Australian Food Industry Launches World's Least Aggressive New Voluntary Self-Regulatory Effort

Waiting for any industry to self-regulate itself is just plain dumb. Honestly, industry's job is to protect and promote sales, and that's of course true for the food industry as well.

Self-regulation tends to crop up not out of altruism or doing the right thing, but rather as a means to forestall legislative regulatory efforts which in turn would prove to be more damaging to sales.

Take this recent initiative out of Australia which will see the food industry not advertising their junk to kids within 150m (500ft) of schools. 150 whole metres! While certainly not likely to do anything at all, it'll be especially useless perhaps in that the school buses themselves will be exempt, as of course will be the bus stops' shelters.

Oh, and as toothless as it is, it's also voluntary.

Really the only thing this initiative will do is provide the food industry with ammunition if and when facing calls for legislated regulation (something we're hearing more and more calls for) and to pretend that they care about anything other than profits.

It's always best to remember, as I've written before, the food industry is neither friend, nor foe, nor partner.

Kellogg's Partners With Random House To Use Free Books To Sell Ultra-Processed Sugary Junk Food To Children

To be clear, neither Random House, nor Kellogg's, should be fairly expected to do the right thing when it comes to health.

Kellogg's job is to sell food. Random House's job is to sell books. Nothing more, nothing less.

So it's hard to get mad with either company for their "Feeding Reading" initiative which provides parents with permission or excuse to buy their children such health foods as:

• Frosted Flakes
• Pop-Tarts
• Eggos
• Nutrigrain Bars
• Froot Loops
• Rice Krispie Treats
• Apple Jacks
• Frosted Mini-Wheats (note, unfrosted mini-wheats are not eligible)
• Corn Pops
• Raisin Bran
• Krave
• Keebler cookies
• Cheez-its
• Austin crackers
• Pringles

Truly, not a single choice parents or children should be encouraged to make. All ultra-processed, sugary, junk (and some crackers and potato chips).

Again, no reason to expect either Random House or Kellogg's to be doing the right thing by kids, but in my opinion, their clear partnership in doing the wrong thing here certainly doesn't reflect well on either of them.

The Only Thing Public Health And The Food Industry Fully And Firmly Agree Upon About Canada's Next Food Guide Is That It Definitely Matters

Generally speaking, there probably isn't much that public health professionals and the food industry agree upon when it comes to Canada's imminent new Food Guide.

Briefly, public health would like to see the Guide discouraging the consumption of sugar sweetened beverages, ultra-processed foods, processed meats, trans-fats, and see a swap recommended so that people are encouraged to replace their saturated fats with unsaturated fats. Public health would also like to see the Guide discourage frequent use of restaurants, encourage cooking, and promote the free-from-distractions consumption of those cooked meals, ideally with loved ones, on a regular basis. There's more, but that's the basic gist.

The food industry would like to see the Guide avoid the discouragement of any particular food, would like to see dairy maintaining its undeserved separate food category while simultaneously not admonishing against chocolate milk, saturated fat swaps, and would like soft, ambiguous language around processed foods and more.

But there is one area where public health and the food industry wholeheartedly agree - they both agree that the Guide matters a great deal and it wields real influence on the eating patterns of Canadians.

No, Canadians don't shop with the Guide in hand, but industry relies on the Guide's messages in their marketing and sales. For instance, if the Guide, as drafts suggest, has indeed eliminated the dairy category and rightly lumped dairy in with other sources of protein, the dairy industry may no longer be able to suggest to kids (even kindergartners), parents, educators and more that we need a particular number of servings of dairy per day. This in turn, along with the removal of chocolate milk as a dairy equivalent, will likely, over time, affect school milk programs, and will certainly impact the "dairy educators" that schools bring in to chat with students. It will also preclude the dairy industry's ability to buy skewed surveys designed to provide a veneer of health to their products, to launch apps to ensure you're having enough, and when articles are written about dairy in the media, no longer will there be a throw away line included about how many servings the Guide recommends daily.

And all of that will undoubtedly affect dairy sales.

Which of course is why the dairy industry has mounted a years long campaign to try to prevent changes to the Guide's dairy recommendations. They've sent in letters to Health Canada and ministers, they've seeded the media with interviews and concerns, and they've even created an astroturf front group called "Keep Canadians Healthy" that pushed Facebook ads to the public encouraging them to be concern and upset about the plans to downgrade dairy, and provided the public with a call to action and a fill in the blank form to mail their MPs (scroll down through the link to see).

So the next time you hear someone cluelessly (or insidiously) suggesting that the Guide doesn't matter (like the feckless Canadian Taxpayers Federation did on CBC's The National two days ago for instance), remember that pretty much the only area where public health and the food industry fully agree in regards to the Guide is the fact that it matters a great deal to what Canadians buy, and consequently, to what Canadians eat.

Why I Resigned My Membership In The Obesity Society

As has been my tradition, in December I repost old favourites from years gone by. This year am looking back to 2015.

For those of you who don't know, The Obesity Society (TOS) is, according to them,

"North America's premier scientific organization devoted to understanding obesity"

And I wholeheartedly agree, they really are, which is why I'm anything but happy to be resigning my membership.

I've been a member for the past decade, and I do my utmost to attend their annual meeting (now known as Obesity Week).

Paying to be a member of a professional organization, to me at least, means that you believe the organization's mission and methods to be congruent with your own, and sadly, that's no longer the case with me and TOS.

My concerns began in early 2013. That was when TOS published their, "Guidelines for Accepting Funds from External Sources" position paper (the document is long longer available on TOS' page but was published by Longwoods back when). In it TOS,

"expressly eliminates all forms of evaluation or judgment of the funding source"

and instead,

"TOS chooses to focus its ethical mission on transparency in disclosing the sources of funding, clear stipulations outlining our commitment to the ethical use of funds, and a commitment to non-influence of the funding sources over the scientific aspects of funded projects and TOS as a whole."

Lastly they stipulated,

"TOS should seek funding from as wide a variety of donors as possible."

Many, myself included, felt that without explicitly saying so, these guidelines were designed as a means to open the door for TOS to seek and take money from the food industry.

Shortly thereafter TOS struck their, "Food Industry Outreach Task Force", which seems to have morphed into their "Food Industry Engagement Council", the most recent meeting of which included representatives from Kellogg's, PepsiCo, Nestlé, Dr. Pepper and Ocean Spray. There appears to be no doubt that TOS meant what they said back in early 2013.

To be clear, I'm all for dialogue, debate, and discussion with the food industry, but I just can't support taking their money, formally working with them on joint projects, or giving them votes at tables. To be sure, in these difficult fiscal times, for public health organizations, the benefit of food industry partnerships is funding. But partnerships of course need to benefit both parties, and for the food industry, partnering with health organizations has much to offer. Public health partnerships provide the food industry with high gloss brand polish, they may lead to direct or indirect co-branded sales, they may confer undeserved positive emotional brand associations, they may silence or soften industry or product criticism, they may provide industry with ammunition to fight industry unfriendly legislative efforts, and they necessitate that the partnered public health group water down public health messaging that may conflict with their partnered private industries' bottom lines.

Put plainly, a public company cannot invest in a group, program, or intervention that in turn would ultimately serve to decrease sales more than not being involved in that same group, program, or intervention. Doing so would not only be an affront to their shareholders, it'd be grounds for their lawsuits.

Let’s hope I’m wrong in thinking history won’t look kindly on these partnerships, that public-health efforts won't be hindered by them, and that instead I’ll look back one day and think I made much ado about nothing, but until then, while I'll still likely see you at Obesity Week, this is why I'll no longer be sporting a "TOS Member" ribbon on my badge.

Book Review: Marion Nestle's Unsavory Truth

But first, definitely a disclosure. It was reading Marion's 2002 Food Politics that started me on my own path of nutrition related public health advocacy, and in the ensuing years, I've had the great pleasure of meeting her, both online and in person, and I value her friendship and counsel. I was also a bit flabbergasted to learn that I had a small part to play in Marion's decision to write Unsavory Truth, as in the afterwords she notes that it was the exposé of the Global Energy Balance Network (in which I played a small role and where I receive mention in Unsavory Truth) that triggered her interest in writing. Consequently there's zero question I'm biased, both personally and professionally, and I've no doubt, she'd approve of me disclosing this before my reviewing her work, which was sent to me freely by her publisher, which explores the many conflicts of interest that exist between the food industry and nutrition professionals.

Unsavory Truth: How Food Companies Skew the Science of What We Eat, is Marion's take on how, and why, the food industry works with researchers and health professionals. She takes us on many different conflicts of interest tours, from nutrition research as a whole, to sugar and candy, to meat and dairy, to "health food", Coca-Cola, advisory committees, the American Society for Nutrition, to nutrition education and dietetic societies.

Overarchingly, Marion sees industry's response to criticism of its involvement as following the playbook set by tobacco which sees them:

"Cast doubt on the science
Fund research to produce desired results
Offer gifts and consulting arrangements
Use front groups
Promote self-regulation
Promote personal responsibility
Use the courts to challenge critics and unfavorable regulations"

And she laments the fact that nutrition, unlike medicine, doesn't seem to take its conflicts of interest as seriously, "

Decades ago, medical professionals recognized the distorted effects of drug company practices, measures the distortions, and took steps to counter them. Medical journals required authors to disclose financial ties to drug companies that might profit from the results of their studies. Medical schools banned drug companies from marketing to students. In 201, Congress required drug companies to disclose payments to physicians. Nothing close to that level of concern, scrutiny or action applies to food-company efforts to engage nutrition professionals"

The aim of the food industry is self-evident and non-indictable. It's profit. And there are many ways for them to invest in research and partnerships to help in that regard. Citing the work of Lisa Bero and colleagues, she explains that when it comes to research, food industry funding can,

"focus on single nutrients, ingredients, or foods rather than on interactions or overall diets. They can compare the effects of single foods by contrasting diets that include them to diets that lack them. They can design trials without randomization, blinding or appropriate comparisons. They can focus on obvious or irrelevant effects. And they can give a positive spin to results that show no effect or fail to publish unfavourable results."

And then by way of examples of each, demonstrates these are anything but theoretical risks, including studies where though the conclusions are valid, like for instance, if compared with sucrose, and when neither are consumed to excess, that the slightly higher amount of fructose in high fructose corn syrup isn't likely to make much difference to health, are designed to prove forgone conclusions that can be spun by their funders and are more apt to be classified as marketing research than basic science.

Marion's also quick to note that,

"industry funding does not inevitably bias a study, although it does suggest that the research question and interpretation require more than the usual level of scrutiny"

Looking to guideline committees and dietetic organizations, the food industry is again represented in ways that require more than the usual level of scrutiny. In 2015, 10 of the 14 members of the Dietary Guidelines Advisory Committee consulted for, or received grants from the food industry, while the food industry also provides direct sponsorship and support for the works of the Academy of Nutrition and Dietetics (AND), and other dietetic organizations. And here the real question is "why?", or perhaps a slightly more nuanced, "is that really necessary?". Regarding AND for instance, Marion reports their own documents note that the cost of removing industry funding from their organization would cost just $17.17 per member per year.

Finally Marion ends with some thoughts on what to do about this mess, and while she covers a number of different options and initiatives, the one she sees as best would be, "an industry-wide program for research paid for by a mandatory tax or levy" whereby all food and beverage companies with sales over some pre-determined level, would pay a fee in proportion to sales revenues which in turn would serve to fund research and programs related to nutrition. Realistically though, she also notes that the likelihood and feasibility of such a system is "zero", and then encourages health professionals and organizations to at the very least, review their policies and to attempt to put some in that safeguard members and individuals, while asking all of us to remain vigilant and aware of the fact that in no way does disclosure alone always suffice.

Like all of Marion's books, Unsavory Truth is fascinating, and wherever you fall on the spectrum of worrying about food industry conflicts, a worthwhile read.

If You Need Proof The Food Industry Doesn't Care About You, Look No Further Than Smucker's "No Sugar Added" Jam

So I was shopping the other day.

We were making a dish that included apricot jam in a sauce and I was having a peek at the various offerings on the shelves.

I grabbed Smucker's Apricot Jam and noted that the front of its package highlighted the "fact" that it had "no sugar added".

The label of course told a different story.

It told me that the second ingredient was "white grape juice concentrate", which is likely on the order of 60% sugar by weight.

So yes, sugar was added.

I expressed my indignation on Twitter and Smucker's responded to tell me that they appreciated my feedback, that the concentrated white grape juice was meant to add "fruit flavor" as well as serve as a sweetener, and that according to the letter of the law, it was legal for them to state that their product contained no added sugar.

We appreciate your feedback. White grape juice concentrate provides added fruit flavor, and acts as a sweetener as well. Please know, we follow all CFIA labeling guidelines, including full disclosure of the total grams of sugar in each product, as listed on the Nutrition Facts.

— Smucker's (@smuckers) May 1, 2018

Now the good news is that at least in Canada, the addition of white grape juice concentrate, which of course is just the addition of sugar, will soon preclude Smucker's front-of-package "No Sugar Added" claim.

But of course if Smucker's actually wanted to do right by its customers it wouldn't be waiting for the Canadian Food Inspection Agency's regulations to change.

But that's not what Smucker's is about. Smucker's, like pretty much all publicly traded food industry players, is about profit, and their "No Sugar Added" jams are great case studies in how we shouldn't wait for the food industry to do the right thing, because unless the right thing aligns with profits, they're not going to do it.

Food Industry Furious With Health Canada's Front-of-Package Plans

If Health Canada takes Chile's lead, we too might see Frosted Flakes boxes change from looking like those on the left to looking like those on the right.

When industry is furious with a government proposal it's a safe bet that proposal is likely to affect their sales, and so when I learned that the food industry was incensed by Health Canada's front-of-package plan proposals (Aric Sudicky, a final year medical resident who was rotating through our office at the time, watched the recent roundtable style consultation hosted to discuss the implementation of what will be a Canada wide front-of-package program, via teleconference and reported to me that industry was none too pleased), I wanted to learn more.

Now this post isn't going to delve into whether or not those are the best 3 targets for front-of-package symbols, instead I want to focus on the lobbying and machinations of industry.

First though, a tiny bit of background.

In creating a new front-of-package symbol for Canadian consumers, what Health Canada doesn't want is a program that emphasizes so-called positive nutrients as 50 percent of Canadian package fronts already have those (put there by the food industry directly to help sell food), or one that requires a second step of thinking to interpret (eg studying the nutrition facts table) as that has been shown to lead to misunderstanding, or a hodgepodge of programs (as more than 150 front-of-package labeling programs have already been documented in Canada) .

What Health Canada does want is a single, standardized system, that involves a prominent symbol, that's consistently located, that doesn't require nutritional knowledge to understand, to help consumers identify products with high levels of nutrients that Health Canada deems are concerning to public health, that by itself provides the required interpretation for its meaning. Such a system would be consistent with the core recommendations made by the U.S. Institute of Medicine.

Breaking it down further, what Health Canada wants is a system that conveys simple to understand information, rather than one that presents data requiring interpretation.

Further still?

Health Canada wants warnings.

In their recent meeting, Health Canada presented their wants to food industry stakeholders, as well as the evidence they feel supports them, and invited them to submit their thoughts and suggestions for a symbol to fit Health Canada's 4 design principles:

1. Follow the "high-in" approach
2. Focus only on the 3 nutrients of public health concern (sugar, sodium, and saturated fat)
3. Be 1 colour (red) or black and white; and
4. Provide Health Canada attribution

As to what this might look like, here are some mockups put together jointly by the Canadian Cancer Society, Canadian Medical Association, Canadian Public Health Association, Diabetes Canada, Dietitians of Canada, and the Heart and Stroke Foundation.

Given that warning symbols aren't likely to be good for business, I was curious as to industry's response to the ask.

Suffice to say, industry is indeed unhappy.

The Retail Council of Canada wants Health Canada to implement instead an instruction for consumers to turn products around and study their nutrition facts tables, and they don't want Health Canada's name mentioned on the symbol. They are apparently worried that including Health Canada's name on the symbol might be misinterpreted as a government endorsement which in turn would lead consumers to eat more of the products with the warning labels. They're also apparently simultaneously worried that if the symbol utilized is already recognized to be a danger symbol, it could lead consumers to believe there is a food safety risk, and that if used, children, accustomed to seeing these symbols on foods, might lead them to think that cleaning supplies with danger symbols are safe to consume.

The Food Processors of Canada used bold to point out that, "the meeting didn't agree to anything", and that, "Health Canada has lost its way on the obesity issue". They think that what's needed is more public education, not a front-of-package warning program.

The Canadian Beverage Association expressed their, "deep concerns", and that though they were happy to have been included in the meeting, their definition of "deep and meaningful dialogue" with industry should include a process whereby industry participants would all discuss and agree upon what the program would entail.

Food and Consumer Products of Canada also wanted to express their disappointment that they weren't provided the opportunity to be more directly involved in crafting the proposal's criteria and their concerns about "the integrity and transparency of the consultation process". They sent a second note expressing their hope that the criteria still have room to evolve and that their preference is for traffic lights as they believe, "information – good and bad – builds on consumer literacy".

Dairy Farmers of Canada expressed their concern that the proposed warning system lacks the nuance required "to distinguish between nutrient-dense and nutrient poor foods" (sweetened milk will likely be slapped with a high in sugar warning), and that they'd be happy to support, especially, "if coupled with exemptions for nutritious dairy products", those programs that would provide data for consumers to study and interpret (like for instance the Facts Up Front program illustrated below).

There was however, one response from industry that was heartening. It was from Nestlé, whose representative reported being, "a little embarrassed" by how industry presented their views during the roundtable, and, "that Nestlé is not fully aligned to some of the comments that were made by some of our trade associations, and a few of us are feeling very frustrated."

Whatever comes of all of this, one thing's for sure. The food industry's near uniform opposition to Health Canada's proposed front-of-package warning label criteria is strong indirect evidence in support of their utility, as for the food industry, salt, sugar, and fat are the drivers of profitability and palatability, and they'll oppose anything they worry might limit their use.

So kudos to Health Canada for sticking to their guns, and also for honouring their pledge to make this process transparent by sharing with me industry's responses.

(and if you clicked on any of the industry letters to read, this is the post roundtable letter from Health Canada to which they're all referring).

Hey American Youth Soccer Organization, Kids Don't Need Sugar To Play

It's difficult to overstate just how aggressively the American Youth Soccer Organization (AYSO) allows Nesquik to push chocolate milk on their young players.

The reason why is simple. In 2014, AYSO partnered with Nesquik and named it, "the official “Chocolate Milk” of AYSO."

Nesquik's AYSO enabled health washing centres around the supposedly "ideal ratio" in chocolate milk of carbohydrates to protein that "can help refuel and restore exhausted muscles".

"Exhausted muscles"?

I did a straw poll on Twitter of parents whose kids play soccer.

94% of the 269 respondents reports their kids as actually moving for less than 60 minutes per soccer outing, with vast majority of respondents reporting less then 30 minutes of movement.

Nonscientific #soccer #parent poll. When your kids play soccer, how many minutes of actually moving per outing do you think they get? RT pls

— Yoni Freedhoff, MD (@YoniFreedhoff) September 9, 2017

Those poll results correspond nicely with those found by objective measures and published in Pediatric Exercise Science whereby accelerometers revealed that kids only spend 17 minutes of a 50 minute soccer match engaging in moderate-to-vigorous activity.

Now putting aside the discussion of ratios and whether chocolate milk has a special role in "refueling", it's difficult for me to imagine that anyone would suggest that kids moving for less than 30 minutes at a stretch (or even an hour), have "exhausted muscles" that need any special attention.

But I'd be wrong, because Registered Dietitian Tara Collingwood is out there for Nesquik to tell parents that chocolate milk is a healthy, perhaps even necessary, choice.

I know this because a close friend of mine and father of recently AYSO soccer enrolled twin 8 year olds and a 5 year old, has been sending me the signed by Collingwood promotional materials that arrive courtesy of AYSO in his inbox.

Here are Collingwood's "Hydration Guidelines" that recommend not only post game chocolate milk, but also suggest kids quaff 4-8oz of a sports drink for every 15 minutes played.

Here's Collingwood's post game snacks handout which of course includes chocolate milk.

Here's Collingwood's grocery list that includes chocolate milk (with its nearly double the per drop calories of Coca-Cola along with 2.5 teaspoons of added sugar per cup) in her list of "best foods"

Here's Collingwood's game day recommendations, which if my calculations are remotely accurate, would provide my friend's barely moving 5 and 8 year olds with somewhere between 400-600 game based calories, and more than a day's worth of added sugar (especially if drinking sport drinks ever 15 minutes as she recommends) apiece.

And here's Collingwood touting chocolate milk as one of 5 "must-have" foods alongside spinach, salmon, bananas, and whole wheat wraps.

And please don't think that AYSO cares enough about your kids to not allow Nesquik to target them directly with marketing either.

Nesquik has also paid Latina Mommy Bloggers to spread the word about the miraculous marriage of soccer and sugar-sweetened milk.

Here's another

And another

And another

In fact there are many, many, more.

AYSO, if you honestly cared about kids' health and sports nutrition, you'd put an end to this partnership, as Collingwood's love of chocolate syrup notwithstanding, it's nutritionally indefensible.

PepsiCo Confirms They Care About Profit, Not Health

This post is not an indictment of PepsiCo.

In fact I've picked on PepsiCo far less than I have on Coca-Cola over the years because for the most part, PepsiCo hasn't cynically pretended that health mattered to them as vocally as has Coca-Cola.

For PepsiCo, health was always about sales. They simply wanted to make money selling less awful junk food.

Well, that hasn't worked out so well, and so PepsiCo, in a 3rd quarter investors meeting a few weeks ago, did as companies do when faced with disappointing sales figures - they pledged to increase their marketing of their flagship sugary beverages (Pepsi and Mountain Dew).

This shouldn't surprise anyone.

PepsiCo's job is to maximize their profits, and while there may be times when profits and public health collide, if they don't, PepsiCo will protect their interests, not yours and mine.

And this post comes with a serving of especially delicious irony in that just one day after PepsiCo's announcement that they were going to pump their sugary fare, PepsiCo's VP of marketing Gary So published this piece on Medium about how great PepsiCo's commitment is to reducing the consumption of calories and sugar from beverages.

As I've said before, the food industry is neither friend, nor foe, nor partner.

[Thanks to Consumerist Community Editor Laura Northrup for pointing me to the AP piece]

Canadian Nutrition Society Calls 13 Daily Teaspoons of Added Sugar "Moderate"

To be fair, it wasn't the Canadian Nutrition Society (CNS) directly who told attendees of their recent annual scientific conference that consuming 13 daily teaspoons of added sugar represented a "moderate" amount, it was the handout they stuffed into all their conference swag bags that did.

That handout, available here, had this to say,

"In 2004 Canadian consumption of added sugars was about 11% of daily energy intake (53g or 13 tsp per day), according to an analysis of dietary intake data from the Canadian Community Health Survey. Average intake ranged from 9.9% of energy in adults aged 19 and above to 14.1% of energy in adolescents aged 9-18 years. This is generally considered to be a moderate amount"

Given it was authored by The Canadian Sugar Institute, it's wholly understandable that they're not lining up with the World Health Organization or Canada's Heart and Stroke Foundation in considering 12 teaspoons of added sugars per day a daily maximum, and 6 teaspoons of sugar per day a better goal. Less understandable though for the CNS.

According to the CNS, their aim is to,

"foster the next generation of skilled nutritionists, thereby building a better and healthier future for all Canadians"

I struggle to see how providing the food industry with the ability to influence and directly access the next generation of nutritionists would fit within that mandate.

(Thanks to the dietetic student attendee who sent me the handout, and for the record, I feel the same way about medical organizations providing pharma with the opportunity to stuff medical conferences' swag bags with their marketing materials)

New Reduced Sugar Kit Kat Bars And The Risks of Overly Simplistic Dietary Demons

One of the things that proponents of low-carb high-fat diets rage against, and probably rightly so, is how the overly simplistic demonization of dietary fats led to the rise of an ultra-processed market place of low-fat (but often high sugar) packaged foods.

And yet many of those same folks spend much of their time beating another overly simplistic drum these days - sugar.

While there's no argument from me that society's excessive consumption of sugar is a large raindrop in our flood of calories and chronic non-communicable diseases, if it becomes a singular focus, we may wind up with products like this new Kit Kat bar.

Nestlé is promoting their new bar on the basis of its reduced sugar content, and its packaging also infers it's "healthier" than before with it's large shout out to having "extra milk and cocoa".

As to the bar itself?

It contains 4 fewer calories than the Kit Kat bar it's replacing along with 0.7g less sugar.

At the end of the day there's a world of difference between "inconsequentially less awful" and "healthier", but that's a distinction that will likely be lost as new lines of ultra-processed foods are launched under the banner of lower sugars.

The Nannies In Philadelphia Will No Longer Sell You 2L Bottles of Soda

Yup, you read that right - if you live in Philadelphia and you want to buy a 2L bottle of soda, soon you'll be forced to buy two 1L bottles.

And yet there's no outcry from the beverage industry.

You'd think there would be. After all, back when nanny Bloomberg tried to pass his cup size ban - the one that would have forced you to buy two 500ml cups if you wanted to drink the volume of a human stomach (1L) worth of soda at once, the beverage industry bought a full page advertisement in the New York Times to complain about it (that's it up above).

But what about Philadelphians' rights to buy as many giant bottles of Pepsi as they want? Why no screaming about Philadelphia's fun and freedom stealing nanny?

Because Philadelphia's nanny is the beverage industry. You see the beverage industry, consequent to Philadelphia's new soda tax, wants to ensure people keep buying plenty of product, and to help ease the tax' sting, they're going to stop selling 2L bottles (which incur more tax) altogether.

So the next time you're tempted to shout about the nanny state when someone like Bloomberg proposes a new policy designed to encourage decreased consumption of junk food, remember, you already live in a nanny state, and the food industry is your nanny.

My Oldest Daughter Fixes Fronts of Packages - A Pictorial

For her science fair project, my oldest daughter looked at the impact of front of packages on consumer perceptions of health. As part of her study, she fixed up some package fronts with more realistic statements.

Are Conflicts of Interest In Nutrition Less Worrisome?

Today's guest post comes from public health ethicist Daniel Goldberg. It has to do with conflicts of interest in nutrition. I've found it fascinating to watch otherwise evidence based individuals suggest that conflicts of interest in nutrition don't matter. That somehow, unlike the risks proven to exist with conflicts in medicine - where highly paid physicians have been shown to be influenced by cheap lunches and plastic pens - that the suggestion that conflicts in nutrition might influence opinions, research, attitudes, and more, is ridiculous. It's not.

The Academy of Nutrition and Dietetics ("AND") recently held its annual meeting. According to registered dietitian Andy Bellatti (and others), during her opening talk, the President of the AND, Lucille Beseler, opined on the rising concerns over financial conflicts of interest among nutritionists and dietitians:

"I'm not so weak-minded that I would make a decision on receiving a pen."

In the course of researching, writing, and teaching about conflicts of interest among health professionals for over a decade, what I have come to marvel at the most is the apparent ease with which leading health professionals insist on a kind of willful ignorance regarding the cognitive science underlying concerns over COIs. This is amazing to me because of the irony: members of professions presumably dedicated to basing their practice on the best evidence proceed to engage concerns over COI with almost no awareness whatsoever of what the best evidence actually suggests regarding the impact of conflicts of interest on human behavior.

This is why, in December of 2015, I published a small chart with explanation in BMJ entitled "COI Bingo." I grew so exasperated with the same tired justifications for financial COIs that I categorized the standard responses into a Bingo chart (up above)

Reasonable people of good conscience can, of course, disagree on whether the behavior of partiality that occurs in the presence of COIs are morally justified, and on the appropriate remedies, if any, for such behavior. But the argument should proceed with all stakeholders fully aware of what the cognitive science actually suggests regarding the impact of COIs on health professional behavior.

What does that evidence show? Beyond a shadow of a doubt, gifts almost certainly do influence health professionals' behavior, at least in the aggregate. Not only have we documented this finding itself ad nauseum, we also have powerful causal explanations that elucidate the mechanisms by which even gifts of de minimis value influence health professional behavior. Virtually all human societies exchange gifts -- they promote social cohesion and are therefore a critical adaptive mechanism. One of the ways gifts accomplish such cohesion is because they tend to automatically, unconsciously create a desire to reciprocate on the part of the recipient.

Commercial industries are well-aware of this phenomenon, which is why they provide such gifts. The gift exchange also cements the relationship with industry, which that in which commercial industry is most interested. The tighter the relationship that exists between commercial industries and health professionals, the more likely it is in the broad run of cases that behavior of partiality will occur. COIs have to be understood iteratively -- the existence of a financial COI does not imply that bad behavior will necessarily take place in any given case. But over the long run of cases, the existence of financial COIs makes shenanigans much more likely -- a conclusion which is -- again -- extremely well-documented in both experimental and uncontrolled (i.e., real-life) conditions.

That these kinds of gifts "work" in the health professions to serve the interests of the "donor" is therefore beyond dispute. Moreover, some of the more darkly amusing findings in the COI literature document our own immunity bias: while we imagine ourselves much less likely to be influenced by pens and mugs, we have serious concerns that the professional sitting next to us may have their judgment clouded if they accept gifts from commercial industry:

Steinman, Shlipak & McPhee 2001

Maybe any given health provider will indeed remain entirely uninfluenced by deep entanglements with commercial industry. But the evidence establishes beyond all doubt that the odds are forever not in your favor.

Ultimately, far too many stakeholders seem willing to wade into the fray with a perfect, almost studied indifference to the significant evidence base regarding COIs. This is itself an ethical problem -- mistakes themselves are not ipso facto morally blameworthy -- but mistakes made because health professionals did not bother to examine an available evidence base and ground their practice in that evidence come much closer to moral failure.

Daniel S. Goldberg is a faculty member in the Center for Bioethics & Humanities at the University of Colorado Anschutz Medical Campus. He is trained as an attorney, a historian, and a public health ethicist.

The NFL, NBA, NHL, and MLB All Apparently Endorse a Chocolate Bar

Gah.

I gave a talk last month at a national conference of personal trainers. In my goody-bag was this Gatorade protein bar.

Its packaging explicitly told me that it contained, "protein to help muscles recover", and the bar itself was named a "Recover" bar.

Turning it over I discovered it sported the logos of the NFL, the NBA, the NHL, and the MLB.

Putting it all together I couldn't help but consider how a kid faced with this bar would react. Powerful claims, a trusted (albeit undeservedly) brand, and then the NFL, NBA, NHL and MLB's blessings? That's some golden marketing right there.

Curious I wanted to learn more about what was in it.

When I turned the bar over at first I couldn't find a nutrition facts panel. But it was there, it's just that it was hidden under the fold of the packaging at the back of the bar.

When I folded it up I discovered that along with the 20g of protein the bar contained came 7.5 teaspoons of sugar and 360 calories. That's a half a teaspoon more sugar and 30% more calories than a Snickers bar.

As I noted in the brief video I posted on Facebook, kids don't stand a chance.

Kudos to Pita Pit. Really! Healthy Help From A Fast Food Joint.

Thanks to Middlesex County's Anita Cramp for sending this photo my way!

It's one she took in a local Pita Pit and as she puts it, Pita Pit has,

"made water the easy and free choice"

So much better than the choice of more expensive bottled water vs. less expensive soda.

Thanks Pita Pit! Would love to see all fast food restaurants follow suit.

Hospital RDs Defend Patient Meals Containing Doritos and Oreos

On Monday I posted a picture sent to me of the meal provided to a patient in the Plano's Texas Health Presbyterian Hospital's ER. It consisted of a sandwich of some sort, a few tablespoons of mayonnaise, what appears to be a fruit cup, and then a bag of both Doritos and Oreos.

Over on my Facebook page, this post sparked a discussion, and included in that discussion were two RDs from the Texas hospital, Amber Murphy and Neva Cochran, who defended the meal.

Murphy defended it with by stating that it was alright for hospitals to be providing patients with junk food because the junk food was being provided to patients in the ER when the hospitals' kitchens were closed and before a formal diet order had been recorded,

"This is the after-hours stock sandwich meal that is typically served when the Room Service line is closed. It's what is available when they can't order something off of their designated menu and is typically served when pts are in the ER and diet orders aren't solidified yet."

Later she suggests that the alternative to handing out Doritos and Oreos would be an organic kale salad with quinoa (which would lead to rioting) and that cookies are comforting,

"I hear what you're saying and I don't expect to change your opinion on a FB rant; however, if our hospital offered something like an organic kale salad with a side of quinoa to some of our patients in the ER, there would be massive rioting. This is a well-portioned boxed meal, that is shelf-stable, a good source of protein and fiber, hospital budget-friendly and easily prepared by our limited kitchen staff. And I don't know about you, but if I'm a patient in the ER that just went thru a traumatic experience, a cookie might just make me feel a little bit better."

Cochran defended it on the basis that because it also has a sandwich and a fruit it's ok,

"There was more to the meal than Doritos. It had a sandwich and fruit but no one seems to notice that."

She then followed that up with the suggestion that the meal was ok because there was no such thing as junk foods and that a diet consisting wholly of broccoli would be bad for you,

"There are no junk foods, only junk diets. Doritos and Oreos can be eaten as part of a healthful diet. A diet of only doritos and oreos is not a healthful diet. Neither is a diet of only broccoli, which I assume no one is calling "junk" but eaten as your only food it does not provide for all necessary nutrients."

As I mentioned on Twitter, the issue of course isn't a single meal that includes Doritos and Oreos, it's that we have so normalized the provision of junk food that not only is there a hospital giving it out to sick patients in their emergency department, there are RDs who are comfortable defending that practice.

A hospital's default meal choice shouldn't be junk food. And it's worth asking whether or not those ER patients had other choices? Frankly I doubt it. I'm guessing their non-options would have included choosing to use hospital vending machines (that likely only contain junk food), or simply to go hungry.

And of course it's not just the ER. We've created a world where to make healthful choices you have to go out of your way to do so, sometimes far out of your way. This is true for adults and kids alike. While I think life does (and even should) include junk food, our crafted environment should require us to go out of our way to find it, not have to say no to it and go hungry in a hospital emergency department, or in a school, a summer camp, an arena, etc.

Recently I gave a talk for the Middlesex Community Healthy Kids Challenge. They kindly provided me with a copy to share. In it I highlight this crazy world we've built. Starting with our ill-advised practice of inviting the food industry to sit on governmental healthy living and eating advisory panels, and then following through with a tour of just some of the more inane examples of a world where junk food is definitely not, "just one", and where you can't possibly be expected to, "just say no".



And if you missed it, here's a video that they've produced demonstrating what responsible and thoughtful organizations can do to help.



And for more from one of their champions Nadine Devin, here's her guest post and call to action on this blog.

(And thanks too to Nadine Devin and Middlesex County for sharing the videos with me)

Chips Ahoy Cookies Are The Official Snacks of Canada Soccer #NotTheOnion

Well to be fair, Canada Soccer's official snacks also include Belvita breakfast cookies and Ritz crackers.

Other Canada Soccer "proud partners" include Coca-Cola, Nutella, and Powerade

Again, I wonder how many more years it'll be before the junkification and partnership of sport by and with the food industry is no longer considered acceptable?

My bet is within the next 20.

Welch's Study Finds Grape Juice Makes You Smarter #NotTheOnion

Oh, and a better driver.

Really.

The findings were part of a study published ahead of print in the American Journal of Clinical Nutrition. The funded at least in part by Welch's study, Concord grape juice, cognitive function, and driving performance: 1 12-wk, placebo-controlled, randomized crossover trial in mothers of preteen children, started with 25 participants randomly assigned to consume 1.5 daily cups of Concord grape juice (containing 233 calories and more than a quarter cup of sugar (13.5 tsp)), or an energy and sugar matched non-concord grape juice "placebo" for 12 weeks followed by a cross-over of treatment arms.

19 participants described as "working mothers" completed the battery of cognitive tests, and 11 sufficiently completed driving simulations. Outcome measures for cognitive function included the number of correctly identified sequences, false positive responses, reaction times, a grooved pegboard assessment of manual dexterity (fill the holes with the pegs), and "Tower of Hanoi" testing. Outcome measures for driving performance included a 25 minute virtual driving scenario.

Now up front I should disclose I'm neither a statistician nor an expert in cognitive function testing so please consider that with my assessment. Ultimately, within the battery of tests (and there were plenty), a few in fact were found to show a statistically significant improvement in favour of the grape juice - most with p values of 0.05. Of course, do enough tests, and chance alone will dictate one will turn out to have a p value of 0.05. Putting that aside, I also can't help but question the significance, even if true, of for instance completing a psychomotor skill test in 60.4s vs. 63.2s (P < 0.05), or as it would pertain to driving, a "car following" accuracy of 0.96 vs 0.97 (P = 0.05).

Sounds like the authors may have wondered the same given their use of the word "subtle" in describing the improvements and their proviso when considering the battery of tests that were run,

"it is important to acknowledge that there were no effects on most cognitive outcomes".

Not surprisingly, that proviso did not stop Welch's from putting out a press release that opened with,

"New research by the University of Leeds in the UK suggests that drinking Concord grape juice daily can benefit certain aspects of memory and everyday tasks in people with stressful lifestyles – specifically working mothers".

So there you have it - the 13.5 teaspoons a day of sugar way to just barely, sort of, in a very small number of very specific tests, as revealed by an incredibly small sample size, make yourself smarter and a better driver.

[And to consider too - did these, acknowledged even by the authors to be meagre, findings really warrant publication in the American Journal of Clinical Nutrition, a journal with an impact factor (nearly 7) higher than roughly 95% of all other scientific journals, and one that was selected by the Special Libraries Association as one of the top 100 most influential journals in Biology and Medicine over the last 100 years? And/or does this just speak to impact factors' lack of utility?]

Guest Post: Help the Environment by Eating More Processed Food?!

Today's guest post comes from our office's fantastic RD Emily Spencer

TerraCycle is an up-cycling and recycling company that collects difficult-to-recycle packaging and products and turns the material into a variety of consumer products like cutting boards, garbage cans, and picnic tables.

Here’s the catch.

TerraCycle has made its way into schools with an aim to teach children about the environment by having them collect and recycle their processed food containers and wrappers, among other items. Don’t get me wrong; I think that teaching children about creating sustainable environments is important. The issue with this is that the school receives points from TerraCycle based on the amount of empty food packaging they send in. These points can then be redeemed as cash rewards for the school. In other words, the more processed, packaged food sent in school lunches, the better. There are even contests in schools where the child who collects the most packaging will win a prize. Wrappers and containers from Schneider’s Lunchmates, Kraft Lunchables, Koolaid Drink Pouches, and Mr. Christie Cookies are a few examples of waste accepted by TerraCycle.

While I’m all for recycling, I can’t help but think that rewarding the frequent consumption of processed, packaged food is not the right approach to help the environment…or the health of our children.

And the story isn’t over yet.

The large majority of the repurposed products made with the children’s empty food packages are covered in recycled food companies' logos (see examples here and up above). So in addition to being rewarded for eating processed food, children (and adults) can now have the pleasure of doing free advertising for the food industry by carrying around heavily branded items like tote bags and backpacks.

I wonder how long it will take until a Koolaid pencil case or Lunchable notepad ends up in a landfill anyway?

Unfortunately this is yet another clever partnership for the food industry that provides little in terms of teaching children about the environment. TerraCycle should stick with repurposing ink cartridges and laptops into useful, unbranded consumer products, not in causewashing "foods" that kids would likely be better served without.

Emily Spencer, RD, MScFN
Registered Dietitian

Emily Spencer, MScFN, RD graduated with a Master’s of Science in Food and Nutrition from Brescia University (affiliated with Western University) in 2014. Her major research project during her master’s degree was focused on evaluating a community based lifestyle and behaviour change program for adults with prediabetes. Her undergraduate BSc in Food and Nutrition was also completed at Brescia University in 2012.

As an adventurous food lover, Emily enjoys cooking and experimenting with foods from all cultures, trying just about anything – even scorpion! You never know what you’ll like until you give it a chance!