Fed Up with corporate influence in food policy and what to do about it

Last week I was finally able to see the new documentary film Fed Up at the wonderful Cedar Lee Theater. The documentary attempts to look at why the obesity epidemic continues to grow, and what we can do about it. FU states that “everything we’ve been told about food and exercise for the last 30 years is dead wrong. FED UP is the film the food industry doesn’t want you to see.” FU is produced by Laurie David (environmental activist and producer of An Inconvenient Truth), produced and narrated by Katie Couric, and directed by Stephanie Soechtig. Soechtig’s name was familiar, as it turns out she was a consulting producer for GMO OMG (I reviewed it here), and also directed Tapped (movie about the bottled water industry, haven’t seen it but heard good things).

Fed Up Movie Poster

There are three parts to the movie: investigation of how we got where we are, interviews with experts detailed below, and stories of a few obese teenagers struggling to lose weight and keep it off. The portraits of the obese teenagers are hard to watch at times, and important to the flow of the movie, but I’ll be focusing on how we got to the obesity crisis. I will also discuss the fact that the film did not include any interviews with dietitians, and what to do about it. But first, let’s discuss who’s been featured in the movie.

There were many knowledgeable experts featured in the movie though I was sad to see no dietitian was included (we’ll talk about possible reasons why that may be). Experts that stuck out to me included Dr. David Kessler, Kelly D. Brownell PhD, Dr. Mark Hyman, Dr. Robert Lustig, Senator Tom Harkin and Pres. Bill Clinton. Most names were familiar, but read more about them after seeing the film. Kessler was the former commissioner of the FDA 1990-1997, a huge proponent of tobacco regulation, and author of The End of Overeating. Kessler largely believes that the outcome of lifelong obesity is not genetic but environmental and avoidable. I was surprised that Kessler used to lead the FDA given his strong convictions on obesity. Brownell is an internationally renowned expert on obesity, current dean of Sanford School of Public Policy at Duke University, and former director of the Rudd Center for Food Policy and Obesity at Yale. Apparently Brownell coined the term “toxic food environment” – a term I often use when teaching nutrition classes when acknowledging the McDonald’s across the street. Hyman is chairman of the Functional Medicine Institute, author of The Blood Sugar Solution, a regular contributor to the Katie Couric Show, and Bill Clinton’s medical adviser. Lustig is an American pediatric endocrinologist at the University of California, San Francisco with special interest in childhood obesity. He is also well known for a talk, Sugar: The Bitter Truth. My friend and fellow RD, Neal Kurmas, sent me a link to that years ago but I never watched (its about an hour and a half)… I need to check it out. Harkin is a politician from Iowa, served as a congressman from 1975-1985 and as a senator ever since. Harkin is Chairman of the United States Senate Committee on Health, Education, Labor and Pensions and has served as chair of the Committee on Agriculture, Nutrition and Forestry in the past. Bill Clinton is… Bill Clinton! Michael Pollan, Michele Simon, JD, MPH, Marion Nestle, Gary Taubes, and Mark Bittman (who has a good review of the movie here) also appeared in the movie.

The experts explain that the “energy balance” theory is non-sense. If we only count calories and do enough physical activity (calories in = calories out) then we won’t gain weight. There is much more to weight gain than eating too many calories and not exercising enough. Instead, we are shown the difference between drinking a sugary pop vs. eating a handful of almonds. The sugary pop causes a rush of sugar absorption, leading to rapid insulin response and weight gain. Contrast this with a handful of almonds, which is low in carbohydrates and high in fiber, the absorption is much slower with the natural fiber and other nutrients. Also discussed is the fact that all sugar raises blood sugar, but (again) fruit and many other unprocessed foods naturally contain fiber which will help slow down blood sugar absorption, insulin response, promote satiety (feeling full), and prevent weight gain. This is all science based information that I also use to teach my diabetes classes. To explain weight gain, we are told that sugar (or high carbohydrate foods that turn to sugar in our body, i.e. cornflakes) create spikes in blood sugar that require insulin. Insulin is the “fat storage” hormone, so as the large rush of sugar comes into the blood, “the body has nothing to do other than to turn it into fat” through insulin. None of the information is new, but FU presents it in a way that makes is easy for anyone to grasp the concepts. One flaw with FU is that they seem to be vilifying sugar vs. processed sources of carbohydrate. One expert even says in the movie that corn flakes and pop are identical once they are digested, both are rapidly broken down to simple sugars and trigger insulin response and weight gain. Yet the end of the movie encourages going sugar free for 10 days. This may not be a bad recommendation, but simply substituting processed foods that have sugar to processed carbohydrates such as potato chips and corn flakes will not solve the problem. The end of the movie shows families cooking all meals instead of eating processed foods, this would have been a better “challenge” but I guess that would make the message a little more complicated then just “sugar is poison.” Looking at the movie poster too, it reads “Congress says pizza is a vegetable” – again this does not have much to do with sugar, but the overall problem that processed foods and their manufacturers have hijacked nutrition recommendations. This is the main problem, we live in a toxic food environment surrounded by processed, unhealthy foods, as if it has to be this way. So why is it this way? I will present some reasons why that FU briefly discusses, but also elaborate in much more detail…

1968-1977: “The McGovern Committee”

Way back in 1968, there was a senate committee created to investigate hunger and malnutrition, called the United States Senate Select Committee on Nutrition and Human Needs, also referred to as “the McGovern committee” for it’s only Chairman George McGovern. Initially, McGovern went to Immokalee, Florida to dramatize the issue of hunger. Immokalee was, and continues to be a base for tens of thousands of migrant farm workers (the same farm workers that have had recent success in raising wages). Unfortunately, the trip did not have the intended effect and McGovern continued to battle Nixon administration and southerners in Congress until 1970, when he compromised to establish the principles of food stamps and a nationwide standard for eligibility. The following year, the committee was expanded to also study environmental conditions that affected eating habits. McGovern toured the abandoned neighborhoods of the Bronx and was highly critical of the Federal Housing Administration’s urban renewal efforts (see this article for examples of the same redlining policies by the FHA in Chicago). It’s amazing that McGovern was looking at the effects of environmental conditions and eating habits in 1971, when over 40 years later we still have little policy addressing this issue.

McGovern eventually faded from the committee, as he was highly involved with opposition to the US involvement in the Vietnam War and in his 1972 U.S. presidential campaign (see Fear and Loathing on the Campaign Trail ’72).  I have to ask, would this country be any different if McGovern won in 1972? Too bad he only won Massachusetts and we ended up with “Tricky Dick” Nixon, a fine leader…

Nixon

needs no description

Anyway, in 1974 the committee was expanded to include national nutrition policy, and expanded to include problems of overeating. In 1977, the committee issued a new set of nutritional guidelines for Americans to combat chronic disease. The Dietary Goals for the United States, often referred to as “The McGovern Report” recommended eating less fat, less cholesterol, less refined and processed sugars, and more complex carbohydrates (this was the first time fruits, vegetables, and whole grains were referred to complex carbs) and fiber. The committee’s “eat less” recommendations resulted in negative reactions from the cattle, dairy, egg, and sugar industries. The American Medical Association protested as they preferred patients see their doctor for advice (what do doctors know about nutrition these days? / what if you don’t have insurance?). Others felt that the guidelines should be handled by the National Research Council/Institute of Medicine (fun fact: the current president of IOM, Victor Dzau, was a board member and is a large shareholder of PepsiCo – yes, the IOM is the same organization that previously endorsed a soda tax… here we go again). Anyway, under heavy pressure, a revised set of guidelines were released, which watered down the advice and wording of many recommendations. FU mentions the problem when you have a single organization, the USDA, that must promote agriculture (eat more corn) and also issue dietary guidelines (cut down on sugar/high fructose corn syrup). So as far back as 1977 we see the influence of the food industry against the public good.

Original guidelines on sugar from the "McGovern Report" in 1977. The guidelines were revised to be more industry friendly.

Original guidelines on sugar from the “McGovern Report” in 1977. The guidelines were revised to be more industry friendly.

 

1981: Government cuts to school lunch program

Fast forward to the 80s, Reagan takes office and is eager to cut government spending. He wastes no time and in 1981 cut nearly 1.5 billion dollars from child nutrition and adjusted federal guidelines. This meant that less children qualified for free or reduced price school lunches, and also higher prices of 25-30 cents. The cut totaled about one-third of the budget, leaving schools to close the gap by serving cheaper, unhealthy food and partnering with many private fast food companies. In 2005, 80% of schools were under exclusive soda contracts. In 2012, 50% of schools offered fast-food on campus. Also, at the same time the Reagan administration proposed to allow ketchup to count as a vegetable in school meals.  The media had a field day, The Washington Post quoted the budget director’s comment that USDA “not only has egg on its face, but ketchup too” and the USDA had to rescind the rule one month later. These antics continue to the present day, with corporations such Schwan Food.  Schwan Food is a privately held Minnesota company that provides much of the pizza sold in school lunches. In 2011, Schwan was able to lobby Congress to pass a rider that let pizza count as a vegetable in the school lunch program, thanks to a dab of tomato paste. All you have to do is follow the money.

Corporations pushing processed foods will always have more money to lobby congress than regular people & scientists recommending whole foods. The system is flawed due to the effect of money on politics. I wish Fed Up spent more time with this issue.

Food Marketing to Children

Speaking of money, another important disparity is what types of foods are marketed and how much money is spent marketing foods to children.  Why is food marketing important to address?

The overwhelming majority of the foods marketed are of poor nutritional quality. Source: Food Marketing Workgroup

I’m not sure I need to write to much about this, as anyone who watches TV or listens to the radio, read magazines etc… is surround by ads for empty calorie foods, that contain little nutrition value and promote weight gain.

Healthy food marketing is only about 16.5% of the nearly 2 billion dollars spend annually by the food industry on food marketing to kids.The odds are stacked against kids from the start to buy into junk food.

If we want our children to eat healthy, shouldn’t we make it easier to eat healthy? Large amounts of money spent on advertising nutrient devoid, processed foods does affect children’s behavior, leading to preferences for higher intake of processed foods at a younger age. Once the body becomes used to eating processed foods, it may be hard to just stop and switch to a healthy diet. Furthermore, widespread food marketing undermines parents’ attempts to feed their children a nutritious diet. FU compares food advertising to children to big tobacco. Senator Harkin says, “I don’t know how they (the food industry) live with themselves.”

flinstones

 2004: World Health Organization report

In 2003, the World Health Organization released a report, known as WHO Technical Report Series 916 TRS AKA TRS 916. This report, presented the Joint WHO/FAO (Food and Agriculture Organization of the United Nation) Expert Consultation on Diet, Nutrition and the Prevention of Chronic Diseases. Specifically, TRS 916 recommends limiting free sugars, defined as added sugars plus sugars naturally present in honey, syrup, and fruit juices, to less than 10% of total energy. So, did the US government join over 191 countries at the World Health Assembly that adopted the WHO global strategy? No. What happened was that industry money again trumped what was good for the public. Sugar industry enlisted senators from sugar-growing states to pressure the DHHS to withdraw funding from WHO, and induced the DHHS to send a critique of the report to WHO that had essentially been written by sugar industry lobbyists. When released in 2004, WHO’s Global Strategy on Diet, Physical Activity, and Health omitted any mention of the 10% sugar recommendation. The barrier that continues to prevent healthy intervention to address obesity is lobbying  by large food corporations and trade groups.

TRS961table

WHO TRS 916 report recommends sugar should be less than 10% of calories. Due to intense pressure from sugar industry groups, the recommendation was later omitted.

 Current: Michelle Obama’s Let’s Move Campaign

According to FU, First Lady Michelle Obama started Let’s Move as a way to “move” forward policies regarding childhood obesity. In March 2010, just a month after launching Let’s Move, Michelle Obama challenged the food industry at a meeting of the Grocery Manufacturers Association (GMA), stating “We need you all to step it up.” Let’s Move seemed promising at first, though was significantly weakened once industry got involved. Initially the campaign wanted stronger regulations on the food industry, but then remaining silent on limiting junk-food marketing towards kids and now focuses almost exclusively on increasing physical activity (as opposed to the current toxic food environment). Of course, we can’t leave lobbying by food corporations out of the equation either. Food corporations spent large amounts of money lobbying to weaken any thought of regulation. They spent $175 million from 2009-2011, over twice as much as the same period of time when Bush was in office. Soda lobbyists spent $40.7 million dollars in 2009 alone when congress considered a penny-per-ounce soda tax to help fight obesity.

Food corporations spent $175 million from 2009-2011, over twice as much then the same period of time when Bush was in office. Source: Reuters

Food corporations spent $175 million from 2009-2011, over twice as much then the same period of time when Bush was in office. Source: Reuters

So, largely due to intense lobbying by food corporations, we see that discussion of any meaningful regulation was avoided. Of course since most Americans are concerned about childhood obesity, the food corporations need to also appear concerned, they do not want consumers to stop buying their products. So we get partnerships and voluntary regulation. Partnerships with Let’s Move included many food corporations such as Wal-Mart, Walt Disney, Nestlé, Kellogg and General Mills. These are the same companies that are members of the GMA that continue to spend large amounts of money lobbying against common-sense obesity prevention policies and instead insist on voluntary self-regulation. In another article, Brownell, then director of the Rudd Center for Food Policy and Obesity at Yale University, insists that “the childhood obesity crisis won’t be solved without forcing food companies to do the things they don’t want to do. History is littered with unfulfilled industry promises to protect kids’ health.” The article gave an example of how food corporations use voluntary labeling with the “Smart Choices” label. The label was introduced in 2009 by fourteen major food corporations, including Kraft, Kellogg, PepsiCo and Unilever. The program gave Fudgsicles, Captain Crunch, Lucky Charms and Kid Cuisine Magical Cheese Stuffed Crust Pizza a little green check mark designating them as “smart” choices. Nutrition experts argued they were anything but healthy. The program was not very successful as the FDA said such systems could mislead customers. The industry saw the writing on the wall, as food corporations stopped using the program, or phased it out over time.

If Captain Crunch is a smart choice what is a dumb choice? Source: Bruce Bradley

 

Conclusion

I enjoyed Fed Up because it gave me a different perspective on how our current dietary guidelines were formed and modified by the influence of large food corporations. Some of the ideas are too simplistic, i.e. “sugar is poison” because it’s not that simple- too much simple carbs will also spike blood sugar. The resulting spike in blood sugar will have to do with how processed the food is and what you are eating with it. I like fresh San Francisco Sourdough bread from Stone Oven for example, but I might put some almond butter on it (fiber), and with it eat a piece of fruit (fiber), granola (fiber & fat), and a poached egg (protein). Healthy fats, proteins, and fiber will all help curb that blood sugar spike. Of course amounts matter too (only 1 slice bread), and I am going to bike to work.. so it’s just not that simple. I don’t think simply vilifying sugar is going to solve the “obesity epidemic.” I would have liked to see a 10 day home cooked meal challenge, instead of a 10 day sugar-free challenge at the end of the film. Cooking more often will cut down on a lot of nutrient-devoid foods (sugar or no sugar), but that would change the whole pretext of the movie I guess.

I would have also liked to see more “bigger picture” discussion. FU could have connected the dots between the policies that shape our food environment and overall lobbying by food corporations to encourage a bigger message: Don’t just take the sugar-free challenge, but also write your representatives that you are tired of corporate lobbyists deciding what is healthy. Just look at Brazil’s nutrition recommendations for an example of how simple recommendations that focus on real food and enjoyment of meals could help combat obesity. Or take the issue of corporate influence even further with a discussion of the Move To Amend (MTA) movement that is taking root all over the country. MTA would effectively state that money is not speech and corporations are not people by amending the constitution. If we had a true democracy that represented the interests of people instead of monied interests, our food system would look a lot different.

I would have also liked to see at least once dietitian featured, or at least a discussion of why no dietitians were featured. This is the elephant in the living room as dietitians believe that they are the nutrition experts, but then an important nutrition documentary comes out without a single RD, which brings me to…

What does the largest organization of food and nutrition experts think about all this?

Before the movie was released, I was browsing FU’s website (http://fedupmovie.com) and noticed that the Academy of Nutrition and Dietetics (AND) was listed as a partner.

ANDfedup2

I tweeted at AND that I was surprised to see they were a partner, and shorty after the AND logo had been removed from the movie’s website.

NoANDfedup2

In light of this, I decided to contact AND and see what they thought about the movie. Thank you AND for taking the time to response to my questions. You can read AND’s responses below.


If AND was not involved with the movie Fed Up, why was their logo featured on the partner section of their website? Why has it since been removed from their website?

The Academy logo erroneously appeared on the Fed Up website and was removed when their error was realized.

 

As the world’s largest organization of nutrition professionals, What is AND’s opinion on the movie?

The Academy does not have an official statement about the movie.

 

I have seen Kristin King, RDN, an AND spokesperson quoted in an article on Boston.com, stating “Ultimately, the choice is just that – a consumer choice. For parents, they are the ones that buy the food. If they are concerned the child is overweight, don’t buy it.”

Does AND agree with this statement, largely that we have a childhood obesity problem because we have a nation of unconcerned parents that chose to buy their children unhealthy food?

The Academy has found that parents are the top influencers on their children’s lives (http://www.eatright.org/Media/content.aspx?id=6442459599#.U3Jjn4FdVyI) and thus are the principle players in helping them eat right.

I have also read a review by Elisa Zied, MS, RD, CDN. Zied states “[Fed Up is] very well done and features many credible experts (though I was disappointed to see that no registered dietitian nutritionists—many of whom are on the front lines working with children and families to help them eat and live better—were featured).” I was surprised to see a review of the movie on parents.com before any mention of the movie on AND’s website and unhappy to hear that no RDNs were included.

AND states that Registered dietitian nutritionists “are the food and nutrition experts.” If RDNs are the experts, why were no RDNs featured in the movie? Of course AND did not make this decision, but why does AND think RDNs were not included? Is there any conflict of interest when the largest professional organization representing RDNs accepts funding from the food industry while these same companies produce calorie dense, low nutrient foods that are likely contributing to obesity?

I would direct you to the producers and directors of the film for questions regarding the selection criteria for the individuals they interviewed.

I have reviewed AND’s facts about corporate sponsorship and saw that “And Now a Word from Our Sponsors” report was addressed. When the report is addressed, AND disputes that many RDNs object to corporate sponsorship, stating “The Academy annually polls a selection of members that statistically represents Academy membership as a whole. Results from these surveys, conducted since 2008… show increased awareness of the Academy’s sponsorship program and continued support by members.” Is this survey data publicly available or available to paying members of AND? If so, could you please provide the annual results of the survey, as well as all survey questions asked and methodology used.

To help guarantee the integrity of the research and the validity of the results, the Academy maintains a strict “arms-length” policy for the sponsor survey. The survey was conducted, at our request, by an independent research company. Our agreement with the company specified in advance that all responses were to be kept anonymous, and we would not have access to the raw data. For that reason, we are unable to provide you with the raw data from the sponsorship survey.

What needs to be done to maintain the credibility of AND (and dietitians):

AND needs to recognize the links between the current toxic food environment and obesity. Parents might be the “top influencer on children’s lives” but there is no doubt that that food environment (such as ads to children) do influence what people eat. Even so, if parent’s are the biggest influence, shouldn’t we make it easier for parents to make healthy decisions by promoting foods that are actually healthy instead of Captain Crunch? This is like having no regulations on alcohol, and blaming an alcoholic for drinking too much. Would you blame an alcoholic for drinking too much gin if it was sold in vending machines and at checkout lines or would you focus on changing policy to make it easier to avoid alcohol? I would say the latter, but the problem is that AND accepts funding from food corporations, so if AND was to take a similar stance, the funding would disappear. Since AND has refused to disclose how much money each individual company gives AND, therefore making it hard to know what effect this would have.

I am not the only dietitian with concerns, a group of about a dozen dietitians called Dietitians for Professional Integrity,  are also calling for a reevaluation of the role of food corporations on AND. The group started a petition asking healthcare practitioners and others  to support severing ties between big food corporations as well as AND, and got more than 25,000 supporters on Change.org. AND responded, stating that only 600 of those signatures were by its members. So it appears that the AND is not concerned at all what the public thinks of the organization, only what it’s members think. This is despite many dietitians have protested by not paying member dues. I guess even though they are practicing RDs, since they are not a member of the professional organization their voice does not matter? Anyway, how does AND know that it’s members support corporate sponsorship? An anonymous survey of course! No details on methods used, questions asked or specific rates of approval, just an anonymous survey. AND states this “guarantee[s] validity of the results.” Sure, allowing a 3rd party to do the confidential survey is a good idea, but how does not having any details of methodology or data guarantee validity?  Asking good questions is not as easy as it seems, and the unfortunate result of ineffective questions is bad data. How are we supposed to trust the data with no methodology?

This is all very concerning to me (and hopefully other RDs), so what can be done to at least start a discussion on the controversial issue?

1. Focus on AND members. Apparently AND does not care what the public or dietitians who are not members of AND think about the credibility of their organization, they only care what members think. Until this attitude changes, concerned dietitians may have to pay dues and work with other members from the inside. The Hunger and Environmental Practice Group seems to be a good place to start. HEN has an internal sponsorship committee that is trying to make change from within.

2. Concerned members should organize and request that AND require the independent research company to publish a report that is able to be viewed by all dues-paying members, and possibly the public, including methodology and results. For example: What types of questions were asked to arrive at this conclusion? How can the company ensure that the results statistically represent Academy membership?

3. If you are an AND member, consider contacting members of the AND Ethics Committee to let them know your thoughts on corporate sponsorship of AND:
Suzy Weems, Chair, AND Ethics Committee (suzy_weems@baylor.edu);
Janet Skates, CDR Representative, AND Ethics Committee (janetskates@yahoo.com);
Mary Russell; Member, AND Ethics Committee (peark02@outlook.com);
Harold Holler, Headquarters Partner, AND Ethics Committee (hholler@eatright.org);
Anna Murphy, Headquarters Partner, AND Ethics Committee (amurphy@eatright.org).

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