Dietary guidelines and health

[An excerpt from Chapter 8 in Food Policy in the United States: An Introduction (Routledge/Earthscan, 2013).]

It is sometimes said that there is no need for a government role in dietary guidance, because people know how to eat well and simply lack the willpower to do so. Is it true that people in the United States already know how to eat healthfully? While many nutrition and health experts say that something is wrong with U.S. eating patterns, they disagree about what is unhealthy.

Consider four perspectives, which each have a large public following:

• A long tradition, including the physician Robert Atkins and the science writer Gary Taubes, blames carbohydrates for weight problems and recommends a diet that may be high in meat and saturated fat (Taubes, 2007).
• An equally well-developed tradition encourages a low-fat plant-based diet and blames meat consumption for health problems (Campbell and Campbell, 2007).
• The respected epidemiologist Walter Willett and colleagues at the Harvard School of Public Health advise a mostly plant-based diet that is not necessarily low in fat, allowing plenty of vegetable oils (Willett et al., 2005).
• Others, including former FDA Commissioner David Kessler and journalist Michael Pollan, are most concerned about the highly palatable artificial creations of an industrial food system (Kessler, 2009). 

These views about diet and health are partly overlapping and partly contradictory. Yet at least some scientific research in peer-reviewed journals can be found to support each one. To make sound judgments, a layperson needs a skeptical attitude towards dietary fads and a trustworthy summary of the balance of the scientific evidence.

One influential summary of the scientific evidence is the federal government’s Dietary Guidelines for Americans (U.S. Department of Agriculture and U.S. Department of Health and Human Services, 2011). The federal government issued the first Dietary Guidelines in 1980 and has revised the document every five years since then. Regardless of a reader’s own views on diet and health, it is useful to understand the mainstream position of the Dietary Guidelines on controversial questions in nutrition science.

The Dietary Guidelines for Americans is used as a source of evidence for claims about diet and health on food labels (see Chapter 9). It provides key inputs for USDA’s Thrifty Food Plan and other model diets for people at different income levels (see Chapter 10). It informs policies and regulations for nutrition assistance programs, including school lunch and school breakfast (see Chapter 11).

This chapter covers how the federal government develops and uses dietary guidance. The chapter:

• reviews historical trends in chronic disease and nutrition, so that we can pay the most attention to the most important health concerns (Section 8.2); 
• considers several market failures that have been cited as motivation for a government role in dietary guidance (Section 8.3);
• explains the process of creating the Dietary Guidelines for Americans and related consumer-oriented graphics (Section 8.4);
• compares current U.S. consumption patterns to the Dietary Guidelines (Section 8.5); and
• explores several policy instruments that have been proposed to guide Americans toward healthier food choices (Section 8.6).

A debate in NYC over soda policy

Heritage Radio Network has posted in full a debate Thursday night about the NYC soda policy proposals.

The debate had four participants:

• I spoke gently in favor of New York City's effort to experiment with moderate policies to change the environment in which sugar sweetened beverages are marketed and sold.  I suggested that the Board of Health's proposed limit on sweetened beverage container sizes was not as radical as it has been portrayed. My 2-minute opening statement begins at 17:25.
• Lisa Young, an author and adjunct professor at New York University, spoke strongly in favor of the proposal, using cups of various sizes as props to buttress her points.
• J. Justin Wilson trashed the proposal on libertarian and free-market grounds.  Wilson represents the Center for Consumer Freedom, an industry-funded organization that runs ads calling NYC Mayor Michael Bloomberg a nutrition nanny.
• Joel Berg directs the New York City Coalition Against Hunger.  He appealed strongly for broader policies to address U.S. poverty and expressed his organization's intention to neither endorse nor oppose the beverage size limitation proposal.  Then, Berg livened the debate by launching into an enjoyably vivid and highly critical analysis of such paternalistic policies.

The event was organized by the Museum of Food and Drink (MOFAD) and hosted by the New York City Food Policy Center at Hunter College.

Coca-Cola's "Cap the Tap" campaign

The MyPlate consumer education materials (.pdf) from the U.S. government wisely encourage folks to "drink water instead of sugary beverages."

The message from beverage companies is something else altogether.

Through its "Cap the Tap" campaign and related materials, Coca-Cola encourages restaurants to talk customers out of choosing tap water and instead to choose higher-profit items such as Coke, Minute Maid juice, Dasani bottled water, or an alcoholic drink. I read about this campaign recently in a hard-hitting post by Andy Bellatti at Civil Eats. A related link to Coca-Cola's CokeSolutions website appears to be broken now, but I found you can still read about the company's message for restaurants on Google Cache. [Note 11/18/2013: the basic link to CokeSolutions is working.  Bellatti points out by Twitter that the "Cap the Tap" graphic from that site is only available now in a Huffington Post screenshot.  Nice work.]

Bellatti also linked to this great, blunt, fascinating page by graphic designer Pen Williamson, with proposed posters that Coca-Cola could use to get restaurants to discourage healthy and inexpensive tap water as a beverage choice [Note: this sentence edited slightly Nov 15 afternoon]. The poster suggests, "provide tap water to guests upon request only."  I don't know if this poster or another similar poster was used in Coca-Cola's "Cap the Tap" campaign.

There is nothing the government can or should do to restrict this type of marketing to restaurants. Yet, I think it is terrible marketing from a nutrition standpoint, which gives us useful context as we interpret the public policy debate over the potential role of beverage companies as part of the solution to the nation's health and nutrition challenges.

WCRF policy strategies to reduce non-communicable disease around the world

The World Cancer Research Fund (WCRF) this month published a new 2-page document (.pdf) summarizing the organization's recommendations on using food policy to address the problem of high rates of non-communicable diseases (NCDs).

The recommendations encourage clear nutrition labeling, healthy school meals programs, well-targeted taxes and healthy food subsidies, and restrictions on advertising for breastmilk substitutes and for unhealthy foods (especially to children).

The WCRF is an international not-for-profit umbrella organization for a network of cancer prevention organizations. WCRF literature reviews on dietary patterns and cancer risk are used by the U.S. federal government as one of several evidence sources for the Dietary Guidelines for Americans.

The WCRF policy recommendations are bolder and more activist than some policy-makers would be ready to consider in the United States, but the WCRF approach nonetheless offers a lot of insight.  For example, a background document on law and obesity prevention (.pdf) carefully considers both advantages and disadvantages of legal approaches to addressing public health nutrition challenges.  It acknowledges not just the political power of food and beverage manufacturers to thwart such policies but also the constitutional protections for commercial speech and the serious concerns consumers may have about policy interventions that limit their autonomy.

For perspective on U.S. food policy debates, it is illuminating to hear an international perspective that is (not surprisingly) comparatively interventionist, but which at the same time fully recognizes the challenges and tradeoffs involved in such policy proposals.