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.

Exercise, weight loss, and the food environment

A clear and effective video from Vox explains why exercise is not directly a cure for overweight. The video's message -- rightly -- is that we should pay close attention to food intake and the quality of the food environment.

The video does note that physical activity has strong direct effects on health. Nonetheless, I would have emphasized the benefits of physical activity even more strongly than the video does.

My first reason for giving physical activity yet more credit is a bit geeky. Much of the research literature uses regression models where a weight measure is the outcome variable and physical activity or exercise is the main explanatory variable. To make sure the analysis really reflects the "effect" of exercise, the studies include additional control variables such as food intake and general health. Yet, when we step up our physical activity, we may experience improvements in health, mood, and feelings of self-efficacy. Including explanatory variables for food intake and health status may risk "over-controlling" for other factors. We may eat healthier when our mood is good. We may avoid periods of poor health and inactivity that lead to weight gain. Perhaps stepping up our physical activity deserves some of the credit for improvements in weight that are being picked up by the control variables.

My second reason for giving physical activity yet more credit is more superficial. For some people who seek to lose weight, the ultimate goal is to look better. I have mixed feelings about whether this is good psychology, but it does seem to be common. Stepping up physical activity may affect posture, muscle tone, and confidence, making people look better in ways that the scale may not register.

But the video certainly is right that researchers in recent years have become more careful about not over-promising physical activity as a complete weight loss program on its own.

 

Debating the role of government and markets in food policy

Politico's Agenda today has a special issue on food policy.

It prominently highlights the great work of my Friedman School colleagues Miriam Nelson and Christina Economos:

Miriam Nelson got the call while she was rock climbing in Canada: It was the White House assistant chef, of all people, summoning her to a closed-door meeting with the new first lady of the United States. It was 2009, Nelson was one of the nation’s top experts on nutrition and exercise, a Tufts University professor at the time, and she wasn’t the only one: a half-dozen more got the same surprise invitation....

With Democrats holding control of Congress, Nelson and the others realized, the East Wing was formulating a big policy push that would use all available levers of the federal government to improve how Americans eat. They wanted a new law to make school lunches healthier; they saw ways to deploy federal stimulus dollars on new cooking equipment in public school cafeterias and to use government financing to get grocery stores into poor communities where fresh food wasn’t readily available. They wanted to overhaul the federal nutrition label so it confronted shoppers more directly with calorie counts. Even the more symbolic side of American food policy was coming under the microscope: A reboot of the decades-old “food pyramid” that told families how to balance a meal.

“You really got the sense that this is something that she was likely to take on,” recalled Nelson, who was asked for advice on nutrition and exercise programs that worked. “It was very exciting.”

I also enjoyed Danny Vinik's interesting poll of food policy experts. It seems revealing that most of the respondents would have supported stronger language in the Dietary Guidelines encouraging Americans to consume less meat (after all, that was the view of the more independent scientific Dietary Guidelines Advisory Committee), limits on healthy food marketing to kids, and state or local initiatives to tax soda. Separately, the majority also supported greater efforts to reduce hunger. But, the majority did not support mandatory GMO labeling. I was included in the sample, and, in each case, I voted with the majority.

A brief digression on survey sampling: The poll is not a scientific survey of observations randomly sampled from a larger population of food policy experts in general. Instead, it is a tabulation of responses from a particular sample of researchers and writers on food policy topics. As such, it seems important to let readers know who was sampled -- which is exactly what Vinik does in a list at the bottom of the article. That seems to me a completely legitimate reporting approach. Also, it is fun to try to guess which of my colleagues gave which answers.

Marion Nestle's Soda Politics: Taking on Big Soda (and Winning)

Marion Nestle's new book is Soda Politics: Taking on Big Soda (and Winning) (Oxford University Press, 2015).

The book is thorough, balanced, hard-hitting, and motivating. It covers health effects, industry structure, marketing to adults, marketing to children, marketing overseas, policy responses, and advocacy movements.

The writing is clear, unassuming, and terse.

The coverage of health effects is persuasive. Nestle discusses cutting edge concerns without overstatement or exaggeration (additives and cancer, particular properties of fructose). She more strongly emphasizes the main established links with even-handed and authoritative force (tooth decay, liquid calories, links to overweight and obesity, and type II diabetes).

Nestle avoids many possible pitfalls in such a book. Though she quotes industry propaganda that paints her as a shrill critic of the modern food system, her own writing shows her to be a careful listener and reader of diverse perspectives. She calls out what is wrong, yet never demonizes opponents. Her chapter on Derek Yach, one-time World Health Organization public health champion and later PepsiCo vice president, is insightful and understanding.

Some radical authors of critical books on a particular industry seem ready not just to reform that industry, but perhaps to do away with all other such industries. One gets the sense that the author is using one industry as a vehicle for more broadly condemning the modern global capitalist economy, but the implied alternative remains blurry.

Other more mainstream authors of critical books find themselves lost for something sensible and upbeat to say in the final chapter. I most dislike it when these final chapters resort to empty hopes that well-meaning people in the industry will just see the light and change their ways.

With Nestle, instead, the reader can picture just what would happen if her book becomes influential: leading health organizations would wean themselves from soda industry money, public opinion would become more demanding, state and local advocates would win new policies on marketing, taxation, and school environments, soda consumption would follow tobacco's downward path, and the United States would enjoy lower rates of obesity and chronic disease.

This will mostly happen because of actions outside of the soda companies.

Like businesses in general, food businesses -- even the most socially conscious -- must put profits first. To be effective, advocates must understand that soda and other food corporations are willing to spend fortunes to influence political processes. Without anywhere near that kind of funding, it becomes necessary to find smarter methods for using the political process to counter soda industry marketing.

Nestle delivers a steady stream of advocacy-related diagnosis and suggestions in short well-organized paragraphs at the end of chapters throughout the book. The final chapter then seamlessly provides conclusions that feel consistent with the whole work.

The book is above all informative. For those readers who share Nestle's critical perspective on the food industry, it is obvious that this book would be informative. But here is the greater surprise: this solid book is by far the best source on this topic for any reader, with any perspective on economics or politics.

If I worked for a trade association, or an industry front group, or an esteemed professional association that relies on soda industry funding, or the House Agriculture Committee, or a sugar manufacturer, or a high-powered corporate law firm, I might store this book in my desk drawer rather than my book shelf ... yet I would read it word for word.

Nanotechnology will revolutionize the food system (and other familiar sentences)

There appears to be a large literature using the same words to say that "nanotechnology" is an "enabling" technology that will "revolutionize the food system".

A 2008 book by Ajit Kumar Roy and Niranjan Sarangi says:

Nanotechnology, as a new enabling technology, has the potential to revolutionize agriculture and food systems....

The first sentence of Norman Scott's chapter in a 2006 book says:

Nanotechnology, as a new enabling technology, has the potential to revolutionize agriculture and food systems in the United States and the World.

The second sentence of a chapter by B. Singh, S. K. Gautam, M. S. Chauhan, and S. K. Singla in a 2005 book says:

Nanotechnology is an enabling technology that has the potential to revolutionize agriculture and food systems.

In a 2012 book, M.E. Popa and A. Popa write:

As an enabling technology, nanotechnology has vast potential to revolutionize agriculture and food systems.

A twist on the typical wording is the idiosyncratic use of the word "enable" instead of "enabling." The first sentence of the abstract for a 2010 article by Q. Huang, H. Yu, and Q. Ru in Journal of Food Science is:

Nanotechnology is an enable technology that has the potential to revolutionize agriculture and food systems.

And that was presumably the source for the first sentence of the abstract for a new 2015 article in Critical Reviews in Food Science and Nutrition, by Harleen Kour, Anisa Malik, Naseer Ahmad, Towseef Wani, Raj Kaul, and Anju Bhat.

Nanotechnology is an enable technology that has the potential to revolutionize agriculture and food systems.

Before we judge too harshly, I should acknowledge that I make little effort to develop novel language for routine background information. It would not shock me if a sentence akin to the following appeared in more than one publication: "The Supplemental Nutrition Assistance Program (SNAP) is the nation's leading anti-hunger program and an important part of the social safety net." But that is a different issue from reusing language for the main point of an article.

The final sentence of the abstract of the 2015 Kour et al. article in Critical Reviews in Food Science and Nutrition is:

In fact, nanotechnology introduces new chances for innovation in the food industry at immense speed, but uncertainty and health concerns are also emerging.

This is the same as the abstract for a 2010 article by Sekhon in Nanotechnology Science Applications:

In fact, nanotechnology introduces new chances for innovation in the food industry at immense speed, but uncertainty and health concerns are also emerging.

For the 2015 Kour et al. article in particular, the indebtedness has risen sufficiently high that the good journal Critical Reviews in Food Science and Nutrition should probably look into the similarities.

More generally, does there seem to be too large a literature parroting the same not-too-skeptical claims about nanotechnology?

Communicating with the dietetics profession

In Mother Jones this week, Kiera Butler has a striking report about the food industry presence at a conference of the California Dietetic Association. The description of attendees consuming and discussing their free McDonald's salads makes the association seem careless with its valuable public image and credibility.

One might ask, how on earth could dietitians ally themselves with major fast food chains, instead of with advocacy groups -- or hard-hitting magazines -- that seek to better represent the public interest?

Part of the answer, surely, is that the food industry provides funding to the dietetics associations. This is the answer Mother Jones might emphasize.

Another part of the answer is that the food industry publicly endorses the best judgment of dietitians and nutrition scientists on the leading diet and health questions of the day. Actual products may not follow this judgment, but the industry's public communications are deeply respectful of the profession. Industry representatives endlessly tell the profession, "We listen to your advice, while those would-be do-gooders in the public interest community foolishly pursue one nutrition fad after another."

For example, consider the claim in the Mother Jones article that mounting scientific evidence shows that "high-fructose corn syrup prompts more weight gain than other sugars." The article links to this four year old 2010 press release from Princeton University, which imprecisely summarizes its supporting scientific journal article (.pdf), which in turn has been strongly criticized by NYU's Marion Nestle, who is quoted as a trusted authority in the same Mother Jones article (!), and who further links to a more detailed evisceration of this research.

It is fine to criticize high-fructose corn syrup (HFCS) along with sugar, because of strong evidence that both are associated with risk of weight gain. But the current evidence does not support Mother Jones' claim that HFCS prompts more weight gain than other sugars. That claim -- and more specifically the casual and uncritical link to the Princeton University press release -- plays into the industry's strategy for befriending dietitians.

Writers and advocates who care about the public interest really can persuade the dietetics profession to adopt a more independent and skeptical stance in its relationships with the food industry. We could begin by avoiding these failures in summarizing the best scientific evidence.

Recent activities of Dietitians for Professional Integrity

Andy Bellatti last month summarized in a column for Civil Eats the recent activities of Dietitians for Professional Integrity, an initiative to encourage the leading dietetics professional association, the Academy of Nutrition and Dietetics, to distance itself more clearly from its food and beverage industry sponsors.

For years, many of my colleagues and I have voiced our discontent that the professional organization that represents us takes money from and partners with the likes of Coca-Cola, PepsiCo, McDonald’s, and Hershey’s, supposedly to foster dialogue with the industry and help Americans get healthier. In reality, Big Food gets free press for feigning concern, while going about its usual business, and the registered dietitian credential gets dragged through the mud.

“Too often I’ve lost the trust of potential clients because, despite my rigorous education in nutrition, they only see the dietetics field as corrupted by big businesses,” says Matt Ruscigno, MPH, RD, one of Dietitians for Professional Integrity’s co-founders.

Over the past four months, Dietitians for Professional Integrity has shared many statements of concern from registered dietitians on its Facebook page, and helped raise awareness of Big Food’s influence on the Academy (from the world’s largest aspartame producer helping to fund the organization’s evidence analysis team on the artificial sweetener to Coca-Cola’s Academy-approved continuing education webinars which  teach dietitians that soda is unfairly vilified).

A key point is that Dietitians for Professional Integrity is not a "nanny state" initiative.  There are good reasons why it is sometimes difficult for government agencies to take strong public interest positions on key challenges to the healthfulness of the food and beverage industry.  Government institutions in a democracy frequently must represent the mainstream of public opinion.  They explicitly must be concerned both with public health and with encouraging a thriving economy.  When government agencies push too hard or are insufficiently deferential to individual preferences in guiding people toward healthy nutritional choices, the public worries about government overreach.

Because of these constraints on government activism, it is especially important that non-profit public interest organizations such as the Academy of Nutrition and Dietetics speak clearly, boldly, and without bias on the nutrition issues of the day.  I think Bellatti and Dietitians for Professional Integrity have a good point in encouraging this private-sector nutrition organization to be more independent from its corporate sponsors.  Sometimes, the Academy should have more courage to criticize food and beverage industry products and marketing practices that really do contribute to an unhealthy nutrition environment.

Interpreting science at #EB2013 in Boston

While enjoying the excellent sessions sponsored by the American Society of Nutrition (ASN) at the Experimental Biology 2013 meetings here in Boston this week, I was struck once again by the way actual nutrition science research results are filtered or digested into short memes of conventional wisdom before they reach the public.

This filtering process is necessary, unavoidable, and even healthy.  And yet it is a key step, which brings politics and interest into the process of producing nutrition policy and dietary guidance.

Here is a passage from my chapter on Dietary Guidance in Food Policy in the United States: An Introduction (Routledge/Earthscan).

Filtering is the process of reading a large body of research and concisely summarizing its relevant points. Because the scientific literature is so heterogeneous, its policy impact depends heavily on how the research is filtered.

Filtering may be biased toward certain types of conclusions. Food industry organizations hire scientists and public relations specialists to spread the good word about favorable studies, without mentioning unfavorable studies. The public relations specialists are evaluated according to their success in placing favorable stories in the mass media. Reporters do not purposely seek to serve as a vehicle for industry public relations, but they face intense pressure to generate buzz by reporting novel and surprising findings. Hence, even though the balance of evidence in the scientific literature changes only slowly, headlines each week tell the public that everything they previously believed about nutrition and health was a big fat lie.

To summarize a complex scientific literature with less bias, scientists prefer to rely on systematic evidence reviews. In a systematic evidence review, an inter-disciplinary team establishes a protocol, a document that describes in advance the procedure for selecting relevant research studies, reducing the temptation to concentrate on studies that are favorable to the team’s prior expectations. For each selected study, the team evaluates the strength of the evidence, again using criteria established in advance.

Systematic evidence reviews do have some limitations. While they can avoid errors that stem from selective reading of just favorable parts of the scientific literature, systematic evidence reviews cannot fix misinterpretations that are widespread in the literature. Also, such reviews may not reflect recent improvements in scientific research. Still, because of their transparency and replicability, systematic reviews can clarify the state of the evidence on contentious scientific issues.

If you are attending the Experimental Biology 2013 meetings this week in Boston, the book itself is on display today at the CRC Press booth (#531 in the exhibition hall).  Please stop by the booth, and please share your thoughts on whether food policy is a worthy topic of study at a meeting of scientists.

An inter-disciplinary approach to U.S. food policy

An excerpt from the first chapter of Food Policy in the United States: An Introduction (Routledge/Earthscan).

The 2010 Dietary Guidelines for Americans, which is the federal  government’s most authoritative official statement on nutrition and health issues (discussed at length in Chapter 8), presents a social and ecological framework for food consumption and physical activity decisions (see Figure). Similar models are found in many other high-profile nutrition policy documents (Institute of Medicine, 2012). To analyze major national problems of obesity and chronic disease, this framework goes far beyond immediate causes such as food and beverage intake and physical activity. Like planetary orbits that are farther from the center, the outer layers list more distant influences on food choices.

The framework calls attention to important topics, including agriculture (Chapter 2), the food and beverage manufacturing industries (Chapter 5), the retailing and restaurant industries (Chapter 6), marketing and the media (Chapter 9) and socioeconomic factors  (Chapter 10). Once nutrition and public health professionals begin to explore these more fundamental influences on food and beverage consumption, they find themselves engaged with challenging topics in economics and political science.

At first, this engagement can be unnerving. When interacting with patients, professionals in medical fields are rightly proud of their ability to diagnose problems and prescribe an appropriate remedy. It is tempting at first to adapt this medical patient approach to food policy applications. For example, if expanding food portion sizes contribute to rising rates of obesity, it is tempting to say government agencies should prescribe smaller portion sizes. If nutrient-dense foods cost too much, it is tempting to say government agencies should prescribe a price ceiling for fruits and vegetables. It is disappointing if policy-makers reject such proposals as politically infeasible. It is downright frustrating if policy-makers say with a straight face that a well-intentioned nutrition policy prescription is unwise. Yet, except in special settings such as school meal programs, determining portion sizes may be a decision that people do not want to delegate to their government. A price ceiling for fruits and vegetables may have unintended consequences, such as reducing the incentives to grow fruits and vegetables.

The outer layers of the social ecological framework bring nutrition policy into contact with many other societal objectives, such as a thriving economy, a healthy environment, poverty alleviation and effective political governance. Powerful policy actors in these outer layers do not—and sometimes should not—behave as if food consumption and physical activity stood alone as the sun at the center of the social ecological solar system. Governments balance food and nutrition concerns against other considerations, just as individuals and families do.

As we explore more deeply the normative question of what food policies best serve the public good, it will appear necessary to discern which decisions should be delegated to governments and which decisions should be made by individuals interacting in economic markets. And, as we explore more deeply the positive question of what policies can win political support, it will appear necessary to anticipate how a variety of producer and consumer interests will respond to such proposals.

These inter-disciplinary explorations are more difficult than simply prescribing the right policy medicine, but ultimately they offer both sharper policy insight and greater potential for political success.

Source: Dietary Guidelines for Americans, 2010.

Dietitians discuss appropriate policies to govern corporate sponsorship at the Academy of Nutrition and Dietetics (AND)

The Hunger and Environmental Nutrition (HEN) practice group within the Academy of Nutrition and Dietetics (AND) has long been encouraging greater transparency about corporate sponsorship issues.  The AND (formerly known as the American Dietetic Association) serves as an influential advocate in U.S. nutrition policy and also as the professional association for registered dietitians.

My students and former students who are registered dietitians have worried about AND corporate sponsorships.  They send me a steady stream of awkward examples of ill-chosen sponsorships, for example with sugar sweetened beverage companies and meat checkoff programs.  One Friedman School graduate student, Ashley Colpaart (who for some years co-blogged here at U.S. Food Policy), has been proposing reforms for AND's corporate sponsorship practices for many years.

Other Friedman School graduate students conducted analyzed a survey of dietitians last year, noting that many dietitians share at least some of these concerns [small edit Feb. 3].  The article was an important source for Michele Simon's hard-hitting and highly critical report this week on AND corporate sponsorship.  The students, Lauren Adler, Alyssa Koomas, and Catherine Wright, wrote:

ADA’s corporate sponsorship program has become a topic of public discussion in recent years. A total of 370 HEN members were surveyed to shed light on member opinions of the corporate sponsorship program and whether our DPG approves or disapproves of the program. The majority of survey respondents appear to disapprove of the corporate sponsorship program, indicating that it negatively impacts their public image as food and nutrition professionals. Additionally, 61% of respondents were willing to pay higher ADA membership fees in order to decrease reliance on corporate sponsors.

In a letter to AND leadership last year (.pdf), some Hunger and Environmental Nutrition practice group members recounted the common experience of having their own independence called into question by others who were aware of the Academy's corporate sponsorship relationships:

[R]egardless if they are real or perceived, the influence of Academy corporate  sponsors has not only sparked scrutiny among journalists, but has led to several conversations in which members have had to defend these relationships and the profession at national conferences and forums. These confrontations have led to rising humiliation and a growing discomfort while fulfilling the role as Delegates. In some instances, this has led to long-­‐time members leaving the organization. We urge the Academy to uphold more transparent and stricter guidelines on access of corporate  sponsors to Academy leadership and to remove their presence at meetings, such as HOD [the AND House of Delegates], in which decisions about the profession and/or the organization are made. This will avoid conflict of interest, advance transparency, maintain professional and organizational integrity, and establish a more credible national presence.

It is difficult for any professional association to find a business model that works, providing needed support for association activities without conflicts of interests.  For example, the HEN practice group itself last year sought to develop its own policies for sponsorships (.pdf), describing the ideal potential sponsors as companies with a combination of nutrition and environmental virtues. I wish them well finding such terrific sponsors, but, realistically, we should admit that giving up compromised sponsorships may imply accepting a smaller scale of operation and revenue for a professional association.

Even recognizing those difficulties, it would have been wise for AND to listen to the input from its own internal rank and file.  As an outsider to AND, nutrition policy advocate Michele Simon offers much harsher criticism of the Academy in her report this week. With hindsight AND leaders might wish they had listened more sympathetically to internal concerns before matters came to this point.

When Marion Nestle blogged about this issue yesterday, generally agreeing with Simon's report, some of the open comments from dietitians were defensive, while others agreed with the concerns about corporate sponsorship.  Nestle has a very good follow-up post today, responding to the discussion so far.  The New York Times also covered this issue, which is unlikely to just fade away any time soon.

A proposal for a global ban on trans fats

While labeling strategies provide a sound public policy response to some food ingredient dilemmas, in other cases it is simpler and more effective to make do without the ingredient altogether.  Some argue that trans fats fall into the category of ingredients that should just be eliminated (with the exception of the small amount of trans fat that occurs naturally in animal food products).  These fats replaced healthier traditional oils and fats just a few decades ago, and some countries have recently been rapidly shifting back away from their use without any major food system damage.

In a commentary this week for the World Public Health Nutrition Association, Vivica Kraak, Uriyoán Colón-Ramos, and Rafael Monge-Rojas recommend a near-complete global ban on trans fats.

This commentary presents a case for public health professionals, practitioners, academics, industry and government representatives, funders, public-interest non-governmental organisations and consumer advocates, to collaborate to support a global trans-fat ban. Coordinated actions to remove this harmful substance from our food and eating environments will be able to contribute to reducing chronic non-communicable disease mortality by 2025.

From nutrition scientists "on behalf of Corn Refiners Association"

Here is a newsletter I received today from an email account labeled oddly: "ASN on behalf of Corn Refiners Association."

Follow the link for the full web version of the email.

The ASN is of course the American Society for Nutrition.  "Experimental Biology 2012" is the most important annual meeting for nutrition scientists.

The tiny footer to the email's web page says:

This email is a paid advertisement sent by ASN on behalf of Corn Refiners Association. ASN occasionally promotes to its members the efforts of other organizations promoting products, services or events that advance ASN's mission: excellence in nutrition research and practice. ASN never releases members' email addresses to any third party. 

While this footer to the email discloses the advertisement, the newsletter's .pdf file from the link does not mention that it is an advertisement.  Clearly, the whole package is designed to look like a newsletter from a scientific association.  In the gentlest way, the newsletter defends fructose and corn sweeteners from criticism.

Does this type of advertisement cost the scientific association much in terms of independent authority and reputation?

Why Calories Count

Why Calories Count, the new book by Marion Nestle and Malden Nesheim, nicely bridges the world of food policy commentary and nutrition science. It offers a great counterpoint to the loud and untrustworthy bazaar of diet books, each blaming some simple villain for the obesity epidemic (too much carbs, too much fat, too little calcium, whatever).  Why Calories Count teaches a wealth of detail about how calories are measured and how their effects are studied.  It also tells great stories, from the history of nutrition science to the poignant service of wartime conscientious objectors who participated in a clinical study of human starvation.  If I were a graduate student in nutrition or public health, I would find this book inspiring as an eloquent and engaging secondary reading alongside a nutrition science textbook.  Strongly recommended.

Links: Jane Brody, Mark Bittman.

How can salt be reduced?

Following the long-awaited new Institute of Medicine (IOM) report on salt released this week, here's a quick summary of a debate that I would find awful tiresome.

Institute of Medicine: "FDA should regulate salt."

Critics: "Big brother should not tell me what to eat."

To me, the more interesting questions are: (1) Is it important for Americans to consume much less salt; and (2) if so, how can this reduction be achieved in an economically sensible way?

The IOM report explains clearly why sodium reduction is important for our health and even for the national economy. It is apparently a myth that salt reduction is only important for a small number of people predisposed to hypertension. If you still hold that view, we'll have to postpone arguing about it until another day. The rest of the post assumes the answer to question (1) is "yes, salt reduction is important." The food industry, which is pursuing some voluntary efforts to reduce sodium in the food supply, concedes this point.

The interesting question is how salt reduction can be achieved. In calling for FDA participation in salt reduction efforts, IOM explains the collective action problem that limits the effectiveness of voluntary measures:

Regulatory action is necessary because four decades of public education campaigns about the dangers of excess salt and voluntary sodium cutting efforts by the food industry have generally failed to make a dent in Americans' intakes, the committee said. The industry's voluntary efforts have fallen short because of lack of a level playing field for all products. Companies have feared losing customers who could switch to competing products or brands with higher salt content.

[Update Apr 26, 2010: This sentence has been toned down, because of the next update below.] Moreover, the food industry's imagination on salt reduction could be more ambitious. For example, the input of the Grocery Manufacturers Association on the federal government's revision of the Dietary Guidelines emphasizes the limited options for high-tech salt replacements and claims that consumers would not accept less salty foods:

[F]ood processors have no alternatives with which to replace the sodium, and must simply accept a less salty flavor in lowered sodium products. But the consumer will not accept such products.

[Update Apr 26, 2010: Although the link above is to the GMA site and seems to have today's date, a reader tells me that the letter is actually GMA's comments on the 2005 Dietary Guidelines. I regret my error in reading. To be more current, here is the corresponding passage from the GMA comments to the 2010 Dietary Guidelines Advisory Committee.

There is no perfect "salt substitute " currently available. Sodium reduction in foods is often a complex, highly technical, expensive and labor intensive task that must frequently be undertaken "silently" without consumer's knowledge.]

Contrast this assessment of the consumer's tolerance with the fascinating and quite well-written Chapter Three of the IOM report, which marshals the evidence for a more optimistic conclusion:

The food supply contains a vast array of commercially successful products and ingredients – fresh, prepared, and manufactured – whose sodium levels range from very high to moderate to very low. The fact that the same individual for example, might be fully satisfied with two snacks of widely varying sodium levels – one a fresh apple and the other a handful of salted pretzels – reminds us how dependent the sodium taste issue is on wider flavor contexts.... [T]he salt taste challenge might be as much a matter of reconsidering flavor options in recipe selection and menu development ... as needing to overcome technical challenges with salt substitutions.

[Update Apr 26: This sentence has been edited to remove an implication that the food industry didn't know these insights. The good food scientists probably recognize these points.] Here are some marketing insights that I draw from the IOM report (my paraphrase):

• Consumers can become happily acclimated to a lower sodium environment over time, just as it took time for them to become accustomed to the current strangely high-sodium environment.
• We could give consumers greater freedom of choice by reducing salt in processed foods and letting everybody use salt shakers; it turns out that people add only 20% as much sodium when they are free to make their own choices.
• There is a difference between "taste" and "flavor." Salt is a "taste." Real "flavors" can be used to make less salty foods delightful.
• Many foods can have less sodium without tasting less salty, by modifying the size of salt particles and their placement on the surface of a food.

Although consumers might eat less processed foods, and more real whole foods, we might enjoy life just fine with less sodium.

Salt policy

Some major food companies -- Kraft, ConAgra, Unilever -- have announced voluntary initiatives to reduce salt. In other countries, such as the United Kingdom, public policy plays a bigger role alongside voluntary measures. On WBUR's syndicated radio show Here and Now, host Robin Young today covers salt policy. She interviewed Cheryl Anderson at Johns Hopkins University and myself.

New York City is calling on the food industry to cut back on sodium. The plan is voluntary and its goal is to reduce the amount of sodium people eat by 25%. Recent research shows that a decrease in sodium would cut new cases of coronary artery disease by 60,000 a year. Our guest is Dr. Cheryl Anderson of Johns Hopkins University. We’re also joined by Parke Wilde of the Friedman School of Nutrition Science and Policy at Tufts University, who discusses the role of public policy in debates about diet.

New study on high-fructose corn syrup

A Princeton University research team is reporting that HFCS increases obesity in rats more than sucrose does. The research appeared in February in the Pharmacology, Biochemistry, and Behavior.

As always, no one study settles the argument on this type of debate. This study moves the needle five degrees toward showing that HFCS is metabolically different from equivalent amounts of table sugar.

The study appears in a refereed journal. It includes a strong research design, randomly assigning rats to a treatment (HFCS) group and two control groups.

[Update 3/23: part of the study includes two control groups, which received either plain sucrose or an ordinary rat food diet, so one can distinguish HFCS from sucrose; a comment says that another part of the study included only one control group, which received the rat food diet, so it is not possible to distinguish HFCS from sucrose].

On the other hand, studies in rats are just one element in an array of evidence. Other elements include human studies and describing a plausible biological mechanism. One mystery is how HFCS (55% fructose) could be much different from sucrose (50% fructuse). The conclusion section of the new article spends most of its time talking about the metabolism of fructose, mentioning but then somewhat breezing over the similarity in fructose content between HFCS and sucrose.

Given that sucrose is a disaccharide, which is metabolized to one fructose and one glucose molecule (Caspary, 1992), it has been argued that there is little difference between fructose and sucrose, since both provide about 50% fructose and 50% glucose in the blood stream; and until recently, there was no evidence that HFCS contributes to long-term weight gain beyond what sucrose contributes (Forshee et al., 2007). However, the present study suggests that HFCS and sucrose can have different effects on body weight and obesigenic measures.

HFCS is different than sucrose in many ways. First, HFCS-55 has proportionately slightly more fructose than sucrose (White, 2008). Second, fructose is absorbed further down the intestine than glucose, with much of the metabolism occurring in the liver, where it is converted to fructose-1-phsophate [sic], a precursor to the backbone of the triglyceride molecule (Havel, 2005). Third, fructose is metabolically broken down before it reaches the rate-limiting enzyme (phosphofructokinase), thereby supplying the body with an unregulated source of three-carbon molecules. These molecules are transformed into glycerol and fatty acids, which are eventually taken up by adipose tissue, leading to additional adiposity (Hallfrisch, 1990). And fourth, HFCS causes aberrant insulin functioning, in that it bypasses the insulin-driven satiety system (Curry, 1989). Whereas circulating glucose increases insulin release from the pancreas,... fructose does this less efficiently, because cells in the pancreas lack the fructose transporter.... Typically, insulin released by dietary sucrose inhibits eating and increases leptin release (Saad et al., 1998), which in turn further inhibits food intake. As previously discussed, meals of HFCS have been shown to reduce circulating insulin and leptin levels (Teff et al., 2004). Thus, fructose intake might not result in the degree of satiety that would normally ensue with a meal of glucose or sucrose, and this could contribute to increased body weight.

In each passage above where it seems the authors plan to talk about a mechanism that is specific to HFCS, the subsequent detail turns out to be all about fructose.

I enjoyed hearing a talk earlier this month by Barry Popkin (author of The World is Fat). Though he has also speculated about a possible distinct effect of HFCS, he now emphasizes just the sweetness and food energy content.

And this brings me to the final point that I wish news coverage of this topic emphasized more heavily. HFCS is a large part of our food supply, perhaps 40% or more of all caloric sweeteners. In these quantities, a special metabolic effect for HFCS is really beside the point for policy purposes. It could well be true that HFCS is making Americans obese in any case, just because we consume so much of it.

Economics of Food Safety and Nutrition

Call for Nominations

The Best Economics Paper: Food Safety and Nutrition

To recognize excellence in research endeavors that advance knowledge of the economics of food safety and human nutrition, the Food Safety and Nutrition Section of the Agricultural and Applied Economics Association (AAEA) is pleased to invite nominations for the 5th Annual Award for the Best Economics Paper in the areas of food safety and human nutrition. Theoretical and applied research papers are equally acceptable. Reviewers will look for innovative original research with a high impact. Authors do not need to be members of AAEA or the Section to be considered.

In order to be eligible, a paper must have been published in an English-language peer-reviewed journal with a publication date of 2009. Nominations, including self nominations, should include a copy of the paper and a brief letter of nomination highlighting the contribution of the piece. Electronic nominations (with a pdf version of the paper) are preferred.

The award and plaque will be presented to the winning author(s) during the Food Safety and Nutrition Section meeting at the 2010 annual meeting of the AAEA in Denver, CO, July 25-27, 2010.

Please submit nominations by March 31st, 2010, to parke.wilde@tufts.edu.

Principles for front of pack scoring systems

Several front-of-pack or supermarket-shelf nutrition labeling programs use scoring systems to rate food products.

Examples include the Hannaford supermarket chain's Guiding Stars system ...
... and the NuVal system used by some other supermarket chains.
The computation of the scores seems fairly arbitrary to me. It might help to start with some basic mathematical principles. Here are three principles that I think a food scoring system should satisfy.

1) The score should not depend on the serving size. A major limitation of all such scoring systems is that our health really depends on how much of each food we eat, and in what combination. Unfortunately, the scores necessarily apply to each food as it sits on the supermarket shelf, not as we consume it. Because the creators of the score have no knowledge of how much we eat, the score should be treated as a description of the density of good and bad nutrients per unit of weight or food energy. The score should not depend on the serving size convention used or the number of servings in a package. I have seen some scoring systems that appear at first glance to be independent of the serving size, but on closer inspection have quirky limits on total daily nutrients per serving that contribute to the score.

2) The score should rate mixed foods in a consistent way. Take the example of a ham and cheese sandwich. Suppose the sandwich is, by weight or by calories, 40% bread, 30% meat, and 30% cheese. The score for a packaged ham sandwich in the supermarket should be the same as a weighted average of the scores for bread, meat, and cheese purchased separately:

SandwichScore = 40%*BreadScore+30%*HamScore+30%*CheeseScore.

Without this principle, the scoring system will be biased in favor of or against manufactured mixed foods in place of separate ingredients. I think a good scoring system would have no such prejudice.

3) The score should rate each good and bad nutrient independently. Suppose adding 20% more salt to a high-fiber food reduces the score by 20%. How much should adding 20% more salt change the score for a low-fiber food? Many of us would say the score should again change by 20%. Unfortunately, existing scoring systems may have strange interactions across the good and bad nutrients, so that the effect of one nutrient on the score depends on the value of other nutrients in a way that the authors probably did not intend.

Currently, the scoring systems seem to me to have an ad hoc quality that makes it difficult to take the quantitative scores very seriously. Broadly speaking, a scoring system may seem to work correctly in giving healthy foods a good score, and unhealthy foods a bad score, but consumers understood those broad outlines of their food options already even without a scoring system. The whole purpose of a scoring system is to add quantitative rigor to the information provided. They may have a long way to go.

In other recent reading on front-of-pack labeling, see the recent series by Timothy Lytton at the Fooducate blog. In general, Lytton suggests that FDA should not get into the business of developing its own front-of-pack system, but instead should just enforce existing rules against making implicit healthy claims for foods that fail to meet FDA's definition of "healthy." One exception to Lytton's hands-off recommendation is that he feels there may be a need for stronger regulation of the complex scoring systems.

Calorie counts and serving sizes

A new study in the Journal of the American Dietetic Association shows that many grocery and restaurant foods understate their food energy (calorie) contents by 8% to 18% on average. Some restaurant items had double the stated calories.

The study, by Prof. Susan Roberts and several other colleagues here at the Friedman School of Nutrition Science and Policy at Tufts, concluded, "this phenomenon could hamper efforts to self-monitor energy intake to control weight."

For interesting coverage, see Marion Nestle, Time Magazine, Slate's Explainer, and Food Navigator.

Forbes sells the next best thing to snake oil

Forbes Magazine this month named Monsanto as "Company of the Year."

Monsanto's business model employs the company's monopoly on several lines of genetically modified crop seeds to extract an unusually large fraction of the producer surplus earned by corn and soybean farmers. The seeds grow corn and soybean plants, which have pesticidal properties or which can tolerate especially large applications of the chemical pesticide glyphosate (Roundup). Roundup, of course, is sold by Monsanto.

That business model is profitable, but it does not usually win praise from others. So, Monsanto's public relations folks spend endless hours promoting products that have not yet been marketed successfully, which some day may end world hunger, repair the environment, or reverse obesity and chronic disease.

Forbes credulously repeats these promises about future products as if they were already here, while burying its more skeptical coverage of Monsanto's main business lines.

The article focuses first of all on Monsanto's efforts to provide omega-3 fatty acids through genetically modified soybeans. These fatty acids are found naturally in fish oils. Citing a not-yet-refereed paper from a recent scientific conference, Forbes gushes: "Wouldn't that be a wonderful product to have for sale? Stops heart disease--and protects the environment, too. People could get their nutritional supplements without depleting fish stocks."

Stops heart disease? For starters, let us look for the statement on omega-3 fatty acids in the Food and Drug Administration's page about health claims that have significant scientific agreement. No wait, omega-3 and fish oil claims are not there, because the evidence is too weak. So, let us look on FDA's page about second-tier "qualified" health claims that have mixed scientific evidence, and which are permitted only because the Supreme Court restricted FDA's ability to regulate claims that might perhaps maybe come true. Here, we find that fish oil merits a qualified health claim. If Monsanto made this claim on a label, the company would have to state the claim's evidence base in "supportive but not conclusive research." Instead of such frankness, wouldn't it be nice for Monsanto if it could instead convince Forbes to carry the message that the product will "stop heart disease."

Even if you believe the fish oil health claim, which many people do, Monsanto's genetically modified technological marvel would achieve the same outcome that you already have available in a common dietary supplement.

Forbes' adoration of Monsanto is not the unanimous view of the business media. Here is Jim Cramer's more insightful summary last Fall of Monsanto's business and policy risks. I use this video in my teaching, in a class session on imperfect competition in the food industry.