Marion Nestle

The Contribution of Expanding Portion Sizes to the US Obesity Epidemic

OBJECTIVES Because larger food portions could be contributing to the increasing prevalence of overweight and obesity, this study was designed to weigh samples of marketplace foods, identify historical changes in the sizes of those foods, and compare current portions with federal standards. METHODS We obtained information about current portions from manufacturers or from direct weighing; we obtained information about past portions from manufacturers or contemporary publications. RESULTS Marketplace food portions have increased in size and now exceed federal standards. Portion sizes began to grow in the 1970s, rose sharply in the 1980s, and have continued in parallel with increasing body weights. CONCLUSIONS Because energy content increases with portion size, educational and other public health efforts to address obesity should focus on the need for people to consume smaller portions.

Big food, food systems, and global health

In an article that forms part of the PLoS Medicine series on Big Food, guest editors David Stuckler and Marion Nestle lay out why more examination of the food industry is necessary, and offer three competing views on how public health professionals might engage with Big Food.

Mediterranean diets: historical and research overview.

Diets consumed by Mediterranean populations have been a subject of interest since antiquity, with more recent investigations focused on their evident health benefits. The work of Ancel Keys in the 1950s established the largely plant-based Mediterranean diet as the original prototype for current dietary guidelines in the United States and elsewhere. As a cultural model for dietary improvement, the Mediterranean diet can be recommended for both its health benefits and its palatability. Given worldwide trends toward dietary uniformity, classic Mediterranean diets may be becoming endangered species, and much basic and applied research is needed to define the ways in which such traditional and healthful dietary patterns can be preserved and promoted.

Can the Food Industry Play a Constructive Role in the Obesity Epidemic

reminders, offering extended payment terms, or reducing or forgiving charges to indigent patients. Practice experts also advise writing off uncollectible accounts rather than sending them to futile and even bankrupting collection, not sending bills to collection precipitously or before talking with the patient, and not substituting bellicose collection for properly terminating a treatment relationship. In today’s world of high medical costs, large medical bureaucracies, and the unsolved problem of millions underinsured, physicians alone cannot rescue patients overwhelmed by medical bills. But the long-standing professional ethos of the relational physician still can honor the bonds of trust and care that tie patients to physicians, even in the emerging era of consumerism.

Front-of-Package Food Labels: Public Health or Propaganda?

AT NO POINT IN US HISTORY HAVE FOOD PRODUCTS displayed so many symbols and statements proclaiming nutrition and health benefits. Front-ofpackage claims, often used in violation of Food and Drug Administration (FDA) labeling regulations, have become ubiquitous in food marketing. Recently, the FDA embarked on an initiative to review front-of-package labeling and asked the Institute of Medicine to consider eventual recommendation of a single, standardized guidance system. Front-of-package labels may so thoroughly mislead the public that another option deserves consideration— eliminate all nutrition and health claims from the front of processed food packages while strengthening the Nutrition Facts Panel.

Associations of Food Stamp Participation With Dietary Quality and Obesity in Children

OBJECTIVE: To determine if obesity and dietary quality in low-income children differed by participation in the Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program. METHODS: The study population included 5193 children aged 4 to 19 with household incomes ≤130% of the federal poverty level from the 1999–2008 NHANES. Diet was measured by using 24-hour recalls. RESULTS: Among low-income US children, 28% resided in households currently receiving SNAP benefits. After adjusting for sociodemographic differences, SNAP participation was not associated with a higher rate of childhood obesity (odds ratio = 1.11, 95% confidence interval [CI]: 0.71–1.74). Both SNAP participants and low-income nonparticipants were below national recommendations for whole grains, fruits, vegetables, fish, and potassium, while exceeding recommended limits for processed meat, sugar-sweetened beverages, saturated fat, and sodium. Zero percent of low-income children met at least 7 of 10 dietary recommendations. After multivariate adjustment, compared with nonparticipants, SNAP participants consumed 43% more sugar-sweetened beverages (95% CI: 8%–89%), 47% more high-fat dairy (95% CI: 7%, 101%), and 44% more processed meats (95% CI: 9%–91%), but 19% fewer nuts, seeds, and legumes (95% CI: –35% to 0%). In part due to these differences, intakes of calcium, iron, and folate were significantly higher among SNAP participants. Significant differences by SNAP participation were not evident in total energy, macronutrients, Healthy Eating Index 2005 scores, or Alternate Healthy Eating Index scores. CONCLUSIONS: The diets of low-income children are far from meeting national dietary recommendations. Policy changes should be considered to restructure SNAP to improve children’s health.

Animal v . plant foods in human diets and health: is the historical record unequivocal?

An ideal diet is one that promotes optimal health and longevity. Throughout history, human societies have developed varieties of dietary patterns based on available food plants and animals that successfully supported growth and reproduction. As economies changed from scarcity to abundance, principal diet-related diseases have shifted from nutrient deficiencies to chronic diseases related to dietary excesses. This shift has led to increasing scientific consensus that eating more plant foods but fewer animal foods would best promote health. This consensus is based on research relating dietary factors to chronic disease risks, and to observations of exceptionally low chronic disease rates among people consuming vegetarian, Mediterranean and Asian diets. One challenge to this consensus is the idea that palaeolithic man consumed more meat than currently recommended, and that this pattern is genetically determined. If such exists, a genetic basis for ideal proportions of plant or animal foods is difficult to determine; hominoid primates are largely vegetarian, current hunter-gatherer groups rely on foods that can be obtained most conveniently, and the archeological record is insufficient to determine whether plants or animals predominated. Most evidence suggests that a shift to largely plant-based diets would reduce chronic disease risks among industrialized and rapidly-industrializing populations. The accomplish this shift, it will be necessary to overcome market-place barriers and to develop new policies that will encourage greater consumption of fruits, vegetables and grains as a means to promote public health.

Health Care Reform in Action — Calorie Labeling Goes National

The Patient Protection and Affordable Care Act requires establishments with 20 or more locations nationwide to post calorie counts along with a succinct statement concerning suggested daily caloric intake. Marion Nestle argues that calorie labeling is well worth the trouble.

Food Lobbies, the Food Pyramid, and U.S. Nutrition Policy

The U.S. Department of Agricultures 1991 withdrawal of its Eating Right Pyramid food guide in response to pressure from meat and dairy producers was only the latest in a long series of industry attempts to influence federal dietary recommendations. Such attempts began when diet-related health problems in the United States shifted in prevalence from nutrient deficiencies to chronic diseases, and dietary advice shifted from “eat more” to “eat less.” The Pyramid controversy focuses attention on the conflict between federal protection of the rights of food lobbyists to act in their own self-interest, and federal responsibility to promote the nutritional health of the public. Since 1977, for example, under pressure from meat producers, federal dietary advice has evolved from “decrease consumption of meat” to “have two or three (daily) servings.” Thus, this recent incident also highlights the inherent conflict of interest in the Department of Agricultures dual mandates to promote U.S. agricultural products and to advise the public about healthy food choices.

ALLERGIES TO TRANSGENIC FOODS : QUESTIONS OF POLICY

Food biotechnology, the use of recombinant-DNA and cell-fusion techniques to confer selected characteristics on plants and animals used for food,1 can be used to increase agricultural productivity....