Nutrition in the News

Walmart plans healthier foods at lower prices

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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. (410) (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.”

References

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.

Move over potatoes, make room for healthier school lunch

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.

Read more about Harvard’s new Healthy Eating Plate.

Read more about glycemic load.

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. (49)

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.

References

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.