Michelle Obama's Moves

Brigget Huber, The Nation, October 10, 2012
 
This article was produced in collaboration with the nonprofit Food & Environment Reporting Network, an investigative reporting nonprofit focusing on food, agriculture and environmental health.
 
In March 2010, Michelle Obama stood on a stage in Washington and leveled a challenge at the food industry's biggest players. "We need you all to step it up," she told a meeting of the Grocery Manufacturers Association. Just a month earlier, she'd launched the Let's Move campaign, the Obama administration's flagship anti-obesity program, which is aimed at reversing the childhood obesity epidemic by 2030.

The first lady hit talking points that would make any children's health expert happy. She urged the manufacturers of products like Doritos, Froot Loops and SpaghettiOs to make them healthier, to cooperate with the government on new food labels, and to get serious about reining in junk food marketed to kids. 

"What does it mean when so many parents are finding that their best efforts are undermined by an avalanche of advertisements?" she asked. The speech was a thrilling display of Mrs. Obama's mettle and a watershed moment, raising expectations among health advocates. Marion Nestle, professor of nutrition, public health and food studies at New York University and a tough critic of Big Food, put it this way: "It was a knockout. An absolute knockout."

That spring seemed to be a season of promise that the blight of childhood obesity—which is on track to make today's kids the first generation of Americans to live shorter lives than their parents—might still be beaten back. Seedlings were pushing up through the soil in the White House kitchen garden, which was in its second season since the first lady had resurrected it; now she was using it as a focal point for a national conversation about food. A presidential task force was charting an ambitious action plan to meet the goals of Let's Move. And at the forefront of it all was the enormously popular mother in chief, who had surprised and impressed many when she chose to make the contentious issue of childhood obesity a focus of her White House tenure.

But three and a half years since the ground was broken on the White House garden, many of those who'd had high hopes say the first lady has logged only modest successes. Experts credit Mrs. Obama for her instrumental role in reforming school lunches, limiting TV watching and increasing healthy food at childcare centers—and, perhaps most important, using her bully pulpit to bring issues of food and nutrition to national attention. But, they say, reversing the childhood obesity epidemic in a generation requires more of the bold action that Mrs. Obama hinted at in her address to the Grocery Manufacturers Association.

From that inspiring moment in March 2010, the administration's strategy appears to have shifted. Or perhaps its resolve has eroded, for it remained mute during a bitter fight to limit junk-food marketing to kids. It has also forged controversial—some say compromising—partnerships with food manufacturers.

"Looking back on it, it's enough to make you weep. So little has been able to be achieved," said Nestle.

Observers put the blame less on a lack of goodwill than on the political realities of taking on the multibillion-dollar food industry, which has lots of lobbying money and friends in Congress and no qualms about fanning the fears of government overreach when it perceives a threat to its interests. "It's a real example of the power corporations have over American government and American life," Nestle said.

It also raises fundamental questions about whether the goals of public health and those of the food industry are at irreconcilable odds. Should those who seek to address the obesity crisis treat food companies as collaborators or as adversaries?

* * *
It's hard to imagine a better spokeswoman for the problem of childhood obesity than Michelle Obama. She's not just charismatic and glowingly fit, but whether dancing the Dougie with school kids or digging in a carrot patch, she puts forth a disarming everymom persona that doesn't wag a finger but says instead, "We're all in this together." She has couched the political in the personal by sharing her struggle to put healthy food on the table and keep her girls at a healthy weight. She even wrote about it in a gorgeous book published this year about the White House garden. It's all gone a long way to scrubbing off the elitist label that often tarnishes advocates who seek to change the food system and make the obesity issue a national concern. "In order to make progress on something like childhood obesity, you need the nation to care about it. She's been helpful in that respect," said Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University.

The proportion of obese or overweight kids has nearly tripled in the past thirty years—the figure is now one in three—and doctors have detected disturbing signs of heart disease and what was once known as adult-onset diabetes in young people. While there are indications that the epidemic is plateauing, it hasn't started to recede yet, though cities like New York and Philadelphia and states like Mississippi and California have recently reported modest declines in childhood obesity rates. But these are "tiny drops compared to the tidal wave of bad things," Brownell said.

Buoyed by her garden's success, in 2009 the first lady set her sights on school lunches, which hadn't been updated in a generation and, amazingly, had minimum calorie levels set but no maximum. This change could have a big impact on low-income kids, who eat most of their meals at school. Mrs. Obama and her staff worked behind the scenes to get a reform bill passed. There was no shortage of drama: Congress inserted itself into the debate to keep french fries on school lunch trays and to count the tomato paste on pizza as a vegetable. But school lunch reform, signed into law in December 2010 as the Healthy, Hunger-Free Kids Act, was ultimately a triumph for the first lady: it gave the Department of Agriculture, for the first time, the power to regulate foods sold in à la carte lines, vending machines and school stores. Margo Wootan, nutrition policy director at the Center for Science in the Public Interest (CSPI), said that Mrs. Obama and her staff were key: "I don't know that we could have passed the bill without their efforts."

As the first lady battled behind the scenes to push through school lunch reform, she also unveiled the Let's Move campaign in February 2010. It had a highly ambitious goal of rolling back the childhood obesity rate to 5 percent, the level it was in 1976, before the epidemic began. To get there, Let's Move would organize its work around five pillars: giving kids a healthy start in life; empowering parents and caregivers to make healthy choices for kids; improving school food; ensuring access to healthy food; and promoting physical activity.

Just three months after Let's Move was launched, the White House Task Force on Childhood Obesity released a report billed as the campaign's action plan. Among its seventy recommendations was one urging food companies to develop uniform voluntary standards for marketing food to kids that conform to federal dietary guidelines. Children's health advocates have long sought to restrict junk-food advertising to kids, which the Institute of Medicine says contributes to obesity. If these voluntary measures didn't work, the report said, federal agencies could step in and regulate. It also called, among other things, for the regulation of the foods sold in schools and clearer nutrition labels for packaged foods: hot-button issues for an industry resistant to such changes.

In a speech announcing the report, the first lady stressed the need to work together: "No one gets off the hook on this one—from governments to schools to corporations to nonprofits, all the way down to families sitting around their dinner table."

At the same time that the administration hinted at the possibility of new regulations, it also sought out partnerships with the food industry in what might be viewed as a carrot-and-stick approach. The question raised by this tactic was: Do voluntary partnerships actually work, or do they merely allow food companies to burnish their image, even as their Washington lobbyists battle real reform measures?

Brownell, of the Rudd Center, spelled out the divergent views in a commentary for the journal PLOS Medicine in July. On one side are those who believe that food manufacturers shouldn't be regulated in the same way as tobacco or alcohol companies. (Wootan at CSPI takes that position: "People don't need tobacco, and you want everyone to stop smoking." But with food, "the goal is to get those companies to shift their mix of healthy products.")

"The assumption is that this industry is somehow different than others, and that because people must eat, the industry is here to stay, and like it or not, working with them is the only solution," Brownell wrote.
But after thirty years' work on policy and public health, Brownell has concluded that this position is "a trap," writing: "I expect history will look back with dismay on the celebration of baby steps industry takes (such as public-private partnerships with health organizations, 'healthy eating' campaigns, and corporate social responsibility initiatives) while it fights viciously against meaningful change (such as limits on marketing, taxes on products such as sugared beverages and regulation of nutritional labeling)."

While Brownell concedes there are small victories to be gained by working with industry, he insists that the childhood obesity crisis won't be solved without forcing food companies to do the things they don't want to do. History is littered with unfulfilled industry promises to protect kids' health, he said in an interview. A recent example was the "Smart Choices" label, introduced in 2009 by fourteen major food companies, including Kraft, Kellogg, PepsiCo and Unilever. The program gave Fudgsicles, Lucky Charms and Kid Cuisine Magical Cheese Stuffed Crust Pizza a little green check mark designating them as "smart" choices. Nutrition experts argued they were anything but healthy.

Or as Brownell put it: "How many more times are we going to get sucker-punched by the industry?"

Mrs. Obama's remarks to the grocery manufacturers, though, implied an awareness of the historical tensions between the food industry and public health efforts. In her speech, she harked back to the early twentieth century, when adulterated foods—including the tubercular beef that Upton Sinclair described in The Jungle—led to the passage of the 1906 Pure Food and Drug Act and laid the groundwork for today's Food and Drug Administration. "Instead of opposing that law and instead of viewing it as a threat, many manufacturers decided to embrace it," Mrs. Obama said. Calling the obesity epidemic a "similar opportunity," she added, "They also realized that increasing public trust and improving products all across the industry as a whole would benefit each of them individually." It was both a subtle defense of regulation and a signal to food companies that their interests and that of the government weren't necessarily at odds.

In that spirit, Let's Move has taken a collaborative approach, forming a nonprofit group called the Partnership for a Healthier America to create and manage private sector alliances. "We don't want to be pushing people from the table; we want to be bringing people to the table," said Larry Soler, the group's CEO, a former executive with the Juvenile Diabetes Research Foundation. The problem of childhood obesity is so broad and complex that no single approach will solve it, Soler added: "Virtually everyone has a role to play in this fight. It's not just food companies; it's schools and families. There's a big problem here, and we're going to need everyone to play a part."

One of the advantages of the voluntary approach, Soler said, is that changes can be put in place quickly. Changing regulations or writing new ones is a slow process, though he noted that his group's voluntary agreements have not interfered with legislative or policy-making efforts. Observers have pointed out that a collaborative approach might also result in less blowback from Republicans and industry-friendly Democrats who have sought to shut down regulatory efforts in Congress, for example, by limiting appropriations.
While seeking cooperation, the organization has also taken steps to avoid the industry's "sucker punch." For starters, it signs partnerships only with companies it believes will have a real impact, and it seeks out the advice of nutrition experts to help make that call, like the CSPI's Wootan, who recently became an informal adviser. Many of the conversations between the group and would-be partners never result in an agreement, Soler said, because some companies find the organization's standards too strict. (The group is also funded by foundations with health-related missions—not industry money.)

For example, companies that partner with Soler's group must agree to an evaluation that determines whether the company followed through on its commitment; the results are made public. "The companies that make it through our process are very serious and are extremely committed," Soler said.

Partnerships like these aren't unique, even for public health advocates. "Partnerships with industry are essential to addressing nutrition and obesity issues," Wootan said. "You can't not talk to companies."
But there is concern about a group closely allied with the government collaborating with entities the government is supposed to oversee. "It normalizes this idea of voluntary partnerships [with] industry as a substitute for real policy-making," said Michele Simon, a public health lawyer and frequent food-industry critic.

* * *
The first corporate agreement the Partnership for a Healthier America announced came in 2010: it was with the Healthy Weight Commitment Foundation, a coalition that includes food giants PepsiCo, Nestlé and Coca-Cola and industry groups such as the Food Marketing Institute. The coalition, which has pledged to cut 1.5 trillion calories from its members' products by 2015, will undergo a multimillion-dollar evaluation by an independent team funded by the Robert Wood Johnson Foundation.

While "1.5 trillion calories" makes for a good sound bite, it would, however, take us back only to 2007 levels, and it's not even close to the 69 trillion calories that would have to be removed from the food supply to take us back to 1970 levels, according to calculations by Hank Cardello, a former executive with Coca-Cola and other food companies who now directs the Hudson Institute's Obesity Initiative. It won't be difficult at all for the companies to meet their mark, said Barry Popkin, a professor of nutrition at the University of North Carolina at Chapel Hill who is leading the evaluation. "It's easy. They can cut a little fat or take some fat out and add some sugar in. They could just cut a few calories out of their beverages and do it."
Popkin's evaluation will look at national health data to see whether the calorie cuts improve health. The hard part, he said, will be getting consumers to buy the healthier foods. (There is also the worry that tweaking processed foods to make them slightly less unhealthy might lead people to eat more packaged products rather than the whole foods health experts advocate.)

But even incremental change is worth celebrating, said Lawrence Cheskin, director of the Johns Hopkins Weight Management Center. "Everything that will lead us in the right direction should be applauded. Purists will argue this is just window-dressing, but it is a step in the right direction."

Even more controversial has been the first lady's alliance with Walmart. In January 2011, the chain said it had made an agreement with the Partnership for a Healthier America to cut prices on healthy foods, reduce the sodium and sugar in packaged foods, and open stores in "food deserts"—neighborhoods lacking fresh grocery retailers. "It's a victory for parents…it's a victory for families…and, most of all, it's a victory for our children," Michelle Obama said at the press conference.

When a giant like Walmart takes even a small step, it can affect millions, and public health experts have praised some of its efforts, including a stricter food labeling system. To some, the Walmart partnership was a sign that Mrs. Obama was putting politics aside in a pragmatic bid to make real change in the food system. The chain's plans to move into food deserts, however, were dismissed by some as an expansion strategy cloaked in social responsibility. The company had been looking to crack urban markets (particularly in progressive cities where it is unpopular) for years, and Mrs. Obama's endorsement was a public relations dream [see "Walmart's Fresh Food Makeover," October 3, 2011]. Putting Walmarts in food deserts, critics worried, could harm the infrastructure of urban farms, food co-ops and farmers' markets that have taken root in such places in recent years. Michel Nischan, the CEO of the nonprofit Wholesome Wave, which doubles the value of food stamps at farmers' markets in twenty-eight states, isn't too concerned. "There's plenty of need to go around," he said.

But the bitterest food fight of the Obama administration took place in 2011 over an effort to limit junk-food marketing to kids. In Mrs. Obama's 2010 speech to food manufacturers, she took the industry to task for marketing unhealthy foods to kids. "Parents are working hard to provide a healthy diet and to teach healthy habits," she said, "and we'd like to know that our efforts won't be undermined every time our children turn on the TV or see a flashy display in the store."

In 2009, Congress had ordered four federal agencies—the Federal Trade Commission, the Food and Drug Administration, the Centers for Disease Control and Prevention, and the Department of Agriculture—to form what became known as the Interagency Working Group and develop a set of guidelines for marketing foods to kids. The standards were to be voluntary, but were nonetheless seen by health advocates as a significant improvement over the current practice, in which each company creates and follows its own marketing guidelines. Now, at least, there would be wider input and standardization.

The industry saw the guidelines as a precursor to regulation. After the first draft was released for public comment in April 2011, the industry released a report that said the guidelines would kill 75,000 jobs. The US Chamber of Commerce said the standards reflected "an unhealthy federal intention and impulse to ban free speech." Food companies began a lobbying and spending frenzy that convinced nearly a third of the Senate and 40 percent of the House to write letters to federal agencies criticizing the proposed rules, according to an analysis of congressional correspondence by the Sunlight Foundation. Food and media companies also pleaded their case at the White House: logs examined by Reuters showed that top executives from Nestlé, Kellogg, General Mills and the media companies Walt Disney, Time Warner and Viacom (which owns Nickelodeon) visited the White House together in July 2011. Two people present at the meeting told Reuters they were there to speak out against the standards. All three food companies are members of the Healthy Weight Commitment Foundation, the Let's Move partnership that agreed to cut calories from their products.

The guidelines' supporters assumed they had an ally in the Let's Move campaign. Public health groups widely supported the proposed rules, which also appeared popular with the public: the FTC received 28,000 public comments in favor and just 1,000 against. Health advocates hoped Mrs. Obama would deploy the quiet leadership that had helped pass the school nutrition bill in support of the guidelines. They were wrong. "On food marketing to kids, we haven't gotten any help from Let's Move," said Wootan, of the Center for Science in the Public Interest.

Wootan, who had originally come up with the idea of government-led voluntary standards, said she and other advocates called and visited the White House, including the first lady's office. They spoke to the agencies involved, and even suggested ways for the administration to rebut what she calls the industry's "bogus talking points."

"The White House was silent," she said, referring to both the West and East wings. Wootan says she never got a satisfactory answer from the Obama administration as to why they wouldn't support the proposed rules. Agencies and offices pointed fingers at one another, she said. White House officials, however, maintain that they supported the effort and blamed Congress for the lack of progress. "We were disappointed when Congress granted the food industry's requests and placed new demands on the working group," said Nick Papas, President Obama's assistant press secretary.

In December 2011, Congress passed a budget bill with a rider that blocked the FTC from working on the marketing standards until it completed a cost-benefit analysis. An administration official said in September that the rider in effect killed the standards, since there was no "credible way" to conduct a cost-benefit analysis on voluntary guidelines.

Eight months later, the first lady announced that Disney—one of the companies that had lobbied against the Interagency Working Group's voluntary standards—had agreed to end junk-food marketing to kids by 2015. But Disney's standards aren't as strict as the guidelines it opposed, and it's unclear how they will be evaluated. They are comparable instead to the voluntary rules adopted by the Better Business Bureau's Children's Food and Beverage Advertising Institute, which cover about 80 percent of foods advertised, including those of Kraft, PepsiCo and Kellogg, Wootan said. These are the kind of voluntary industry-led rules that child health advocates have found so wanting. At the announcement, Disney chief executive Bob Iger stood beside top regulators involved in the Interagency Working Group and told reporters that actions like Disney's could "create huge change without having the government step in to directly regulate or legislate our efforts," Reuters reported at the time. A Disney spokesman would not elaborate, saying only that the company had been working on childhood nutrition initiatives since 2006 and was strongly supportive of Let's Move.

* * *
In November 2011, speaking at a summit organized by the Partnership for a Healthier America, Mrs. Obama heaped praise on the food companies. She congratulated manufacturers for cutting sugar and salt, restaurants for overhauling kids' menus, and grocery stores for building in food deserts, and she also praised the efforts of parents and schools. Then she pivoted: "I want to talk about the crisis of inactivity that we see among our kids and what each of us can do to start solving that problem."

Eddie Gehman Kohan, founding editor of Obama Foodorama, a blog that has chronicled every food-related facet of the administration, called it "a fundamental shift." Nestle, Simon and others registered dismay at what they saw as a departure from the politically charged arena of food. Food companies like to talk about exercise because it shifts the emphasis from their products and reinforces the industry's insistence that any food can have a place in a healthy diet. It also shifts the conversation from one about systemic problems—such as food marketing—to individual lifestyle choices (i.e., "just exercise more!"). But studies show that exercise, while offering huge health benefits, cannot by itself address obesity or ward off the weight gain that arises from eating junk food.

Sam Kass, assistant chef and senior policy adviser for healthy-food initiatives at the White House, insists that reports of a "fundamental shift" are incorrect and that exercise was one of Let's Move's pillars from the beginning. "The notion that we were somehow moving away from nutrition was simply wrong," he said.

Gehman Kohan, writing in an e-mail, added: "It makes for an attention-grabbing headline to accuse the First Lady of 'caving' to greedy private interests that might donate to the Obama campaign during an election year, but that simply was not the case."

An examination of press releases from both Let's Move and the Partnership for a Healthier America put out since the first lady's speech in November 2011 shows that the number of food- and exercise-related announcements have been about even. Before Mrs. Obama's November speech, however, food announcements greatly outnumbered those related to exercise by more than two to one, which might explain why some perceived a shift. Soler said exercise partnerships have been in the works for some time but have taken longer to coalesce.

The trajectory of Let's Move has left many of those initially optimistic about the program feeling doubtful that it will accomplish much more: the best of intentions appear to be mired in the unhappy realities of American politics. "It's dead in the water," Nestle said. "They can get some little tweakings through, maybe, but the force of it is gone. It's compromised at this point."

Kass is much more enthusiastic: "We've made progress beyond anything we could have dreamed of two and a half years ago. We've seen this issue become front and center in the minds of millions."

That's due largely to Mrs. Obama's leadership and persuasion. But her sole authority is moral authority. While she's brought tremendous attention to obesity and healthy living, she doesn't have the power to make the regulatory changes that public health experts say are key. "It's not her fault," said Simon. "She's just in the wrong wing of the White House."

Brownell likewise said he doesn't blame the Obama administration and Let's Move for failing to accomplish broader change. "Citizens United didn't help, the fact that we're in an election year will slow things down, and regulatory agencies have been gun-shy," he said. Noting the campaign's substantial victories, such as school lunch reform and improved nutrition at daycare centers, he added: "Those are some pretty big changes, but not signs the food industry is changing its ways."

If leaders are to take the bold steps, such as soda taxes and marketing restrictions, that public health advocates urge, they'll need to be backed—and pushed—by a more vigorous movement. "What they need is a public that demands these things and that gives politicians cover to take these actions," Brownell said. Without that, Let's Move may well have done all the moving it can.

Powerful new video on Kids and Excercise

Today's kids are the first generation with a shorter life expectancy than their parents. Recently launched Designedtomove.org is a fight against inactivity by educating younger generations how they can gain those five years back. Technological advancements has designed us to be sitting too long and too comfortably.

What would you do with 5 more years?

http://www.designedtomove.org/#/watch_video

Interesting: The Nutrition Science Initiative

Nonprofits begin with the awareness of a problem that needs to be solved, and then a simple question: if we don’t do it, who will?

Nutrition Science Initiative

For us, the problem is inescapable: Over the course of our lives, we’ve witnessed extraordinary progress in science, technology, and medicine, yet these advances have been accompanied by unprecedented increases in the numbers of obese and diabetic Americans. The seemingly simple question of what constitutes a healthy diet – what should we eat to live long and active lives – has remained mired in endless controversy. The official wisdom certainly doesn’t seem to be helping, and a morass of diet books and websites are at odds about which approaches might be better.

In April 2011, after a brief email correspondence, we met in person for the first time. Sitting in a café in Oakland, California, we spoke at length about our personal and professional obsessions with diet and health, and about this national failure to curb the ongoing epidemics of obesity and type 2 diabetes.

More than anything, we discussed what it might take to solve the problem. One fact seemed clear: the medical research establishment had simply failed to provide definitive, unambiguous answers to these unresolved questions of diet and health. Despite billions of dollars spent on medical research, the definitive experiments had never been done, having been perceived as either too expensive, too difficult, or simply not worth the effort.
Our solution was to create the Nutrition Science Initiative (NuSI), an organization that would provide the resources necessary for independent researchers to do the hard science that could indeed answer these controversial but critical questions once and for all.

We don’t know how this undertaking will end.  We are not invested in particular outcomes.  We are invested in finding scientifically sound solutions, and we remain loyal to the mission of communicating the results in a consistent manner that can be both heard and understood by influential scientists, policy makers, the media, and the general public.  We look forward to the day when NuSI is no longer necessary, when – with the full support of rigorous science – we can choose with informed confidence what to eat and what to feed our families.
We thank you for your interest in NuSI.

Gary Taubes and Peter Attia, M.D.
Founders, Nutrition Science Initiative

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.”

Stanford Study - Organic Produce Reduces Exposure to Pesticides

News Release - Environmental Working Group 
Organic Produce Reduces Exposure to Pesticides, Research Confirms
Stanford Univ. Study Also Finds Organic Meat Has Fewer Antibiotic-Resistant Bacteria
August 31, 2012

Environmental Working Group : "Consumers can markedly reduce their intake of pesticide residues and their exposure to antibiotic-resistant bacteria by choosing organic produce and meat, according to researchers at Stanford University who reviewed a massive body of scientific studies on the much-debated issue. The Stanford team analyzed more than 230 field studies and 17 human studies conducted in the United States and Europe to compare pesticide residues, antibiotic resistance and vitamin and nutrient levels in organic and conventionally produced foods. The study, published Monday, September 3, 2012 is available online at the website of The Annals of Internal Medicine (abstract only)...Based on its review of the available research, the Stanford team also concluded that conventionally raised meat harbors more antibiotic resistant bacteria. It found that consumers of non-organic chicken or pork are 33 percent more likely to ingest three or more strains of antibiotic-resistant bacteria than those who eat organic meat."

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.