FDA May Tackle Serving Size Concerns in Food Labeling Overhaul

"Once you pop, you can't stop!"

What clever marketing. Like a self-fulfilling prophecy, really. I mean "Bet you can't eat just one!" -- that'll get you, too.

Well, it's time we faced the facts of American food culture straight up. Bigger is better, and more makes you merrier. Tell me, who eats for breakfast a bowl filled with only 1 cup of cereal or -- heaven forbid -- 1/2 cup of granola? And how many people eat 1 oz (about 6-10) of tortilla chips and stop at that?

Yet, if you look at the food labels -- that is what a typical serving size would be!

While food companies have known this (and exploited it) for years, the US Food and Drug Administration (FDA) has been slow to catch on...

Altering Our Salt Obsession: A New York City Initiative

Salt is a hot topic in health right now. For more than a decade Americans have been consuming nearly twice the recommended amount of salt in their foods, mostly due to eating out more and the increased consumption of heavily processed, heavily salted foods.

Nutritionists and doctors have been concerned about individuals' excess consumption of salt (or sodium), particularly among those with high blood pressure. The US Department of Health and Human Services recommends a maximum of 2,300 mg of sodium/day (only about 1 tsp of salt), and even less for those with high-blood pressure. But many Americans consume closer to 3 tsp of salt each day.

Eating too much salt has been shown to raise blood pressure and increase a person's risk of suffering from heart disease or stroke. That's why if you or someone you know has been diagnosed with high blood pressure, your doctor has likely advised you to cut back on your salt intake and switch to low- or no-sodium products so that you can add your own salt to taste.

This week public health professionals and politicians stirred interest in salt -- particularly the abundant use of salt and salt-laden products by restaurants, especially fast food restaurants. The New York Times reported on January 11 of Mayor Bloomberg's plan to support the reduction of salt in packaged and restaurant foods by 25% over the next 5 years.

Sugar-Sweetened Beverages the Next Tobacco?

Image from the NY City Department of Health Anti-Obesity Campaign

In class this week, we discussed strategies for reducing the consumption of sugar-sweetened beverages at home. Sugar-sweetened beverages are exactly what they sound like: any drink sweetened with sugar (sodas, fruit juices, "vitamin" or flavored waters, sports drinks, energy drinks....etc.).

The larger question at hand was: Can we utilize the same strategies that brought down the tobacco industry for reducing the consumption and availability of sugary drinks?

The idea of a "soda tax" has come under scrutiny by conservatives who don't like the idea of taxing anything, as well as groups that are strongly supported (i.e. funded) by the food and beverage industry, like the Center for Consumer "Freedom." And, yes, the quotes are my doing...

However, many in public health believe that taxation will curb consumption of sugar-sweetened beverages, particularly among those who consume the most and are most likely to suffer poor health and overweight because of it. Nonetheless, soda is just the tip of the iceberg when it comes to liquid, non-nutritive calorie consumption, especially among kids. There are many other beverages that provide just as many calories and can contribute to weight gain. What will happen when the beverage industry just switches production (and all its marketing!) to these other sugary beverages? Another tax?

Taxation of tobacco has been a primary strategy in reducing its consumption and preventing people from starting to use it. Yet, taxation of tobacco has gone extremely high! Right now the federal tax on tobacco is $1.00 per 20-cigarette pack, and states can tax tobacco even higher ($3.46). Would a soda tax ever get that high? Not likely. Harvard researchers suggest that just a $0.01 per ounce of soda would be enough to change consumption patterns of consumers; a typical 20 oz. soda would be marked with a 20 cent tax.

However, the strategy that I am most excited about is social marketing -- advertising that promotes healthy behaviors and discourages unhealthy ones. If you haven't seen the sugar-sweetened beverage ads out of New York City, check out my other post on this topic. Marketing can't just tell you that something is bad, it must suggest alternatives.

If you are looking for alternatives to sugary drinks here are a couple promoted on the Harvard Nutrition Source website:

• Plain (or Infused) Water -- I think this means throwing some lemons or cucumbers in with the plain water to add flavor without the calories.
• Tea -- Go light on the sugar and honey, of course.
• Coffee -- Choose milk over cream, go sugar-free.
• Sparkling water -- add a splash of 100% fruit juice for flavor, without packing in the calories.

The website even has a recipe for a healthy "fresh fruit cooler," which is a great alternative to store-bought smoothies. Notice, drinks that are "sugar-free" because they utilize artificial sweeteners are NOT included in this list.

Right now there is a national movement to get junk foods and soft drinks out of schools. While I believe this needs to happen soon, most kids get unhealthy foods outside of schools. A 2006 study by Harvard researchers found that 60-80% of sugar-sweetened beverages were consumed by kids at home.

This suggests that we need a national movement, not just to change school environments to provide healthier beverages, like water and low-fat milk, but also change social norms around providing sugary drinks to kids in homes.

What would sway parents to pass up purchases in the beverage aisle and stick to **free** tap water and nutrient-rich milk for kids?

That's a tough question. The strategy needs to incorporate environmental change, excellent social marketing of the health dangers of daily consumption of sugary drinks, and grassroots/community efforts. If we can get sugar-sweetened beverages out of schools (where they have no right to be!), perhaps we can raise awareness about the issues so that we can get them out of homes, too!

Could the tobacco model work? Perhaps. It may be important to look to other public health campaigns; however, to get the most insight into what public health strategies will be most effective. How about alcohol control campaigns?

How Healthy is Your Breakfast Cereal?

Cereal is about as commonplace in the American home as peanut butter and jelly (unless you are allergic, I guess). At some point in our nations history, whole cereal grain breakfast that took minutes or hours to prepare were replaced by highly processed refined grain "cereals" that had loads of added sugar and went by the name of Cap'n and Lucky.

Until today's release of the Yale Rudd Center's Cereal Facts website, there was little way to know whether the cereal you were eating was healthy or all hype. Case in point: a friend posted a picture of Facebook with a Fruit Loops box reading "NOW WITH FIBER" on the front package (see yesterday's post for more on this...) which clearly illustrated food industry's widespread marketing of unhealthy food with their "healthy" components placed first, and foremost for consumers to see.

Smart Choices Labeling System Divided, Fails?

The "Smart Choices" label, which was meant to be a guide for consumers to make healthier food choices when shopping the supermarket, may be lying on its deathbed, according to a recent article in the New York Times. A few of the major food industry supporters, including PepsiCo and Kellogg's have cut its ties with the program and will phase out production of products (like Froot Loops cereal) with the Smart Choices logo prominent on the box front. Although, Kraft indicates it has no intentions to remove the logo from its foods.

Soda Tax To Combat Obesity, Will it Work?

Cigarettes are taxed, alcohol is taxed, why aren't soft drinks taxed?

One huge reason for the dirth of legislation levied against unhealthy foods including sodas is the enormous lobby of the food industry in DC and across the country. Whenever there is serious consideration of restricting access to unhealthy foods (such as in public schools) there is enormous resistance. Big Food has lots of money to manipulate (I mean influence) public opinion so that there is not enough momentum and public support for anti-junk food policies. The sad story is that public health professionals can have nearly the same trouble improving access to healthy, nutritious foods in these same places!!

The lead story of the Business section of today's New York Times was "Tempest in a Soda Bottle: Proposed Tax on Sugary Beverages Debated." It discusses the increased political open-mindedness to the idea of a tax on soft drinks and sugar-sweetened beverages in the US and the likely resistance to such a proposal.

Here's why I think this could be a good idea.

Missing the Health in Health Care Reform

Michael Pollan was preaching to the choir today in his New York Times op-ed piece on "Big Food Vs. Big Insurance." His words were music to my ears:

"...the fact that the United States spends twice as much per person as most European countries on health care can be substantially explained...by our being fatter. ...

That's why our success in bringing health care costs under control ultimately depends on whether Washington can summon the political will to take on and reform a second, even more powerful industry: the food industry."

As excited as I was to hear Obama's rallying cry on health care reform last night, I was disappointed to hear prevention offered as a critical element of reform only one, maybe two, times.  Prevention isn't a sexy or politically inspiring topic, I know. Yet, public health is all about prevention. Public health is about "creating the conditions in which people can be healthy."

The food industry has significantly changed the way Americans (and populations globally) eat. Few countries have been spared. Those that refuse to let huge US-based multinational food manufacturers in, or that limit their reach, have often met much resistance and criticism. Yet, as Barbara Kingsolver would say, these resistant countries are protecting their food culture. They are also consequently protecting their health.

In an effort to get the cheapest, most convenient food we have sacrified quality, nutrition, and health. We have kids in America who are both obese AND malnourished. How have we let that happen?

While I am all in support of health care reform moving forward, it will in no way be a panacea for America's poor health. There are enough players out there who want to profit from sickness, not just the insurance companies. Pollan has brought this to our attention, once again.

"Smart Choices" Is Fool's Gold

The New York Times today ran a story today on the "Smart Choices" food labeling campaign that is being heavily endorsed by the biggest food industry players. The program claims to respond to consumers' need to be able to make quick, convenient choices on "healthier" food products. I mean, who has time to read through ingredient lists and nutrition labels? Well...I do. But, I know most people do not. Nonetheless, despite its good intentions, this food labeling system is inherently flawed.

Actually, this is a public health abomination! Walter Willett (whose name often appears on Veritas Health), is actually quoted in the article as saying "These are horrible choices." Enough said.

It is really no surprise to me that the article was titled "For Your Health, Froot Loops." As I've written before, sugary breakfast cereals seem to be constantly popping up in marketing to parents and kids as a nutritious breakfast food. It's as if food manufacturers fear people will find out that highly refined, processed cereals are not that great for them and switch to something that resembles what one might find at a farm somewhere (fruit, eggs, dairy, etc.).

So why am I so upset by this? It's just a few labels, right? Well, not exactly. This is an example of industry exploiting a true (Veritas) public health need. Consumers, parents especially, need to have a more simple, credible system on which to base their food choices. This, as Willett dually notes, is not a credible system.

It is not as though parents are choosing between donuts and Fruit Loops as Eileen Kennedy of the Friedman School of Nutrition Science and Policy is quoted as saying. Indeed, it will be more likely a consumers' choice between Froot Loops and some other "un-labeled" potentially healthier cereal product. One that possibly is unable, or unwilling to pay the annual $100,000 dues for the label.

As Kennedy notes, those products without the "Smart Choices" label will be perceived as nutritionally inferior, and, even worse, that those with the label are good for you. I believe there is a big difference between what is good for you and what is "better" for you...relative to something that is really "bad" for you. Come on, "Cocoa Puffs" do not provide any of the health benefits of cacao and there is no fruit in Froot Loops.

Other questions I have: What must companies do to get the "Smart Choices" label? And why are there such generous guidelines for what products qualify? Since when and who exactly decided that Coco Puffs and Froot Loops (in addition to many other similar products, I presume) are actually smart choices? This statement in the article is telling...

Ten companies have signed up for the Smart Choices program so far, including Kellogg’s, Kraft Foods, ConAgra Foods, Unilever, General Mills, PepsiCo and Tyson Foods. Companies that participate pay up to $100,000 a year to the program, with the fee based on total sales of its products that bear the seal.

Recently, I read that if it requires a label it probably isn't that good for you. Here's to simple criteria. In general, stick to foods that don't require a label to tell you that it is a smart choice.

When Kids Lack Calcium and Vitamin D...

...feed them Trix and Lucky Charms?!

The commercial begins with two cute kids in the frame. One is trying to figure out the other's height with measuring tape; they are playing in a large kitchen. Then the fact, which is something to the effect of

"Did you know: not enough kids are getting enough calcium and vitamin D in their diet."

So what does the ad suggest? Feed your kids more vegetables (dark green leafy vegetables are a good source of calcium and salmon or tuna are excellent sources of vitamin D)? Encourage your kids to play outside during the day (sunlight is the best way to help your body produce its own vitamin D reserves)? No...

It's General Mills (GM) to the rescue! The sugar laden cereals they manufacture have added calcium and vitamin D. Didn't you know? And your kids may be fussy over collard greens or baked salmon and they love video games so much that you would be interrupting their valuable screen time to take them outside...so just feed them their favorite cereals. I'm not dissing all cereals, though I do wonder how they became such a staple in the American diet. It's just that I could think of a million things to market to increase kids intake of calcium and vitamin D, and Trix (it's for kids!) is NOT one of them.

Not to mention the fact that the universal companion to cereal (i.e. milk) has 30% of the daily recommended amount of calcium and 25% of the daily amount of vitamin D.

We've heard about the benefits of calcium a million times. But why is vitamin D so important? Vitamin D has been shown to promote bone strength and muscle growth (oh...you thought that was the calcium?). It may even protect against some common cancers.

The Harvard School of Public Health Nutrition Source suggests that most adults take a vitamin D supplement (especially those in colder, northern climates). I actually just bought some vitamin D3 (1,000 IU) at the health food store today. I plan on having it on those days when I just don't get to exercise outside (winter...brr...). I'm not sure that I would give that much (400 IU/day is recommended for children).

Back to the commercial...

It aired on the Food Network around 6:30pm today, at least that is when I saw it. Will the marketing tactic work? Without communicating alternative, natural sources of calcium and vitamin D it just might.

Big Food: Bad News?

Here are two articles I came across in Consumer Affairs this morning:

FDA Warns General Mills About Cheerios Claims

According the the Food and Drug Administration (FDA) Cheerios has stepped out of bounds in its recent campaign to market that "Cheerios may reduce your cholesterol!". GM also promotes other scientific claims such as the ability of Cheerios to lower LDL cholesterol (the bad kind) and to lower cholesterol 4% over 6 weeks. FDA officials feel that these statements market Cheerios as a drug, not food because of these claims.

I applaud the FDA efforts in this area. GM and other large food companies are itching to show just how "healthy" their foods really are -- when really, their foods are not all that healthy. In fact, they would love to play up the RELATIVE advantage of sugary cereal over no cereal or the benefits of diet soda over regular soda. 

Come on! Leave out the sugar, cut back the sodium and use less refined products. Then you might not have to try so hard to prove that your food is good for the public.

Nothing beats a home cooked meal. We all should try it some time.

Senate Studies Soda Tax

The Center for Science in the Public Interest, a public health advocacy group, has finally gottenthe attention of Congress in efforts to pass a national tax on soft drinks and sugar-ladenbeverages.

According to the article a study conducted by the Harvard School of Public Health in 2006 found that added sweeteners contributed to 1/3 of all carbohydrate calories that Americans consume, and that the sugar from sugar-sweetened drinks is a full 1/2 of that caloric amount.

We have been down this road before without much success. Even in Massachusetts we have a law that explicitly exempts CANDY and SODA from State sales tax. How can this be?! Our Stateneeds money and this sort of sales tax on absolutely, undeniably, unhealthy food seems likelow hanging fruit, right?

How many of our politicians are in bed with the food and beverage industry to block this votefrom passing? We will know in due time.

Is "Three Glasses of Milk a Day" Too Much?

Is your physician (or your spouse) pushing you to have three servings of dairy a day? Is that wisdom (based primarily on nutrition guidelines in the US stating that we need upwards of 1000 mg of calcium daily), though well-intentioned, misguided?

A recent lecture Dr. Walter Willett of the Harvard School of Public Health addressed this debate head-on. He cited much scientific evidence (some strong and some weak) and concluded that 3 servings of dairy, particularly milk does not only not seem to benefit adults, but may actually be harmful in excess. Similarly, while milk likely leads to bone growth it does not prevent against fractures the way that it once was anticipated to.

The take-away message: consume dairy in moderation (1.5 servings a day is fine) and make sure I am getting enough Vitamin D in my diet and through outdoor activity.

For more information see my post at Society and Health.

Fast Food and Obesity: A Causal Relation??

The New York Times reported on a recent Working Paper that examined changes in obesity among high-school students and excessive weight gain during pregnancy before and after a fast-food outlet opened in several cities across the United States. What did they find? Check out my blog post at Society and Health. 

Appetite for Profit: An Introduction to the Food Industry

We've heard of Big Tobacco and Big Pharma -- what about Big Food? How much have consumers, politicians, and even public health professionals considered the co-optation of "healthy food" by mega-food corporations such as McDonalds, Kraft, and General Mills? There are many examples of how these companies or their spokespersons have tried and mostly succeeded in preventing healthier foods and drinks in schools, destroyed legislation to increase consumer access to nutrition information, and sent the message that physical exercise, not diet is what is making American obese. 

Appetite for Profit: How the food industry undermines our health and how to fight back is an excellent book by public health lawyer and advocate, Michele Simon. For anyone interested in gaining an expert perspective (I'm not saying it is unbiased - per se) in this issue this is a must read. People interested in childhood obesity and advertising to children may also find this book to be quite insightful.

The most useful sections of the book are found in the appendices. For example, who is the Center for Consumer Freedom? The name sounds good - I'm a consumer and I'm all for freedom! A brief glance at the appendix or a turn to one of the many pages in her book that references the CCF one will note that this "freedom" applies first and foremost to the restaurant industry. One ought be wary of many of the organizations involved in food advertising, lobbying, legislation, and policy. Many are not what they appear to be.

In addition to helping us identify industry-backed "objective" organizations, Simon also presents cogent arguments against several of the "myths" propagated by Big Food. For instance, why restaurant nutrition labeling won't put local restaurants (or industry leaders) out of business, how such tactics (point of sale nutrition information) can help consumers chose healthier options, and how schools (and more importantly, students) can thrive without soda and sports drinks sold in school.

This book renewed my passion for creating a healthier environment where we all have the ability to choose to live and eat well. My next task: understanding the Farm Bill. I have heard so much about this important piece of legislation that has an enormous amount of influence over what I find at the grocery store, where it is from, and how much it costs. 

What are your thoughts?

McDonald's Moms Marketing Madness

What alliteration! My new not-so-cuss word for how livid I am about this new marketing maneuver by McDonald's (...there I go again). I can't believe I did not see it coming. I'm sure other advocates did. 

So here is how it went down...

I was quitely watching CNN the other night, tucked under my blanket, homework in hand, when all of a sudden "moms declare McDonald's FRENCH FRIES healthy..." I think I stopped breathing. Of all things, the french fries are healthy?! And of all people, moms are now voluntary public media advocates for McDonald's?! 

This is clever, very clever. 

Honestly there is not much I can say about this. Later clips on CNN suggest that many moms won't be fooled. While I am all for a big mac (well maybe a chicken sandwich...) every once in a while, I cannot imagine anyone saying that McDonald's main offerings are healthy. Though, I will give the salads some credit. Perhaps, McDonald's is healthy if you are comparing french fries and double bacon cheeseburgers to...umm...cheez whiz and ding dongs? 

Many don't believe that big macs, chicken nuggets, and french fries harm health. I beg to differ (call me crazy or rent Super Size Me). Do you know that years ago (perhaps still today) people & their kids ate McDonald's food thinking that it was perfectly "healthy." There can be no debate that fast food corporations have done everything within their power to prevent nutrition information from effectively reaching consumers. Furthermore, even if fast food does harm health, no one can prove that disease had anything to do with diet. Maybe lack of exercise, but diet...no. For more on Big Food "wellness" tactics check out Michele Simon's Book: Appetite for Profit.

I digress. There are fervent believers on both sides of the issue. I know this post leans to the left. Feel free to comment either way. I need to know what you think -- my future public health career may depend on it!