on pasture use industrial breeds that have been bred to do one thing well: fatten quickly in confinement. As a result, they can suffer painful leg injuries after several weeks of living a “natural” life pecking around a large pasture. Free-range pigs are routinely affixed with nose rings to prevent them from rooting, which is one of their most basic instincts. In essence, what we see as natural doesn’t necessarily conform to what is natural from the animals’ perspectives. 

The economics of alternative animal systems are similarly problematic. Subsidies notwithstanding, the unfortunate reality of commodifying animals is that confinement pays. If the production of meat and dairy was somehow decentralized into small free-range operations, common economic sense suggests that it wouldn’t last. These businesses — no matter how virtuous in intention — would gradually seek a larger market share, cutting corners, increasing stocking density and aiming to fatten animals faster than competitors could. Barring the strictest regulations, it wouldn’t take long for production systems to scale back up to where they started. 

All this said, committed advocates of alternative systems make one undeniably important point about the practice called “rotational grazing” or “holistic farming”: the soil absorbs the nutrients from the animals’ manure, allowing grass and other crops to grow without the addition of synthetic fertilizer. As Michael Pollan writes, “It is doubtful you can build a genuinely sustainable agriculture without animals to cycle nutrients.” In other words, raising animals is not only sustainable, but required. 

But rotational grazing works better in theory than in practice. Consider Joel Salatin, the guru of nutrient cycling, who employs chickens to enrich his cows’ grazing lands with nutrients. His plan appears to be impressively eco-correct, until we learn that he feeds his chickens with tens of thousands of pounds a year of imported corn and soy feed. This common practice is an economic necessity. Still, if a farmer isn’t growing his own feed, the nutrients going into the soil have been purloined from another, most likely industrial, farm, thereby undermining the benefits of nutrient cycling. 

Finally, there is no avoiding the fact that the nutrient cycle is interrupted every time a farmer steps in and slaughters a perfectly healthy manure-generating animal, something that is done before animals live a quarter of their natural lives. When consumers break the nutrient cycle to eat animals, nutrients leave the system of rotationally grazed plots of land (though of course this happens with plant-based systems as well). They land in sewer systems and septic tanks (in the form of human waste) and in landfills and rendering plants (in the form of animal carcasses). 

Farmers could avoid this waste by exploiting animals only for their manure, allowing them to live out the entirety of their lives on the farm, all the while doing their own breeding and growing of feed. But they’d better have a trust fund. 

Opponents of industrialized agriculture have been declaring for over a decade that how humans produce animal products is one of the most important environmental questions we face. We need a bolder declaration. After all, it’s not how we produce animal products that ultimately matters. It’s whether we produce them at all. 

James E. McWilliams is the author of “Just Food: Where Locavores Get It Wrong and How We Can Truly Eat Responsibly.”

Is an Egg for Breakfast Worth This? - NYTimes.com

Nicholas D. Kristof, The New York Times, April 11, 2012

 

Supermarket eggs gleam with apparent cleanliness, and nothing might seem more wholesome than breaking one of them into a frying pan.

Think again. The Humane Society of the United States plans to release on Thursday the results of an undercover investigation into Kreider Farms, a major factory farm that produces 4.5 million eggs each day for supermarkets like ShopRite.

I’ve reviewed footage and photos taken by the investigator, who says he worked for Kreider between January and March of this year. In an interview, he portrayed an operation that has little concern for cleanliness or the welfare of hens.

“It’s physically hard to breathe because of the ammonia” rising from manure pits below older barns, said the investigator, who would not allow his name to be used because that would prevent him from taking another undercover job in agriculture. He said that when workers needed to enter an older barn, they would first open doors and rev up exhaust fans, and then rush in to do their chores before the fumes became overwhelming.

Mice sometimes ran down egg conveyer belts, barns were thick with flies and manure in three barns tested positive for salmonella, he said. (Actually, salmonella isn’t as rare as you might think, turning up in 3 percent of egg factory farms tested by the Food and Drug Administration last year.)

In some cases, 11 hens were jammed into a cage about 2 feet by 2 feet. The Humane Society says that that is even more cramped than the egg industry’s own voluntary standards — which have been widely criticized as inadequate.

An automatic feeding cart that runs between the cages sometimes decapitates hens as they’re eating, the investigator said. Corpses are pulled out if they’re easy to see, but sometimes remain for weeks in the cages, piling up until they have rotted into the wiring, he added.

Other hens have their heads stuck in the wire and are usually left to die, the investigator said.

“These allegations by the Humane Society are a gross distortion of Kreider Farms, our employees and the way we care for birds,” Ron Kreider, the president of Kreider Farms, told me in a statement. He acknowledged that three barns had tested positive for salmonella but said that consumers were never endangered.

“The reality of food processing can be off-putting to those not familiar with animal agriculture,” added Kreider, the third-generation family leader of the company. “When dealing with millions of birds, there is always a small percentage of dead birds. Older-style chicken houses will inherently contain a level of fly and rodent activity.” Kreider added that his company was leading the industry in replacing old barns with state-of-the-art ones.

Like many readers, I don’t particularly empathize with chickens. It’s their misfortune that they lack big eyes.

As a farmboy from Yamhill, Ore., I found our pigs to be razor smart, while our geese mated for life and our sheep and cattle had distinct personalities. The chickens were the least individualistic of the animals we raised. (I’ll get letters from indignant chicken-lovers, I know!)

Industrial operations like Kreider are dazzlingly efficient at producing cheap eggs, so they save consumers money. Still, I flinch at a system in which hens are reduced to widgets. Many of us do, which is why Burger King, Denny’s, Quiznos and Hardee’s have started buying more cage-free eggs.

Last year, the main egg industry trade association, United Egg Producers, joined with the Humane Society of the United States in an agreement to support new federal standards that would provide more space for hens. That was a landmark: farmers and animal protection activists agreeing on a way forward.

But Kreider Farms is not a member of United Egg Producers, and some industry outliers and cattle and hog farmers are trying to kill the deal. They fear a precedent of federal concern for animal welfare, so the legislation faces strong resistance.

For those who are wavering, think for a moment about the arc of empathy. Centuries ago, we humans amused ourselves by seeing other people executed or tortured. Until modern times, we considered it sport to see animals die horrible deaths. Now our sensibilities have evolved so that there is an outcry when animals are abused — unless it happens out of sight on farms.

The police would stop wayward boys who were torturing a stray dog, so should we allow industrialists to abuse millions of hens? Shouldn’t we agree on minimum standards?

Granted, it is not easy to settle on what constitutes cruelty to animals. But cramming 11 hens for most of their lives into a cage the size of an oven seems to cross a line.

Somehow, fried eggs don’t taste so good if you imagine the fetid barn in which they were laid.

Doctors Learn to Cook Healthy, ‘Crave-able’ Foods - NYTimes.com

To Heal, First Eat

Patricia Leigh Brown, The New York Times, April 10, 2012

SOME people cannot travel without Advil or a neck pillow. Dr. David M. Eisenberg, an associate professor at the Harvard Medical School and the Harvard School of Public Health, feels incomplete without his beloved paring knife and eight-inch Wüsthof cleaver.

He was wielding both with sweaty zeal the other day on the dais of the Culinary Institute of America at Greystone, demonstrating a stir-fry with perfectly browned shiitake mushrooms and a heavy dose of sake to the 400 or so pediatricians, endocrinologists, dietitians and other health practitioners who were spending three and a half days in the Napa Valley learning how to cook. “This isn’t neurosurgery,” Dr. Eisenberg said as he whacked a garlic clove with the cleaver. “This is hearty, affordable, cravenly delicious food.”

The son of a Brooklyn baker, Dr. Eisenberg is the founder and chief officiant of “Healthy Kitchens/Healthy Lives,” an “‘interfaith marriage,” as he calls it, among physicians, public health researchers and distinguished chefs that seeks to tear down the firewall between “healthy” and “ crave-able” cuisine. Although physicians are on the front lines of the nation’s diabetes and obesity crises, many graduate from medical school with little knowledge of nutrition, let alone cooking. It is a deficiency that is becoming increasingly apparent as the grim statistics climb. (By 2050, for example, as many as 1 in 3 adults will develop diabetes if current trends continue.)

To Dr. Eisenberg, flavor is a health issue. Now in its eighth year, the sold-out event is in the vanguard of a major shift in attitude among a young generation of medical professionals who grew up with farmers’ markets. Their ranks include students at the Baylor College of Medicine in Houston, who have hired a chef to teach cooking skills, and a doctor in suburban Chicago who was so inspired by “Healthy Kitchens/Healthy Lives” that he went home and installed a demonstration kitchen in his medical office.

Doctors like Jim Fox, a 51-year-old cardiologist from Traverse City, Mich., exchanged stethoscopes for chefs’ toques to immerse themselves in the fine arts of “Mastering Healthy Marinades and Grilling Techniques” and “Healthy Cooking With Nuts and Legumes.”

“I want to help my patients not need my services,” Dr. Fox said as he chopped rosemary for a mustard-crusted seared lamb loin. “I’d love to be put out of work.”

In a place that celebrates perfect pairings (say, a riesling with a spicy chicken Madras), the combination of James Beard Award-winning chefs with heavy guns from the Harvard School of Public Health, including Dr. Walter Willett, an epidemiologist and international authority on the health consequences of food choices, could at times feel surreal.

A sold-out session called “Wine: The Latest Research on the Health Impacts Plus a Guided Tasting,” taught by John Buechsenstein, a winemaker, and Eric B. Rimm, a cardiovascular epidemiologist from Harvard, preceded a tasting of a Washington State gewürztraminer and other wines accompanied by a geeky PowerPoint presentation. It detailed an experiment in which mice with lousy diets were given the equivalent of 8 to 10 bottles of wine a day (they did as well as regular mice). Cheers!

At a knife-skills class, Dr. Kriston J. Kent, a facial plastic surgeon from Naples, Fla., learned to make incisions in potatoes and celery. “Easier than avoiding important blood vessels,” he said. He is now pursuing a public health degree. “The emphasis shouldn’t all be on the knife,” he said of his practice. “How you look has a lot to do with how you feel.”

Satiety (rhymes with anxiety) was the mantra of the $1,200 conclave, which serves as continuing medical education despite pleasures like chocolate-dipped apricots (a healthy snack) and recipes by well-known chefs likeSuvir Saran, late of the restaurant Devi in New York. Mr. Saran prepared guacamole with toasted cumin seeds, a touch he called “the Indian version of bacon bits.”

“I think they’re hungry,” he said of the medical crowd. “Many doctors treat food as a clinical procedure rather than the sensual act it ought to be.”

For Dr. Eisenberg, 56, a passionate cook who spent weekends as a child filling cream puffs and sprinkling cinnamon and nuts on rugelach in his father’s bakery, deprivation in the form of low-fat diets and bland overcooked vegetables is an enemy of doctors and patients. “For years we’ve told people ‘Don’t eat that’ or ‘Here’s your problem,’ ” he said of the physicians’ party line. “Sometimes,” he added of his own thrice-yearly yearning for steak, “you have to feed your inner jerk.”

His commitment to healthy food began when his father, a cake artist who “always smelled like a cross between a cinnamon stick and a whiff of Old Spice,” died of a heart attack when Dr. Eisenberg was 10. An expert on integrative medicine, Dr. Eisenberg was one of the first United States medical exchange students to the People’s Republic of China. He started “Healthy Kitchens/Healthy Lives” in partnership with the Culinary Institute and the Harvard School of Public Health, based on the radical notion that if doctors could learn to channel their inner Julia Child (sans butter), they could serve as role models and cheerleaders for their patients.

It’s not about ego. Over the years, research has shown that doctors who practice healthful behaviors like exercising, using sunscreen and not smoking have a greater likelihood of advising patients to do the same. A study last month in the journal Obesity reported that overweight doctors may be less prone than other physicians to discuss diet and exercise with their patients. “We’re all human,” said Dr. Matt Everett, a now-gangly 55-year-old physician from Marysville, Ohio, who was inspired to lose weight after seeing patients in their 40s and 50s having strokes and heart attacks. “We all struggle with the same things.”

For doctors like Martin Abrahamson, the chief medical officer for the Joslin Diabetes Center in Boston, there were revelations within Greystone’s cool, monasterylike stone walls, where chefs in white glide up and down staircases with nary a glance at the school’s historic corkscrew collection. “I’ve never cooked in my life,” he said, wearing a pinstripe suit beneath his apron, his hands drenched in marinade.

Dr. Abrahamson and his cronies listened raptly as the chef Tucker Bunch talked about “the little worm that unfurls” in overcooked quinoa (he advocates toasting it). “Doctors treat salt like an exacerbator of disease,” Mr. Bunch observed somewhat wryly. “So they under-season food with religious fervor.”

Nevertheless, they soaked up the dazzling feats of culinary derring-do, especially when the chef Patrick Clark sliced an onion in 10 seconds that fell into Sydney Opera House-like curves on the cutting board.

The collaboration between the Culinary Institute and Harvard epidemiologists and nutritionists goes back to 2002, when Dr. Willett, chairman of the institute’s scientific advisory board, began researching the health benefits of the Mediterranean diet. The team is now working with chefs from mega-chains like Applebee’s, Starbucks and Subway, to encourage them to reduce sodium and add more whole grains, nuts, legumes and healthier oils to their menus.

Dr. Eisenberg would like to see teaching kitchens in the places that need them most: medical schools, hospitals, universities, public schools and military bases. “What if teaching kitchens were as prevalent as computer labs in schools?” he asked. (He is working on a prototype.) Nutritionists often don’t know how to cook, Dr. Eisenberg pointed out, “which is a little bit like psychiatrists who are all screwed up.”

Yet after three days of thinking deep thoughts, all the while gorging on aromatic wheat-berry salads and peanut limeade (sounds revolting, tastes great), there was a palpable sense of a wellness tide turning.

For instance, Dr. John Principe of Palos Heights, a Chicago suburb, said that he seriously thought about quitting medicine, fed up with “a pill for every ill.” Fantasizing about a second career as a chef, he attended “Healthy Kitchens” five years ago and realized that he might be able to combine the two.

He now holds a culinary boot camp in the 2,400-square-foot kitchen and lecture room he built below his medical office, where he teaches people how to whip up cauliflower crust pizza and other dishes. (The sessions qualify for insurance under the group medical appointment model.) “Instead of being in the downtrodden mode, it’s given me a zest for life,” he said.

At the Baylor College of Medicine, Jasdeep Mangat, a 24-year-old medical student, was a founder of Choosing Healthy, Eating Fresh (CHEF), enlisting a chef from a local bistro to teach classes for 20 students using five portable gas burners in the student lounge. “We need to walk the talk,” he said.

And seven years ago, Dr. Daniela Connolly, now 40, and her husband, Patrick, bought a farm in Chester, N.H., to feed their five children healthy and reliable food.

She often runs into her patients while selling eggs at the farmers’ market and sometimes when they unknowingly show up at the house to pick up their Field to Fork Farm C.S.A. boxes. They are invariably surprised by how dirty she is.

After three days of “Healthy Kitchens,” she is now convinced she needs to teach her patients healthy cooking. “In a perfect world, I would have my patients meet me at the farm,” she said. “That would make me a really happy doctor.”