Currently browsing posts about: Ultraprocessed

The current Dietary Guidelines Advisory Committee has produced its draft recommendations.  These, as I discuss tomorrow, are mostly banal, much the same as all guidelines since 1980.

But this year there are two rather shocking exceptions, both having to do with what is not recommended.

Incredible non-recommendation #1.  Reduce the focus of the Dietary Guidelines on reduction of chronic disease risk.

What???  The entire purpose of the Dietary Guidelines is to reduce the risk of diet-related disease.  Chronic diseases—obesity, type-2 diabetes, heart disease, cancer, etc—are the leading causes of death and disability among U.S. adults.

Maybe this was a typo?  Surely this committee means to say “Recommend increasing the focus of the Dietary Guidelines on chronic disease risk reduction.

The current wording is a travesty.  I’m not the only one who thinks so.  See Jerry Mande’s Tweet (X).

Update: I gather the uproar over this did some good and the committee is changing the wording.

Incredible non-recommendation #2.  Say nothing about ultra-processed foods.

The committee made it clear that they were not going to say a word about ultra-processed foods.  At least not now.  Why not?

Scientific experts tasked with advising federal officials drafting the 2025-2030 Dietary Guidelines for Americans said the data were far too limited to draw conclusions…Ultra-processed foods don’t have a recognized definition or a robust body of scientific literature that has studied them, they said, so guidelines would be premature.

Another travesty.  An overwhelming body of observational research suggests harm from diets high in ultra-processed foods.  OK, these studies only demonstrate association, not causation.

But—not one, but two well-controlled clinical trials demonstrate that ultra-processed foods induce people to consume more calories than they would otherwise: 500 more in one trial and more than 800 in the second.  These are enormous differences.

Yes, it would be great to know why, exactly.  And yes, the definition of ultra-processed can be fuzzy with respect to a few—remarkably few—foods.

But what more do you need to know?  Isn’t this enough to tell people that if they want to keep caloric intake under control, a good way to do that would be to limit consumption of ultra-processed foods?

But this committee chose to ignore the controlled trials because they didn’t last long enough.

As I explain in that link, the committee’s hands are tied by having to make “science-based” recommendations.  But in nutrition, most of the science is observational, which is why those controlled trials, short in duration as they are, matter so much.

The committee needs to revisit this decision.  If the guidelines do not include a recommendation to limit intake of ultra-processed foods, they will be ignoring the science and will be behind the times.

Worse, the guidelines will not help Americans reduce their risks for chronic disease.

See: Stat News:  5 questions about the next U.S. dietary guidelines, and the ‘impossible restriction’ on them: Difficulty of nutrition research leaves problems like ultra-processed foods largely unaddressed. 

Tomorrow: the banality of the latest recommendations.

I attended a meeting at Cornell last week at which FDA Commissioner Robert Califf answered questions from faculty and staff.

He started out by remarking on the poor health status of Americans, despite our spending twice as much on health as any other country.  He noted the disparities in health status, particularly singling out the declining health of rural Americans.

In answer to questions from panel members and, later, from the audience, he said (my notes and paraphrase, unless in quotes):

• We have real health problems on the ground right now.
• The  big issue is chronic disease, on which we are “doing terribly.”
• We have to deal with the marketing of ultra-processed foods designed to make you hungry for more.
• On tradeoffs in trying to discourage ultra-processed foods: This isn’t like drugs with clear risk/benefit calculations.  Food research has big confidence intervals and less rigorous estimates. The FDA has lots of bosses.  The executive branch and Congress can overrule anything it does.
• One Health (the movement to treat human and animal health issues as parts of a whole) is essential to the future of humanity.
• Climate change has moved pathogens into areas where they didn’t used to be.
• Action on animal antibiotics stagnated as a result of the pandemic: “We are all sinners in this regard.”
• We need a global strategy; infectious diseases do not respect borders.
• ”There is a lot of rhetoric about food safety, but the systems do not come together as they should.
• There is too much financial influence on policy.  “Policy is everyone’s job.”
• A lot of people are making a lot of money on our food and health systems, but it’s not spent on the right things.
• On the Supreme Court’s overturn of Chevron: the FDA cannot extend its rulings beyond what Congress intended.  It will slow things down.
• “We should reserve most of our energy to do our jobs well.”
• Courage is important: we must have courage to do things differently.

Comment

I was impressed by his knowledge, thoughtfulness, and concern about public health issues, especially those around food, as well as his understanding of the current political barriers against using expertise and regulation to improve food systems and public health.

He used the occasion to encourage students to consider careers in the FDA and noted the remarkably low turnover of permanent staff.

Jerry Mande sent me a link to a report of remarks the Commisioner made in December: America has a life expectancy crisis. But it’s not a political priority (Washington Post), and also to Helena Bottemiller Evich’s report, FDA Commissioner says ultra-processed foods drive addictive behavior.

So the Commissioner is giving serious thought to these issues.  So are others: see Announcement below.

The big question: who at FDA will take the lead on all this?

The FDA has just undergone a major reorganization.

As of October 1, the Human Foods Program looks like this.

The big question: who will head the new Nutrition Center of Excellence?

My big hope: Califf will appoint someone to that position who shares his committment to reducing diet-associated chronic disease.  Fingers crossed.

Announcement

Senator Bernie Sanders (I-Vt.), announced that his Committee on Health, Education, Labor, and Pensions (HELP) will hold a hearing on the urgent need for the FDA to “adequately protect Americans – especially children – from unhealthy foods that are pushed on consumers by the food and beverage industry.”  Here is his invitation letter to Commissioner Califf and Deputy Commissioner Jim Jones, who heads the FDA’s Human Foods Program.

When: 10:00 a.m. ET, Thursday, December 5, 2024
Where: Room 562 Dirksen Senate Office Building. The hearing will also be livestreamed on the HELP Committee’s website and Sanders’ socials.

A reader, Bart Peuchot, writes:

I would be very interested to have your view on this new publication for Nature.

As you taught me, I checked the competing interests and it seems to be a perfect industry-funded publication.

And then ,I ran across this Tweet (X) from @Stuart Gillespie:

New paper concluding “more research needed”
…brought to you by Nutrition Foundation of Italy…
…which in turn is brought to you by
…..@Nestle @McDonalds @CocaCola Ferrero, Barilla, Danone et al…

Well.  What  is this about?

I went right to the paper: Visioli, F., Del Rio, D., Fogliano, V. et al. Ultra-processed foods and health: are we correctly interpreting the available evidence?. Eur J Clin Nutr (2024). https://doi.org/10.1038/s41430-024-01515-8

Aha! Another attack on the concept of ultra-processed foods.  The article concludes

the available evidence on how different UPFs have been associated with health, as well as the results of studies examining specific food additives, call into question the possibility that ultra-processing per se is the real culprit. It is possible that other unaccounted for confounding factors play an important role. Future, urgently needed studies will clarify this issue.

The Italian food industry has been especially active in opposing NutriScore labels and anything else that might discourage sales of foods high in sugar, salt, and saturated fat.

But it is not alone in pushing back against the concept of  ultra-processed foods—an existential threat to junk food manufacturers.

Here, for example, is Hank Cardello,  the Executive Director of Leadership Solutions for Health + Prosperity at Georgetown’s Business School writing in Forbes:: New Report Highlights The Sweet Side Of Ultra-Processed Foods.

With ultra-processed foods (UPFs) replacing “junk food” as the new bogeyman for public health advocates, a new study published by  the Georgetown University Business for Impact Center (full disclosure: I am one of the authors) reveals that all UPFs are not created equal. The report spotlighted that candy in particular was the exception, since that category contributes only 6.4% of added sugars and less than 2% of our calories. The most surprising discovery is that the “healthiest of the healthiest” consumer cohort in the study purchased candy 26% more frequently than the general population.

The report: New Consumer Insights on Ultra-Processed Indulgent Foods: How Confectionery Products Are Different.

Candy behaves differently from other ultraprocessed indulgent products. New NMI and NHANES data re-confirm that candy is different and should not be lumped together with other indulgent products. Consumers do not overconsume  chocolate and candy, so targeting these foods will not impact obesity. An approach that focuses on product categories that consumers with the highest BMIs eat and drink the most will be more effective.

OK, readers: Take a guess at who paid for this.

Funding for this paper was provided by the National Confectioners Association.

As I keep saying, you can’t make this stuff up.

I don’t like writing about the dietary guidelines process while it is still ongoing because so much can change between now and the time the advisory committee submits its report, and USDA and HHS issue the actual guidelines.

But this Dietary Guidelines Advisory Committee is dealing with the concept of ultra-processed foods and is tied in knots over it.

So I will devote this week to the guidelines.

• Today: Why knots?
• Wednesday: Why isn’t NIH funding more rigorous nutrition research?
• Thursday:  Why all the fuss when guidelines always say the same things?

OK.  Let’s get to it.

Why do I think the Dietary Guidelines Advisory Committee (DGAC) is tied in knots over ultra-processed foods (UPF)?

1. It  is required to make evidence-based recommendations.  This is impossible with observational evidence.
2. It is required to exclude the one existing controlled clinical trial from consideration (because it was too short).

Therefore, it had to conclude: ““Limited evidence suggests that dietary patterns with higher amounts of foods classified as UPF consumed by adults and older adults are associated with greater adiposity (fat mass, waist circumference, BMI) and risk of obesity/overweight. Evidence Grade: Limited.”

The DGAC is in an impossible position, and doing the best it can under the circumstances.

I need to say a word about evidence-based recommendations.  How I wish they could be.   If all you have is observational studies, you need to interpret them carefully.  Interpretation is subject to bias.

When I was a DGAC member (1995 guidelines), the agencies recognized what we were up against.  They instructed us to review the available research and give the best advice we possibly could based on it.

All of this raises a philosophical question: Should government agencies issue advice based on incomplete and inadequately controlled observational research?  Or should they say nothing?

This committee, apparently, is considering saying nothing about ultra-processed foods: “It would be hugely problematic to tell people to avoid 60% of the food supply without having something good to replace it.”

Really?  Plenty of “something good” is available.  It’s called food: fruits, vegetables, grains, meat, fish, dairy, eggs.

These—unprocessed and minimally processred—can be delicious, nutritious, and satisfying, and at reasonable cost.

—–

Tomorrow: Why don’t we have more rigorous research?

Addition:  The video of the meeting.  The discussion of ultra-processed foods starts at 3:51:45 .

If you are still confused about ultra-processed foods and the current status of this truly important dietary concept, here is a great place to start: The Financial Times of all things: “Deny, denounce, delay”: The battle over the risk of ultra-processed foods.

Why important?  The message is clear: eat less of them.  Hence, the article’s subtitle: “Big Food is trying to dampen fears about the effects of industrially formulated substances.”

This piece is totally worth reading.

It is clear that the public is now much more aware of UPFs, and concerned about them. Two-thirds of Europeans now believe that ultra-processed foods are unhealthy and will cause health problems in later life, according to a February survey of 10,000 people in 17 countries, and 40 percent do not trust that the authorities are regulating them well enough. Research by Mintel in the UK has found that 70 percent of UK adults try to avoid ultra-processed foods.

“I don’t think even Carlos Monteiro in his wildest dreams expected the public discourse to get so attuned,” says Lang at City University. “The public is running with it. The genie is out of the bottle.”

Every now and then a headline makes me gasp:

Deena Shankar’s article in Bloomberg News begins:

It’s been just about a year since the US government slashed additional pandemic-related food-stamp benefits, and some of the companies that make and sell food are seeing that hit their sales.

As she explains,

Enhanced benefits for the Supplemental Nutrition Assistance Program, or SNAP, ended last February, meaning families and individuals saw monthly cuts of $95 to $250 or more in what they received. Families with kids lost at the high end of the spectrum, according to the Center on Budget and Policy Priorities, a nonpartisan research and policy institute.

Never mind the effects of reduced benefits on low-income families.

packaged-food giant Kraft Heinz Co. cited the reduction in benefits as a major headwind that the company and the industry faced in 2023. “We saw some challenges in our mac-and-cheese business,” Chief Executive Officer Carlos Abrams-Rivera said on an earnings call. “Frankly, it’s a business that is driven disproportionately by our SNAP exposure.”

How’s that for a gasp-inducing statement.  SNAP recipients are the core customers for this product.

If you want to know about inequities in the US food system, start here.

Kraft Mac & Cheese exemplifies cheap ultra-processed food.

Walmart sells five boxes for $4.88, less than a dollar a box.

For that, you are supposed to get three servings per box, but the whole box adds up to:

• 750 calories
• 1680 mg sodium,(4.2 grams of salt)
• 27 grams sugars

And what’s in this?

ENRICHED MACARONI (WHEAT FLOUR, DURUM FLOUR, NIACIN, FERROUS SULFATE [IRON], THIAMIN MONONITRATE [VITAMIN B1], RIBOFLAVIN [VITAMIN B2], FOLIC ACID), CHEESE SAUCE MIX (WHEY, MILKFAT, SALT, MILK PROTEIN CONCENTRATE, SODIUM TRIPHOSPHATE, CONTAINS LESS THAN 2% OF TAPIOCA FLOUR, CITRIC ACID, LACTIC ACID, SODIUM PHOSPHATE, CALCIUM PHOSPHATE, WITH PAPRIKA, TURMERIC, AND ANNATTO ADDED FOR COLOR, ENZYMES, CHEESE CULTURE).

Walmart sells a pound of carrots for $1.38.

There is something seriously wrong with a food system that makes a 750-calorie Mac and Cheese product so much cheaper than a pound of carrots.

I learned about this one from Beverage Daily:

Unexpected and bold: The iconic nacho cheese taste of Doritos imbued into a first-of-its-kind spiritThe Frito-Lay brand has collaborated with Danish flavour innovator Empirical to launch Doritos Nacho Cheese Spirit – a limited edition, multi-sensorial experience that really tastes like nacho cheese…. Read more

Limited edition bottles will be available in select New York and California markets for $65 for a 750ml bottle.

Now you get to have your ultra-processed snack and 42% alcohol by volume—all at once!

Oh no!  According to the company, the product is sold out.

You can’t make this stuff up.

Let’s start the new year with some good news.

I was excited to read in The Lancet that Colombia has enacted a tax on junk foods.

The new tax was included in a wider reform that passed into law in December, 2022, seeking to reduce the
burden of obesity and other diseases on Colombia’s health system, while also bringing in revenue in a country that manages a fiscal deficit.

This is a tax on ultra-processed foods!

The tax is being implemented gradually, beginning at 10%, before rising to 15% in 2024 and 20% in 2025, and targets foods are high in salt and saturated fat, as well as industrially manufactured prepackaged foods.

Colombia already has warning labels.  Here’s who else has them.

The warning label movement!

Now, if we only could get these in the U.S….

But note: not everyone loves the tax.  The Guardian reports charges that it is unfair to the poor.  But so is type 2 diabetes.