Sunday, March 15, 2020

A consumer food data system for 2030 and beyond

Government policy influences all parts of the food marketing chain, including farms, food manufacturers, retailers, restaurants, and diverse nutrition assistance programs. At every stage, sound policy-making depends on high-quality data.

The National Academies Press this month published a new consensus report from the Center for National Statistics (CNSTAT), entitled A Consumer Food Data System for 2030 and Beyond, with recommendations to help guide the federal government in consumer food data collection and dissemination. The report panel was chaired by UC Davis professor Marianne Bitler (I was a panel member).

As the report summary explains, trade-offs are essential, because it is challenging for any consumer food data system (CFDS) to achieve all of the characteristics that we would wish:
  • Comprehensiveness. To monitor levels and trends in food behaviors and related outcomes, and to identify the effects of public programs and policies on those behaviors, a comprehensive data system requires a variety of sources spanning multiple topics.
  • Representativeness. Data on food behaviors and outcomes is most useful if it is representative of the U.S. population, both nationally and sub-nationally.
  • Timeliness. To have maximum program and policy impact, the system collects data at regular intervals, repeats over time at an appropriate frequency, and releases data without undue delay.
  • Openness. Because data programs are maintained with taxpayer funds, data should be accessible to the public and to the research community. Security and privacy concerns must be addressed before making de-identified data available.
  • Flexibility. A flexible data system recognizes that food and consumer data will be used for some research applications that were planned in advance, as well as for applications generated by a broad, entrepreneurial, and inventive community of research users studying unanticipated changes in policy, food retail markets, or consumer preferences.
  • Accuracy. Accurate measurement and reporting are the foundation of effective evidence-based policy making, so a desirable data system is one that seeks continuous quality improvement. Given increased reliance on data produced by state and local governments and commercial entities for purposes other than scientific study, continual assessment and improvement of the quality of these sources will be a central part of the CFDS.
  • Suitability for causal analysis. While some policy questions can be answered with descriptive information, others require cause-and-effect inference. With this in mind, data design efforts should include (i) the collection and sharing of policy variables for use in implementing quasi-experimental designs, (ii) the use of administrative data for potential program evaluations with random-assignment research designs, and (iii) the creation of longitudinal survey and administrative data (either repeated cross-sections or panel data) for use in statistical analyses that offer causal insight.
  • Fiscal responsibility. The CFDS should maximize the research value of federal dollars invested in the data system (including staff time) through its combined impact in descriptive information, monitoring functions, and estimation of causal effects.
Looming behind the report is the panel's awareness of the increasing difficulties of collecting traditional survey data, due to rising costs and greater difficulty maintaining a high response rate. The data systems of the future will combine survey data with administrative data and proprietary data (such as retailer scanner data) in new ways.

Friday, February 28, 2020

For the food industry, it is essential to have coherent federal leadership on dietary and environmental issues together

For the food industry -- and also for meeting important public interest goals -- it would be beneficial for the U.S. federal government to consider environmental sustainability along with nutrition science in the Dietary Guidelines for Americans (DGA).

In 2013, the Food Forum of the National Academies organized a workshop on sustainable dietary guidelines (covered previously). At the time, we had little hope the topic would be included in the actual guidelines. Then, in 2015, hopes were raised when the Dietary Guidelines Advisory Committee (DGAC) included scientific literature on sustainability in its report, which serves as an important input to the U.S. Department of Agriculture (USDA) and the Department of Health and Human Services (DHHS), which then jointly produce the official dietary guidelines once every five years. That year, former Deputy Secretary of Agriculture Kathleen Merrigan, several other colleagues, and I argued in an opinion column for Science that the federal agencies should use this material on sustainability in the official report. However, the agencies excluded all mention of sustainability in the end. Since then, the National Academies has continued to organize fascinating workshops on this topic (see video presentations and proceedings), but we have little indication of progress in the federal guidelines.

The Menus of Change initiative, a collaboration between the Harvard TH Chan School of Public Health and the Culinary Institute of America encourages the restaurant industry in particular to explore new ways of providing healthy and sustainable food in a profitable way. I have served on the Scientific and Technical Advisory Committee for several years. The experience clearly shows that major food industry sectors see the need to address complex consumer expectations for environmental and nutrition issues together. From a practical standpoint, it would be impossible for business executives to separate the issues.

For the new 2020-2025 Dietary Guidelines for Americans, an advisory committee report is expected later this spring, and then the official report will come out a few months later. This week, the Union of Concerned Scientists (UCS) released a policy brief (.pdf) encouraging the federal government once again to favorably consider including sustainability in the official report.
A growing body of research shows that shifting what we eat could improve the health of the population and the planet. However, the US government has declined to incorporate this evidence into federal food policies. As government agencies develop the 2020-2025 Dietary Guidelines for Americans, a review of recent studies on dietary patterns and sustainability by the Union of Concerned Scientists and colleagues shows that current US dietary advice may not support the long-term environmental sustainability of the food system. This policy brief outlines key actions and recommendations for federal agencies and policymakers to help protect public health and food security for generations to come.
The policy brief draws on a literature review published this week [updated March 16] in Advances in Nutrition, by UCS researchers and several Friedman School community members, including Rebecca Boehm (alum), Nicole Tichenor Blackstone (faculty), and Naglaa El-Abbadi and Salima Taylor (students).

I hope the government does include sustainability. Just as the dietary guidelines help consumers and government agencies understand the connections between diet and health, by providing a steady and sober summary of the balance of evidence in a complex literature, it would be valuable to do likewise for environmental sustainability. This is not a mere digression into a side topic. In the 2020-2030 decade, the climate emergency will be central to almost all policy debate on major social and economic decisions, including decisions about the food system. If political pressure from selected agricultural industries causes these issues to be excluded from the dietary guidelines, federal food and nutrition policy will be hampered for years to come.

Monday, February 17, 2020

The Labor of Lunch, by Jennifer Gaddis

In her new book, "The Labor of Lunch" (University of California Press, 2019), Jennifer Gaddis of University of Wisconsin-Madison covers the history and politics of federal school meals programs from every angle.

The book contrasts with contemporary behavioral economics research, which treats lunchrooms as a "laboratory" for small random-assignment trials of minor changes in product presentation. Gaddis instead pays attention to the big social issues that always have complicated school meals programs: women's work, the labor movement, racism, federal budgets, and class differences in food tastes for nutrition experts and broader populations.

To illustrate the scope, ambition, and topic coverage of the book, here are some homework questions one could ask students after they read this book:
  1. What makes the lives of lunch-workers precarious?
  2. What organizational sponsor of a free school meals program was labeled the "greatest threat to the internal security of the country” by Federal Bureau of Investigation director J. Edgar Hoover?
  3. In training programs focused on sanitation and cost reduction, what important topic was left out?
(Answers: 1. Neoliberal capitalism. 2. The Black Panther Party. 3. Scratch cooking.)

The concluding chapter aims for expansive changes rather than short-term victories:
There are high-road alternatives to both the cheap food economy and to real food lite that offer a pathway toward a new economy of care in American public schools. Accessing this high road depends foremost on revaluing the labor of lunch. We must invest in professionalizing school cafeteria workers and recognize them for the multiple forms of care they already provide to the nation’s children. I want to move beyond this foundational argument, however, to propose a more expansive vision of what food systems could look like if we focus our collective efforts on transforming the NSLP into a hub for food justice—real food and real jobs—in every community across the rural-urban divide.
In a related New York Times column last week, Gaddis asks why parents still are sending kids to school with bag lunches rather than supporting the school meals programs. It reminds me of a conversation with my children a couple years ago. The kids knew their parents had always placed them in the school meals program as a matter of principle, rather than complete confidence in the product. When they mentioned having brand-name restaurant chain pizza in high school for lunch, they could tell from my face I was disdainful. They reassured me it was just twice weekly. Twice a week for pizza is not so awful, I conceded. But they meant only twice weekly was there brand-name restaurant chain pizza; on the rest of the days, there was reheated frozen generic pizza.

In some respects, the radical critical tradition of Gaddis' narrative may differ from that of most of my colleagues in agricultural economics, or myself. But any reader of this book will see these important nutrition programs should be dramatically better on grounds of taste, nutrition, and fairness to workers.

Thursday, February 06, 2020

Funding announcement from Tufts and USDA for WIC telehealth innovations

My colleagues at Tufts University and I are happy to announce that we are now requesting proposals from WIC State Agencies or a consortium of WIC State Agencies (SAs), through April 10th for the USDA/Tufts Telehealth Intervention Strategies for WIC (THIS-WIC) grant opportunity.

The opportunity is made possible through funding from the USDA, Food and Nutrition Service and will help WIC State Agencies (SAs) develop and implement telehealth innovations to enhance nutrition education and breastfeeding support for WIC participants, particularly those who have a hard time getting to WIC clinics (e.g., rural areas).

In addition to supporting participants, telehealth innovations offer many potential benefits to SAs, like improving retention.

THIS-WIC will assist and support SAs throughout the application process and during project implementation. The THIS-WIC team will:
  • provide technical support to WIC SAs throughout the application process and project implementation period;
  • lead evaluations in collaboration with WIC SAs to assess the impact of the innovations; and,
  • share promising initiatives as well as potential solutions to commonly encountered challenges.
The application process has two phases:
  • Phase I – interested applicants should submit a Brief Proposal (no more than 3 pages) by April 10th, 2020 (11:59p ET)
  • Phase II – selected applicants from Phase I will be invited to submit a Full Proposal by August 7th, 2020 (11:59p ET)
THIS-WIC anticipates supporting 5-8 WIC SAs for 30 months, with funding up to $1 million (includes direct and indirect costs), depending on the scale and scope of the proposed intervention.

The THIS-WIC team will hold three, one-hour webinars to provide additional details about the application process, to provide deeper insight into telehealth innovations, and to further layout expectations for the evaluation of proposed projects.

All the webinars will include time for potential applicants to ask questions of the THIS-WIC team.
  • RFP Overview: 3-4 pm (EST) on February 13th, 2020, hosted by the THIS-WIC team to provide an overview of the RFP and application process. Register here.
  • Designing a Telehealth Solution: 3-4 pm (EST) on February 19th, 2020, will be jointly hosted by THIS-WIC and the TRCs to provide a deep dive into telehealth innovations related to each priority area and an overview of best practices when designing telehealth solutions. Register here.
  • Unpacking the Evaluation: 4-5 pm (EST) on February 24th, 2020, will be led by the THIS-WIC team to clarify further roles and expectations related to the evaluation of the telehealth solutions. Register here.
For more information about this opportunity and the application process, please visit the THIS-WIC website.

Wednesday, December 04, 2019

What are the First Amendment obstacles to mandatory front-of-pack labeling?

Suppose the government wanted to require front-of-pack nutrition labels for packaged food and beverages, making it easier for consumers to see at a glance some key nutritional qualities.

In the United States, could the manufacturers claim that such a rule violates their First Amendment rights?

In the journal Food Policy this past summer, Jennifer Pomeranz, Dariush Mozaffarian, Renata Micha, and I study the precedents. Much depends on whether a particular labeling policy could satisfy a legal principle called the Zauderer test. This test stipulates, for example, that the mandatory labeling information must be factual and uncontroversial. 

Looking at the wide array of front-of-pack labeling schemes around the world, we find that some varieties are more likely than others to pass this test. Certain proposals for simple mandatory symbols indicating "healthy" or "unhealthy" broadly, without communicating much nutrition information, could be ruled unconstitutional.

The article is titled, "Mandating front-of-package food labels in the U.S. – What are the First Amendment obstacles?"

Pomeranz et al. (2019). Table 1 (small excerpt).

Wednesday, October 02, 2019

What the new studies REALLY say about red and processed meat

New studies this week in the Annals of Internal Medicine have generated much fiery news coverage.

For example, Time's headline says: "Should You Stop Eating Red Meat? A New Paper Has a Controversial Answer." As always, the nutrition reporter portrays nutrition science as fickle, endlessly reversing itself.

It's not true. The actual scientific content in the new studies confirms what we already knew.

The best available evidence suggests that reducing red and processed meat consumption will reduce risk of death from cardiovascular disease and cancer.

It always is the case that nutrition scientists and communicators must accomplish two tasks: 
  1. understand the available evidence; and 
  2. reflect on what burden of proof should be used for nutrition policy decision making.
The new studies made atypical decisions about Task #2. For reasons that are not clear to me -- perhaps out of a scientific sense of caution or perhaps out of a bias in favor of red and processed meat -- they ramped up the burden of proof that they apply to recommendations that advise less red and processed meat. Citing research guidelines that give highest scores for pharmaceutical trials [edited slightly 4pm], they rate most of the available evidence in any direction as weak. This is not how I would have communicated the evidence. In my view, it is understandable that randomized control trials cannot be widely used on this topic, because one would have to wait too long for a sufficient number of cancers or heart attacks attributable to a meat intake intervention in a well-powered study. So, I have long accepted cohort and observational studies as the best available evidence on this topic. The new studies do pretty much the same, but they label each piece of evidence as "weak." They are free to apply these labels, and I feel free to ignore these labels.

Turning to Task #1, the studies confirm what I already knew. For example, here are my statistical interpretation sentences for several main results from the new studies.

On average, reducing weekly unprocessed red meat intake by 3 servings is associated with:
  • 7% lower risk of death, 
  • 10% lower risk of death from cardiovascular disease,
  • 6% lower risk of stroke,
  • 10% lower risk of type 2 diabetes,
  • 7% lower risk of death from cancer.
The list of results continues for processed meat.

If you want to describe these effects as "small" and you want dietary changes that reduce your risk by twice as much, then knock yourself out. You may reduce your red meat intake by perhaps approximately [note: qualifying adjective added 4pm] 6 servings.

I recognize that these results are accompanied by blistering disparagement of recommendations to eat less red and processed meat, but I don't trust these authors enough to place credence on their rhetorical choices. Their scientific results are what matters. 

Reading these scientific results, even acknowledging the limits of our knowledge, I will continue to support existing recommendations to eat less red and processed meat. No better evidence exists.

Friday, September 27, 2019

Processed meat labels saying "uncured" and "no nitrites added" are misleading

A large body of evidence reviewed by the World Health Organization found that processed meat consumption increases the risk of cancer. Seeking to alleviate consumer concern, food companies label some of their products as "uncured" or "no nitrites added." However, these products may have essentially as much nitrites or nitrates as regular products.

In an August 29 report from Consumer Reports (CR), policy analyst (and Friedman School Ph.D. student) Charlotte Vallaeys explained the issue.
“Thanks to the topsy-turvy world of government food labeling rules, ‘no nitrites’ doesn’t mean no nitrites,” says Charlotte Vallaeys, senior food and nutrition policy analyst at CR. Instead, it means that the nitrates and nitrites used to “cure”—or preserve and flavor—meat come from celery or other natural sources, not synthetic ones, such as sodium nitrate or nitrite.
The issue was picked up in August by NPR in a report by Allison Aubrey.

This issue also is the subject of a new citizen petition from the Center for Science in the Public Interest (CSPI) and Consumer Reports, which in turn led USDA to open a public comment period until Nov. 12.

Meanwhile, I remain concerned that the federal government's Dietary Guidelines for Americans (DGA) for 2020-2025 may overlook scientific evidence on processed meat and cancer risk. It is important for USDA and DHHS to review this evidence directly, as its own topic, not just tangentially when it arises as part of broader studies of dietary patterns. That scientific issue was covered in a blog post in early August, noting our recent article in Milbank Quarterly.

In related work, my colleague Dr. David Kim and several co-authors and I have a new article in the American Journal of Preventive Medicine (AJPM), published today, with a modeling analysis of the health benefits that could arise if warning labels or a tax on processed meat effectively reduced intake and thereby reduced cancer risk. The abstract concludes:
The model shows that implementing tax or warning labels on processed meats would be a cost-saving strategy with substantial health and economic benefits. The findings should encourage policy makers to consider nutrition-related policies to reduce cancer burden.