December 4, 2013
Diet Drugs Work: Why Won't Doctors Prescribe Them?
Posted by Suzanne Koven<http://www.newyorker.com/magazine/bios/suzanne_koven/search?contributorName=Suzanne%20Koven>
[obese-580.jpg]
The woman sat on my exam table and pointed to her snug paper gown. "Doctor," she said, "I need your help losing weight."
I spent the next several minutes speaking with her about diet and exercise, the health risks of obesity<http://www.nhlbi.nih.gov/health/health-topics/topics/obe/risks.html>, and the benefits of weight loss<http://www.ncbi.nlm.nih.gov/pubmedhealth/pmh0004993/>—a talk I've been having with my patients for more than twenty years. But, like the majority of Americans<http://www.cdc.gov/obesity/data/adult.html>, most of my patients remain overweight.
Afterward, I realized that what my patient wanted was a pill that would make her lose weight. I could have prescribed her one of four drugs currently approved by the F.D.A.: two, phentermine and orlistat, that have been around for more than a decade, and two others, Belviq (lorcaserin) and Qsymia (a combination of phentermine and topiramate)<http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm312380.htm>, that have recently come onto the market and are the first ever approved for long-term use. (Ian Parker wrote about the F.D.A.'s approval process for new medications<http://www.newyorker.com/reporting/2013/12/09/131209fa_fact_parker?currentPage=all> in this week's issue.) The drugs work by suppressing appetite, by increasing metabolism, and by other mechanisms that are not yet fully understood. These new drugs, along with beloranib<http://www.dddmag.com/news/2013/11/phase-2-results-zafgens-weight-loss-drug-beloranib-released>—which produces more dramatic weight loss than anything currently available but is still undergoing clinical trials—were discussed with great excitement last month by experts and researchers at the international Obesity Week<http://www.obesity.org/2013-11-12/obesity-week-2013-annual-scientific-meeting-of-the-obesity-society.htm> conference in Atlanta.
But I've never prescribed diet drugs, and few doctors in my primary-care practice have, either. Donna Ryan, an obesity specialist at the Pennington Biomedical Research Center at Louisiana State University, has found that only a small percentage of the doctors she has surveyed regularly prescribe any of the drugs currently approved by the F.D.A. Sales figures<http://www.nytimes.com/2013/07/02/business/few-signs-of-a-taste-for-diet-pills.html?pagewanted=1&hp&_r=2&> indicate that physicians haven't embraced the new medications, Qsymia and Belviq, either.
The inauspicious history of diet drugs no doubt contributes to doctors' reluctance to prescribe them. In the nineteen-forties, when doctors began prescribing amphetamines for weight loss, rates of addiction soared<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2377281/>. Then, in the nineties, fen-phen<http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm180078.htm>, a popular combination of fenfluramine and phentermine, was pulled from the market when patients developed serious heart defects. Current medications are much safer, but they produce only modest weight loss, in the range of about five to ten per cent, and they do have side effects.
Still, as Ryan pointed out, doctors aren't always shy about prescribing medications that cause side effects and yield undramatic results. A five to ten per cent weight loss might not thrill patients, or even nudge them out of being overweight or obese, but it can improve diabetes control, blood pressure, cholesterol, sleep apnea, and other complications of obesity. And, although the drugs aren't covered by Medicare or most states' Medicaid programs, private insurance coverage of weight-loss drugs has improved and is likely to expand further under the Affordable Care Act,<http://www.usatoday.com/story/news/nation/2013/07/04/obesity-disease-insurance-coverage/2447217/> which requires insurers to pay for obesity treatment. So what prevents physicians from prescribing these drugs?
Several leading experts and researchers attending Obesity Week told me that the problem is that, while specialists who study obesity view it as a chronic but treatable disease, primary-care physicians are not fully convinced that they should be treating obesity at all. Even though physicians since Hippocrates<http://www.thelancet.com/journals/lancet/article/piis0140-6736%2810%2961065-3/fulltext> have known that excess body fat can cause diseases, the American Medical Association announced that it would recognize obesity itself as a disease only a few months ago<http://www.nytimes.com/2013/06/19/business/ama-recognizes-obesity-as-a-disease.html>. These divergent views on obesity represent one of the widest gulfs of understanding between generalists and specialists in all of medicine.
Lee M. Kaplan, co-director of the Weight Center at Massachusetts General Hospital, thinks that some bias comes from the average physician's lack of appreciation for the complex physiology of weight homeostasis. Humans have evolved to avoid starvation rather than obesity, and we defend our body mass through an elaborate system involving the brain, the gut, fat cells, and a network of hormones and neurotransmitters, only a fraction of which have been identified. Obesity, Kaplan said, which represents dysfunction of this system, is likely not one disease but dozens.
That one person's obesity is not like another's may explain why some people lose a lot of weight with surgery, or a particular diet or drug, and some don't. Kaplan thinks that if more doctors understood this, they'd view obesity treatment more receptively and realistically. He said, "If I were to say to you, 'I have this drug that treats cancer,' and you asked me, 'What kind of cancer?,' and I said, 'All cancers,' you'd laugh, because you recognize intuitively that cancer is a heterogeneous group of disorders. We're going to look back on obesity one day and say the same thing."
Obesity is potentially, in part, a neurological disease. Jeffrey Flier<http://www.sciencedirect.com/science/article/pii/s009286740301081x>, an endocrinologist and dean of Harvard Medical School, has shown, like others, that repeatedly eating more calories than you burn can damage the hypothalamus, an area of the brain involved in eating and satiety. In other words, Big Gulps, Cinnabons, and Whoppers have altered our brains such that many people—particularly those with a genetic predisposition to obesity—find fattening foods all but impossible to resist once they've eaten enough of them. Louis J. Aronne, director of the Comprehensive Weight Control Program at New York-Presbyterian/Weill Cornell Medical Center, explained to me, "With so much calorie-dense food available, the hypothalamic neurons get overloaded and the brain can't tell how much body fat is already stored. The response is to try to store more fat. So there's very strong scientific evidence that obesity is not about people lacking willpower."
But this message has not found its way into society, where obese people are still often considered self-indulgent and lazy, and face widespread discrimination<http://health.usnews.com/health-news/news/articles/2012/08/23/many-obese-americans-struggle-with-stigma-discrimination-poll-finds>. Several obesity experts told me they've encountered doctors who confide that they just didn't like fat people and don't enjoy taking care of them. Even doctors who treat obese patients feel stigmatized: "diet doctor" is not a flattering term. Donna Ryan, who switched from oncology to obesity medicine many years ago, recalls her colleagues' surprise. "I had respect," she says. "I was treating leukemia!"
George Bray, also of the Pennington Biomedical Research Center, thinks that socioeconomic factors play into physicians' lack of enthusiasm for treating obesity. Bray points to the work of Adam Drewnowski<http://onlinelibrary.wiley.com/doi/10.1111/j.1753-4887.2009.00157.x/full> at the University of Washington, who has shown that obesity is, disproportionately, a disease of poverty. Because of this association, many erroneously see obesity as more of a social condition than a medical one, a condition that simply requires people to try harder. Bray said, "If you believe that obesity would be cured if people just pushed themselves away from the table, then why do you want to prescribe drugs for this non-disease, this 'moral issue'? I think that belief permeates a lot of the medical field."
Obesity experts with whom I spoke tended to be more optimistic than other physicians about the possibility that obesity can be treated successfully and that the obesity epidemic will be curbed. They point to exciting new research—for example, the finding that an alteration in gut bacteria<http://stm.sciencemag.org/content/5/178/178ra41>, rather than mechanical shrinking of the stomach or intestine, may be what causes weight loss after gastric bypass. This raises the possibility that the benefits of surgery might become available without the surgery itself. They also note that public-health efforts seem to be reducing childhood obesity<http://www.nytimes.com/2013/08/07/health/broad-decline-in-obesity-rate-seen-in-poor-young-children.html?_r=0>, even in poor communities. But they remain concerned that despite such promising developments, many physicians still don't see obesity the way they do: as a serious, often preventable disease that requires intensive and lifelong treatment with a combination of diet, exercise, behavioral modification, surgery, and, potentially, drugs.
Louis Aronne thinks this will change as more physicians enter the field of obesity medicine, the physiology of obesity is better understood, and more effective treatment options become available. He likens the current attitude toward obesity to the prevailing attitude toward mental illness years ago. Aronne remembers, during his medical training, seeing psychotic patients warehoused and sedated, treated as less than human. He predicts that, one day, "some doctors are going to look back at severely obese patients and say, 'What the hell was I thinking when I didn't do anything to help them? How wrong could I have been?' "
Patients like the woman who asked me to help her lose weight may not have to wait that long. Specialists are now developing programs to aid primary-care physicians in treating obesity more aggressively and effectively. But we'll have to want to treat it: as Kaplan argues, "Whether you call it a disease or not is not so germane. The root problem is that whatever you call it, nobody's taking it seriously enough."
Suzanne Koven<http://www.suzannekovenmd.com/> is a primary-care doctor at Massachusetts General Hospital in Boston and writes the column "In Practice" at the Boston Globe.
Photograph by Patrick Allard/REA/Redux.
Read more: http://www.newyorker.com/online/blogs/elements/2013/12/diet-drugs-work-why-wont-doctors-prescribe-them.html?printable=true¤tPage=all#ixzz2mc0iaix5
Thursday, December 5, 2013
Wednesday, November 27, 2013
Making Nutritional Information Digestible
Making Nutritional Information Digestible: Effects of a Receipt-Based Intervention on Restaurant Purchases<http://www.nber.org/papers/w19654.pdf>, by Kelly Bedard and Peter J. Kuhn. NBER Working Paper No. 19654, November 2013
"We study the effects of receipts that include personalized ordering suggestions designed to reduce fat and calorie consumption on purchasing behavior at a restaurant chain. We find that customers, in the aggregate, made most of the item substitutions that were encouraged by the messages, such as substituting ham for sausage in a breakfast sandwich, or substituting frozen yogurt for ice cream, though effects on overall calories and fat consumed were small. The results illustrate the potential of emerging information technologies, which allow retailers to tailor product marketing to individual consumers, to contribute in meaningful new ways to the battle against obesity."
"We study the effects of receipts that include personalized ordering suggestions designed to reduce fat and calorie consumption on purchasing behavior at a restaurant chain. We find that customers, in the aggregate, made most of the item substitutions that were encouraged by the messages, such as substituting ham for sausage in a breakfast sandwich, or substituting frozen yogurt for ice cream, though effects on overall calories and fat consumed were small. The results illustrate the potential of emerging information technologies, which allow retailers to tailor product marketing to individual consumers, to contribute in meaningful new ways to the battle against obesity."
Sunday, November 17, 2013
To Fight Obesity, a Carrot, and a Stick
To Fight Obesity, a Carrot, and a Stick
By TINA ROSENBERGhttp://opinionator.blogs.nytimes.com/2013/11/16/to-fight-obesity-a-carrot-and-a-stick/?ref=opinion&_r=0&pagewanted=printChildhood obesity, at long last, may have peaked — even among the poor, where the problem is most prevalent. Between 2008 and 2011, according to a study from the Centers for Disease Control and Prevention, 19 states and territories saw a small but significant drop in obesity rates among low-income preschoolers.
This is a problem that many people assumed would only get worse. So how has this small bit of success been achieved?
One factor is certainly an extensive behavior-change campaign; official America is now bribing, cheering and badgering us to eat fruits and vegetables, exercise, drink water instead of soda and cut down on screen time. Another is that cities and civic groups are doing creative things to bring healthier food to poor neighborhoods. These changes help. But there may be a more direct reason for the progress against child obesity.
The C.D.C. study focused on preschool-age children, from 2 to 4 years old, most of them enrolled in the federal Special Supplemental Nutrition Program for Women, Infants and Children, known as WIC. WIC provides vouchers to pregnant and nursing women, and mothers of children under 5 to buy specific foods.
In 2009, WIC changed its rules. There are new vouchers specifically for produce, for example. Milk must be reduced-fat, and bread and rice must be whole-grain. And stores participating in WIC must carry these items. You can see that change in corner stores and bodegas across the country, including, for example, Luciano Espinal’s Deli Grocery, on Lehigh Avenue in North Philadelphia.
Mr. Espinal’s store has two aisles and a deli counter in the back. There are similar stores all over the neighborhood, their shelves filled with snack cakes, chips, soda, white bread. The only fresh foods are the iceberg lettuce and tomatoes needed by the deli counter, and maybe potatoes and onions.
But Mr. Espinal’s store accepts WIC vouchers. So he carries things non-WIC stores do not: apples, oranges, green peppers and bananas. He also carries the WIC-required whole-grain bread, brown rice and 2 percent milk.
Of course, people could buy more of the unhealthy stuff with their own money. But the evidence says they don’t. Yale’s Rudd Center for Food Policy and Obesity looked at purchases by WIC participants in Massachusetts and Connecticut, including what they bought with their own cash. After the WIC changes, participants bought significantly more whole-grain bread and brown rice and reduced-fat milk, and far less white bread, whole milk, cheese and juice.
Attitudes are changing. Access to healthy food is increasing. But that doesn’t address what is probably the most important problem: cost. On a limited budget, people buy cheap and unhealthy food. Community groups and cities can’t solve that problem — not for more than a handful of people at a time, anyway.
But the federal government can.
The success of the WIC reforms proves it. The program matters: half of all infants and a quarter of all children under 5 in the United States will be on it at some point. But with nine million participants, it is dwarfed by the Supplemental Nutrition Assistance Program, or SNAP — commonly known as food stamps — which reaches more than 47 million people. Food stamps keep people from starving. But you cannot buy fresh produce on $1.40 per meal. (Let’s contemplate the extra medical bills we’ll be paying because of Congress’s decision to let the Recovery Act’s increases in food-stamps benefits expire.) SNAP needs some help.
One strategy is to provide financial incentives to buy fruits and vegetables. This is happening in many farmers’ markets; Philly Food Bucks, for example, gives people a $2 coupon for every $5 in food stamps they spend on produce at participating markets. Food stamps sales at these markets have increased by nearly 400 percent. In some states, eligible produce must be locally grown, a change farmers appreciate.
The idea is spreading to supermarkets. This summer the Agriculture Department released results of its Healthy Incentives Pilot in Hampden County, Mass. Supermarket shoppers earned 30 cents for each food stamp dollar they spent on fruit and vegetables. Those in the program bought 25 percent more produce than the control group, at a cost of 15 cents per day.
These programs are lovely, but they reach relatively few people, and they are expensive. Another strategy is harsher: Copy WIC and limit the foods that food stamps can buy. Such a change could cover the whole country in one administrative stroke. And, of course, it is virtually free. With even more cuts in food stamps looming in the farm bill, that’s important.
Minnesota, Mississippi and New York asked the Department of Agriculture for permission to take soda or candy out of SNAP. Mississippi later withdrew its request. The department said no to New York, saying the program was poorly designed. It told Minnesota that the state could not change the federal program’s definition of what could be covered.
None of the obstacles to limiting food stamps to healthier foods seem insurmountable. It is administratively simple to draw a line.
But not politically simple. It’s not just that people on food stamps are an enormous market for soda and junk food. Big Soda has unusual allies. Restricting purchases is not controversial with WIC, which exists to supplement nutrition. But it is with food stamps, which exist to supplement income.
“There are people in the anti-hunger community who support a soda tax in general because it affects everyone, but they oppose banning soda from SNAP because it affects only poor people,” said Marlene B. Schwartz, director of the Yale Rudd Center. “Their philosophical argument is, if it’s the right thing to do for everyone, then make it for everyone.”
Other approaches exist. A portion of food stamps benefits could be set aside for produce. Or states could use the guidelines they already follow — to little controversy — with sales taxes. More than half the states tax soda or junk food at a higher rate than the food tax rate — in effect, they do not consider them food.
“Instead of arguing about healthy versus unhealthy, I would almost rather say what counts as food,” said Ms. Schwartz. “States already figured out what is and isn’t food.”
Sunday, November 3, 2013
Whole Foods¹ New Produce Ratings: Transparency Bears Fruit
Whole Foods' New Produce Ratings: Transparency Bears Fruit
* by Jim Slama
* Oct. 29, 2013
* original <http://civileats.com/2013/10/29/whole-foods-new-produce-ratings-transparency-bears-fruit/>
Whole Foods Market (WFM) is again at the forefront of the movement for greater transparency in food production and processing. The supermarket chain recently announced<http://media.wholefoodsmarket.com/news/produce-rating-release> a comprehensive ratings system for fresh produce and flowers, which parallels the color-coded animal welfare standards for meat and the sustainability standards for seafood that Whole Foods earlier pioneered.
The produce ratings are another big step forward for the good food movement and its efforts to encourage responsible production, quantified by third-party certification. Each of these programs also is indicative of Whole Foods<http://www.wholefoodsmarket.com/>' history as an international leader in promoting independent certification for product attributes such as organic, non-GMO, gluten-free, fair trade, and more.
Earlier this year, Whole Foods announced<http://www.huffingtonpost.com/2013/03/08/whole-foods-gmo-labeling-2018_n_2837754.html> that, by 2018, all products in its stores will be required to carry labels identifying whether they contain genetically modified organisms (GMOs). The Non-GMO Project<http://www.nongmoproject.org> reports that in response to this action, more than 900 manufacturers have begun the process of getting certified as GMO-free, a number that is expected to swell as the labeling deadline approaches.
"We are constantly evolving and looking at ways we can improve our communities and our planet, support our supplier partners, and help our customers make informed choices by providing them with deeper transparency. Implementing our new comprehensive produce ratings system is our latest effort to do just that," said John Mackey<http://www.wholefoodsmarket.com/person/john-mackey>, co-founder and co-CEO of Whole Foods Market.
Actions such as its GMO labeling and produce rating policies may mitigate the mixed feelings that some in the good good movement bear toward Whole Foods, despite the major role it has played in popularizing and educating consumers about sustainable food options.
Mackey hews to a libertarian philosophy on economics and politics that he outlined out in his book, Conscious Capitalism<http://www.amazon.com/Conscious-Capitalism-Liberating-Heroic-Business/dp/1422144208>. He has been outspoken in his criticisms of the Affordable Care Act (AKA Obamacare), and in his contrarian views on global warming. This, along with the company's opposition to union representation for employees, have raised some hackles, including those of some Whole Foods customers who have differing views.
The upscale pricing of many items on its shelves is an issue for some in the movement, especially those who are working to expand access to healthy, sustainable food for less affluent Americans. Whole Foods is moving to address this issue by planning stores with more moderate pricing in some low-income neighborhoods, such as Detroit<http://www.mlive.com/business/detroit/index.ssf/2013/08/whole_foods_ceo_tells_bloomber.html> and the Englewood<http://articles.chicagotribune.com/2013-09-04/business/chi-whole-foods-englewood-chicago-20130904_1_foods-market-whole-foods-food-desert> neighborhood on Chicago's South Side.
Despite such issues, the company continues to grow, even as its actions keep it at the forefront of sustainability. This is evidenced by the fact that Mackey and co-CEO Walter Robb<http://media.wholefoodsmarket.com/experts/global/walter-robb> have created the most valuable supermarket chain in America as ranked by its $22 billion market capitalization.
<http://civileats.com/wp-content/uploads/2013/10/FarmedHere.jpg>[FarmedHere]<http://civileats.com/wp-content/uploads/2013/10/FarmedHere.jpg>Good, Better, and Best
Whole Foods' three-step system for produce and flowers will be launched in September 2014 and rank items as "good," "better," and "best," depending on the methods of production. Whole Foods staff, a team of sustainable agricultural experts, and current suppliers developed a science-based index which examines 10 different aspects of production including:
? Pest management, including prohibited and restricted pesticides
? Farmworker welfare
? Pollinator protection
? Water conservation and protection
? Soil health
? Ecosystems
? Biodiversity
? Waste, recycling, and packaging
? Energy
? Climate
The system will reward organic practices while also acknowledging the benefits of other certifications, including Fair Trade<http://www.fairtradeusa.org/>, Rainforest Alliance<http://www.rainforest-alliance.org/>, Protected Harvest<http://www.protectedharvest.org/>, and Demeter Biodynamic<http://www.demeterbta.com/>.
According to Edmund LaMacchia<http://www.wholefoodsmarket.com/person/edmund-lamacchia>, global vice president of perishables for Whole Foods Market, the "ratings provide an industry-leading approach that eliminates or restricts the most toxic pesticides from the nation's food supply and provide incentive for growers to measure and reduce other pesticide use." They will also reward "growers who take action to protect pollinators through specific pesticide practices, habitat restoration, and by controlling the impact of managed hives on the farm."
"Whole Foods was the national leader in taking organic mainstream, and with these standards they are encouraging and rewarding producers to create safer and more sustainable food," says organics expert Chuck Benbrook<http://csanr.wsu.edu/pages/Benbrook>, a professor at Washington State University and adviser to Whole Foods in developing the produce standards.
Farmer Jim Cochran<http://www.nrdc.org/greenbusiness/swanton.asp> of Swanton Berry Farm in Davenport, California, has been a major supplier to Whole Foods for decades and credits their stores with "expanding markets for organic produce in an exponential way, by providing farmers vast new markets." Cochran is a pioneering organic strawberry grower in California whose farmworkers are unionized and participate in an innovative employee ownership plan.
Cochran thinks the produce standards can be transformative, saying, "They go well beyond organic by quantifying every major issue of sustainability plus labor standards. Such a systemic approach, if implemented properly, will be a game changer for the produce industry."
This sentiment was affirmed at the recent Produce Marketing Association national convention in New Orleans. "The WFM standards were all the buzz at the show," according to Bob Scaman, the co-founder of Goodness Greeness<http://goodnessgreeness.com/eSource/default/Login.aspx?role=customer>, an organic produce distributor and food hub in Chicago. "Within a few weeks of the announcement, farms and produce companies had already realized that they will need to ramp up practices in sustainability and labor. And because of Whole Foods' buying power and market leadership, it will be a seismic shift across the industry "
This program continues Whole Foods leadership in building accountability into the food they sell. Theirs were the first major supermarkets to promote organic food by prominently displaying organic labels on products and store shelf promotions, while educating consumers about the benefits of organic. Now other retailers and restaurants such as Chipotle<http://www.chipotle.com/en-us/menu/ingredients_statement/ingredients_statement.aspx> are following suit.
An issue the standards don't appear to address is local food procurement, despite the fact that Whole Foods was an early adopter in labeling and promoting local produce. This was one of the major criticisms of Whole Foods in The Omnivore's Dilemma<http://michaelpollan.com/books/the-omnivores-dilemma/>, a 2006 book by journalist Michael Pollan<http://michaelpollan.com> that helped increase public awareness of the issues of industrial versus sustainable food production. It is an area in which Whole Foods still faces heat because many of their regions struggle with getting adequate quantities of locally sourced fruits and vegetables.
"One of the biggest challenges we face is building a supply chain of sustainably grown, regionally produced fruit and vegetables. Most small farms don't have the capacity to sell us nearly enough food to supply 43 stores," says Michael Bashaw<http://media.wholefoodsmarket.com/experts/regional-leadership/michael-bashaw>, Whole Foods Midwest regional president. "To address this, we will be working with food hubs and other aggregators to build our offerings of local food. In addition, the new produce standards and labeling will also give our produce buyers more motivation to increase the local, organic, and sustainable options for our customers."
[WFMmeatcase]<http://civileats.com/wp-content/uploads/2013/10/WFMmeatcase.jpg>
Some think the Whole Foods' produce standards will have an effect similar to its animal welfare standards. Whole Foods first developed a defined set of standards for certification and then launched the non-profit Global Animal Partnership<http://www.globalanimalpartnership.org/> (GAP) to administer the system. Their standards include:
Step 1: Prohibits cages and crates to confine livestock.
Step 2: Requires environmental enrichment for indoor production systems.
Step 3: Outdoor access.
Step 4: Pasture-based production.
Step 5: An animal-centered approach with all physical alterations prohibited.
Step 5+: The entire life of the animal spent on an integrated farm.
The GAP system is now being adopted by many producers who want access to customers who care, often deeply, about how farm animals are raised. For example, when Tyson Foods, Inc.<http://www.tyson.com/>, the Arkansas-based producer that is one of the nation's largest poultry corporations, launched<http://www.journalpatriot.com/news/article_b6eaca84-8820-11e2-9de2-0019bb30f31a.html> an antibiotic-free chicken line, it was certified by GAP as Step 2.
The meat case at Whole Foods stores indicates where the food was produced and the standard under which it falls.
"Whole Foods did a great job in engaging producers in developing this standard," says George Siemon,<http://www.organicvalley.coop/?id=688> CEO of Organic Valley<http://www.organicvalley.coop/>, a billion-dollar farmer-owned organic cooperative based in Wisconsin that mainly produces dairy and meat products. Siemon, who also is a board member of Global Animal Partnership. "The system allows producers to positively differentiate themselves and move up in ratings, which can provide them access to new markets and sometimes better pricing for their products. I can see how the new produce standards will have a similar effect and help smaller organic producers with strong sustainability, labor, and pest management practices to expand and gain new markets."
The retailer also played a key role in developing the Marine Stewardship Council<http://www.msc.org/> (MSC) and became the first major retailer to sell seafood certified as sustainable. "Committing to MSC-certified sustainable products and launching our comprehensive wild-caught seafood rating system has given us the infrastructure to provide full transparency to help our shoppers make informed decisions that support the future health of our oceans," says Margaret Wittenberg,<http://www.wholekidsfoundation.org/about/leadership-members/margaret-wittenberg-bio> global vice-president of quality standards for Whole Foods Market. Wittenberg was an early MSC Board member and key driver of its success.
Whole Foods took this to another level by working with the Monterey Bay Aquarium<http://www.montereybayaquarium.org/> in Monterey, Calif., and its Seafood Watch<http://www.montereybayaquarium.org/cr/seafoodwatch.aspx> program, as well as the Blue Ocean Institute<http://blueocean.org/programs/sustainable-seafood-program/>, to implement a three-tiered color-coded standard for seafood sold at its stores: best (green), good (yellow), and avoid (red). On Earth Day in April 2012, Whole Foods banned the sale of non-sustainable seafood<http://www.huffingtonpost.com/2012/04/23/whole-foods-seafood-ban-sustainable-fish_n_1446071.html> bearing the red label. This program has played a key role in influencing the seafood-buying practices of restaurants, institutions, individual consumers, and most of the large-scale supermarkets in America.
The best example of this is Walmart<http://www.walmart.com/>, the mega-retailer that followed WFM's lead in sustainable seafood<http://corporate.walmart.com/global-responsibility/environment-sustainability/sustainable-seafood>. It now requires "all fresh and frozen, farmed and wild seafood suppliers to become third-party certified as sustainable using Marine Stewardship Council (MSC), Best Aquaculture Practices<http://www.gaalliance.org/bap/standards.php> (BAP) or equivalent standards. . . all uncertified fisheries and aquaculture suppliers must be actively working toward certification."
Walmart's statement continues, "As of January 31, 2012, 76 percent of our fresh, frozen, farmed and wild seafood suppliers were third-party certified and an additional 8 percent had developed the required certification plans."
The truth is that Whole Foods, while not uncontroversial, has been a market leader on sustainability issues for years. It's unlikely that conventional supermarket chains would have nearly as many organic or otherwise sustainably produced items in stock had the issue not been forced by this rapidly growing retail competitor. The good food movement will benefit if Whole Foods' produce ratings similarly bear fruit.
Originally published at Good Food on Every Table<http://goodfoodoneverytable.com/2013/10/07/whole-foods-new-produce-ratings-transparency-bears-fruit/>
* by Jim Slama
* Oct. 29, 2013
* original <http://civileats.com/2013/10/29/whole-foods-new-produce-ratings-transparency-bears-fruit/>
Whole Foods Market (WFM) is again at the forefront of the movement for greater transparency in food production and processing. The supermarket chain recently announced<http://media.wholefoodsmarket.com/news/produce-rating-release> a comprehensive ratings system for fresh produce and flowers, which parallels the color-coded animal welfare standards for meat and the sustainability standards for seafood that Whole Foods earlier pioneered.
The produce ratings are another big step forward for the good food movement and its efforts to encourage responsible production, quantified by third-party certification. Each of these programs also is indicative of Whole Foods<http://www.wholefoodsmarket.com/>' history as an international leader in promoting independent certification for product attributes such as organic, non-GMO, gluten-free, fair trade, and more.
Earlier this year, Whole Foods announced<http://www.huffingtonpost.com/2013/03/08/whole-foods-gmo-labeling-2018_n_2837754.html> that, by 2018, all products in its stores will be required to carry labels identifying whether they contain genetically modified organisms (GMOs). The Non-GMO Project<http://www.nongmoproject.org> reports that in response to this action, more than 900 manufacturers have begun the process of getting certified as GMO-free, a number that is expected to swell as the labeling deadline approaches.
"We are constantly evolving and looking at ways we can improve our communities and our planet, support our supplier partners, and help our customers make informed choices by providing them with deeper transparency. Implementing our new comprehensive produce ratings system is our latest effort to do just that," said John Mackey<http://www.wholefoodsmarket.com/person/john-mackey>, co-founder and co-CEO of Whole Foods Market.
Actions such as its GMO labeling and produce rating policies may mitigate the mixed feelings that some in the good good movement bear toward Whole Foods, despite the major role it has played in popularizing and educating consumers about sustainable food options.
Mackey hews to a libertarian philosophy on economics and politics that he outlined out in his book, Conscious Capitalism<http://www.amazon.com/Conscious-Capitalism-Liberating-Heroic-Business/dp/1422144208>. He has been outspoken in his criticisms of the Affordable Care Act (AKA Obamacare), and in his contrarian views on global warming. This, along with the company's opposition to union representation for employees, have raised some hackles, including those of some Whole Foods customers who have differing views.
The upscale pricing of many items on its shelves is an issue for some in the movement, especially those who are working to expand access to healthy, sustainable food for less affluent Americans. Whole Foods is moving to address this issue by planning stores with more moderate pricing in some low-income neighborhoods, such as Detroit<http://www.mlive.com/business/detroit/index.ssf/2013/08/whole_foods_ceo_tells_bloomber.html> and the Englewood<http://articles.chicagotribune.com/2013-09-04/business/chi-whole-foods-englewood-chicago-20130904_1_foods-market-whole-foods-food-desert> neighborhood on Chicago's South Side.
Despite such issues, the company continues to grow, even as its actions keep it at the forefront of sustainability. This is evidenced by the fact that Mackey and co-CEO Walter Robb<http://media.wholefoodsmarket.com/experts/global/walter-robb> have created the most valuable supermarket chain in America as ranked by its $22 billion market capitalization.
<http://civileats.com/wp-content/uploads/2013/10/FarmedHere.jpg>[FarmedHere]<http://civileats.com/wp-content/uploads/2013/10/FarmedHere.jpg>Good, Better, and Best
Whole Foods' three-step system for produce and flowers will be launched in September 2014 and rank items as "good," "better," and "best," depending on the methods of production. Whole Foods staff, a team of sustainable agricultural experts, and current suppliers developed a science-based index which examines 10 different aspects of production including:
? Pest management, including prohibited and restricted pesticides
? Farmworker welfare
? Pollinator protection
? Water conservation and protection
? Soil health
? Ecosystems
? Biodiversity
? Waste, recycling, and packaging
? Energy
? Climate
The system will reward organic practices while also acknowledging the benefits of other certifications, including Fair Trade<http://www.fairtradeusa.org/>, Rainforest Alliance<http://www.rainforest-alliance.org/>, Protected Harvest<http://www.protectedharvest.org/>, and Demeter Biodynamic<http://www.demeterbta.com/>.
According to Edmund LaMacchia<http://www.wholefoodsmarket.com/person/edmund-lamacchia>, global vice president of perishables for Whole Foods Market, the "ratings provide an industry-leading approach that eliminates or restricts the most toxic pesticides from the nation's food supply and provide incentive for growers to measure and reduce other pesticide use." They will also reward "growers who take action to protect pollinators through specific pesticide practices, habitat restoration, and by controlling the impact of managed hives on the farm."
"Whole Foods was the national leader in taking organic mainstream, and with these standards they are encouraging and rewarding producers to create safer and more sustainable food," says organics expert Chuck Benbrook<http://csanr.wsu.edu/pages/Benbrook>, a professor at Washington State University and adviser to Whole Foods in developing the produce standards.
Farmer Jim Cochran<http://www.nrdc.org/greenbusiness/swanton.asp> of Swanton Berry Farm in Davenport, California, has been a major supplier to Whole Foods for decades and credits their stores with "expanding markets for organic produce in an exponential way, by providing farmers vast new markets." Cochran is a pioneering organic strawberry grower in California whose farmworkers are unionized and participate in an innovative employee ownership plan.
Cochran thinks the produce standards can be transformative, saying, "They go well beyond organic by quantifying every major issue of sustainability plus labor standards. Such a systemic approach, if implemented properly, will be a game changer for the produce industry."
This sentiment was affirmed at the recent Produce Marketing Association national convention in New Orleans. "The WFM standards were all the buzz at the show," according to Bob Scaman, the co-founder of Goodness Greeness<http://goodnessgreeness.com/eSource/default/Login.aspx?role=customer>, an organic produce distributor and food hub in Chicago. "Within a few weeks of the announcement, farms and produce companies had already realized that they will need to ramp up practices in sustainability and labor. And because of Whole Foods' buying power and market leadership, it will be a seismic shift across the industry "
This program continues Whole Foods leadership in building accountability into the food they sell. Theirs were the first major supermarkets to promote organic food by prominently displaying organic labels on products and store shelf promotions, while educating consumers about the benefits of organic. Now other retailers and restaurants such as Chipotle<http://www.chipotle.com/en-us/menu/ingredients_statement/ingredients_statement.aspx> are following suit.
An issue the standards don't appear to address is local food procurement, despite the fact that Whole Foods was an early adopter in labeling and promoting local produce. This was one of the major criticisms of Whole Foods in The Omnivore's Dilemma<http://michaelpollan.com/books/the-omnivores-dilemma/>, a 2006 book by journalist Michael Pollan<http://michaelpollan.com> that helped increase public awareness of the issues of industrial versus sustainable food production. It is an area in which Whole Foods still faces heat because many of their regions struggle with getting adequate quantities of locally sourced fruits and vegetables.
"One of the biggest challenges we face is building a supply chain of sustainably grown, regionally produced fruit and vegetables. Most small farms don't have the capacity to sell us nearly enough food to supply 43 stores," says Michael Bashaw<http://media.wholefoodsmarket.com/experts/regional-leadership/michael-bashaw>, Whole Foods Midwest regional president. "To address this, we will be working with food hubs and other aggregators to build our offerings of local food. In addition, the new produce standards and labeling will also give our produce buyers more motivation to increase the local, organic, and sustainable options for our customers."
[WFMmeatcase]<http://civileats.com/wp-content/uploads/2013/10/WFMmeatcase.jpg>
Some think the Whole Foods' produce standards will have an effect similar to its animal welfare standards. Whole Foods first developed a defined set of standards for certification and then launched the non-profit Global Animal Partnership<http://www.globalanimalpartnership.org/> (GAP) to administer the system. Their standards include:
Step 1: Prohibits cages and crates to confine livestock.
Step 2: Requires environmental enrichment for indoor production systems.
Step 3: Outdoor access.
Step 4: Pasture-based production.
Step 5: An animal-centered approach with all physical alterations prohibited.
Step 5+: The entire life of the animal spent on an integrated farm.
The GAP system is now being adopted by many producers who want access to customers who care, often deeply, about how farm animals are raised. For example, when Tyson Foods, Inc.<http://www.tyson.com/>, the Arkansas-based producer that is one of the nation's largest poultry corporations, launched<http://www.journalpatriot.com/news/article_b6eaca84-8820-11e2-9de2-0019bb30f31a.html> an antibiotic-free chicken line, it was certified by GAP as Step 2.
The meat case at Whole Foods stores indicates where the food was produced and the standard under which it falls.
"Whole Foods did a great job in engaging producers in developing this standard," says George Siemon,<http://www.organicvalley.coop/?id=688> CEO of Organic Valley<http://www.organicvalley.coop/>, a billion-dollar farmer-owned organic cooperative based in Wisconsin that mainly produces dairy and meat products. Siemon, who also is a board member of Global Animal Partnership. "The system allows producers to positively differentiate themselves and move up in ratings, which can provide them access to new markets and sometimes better pricing for their products. I can see how the new produce standards will have a similar effect and help smaller organic producers with strong sustainability, labor, and pest management practices to expand and gain new markets."
The retailer also played a key role in developing the Marine Stewardship Council<http://www.msc.org/> (MSC) and became the first major retailer to sell seafood certified as sustainable. "Committing to MSC-certified sustainable products and launching our comprehensive wild-caught seafood rating system has given us the infrastructure to provide full transparency to help our shoppers make informed decisions that support the future health of our oceans," says Margaret Wittenberg,<http://www.wholekidsfoundation.org/about/leadership-members/margaret-wittenberg-bio> global vice-president of quality standards for Whole Foods Market. Wittenberg was an early MSC Board member and key driver of its success.
Whole Foods took this to another level by working with the Monterey Bay Aquarium<http://www.montereybayaquarium.org/> in Monterey, Calif., and its Seafood Watch<http://www.montereybayaquarium.org/cr/seafoodwatch.aspx> program, as well as the Blue Ocean Institute<http://blueocean.org/programs/sustainable-seafood-program/>, to implement a three-tiered color-coded standard for seafood sold at its stores: best (green), good (yellow), and avoid (red). On Earth Day in April 2012, Whole Foods banned the sale of non-sustainable seafood<http://www.huffingtonpost.com/2012/04/23/whole-foods-seafood-ban-sustainable-fish_n_1446071.html> bearing the red label. This program has played a key role in influencing the seafood-buying practices of restaurants, institutions, individual consumers, and most of the large-scale supermarkets in America.
The best example of this is Walmart<http://www.walmart.com/>, the mega-retailer that followed WFM's lead in sustainable seafood<http://corporate.walmart.com/global-responsibility/environment-sustainability/sustainable-seafood>. It now requires "all fresh and frozen, farmed and wild seafood suppliers to become third-party certified as sustainable using Marine Stewardship Council (MSC), Best Aquaculture Practices<http://www.gaalliance.org/bap/standards.php> (BAP) or equivalent standards. . . all uncertified fisheries and aquaculture suppliers must be actively working toward certification."
Walmart's statement continues, "As of January 31, 2012, 76 percent of our fresh, frozen, farmed and wild seafood suppliers were third-party certified and an additional 8 percent had developed the required certification plans."
The truth is that Whole Foods, while not uncontroversial, has been a market leader on sustainability issues for years. It's unlikely that conventional supermarket chains would have nearly as many organic or otherwise sustainably produced items in stock had the issue not been forced by this rapidly growing retail competitor. The good food movement will benefit if Whole Foods' produce ratings similarly bear fruit.
Originally published at Good Food on Every Table<http://goodfoodoneverytable.com/2013/10/07/whole-foods-new-produce-ratings-transparency-bears-fruit/>
Wednesday, October 16, 2013
Myths, Presumptions, and Facts about Obesity
Myths, Presumptions, and Facts about Obesity. N Engl J Med 2013; 368:446-454 January 31, 2013 DOI: 10.1056/NEJMsa1208051 “Passionate interests, the human tendency to seek explanations for observed phenomena, and everyday experience appear to contribute to strong convictions about obesity, despite the absence of supporting data. When the public, mass media, government agencies, and even academic scientists espouse unsupported beliefs, the result may be ineffective policy, unhelpful or unsafe clinical and public health recommendations, and an unproductive allocation of resources. In this article, we review some common beliefs about obesity that are not supported by scientific evidence and also provide some useful evidence-based concepts. We define myths as beliefs held to be true despite substantial refuting evidence, presumptions as beliefs held to be true for which convincing evidence does not yet confirm or disprove their truth, and facts as propositions backed by sufficient evidence to consider them empirically proved for practical purposes.” |
Thursday, October 10, 2013
Why are doctors afraid to tell fat people they're fat?
Obesity is not a disease. Pretending otherwise will stoke an epidemic and crush the NHS
Why are doctors afraid to tell fat people they're fat?
13 Comments<http://www.spectator.co.uk/features/9049971/the-battle-of-the-bulge/#comments> Max Pemberton<http://www.spectator.co.uk/author/maxpemberton/> 12 October 2013
'Well, what diets have you tried so far?' asked the GP, flicking through the patient's notes. I was an innocent trainee doctor on my general practice placement at the time and watched the interaction carefully, sensing a row was about to ensue. 'Look, I don't want to go on a diet, I want you to prescribe me these,' snapped the patient, bringing out a neatly folded page she had torn out of a magazine. The GP, rolling his eyes at me, took the paper but didn't read it. I suspected he'd read it before. This was yet another example of what's becoming a very British epidemic: obesity being self-diagnosed as disease.
The doctor attempted to explain that tablets really aren't suitable in her case. As well as having some potentially nasty side effects, they're expensive to prescribe, and don't offer a long-term solution. This was clearly not what the woman wanted to hear. 'Fine then, don't help me, see if I care. I'll get my sister to get them off her GP — he gives her whatever she wants'; and she stormed out. It struck me as bizarre that while some people using the NHS are dangerously malnourished, other people are desperate to take tablets to ensure that their food passes through their body unabsorbed, while the taxpayer foots the bill.
It happens all the time. The patients who are not interested in changing their diet in any way, demanding to have their cake, eat it and then pop a pill so that the calories never touch their waistline. And as a result, Britain now combines austerity with obesity. The majority of us are now overweight or obese — a third of children are considered too heavy. It costs an extra £5 billion a year, and 300 hospital admissions a day are directly due to obesity. To pick up the newspapers is to witness a country adjusting itself to losing a national battle of the bulge.
Take the East Midlands Ambulance Service. It emerged this week that it has been picking up so many fat patients — weighing in excess of the 28-stone maximum — that it needs a new fleet. It has, hitherto, been struggling along with just one ambulance for fatties (a 'bariatric' vehicle), but now thinks all 272 of its ambulances need to be upgraded with double-wide stretchers for patients who (it says) can weigh in at 55 stone. The plan will cost £27 million.
Once the obese patient is in hospital, a whole new set of equipment is required: reinforced operating tables, sturdier trollies, longer needles and even wider MRI scanners. There is a great demand for bariatric surgeons. One of them, Sally Norton, recently wrote in the Royal College of Surgeons' house journal that without special equipment for the obese, there may be 'enquiries into the potential use of veterinary or zoological scanners, with resultant loss of dignity for the patient'. There is a cost to all this: in the kit, and in operations like gastric bypass operations, which have increased sevenfold over the last seven years.
Moving obese patients out of their house can be too difficult for the NHS. Recently the fire service had to demolish two walls of a house in south Wales so that a 63-stone teenager could be taken to hospital. This required more than 40 emergency service workers at an estimated cost of £100,000. Over the past five years, fire services have been called to more than 2,700 incidents to assist 'severely obese' people, including some who had got stuck in the bath. Rescuing fatties is now a routine operation, with its own entry in the Fire Brigade incident reporting system (filed under 'bariatric persons').
So what to do? The government spends money asking us to eat 'five a day' fruit and veg, but it seems to have no effect. Nottingham, the fattest region in Britain, recently decided to spend £500,000 on replacing pavements in areas with particularly fat pedestrians, to try and encourage people to walk more. Our landscape is being, quite literally, reshaped in order to accommodate the obese. In the past few years, we have moved from being outraged about the epidemic to just planning around it. Like a middle-aged man deciding to eat what he wants and let himself go, Britain is pulling on a pair of tracksuit bottoms and heading to the fridge.
It need not be this way. For too long, my fellow doctors have pussyfooted around their obese patients, too scared to confront the, er, elephant in the room. They don't want to cause offence. Unbelievably, draft guidelines announced last year by the National Institute of Clinical Excellence and Health (Nice) suggested that doctors should even avoid the use of the term 'obese' for fear that larger patients might be upset. Instead, Nice recommended advising corpulent patients that they should seek a 'healthier weight'.
But nice euphemisms mean that people don't confront reality. I'm not going to stop diagnosing cancer just because people don't like hearing the dreaded word. So why should it be different when informing people that they are obese? Sometimes morbidly so. What Nice is delicately skirting round is what many doctors, nurses and dieticians will confirm: people don't like being told that they are overweight, even if it's objectively clearly the case. And by pretending that this is a disease, the doctors are making it even worse.
['He should just be grateful he wasn't turned into lasagne.']
'He should just be grateful he wasn't turned into lasagne.'
There's something comforting about blaming obesity on genes. It enables people to relinquish responsibility for their weight, which can be seen as outside their control. It's nothing new, either. Years ago, fat people blamed their 'glands'. When I started medical school, I patiently waited for us to be taught about these magical 'glands' that made people fat. I'm still waiting. Even when people have problems with an underactive thyroid, which can slow the metabolism and result in weight gain, this can be treated with thyroid replacement tablets and the metabolism returns to normal. As a rule, however, fat people have one thing in common: they eat more than they need to.
Certainly some people metabolise food at a different rate to others, meaning they are more likely to lay down fat stores than other people. But this is a reason to eat less, not to become fat. You cannot get away from the basic biology of the human body — fat is simply stored excess energy, and weight gain is only possible when the total amount of energy consumed exceeds the total amount of energy expended. Even those who have a genetic predisposition to become fat are not slaves to their DNA.
An in-depth study published last year, which looked at the genes of more than 20,000 people and was conducted at the Medical Research Council's epidemiology unit in Cambridge, found some people are predisposed to be overweight. But an active lifestyle and reducing food intake can counteract that. Simple. While some will be annoyed by this research, I find it empowering. The idea that our genes control us is profoundly depressing. After all, there is more to being human than a few strands of DNA.
The rate of people considered clinically obese has risen from around 1 to 2 per cent of the population in the 1960s to over 25 per cent now. Why? A simple answer would be lifestyle, but it's actually a little more complicated. A fascinating survey conducted by the Department of Health compared data collected from 1967 and 2010. It showed that, while people back then were slimmer, they ate fattier foods and had access to far fewer gyms. We eat better now, we work out more. But we live relatively sedentary lives. Only three out of ten households had a car then, compared to seven out of ten now. While 75 per cent of people walked for at least half an hour a day in the 1960s, this is only about 40 per cent now.
What really stands out, more than the lifestyle differences, is the sharp contrast in the attitudes towards obesity between the two different eras. The 1967 survey found that nine out of ten people had attempted to lose weight in the past year, compared with barely half of adults questioned in 2010. Perhaps most tellingly though, 40 years ago only 7 per cent of those people who considered themselves overweight had failed to do anything about it, compared with nearly half now.
It would be easy to blame Britain's fatness on lifestyle changes, but the worst of it is attitude. People just aren't bothering to lose weight any more. Perhaps obesity is viewed as more normal. But this is also down to the attitude that we doctors increasingly encounter in our consulting rooms: the reluctance of patients to accept that ailments can be blamed on their behaviour, for which they are reluctant to take responsibility.
Patients blame obesity on the government, cunning food manufacturers, their parents and their genes. They demand fat-loss pills on the NHS and stomach-stapling surgery as a right. In a world where health care is becoming consumerised, patients see themselves as customers. There's not much demand for hard truths.
America has severe obesity problems, and seems resigned to them. But Britain has a National Health Service, and therefore a far higher capacity to change. It ought to be easy. Doctors should be required to tell patients a blunt truth: if you're fat, eat less, exercise more, or both. And if you keep guzzling the tasty treats, you will die earlier. It's not a disease, it's a mindset — and that means it can be changed. We doctors need to be a little less understanding, a little more judgmental, and realise that our oath — 'do no harm' — must come before our desire to save the feelings of our patients. The truth can be the hardest drug to administer. But holding our tongues, prescribing the fat pills and bankrupting the NHS in the process is the worst solution of all.
This article first appeared in the print edition of The Spectator magazine, dated 12 October 2013<http://www.spectator.co.uk/issues/12-october-2013/>
Why are doctors afraid to tell fat people they're fat?
13 Comments<http://www.spectator.co.uk/features/9049971/the-battle-of-the-bulge/#comments> Max Pemberton<http://www.spectator.co.uk/author/maxpemberton/> 12 October 2013
'Well, what diets have you tried so far?' asked the GP, flicking through the patient's notes. I was an innocent trainee doctor on my general practice placement at the time and watched the interaction carefully, sensing a row was about to ensue. 'Look, I don't want to go on a diet, I want you to prescribe me these,' snapped the patient, bringing out a neatly folded page she had torn out of a magazine. The GP, rolling his eyes at me, took the paper but didn't read it. I suspected he'd read it before. This was yet another example of what's becoming a very British epidemic: obesity being self-diagnosed as disease.
The doctor attempted to explain that tablets really aren't suitable in her case. As well as having some potentially nasty side effects, they're expensive to prescribe, and don't offer a long-term solution. This was clearly not what the woman wanted to hear. 'Fine then, don't help me, see if I care. I'll get my sister to get them off her GP — he gives her whatever she wants'; and she stormed out. It struck me as bizarre that while some people using the NHS are dangerously malnourished, other people are desperate to take tablets to ensure that their food passes through their body unabsorbed, while the taxpayer foots the bill.
It happens all the time. The patients who are not interested in changing their diet in any way, demanding to have their cake, eat it and then pop a pill so that the calories never touch their waistline. And as a result, Britain now combines austerity with obesity. The majority of us are now overweight or obese — a third of children are considered too heavy. It costs an extra £5 billion a year, and 300 hospital admissions a day are directly due to obesity. To pick up the newspapers is to witness a country adjusting itself to losing a national battle of the bulge.
Take the East Midlands Ambulance Service. It emerged this week that it has been picking up so many fat patients — weighing in excess of the 28-stone maximum — that it needs a new fleet. It has, hitherto, been struggling along with just one ambulance for fatties (a 'bariatric' vehicle), but now thinks all 272 of its ambulances need to be upgraded with double-wide stretchers for patients who (it says) can weigh in at 55 stone. The plan will cost £27 million.
Once the obese patient is in hospital, a whole new set of equipment is required: reinforced operating tables, sturdier trollies, longer needles and even wider MRI scanners. There is a great demand for bariatric surgeons. One of them, Sally Norton, recently wrote in the Royal College of Surgeons' house journal that without special equipment for the obese, there may be 'enquiries into the potential use of veterinary or zoological scanners, with resultant loss of dignity for the patient'. There is a cost to all this: in the kit, and in operations like gastric bypass operations, which have increased sevenfold over the last seven years.
Moving obese patients out of their house can be too difficult for the NHS. Recently the fire service had to demolish two walls of a house in south Wales so that a 63-stone teenager could be taken to hospital. This required more than 40 emergency service workers at an estimated cost of £100,000. Over the past five years, fire services have been called to more than 2,700 incidents to assist 'severely obese' people, including some who had got stuck in the bath. Rescuing fatties is now a routine operation, with its own entry in the Fire Brigade incident reporting system (filed under 'bariatric persons').
So what to do? The government spends money asking us to eat 'five a day' fruit and veg, but it seems to have no effect. Nottingham, the fattest region in Britain, recently decided to spend £500,000 on replacing pavements in areas with particularly fat pedestrians, to try and encourage people to walk more. Our landscape is being, quite literally, reshaped in order to accommodate the obese. In the past few years, we have moved from being outraged about the epidemic to just planning around it. Like a middle-aged man deciding to eat what he wants and let himself go, Britain is pulling on a pair of tracksuit bottoms and heading to the fridge.
It need not be this way. For too long, my fellow doctors have pussyfooted around their obese patients, too scared to confront the, er, elephant in the room. They don't want to cause offence. Unbelievably, draft guidelines announced last year by the National Institute of Clinical Excellence and Health (Nice) suggested that doctors should even avoid the use of the term 'obese' for fear that larger patients might be upset. Instead, Nice recommended advising corpulent patients that they should seek a 'healthier weight'.
But nice euphemisms mean that people don't confront reality. I'm not going to stop diagnosing cancer just because people don't like hearing the dreaded word. So why should it be different when informing people that they are obese? Sometimes morbidly so. What Nice is delicately skirting round is what many doctors, nurses and dieticians will confirm: people don't like being told that they are overweight, even if it's objectively clearly the case. And by pretending that this is a disease, the doctors are making it even worse.
['He should just be grateful he wasn't turned into lasagne.']
'He should just be grateful he wasn't turned into lasagne.'
There's something comforting about blaming obesity on genes. It enables people to relinquish responsibility for their weight, which can be seen as outside their control. It's nothing new, either. Years ago, fat people blamed their 'glands'. When I started medical school, I patiently waited for us to be taught about these magical 'glands' that made people fat. I'm still waiting. Even when people have problems with an underactive thyroid, which can slow the metabolism and result in weight gain, this can be treated with thyroid replacement tablets and the metabolism returns to normal. As a rule, however, fat people have one thing in common: they eat more than they need to.
Certainly some people metabolise food at a different rate to others, meaning they are more likely to lay down fat stores than other people. But this is a reason to eat less, not to become fat. You cannot get away from the basic biology of the human body — fat is simply stored excess energy, and weight gain is only possible when the total amount of energy consumed exceeds the total amount of energy expended. Even those who have a genetic predisposition to become fat are not slaves to their DNA.
An in-depth study published last year, which looked at the genes of more than 20,000 people and was conducted at the Medical Research Council's epidemiology unit in Cambridge, found some people are predisposed to be overweight. But an active lifestyle and reducing food intake can counteract that. Simple. While some will be annoyed by this research, I find it empowering. The idea that our genes control us is profoundly depressing. After all, there is more to being human than a few strands of DNA.
The rate of people considered clinically obese has risen from around 1 to 2 per cent of the population in the 1960s to over 25 per cent now. Why? A simple answer would be lifestyle, but it's actually a little more complicated. A fascinating survey conducted by the Department of Health compared data collected from 1967 and 2010. It showed that, while people back then were slimmer, they ate fattier foods and had access to far fewer gyms. We eat better now, we work out more. But we live relatively sedentary lives. Only three out of ten households had a car then, compared to seven out of ten now. While 75 per cent of people walked for at least half an hour a day in the 1960s, this is only about 40 per cent now.
What really stands out, more than the lifestyle differences, is the sharp contrast in the attitudes towards obesity between the two different eras. The 1967 survey found that nine out of ten people had attempted to lose weight in the past year, compared with barely half of adults questioned in 2010. Perhaps most tellingly though, 40 years ago only 7 per cent of those people who considered themselves overweight had failed to do anything about it, compared with nearly half now.
It would be easy to blame Britain's fatness on lifestyle changes, but the worst of it is attitude. People just aren't bothering to lose weight any more. Perhaps obesity is viewed as more normal. But this is also down to the attitude that we doctors increasingly encounter in our consulting rooms: the reluctance of patients to accept that ailments can be blamed on their behaviour, for which they are reluctant to take responsibility.
Patients blame obesity on the government, cunning food manufacturers, their parents and their genes. They demand fat-loss pills on the NHS and stomach-stapling surgery as a right. In a world where health care is becoming consumerised, patients see themselves as customers. There's not much demand for hard truths.
America has severe obesity problems, and seems resigned to them. But Britain has a National Health Service, and therefore a far higher capacity to change. It ought to be easy. Doctors should be required to tell patients a blunt truth: if you're fat, eat less, exercise more, or both. And if you keep guzzling the tasty treats, you will die earlier. It's not a disease, it's a mindset — and that means it can be changed. We doctors need to be a little less understanding, a little more judgmental, and realise that our oath — 'do no harm' — must come before our desire to save the feelings of our patients. The truth can be the hardest drug to administer. But holding our tongues, prescribing the fat pills and bankrupting the NHS in the process is the worst solution of all.
This article first appeared in the print edition of The Spectator magazine, dated 12 October 2013<http://www.spectator.co.uk/issues/12-october-2013/>
Tuesday, October 1, 2013
We Don¹t Know What to Eat
We Don't Know What to Eat
How bad science created a misinformed national diet—and did nothing to slow the growth of obesity.
http://www.psmag.com/health/dont-know-eat-66727/
[http://d1435t697bgi2o.cloudfront.net/wp-content/uploads/2013/09/plate-of-food.jpg]
(PHOTO: SUZANNA BARZAGHI/SHUTTERSTOCK<http://www.shutterstock.com/>)
September 25, 2013 • By Aaron Gordon<http://www.psmag.com/author/aaron-gordon/> • 5 Comments<http://www.psmag.com/health/dont-know-eat-66727/#disqus_thread>
If you go to the National Institute of Health's website today, you will find a section on a "Healthy Eating Plan<http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/calories.htm>." That plan recommends a diet "low in saturated fats, trans fat, cholesterol, salt, and added sugars, and controls portion sizes." These recommendations may well have been copied and pasted from 1977.
Nothing has changed over the past 36 years, except for this: everyone is fatter.
The U.S. government began issuing dietary guidelines in 1977, when the Senate Select Committee on Nutrition and Human Needs, led by Senator George McGovern, issued the first dietary recommendations for the American people<http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/DGAC/Report/E-Appendix-E-4-History.pdf>. Although these recommendations were made some 36 years ago, you probably recognize them immediately: "Increase consumption of complex carbohydrates and 'naturally occurring sugars;' and reduce consumption of refined and processed sugars, total fat, saturated fat, cholesterol, and sodium." And those should sound identical to your doctor's advice: decreased consumption of refined and processed sugars; foods high in total and animal fat, eggs, butterfat, and other high-cholesterol foods; and foods high in salt.
There's little to no good science behind our diet.
According to the Centers for Disease Control, obesity has more than doubled among adults since these dietary recommendations were put in place in the 1970s, and as of 2010<http://www.cdc.gov/nchs/fastats/overwt.htm>, more than one-third of Americans were obese. Over the same time, the rate of diabetes has quadrupled, up to eight percent of the population<http://www.cdc.gov/diabetes/statistics/prev/national/figadults.htm> in 2011. Clearly, something hasn't been going according to plan.
Perhaps you've witnessed someone struggle with a diet, or struggled yourself. It's not just stuff of TV shows; people breaking down, sobbing, wishing they looked differently and trying incredibly hard but it just isn't working. This happens to real people, millions of them. It seems odd and a bit heartless to assert that this meteoric rise in obesity and associated diseases is a result of people not trying hard enough.
But there's another explanation, one that's gaining traction across the scientific community. Maybe the science behind this diet was bad, and the decision to launch the country into the diet was a poor one, and the non-decision to back off in the face of contradictory evidence even worse. At its most charitable, these experts say, it was a bad experiment. At its worst, it was a crime that has cost millions of lives, and the toll keeps rising.
THE SENATE SELECT COMMITTEE on Nutrition and Human Needs based their recommendations largely on the Seven Countries Study, which was first published in 1970 and led by University of Minnesota researcher Ancel Keys, whose findings were affirmed by several subsequent, large-scale studies such as the Nurses' Health Study, which found that high saturated-fat diets were related to high cholesterol, and higher cholesterol in turn led to higher risks of obesity, heart attack, stroke, heart disease, and mortality. The Seven Countries Study painted a direct link between dietary fat, misery, and death—and that's been the story ever since.
But there were issues from the start.
"Keys chose seven countries he knew in advance would support his hypothesis," Gary Taubes wrote in Good Calories, Bad Calories: Fat, Carbs, and the Controversial Science of Diet and Health<http://www.amazon.com/Good-Calories-Bad-Controversial-Science/dp/1400033462>. "Had Keys chosen at random, or, say, chosen France and Switzerland rather than Japan and Finland, he would likely have seen no effect from saturated fat, and there might be no such thing today as the French paradox—a nation that consumes copious saturated fat but has comparatively little heart disease."
Zoe Harcombe, author of the Obesity Epidemic: What Caused It? How Can We Stop It?, also found<http://www.zoeharcombe.com/2010/11/cholesterol-heart-disease-%E2%80%93-there-is-a-relationship-but-it%E2%80%99s-not-what-you-think/>, using World Health Organization data, that not only is there no statistical correlation between mean cholesterol levels and mortality, but there's no positive relationship whatsoever.
"Cholesterol (and protein and phospholipids and triglyceride—the four substances found in all lipoproteins) is found at the scene of damage to arteries," Harcombe told me, "but the four vital components of lipoproteins are there to repair that damage. They did not cause the damage any more than police caused the crime when they are found at the scene of that crime."
According to Harcombe and Taubes, Keys used cherry-picked data to reach a logically-flawed conclusion, but it was the biggest study available, so George McGovern jumped on it because, in his words, "Senators don't have the luxury that a research scientist does of waiting until every last shred of evidence is in."
But what about the studies that affirmed the Seven Countries research?
FOUNDED IN 1976—A year before McGovern's recommendations—the Nurses' Health Study takes surveys of nurses' health habits. These types of studies—including the Seven Countries Study—are called "observational studies," and they can only tell us so much. The first Nurses' Health Study followed 121,700 nurses between the ages 30 and 55 between 1976 and 1989, a massive sample that is sure to capture a wide variety of individuals. But the conclusions ignore this and instead focus on individual effects, even though the participants were free to live their lives as they wanted during the 13 years of the study. Nothing was controlled; all health-related variables were in play.
Taubes outlined one of the chief issues with such a study in a 2007 New York Times Magazine article, which he quoted in this blog post<http://garytaubes.com/2012/03/science-pseudoscience-nutritional-epidemiology-and-meat/>. It's known as the "compliance effect."
Quite simply, people who comply with their doctors' orders when given a prescription are different and healthier than people who don't. This difference may be ultimately unquantifiable. The compliance effect is another plausible explanation for many of the beneficial associations that epidemiologists commonly report, which means this alone is a reason to wonder if much of what we hear about what constitutes a healthful diet and lifestyle is misconceived.
This Nurses' Health Study, then, is only really telling us who leads a healthy lifestyle and who doesn't.
The worst of it is, we still make these elementary mistakes. In 2012, a study was released that supposedly affirmed red meat's link to death, cancer, and heart risk<http://www.bbc.co.uk/news/health-17345967>. When Harcombe looked at the actual data, she found the same thing as the Nurses' Health Study: correlations that simply don't tell us anything<http://www.zoeharcombe.com/2012/03/red-meat-mortality-the-usual-bad-science/>. Some excerpts from her analysis:
• "As red & processed meat consumption increases, so exercise falls. Could lack of exercise impact mortality?"
• "As red & processed meat consumption increases, so does BMI. Could BMI impact mortality?"
• "As red & processed meat consumption increases, so does smoking – the top quintile virtually three times higher than the lowest. Could smoking impact mortality?"
• "As red & processed meat consumption increases, so does diabetes. Could diabetes impact mortality?"
• "As red & processed meat consumption increases, so does calorie intake. Could calorie intake impact mortality?"
• "As red & processed meat consumption increases, so does alcohol intake. Could alcohol intake impact mortality?"
So instead of possibly linking exercise, Body Mass Index, diabetes, smoking, caloric intake, or alcohol intake to mortality, the conclusion was that, no, it is red meat that impacts mortality. It's the compliance effect, again. To isolate red meat as the culprit is to ignore variables the researchers were not controlling for. It is, in short, bad science.
"The Nurses Health Study showed exactly the same correlations—the numbers were slightly different but the trends were the same," Harcombe wrote in her analysis of the 2012 red meat study. "As red and processed meat consumption increased so exercise and high cholesterol fell; BMI, smoking, diabetes, calorie intake and alcohol intake all increased."
Furthermore, according to the Nutrition Science Initiative<http://nusi.org/>, a foundation co-created by Taubes to yield better science behind epidemiology, the purported results from these landmark studies have never been consistently replicated in controlled environments. There's little to no good science behind our diet.
So if our recommended diet is faulty, what should we eat? This is where the real harm of the last 35 years of questionable science comes to the forefront: we simply don't know yet. When you spend the better part of three decades chasing a ghost, all you're left with is a pretty good idea that there is no ghost. The medical community's dedication to these established diets had led us burrowing deeper into the same rabbit hole, rarely exploring new pathways.
We have to eat, though, so when asked for dietary advice, experts need to say something. And that brings us right back to theories.
As he wrote in Why We Get Fat: And What To Do About It<http://www.amazon.com/Why-We-Get-Fat-About/dp/0307474259>, Taubes believes a high-fat, moderate protein diet is the best one, because insulin triggers hormones that put fat in our fat tissue, and a bit ironically, fat is the one nutrient that doesn't trigger insulin secretion. Harcombe told me the root of a good diet is avoiding foods that didn't exist before the obesity epidemic. Or: "eating real food. Meat, eggs and dairy foods from pasture living animals; fish; vegetables; salads; nuts/seeds; fruits in season—that's the basis of a good diet." You're likely to encounter other diets that purport to have the answers as well. They may or they may not, but at least we can be pretty sure of one diet that doesn't work. It only took us three decades and an epidemic to prove it.
How bad science created a misinformed national diet—and did nothing to slow the growth of obesity.
http://www.psmag.com/health/dont-know-eat-66727/
[http://d1435t697bgi2o.cloudfront.net/wp-content/uploads/2013/09/plate-of-food.jpg]
(PHOTO: SUZANNA BARZAGHI/SHUTTERSTOCK<http://www.shutterstock.com/>)
September 25, 2013 • By Aaron Gordon<http://www.psmag.com/author/aaron-gordon/> • 5 Comments<http://www.psmag.com/health/dont-know-eat-66727/#disqus_thread>
If you go to the National Institute of Health's website today, you will find a section on a "Healthy Eating Plan<http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/calories.htm>." That plan recommends a diet "low in saturated fats, trans fat, cholesterol, salt, and added sugars, and controls portion sizes." These recommendations may well have been copied and pasted from 1977.
Nothing has changed over the past 36 years, except for this: everyone is fatter.
The U.S. government began issuing dietary guidelines in 1977, when the Senate Select Committee on Nutrition and Human Needs, led by Senator George McGovern, issued the first dietary recommendations for the American people<http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/DGAC/Report/E-Appendix-E-4-History.pdf>. Although these recommendations were made some 36 years ago, you probably recognize them immediately: "Increase consumption of complex carbohydrates and 'naturally occurring sugars;' and reduce consumption of refined and processed sugars, total fat, saturated fat, cholesterol, and sodium." And those should sound identical to your doctor's advice: decreased consumption of refined and processed sugars; foods high in total and animal fat, eggs, butterfat, and other high-cholesterol foods; and foods high in salt.
There's little to no good science behind our diet.
According to the Centers for Disease Control, obesity has more than doubled among adults since these dietary recommendations were put in place in the 1970s, and as of 2010<http://www.cdc.gov/nchs/fastats/overwt.htm>, more than one-third of Americans were obese. Over the same time, the rate of diabetes has quadrupled, up to eight percent of the population<http://www.cdc.gov/diabetes/statistics/prev/national/figadults.htm> in 2011. Clearly, something hasn't been going according to plan.
Perhaps you've witnessed someone struggle with a diet, or struggled yourself. It's not just stuff of TV shows; people breaking down, sobbing, wishing they looked differently and trying incredibly hard but it just isn't working. This happens to real people, millions of them. It seems odd and a bit heartless to assert that this meteoric rise in obesity and associated diseases is a result of people not trying hard enough.
But there's another explanation, one that's gaining traction across the scientific community. Maybe the science behind this diet was bad, and the decision to launch the country into the diet was a poor one, and the non-decision to back off in the face of contradictory evidence even worse. At its most charitable, these experts say, it was a bad experiment. At its worst, it was a crime that has cost millions of lives, and the toll keeps rising.
THE SENATE SELECT COMMITTEE on Nutrition and Human Needs based their recommendations largely on the Seven Countries Study, which was first published in 1970 and led by University of Minnesota researcher Ancel Keys, whose findings were affirmed by several subsequent, large-scale studies such as the Nurses' Health Study, which found that high saturated-fat diets were related to high cholesterol, and higher cholesterol in turn led to higher risks of obesity, heart attack, stroke, heart disease, and mortality. The Seven Countries Study painted a direct link between dietary fat, misery, and death—and that's been the story ever since.
But there were issues from the start.
"Keys chose seven countries he knew in advance would support his hypothesis," Gary Taubes wrote in Good Calories, Bad Calories: Fat, Carbs, and the Controversial Science of Diet and Health<http://www.amazon.com/Good-Calories-Bad-Controversial-Science/dp/1400033462>. "Had Keys chosen at random, or, say, chosen France and Switzerland rather than Japan and Finland, he would likely have seen no effect from saturated fat, and there might be no such thing today as the French paradox—a nation that consumes copious saturated fat but has comparatively little heart disease."
Zoe Harcombe, author of the Obesity Epidemic: What Caused It? How Can We Stop It?, also found<http://www.zoeharcombe.com/2010/11/cholesterol-heart-disease-%E2%80%93-there-is-a-relationship-but-it%E2%80%99s-not-what-you-think/>, using World Health Organization data, that not only is there no statistical correlation between mean cholesterol levels and mortality, but there's no positive relationship whatsoever.
"Cholesterol (and protein and phospholipids and triglyceride—the four substances found in all lipoproteins) is found at the scene of damage to arteries," Harcombe told me, "but the four vital components of lipoproteins are there to repair that damage. They did not cause the damage any more than police caused the crime when they are found at the scene of that crime."
According to Harcombe and Taubes, Keys used cherry-picked data to reach a logically-flawed conclusion, but it was the biggest study available, so George McGovern jumped on it because, in his words, "Senators don't have the luxury that a research scientist does of waiting until every last shred of evidence is in."
But what about the studies that affirmed the Seven Countries research?
FOUNDED IN 1976—A year before McGovern's recommendations—the Nurses' Health Study takes surveys of nurses' health habits. These types of studies—including the Seven Countries Study—are called "observational studies," and they can only tell us so much. The first Nurses' Health Study followed 121,700 nurses between the ages 30 and 55 between 1976 and 1989, a massive sample that is sure to capture a wide variety of individuals. But the conclusions ignore this and instead focus on individual effects, even though the participants were free to live their lives as they wanted during the 13 years of the study. Nothing was controlled; all health-related variables were in play.
Taubes outlined one of the chief issues with such a study in a 2007 New York Times Magazine article, which he quoted in this blog post<http://garytaubes.com/2012/03/science-pseudoscience-nutritional-epidemiology-and-meat/>. It's known as the "compliance effect."
Quite simply, people who comply with their doctors' orders when given a prescription are different and healthier than people who don't. This difference may be ultimately unquantifiable. The compliance effect is another plausible explanation for many of the beneficial associations that epidemiologists commonly report, which means this alone is a reason to wonder if much of what we hear about what constitutes a healthful diet and lifestyle is misconceived.
This Nurses' Health Study, then, is only really telling us who leads a healthy lifestyle and who doesn't.
The worst of it is, we still make these elementary mistakes. In 2012, a study was released that supposedly affirmed red meat's link to death, cancer, and heart risk<http://www.bbc.co.uk/news/health-17345967>. When Harcombe looked at the actual data, she found the same thing as the Nurses' Health Study: correlations that simply don't tell us anything<http://www.zoeharcombe.com/2012/03/red-meat-mortality-the-usual-bad-science/>. Some excerpts from her analysis:
• "As red & processed meat consumption increases, so exercise falls. Could lack of exercise impact mortality?"
• "As red & processed meat consumption increases, so does BMI. Could BMI impact mortality?"
• "As red & processed meat consumption increases, so does smoking – the top quintile virtually three times higher than the lowest. Could smoking impact mortality?"
• "As red & processed meat consumption increases, so does diabetes. Could diabetes impact mortality?"
• "As red & processed meat consumption increases, so does calorie intake. Could calorie intake impact mortality?"
• "As red & processed meat consumption increases, so does alcohol intake. Could alcohol intake impact mortality?"
So instead of possibly linking exercise, Body Mass Index, diabetes, smoking, caloric intake, or alcohol intake to mortality, the conclusion was that, no, it is red meat that impacts mortality. It's the compliance effect, again. To isolate red meat as the culprit is to ignore variables the researchers were not controlling for. It is, in short, bad science.
"The Nurses Health Study showed exactly the same correlations—the numbers were slightly different but the trends were the same," Harcombe wrote in her analysis of the 2012 red meat study. "As red and processed meat consumption increased so exercise and high cholesterol fell; BMI, smoking, diabetes, calorie intake and alcohol intake all increased."
Furthermore, according to the Nutrition Science Initiative<http://nusi.org/>, a foundation co-created by Taubes to yield better science behind epidemiology, the purported results from these landmark studies have never been consistently replicated in controlled environments. There's little to no good science behind our diet.
So if our recommended diet is faulty, what should we eat? This is where the real harm of the last 35 years of questionable science comes to the forefront: we simply don't know yet. When you spend the better part of three decades chasing a ghost, all you're left with is a pretty good idea that there is no ghost. The medical community's dedication to these established diets had led us burrowing deeper into the same rabbit hole, rarely exploring new pathways.
We have to eat, though, so when asked for dietary advice, experts need to say something. And that brings us right back to theories.
As he wrote in Why We Get Fat: And What To Do About It<http://www.amazon.com/Why-We-Get-Fat-About/dp/0307474259>, Taubes believes a high-fat, moderate protein diet is the best one, because insulin triggers hormones that put fat in our fat tissue, and a bit ironically, fat is the one nutrient that doesn't trigger insulin secretion. Harcombe told me the root of a good diet is avoiding foods that didn't exist before the obesity epidemic. Or: "eating real food. Meat, eggs and dairy foods from pasture living animals; fish; vegetables; salads; nuts/seeds; fruits in season—that's the basis of a good diet." You're likely to encounter other diets that purport to have the answers as well. They may or they may not, but at least we can be pretty sure of one diet that doesn't work. It only took us three decades and an epidemic to prove it.
Saturday, September 21, 2013
Dinner Is Printed
Dinner Is Printed
By A. J. JACOBS
http://www.nytimes.com/2013/09/22/opinion/sunday/dinner-is-printed.html?ref=opinion&_r=0&pagewanted=print
THE hype over 3-D printing intensifies by the day. Will it save the world? Will it bring on the apocalypse, with millions manufacturing their own AK-47s? Or is it all an absurd hubbub about a machine that spits out chintzy plastic trinkets? I decided to investigate. My plan: I would immerse myself in the world of 3-D printing. I would live for a week using nothing but 3-D-printed objects — toothbrushes, furniture, bicycles, vitamin pills — in order to judge the technology’s potential and pitfalls.
I approached Hod Lipson, a Cornell engineering professor and one of the nation’s top 3-D printing experts, with my idea. He thought it sounded like a great project. It would cost me a mere $50,000 or so.
Unless I was going to 3-D print counterfeit Fabergé eggs for the black market, I’d need a Plan B.
Which is how I settled on the idea of creating a 3-D-printed meal. I’d make 3-D-printed plates, forks, place mats, napkin rings, candlesticks — and, of course, 3-D-printed food. Yes, cuisine can be 3-D printed, too. And, in fact, Mr. Lipson thinks food might be this technology’s killer app. (More on that later.)
I wanted to serve the meal to my wife as the ultimate high-tech romantic dinner date. A friend suggested that, to finish the evening off, we hire a Manhattan-based company that scans and makes 3-D replicas of your private parts. That’s where I drew the line.
As it turned out, the dinner was perhaps the most labor-intensive meal in history. But it did give me a taste of the future, in both its utopian and dystopian aspects.
In case you don’t subscribe to Wired, a 3-D printer is sort of like a hot-glue gun attached to a robotic arm. But instead of squeezing out glue, the tube extrudes plastic.
The shape is your choice. Using special software, you can design any object on your computer — say, a coffee mug with two handles — then load the file into the 3-D printer. You wait a couple of hours as the printer nozzle shuttles back and forth, oozing out melted plastic layer by layer until — voilà — your ambidextrous mug. Other types of printers work with metal, biological tissue, ceramics and food.
To its boosters, the 3-D printer is a revolution in the making. It will democratize manufacturing. Just as the Internet turned us all into couchbound Gutenbergs with the ability to publish to millions of readers with a single click, 3-D printers will turn us all into Henry Fords, Ralph Laurens and Daniel Bouluds. In the future, if you want a new pair of boots for that night’s party, just load in a nylon cartridge, choose a design, punch a button and slip them on.
OF course, the revolution isn’t here yet, at least not for home users. According to an industry consultant, Terry Wohlers of Wohlers Associates, only about 68,000 consumer printers have been sold. Most home users are hobbyists, and the geek factor remains high. The biggest chunk of the fast-growing $2.2 billion 3-D printing economy is industrial.
Food printing is so far a minor phenomenon, confined mostly to science fairs, universities and a handful of chocolate devotees. And, I hoped, me. But before I became a chef of the future, I’d need to make the plates and utensils.
I bought a Cube 3-D printer, perhaps the sleekest of the home gadgets. It looks like a sewing machine mated with a MacBook. It’s not cheap: $1,299, plus $49 dollars for each cartridge of plastic. I downloaded design software to my laptop and diagramed a fork. I clicked a button, and 20 minutes later, my “fork” emerged from my printer. It was a lopsided hunk of neon-green plastic with four sharp points at the end. It resembled something a chimp might use to extract termites.
Tony Cenicola/The New York Times
Tubes containing food pastes.
My next half-dozen tries weren’t much better. I printed a cup that leaked, an ice-cube tray that refused to release its cubes, and a spoon that unintentionally called to mind one of Salvador DalÃ's melted clocks. My wife, Julie, called my new cutlery drawer “the island of misfit utensils.”
In my defense, 3-D printing is surprisingly hard — a fact its advocates don’t dwell upon. So much can go wrong: The nozzle clogs, the machine overheats, the print pad tilts. In fact, Web sites like the blog Epic3DPrintingFail are devoted to photos of projects gone hilariously awry — including one box that looks as if it were the brainchild of a drunk Frank Gehry.
It’s also mind-numbingly slow. A teacup takes about four hours to print, accompanied by nonstop whirring. When I tried to design and print a replacement die for my son’s Monopoly game, it was a daylong project. My son helpfully pointed out that Amazon has one-click ordering.
That said, I did improve with practice. I was particularly proud of my wineglass, with its tapered cone. I became obsessed with the design software, spending hours squashing spheres and hollowing out cylinders. I downloaded some of the hundreds of free, publicly shared designs (though my wife nixed the Tetris-themed earrings).
I found myself almost giddy after every successful print: Yes, I created this napkin ring! I can make anything. I am a god and bright blue plastic is my universe!
The power can lead to narcissism. You think Americans in the Facebook era take excessive photos of ourselves? Get ready for selfie statues. At a 3-D printer store in NoHo run by Makerbot, you can get 3-D scans of your head (four cameras simultaneously snap photos of you from different angles). I got one of my 7-year-old son and printed a fist-size orange plastic bust of him. At home, we converted his head into a salt shaker for the dinner by poking a hole in the top of his plastic skull and adding some Morton’s.
If my table setting was going to look at all respectable, I’d need to call in the pros. I asked Mr. Lipson if I could hire him and his team to help.
What a difference a Ph.D. makes. They sent back blueprints for the cutlery — a fork and spoon made of lacy, spiraling steel. I told the engineers that my wife likes Italy, so they sent Italian-themed designs. A wineglass inspired by a Roman column, with Corinthian flourishes. A candleholder influenced by Venetian gondola poles, adorned with Julie’s favorite flower, the peony.
I showed the images to my wife. She paused. “You might have gone a little over the top with the Italian theme,” she said. “I think we have different agendas here. You want personalized designs that could only happen with 3-D printing. I want stuff we will actually use more than once.” Mr. Lipson printed most of my dinnerware at a New York-based company called Shapeways, which has fancy, cutting-edge 3-D printers that work with metal and ceramics. Again, it’s not cheap. The cost for my fork, for instance? $50.
I couldn’t afford a 3-D-printed dinner tuxedo, but Mr. Lipson offered to design a tie. “It’ll be a bit like chain mail,” he said. “I wouldn’t want to blow my nose on it. But it will work.” A few weeks later, the tie arrived: a long swath made entirely of white interlocking rings of nylon. I had trouble adjusting the tie, so I wore it loose and low, like a young banker after a few too many vodka tonics.
At last, meal day arrived. The Cube can print only plastic, not food, so I had called in my tech team.
At noon, Jeffrey I. Lipton — a 25-year-old Cornell Ph.D. candidate in engineering — arrived and unloaded boxes of equipment. Out came an air compressor, plastic tubes and bottles of xanthan gum, a food thickener. Our kitchen table was overtaken by a large 3-D printer that had been used for various other experiments — like printing artificial buttocks muscle for medical training.
“Don’t worry,” Mr. Lipton said. “It’s been cleaned.”
Mr. Lipson believes that the 3-D printer could be the most powerful kitchen tool ever created. You will have unlimited control over your meal’s shape, consistency, flavor and color. Just think of what it means for parents, he said: “What boy wouldn’t want to eat a Lamborghini, even if it’s made of broccoli?”
The most ardent supporters of 3-D-printed food have big ideas. NASA gave $125,000 to a Texas company to study 3-D-printed cuisine for astronauts. The benefit is, they could design a wide assortment of meals from shelf-stable ingredients.
There’s talk of embedding medicines in meals. In his book “Fabricated,” Mr. Lipson dreams of digitally driven dinners, where the printer uses your body’s up-to-the-minute data to create the perfect lasagna for your nutritional needs, with, say, extra protein or vitamin A.
Junk-food makers hope 3-D printing will allow them to patent a new way to combine salt, sugar and fat. Animal-rights activists hope printers will squeeze out pork chops made from the lab-grown stem cells of pigs. And idealists believe that the technology will help solve world hunger. The hope? We can more efficiently ship powdered food to developing countries, where it can be printed into a variety of meals. A group of Dutch researchers is working on inexpensive bases made from algae and insect protein.
When Mr. Lipson’s engineers were experimenting with printing food in 2009, they created artificial snacks made from gelatin and flavoring. The resulting food cubes — infused with banana and vanilla — were sampled by undergraduate volunteers. They were not a hit. “It was met with universal condemnation,” says Mr. Lipton. “It was very ‘Soylent Green.’ ”
Instead, the lab now squishes whole foods down into a paste that can be used as the printer’s ink. The menu for my dinner took weeks to figure out, balancing my wife’s tastes and the lab’s scientific constraints. “It needs to be something processed,” said Mr. Lipson. “Like quiche or meatloaf. It can’t be a salad or steak.”
Our final picks? Pizza, an eggplant dish, corn pasta and panna cotta.
Our pizza will be in the shape of Italy, a topographically correct replica of the country, complete with the Apennine Mountain range in the middle.
Mr. Lipton punched some codes into his laptop (e.g., 20 psi for air pressure), and the pizza dough began squirting out of a long tube.
The tomato sauce — which was thickened with xanthan gum to achieve the right viscosity — proved more challenging. “These oregano flakes are killing me,” Mr. Lipton said with a sigh, fiddling with the dial on the air compressor. The flakes were clogging up the tube’s nozzle, leading to what one onlooker called a Vesuvian eruption of red sauce in Northern Italy.
After extruding the cheese, the pizza was ready for heating. Future 3-D printers will most likely use lasers to zap the food. Mr. Lipton used a more traditional method: our oven.
Twenty minutes later, we had a pizza shaped like Italy, or at least Italy and its surrounding coastal waters (the dough rose with the heat, expanding the borders).
My wife and I put our slices on our 3-D-printed plates, cut a piece with our 3-D-printed forks. We clinked our 3-D-printed wineglasses and listened to some Sinatra playing (very faintly) on a plastic and rubber 3-D-printed speaker.
WE each took a bite. We raised our eyebrows. It tasted like the 22nd century. Actually, it tasted like a slightly chewier version of non-3-D-printed pizza. I wasn’t magically transported to the holo-deck of the Starship Enterprise, but it was good eating. In my wife’s opinion, almost as good as Patsy’s, which is high praise.
“We actually found that creating totally new taste sensations alarms people,” Mr. Lipson told me. “Humans are quite phobic that way. So we try to stick to tastes people are somewhat used to.”
Continuing with the carb-heavy theme, we next printed out corn-based noodles in the shape of our initials. They emerged from the nozzle in little squiggles, looking like a plateful of tiny beige Slinkies. They tasted like a more delicate version of angel-hair pasta.
Our side dish was a 3-D Frankenfood: a paste made of squash and eggplant and printed in the shape of a gear (a design that seemed appropriately mechanical). The idea was to show the potential for 3-D printing to combine any vegetables — or meats or fruits or nuts — into a single object. We would create a new hybrid: the eggsquash, or the squant. Unfortunately, our eggsquash’s texture was too gummy to enjoy, so my wife and I left half on the plate.
Tony Cenicola/The New York Times
The tie, the dishes and the cutlery were all created with a 3-D printer.
The dessert was panna cotta. The plan was to have a secret 3-D-printed message hidden inside. If cut in half, the dessert was supposed to reveal the letters “NYC” in blue cream. (The lab had done a similar trick with a “C” buried inside a cookie.)
Mr. Lipton dyed some of the panna cotta blue, but it never made it out of the tube. “This isn’t going to work,” Mr. Lipton said, after searching his gear. To inject the secret letters, we needed a second compressor hose, which Mr. Lipton had left at the Cornell lab. Instead, we had (once again) food in the shape of our initials. It was creamy and light, though the monogrammed letters made us feel uncomfortably Trump-like.
Thanks to the technical snafus, the meal finished late — or at least late by parents-of-young-kids standards. Mr. Lipton packed up his gear around 11 p.m.
After spending weeks with 3-D printing, I have no doubt it will change the world in ways we can hardly imagine. Much of the change will be behind the scenes, unobserved by consumers. Engineers foresee a lightweight largely 3-D-printed airplane that could cut fuel costs significantly. That savings will (fingers crossed) be passed along to travelers. As Mr. Lipton says, we are in for a “silent revolution.”
But will there also be a revolution in our homes and kitchens? Will 3-D printers transform our lives like the PC and Mac did? That remains to be seen.
It will be a battle between two forces: one, our love for ego-gratifying stuff tailored to our every whim. And two, our built-in laziness. Will we make the effort to print out a hexagonal ostrich burger with cucumber swirls (and then clean the printer) when we can just get a Quarter Pounder at the drive-through on the way home? I’m a techno-optimist, so I hope so.
In the meantime, I’d judge this the strangest and most memorable meal of my life, and that includes a dinner party that featured vegan cow entrails.
Tuesday, September 10, 2013
Fwd: Nutrition and Physical Activity Initiative Summer 2013 Newsletter
Begin forwarded message:
From: Lisel Loy <projects@bipartisanpolicy.org<mailto:projects@bipartisanpolicy.org>>
Date: September 10, 2013, 3:28:55 PM EDT
To: <sverhulst@markle.org<mailto:sverhulst@markle.org>>
Subject: Nutrition and Physical Activity Initiative Summer 2013 Newsletter
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Colleagues,
As fall approaches, we would like to take the opportunity to update you on our activities over the summer months and give you a glimpse of what we have planned for the fall. This June, we celebrated the one year anniversary of our report Lots to Lose: How America's Health and Obesity Crisis Threatens Our Economic Future<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=5&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fbipartisanpolicy.org%2Fprojects%2Flots-lose%3F_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d>. We continue to work on our key priority areas for 2013, including: accelerating improvements in food and physical activity at large organizations; improving nutrition and physical activity training for health care professionals; and demonstrating the value of prevention. This summer we also engaged more deeply in the timely discussion of how we can better align food and farm policy with dietary guidelines to improve health and contain health care costs.
Read the full update on our priority areas here<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=6&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fbipartisanpolicy.org%2Fsites%2Fdefault%2Ffiles%2FNPAI%2520Newsletter.pdf%3F_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d> and see below for event hightlights.
Best regards,
Lisel Loy, Laura Zatz, Priya Bettadapur, Bruce Knight, Robin Schepper, and Matthew Levy
________________________________
Publications and Commentary
Health Affairs
* The Essential Role Of Food And Farm Policy In Improving Health<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=7&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fcontent.healthaffairs.org%2Fcontent%2F32%2F9%2F1519.abstract%3F%3Dright%26_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d> by Dan Glickman and Ann M. Veneman
The Hill
* Farm Policy, Nutrition Go Together<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=8&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fthehill.com%2Fspecial-reports-archive%2F1543-healthy-america-july-2013-%2F311505-farm-policy-nutrition-go-together-%3F_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d> by Dan Glickman and Ann M. Veneman
Community Health Care
* Conversations in Health Care Series: Interview with Dan Glickman<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=9&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fbipartisanpolicy.org%2Fmultimedia%2Faudio%2F2013%2F07%2F03%2Fconversations-health-care-secretary-dan-glickman%3F_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d>
Commentary in Trust for America's Health "F as in Fat" report
* The Value of Prevention in Improving Health Outcomes and Cutting Costs: Continuing to Build the Case<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=10&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fhealthyamericans.org%2Fhealth-issues%2Fwp-content%2Fuploads%2F2013%2F08%2FTFAH2013FasInFatReport29.pdf%23page%3D27%3F_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d> by Lisel Loy and Laura Zatz
BPC Blog Posts
* World Breastfeeding Week: Supporting the Choice to Breastfeed<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=11&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fbipartisanpolicy.org%2Fblog%2F2013%2F08%2F26%2Fworld-breastfeeding-week-supporting-choice-breastfeed%3F_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d>
* An Ounce of Prevention—Prevention's Value in Curing Our Health Care Spending Woes<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=12&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fbipartisanpolicy.org%2Fblog%2F2013%2F08%2F20%2Founce-prevention%25E2%2580%2594prevention%25E2%2580%2599s-value-curing-our-health-care-spending-woes%3F_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d>
* Making All School Foods Healthier: New Guidelines for Competitive Foods, Bridging the Gaps Among Food and Farm Policy, Health, and Health Care Costs<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=13&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fbipartisanpolicy.org%2Fblog%2F2013%2F07%2F08%2Fmaking-all-school-food-healthier-new-guidelines-competitive-foods%3F_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d>
* Leading Food and Beverage Companies Announce Reduced Calorie Footprint<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=14&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fbipartisanpolicy.org%2Fblog%2F2013%2F05%2Fleading-food-and-beverage-companies-announce-reduced-calorie-footprint%3F_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d>
Event Highlights: Where NPAI Has Presented Recently…
* "Key Messages of the Bipartisan Policy Center on Prevention and Health Promotion," a presentation by Senator Bill Frist at the Vitality Institute Launch in New York City (May)
* "Calorie Cutback: Progress Report on 2010 Commitment to Reduce Calories in the Marketplace", Healthy Weight Commitment Foundation announcement at the Bipartisan Policy Center, moderated by Secretary Dan Glickman (May)
* "Capacity Building in Nutrition Sciences: Revisiting the Curricula for Medical Professionals" keynote presentation given by Dr. Matt Levy at the New York Academy of Sciences Conference (June)
* "Anti-Hunger Advocacy in a Challenging Environment," Food Research and Action Center Annual Benefit Dinner, welcome and panel participation by Secretary Dan Glickman (June)
* "F as in Fat: What is Our Nation Doing to Combat Obesity?" 7th Biennial Childhood Obesity Conference in Long Beach, panel participation by Robin Schepper (June)
________________________________
Upcoming Events
* Ireland's Nutrition and Health Foundation Seminar "Obesity and Behaviour Change", keynote "Strategies for Childhood Obesity in the United States" by Robin Schepper (September 12th, Dublin, Ireland)
* Clinton Global Initiative Annual Meeting, panel "Our Food. Our Health. Our Lives" moderated by Secretary Dan Glickman (September 24th, New York, NY)
* 2013 Everybody WALK Walking Summit "Roundtable Roundup: Patterns, Innovations, and Common Interests" by Secretary Dan Glickman (October 1st, Washington, DC)
* Bipartisan Policy Center, Alliance for a Healthier Generation, and American College of Sports Medicine forum, "Teaching Nutrition and Physical Activity in Medical School: Training Doctors for Prevention-Oriented Care" with remarks from Secretary Donna Shalala and Secretary Dan Glickman (October 17th, Washington, DC)
Register to attend here.<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=15&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fbpcevents.cloudapp.net%2FPages%2FHome.aspx%3Feventid%3D%7B4A90AB9F-7603-E311-8B54-78E3B510FDBD%7D%26_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d>
* Academy of Nutrition and Dietetics' Food & Nutrition Conference & Expo, panel discussion: "Building Better Mousetraps: How Creative Partnerships Can Insert Nutrition Services Into Health Care Issues" with Lisel Loy (October 21st, Houston, TX)
* American Public Health Association Annual Conference, Panel Discussion "The Economic and National Security Imperative for Moving Communities Toward Obesity Prevention: Implementing Evidence-Based Policy Change Across Sectors" with Governor Jim Douglas, Robin Schepper, and Matt Levy (November 5th, Boston, MA)
Read the full update here<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=16&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fbipartisanpolicy.org%2Fsites%2Fdefault%2Ffiles%2FNPAI%2520Letter.pdf%3F_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d>
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From: Lisel Loy <projects@bipartisanpolicy.org<mailto:projects@bipartisanpolicy.org>>
Date: September 10, 2013, 3:28:55 PM EDT
To: <sverhulst@markle.org<mailto:sverhulst@markle.org>>
Subject: Nutrition and Physical Activity Initiative Summer 2013 Newsletter
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Colleagues,
As fall approaches, we would like to take the opportunity to update you on our activities over the summer months and give you a glimpse of what we have planned for the fall. This June, we celebrated the one year anniversary of our report Lots to Lose: How America's Health and Obesity Crisis Threatens Our Economic Future<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=5&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fbipartisanpolicy.org%2Fprojects%2Flots-lose%3F_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d>. We continue to work on our key priority areas for 2013, including: accelerating improvements in food and physical activity at large organizations; improving nutrition and physical activity training for health care professionals; and demonstrating the value of prevention. This summer we also engaged more deeply in the timely discussion of how we can better align food and farm policy with dietary guidelines to improve health and contain health care costs.
Read the full update on our priority areas here<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=6&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fbipartisanpolicy.org%2Fsites%2Fdefault%2Ffiles%2FNPAI%2520Newsletter.pdf%3F_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d> and see below for event hightlights.
Best regards,
Lisel Loy, Laura Zatz, Priya Bettadapur, Bruce Knight, Robin Schepper, and Matthew Levy
________________________________
Publications and Commentary
Health Affairs
* The Essential Role Of Food And Farm Policy In Improving Health<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=7&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fcontent.healthaffairs.org%2Fcontent%2F32%2F9%2F1519.abstract%3F%3Dright%26_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d> by Dan Glickman and Ann M. Veneman
The Hill
* Farm Policy, Nutrition Go Together<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=8&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fthehill.com%2Fspecial-reports-archive%2F1543-healthy-america-july-2013-%2F311505-farm-policy-nutrition-go-together-%3F_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d> by Dan Glickman and Ann M. Veneman
Community Health Care
* Conversations in Health Care Series: Interview with Dan Glickman<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=9&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fbipartisanpolicy.org%2Fmultimedia%2Faudio%2F2013%2F07%2F03%2Fconversations-health-care-secretary-dan-glickman%3F_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d>
Commentary in Trust for America's Health "F as in Fat" report
* The Value of Prevention in Improving Health Outcomes and Cutting Costs: Continuing to Build the Case<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=10&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fhealthyamericans.org%2Fhealth-issues%2Fwp-content%2Fuploads%2F2013%2F08%2FTFAH2013FasInFatReport29.pdf%23page%3D27%3F_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d> by Lisel Loy and Laura Zatz
BPC Blog Posts
* World Breastfeeding Week: Supporting the Choice to Breastfeed<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=11&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fbipartisanpolicy.org%2Fblog%2F2013%2F08%2F26%2Fworld-breastfeeding-week-supporting-choice-breastfeed%3F_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d>
* An Ounce of Prevention—Prevention's Value in Curing Our Health Care Spending Woes<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=12&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fbipartisanpolicy.org%2Fblog%2F2013%2F08%2F20%2Founce-prevention%25E2%2580%2594prevention%25E2%2580%2599s-value-curing-our-health-care-spending-woes%3F_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d>
* Making All School Foods Healthier: New Guidelines for Competitive Foods, Bridging the Gaps Among Food and Farm Policy, Health, and Health Care Costs<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=13&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fbipartisanpolicy.org%2Fblog%2F2013%2F07%2F08%2Fmaking-all-school-food-healthier-new-guidelines-competitive-foods%3F_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d>
* Leading Food and Beverage Companies Announce Reduced Calorie Footprint<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=14&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fbipartisanpolicy.org%2Fblog%2F2013%2F05%2Fleading-food-and-beverage-companies-announce-reduced-calorie-footprint%3F_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d>
Event Highlights: Where NPAI Has Presented Recently…
* "Key Messages of the Bipartisan Policy Center on Prevention and Health Promotion," a presentation by Senator Bill Frist at the Vitality Institute Launch in New York City (May)
* "Calorie Cutback: Progress Report on 2010 Commitment to Reduce Calories in the Marketplace", Healthy Weight Commitment Foundation announcement at the Bipartisan Policy Center, moderated by Secretary Dan Glickman (May)
* "Capacity Building in Nutrition Sciences: Revisiting the Curricula for Medical Professionals" keynote presentation given by Dr. Matt Levy at the New York Academy of Sciences Conference (June)
* "Anti-Hunger Advocacy in a Challenging Environment," Food Research and Action Center Annual Benefit Dinner, welcome and panel participation by Secretary Dan Glickman (June)
* "F as in Fat: What is Our Nation Doing to Combat Obesity?" 7th Biennial Childhood Obesity Conference in Long Beach, panel participation by Robin Schepper (June)
________________________________
Upcoming Events
* Ireland's Nutrition and Health Foundation Seminar "Obesity and Behaviour Change", keynote "Strategies for Childhood Obesity in the United States" by Robin Schepper (September 12th, Dublin, Ireland)
* Clinton Global Initiative Annual Meeting, panel "Our Food. Our Health. Our Lives" moderated by Secretary Dan Glickman (September 24th, New York, NY)
* 2013 Everybody WALK Walking Summit "Roundtable Roundup: Patterns, Innovations, and Common Interests" by Secretary Dan Glickman (October 1st, Washington, DC)
* Bipartisan Policy Center, Alliance for a Healthier Generation, and American College of Sports Medicine forum, "Teaching Nutrition and Physical Activity in Medical School: Training Doctors for Prevention-Oriented Care" with remarks from Secretary Donna Shalala and Secretary Dan Glickman (October 17th, Washington, DC)
Register to attend here.<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=15&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fbpcevents.cloudapp.net%2FPages%2FHome.aspx%3Feventid%3D%7B4A90AB9F-7603-E311-8B54-78E3B510FDBD%7D%26_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d>
* Academy of Nutrition and Dietetics' Food & Nutrition Conference & Expo, panel discussion: "Building Better Mousetraps: How Creative Partnerships Can Insert Nutrition Services Into Health Care Issues" with Lisel Loy (October 21st, Houston, TX)
* American Public Health Association Annual Conference, Panel Discussion "The Economic and National Security Imperative for Moving Communities Toward Obesity Prevention: Implementing Evidence-Based Policy Change Across Sectors" with Governor Jim Douglas, Robin Schepper, and Matt Levy (November 5th, Boston, MA)
Read the full update here<http://link.bipartisanpolicy.org/c/1/?aId=11743737&requestId=b25313-b03b9a27-b1ac-4e73-958e-9ebabfc96afe&rId=contact-7afd9e1207ccdf1196db001cc4aaea7e-b080d4f70a19493c8528165d2bbc109b&uId=16&ea=fireuhyfg=bet=znexyr&dUrl=http%3A%2F%2Fbipartisanpolicy.org%2Fsites%2Fdefault%2Ffiles%2FNPAI%2520Letter.pdf%3F_cldee%3Dc3Zlcmh1bHN0QG1hcmtsZS5vcmc%253d>
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