Guest Post: A ridiculous burger

As you are probably aware, this is a time of transition for Veritas Health. I just completed my Master's degree from Harvard School of Public Health and am moving back to the San Francisco Bay Area to begin a new phase in my public health career.

Interviewing and packing has been taking up a lot of my time these past few weeks - so I am extremely grateful to Jessica Yen, who serendipitously offered to write a guest post for VH. Jessica is a great friend and public health colleague and I hope that you enjoy her writing and insights as much as I do!
- Katelyn Mack

A Ridiculous Burger
by Jessica Yen

The other day my roommate saw a report that Lotteria, a fast food chain restaurant in Japan, has a new ten-layered hamburger called the “Cheeseburger Tower.”  Ten slices of cheese alternating between ten beef patties, the burger will subtract ten dollars from your wallet and add ten points to your cholesterol level. 

The ad claims that they created the Cheeseburger Tower in response to customer demand, but really now – I’d like to have seen those focus groups!  And although one would hope that such a menu item could not possibly catch on among Japanese consumers, it’s the broader health implications that worry this household of self-professed public health nerds.

Remember the Food Pyramid?

Every five years the US federal government reviews the Dietary Guidelines for Americans. Remember the days of the "Food Pyramid" and then the recent 2005 edition of the "My Pyramid"? Well, if you missed my past post on the topic you should see the Harvard School of Public Health rendition - the Healthy Eating Pyramid - which has a much simpler and scientific food guide for health!

Marion Nestle noted author and public health professor said in a blog post in the Daily Green today that the new recommendations acknowledge

"The need to change the food environment to help individuals meet the Dietary Guidelines."

This is a huge step in the right direction. No longer are our food addictions being looked at simply from the perspective on the individual, but as rooted firmly in the policies and norms of the communities we live in. Our environment impacts our choices, and our food choices affect our health.

There will be an opportunity for public comment on the new guidelines early this summer.

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...

Jamie Oliver (Naked Chef) Takes on Child Obesity at Ted

Jamie Oliver gives a Ted Prize speech on childhood obesity at the Ted Conference in southern California. He believes that the food reality in America is awful and that action must be taken.  Oliver is a food ambassador that commands attention, even of our nations tech leaders!

This is not a research presentation; it's a passionate, moving talk on the realities of death and the TRUE costs of a poor food culture.

Soda Causes Cancer, Could it be?

A study done in Singapore has found that drinking 2 or more sodas per week is associated with nearly twice the risk of pancreatic cancer than staying soda free. The study was published this month in the journal Cancer Epidemiology, Biomarkers, & Prevention and reported on WebMD.

It's no surprise that the beverage industry is doing all it can to discredit the study; however, the methods used seem surprisingly sound. In fact, while the American Beverage Association claims that other studies have shown no association between soda and pancreatic cancer, a 2005 study out of Harvard School of Public Health found that soda (i.e. sugar sweetened beverage) consumption was associated with increased risk of pancreatic cancer in women, particularly those who were overweight.

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.

Leisure Time in Bavaria -- Germany, that is.

Snow capped mountains and miles of farmland lined the streets and highways on my way through the Bavarian Alps last week. I was on a vacation with my family in southern Germany where we spent a few days in Stuttgart and a few more in Garmisch with family who have lived there for the past six years.

What struck me most during my days was not least the cold but that despite the cold if you walked anywhere you saw at least a dozen Germans walking outside, as well.

Nourishing Traditions: A book that gets to the heart of food

There is no arguing that our food system has dramatically changed over the past half century. The American diet has been overhauled with the advent of fast-food, supermarkets, and convenience foods (read: shelf-stable products all found in the interior of your local market or in those vending machines you frequent). These changes have affected public health in unimaginable ways -- not the least of which is the rapid rise of obesity and Type 2 (preventable) diabetes among adults and children of all ages.

This Christmas, I asked my in-laws for a cookbook that could revolutionize the way I think about and interact with food. That book, Nourishing Traditions, is subtitled "The cookbook that challenges politically correct nutrition and the diet dictocrats." And if that doesn't say enough -- it's filled with recipes calling for raw, whole fat dairy, lard and numerous recipes calling for whey (the liquid part of curds and whey -- or that clear, yellowish liquid that settles when you have a tub of yogurt in your fridge).

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?

Can What You Eat Prevent Depression?

Did you know that eating a lot of processed foods (most of the foods in the center aisles) may be related to developing depression? A study recently reported by BBC News and passed along to a fellow colleague at Harvard School of Public Health (thanks Rachael!) has reached this conclusion -- and I am apt to agree.

Take-Home Message
Eat a diet rich in whole foods (fruits, vegetables, unprocessed meats, natural fats, and whole grains) and forgo the traditional diet of refined sugars and wheat, artificial fats, and *deli* meat and cheese.

Why should you? 
Because you can might not just impact your waist line, but also your mental health.

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.

How to Lose Weight in Ten Days

Gimmicks.

Losing It
Weight loss isn't easy. The following weight loss plans: Atkins, South Beach, Green Tea, Low Carb, Low Fat all have one thing in common: they focus on diet. Why do all these weight loss fads all focus on changing what you eat? The answer may be simpler than you think: results. Changing what you eat is the quickest way to lose weight. Eat fewer calories and you will lose weight, all else being equal.

What does it take to burn 300 calories through physical activity? Likely, an hour of brisk walking or a 3 mile jog. What would it take to eat 300 fewer calories? Forgo the tortilla at Chipotle or the beef in your stir-fry. For many people, changing diet is more convenient and less challenging (mentally and physically) than becoming more physically active.

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.

Low-Fat Diet Disaster

Saturated fat has historically been the "number one enemy" of dietitians and nutritionists. For decades, popular thought was that the most effective way to lose weight or to prevent weight gain was to eat a diet low in fat. This approach to weight loss and management has had disastrous consequences; however, because of its subsequent timing with the explosion of refined carbohydrates (as opposed to whole grain foods) and sugary beverages.

Indeed, there is little, if no, evidence that eating a diet low in fat will result in weight loss in the long-term. We discussed eating patterns, such as a low-fat diet, in a class I am taking this semester on Obesity Epidemiology with Frank Hu, author of the book by the same title.  In it, he reviews the most current research on the causes of obesity and the health consequences of obesity. Oh, and you thought obesity was itself a disease.

NYC Ads Target Sugar-Sweetened Drinks

This is the most eye-catching public health campaign ad that I have seen in a long time that does not have to do with violence. While it specifies cutting back on sodas in the text, the liquid resembles sugar-laden iced team more than Coca-Cola and could apply to a wide range of beverages.

In fact, you can check out the entire ad campaign at the New York City Department of Health website, which shows a series of three ads: one with a bottle of Coke being poured, one using Gatorade, and one with the Snapple (of course, these bottles are not actually branded as such...). You can comment on the posters at the nycHealthy blog here.

The ad was first brought to my attention by Dr. Oz (known for his frequent guest appearances on Oprah) on Twitter who asks whether the ads are "too much?"

Too much of what? The truth?

I love this edgy ad campaign that pushes the boundaries and wakes up America to the food traps that are destroying our health and costing us millions, even billions of dollars health care bills for preventable illness. Sugar-sweetened beverages are low-hanging fruit with lots of empirical evidence to support their limited consumption. I wonder whether this campaign will be extended to other States and regions, as well.

Way to go NY City Department of Health!!

An Eating Local Challenge @ TastyKate

I have decided to commit to increasing my consumption of locally grown/raised foods during my last year at HSPH (Harvard School of Public Health). It was difficult to decide whether to initiate this using Veritas Health or my food blog, TastyKate, but finally decided that TastyKate was a better venue. Check out my first post here.

There are many barriers to healthy eating that we, in public health, are always throwing around. Healthy food is too expensive. It's not available. It takes to much time to make. I'm going to try to put some of those theories to the test.

I hope that you will follow along. This will certainly be an adventure.

Gluten-Free = Wallet Woes

After a few months living in California I was struck by the number of food allergies and intolerances of my friends, colleagues, and their families. Gluten-free, lactose-free, peanut-free, pit-free...the list goes on and on. I don't believe that these diseases are just more 'common' in people living in the Bay Area, rather I think it is more likely that doctors (and patients) are probably more aware of food allergy signs and symptoms and thus more apt to screen for and diagnose these problems. In a highly educated, wealthy area like the Penninsula (i.e. Silicon Valley) this makes sense.

The peanut allergy epidemic (I'm not sure that it would officially be characterized as such....) that led to pretzels in airplanes and banning of peanut products in some schools surely raised America's awareness about some food allergy issues. Lactose intolerance has been around for a long time and is fairly well-known. Although many Americans suffer through stomachache after stomachache unwilling to believe that glass of milk or bowl of ice cream could be the culprit. Celiac disease, an extreme form of gluten intolerance is another story.

This week the New York Times ran an article on Celiac disease entitled 'The Expense of Eating with Celiac Disease'. Celiac disease (CD) is an immune disorder triggered by eating products containing gluten (a protein found in most of America's staple grains: wheat, rye, and barley). Even products that you might not have these grains as a primary ingredient may contain traces of it that can trigger extreme pain and health problems for someone with CD.

While the number of Americans with CD is fairly small, a recent epidemiological study in Gastroenterology shows that the disease is more common now than in the 1950s. Lack of diagnosis and treatment of CD also seems to increase the risk of premature death (nearly 4 times!). Though few people are diagnosed with full out CD, many more likely suffer from gluten sensitivities (or intolerance) that might not reach clinical or immunological proportions. Avoiding gluten for the gluten-sensitive can result in greater energy and stamina, fewer digestive problems, and an overall feeling of wellness.

Nonetheless, dealing with health conditions related to food allergies and intolerances, including CD is not covered by health insurance in the US. This is because, as the NY Times article points out, there is no pill or prescription to treat it. The regimen: a strict, allergy-free diet. For those that can't have gluten this means avoiding many cheap, inexpensive, American staples. It means eating more 'whole foods' (fruits, vegetables, meats, legumes, etc). If you think I'm kidding, go to the grocery store and compare the price of a bag of brown rice flour to a bag of wheat flour.

Apparently in Britain, those with CD are afforded insurance coverage (albeit through their government plan) to help offset the added cost of a gluten-free diet.

I think these lifestyle changes are often overlooked by health insurance companies because they don't fit the pharmaceutical quick fix framework. However, I hope that there is good debate over how these types of real-world issues related to a diagnosable, medical condition can be subsidized and included in an insurance plan (even if its through that pre-taxed flexible spending account that you can use to buy over-the-counter drugs and copays).

• For more information on how to eat gluten-free on a budget read the NY Times article.
• For more on the article in Gastroenterology read the following review in Science Daily.
• For recipes and cooking tips/ideas check out one of my favorite food blogs: Karina's Kitchen (aka the gluten free goddess).

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.

RWJF Tackles America's Nutrition Deficit

Farmer's Market Ad in Boston T

Today I listened to a Webinar hosted by the Robert Wood Johnson Foundation (RWJF) which discussed the nutrition recommendations of their own Commission to Build a Healthier America. The conversation, moderated on Harvard School of Public Health's own Dr. David Williams, focused on two of their three overarching recommendations:

1. Fund and design WIC and SNAP (Food Stamps) programs to meet the needs of hungry families for nutritious food.
2. Create public-private partnerships to open and sustain full-service grocery stores in communities without access to healthful foods.

The Webinar discussed how to address America's love affair with unhealthy, processed, nutrition-empty foods. How can we change the eating habits of nation? The Commission advocates personal responsibility, as well as committing as a society to remove the obstacles that prevent Americans from choosing healthy, nutritious food.

Obstacles? What Obstacles?

I was surprised that a few folks on the panel (made up of a broad spectrum of leaders from both sides of the political aisle, as well as those who serve in government and private industry) seemed shocked at the realization that their are huge disparities in access to fresh produce in neighborhoods based on socioeconomic status (e.g. income). Many low-income communities still do not have a local grocery store. This was something panelists recently learned. It outraged them. And they seem committed to doing something about it! That there are communities with easier access to McDonald's and liquor stores than to fresh fruits and vegetables needs remedy.

The Commission has put together a list of model programs for each of its recommendations, one of which I highlighted in an earlier Society & Health post on food desserts based out of Philadelphia. This widely acclaimed local program may be turned into a national "Fresh Food Financing Initiative". Other models include a standardized evaluation of elementary school food environments sponsored by the USDA and the Farmer's Market Nutrition Programs.

I recently noticed that 14 Boston Area Farmer's Markets (a select group, perhaps) provide a 2-1 matching for patrons who purchase produce using food stamps (here's an article from the Globe). This may provide an economic incentive for low-income women to choose healthy, farm fresh produce over grocery or convenience store alternatives.

This conversation is critical right now. We need to focus on health, not just health care. Health reform, not just health care reform. All of us can work toward eating healthier, and all it probably takes is some common-sense (my mom has thankfully always had this!). Doing so will mean living longer, healthier lives.

You can check out more from the Commission and Q&A's from the Webinar on their blog.