Coverage from The Boston Globe Magazine, featuring HSPH’s Walter Willett
Congress Scraps Limits on French Fries, Keeps Pizza a Vegetable
No one would mistake French fries and pizza for a healthy meal. Yet Congress has overturned a plan that would limit French fries in school lunch. And it’s scrapped or stalled other healthy menu changes that would boost vegetables and lower salt.
The final version of an agricultural spending bill, passed by Congress and signed into law in late November 2011, has watered down a comprehensive U.S. Department of Agriculture (USDA) proposal for improving school lunches. The USDA’s original plan was based on sound science and could have helped turn around this country’s obesity and diabetes epidemics. But the guidelines came under fire from food industry lobbyists, among them, potato growers, frozen pizza makers that supply schools, and the salt industry.
The USDA’s proposal would have capped the amount of potatoes and starchy vegetables that school lunches could serve at one cup per week—the equivalent of a medium baked potato—and promoted a wider variety of vegetables, especially dark green and orange varieties, such as broccoli, spinach, and carrots. (1) It would have also changed the serving size for tomato paste, bumping it up from 2 tablespoons to ½ cup—a change that meant a pizza slice, with its dab of tomato paste, could no longer count towards the school lunch vegetable requirement. The changes were part of a long-awaited overhaul of the nutrition standards in U.S. school meal programs, based on recommendations from an expert panel at the Institute of Medicine (IOM). (2)
Congress’ new wording in the funding bill scrapped the weekly limit on starchy vegetables. It also spelled out that the USDA must stick with the status quo on tomato products, meaning that the tomato paste on a pizza slice can still count as a vegetable.
These changes have been met with harsh criticism from nutrition and public health advocates, and with good reason: Potatoes, which are high in fast-digested carbohydrate, seem to be a particular culprit for weight gain and diabetes. (3, 4) Children eat plenty of potatoes but don’t eat enough dark green and orange vegetables. (2) Continuing to allow unlimited potatoes and pizza sauce to count as vegetables won’t do much to achieve the IOM’s goal of boosting children’s vegetable intake, and ultimately, improving their health.
In addition to backpedaling on potatoes and pizza, Congress put the brakes on planned sodium reductions in school lunch, “until the [USDA] Secretary certifies that the Department has reviewed and evaluated relevant scientific studies and data relevant to the relationship of sodium reductions to human health.” Yet this hesitancy does not make scientific sense: More than 90 percent of school children already get more than recommended amounts of sodium each day. (2) Though the salt industry lobbies mightily to the contrary, there’s ample evidence that high sodium intakes contribute to high blood pressure, even in children and teens, (5) and to heart disease in adults, and that curbing sodium lowers cardiovascular disease and death rates over the long term.
Congress also pushed back on the USDA’s plan to require more whole grains, saying that the USDA needs to define what whole grains are before it can issue such a requirement.
In a statement to the Associated Press, a USDA spokeswoman, Courtney Rowe, said the agency will still work to improve the nutritional quality of school lunch: “While it’s unfortunate that some members of Congress continue to put special interests ahead of the health of America’s children, USDA remains committed to practical, science-based standards for school meals.”
1.U.S. Department of Agriculture. Nutrition Standards in the National School Lunch and School Breakfast Programs: A Proposed Rule by the Food and Nutrition Service on 01/13/2011. Federal Register. 2011;76:2494–2570.
2. Institute of Medicine. School Meals: Building Blocks for Healthy Children. Washington, D.C.: National Academies Press; 2009.
3. Halton TL, Willett WC, Liu S, Manson JE, Stampfer MJ, Hu FB. Potato and french fry consumption and risk of type 2 diabetes in women. Am J Clin Nutr. 2006;83:284-90.
4. Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med. 2011;364:2392-404.
5. He FJ, Marrero NM, MacGregor GA. Salt and blood pressure in children and adolescents. J Hum Hypertens. 2008; 22:4–11.
Here’s yet another reason why you should eat more fruits and vegetables and cut back on processed foods: A large new study finds that people who eat high sodium, low potassium diets have a higher risk of dying from a heart attack or from any cause. The study, which appears in the July 11, 2011 issue of Archives of Internal Medicine, (1) bolsters the already-substantial evidence that high salt diets have negative effects on health. (2-4) And it highlights a key dietary change people can make to lower their risk: Eat more fresh vegetables and fruits, which are naturally high in potassium and low in sodium—and eat less bread, cheese, and processed meat, since these and other processed foods are high in sodium and low in potassium.
“Much confusion was caused by a recent, widely quoted report concluding that lower salt intakes were associated with higher risk of cardiovascular disease,” says Dr. Walter Willett, chair of the Dept. of Nutrition at Harvard School of Public Health. “This new study is much larger and controlled for key factors that were ignored in the previous report.”
Sodium and potassium have opposite effects on heart health: High salt intakes increase blood pressure, ultimately leading to heart disease; high potassium intakes can help relax blood vessels and decrease blood pressure. Our bodies need far more potassium each day than sodium, and most Americans should limit their sodium intake to 1,500 milligrams per day, the amount in about two-thirds of a teaspoon of table salt. (5) But the typical US diet—heavy on the processed foods, light on the produce—is just the opposite: Americans average about 3,300 milligrams of sodium per day, about 75 percent of which comes from processed foods, while only getting about 2,900 milligrams of potassium each day. (3,6)
The newest study, which is based on diet reports from participants in the National Health and Nutrition Examination Survey, followed just over 12,000 men and women for an average of 15 years. Sodium intakes averaged about 4,300 milligrams per day in men and 2,900 milligrams a day in women.(1) Potassium intakes averaged a good bit lower (3,400 milligrams and 2,400 milligrams), and substantially lower than the 4,700 milligrams per day that the US government recommends. (7)
People with the highest sodium intakes had a 20 percent higher risk of death from any cause than people with the lowest sodium intakes. People with the highest potassium intakes had a 20 percent lower risk of dying than people with the lowest intakes. But what may be even more important for health is the relationship of sodium to potassium in the diet: People with the highest ratio of sodium to potassium in their diets had double the risk of dying of a heart attack than people with the lowest ratio, and they had a 50 percent higher risk of death from any cause. (1)
Given that processed foods are responsible for much of people’s sodium intake in the US and Europe, governments have started working with the food industry to lower sodium levels. Finland and the United Kingdom have led successful sodium reduction efforts, (8) and in the US, the Institute of Medicine has recommended that the Food and Drug Administration regulate the amount of salt in commercially prepared food—a recommendation that’s likely to receive pushback from the salt industry, which continues to argue that salt has little influence on blood pressure. (9) Encouragingly, some manufacturers have voluntarily agreed to cut back on sodium by 20 percent over the next five years, as part of New York City’s National Salt Reduction Initiative. (10) Walmart has also pledged to cut back on sodium and decrease the prices of fresh produce in its stores. It remains to be seen whether the food industry will be able to deliver on these pledges. (Campbell Soup reportedly announced in early July 2011 that it was raising the salt levels in some of its soups, blaming its previous salt reduction efforts—and the resulting changes in product taste—for sagging sales.
It could take a decade for any US regulatory changes to take effect. In the meantime, there are steps that consumers can take to curb sodium intake and boost potassium.
1. Yang Q, Liu T, Kuklina EV, et al. Sodium and Potassium Intake and Mortality Among US Adults: Prospective Data From the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2011;171:1183–91.
2. Strazzullo P, D’Elia L, Kandala NB, Cappuccio FP. Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies. BMJ. 2009;339:b4567.
3. Brown IJ, Tzoulaki I, Candeias V, Elliott P. Salt intakes around the world: implications for public health. Int J Epidemiol. 2009;38:791–813.
4. World Cancer Research Fund, American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective. London; 2007.
5. Application of lower sodium intake recommendations to adults—United States, 1999–2006. MMWR Morb Mortal Wkly Rep. 2009;58:281–3.
6. Dietary Guidelines for Americans Scientific Advisory Committee. 2010. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, to the Secretary of Agriculture and the Secretary of Health and Human Service.
7. Institute of Medicine. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate. Washington, D.C.: National Academies Press; 2005.
8. He FJ, MacGregor GA. A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens. 2009;23:363–84.
9. Institute of Medicine. Strategies to Reduce Sodium Intake. Washington, D.C.: National Academies Press; 2010.
10. National Salt Reduction Initiative – Statement of Commitment by Health Organizations and Public Agencies. 2011.
Walmart, the largest retailer in the U.S., has pledged to cut the trans fat, salt, and sugar from thousands of its grocery products by 2015 in the U.S.—and to cut prices on produce and other healthy foods.
Unveiling the company’s plans at an event with First Lady Michelle Obama on January 20, 2011, Walmart executives said they would work with suppliers to
- remove all of the remaining industrial trans fats from its grocery products, including the small amounts that fall beneath the FDA food labeling threshold;
- cut back on sodium by 25 percent in foods that are often hidden sources of sodium, including bread and baked goods, lunch meats and fresh meats, cheese, condiments, chips, soups, and boxed and frozen meals; and
- cut back on added sugar by 10 percent in foods that consumers often don’t realize are high in added sugar—such as breakfast cereals and snack bars, pancakes and waffles, flavored milk and yogurt, condiments and sauces, and fruit drinks; it will not, however, change the added sugar content of sugary treats or sugar-sweetened soft drinks.
The changes reportedly will apply to Walmart’s house-branded products, and Walmart executives say they will encourage other product suppliers to follow suit.
In addition to making its grocery foods healthier, Walmart is trying to make healthy foods more affordable. Executives say they will cut prices on fresh fruits and vegetables and “better-for-you” packaged food items, such as whole grain pastas and reduced sodium meals, so that the healthy foods are no pricier than their less-healthful counterparts. And they announced their intention to open stores in “food deserts”—neighborhoods, often urban, that don’t currently have easy access to affordable, fresh healthy foods.
These changes will take time and effort. To cut prices on produce, Walmart will need to increase its local sourcing of fruits and vegetables and wring unnecessary costs out of its supply chain. To achieve its other nutrition goals, Walmart’s suppliers will have to stealthily reformulate their products to cut back on salt and sugar without sacrificing taste.
Given Walmart’s size—its 4,300 Walmart and Sam’s Club stores draw more than 140 million U.S. customers per week—and its clout in the food and grocery industry, the planned changes promise to have a major impact on foods sold at other grocery stores across the country.
“This new initiative has the potential to transform the marketplace and help Americans put healthier foods on their table every day,” said Mrs. Obama, speaking at the Walmart announcement. The First Lady has spearheaded the “Let’s Move!” initiative, which is working to curb U.S. childhood obesity rates, and Let’s Move! staff worked with Walmart on the development of its plan. Reportedly, this is the first time that the First Lady has given this type of support to a single company’s nutrition efforts.
The announcement represents an important victory for public health activists who have been working for more than a decade to eliminate heart-harmful trans fats from the food supply, and who have been intensifying efforts to curb added sodium.
Most Americans get the majority of their daily sodium, on the order of 75 percent, from processed and prepared foods, many of which don’t even taste salty. (1) High sodium diets increase the risk of high blood pressure, heart disease, and stroke, and it’s been estimated that curbing Americans’ excessive sodium intakes—on average, 3,400 milligrams per day, more than double what’s recommended for most adults—could save billions of healthcare dollars and upwards of 90,000 lives annually. (2, 3)
Still, there are some who think that Walmart could have gone farther with its planned changes. Walmart’s initiative does not address the biggest source of added sugar in Americans’ diets—the billions of gallons of sugar-sweetened soft drinks that Americans consume each year and that contribute mightily to the obesity and diabetes epidemics. (4–10) (The rationale for not addressing sugary soft drinks, according to Walmart executives: Consumers can already choose sugar-free beverages from Walmart’s shelves.)
Similarly, a 25 percent sodium reduction may sound like a lot, but other food producers have already begun reducing sodium by similar amounts. Walmart could have made a bigger impact by adopting stricter food category-specific sodium thresholds, similar to what has been proposed in New York City.
Walmart executives positioned this as a customer-driven initiative, saying that customers have been asking for healthy foods that are more affordable—and asking for help identifying healthy options. So Walmart also plans to create front-of-package nutrition labels that make it easier for consumers to spot healthy foods. Front-of-package nutrition labels have been a source of consumer confusion, and the focus of government attention, with an independent Institute of Medicine Panel working to propose standards that companies must follow. Walmart said that its labeling would complement, rather than compete with, industry efforts.
“Even though some of us had hoped that Walmart might go a bit farther, this is a very important step in the right direction,” says Dr. Walter Willett, Fredrick John Stare Professor of Epidemiology and Nutrition and chair of the Department of Nutrition at Harvard School of Public Health. “Very importantly, Walmart promises to remove the price difference between healthier and regular versions of the same food, which will be hugely beneficial for those with low incomes, who are often forced to purchase products they know are not good for the well being of their families. We hope that other grocery stores will follow this lead, and go even further in helping Americans have better lives.”
1. Brown IJ, Tzoulaki I, Candeias V, Elliott P. Salt intakes around the world: implications for public health. Int J Epidemiol. 2009; 38:791-813.
2. Palar K, Sturm R. Potential societal savings from reduced sodium consumption in the U.S. adult population. Am J Health Promot 2009; 24:49-57.
3. Bibbins-Domingo K, Chertow GM, Coxson PG, et al. Projected effect of dietary salt reductions on future cardiovascular disease. N Engl J Med. 2010; 362:590-9.
4. Beverage Digest. Beverage Digest Fact Book 2008: Statistical Yearbook of Non-Alcoholic Beverages. Bedford Hills, New York, 2008.
5. Bleich SN, Wang YC, Wang Y, Gortmaker SL. Increasing consumption of sugar-sweetened beverages among US adults: 1988-1994 to 1999-2004. American Journal of Clinical Nutrition. 2009; 89:372-81.
6. Wang YC, Bleich SN, Gortmaker SL. Increasing caloric contribution from sugar-sweetened beverages and 100% fruit juices among US children and adolescents, 1988-2004. Pediatrics. 2008; 121:e1604-14.
7. Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ, Willett WC, Hu FB. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. Journal of the American Medical Association. 2004; 292:927-934.
8. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. American Journal of Clinical Nutrition. 2006; 84:274-288.
9. Malik VS, Willett WC, Hu FB. Sugar-sweetened beverages and BMI in children and adolescents: reanalyses of a meta-analysis. American Journal of Clinical Nutrition. 2009; 89:438-9; author reply 439-40.
10. Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. American Journal of Public Health. 2007; 97:667-675.
The U.S. Department of Agriculture (USDA) has come under fire from politicians and potato lobbyists over its proposal to cut back on French fries and potatoes in school lunch and offer broccoli and other vegetables instead. Yet its plan is based on sound science—and could help turn around this country’s obesity and diabetes epidemics.
The USDA’s proposal is a straightforward switch: Cap the amount of potatoes and other starchy vegetables that school lunch can serve at one cup per week—the equivalent of a medium baked potato—and promote a wider variety of vegetables, especially dark green and orange varieties, such as broccoli, spinach, and carrots. (1) The recommendation is part of a 76-page proposed overhaul of the nutrition standards in U.S. school meal programs, and the agency is on solid scientific footing: It’s following the recommendations from an expert panel at the Institute of Medicine (IOM), which spent a year reviewing research on children’s nutrient needs, as well as food choices that prevent obesity and chronic disease. (2)
Read more about the health benefits of vegetables and fruits.
U.S. children, on average, only eat about 40 percent of the government’s daily recommended vegetable intake—and 29 percent of that comes from potatoes, most of them fried. (2) Children are especially low in their intake of dark green vegetables, orange vegetables, and legumes (dried beans), getting less than 20 percent of the recommended intake.
By limiting starchy vegetables at lunch, and setting new requirements for dark green and orange vegetables, the IOM was trying to steer children’s diets in a healthier direction: “The committee anticipates that…with repeated exposures and high-quality food preparation, students will learn to value the vegetable items offered.” (2, p. 170) In other words, over time, kids will get used to eating broccoli, carrots, and other colorful vegetables—and may even start to like them.
Potatoes don’t count as a vegetable on Harvard’s new Healthy Eating Plate, and with good reason: They are very high in carbohydrate—in particular, the kind of carbohydrate that the body digests rapidly, causing blood sugar and insulin to surge and then dip. (The scientific term for this is that they have a high glycemic load.) In the short term, this roller coaster-like effect on blood sugar and insulin can lead people to feel hungry again, soon after eating—and this, in turn, can lead to overeating. (3) Over the long term, diets high in potatoes and similarly rapidly-digested, high carbohydrate foods can contribute to obesity, diabetes, and heart disease. (4–9)
Potatoes do contain important nutrients—vitamin C, potassium, and vitamin B6, to name a few. But the potato is not the only source of these nutrients, nor is it the best: Cup for cup, for example, broccoli has nearly nine times as much vitamin C as a potato, and white beans have about double the potassium. Yet a cup of potatoes has a similar effect on blood sugar as a can of Coca Cola or a handful of jelly beans. (10) That’s a high metabolic price to pay for nutrients that children can easily get from other sources.
Potatoes seem to be a particular culprit for weight gain and diabetes. A recent study from Harvard School of Public Health that tracked the diet and lifestyle habits of 120,000 men and women for up to 20 years looked at how small food-choice changes contributed to weight gain over time. People who increased their consumption of French fries and baked or mashed potatoes gained more weight over time—an extra 3.4 and 1.3 pounds every four years, respectively. (6) People who decreased their intake of these foods gained less weight, as did people who increased their intake of other vegetables. A similar long-term study found that high potato and French fry intakes were linked to a greater risk of diabetes in women, and that replacing potatoes with whole grains could lower diabetes risk. (5)
For people who are lean and active, potatoes likely don’t exact such a severe metabolic toll. But one out of three children and two out of three adults in the U.S. are overweight or obese, and many do not get enough daily physical activity. That’s all the more reason to use potatoes sparingly in our meals, if at all.
“Eating more than two servings of potatoes a week may be okay for people who dig their own,” says Walter Willett, Professor of Epidemiology and Nutrition and chair of the Department of Nutrition at HSPH. “But today, few Americans get the amount of physical activity our ancestors did 80 years ago, and that means our metabolism responds poorly to high amounts of starch.”
Some politicians and potato lobbyists have raised concerns that replacing potatoes with a wider variety of vegetables would add $6.8 billion to the cost of school lunches over the next five years. (11) But that appears to be a short-sighted point of view: Obesity costs this country an estimated $152 billion a year in healthcare expenses, and those could rise to an estimated $319 billion by 2020. (12) That makes the cost of this school lunch upgrade seem like just a drop in the potato bucket.
1.U.S. Department of Agriculture. Nutrition Standards in the National School Lunch and School Breakfast Programs: A Proposed Rule by the Food and Nutrition Service on 01/13/2011. Federal Register. 2011;76:2494–2570.
2. Institute of Medicine. School Meals: Building Blocks for Healthy Children. Washington, D.C.: National Academies Press; 2009.
3. Abete I, Astrup A, Martinez JA, Thorsdottir I, Zulet MA. Obesity and the metabolic syndrome: role of different dietary macronutrient distribution patterns and specific nutritional components on weight loss and maintenance. Nutr Rev. 2010;68:214-31.
4. Halton TL, Willett WC, Liu S, et al. Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med. 2006;355:1991-2002.
5. Halton TL, Willett WC, Liu S, Manson JE, Stampfer MJ, Hu FB. Potato and french fry consumption and risk of type 2 diabetes in women. Am J Clin Nutr. 2006;83:284-90.
6. Mozaffarian D, Hao T, Rimm EB, Willett WC, Hu FB. Changes in diet and lifestyle and long-term weight gain in women and men. N Engl J Med. 2011;364:2392-404.
7. Barclay AW, Petocz P, McMillan-Price J, et al. Glycemic index, glycemic load, and chronic disease risk–a meta-analysis of observational studies. Am J Clin Nutr. 2008;87:627-37.
8. Beulens JW, de Bruijne LM, Stolk RP, et al. High dietary glycemic load and glycemic index increase risk of cardiovascular disease among middle-aged women: a population-based follow-up study. J Am Coll Cardiol. 2007;50:14-21.
9. Chiu CJ, Liu S, Willett WC, et al. Informing food choices and health outcomes by use of the dietary glycemic index. Nutr Rev. 2011;69:231-42.
10. The University of Sydney. Glycemic Index Database. Accessed October 8, 2011.
11. Huang, J. USDA wants to limit potatoes in school lunches. National Public Radio. October 5, 2011.
12. Dor AF, Langwith C, Tan E. A heavy burden: The individual costs of being overweight and obese in the United States. The George Washington University School of Public Health and Health Services Department of Health Policy, 2010.
When rushing through the supermarket, who has time to pore over Nutrition Facts labels and compare ingredient lists?
That’s why more than a dozen rating systems have been established to help shoppers identify healthful products. (1) Some, like the Guiding Stars program in Hannaford supermarkets, put rating information on food shelf tags below various products. (2) Others, like the controversial (and now on-hold) Smart Choices Program, put jazzy labels on the front of packages. (3) The problem with these programs is that they use varied, and sometimes dubious, rating systems.
Take Smart Choices as an example. Started by the country’s top food companies (ConAgra, Kellogg’s, Kraft Foods, Pepsico, Unilever, and others), the program gave its seal of approval to foods that meet certain standards. Products could not exceed defined thresholds for fats (saturated, trans, total), sodium, cholesterol and added sugars, and were required to include calcium, fiber, or certain vitamins. (4) Under these guidelines, Apple Jacks, Cocoa Krispies, Cocoa Puffs, Corn Pops, Froot Loops, and Keebler Cookie Crunch—which all have 12 grams of sugar—got the same Smart Choices check mark as Cheerios (which has 1 gram of sugar).
“In principle, the Smart Choices seal could have been very useful for identifying foods that meet a high nutritional standard,” says Dr. Walter C. Willett, chair of the Harvard School of Public Heath Department of Nutrition. “However, the program’s standard was so low that even horrendous junk foods could qualify.”
The U.S. Food and Drug Administration (FDA) put the Smart Choices program on notice in August 2009 with a letter that it would be concerned if any front-of-package labeling system “used criteria that were not stringent enough to protect consumers against misleading claims; were inconsistent with the Dietary Guidelines for Americans; or had the effect of encouraging consumers to choose highly processed foods and refined grains instead of fruits, vegetables, and whole grains.” (5)
In late October 2009, the FDA announced it was establishing an independent panel to propose standards that companies must follow if they want to put nutrition guides or labels on the front of packages. (6) Soon after that, Smart Choices announced that it would “voluntarily postpone active operations and not encourage wider use of the logo,” (7) and news reports say that the program’s key founding companies have agreed to phase out the logo from their products. (8–10)
Until the FDA’s proposed standards come along, it’s a good idea to make your own smart choices by reading Nutrition Facts labels and ingredient lists instead of relying on those that may be as interested in a company’s health as yours.
1. Nutrition rating systems: a comparison. Fooducate Blog. Last updated September 2009. Accessed November 2, 2009.
2. Hannaford Bros. What is Guiding Stars? Hannaford.com. Accessed November 2, 2009.
3. Smart Choices Program. Guiding food choices. SmartChoicesProgram.com. Accessed November 2, 2009.
4. Smart Choices Program. Which foods get into the Smart Choices Program? SmartChoicesProgram.com. Accessed November 2, 2009.
7. Smart Choices Program. Press release: Smart Choices Program postpones active operations. SmartChoicesProgram.com. Last updated October 23, 2009. Accessed November 2, 2009.
8. Neumann W. Food label program to suspend operations. The New York Times: October 24, 2009, B1
9. Kraft Foods chooses to phase out ‘Smart Choices’ label. ChicagoTribune.com. Last updated October 29, 2009. Accessed November 2, 2009.
10. Eight food manufacturers agree to drop Smart Choices logo. LegalNewsLine.com. Last updated October 29, 2009. Accessed November 2, 2009.
Adding a penny per ounce tax to sugar-sweetened beverages could slow the growth of obesity in the U.S.—and could raise billions of dollars for obesity prevention and other health programs, according to a new analysis by seven public health experts in The New England Journal of Medicine.(1)
Overweight-and obesity-related medical costs in the U.S. total an estimated $147 billion a year—nearly 10 percent of all health care spending—and sugary drinks are a major contributor to the nation’s obesity epidemic. (2-4)
A penny-per-ounce excise tax would likely spur consumers to cut their sugary drink calorie consumption, potentially by 8 to 10 percent—enough to promote weight loss and lower the risk of sugary drink-related chronic diseases—and could raise nearly $15 billion per year, the authors write. Levying an excise tax directly on beverage manufacturers—rather than a sales tax on consumers—would likely be the most efficient way to collect the tax and lead to the greatest effect on consumption because consumers would see this as a higher price. A tax on the sugar content of beverages would also give manufacturers an incentive to cut down the sugar content of drinks.
How much money could a tax on sugary drinks raise in your state? Try the soda tax revenue calculator at the Rudd Center for Food Policy and Obesity website.
Find out how much sugar is in soft drinks, iced tea, sports drink, juices, and other beverages.
1. Brownell KD, Farley T,Willett WC, Popkin BM, Chaloupka FJ, Thompson JW, Ludwig DS. The public healthand economic benefits of taxing sugar-sweetened beverages. The New England Journal of Medicine. 2009.
2. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Affairs (Millwood). 2009; July 29 (Epub ahead of print).
3. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: asystematic review. American Journal of Clinical Nutrition. 2006; 84:274-288.
4. Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. American Journal of Public Health. 2007; 97:667-675.
A Closer Look at Obesity, Health Risks, and Mortality
Writing in the November 7, 2007, Journal of the American Medical Association, federal researchers concluded that being overweight isn’t associated with the chances of dying from heart disease or cancer. (1) Even more surprisingly, they found that overweight may be associated with lower risks of dying from emphysema, infections, injuries, Alzheimer’s disease, and a potpourri of other diseases not related to cardiovascular disease or cancer. Obesity was associated with excess deaths from cardiovascular disease, diabetes, and kidney disease, but not cancer. With nearly two-thirds of Americans considered as being overweight, studies like this one seem to offer reassurance that carrying extra pounds isn’t so bad.
There’s just one small problem with this study: Its conclusions are almost certain to be wrong. Serious flaws with the study led to an underestimation of the impact of obesity; furthermore, its findings are inconsistent with many other larger studies conducted over the past 20 years.
The researchers, from the Centers for Disease Control and Prevention (CDC), derived estimates for the risk of dying from various diseases using three National Health and Nutrition Examination Surveys (NHANES) of about 37,000 Americans conducted between 1971 and 1975, 1976 and 1980, and 1988 and 1994. They then applied these estimates to deaths recorded in the United States in 2004, the last year for which full data are available, to come up with a determination of the number of deaths associated with being underweight, overweight, or obese, all compared with normal weight. (1) These categories refer to various ranges of body mass index (BMI), a measure that combines weight and height. Normal weight corresponds to a BMI between 18.5 and 24.9. Underweight is a BMI below 18.5, overweight is between 25.0 and 29.9, obesity is 30 to 34.9, and severe obesity is over 35.
In these analyses, being underweight wasn’t associated with the chances of dying from cardiovascular disease or cancer, but was associated with an increased risk of dying from other causes. Being overweight was not associated with the risk of dying from cardiovascular disease or cancer, but was associated with an increased risk of dying from diabetes or kidney disease and a reduced risk of dying from other causes. Obesity was associated with an increased risk of dying from cardiovascular disease, but not cancer or other causes.
The biggest flaw in this report is that the NHANES studies are simply too small to account for biases that often pose problems in studies of deaths and causes of death. One is reverse causation—low body weight often results from chronic disease, rather than being a cause of chronic disease. People with BMIs below 25 are a mix of healthy individuals and those who have lost weight due to a disease that may or may not have been diagnosed. The other is smoking—leaner people are more likely to smoke than their heavier counterparts. When reverse causation and the adverse effects of smoking aren’t fully accounted for, death rates among lean individuals will be inflated and those among overweight and obese individuals will be diminished. A careful critique of using the NHANES data to estimate mortality demonstrated that adequately “correcting for statistical biases and using higher ideal-weight categories increased the estimate of excess deaths attributable to obesity by approximately 400 percent and changed the negative estimate for overweight to a large positive estimate.” (2)
The CDC study isn’t even news. Findings from larger studies that have better accounted for reverse causation and smoking clearly show that increasing weight increases the risks of dying from cardiovascular disease, cancer, and other causes. More than 20 years ago, a study published by the American Cancer Society that included a million men and women documented the impact of excess weight on dying from cancer after accounting for smoking. (3) In 1999, researchers following a different million-person cohort for 14 years restricted their analyses to initially healthy nonsmokers. The risk of death from all causes, cardiovascular disease, cancer, or other diseases increased as BMI increased above the healthiest range of 23.5 to 24.9 in men and 22.0 to 23.4 in women. (4) A similar association between weight and mortality was observed in the Nurses’ Health Study (5) and a prospective study of more than 500,000 older men and women in a National Institutes of Health/AARP study. (6)
Interestingly, another report in the same issue of the Journal of the American Medical Association demonstrated that obesity is increasing the disabilities among older people, interfering with the ability to do simple, everyday activities such as climb the stairs, bend over, lift a bag of groceries, or walk around the block. (7)
The CDC study notwithstanding, the overwhelming weight of the evidence suggests that one way to stay healthy and live longer is to do what you can to keep your weight in the healthy range, and especially to minimize any upward creep in your weight or waistline during adulthood.
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