30 Issues: 'Healthy' Food, Nutrition and Access
Brian Lehrer: Brian Lehrer on WNYC. We're in our midterm election series, 30 Issues in 30 Days. We'll do Issue 13 in just a minute, but let me take a step back for just a second and reset where we are in the series. We began with three days on abortion rights as an issue in elections this fall. We followed that with two days on immigration, three days on the culture wars in education, and two shows on climate. Today we conclude three segments on public health as an issue. Tomorrow and Friday we'll be talking about crime and criminal justice.
Then for the full two weeks after that, relevant to what we were just discussing in our last segment, beginning next Monday we'll devote a full third of the series, that's 10 of our 30 issues, to the topic you asked for the most in a series of call-ins we did this summer. It's Democracy in Peril. We try to be a pro-democracy show on a pro-democracy station. It's crazy to even have to say that or think which side of democracy or no democracy are we on? Here we are in 2022.
Our 10 segments on Democracy in Peril will cover a range of democracy issues from the way votes are counted and certified being under attack, to Republicans trying to change the rules for referendums now that the pro-abortion rights referendum won in Kansas. Funny, because Republicans really pushed the initiative and referendum mode of setting rules in society over recent decades. The history of that is so interesting, and we'll do that in our democracy series. Two campaigns on both the left and the right saying the US needs a whole new constitution, not just amendments to the one we have. A 10-part Democracy in Peril series as part of 30 Issues in 30 Days beginning here next Monday.
Coming back to the present, concluding our three on public health, on Monday we asked if either party has a plan for our COVID-endemic future. Yesterday, we asked if there is a Democratic and Republican way to protect mental health, and now we get to Issue 13: How to label packaged foods. Now, this is not an issue we see candidates campaigning on, but the Food and Drug Administration has just proposed new standards for allowing packaged foods to use the word "healthy" on their labels.
Unhealthy eating is a leading cause of preventable disease and death in this country, and the food labeling rules are as much about politics as they are about food science, unfortunately. The FDA is even designing a little symbol, that they'll allow on many packaged foods, that includes the word "health" as well as the initials FDA in a little box.
With us now is our guide to the FDA's "healthy" food labeling proposal and what kinds of politics from either party go into it, is none other than Marion Nestle, professor emerita of nutrition, food science, and public health at NYU. She writes a blog called Food Politics and is the author of many books, including a brand new memoir called Slow Cooked: An Unexpected Life in Food Politics. Marion, we always learn something when you come on the show. Welcome back to WNYC.
Marion Nestle: Oh, happy to be here.
Brian Lehrer: Would you like to start with the premise of the article you wrote on the website STAT News last week saying health claims are not about health? Want to set that up for us?
Marion Nestle: Sure. The FDA has just come out with new proposed guidelines on the use of the word "healthy" on food packages. I don't know whether to laugh or cry when I talk about this because the whole thing seems so ridiculous. The point about a label like "healthy" or any other health claim on a food package is that it's really not about health; it's about marketing those products. The reason why food labels are so political is because of their marketing purpose.
The objective of a food company is to sell products. That's really all they care about. That's different from consumers' objectives, which might be to feed their family in the healthiest way possible or to eat in the healthiest way possible. When we get into the aisles of supermarkets that contain packaged foods, we're in healthy never never land. It just sort of boggles the mind. If you want to eat healthfully, eat fruits, vegetables, meat, dairy, fish, eggs. Eat real food. It's the packaged foods that are so profitable that get us into trouble.
Brian Lehrer: In that context, can we do some food labeling history first-
Marion Nestle: Sure.
Brian Lehrer: -before we actually get into what's going to change or what the FDA is proposing to change on the labels we see in stores all the time? We all see the nutrition labels on food packages, how many calories, how much fat and sugar and sodium, what percentage of the recommended daily maximum is in each serving. Also, some of the good things in the product, all of that, but food packages didn't always have those labels. When and how did they come to be?
Marion Nestle: Well, the history of it is long and complicated, but it really started in the 1980s when Kellogg's made a deal with the National Cancer Institute to put something on all brand packages that said that they could help reduce the risk of cancer. Up until that point, packages were not allowed to make health claims on food packages. They weren't allowed to make any kind of health claim. The FDA viewed that as a drug claim and said they would have to prove through controlled clinical trials that All-Bran prevented cancer, which obviously would be impossible to do.
Kellogg's pushed and pushed and pushed on it, and by 1990 Congress passed a law allowing health claims on food packages. That was when the whole labeling-- They did that because the food industry was really opposed to having nutrition facts on food labels. They didn't want people to know what was inside those food packages. That was the deal that they made with Congress. If Congress would allow health claims, they would allow the nutrition facts labels and ingredient lists on food packages.
That happened in 1990, and then the FDA did a lot of testing of designs. They tested a whole bunch of prototypes of the nutrition facts panel. When the testing was over, it turned out nobody understood any of the prototypes very well. The FDA picked the one that was least worst understood, if that's grammatical sense.
Brian Lehrer: Least worst understood.
Marion Nestle: Yes. They picked the one that was least poorly understood. They were all poorly understood, so they picked the one that was--
Brian Lehrer: That's when nobody in the class gets over 70 on the test, and you celebrate the student who did the least bad.
Marion Nestle: Exactly. You got it. That's what we're living with. Because the labels are so hard for most people to understand, they're even hard to teach. I do a lot of teaching of food labels, and they're difficult to teach even to students who are particularly interested in this. They're complicated. Some are floors, some are ceilings. You have to know what a daily value is. You have to know a lot to understand them.
There's been a big push to put front-of-package labeling on some kind of symbol or some kind of design that will tell people at a glance what's a healthy product. That's where this "healthy" proposal is coming from. The FDA has been working on it for years. The reason why I don't know whether to laugh or cry is that hardly anybody, any of the food manufacturers, use the "healthy" label, and the FDA has set the rules up so that even fewer will be able to use it.
In any case, there are other kinds of labels that are much better. Like the warning labels that are used in a lot of countries in Latin America that tell people that a product has too much salt, sugar, saturated fat, or calories for what you want. I don't know. This is all about selling food packages. It's not about eating healthfully or going to the peripheral aisles of the supermarket and doing your own home cooking, which lots of people can't do.
Brian Lehrer: Listeners, if you have questions about the FDA food labels on the food products, the packages that you see in whatever stores you're shopping, for not just real food, like fresh produce and things like that, but packaged foods for food politics expert and nutritionist Marion Nestle, 212-433-WNYC. As the FDA proposes to revise those labels, again 212-433-9692 or tweet @BrianLehrer.
I want to stay on the history because what's in your book in this regard is so fascinating. You write in your new book Slow Cooked that at one point you worked for the federal government. You were the project officer in charge of completing the first-ever Surgeon General's Report on Nutrition and Health, and to write the policy recommendations and oversee the report's release.
You write, "I greatly underestimated what a hard time I would have in that office. Looking back on that period, I think of it as my two years in federal prison," yikes, "because no matter what the research indicated, the Surgeon General's report would not recommend eating less meat as a way to reduce saturated fat, nor would it recommend eating less of specific foods that were sources of sugar or salt. We were part of the industry-friendly Reagan administration. Agencies dealing with food issues had learned to avoid congressional interference by resorting to euphemisms."
Ha. Can you give us an example or two of how you had to resort to euphemisms in the nutritional advice Americans were getting from their government, and if those euphemisms showed up on food labels?
Marion Nestle: Sure. We're still using euphemisms. The dietary guidelines for Americans say "Eat more fruits and vegetables." Anytime you talk about eating more you talk about real foods. Then they resort to nutrients when they talk about what you need to eat less of. It's "Eat less saturated fat, sugar, and salt." It's not eating less of the packaged ultra-processed foods that contain saturated fat, sugar, and salt, or the meat that's high in saturated fat. They use nutrients instead of the foods as euphemisms, or as it's sometimes called, it's nutritionism. You use nutrients to stand for the entire food, and we're still doing that. That's what the dietary guidelines say.
The dietary guidelines are the basis of the FDA's new "healthy" claim proposal. If a food is high in saturated fat, salt, or sugar, it doesn't qualify for "healthy", but at least they're requiring that the product have some food in it, which I thought was a great step forward.
Brian Lehrer: Another example from the '80s that you give in the book, "Whereas 'eat less beef' called the industry to arms," - in other words, they would bark and they wouldn't get away in the government with labeling 'eat less beef' - "'eat less saturated fat' did not raise that alarm." You also write, "Sugar producers could live with 'choose a diet moderate in sugar.' Eventually, the Surgeon General's report would recommend the uncontroversial 'choose lean meats,' and they would suggest limiting sugars, but only for people vulnerable to dental cavities." Marion, which Americans are those who are vulnerable to dental cavities?
Marion Nestle: How about everyone?
Marion Nestle: Every single one of them. It was an amazing experience to work with that and to try to get the message out. It was ancient history. It was the late 1980s. Another federally sponsored report came out a year later, even longer, saying exactly the same things. This was a moment in time when there was said to be consensus about dietary recommendations, but they did not say "eat less meat" even though we now know that eating less meat is probably a good idea for most Americans. It would be good for their health and good for planetary health, but planetary health didn't enter into it in the late 1980s.
Brian Lehrer: By the way, that was the only official concern about too much sugar, cavities not diabetes, to take a random example?
Marion Nestle: Not diabetes, to take a random example, because the FDA had come out with a major report on sugar and health just a couple of years earlier that said the only problem with sugar was dental caries. I've had a lot of suspicions about that report and who sponsored it, but I've not been able to find anything about it that casts the usual kind of suspicion on its origins. It's just that that was the consensus at the time apparently, except for some people who were screaming bloody murder about sugars but nobody paid any attention to them.
Brian Lehrer: Now, for people who look at the labels closely enough today, they'll see the percentage of what they call daily value of each listed item. 2 grams of saturated fat, for example, also says 10% of daily value. That's a euphemism in and of itself or a vague term, daily value. What does it mean?
Marion Nestle: It's supposed to mean either an upper limit or a floor depending on which nutrient you're talking about. In the case of saturated fat, it's an upper limit. You're not supposed to have more than 20 grams a day, or if 2 grams is 10% then 20 grams is what you're allowed. Is that right?
Brian Lehrer: I think that's the actual number.
Marion Nestle: Yes, it's the number. It's an upper limit. For fruits and vegetables or for some of the vitamins, it's lower limits or it's floors. It's the minimum you're supposed to have. It's very, very hard to explain it to people except that for some of them a high percentage is good, and for some of them a high percentage is bad.
Brian Lehrer: The new FDA food labeling proposals, what is their task right now as they see it? This is the news hook to why we're having this conversation about food labeling history in our 30 Issues in 30 Days election series segment. What is the FDA trying to address by proposing revised food labels right now?
Marion Nestle: This is going to seem like such a stretch. I can hardly say it in a straight face or straight voice, but there are two big food problems in American society right now. Not having enough food or not having a regular supply of food, what we're now calling food insecurity, and then diet-influenced chronic diseases like Type 2 diabetes, heart disease, cancer, and COVID-19 for that matter. Diseases that are related to overconsumption of food, to obesity, and to diseases for which obesity is a risk factor. This is a big problem in our society. Three-quarters of American adults are overweight or obese. By CDC standards it's become normal.
That means that three-quarters of the American population is at either small to increasing risk of all of these chronic diseases. They cost a lot. They're terrible to have for individuals. Then they're not very good for society either, and we're seeing it in younger and younger children. The FDA wants to make it easier for individuals to make healthier food choices. I think there are two approaches to doing this. They have picked the approach; the personal responsibility approach. The assumption is that if you knew what a healthy food product was you would choose it. If you didn't know, if you're ignorant of it, then you can't be blamed. This way you can be blamed.
The idea is to label food products and to indicate which ones are good for you, taking a positive approach. Not which ones you should avoid because that will get the food industry upset, but which ones you can choose because they're healthy. That's what it's trying to do. Will it work? I have no idea. I don't think it'll work. I'm dubious about the whole thing. I don't think that having individual food choices is the way to achieve public health objectives. We need policies.
How about regulating the food industry so it can't market junk food, especially to children? Or how about setting up some restrictions on food companies getting involved in public policy and influencing the dietary guidelines and doing all the other things that food companies are doing? It seems to me that would be a much better approach.
Brian Lehrer: We'll take some phone calls for you in just a minute. As you could imagine, a lot of people have questions about nutrition labels on packaged foods. In the context of our 30 issues election series, why is this happening again right now, this revision? If the Reagan administration, when you worked there, was friendly to the food industry as you wrote in your book, does today's push have anything to do with the Biden administration being in power since the FDA is an executive branch agency? Is there a Democratic and Republican approach to food labels?
Marion Nestle: One would hope that the current approach would be more public-health oriented, but to take a really public-health oriented position on diet and diet-related disease you would have to control what the food industry does. What I always like to explain is that food companies are not social service agencies, they're not public health agencies. They're businesses with stockholders to please. Their first and only priority is to make money for their stockholders. That's what they're in business to do.
Brian Lehrer: Right, but the government is in business to regulate them. You did write that the new proposed labels would be a lot better than the labeling anarchy that currently exists. How would the new proposed labels be an improvement?
Marion Nestle: They're an improvement because they will only allow food products to put a "healthy" claim on the package label if they contain real food - what a concept - and if they are below certain upper limits of saturated fat, salt, and sugar. The improvement is that they have exceptions made for-- I can't even say this with a straight face. They have exceptions made for real foods. Foods like avocados or nuts that are high in fat that used to be forbidden to claim themselves as "healthy" can now have "healthy" labels on them.
Maybe we're going to start seeing these "healthy" stickers on real fruits and vegetables in the supermarket, but the whole issue is to discuss what the deal is on packaged foods. These are the foods that are most profitable for food companies. They're the ones that are considered to be ultra-processed, which is a relatively new term that describes foods that are industrially produced, don't look anything like the foods they came from, can't be made in home kitchens, and are clearly shown to encourage people to eat and eat and eat. You can't eat just one.
They're the ones that you just can't stop eating, and so they induce people to take in more calories. The food industry loves them because they're enormously profitable, and that's what we're up against from a public health standpoint. It's public health against food industry profits.
Brian Lehrer: Janet in Manhattan, you're on WNYC. Hi, Janet.
Janet: Oh, hi. I just wanted to talk about a problem that I see that I learned about, about 30 or 40 years ago, from Gary Null, nutritionist on the radio, and it's what he called hidden sugars. Apparently the FDA, in the listing of ingredients, it allows companies to list different sugars separately. For example, you'll see in peanut butter it'll say peanuts, sugar, dextrose, et cetera, et cetera.
Now, when you find dextrose and sugar listed separately, that's probably a clue that if you added them together, as you should, and reported it as sugar, that sugar would be the highest ingredient. You would have peanut butter where the ingredients say sugar and then peanuts because ingredients have to be listed in the proportion in which they appear in the food.
Brian Lehrer: Janet, let me get an answer from Marion Nestle for you for that. What about hidden sugar as opposed to--
Marion Nestle: The FDA allows probably 50 different terms for one kind of sugar or another, and this is where food label sophistication comes in. Because when you see something like that, the nutrition facts label now requires the companies to put in something called added sugars. Those added sugars will be all added together. You'll see the number of grams of added sugars and you can add it up and see that, but you have to know how to do that. You have to know how to imprint the nutrition facts label with the ingredient list to make sense of it, and the caller is absolutely right about the problem of doing that.
Brian Lehrer: Marcia in Brooklyn, you're on WNYC. Hi, Marcia.
Marcia: Hi, Brian. I just was curious the politics around the organic food. Why can't the organic section just be labeled "healthy eats"? Can we get that policy knowing about the herbicides that are also used to produce organic foods, and why can't we start looking at policies federally that put subsidies into production of sustainable farming and organic foods versus all these other manufacturers and the hyper-agricultural industry? That's it.
Brian Lehrer: Thank you, Marcia. Yet, if I can complicate the question, even that is complicated in that there are plenty of products out there that are packaged products that are labeled organic, but that also might be high in sugar, for example.
Marion Nestle: Yes. There's organic junk food just like there is every other kind. Organics are a production term, and they have to do with the ways in which the foods are produced. They have nothing to do with their effects on health other than having to do with the pesticides. Just because it's organic doesn't necessarily mean that it's healthy or that it would qualify for the new FDA's "healthy" label, especially if it's high in salt, sugar, saturated fat, which it certainly could be.
I am certainly with the caller on the need for changing our agricultural system so that it supports the growing of food rather than feed for animals or fuel for automobiles, and supports a much healthier sustainable regenerative agriculture system. I'm with you on that one.
Brian Lehrer: As we run out of time, I will mention that your book also includes a cartoon of you that's become one of your signature items. It's a cartoon caricature of you holding a giant fork, and the caption says, "Vote with your fork. Better yet, vote with your vote." Do you think government food regulation, in the interest of public health, is on the ballot in some sense this year, even though it's not making news as an explicit campaign issue?
Marion Nestle: I think it is, but it needs to be a much noisier campaign issue. We need much, much more than a "healthy" label on food products to have a healthier and more sustainable food system. I want to see much more noise about food policy.
Brian Lehrer: That's Issue 13 in our 30 Issues in 30 Days election series, and the last of our three segments on public health. Again, we thank Marion Nestle, professor emerita of nutrition, food science, and public health at NYU. She writes a blog called Food Politics and is the author of many books, including the brand new memoir that we've been citing from called Slow Cooked: An Unexpected Life in Food Politics. Marion, thanks so much.
Marion Nestle: My pleasure.
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