Coverage from U.S. News & World Report, featuring HSPH’s Walter Willett
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.
Coverage from Spices of Life, Featuring HSPH’s Lilian Cheung
The Fertility Diet: Groundbreaking Research Reveals Natural Ways to Boost Ovulation and Improve Your Chances of Getting Pregnant (McGraw-Hill), by Jorge Chavarro, M.D., Sc.D., Walter Willett, M.D., Dr.P.H., and Patrick J. Skerrett offers couples a diet and lifestyle plan that can help improve fertility, naturally—and is good for overall health, during pregnancy and beyond.
The Good-for-You Gimlet? — coverage from Newsweek.com, December 30, 2009 featuring HSPH’s Eric Rimm
Fishing for Facts — coverage from The Boston Globe, December 14, 2009 featuring HSPH’s Eric Rimm
Soy Foods Could Help Breast Cancer Survivors — coverage from USA Today, December 10, 2009 featuring HSPH’s Walter Willett
Knowing What’s Worth Paying For in Vitamins — coverage from The New York Times, December 4, 2009, featuring HSPH’s Eric Rimm
The Flu Figthers in Your Food — coverage from The Wall Street Journal, November 24, 2009 featuring HSPH’s Anuraj Shankar
Coca-Cola Deal with Family Doctors Draws Fire — and a Harvard Counteroffer — coverage from Boston.com, November 13, 2009 featuring HSPH’s Walter Willett
Teenage Obesity May Raise Risk of MS — coverage from WebMD, November 9, 2009 featuring HSPH’s Kassandra Munger
Coconut Water Takes on the World — coverage from The Financial Times, November 4, 2009 featuring HSPH’s Lilian Cheung
Can Americans Change Their Taste for the Sweet and Salty? — coverage from U.S. News and World Report.com, October 30, 2009 featuring HSPH’s Lilian Cheung.
Obesity: A Weighty Issue — coverage from CBSNews.com, October 25, 2009 featuring HSPH’s Walter Willett
Scientists Seek Origins of Obesity in the Womb — coveragae from the Associated Press, October 23, 2009 featuring HSPH’s Matthew Gillman
Good for the Oceans, Good for You — coverage from The Washington Post, October 20, 2009 featuring HSPH’s Dariush Mozaffarian
Urate Linked to Slowed Parkinson’s Disease — coverage from UPI, October 15, 2009 featuring HSPH’s Alberto Ascherio
Middle-Age Obesity Warning — video from BBC News, September 30, 2009 featuring HSPH’s Qi Sun
Mid-Life Obesity Predicts Women’s Later Health Woes — coverage from The Washington Post, September 30, 2009 featuring HSPH’s Qi Sun
Midlife Fat Could Mean Disease in Later Years — coverage from ABCnews.com, September 30, 2009 featuring HSPH’s Qi Sun
Taxing Your Sweet Tooth — video and article from NBC13.com, September 16, 2009 featuring HSPH’s Walter Willett
Most Adult Americans at Some Risk for Heart Disease — coverage from U.S. News & World Report/HealthDay, September 14, 2009 featuring HSPH’s Rob van Dam
For Your Health, Froot Loops — coverage from The New York Times, September 4, 2009 featuring HSPH’s Walter Willett
Heart Association Recommends Limits on Added Sugars — coverage from The Boston Globe, August 24, 2009 featuring HSPH’s Walter Willett
A Bittersweet Story: How Sugary Drinks Have Become the Key Target in the Battle Against Obesity — coverage from The Boston Globe, August 3, 2009 featuring HSPH’s Walter Willett
Health Officials Are Not Too Sweet on Diet Soft Drinks Either — coverage from The Boston Globe, August 3, 2009 featuring HSPH’s Walter Willett
Food 101: What’s the Skinny on Vitamin D? — coverage from Examiner.com, July 27, 2009 featuring HSPH’s Edward Giovannucci
Walter Willett: The Facts on Diet and Breast Cancer — coverage from U.S. News & World Report, July 13, 2009 featuring HSPH’s Walter Willett
Fat Hormone Reduces Risk Of Type 2 Diabetes — coverage from WCBS-TV New York, July 7, 2009 featuring HSPH’s Rob van Dam
Taxing Soda — video from MSNBC.com, June 30, 2009 featuring HSPH’s Walter Willett
Soda Tax Mulled as Senators Seek Health Overhaul Money — coverage from USA Today, June 14, 2009 featuring HSPH’s Walter Willett
Walter Willett: On Getting Off Statins – What Kinds of Diet and Lifestyle Changes Will Suffice? — coverage from U.S. News & World Report.com, June 3, 2009 featuring HSPH’s Walter Willett
Good to the Last Drop — coverage from The Boston Globe, May 11, 2009 featuring HSPH’s Rob van Dam and Alberto Ascherio
The Sugar We Drink — coverage from My SA Life (San Antonio Express News), May 11, 2009 featuring HSPH’s Walter Willett and Lilian Cheung
Web Site Raises Awareness on Sugars —coverage from The Harvard Crimson, April 24, 2009 featuring HSPH’s Walter Willett and Lilian Cheung
Harvard Nutritionists Take Aim at Sugary Drinks — coverage from The Harvard University Gazette, April 23, 2009 featuring HSPH’s Walter Willett and Lilian Cheung
Malnutrition, Obesity Present Global Food Challenges — coverage from The Harvard University Gazette, April 23, 2009 featuring HSPH’s Wafaie Fawzi
Soft Drinks and Energy Drinks: Too Sweet for Your Own Good — coverage from U.S. News and World Report.com, April 21, 2009 featuring HSPH’s Walter Willett and Lilian Cheung
AACR 2009: Diet, Nutrition, and Cancer – Don’t Trust Any Single Study — coverage from Medscape Oncology.com, April 21, 2009 featuring HSPH’s Walter Willett (free registration required to access site)
All Sugars Aren’t the Same: Glucose Is Better, Study Says — coverage from Time.com, April 21, 2009 featuring HSPH’s Walter Willett
U.S. Nutritionists Urge New, Not-as-Sweet Drinks — coverage from Reuters.com, April 20, 2009 featuring HSPH’s Walter Willett and Lilian Cheung
- coverage from Reuters China, April 22, 2009
Fish Oil Supplements, EPA, DHA, and ALA: Does Your Omega-3 Source Matter? — coverage from U.S. News & World Report, April 8, 2009 featuring HSPH’s Walter Willett
Obama Garden Watch: 10 Vegetables Worth A Fist Bump — coverage from The Huffington Post, April 6, 2009 featuring The Nutrition Source
Calorie Counters Have It Right, Diet Study Says — coverage from The Wall Street Journal.com, February 26, 2009 featuring HSPH’s Frank Sacks
It’s Not What You Eat, It’s How Much: Diet Does Not Matter as Much as Sticking to It, Study Says — coverage and video from ABC News.com, February 26, 2009 featuring HSPH’s Frank Sacks
In 4-Diet Study, All Lost Weight if They Watched Their Calories — coverage from USA Today.com, February 26, 2009 featuring HSPH’s Frank Sacks
Low-Fat? Low-Carbs? Answering Best Diet Question — coverage from CNN.com, February 26, 2009 featuring HSPH’s Frank Sacks
In Diet, It’s Calories that Count: Study Compared Range of Menus — coverage from The Boston Globe, February 26, 2009 featuring HSPH’s Frank Sacks
Study Zeroes In on Calories, Not Diet, for Loss — coverage from The New York Times, February 25, 2009 featuring HSPH’s Frank Sacks
Diets That Reduce Calories Lead to Weight Loss, Regardless of Carbohydrate, Protein or Fat Content — press release of February 25, 2009 featuring HSPH’s Frank Sacks.
Good Carbs, Bad Carbs, Which Is Which? Not All Carbohydrates Are Created Equal — coverage from U.S. News & World Report, February 19, 2009 featuring HSPH’s Walter Willett
Does Eating Broccoli Help Prevent Cancer? — coverage from The Boston Globe, February 2, 2009 featuring HSPH’s Walter Willett
AHA Champions Omega-6 PUFAs to Counter Popular Nutrition Advice — coverage from TheHeart.org, January 28, 2009 featuring HSPH’s Dariush Mozaffarian.
The Fallacy of Total Fat; Doing Away With All Fat, Even Unsaturated Fat, Can Be Harmful — coverage from U.S. News & World Report, January 26, 2009 featuring HSPH’s Walter Willett
Dietary Changes Come Hard; It’s Easier When Food Manufacturer’s Do the Work — coverage from U.S. News & World Report, January 26, 2009 featuring HSPH’s Walter Willett
Nine Nutrition Essentials for 2009 — coverage from Cooking Light magazine, January 14, 2009 featuring HSPH’s Walter Willett
The Expert: Dr. Rob van Dam
Assistant Professor in the Department of Nutrition, Harvard School of Public Health
- Drinking up to six cups a day of coffee is not associated with increased risk of death from any cause, or death from cancer or cardiovascular disease.
- Some people may still want to consider avoiding coffee or switching to decaf, especially women who are pregnant,or people who have a hard time controlling their blood pressure or blood sugar.
- It’s best to brew coffee with a paper filter,to remove a substance that causes increases in LDL cholesterol.
- Coffee may have potential health benefits, but more research needs to be done.
- Read more about coffee and tea compared to other beverages.
Is Red Meat’s Bad Name Justified? — coverage from the Los Angeles Times, November 10, 2008 featuring HSPH’s Walter Willett
More Than Pickles and Ice Cream: The Link Between Diet and Fertility — coverage and podcast from Scientific American, October 15, 2008 featuring HSPH’s Walter Willett
Caffeine, Breast Cancer Link Minimal — coverage from WebMD.com, October 13, 2008 featuring HSPH’s Walter Willett
Hormone Discovery May Help Combat Diabetes — coverage from Reuters UK, September 18, 2008 featuring HSPH’s Gökhan Hotamisligil
Fat Molecule Fights Weight Gain — coverage from ScienceNOW Daily News, September 18, 2008 featuring HSPH’s Gökhan Hotamisligil
Following a Combination of Healthy Lifestyle Factors May Sharply Reduce Risk of Premature Death — press release of September 17, 2008 featuring HSPH’s Rob van Dam
Lifestyle Key to a Longer Life — coverage from The Press Association, September 16, 2008 featuring HSPH’s Rob van Dam
Processed Meats and Your Kids — coverage and video from KSFY TV news, September 9, 2008 featuring HSPH’s Walter Willett
Hard to Swallow — coverage from The Baltimore Sun, September 8, 2008 featuring HSPH’s Meir Stampfer
Fish Oil Supplements Help With Heart Failure — coverage from U.S. News & World Report, August 31, 2008 featuring HSPH’s Dariush Mozaffarian.
New Attack Ad on TV, But This One Targets Hot Dogs — coverage from The Associated Press, August 26, 2008 featuring HSPH’s Lilian Cheung
New Dunkin’ Donuts Menu Runs on Salt, Lacks Fiber — coverage from The Boston Herald, July 31, 2008 featuring HSPH’s Walter Willett
Soya-Based Foods May Harm Male Fertility, Say Scientists — coverage from The Guardian, July 24, 2008 featuring HSPH’s Jorge Chavarro
Best Diet: Low-Fat, Low-Carb or Mediterranean? — coverage from ABC News, July 16, 2008 featuring HSPH’s Meir Stampfer
Which Are Worse: Calories from Carbs or Fat? — coverage from Time, July 15, 2008 featuring HSPH’s Walter Willett
Babies Gain More Weight in Day Care — coverage from Time, July 8, 2008 featuring HSPH’s Karen Peterson
Omega-3, Some Omega-6 Fatty Acids Boost Cardiovascular Health — coverage from HealthDay.com, July 7, 2008 featuring HSPH’s Hannia Campos
So Many Vitamins, So Little Time: Truths and Myths About Dietary Supplements — coverage and video from ABC News 20/20, July 4, 2008 featuring HSPH’s Eric Rimm
Move Over Food Pyramid, There’s A New Guide — video from New England Cable News, June 12, 2008 featuring HSPH’s Lilian Cheung
Vitamins Improve Tuberculosis Treatment — coverage from Reuters UK, June 12, 2008 featuring HSPH’s Eduardo Villamor
Study Links Sunshine Vitamin, Heart Health — coverage from CBS News, June 9, 2008 featuring HSPH’s Edward Giovannucci
Metabolic Syndrome Not a Good Predictor of Death — coverage from Reuters, May 20, 2008 featuring HSPH’s Dariush Mozaffarian
You Name It and Exercise Helps It — coverage from The New York Times, April 29, 2008 featuring HSPH’s Frank Hu
State Ban on Trans Fat Would Set a National Example — op ed piece from the Metrowest Daily News, April 26, 2008 by HSPH’s Walter Willett and Massachusetts State Rep. Peter Koutoujian
High Levels of Urate Could Slow Parkinson’s — coverage from USA TODAY, April 14, 2008 featuring HSPH’s Alberto Ascherio
Less Sleep, More TV Leads To Overweight Infants And Toddlers — coverage from Science Daily, April 7, 2008 featuring HSPH’s Matthew Gillman
Some Scientists Questioning Folic Acid Fortification — coverage from Baltimore Sun, January 30, 2008 featuring HSPH’s Walter Willett
New Drugs and Hopes For an MS Vaccine — coverage from The Philadelphia Inquirer, December 22, 2007 featuring HSPH’s Alberto Ascherio
Coffee, Pregnancy and Premenstrual Syndrome — coverage from The Times, January 28, 2008 featuring HSPH’s Alberto Ascherio.
Study Shows Caffeine Elevates Blood Glucose Levels in People With Diabetes — coverage from CBS News, January 29, 2008 featuring HSPH’s Rob van Dam
Caffeine Could Spell Trouble For Diabetics — coverage from U.S. News and World Report, January 28, 2008 featuring HSPH’s Rob van Dam
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.
1. Flegal KM, Graubard BI, Williamson DF, Gail MH. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA. 2007; 298:2028–37.
2. Greenberg JA. Correcting biases in estimates of mortality attributable to obesity. Obesity (Silver Spring). 2006; 14:2071–79.
3. Garfinkel L. Overweight and mortality. Cancer. 1986; 58:1826–29.
4. Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW, Jr. Body mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999; 341:1097–105.
5. Manson JE, Willett WC, Stampfer MJ, et al. Body weight and mortality among women. N Engl J Med. 1995; 333:677–85.
6. Adams KF, Schatzkin A, Harris TB, et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 2006; 355:763–78.
7. Alley DE, Chang VW. The changing relationship of obesity and disability, 1988–2004. JAMA. 2007; 298:2020–27.