Marion Nestle: Liberty from big soda

Why Bloomberg's 'ban' should be only the beginning of a public health revolution

Marion Nestle, New York Daily News, March 8, 2013

Barring any late legal surprises, Mayor Bloomberg's 16-ounce cap on sugary sodas goes into effect on Tuesday, March 12. After that, restaurants, movie theaters, sports venues and food carts will not be permitted to sell extra-large portions of sugar-packed drinks.

Stay calm. This does not signal the end of democracy in America. This is not the nanny state gone out of control.

If we want Americans to be healthy, we are going to have to take actions like this - and many more - and do so soon. It's long past time to tax sugar soda, crack down further on what gets sold in our schools, tackle abusive marketing practices, demand a redesign of labels - and extend the soda cap, no matter how controversial it may seem. This must be the beginning, not the end, of efforts toward a healthier America.

In short, we need a series of serious changes to make the healthy choice the easy choice. The soda size cap is a nudge in that direction. You will still be able to drink all the soda, and down all the sugar, that you want. The cap on soda size makes it just a tiny bit harder for you to do so.

That "tiny bit harder" is its point. If you have to order two sodas instead of one, maybe you won't. If you have to add sugar to your coffee drink yourself, maybe you will only add one or two teaspoons instead of the 10 or more someone else put in there for you.

For a public health nutritionist like me, the soda size cap is a terrific idea. Unlike other foods, sodas are a unique target for intervention. They contain sugars - and sugar calories - but nothing else of nutritional value. They are candy in liquid form. Candy has a place in healthy diets, but a small one. So it should be for sodas.

It's no surprise that people who drink large amounts of liquid candy have worse diets, are heavier, and have more health problems than those who do not. And it looks like the body doesn't compute the calories from liquid sugars as accurately as it does for sugars in foods.

On top of that, big sizes make the problems worse. To state the obvious, larger portions have more calories. If an 8-ounce soft drink provides 100 calories, then a 16-ounce drink provides 200, a 32-ounce drink provides 400 and a 64-ounce drink provides 800.

But big sizes also have other effects. They induce people to eat and drink more than they would if given smaller portions. Big sizes confuse people into underestimating the number of calories consumed.

Most people eat whatever size is in front of them - the "default," in public health-speak - and are content with that amount. So a reasonable goal of public health intervention is to change the default drink to a smaller size. Hence: Bloomberg's 16-ounce size cap.

From my nutritionist's perspective, a 16-ounce soda is still generous. Just one contains the equivalent of 12 packets of sugar. Just one provides 10% of the daily calorie needs of someone who typically eats 2,000 calories a day. Just one contains the upper limit of sugar intake that health officials recommend for an entire day. Once you down a 16-ounce soda, it's best to stop right there.

You may find this hard to believe, but the original Coca-Cola was 6.5 ounces, smaller than any size available today. In the 1950s, Coke advertised its 16-ounce bottle as large enough to serve three.

Times have changed. The sizes of foods and drinks have expanded, and so have waistlines. This is no coincidence. On the basis of calories alone, larger portions are all you need to explain why Americans are putting on pounds.

City officials concerned about the health of their citizens, as those in New York most definitely are, want to do everything they can to prevent obesity and the illnesses that go with it. Their rationale is humanitarian, but also fiscal. Poor health is expensive for both individuals and society. You don't believe that excessive weight is an issue? Just ask the military.

We can thank Big Soda - Coca-Cola, Pepsi and their trade association, the American Beverage Association - for the contribution of big sodas to weight gain. Soda companies have spent fortunes to create demand, to make drinking large amounts seem normal, to market sodas as essential for health and happiness and, these days, to fight Bloomberg's soda cap and take the city to court over it.

Soda companies may make things you like to drink, but they are not social service agencies. Their job is to get you to buy more soda to satisfy the financial demands of investors. They are about business. They are not about fun or happiness or personal choice - and they certainly are not about health.

The soda industry may profess to care more about your well-being these days, but it ultimately will not do anything to promote health if doing so harms sales.

So-called "nanny-state" measures - like bans on driving while drunk, smoking in public places and, now, selling absurdly large sugary drinks - help to level the playing field. Such measures are about giving everyone an equal opportunity to live a safer and healthier life.

At the moment, it is up to you to make healthier choices, but that's not easy in the face of relentless soda marketing. Governments have a responsibility to provide healthier environments for their citizens.
Here are some additional actions New York City should take, if only it were allowed to.

Close the loopholes. The city does not have jurisdiction over sales of sodas in convenience stores and supermarkets. The state does. Gov. Cuomo denied Mayor Bloomberg's request to extend the size cap to those stores, not on principle but because he hadn't thought about it. He should, right now. Let's keep all sugary drinks to 16 ounces or less.

Fix the price differential. A 7.5-ounce can of soda costs twice as much per ounce as a two-liter bottle, and you can't buy just one; it comes in an 8-pack. Price determines sales. If a 16-ounce soda costs a dollar, a 32-ounce soda should cost two dollars.

Tax sodas. Most people wouldn't dream of eating candy all day, but soda companies have made it seem normal to drink sodas from morning to night. Raising the price of sodas would discourage sales, especially among young people most susceptible to marketing efforts and most vulnerable to weight gain. A one-cent tax per ounce should do the trick and raise plenty of needed revenue besides.

Remove vending machines from schools. Yes, the Beverage Association only puts "better-for-you" drinks in school vending machines, but sugar-filled sports drinks are still liquid candy. And kids should not have to pay for water in schools.

Restrict marketing of sodas to children. Soda companies market extensively to children and adolescents, especially those in low-income neighborhoods. Just look at billboards, celebrity photos on soda cans and Pepsi's $50 million dollar deal with Beyoncé. They should not be permitted to market to kids this way. We already have restrictions on cigarette and alcohol marketing to kids. It breaks no new ground to add sodas to the list.

Don't let SNAP (food stamp) benefits be used for sodas. Bloomberg tried this, but the federal Department of Agriculture said no. There is absolutely no reason that taxpayer-subsidized food assistance for low-income people should go toward junk with no nutritional value. He should try again.

Show full calories on the front of containers. The current way calories are tallied, in a measure called "calories-per-serving," is confusing because the servings are unrealistically small and people don't do the math. Soda cans already give the full calories in tiny type on the Nutrition Facts label, but I want to see the full calories in big type on the front.

Actions like these will evoke ferocious opposition from the soda industry, and it will spare no expense to make sure such things never happen. We would surely hear more and more howls of "nanny-state" from those who insist Bloomberg has led us to the brink of a public health police state. Polls say that many New Yorkers oppose the 16-ounce cap and would oppose measures like this, too.

But I can't tell whether the opposition comes from genuine concern about limits on personal choice or because soda companies have spent millions of dollars to protect their interests and gin up histrionic, misinformed opposition.

Come Tuesday, the 16-ounce soda is the new default size in New York City. While waiting for the court decision and for politics to play out, why not give it a chance? Maybe it will help you live a healthier and longer life.

Nestle is a professor of nutrition, food studies and public health at New York University. She is the author of "Why Calories Count."

Interview with Dr. Neal Barnard

Suzan Koven, The Rumpus, September 26, 2012

I love cheeseburgers. How they smell and how they taste. With fried onions and lettuce and tomatoes and lots of ketchup. I love the memory of eating them in the bar in Baltimore where my husband and I went all the time early in our marriage–the place that served them big as saucers in red plastic paper-lined baskets, with cold National Premium on tap and '80s hits by Donna Summer and Joe Jackson on the jukebox.


I don't eat too many cheeseburgers these days. Middle age, caring for my once-vibrant mother after her heart attack and stroke, and decades spent counseling my patients about the dangers of saturated fat have sobered me into moderation.

But lately I've been wondering if moderation is enough.

Reports of the cruel treatment of animals raised for food, such as a recent undercover video leading to shutdown of a California slaughterhouse, force me to face the fact that eating animals always involves, well, killing animals. Information, presented in the popular documentary Forks Over Knives, about the health problems caused by even "healthier" versions of animal products, such as lean meat, fish, and low-fat dairy products, makes me wonder about avoiding all animal products—going vegan.

Change is hard—especially when it involves food, so deeply tied to identity. Who would I be if I never had another pastrami on rye, hunk of cheddar, or Thanksgiving turkey? But who would I be, as a person and as a doctor, if kept eating these things?

I discussed my quandary with author, medical researcher, and activist Dr. Neal Barnard. Dr. Barnard has advocated for animal protection and veganism for the past thirty years. Physicians Committee For Responsible Medicine (PCRM), the nonprofit he founded in 1985, works to educate clinicians and the public about the benefits of veganism, and to end animal experimentation. Dr. Barnard also conducts research on the effects of vegan diets on diabetes, chronic pain, and other conditions, and lobbies the U.S. government for changes in agricultural subsidies and healthier school lunches.

I met with Dr. Barnard in the Washington office of PCRM. He's 58 but looks…I was going to say "younger" but I really mean healthier. He's lean and energetic and makes you realize how flabby and lethargic most Americans of all ages look these days.

He's an excellent advertisement for a vegan diet.

Dr. Barnard had much to say about what motivates people to adopt veganism, about the idea that humans are natural carnivores, about what's really involved in producing animal-derived food, and about Michelle Obama's "Let's Move" campaign.

Though he was open to discussing any aspect of his work, I was most interested in how people decide not to eat animals and then stick with that decision. I told him that—like the average Rumpus reader, I imagine—I'm not blind to animal cruelty, not blind to the health effects of eating animal products, or to the relation of meat eating to global warming. And yet I've found it hard, over the years, not to slip back into denial about these things and start eating meat again.

I began by asking Dr. Barnard about the moment when he, born into a family of cattle ranchers, decided to become a lifelong vegan.

***

The Rumpus: I read that you stopped eating meat one day when you were in medical school. You assisted in an autopsy on someone who'd had a heart attack, saw the fat in the arteries and the severed ribs. And then you went to the hospital cafeteria for lunch and they were serving…ribs. That moment seems to encapsulate the complementary missions in your career: promoting health and preventing cruelty to animals. At the time, which felt more important to you?

Dr. Neal Barnard: You know there's another piece of it, which is the element of disgust. The way you'd feel if someone handed you a glass of blood. In some cultures that would be a totally normal thing to do. But in our culture, that would be absolutely disgusting. I've heard it said that of all of the motivators, that is the strongest one. The health messages and morality messages pale compared with that.

But to answer your question more directly, both were important. I grew up in North Dakota, and I was aware of what animals go through because I had driven animals to slaughter and I'd killed animals. And I was aware that there were certain ethical issues, but they weren't preying on my mind very heavily. And I was aware of the health issues—sort of.

Rumpus: But isn't there an evolutionary basis for meat eating—for us not to be disgusted by it? We have canine teeth, our forebears speared animals and ate them. Aren't we hardwired for meat eating? Is the fact that cooking meat smells good to us really just a cultural thing?

Barnard: Meat smells good, bleu cheese smells good—to some people. But it's acquired. If you ask a guy who's thirty-five if a cold beer on a hot summer day would taste good, he'd say, "Yeah, that would taste wonderful." But if you could go back in time to his first taste behind the garage when he was fifteen, it probably tasted disgusting. We acquire certain tastes for things.

And if you took a baby and put a bunny in front of him, and if you had a cat and a bunny, the cat at any age would want to attack and kill the bunny and the child would say, "Oh, look at the bunny!" So the idea that we have some innate aggression towards animals…we don't.

About the teeth: if you open the mouth of a cat, a carnivore, you see that they have long canines, way beyond the other teeth. If you open the mouth of a dog, you see the same. If you open your mouth, you don't. You have canines that are the same length as your incisors. If you have long canine teeth, it allows you to do two things: one, it allows you to snatch your prey. The other thing it allows you to do is to pull away the hide. If a dog happens to catch a rabbit or another animal, it can very easily remove the hide. If a cat catches a squirrel, they have no trouble with that. But if a person does that, they will work all day and all night to get the skin off of an animal, because they don't have long canine teeth anymore.

We also don't have claws. Plus we're not fast. Plus we don't have very good vision, or good sense of smell. An owl is a predator and can detect a mouse at a tremendous distance. Dogs have a sense of smell much greater than ours and they're much faster than we are. We have fairly dull senses, fairly slow locomotion. In our Olympic trials, we celebrate speeds that would be an embarrassment to a bird or a dog or another animal.

We have nothing to kill prey with and nothing to remove the hide with. So the question is when did that change come? It's something like 3.5 million years ago that we lost our long canine teeth. And most of the great apes did, too—and they're almost entirely vegetarian. Chimpanzees will eat a little bit of meat. But, they never eat dairy products, and no other animal would do that.

Rumpus: What do you think that's all about, humans eating dairy? Is that an evolutionary thing or purely cultural?

Barnard: It isn't evolution. It's creativity. It's the same as eating meat. Meat eating wasn't really practical until the Stone Age. The Stone Age gave us arrow heads and eventually knives, and that allowed us to kill animals in ways you couldn't before, and once you had them you were able to remove the skin and bones.
We're not carnivores. We've never been carnivores, ever. And even today, the most you can say is that people have become honorary omnivores. And that's only because a) we are creative and find ways to do things that are not natural for us; and b) the dangers of eating animal products occur after the age of reproduction. If people developed cardiovascular disease that was fatal by the age of twelve or thirteen, eating animals would have died out long ago. You get it after you've already reproduced.

Dairy is a northern European invention and nothing that nature ever had in mind. It's all because we figured out how to make cows stand still.

Rumpus: So suppose someone wants to pull back on this 3.5 million years of meat and dairy eating. How do you feel about the incremental approach? Giving up just red meat, say. Or becoming a pescatarian, or a lacto-ovo vegetarian rather than a vegan?

Barnard: It doesn't do a lot of good for your health to move from red meat to white meat, but it gets you further down the road towards making more substantial changes later. So any move is a good move. And while it's certainly true that many people think that dairy doesn't have a cost to the animal, it's because they never went to a dairy farm.

Rumpus: How about this trend I've noticed: super-aggressive meat eating—usually locavore or "farm to table." In the TV show Portlandia, they make fun of these restaurants where the waiter tells you what a nice life the chicken led before it arrived on your plate. I went to a place in Boston that serves locally sourced pork with the jaw and teeth on the side as a garnish. Among modern, urban, liberal people, this seems to be a thing—among the same people who you'd think would be exploring vegetarianism. Have you noticed this?
Barnard: Yeah, that's the same person who reads Cigar Afficionado. It's someone who's thumbing their nose at science and hoping they're an exception to the rule.

Rumpus: But it's a whole movement, it seems, in culinary culture. You think "locavore," etc. is a smokescreen?

Barnard: It's a rationalization—and this too shall pass.

Rumpus: It'll pass because we can't sustain it environmentally and we can't sustain it health-wise? Because ultimately you get just as sick from a free-range chicken as from Chick Fil-A?

Barnard: Apologizing to the animals or having them come from a local farm doesn't change the ethics of it nor does it change the health aspects of it.

Rumpus: How about seafood? I know someone who doesn't eat meat or poultry but she does eat shellfish because she feels that while she couldn't kill a cow or a chicken, she could net a shrimp herself. She can't imagine that a shrimp suffers. Is shrimp really part of the same spectrum of suffering that you talk about?

Barnard: She's just feeling what she can picture—and she can't picture the shrimp suffering very much. On the other hand, if she saw her six-year-old son pulling the wings off a butterfly, or pulling the legs off a bug one by one, would she send him to a psychiatrist or not?

Rumpus: So it's a narrative that works for us—that animals don't suffer as we do—and we go with that?

Barnard: I think that's right. Another thing to think about is why people make the decisions that they do. The evidence that someone who eats animal remains is much more likely to have heart attacks, certain cancers, weight problems, hypertension, dementia of the Alzheimer's type—that evidence is quite conclusive. So why do they do it? Well, first, they might not have the information. There's a lot of noise, a lot of conflicting information out there. That's the first thing.

Rumpus: You mean like about milk being the "perfect food"…?

Barnard: Yes: "you need red meat for iron," "you need 'complete' protein," whatever… The second thing is: where is your herd going? I think herd mentality is a good thing overall. Because if every sheep had to figure out the velocity of the wolf and their personal risk, that would take forever. It's much better to say, "If the herd is running, I'm running with those guys." And humans have herd mentality, too.

Rumpus: I read somewhere that you said there are no non-vegetarians, only "pre-vegetarians." Do you see our "herd" running in the right direction?

Barnard: Well, we're kind of running in two different directions. Overall, our population is in the worst shape it's ever been. Children are in terrible shape. We have absolutely unprecedented numbers of obese and overweight children—one in three now. A generation ago it was something like one in ten. However, meat intake is starting to fall. It peaked in 2004. We're down about 5% from 2004. We were at 201.5 lbs per person per year. I'm talking about all meat together—red meat, chicken, poultry, fish. And we're now at 188.9 lbs per person per year in the U.S. That's good. So we've been in bad shape, and the effects of our previous meat eating are still very evident, but at the same time, conflicting with that in a good way is that the number of people who are changing is bigger than it's ever been.

Rumpus: I've noticed that your work recently has emphasized the public health aspects of veganism, perhaps more than animal protection. Is that because the public health issues are so overwhelming?

Barnard: I think both are really intertwined. Take diabetes: it's the worst it's ever been in the U.S. and in almost every other country. And it's getting worse year by year. The federal government's response is to fund research that is headed towards making new drugs. To do that, the government spends approximately half a billion dollars a year on animal research, consuming about 70,000 animals per year. I am going to assert that the use of those animals in developing drugs would have made sense decades ago before it was really clear that diabetes is a lifestyle-related disease for the most part. So instead, if we studied human beings which can include human genes, human blood samples, and human behavior, then you can leave the animals out of the labs and you can leave them off your plate.

Rumpus: In terms of your work, do you feel that the upcoming election matters a lot? In other words, do you see President Obama as being a positive leader in terms of your work?

Barnard: As a nonprofit we are absolutely not allowed to make any comment about a political candidate, however I will say this: we have pushed the current administration to be more vigorous, and whoever is in the next administration, we'll push them, too. I feel that [Michelle Obama's] "Let's Move" campaign is mostly window dressing. I'd hoped it wouldn't be that way and it doesn't have to be that way. Does she really want to stop childhood obesity? I don't know the answer to that. I can't tell.

Rumpus: But of course she's operating in such a hostile environment…

Barnard: But it has become a very feeble effort. And whether it was ever intended to be more than that, I don't know. But my feeling is, if it's literacy [Laura Bush's cause] or billboards [referring to Lady Bird Johnson's attempt to get ugly signs off highways], you can fool around, because nobody is going to die as a result. But if you're talking about something like childhood obesity, which kills those children when they grow up, you can't say "Do more hula hoops," as if that will solve it. And so we have encouraged the first lady to show some leadership and to try to get this government to stop subsidizing unhealthy food, to stop promoting exercise as a substitute for good eating habits.

Rumpus: And has the administration been receptive?

Barnard: Completely unreceptive.

Rumpus: Just because it's too big to…

Barnard: I can't speak for them. All I know is that they have shown no interest in going in the direction that we have suggested.

Rumpus: What about the medical profession? I can tell you that the colleagues in my primary care group are not promoting vegetarianism, or even talking much about nutrition at all. Some of that has to do with time. Some of it has to do with the fact that we're so poorly educated in nutrition. And yet, why are we not making the connection?

Barnard: I think it starts with doctors knowing what nutrition can do. Up until now, it's been pretty disappointing. You bring a person in with diabetes and start them on "medical nutrition therapy" [a standard, non-vegetarian diabetic diet] and nothing happens. You start them on insulin and you can bring their glucose down as much a you want. When we use vegan diets, the results are much better and you have a much more grateful patient.

Rumpus: And haven't you compared them head to head in a study? Was vegan better?

Barnard: In our NIH trial the vegan diet is way, way better.

Rumpus: What about Atkins, low-carb, or "paleo" diets? Some argue that it's carbohydrates, not saturated animal fats that cause obesity, diabetes, and other chronic conditions.

Barnard: The thinnest people on the planet are those who eat the most carbohydrates. I'm thinking of people in rural Japan and China, where McDonald's hasn't yet arrived. These are the thinnest, healthiest, longest-lived people with the least risk of cardiovascular disease and diabetes. As soon as you put a McDonald's in their neighborhood, rice intake and intake of carbohydrates in general fall dramatically, waistlines get wider, diabetes goes up. In Japan, from 1980 to 1990, diabetes went up from less than 5% to about 11-12% of the population. Just like that. So the idea that carbohydrates are responsible for that is complete nonsense. People do lose weight on an Atkins diet. The reason they lose weight is because of calorie reduction. If a person's caloric intake has not fallen, if they are really shoveling in the steak, they don't lose weight. And a third of low carb dieters will have a substantial elevation in their cholesterol. And there was a paper on cognition, that said that objectively, though they may not be aware of it, people on [an] Atkins diet are slower, their reaction time is not as good.

Rumpus: We have made progress, though. We've gone from those dusty health food stores of the 1970s, to veggie burgers everywhere…

Barnard: Including at the Republican National Convention! They had veggie burgers on the menu!

Rumpus: Do you feel like the environment in which you're working is less hostile and less lonely than back in the early days of your career?

Barnard: Dramatically so. Bill Clinton went vegan, and Rosie O'Donnell, Ellen Degeneres, and the Williams sisters… In the past couple of years there have been all these athletes, including super runners and football players… If you look at what's happened to those dusty health food stores, they're gone. They've been replaced by Whole Foods and similar places that are enormous, that have every possible vegan product that you could ever want.

Rumpus: But Whole Foods is expensive. Have you gone to developing countries? Have you gotten the reaction that veganism is somehow a luxury of rich, Western people?

Barnard: No, it's the reverse. In China, because China is gaining wealth, rice consumption is way down. Rice is a poor person's food, and they're eating less of it. To wait in line at a fast food chain is cool. And they haven't historically had weight problems. So they don't have this culture of, "I need to lose weight." Whereas Americans do have that culture.

Rumpus: But it sounds like they're not far behind us…

Barnard: Oh, they're leap-frogging us! But I don't think China or Japan or India, for that matter—where there's a lot of diabetes now—I don't think they're putting two and two together: that it's the Western diet that's causing it. Since I first went to India twenty some years ago, there's been a palpable change. There's now pizza everywhere, meat is much more popular than it's ever been. Vegetarianism is "that quaint thing our parents did."

Rumpus: So, I just want to circle back to the very beginning of our conversation, to disgust. That's a hard sell if that's the most potent motivator. To encourage veganism do we have to disgust people and make them feel guilty and force them to look at what they don't want to look at?

Barnard: I think we have to do everything that's useful. We're doctors. Our job is to tell the truth. And it doesn't have to be embellished in any way. People have to know that if they've wanted to lose weight, if they've wanted to get their diabetes better and get their cholesterol down, here is how it works. Beyond that point, you can't force people into changes, you have to guide them. I think it's also fair game to play all the emotional cards, which can mean talking about celebrities and how they've changed—which helps us to realize that part of our "herd" are moving in a different direction.

I am always struck by how difficult it is for people to see how much cruelty they are bringing not only upon animals but upon themselves and their loved ones and other people, how much we are screwing up the planet, how much we are hurting our own health, how hard it is to change all that, how eager people are to make a buck at everybody else's expense—all those things are discouraging.

But I think it's fair, if something really is disgusting, to make people aware of it. For example, I just sampled about 120 chicken samples in Buffalo, New York. And we sent them to the lab and tested for fecal contaminaton. We'll find it in about half of the samples. If you take a chicken thigh and wring it out, there's fecal soup that comes out of it because there's chicken feces everywhere in these places, and as they go through the chill bath, that spreads it around and the meat soaks it up and that measurably increases the weight of the chicken product they're selling. How many people know that? They see the little preparation label that tells you to make sure you cook it, as if somehow a little peppering of bacteria has come from the atmosphere. They don't realize that it's chicken dung that's not just on the surface but soaked into the meat. So people are serving their kids cooked poop. I think it's fair game for people to know that. They may decide they're going to do it anyway. But if some people think, "Why am I eating a dead bird soaked in poop?" I think if some people get disgusted by that, it's all to the good. Their coronary arteries will be healthier.


Suzanne Koven is a primary care internist in Boston and a columnist at the Boston Globe. E-mail her at inpracticemd@gmail.com and visit her website at suzannekovenmd.com. More from this author →

NYC Board of Health Passes 'Soda Ban'

Michael Howard Saul, The Wall Street Journal, September 13, 2012

The New York City Board of Health on Thursday approved Mayor Michael Bloomberg’s controversial proposal to ban the sale of large sugary drinks in restaurants and other venues, a sweeping initiative that backers hope will reduce obesity and critics decry as government run amok.

Beginning March 12, the city will prohibit restaurants, mobile food carts, delis and concessions at movie theaters, stadiums or arenas from selling sugary drinks in cups or containers larger than 16 ounces. The city will begin fining sellers for violating the ban in mid-June.

The proposal passed by a vote of eight to zero, with one abstention, one absence and one vacancy on the board. Dr. Thomas Farley, the board’s chairman, called the vote “historic.”

Opponents said they are exploring all possible paths to prevent the new ban from taking effect next year, including the possibility of a legal challenge. Recent polls show a majority of city voters oppose the initiative.

Opponents have complained that the deck was stacked against them because every member of the board is appointed by the mayor. Adding to that perception, before the board voted, the administration delivered a 20-minute presentation rebutting the critics’ points.

After more than 38,000 oral and written comments, the administration proposed no changes to the initial proposal that was made public in May.

Joel Forman, a board member, said there is “overwhelming” evidence that obesity is a major health problem in the city and nation.

“I can’t imagine the board not acting,” he said. “I laud the proposal and I support it.”

Dr. Forman said he hopes the initiative will “spread nationally.”

Pamela Brier, a board member, described the initiative as “terrific” and said she wholeheartedly supported it.

“It’s hard to do – there are a lot of unhappy people,” she said, noting the criticism. She said she hopes the ban becomes the “new norm.”

Board member Lynne Richardson said she was skeptical at first but found the arguments for it “convincing” and “compelling.” She said the opponents engaged in “hyperbole that was stunning.”

Board member Susan Klitzman said the obesity problem in New York is patently obvious. “To not act would really be criminal.”

Deepthiman Gowda, a board member, called the initiative a “small” but “bold” and “exciting” step forward.

“The reality is we are in a crisis,” he said. “We need to act on this.”

Several of the board members stressed that they listened carefully to the public’s input, spending many hours reading the flood of comments both for and against.

The proposal is the latest high-profile initiative from Bloomberg, who has made public health a hallmark of his nearly 11-year tenure at the helm of the nation’s most populous city. In 2002, the mayor persuaded the City Council to approve a ban on cigarettes in restaurants and bars, a law that has since become widely popular in the city and adopted around the globe.

“Obesity is going to kill more people in the world his year than starvation,” Bloomberg said during an interview on MSNBC, just hours before the board’s vote.

The mayor has defended the ban, which he described Thursday as “portion control,” as an upfront way to alert consumers about the dangers of large sugary drinks. While the new rule bans the sale of sugary drinks in large cups, consumers may purchase as many drinks as they choose.

“I don’t think it’s government’s job to ban people from doing things with a handful of exceptions,” Bloomberg said. “But, generally, it’s government’s job to tell you the facts of what is bad for you and let you make your own decision.”

Bloomberg announced Thursday afternoon that the new Barclays Center, home of the Brooklyn Nets basketball team, will be the first major venue to voluntarily implement the ban.

Eliot Hoff, a spokesman for New Yorkers for Beverage Choices, a coalition of individuals, companies and groups opposed to the ban, said there was never any hope the Board of Health would reject the proposal because the mayor appointed all the members. More than 250,000 New Yorkers and 2,100 business owners have signed a petition against the ban because it is “arbitrary and restricts our choices,” Hoff said.

“We’re smart enough to make our own decisions about what to eat and drink,” said Hoff, adding that the ban goes “against the wishes of a majority of New Yorkers and we will not let that fact go unnoticed.”

A sugary drink is defined as any beverage sweetened with sugar or another caloric sweetener that contains more than 25 calories per 8 fluid ounces and contains less than 51% milk or milk substitute by volume as an ingredient. A diet soda, a milk shake or sweetened latte that is larger than 16 ounces wouldn’t be banned.

During the first three months after the ban takes effect, the city will inspect and inform sellers when they are not in compliance with the law. The city will allow a three-month grace period before it begins issuing notice of violations that are subject to fines.

More than half of New York City adults, or 58%, are overweight or obese, and nearly 40% of city public-school students in eighth grade or below are obese or overweight, according to the city.

During the mayor’s tenure, the Board of Health had required calorie counts to be posted on menu boards and banned the use of trans-fats in foods. The mayor’s administration also launched a major effort to limit the intake of salt.

Many of the initiatives, at first, were unpopular but public sentiment then changed, the mayor and other administration officials have pointed out. On Wednesday, for example, McDonald’s announced it will begin posting calorie counts on all its menus nationwide next week.

“Two or three years ago, they sued us to stop doing it in New York City,” the mayor said on Thursday. “I’ll rest my case, thank you.

In other business, the board also unanimously approved another controversial proposal that would require written consent from a parent or legal guardian when oral suction is performed during a baby boy’s circumcision. The written consent will require notification that the city advises against oral suction because of health risks, including the possibility of infecting the baby with herpes.

Dr. Forman said he thinks the board should consider even stronger action. “It’s crazy that we allow this to go on” he said.

Opponents, including some religious leaders, have called the requirement an infringement on their religious rights.

Watch a video about New York’s soda ban:

'Soda Ban Explained'

Casey Neistat, The New York Times, September 9, 2012

Soda Ban Explained: The filmmaker Casey Neistat presents a guide to Mayor Michael R. Bloomberg’s proposal to restrict sales of big sugary drinks in New York.

I don’t drink much soda, I don’t buy Big Gulps, and my body mass index is right where it should be. Until the public hearing on July 24, I had largely ignored Mayor Michael R. Bloomberg’s proposed ban on large, sugary drinks because it would have no effect on my daily life. It was watching supporters of the ban struggle to articulate exactly what it would mean that motivated me to educate myself and ultimately make a movie about it. The proposal is best conveyed visually, not verbally.

To start — the proposed ban on large, sugary drinks isn’t really a ban on anything. Even if the New York City Board of Health passes the ban this coming Thursday, 7-Eleven, the ubiquitous convenience-store chain, will still be able to serve its 50-ounce Orange Explosion Slurpee, which contains 107 grams of sugar, the equivalent of nearly four full-size Snickers bars. Dunkin’ Donuts could still sell its large Vanilla Bean Coolatta (174 grams of sugar, or nearly six Snickers bars, in its 32 ounces). And if you can find a place with unlimited refills, you can still drink as much soda as you like.

The proposal would not include alcohol, fruit juices or any diet soda. Grocery stores and convenience stores would be exempt. Iced coffee and other beverages where the sugar is added by the customer would remain unaffected. Drinks are also exempt if they contain more than 50 percent milk, which would most likely allow Dunkin’ Donuts to sell Coolattas, and Starbucks Frappuccinos, as long as they can prove the milk content is there. Buying multiple 16-ounce drinks is also O.K. The ban will certainly not stop people from getting exactly what they want, as Mayor Bloomberg has made clear.

“All we’re doing here is educating,” Mayor Bloomberg said. “It forces you to see the difference.” Limiting the serving size forces people to consider how much they’re ingesting. Earlier this year the Center for Consumer Freedom ran a full-page ad in The Times saying that “New Yorkers need a Mayor, not a Nanny.” With 58 percent of adults in New York City overweight or obese and 5,800 deaths a year in the city because of obesity, it is evident that some people just aren’t responsible enough to feed themselves. This lack of nutritional responsibility affects everyone — obesity costs the city $4 billion a year in direct medical costs. A nanny is just what New York City, and the rest of America, needs.

If New Yorkers reduced portion size to 16 ounces from 20 ounces for one sugary drink every two weeks, it would collectively save approximately 2.3 million pounds over one year. This proposal could be the catalyst the city needs. Obesity is an epidemic, a crisis whose impact is widespread — over 27 percent of young adults in America are too overweight to serve in our military. Sugary drinks alone are not to blame, but they are part of the problem, and this proposal is a small step toward a solution.

Casey Neistat is a New York-based filmmaker. He has made dozens of short films released exclusively on the Internet and is the writer, director, editor and star of the series “The Neistat Brothers” on HBO. His previous Op-Docs include “Texting While Walking,” “Bike Thief” and “Taxi Lost and Found.”

Employing Dietitians Pays Off for Supermarkets

Stephanie Storm, The New York Times, August 24, 2012

MOLINE, Ill. — Lois E. Florence recently left her doctor’s office with a diagnosis of colitis, an intestinal disorder, and a complicated set of instructions for changing her diet.

After several setbacks she had a chance conversation with the pharmacist at her local Hy-Vee grocery store here that changed everything. 

He referred her to the store’s dietitian, Dawn Blocklinger, and on a recent sunny morning, the two of them spent almost an hour compiling a list of the foods Mrs. Florence, 79, could eat and alternatives for the ones she couldn’t, like rye bread to replace wheat and Tofutti instead of ice cream. 

Then they went shopping. 

Hy-Vee is the only grocery chain in the country that posts a registered dietitian in almost every one of its 235 stores. In rural areas, some of its more than 190 dietitians serve a cluster of stores. 

That puts it at the forefront of a phenomenon sweeping the grocery business as it tries both to capitalize on growing consumer awareness of the role food plays in health and wellness and to find new ways to fend off competition from specialty markets like Whole Foods and big-box stores like Walmart. 

“There’s been an explosion of interest in having a dietitian among grocery store retailers in the last three or four years,” said Annette Maggi, chairwoman of the supermarket subgroup of the food and culinary professionals practice group at the Academy of Nutrition and Dietetics and a consultant to the retail and food manufacturing industries. 

The supermarket subgroup now has more than 400 members and its numbers are rising, Ms. Maggi said. Jane Andrews at Wegman is widely regarded as the grande dame of supermarket dietitians, becoming the first dietitian on its staff in 1988 and now supervising a team of six. Other regional chains like Meijer, Giant Eagle, Bashas’ and H-E-B also have them, and bigger grocery stores are getting involved, too. 

Kroger, which already has dietitians on staff, is adding more of them to its King Soopers chain in the West.

At Meijer, a regional supermarket chain in the Midwest, the five dietitians do about 100 events a quarter, 80 to 85 appearances at community events, health assessments with company employees, in-store cooking demonstrations and educational programs on health subjects like diabetes and heart disease. 

They also are responsible for maintaining pages on the company Web site and producing a variety of pamphlets and booklets. 

“Like almost all of us, I started out in a hospital, but I switched because I wanted to talk to people about what they were eating before they got sick,” said Shari Steinbach, the lead dietitian at Meijer. 

Ms. Steinbach has been a grocery store dietitian for 24 years, and she said she had never seen interest in the position so high. “I think retailers are starting to see our value,” she said. “They can document increased sales of healthier items, the e-mails from shoppers wanting appointments, the invitations from manufacturers wanting us to come to their conferences.” 

Andy McCann, senior vice president for retail health at Hy-Vee, said he got about three or four calls and e-mails each week from other grocery store operators wanting to know more about Hy-Vee’s dietitians.

One of the most frequent questions callers have is how Hy-Vee calculates its financial return on its investment in dietitians. “We have store directors in eight states who have looked at it and say they can’t afford not to have a dietitian in their stores,” Mr. McCann said. “It’s very difficult to calculate a return on investment, but when you look at day to day what the dietitians do, it’s easy to see how they’re valuable.” 

At Hy-Vee, dietitians offer in-store consultations and store tours with customers, hold cooking classes, assemble take-home meals, take biometric screenings, do presentations in schools, businesses and civic events, work with merchandisers, help set up community gardens, assess products for nutritional value and a variety of other things. 

They also explain the NuVal system, a nutritional scoring system done by independent nutritionists and medical experts that more and more retailers, including Hy-Vee, are deploying to help consumers assess products.

The dietitian’s role is expanding, said Phil Lempert, a grocery industry expert and author of the blog Supermarket Guru. “The field of nutrition is getting more and more complicated,” Mr. Lempert said. 

“Merchants used to buy on price and promotion, but you can’t buy that way any more with all the product claims. You need someone around who understands whether products can really deliver, whether they’re safe.” 

He has set up a new organization, the Retail Dietitians Business Alliance, that will offer its members a weekly newsletter with tips on merchandising, webinars about how to demonstrate the value of a dietitian in a retail setting, and workshops at gatherings like Expo West in March and the Food Marketing Institute’s Health and Wellness Conference. 

Recently, Kristen Decker, the dietitian at the Utica Ridge Hy-Vee in Davenport, Iowa, just across the Mississippi River from Moline, spent her morning preparing Fast Fit Meals, a program that supplies three meals and two snacks a day totaling 1,200 to 1,500 calories to cover five days a week. Shoppers pay $75 for a week and pick up the food and instructions for preparing it each day on a specific day of the week. 

“We have four weeks of menus, and they never eat the same thing twice during that period,” Ms. Decker said. “There is a mix of fresh, frozen and dry, and if you don’t like fish or broccoli, we’ll find a substitute.”

Six shoppers were stopping by that evening to pick up meals, but Ms. Decker said that number would double after the summer break. 

“Customers don’t have a lot of time, or they don’t know what to look for,” she said. “The claims on the front of the packaging aren’t always about nutrition, or sometimes they just don’t know what’s important. I had a customer, for instance, ask about whether he should be more concerned about sugar or fat.” 

Megan Leahy, the deli manager at the Hy-Vee in Rock Island, Ill., knows to watch the fats she eats. Ms. Leahy has Chrissy Watters, the dietitian in her store, monitor her cholesterol, heart rate, weight and other biometrics, which entitles her to a discount on her insurance. 

“Your glucose is perfect,” Ms. Watters told her. “You’re still working on your waist circumference.”

She recommended more aerobic activity, eating more fish and using canola oil. 

Ms. Leahy has started running, and she said Ms. Watters had given her some ideas for foods lower in cholesterol, including a spinach dip made with yogurt. But she wrinkled her nose at the mention of fish, which all of the dietitians said was a hard sell. “I’m like a 5-year-old when it comes to trying new food,” Ms. Leahy said. 

While Ms. Watters was giving a tour of the store, a call came in from Chris Carlson, a shopper whom she had advised. Mr. Carlson had come to her after having a blood test showing his triglycerides were at 880 and his total cholesterol was at 332. 

“I knew I needed to make significant changes, and I had contacted various groups, but they all wanted me to pay a lot of money to do their programs,” Mr. Carlson said. 

His wife had consulted with a Hy-Vee dietitian when her mother found out she was gluten intolerant, and she suggested he make an appointment with Ms. Watters. “She gave use some ideas about how to change our diets with different meats and get off the sugar and walked us through the store,” Mr. Carlson said. 

He called that day, two months later, because he had been to the doctor and his cholesterol had dropped to 170 and he had lost 27 pounds. “As someone whose business is sales, I can see how having someone like Chrissy is good for Hy-Vee,” Mr. Carlson said.

New Report: America Trashes Forty Percent of Food Supply

Press Release - Natural Resources Defense Council

New Report:  America Trashes Forty Percent of Food Supply

August 21, 2012

New analysis by the Natural Resources Defense Council: "Food is simply too good to waste. Even the most sustainably farmed food does us no good if the food is never eaten. Getting food to our tables eats up 10 percent of the total U.S. energy budget, uses 50 percent of U.S. land, and swallows 80 percent of freshwater consumed in the United States. Yet, 40 percent of food in the United States today goes uneaten. That is more than 20 pounds of food per person every month. Not only does this mean that Americans are throwing out the equivalent of $165 billion each year, but also 25 percent of all freshwater and huge amounts of unnecessary chemicals, energy, and land. Moreover, almost all of that uneaten food ends up rotting in landfills where it accounts for almost 25 percent of U.S. methane emissions. Wasted: How America is Losing Up to 40 Percent of Its Food from Farm To Fork to Landfill – analyzes the latest case studies and government data on the causes and extent of food losses at every level of the U.S. food supply chain. It also provides examples and recommendations for reducing this waste."

Growing the food movement: lists of advocacy groups

Marion Nestle, Food Politics, August 1, 2012

Whenever I give a talk, someone in the audience invariably asks how to get involved in food advocacy. My suggestion is usually to go online and look for local groups working on issues of interest or, if lucky enough to have a nearby Edible magazine, read the ads.

These are still useful starting points and I list them and others in the FAQ section on this site (questions 3 and 4).

More recently, I’ve been asked a more complicated question: Why don’t all those organizations get together? If they did, they would form a major political force.

Vivian Wang, an undergraduate at NYU, asked that very question after one of my talks. She volunteered to start doing some preliminary work by attempting to identify local and national food advocacy groups.

It didn’t take her long to discover the enormity of that task.

Nevertheless, she created spreadsheet of the groups she was able to find. She organized her findings by the tabs at the bottom, which she named:

· Long Lists: These are groups with websites that provide information about resources including many other advocacy groups.

· NYC-based: Groups in New York City. These are also given on different spreadsheets in the other categories

· Advocacy

· Agriculture

· Education

· Hunger

· Local Food

· Organic Food

· Urban Farming

· NYU-based: food and nutrition clubs at New York University


See also - http://blogs.law.harvard.edu/foodpolicyinitiative/files/2012/06/CAREER-GUIDE-JUNE-2012-v4.pdf

A Fresh Look at What School Menus Can Be

Dan Frosch, The New York Times, July 17, 2012

DENVER — With the authority of a celebrity chef, Adam Fisher gestured toward the bushels of fresh basil, oregano and parsley sitting on the counter in front of him, as the crowd leaned forward.

“We almost want to treat fresh herbs like we treat fresh flowers,” he commanded, speaking into a microphone clipped to his apron. “You want to snip off the ends, and ideally you want to store them in some water.” 

Mr. Fisher may not be some fast-talking TV personality, but he is a chef, a food supervisor for the Denver Public Schools, and he was giving a demonstration on how to whip up cafeteria food — in this case, cucumber and pasta salads — from scratch. 

With new federal standards for school meals going into effect this month, and a renewed focus on the issue brought by the first lady, Michelle Obama, thousands of school chefs, food service workers and nutrition experts from around the country gathered in Denver this week at an annual conference put on by the School Nutrition Association, a nonprofit organization of school food professionals. 

As vendors hawked samples of every imaginable school fare — whole-grain rolls, turkey sandwiches, pizza squares — cooks and school food administrators traded tips on how to improve their schools’ cuisine, part of a nationwide push to make school food tastier and more healthful. 

But it was the new federal Department of Agriculture nutrition standards for school meals that seemed the main topic of conversation. 

The rules establish calorie and sodium limits for meals, require schools to serve larger portions of fruits and vegetables and mandate that all milk be 1 percent or nonfat. Requirements for the use of whole grains are also being phased in. 

With more schools cooking meals from scratch — which invariably means more fresh local fruits and vegetables in the kitchens rather than processed foods — districts have largely been able to keep pace with the new regulations, nutrition experts said. 

“School districts for the last 15 years have been working on ways to improve their menus,” said Julia Bauscher, the School Nutrition Association’s new vice president and school nutrition director for the Jefferson County Public Schools in Louisville, Ky. “The majority of the members that are here probably are already meeting some of the new standards.” 

Gone, at least in many places, are the days when lunch ladies served fried just-about-anything with a side of unrecognizable slop. These days, many school meals start with raw ingredients and take longer to prepare. School staples like chicken nuggets are typically baked, not tossed in the fryer, and hot dogs are more likely to be made of turkey. And even those longtime favorites are served in the cafeteria less frequently. 

“Ten or 15 years ago, you wouldn’t have seen a salad bar, a fresh fruit and veggie bar, homemade pasta salads,” said Theresa Hafner, executive director of the food services department for Denver Public Schools. “You probably wouldn’t have seen homemade biscuits, or homemade hamburger buns, made with a white whole-wheat flour.” 

In Denver, for example, 95 percent of the public school lunch menu and about half of the breakfast menu is now prepared from scratch, since the school district introduced cooking from scratch in the fall of 2010. 

The switch has not come without a cost. Since 2010, Ms. Hafner has hired more than 100 additional food service workers, as scratch cooking is more labor intensive. And her food expenses have gone up 20 percent, since fresh produce must be bought for the schools’ fruit and salad bars. 

Adam Simmons, the child nutrition director for the public school system in Fayetteville, Ark., said that while the new rules were well intentioned, he worried that sodium limits and expanded servings of fruits and vegetables could result in more food being left on the tray.

“You’re increasing serving sizes on fruits and vegetables so much, I think you’re really going to just increase trash,” said Mr. Simmons, who spearheaded a switch to 70 percent scratch cooking in his school district. 

Ultimately, though, he and other nutrition experts viewed the new regulations as positive, as long as the school chefs still make the food taste good. 

“Putting things on a plate doesn’t make it a nutritious meal. The students have to consume it,” he said. “And if they do, it will open them to more fresh fruits and vegetables. In the long run, this can do great things.”

PLoS Medicine series on Big Food

Editorial: PLoS Medicine Series on Big Food: The Food Industry Is Ripe for Scrutiny, The PLoS Medicine Editors, PLoS Medicine: Published 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001246
Essay: Big Food, Food Systems, and Global Health, David Stuckler, Marion Nestle, PLoS Medicine: Published 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001242
Essay: Food Sovereignty: Power, Gender, and the Right to Food, Rajeev C. Patel, PLoS Medicine: Published 26 Jun 2012 | info:doi/10.1371/journal.pmed.1001223
Essay: The Impact of Transnational “Big Food” Companies on the South: A View from Brazil, Carlos A. Monteiro, Geoffrey Cannon, PLoS Medicine: Published 03 Jul 2012 | info:doi/10.1371/journal.pmed.1001252
Perspective: Thinking Forward: The Quicksand of Appeasing the Food Industry, Kelly D. Brownell, PLoS Medicine: Published 03 Jul 2012 | info:doi/10.1371/journal.pmed.1001254
Policy Forum: Soda and Tobacco Industry Corporate Social Responsibility Campaigns: How Do They Compare?, Lori Dorfman, Andrew Cheyne, Lissy C. Friedman, Asiya Wadud, Mark Gottlieb, PLoS Medicine: Published 19 Jun 2012 | info:doi/10.1371/journal.pmed.1001241
Policy Forum: Manufacturing Epidemics: The Role of Global Producers in Increased Consumption of Unhealthy Commodities Including Processed Foods, Alcohol, and Tobacco, David Stuckler, Martin McKee, Shah Ebrahim, Sanjay Basu, PLoS Medicine: Published 26 Jun 2012 | info:doi/10.1371/journal.pmed.1001235
Policy Forum: “Big Food,” the Consumer Food Environment, Health, and the Policy Response in South Africa, Ehimario U. Igumbor, David Sanders, Thandi R. Puoane, Lungiswa Tsolekile, Cassandra Schwarz, Christopher Purdy, Rina Swart, Solange Durão, Corinna Hawkes, PLoS Medicine: Published 03 Jul 2012 | info:doi/10.1371/journal.pmed.1001253