Sin taxes for unhealthy food

Whether to impose excise taxes on unhealthy food – much like those on tobacco and alcohol – is a matter of continual debate in health-policy circles and state governments. Advocates assert that the increased cost of food with dubious nutritional value would reduce consumption of it. They have an attentive audience in state legislators, who legally must balance their budgets. Opponents argue that such a tax would be regressive, unduly penalizing low-income residents who spend a greater percentage of their household budgets on food.

Most states already tax soda sold in grocery stores and vending machines, but not at a level that significantly affects sales. A study of North Carolina young adults showed that a 10 percent increase in the price of pizza and soda was associated with a 7 percent decrease in calories consumed in soda and 12 percent decrease in pizza.

A U.S. Department of Agriculture analysis estimated that a 20 percent price increase in sugar-sweetened beverages – including some fruit juices – would decrease average consumption by 37 calories a day, lowering the adult incidence of obesity and being overweight by 10 percent each.

Scientists tested the effectiveness of “sin taxes” compared with price discounts for healthier food. A group of volunteers – all mothers – shopped at a simulated grocery store. First, they bought groceries at regular prices. Researchers then imposed taxes of 12.5 percent, then 25 percent on unhealthy items, or they decreased the prices of healthy food comparably. The result: Sin taxes were more effective than discounts in raising the nutritional value of the shopping basket.

Book review: The Blood Sugar Solution

Diabetes may well be the fastest-growing non-communicable epidemic in world history.

From 1983 to 2008, diabetes increased seven-fold from 35 to 240 million worldwide. From 2008 to 2011 alone, 110 more people became diabetics.

Dr. Mark Hyman does a good job of explaining how this is happening in The Blood Sugar Solution: The UltraHealthy Program for Losing Weight, Preventing Disease and Feeling Great Now (Little Brown, $27.99).

He describes “diabesity” as a continuum of health problems from overweight and mild insulin resistance to obesity and diabetes. It is almost entirely caused by environmental and lifestyle factors and, therefore, preventable. About 1 out of 4 cases of diabetes remains undiagnosed, as well as nearly all of those with prediabetes.

Hyman points to the usual dietary suspects that contribute to the problem: excess sugar consumption, processed food and sodium. However, he expands the culprits to include environmental factors such as pollution, pesticides, hormones and antibiotics in food.

The book includes a six-week “action plan” to lower blood sugar and the requisite recipes section. Buyers beware: While the book contains valuable information, it is also a Trojan horse for a website that sells his expensive “recommended” supplements.

Supermarket nutrition labeling

The Institute of Medicine has recommended nutrition labeling on the front of food packages that would highlight four key ingredients: calories, saturated fat, trans fat and sodium. The FDA is also planning to establish a single format for front-of-package labels. Labels currently are on the side or back panels of most food packages.

Beginning January , the federal government required nutrition labels that reveal the calories and fat content of 40 popular meat and poultry items. This should cut through the marketing hype of “80 percent lean,” which means 20 percent is not.

Grocery stores are beginning to assist shoppers in selecting healthier food. Grocery chain Hannaford Bros., located in New York and New England, began its Guiding Stars program in 2006. Each food item in the store was assigned zero to three stars based on fats, sodium, added sugars, vitamins, minerals, fiber and whole grains. Excluding produce, only about 15 percent of Hannaford’s food items qualified for at least one star. During its first two years, shoppers bought 2.9 million more starred items each month.

Mindless eating

Almost 90 percent of Americans have no clue how many calories they should eat per day. Calories consistently rank toward the bottom of consumer eating priorities. According to a Food Marketing Institute study in 2002, only 13 percent said they were concerned about calories. Annual per-person meat consumption rose by 57 pounds and cheese intake quadrupled from 1950 to 2000.

Do not necessarily count on your doctor to dispense authoritative nutrition advice. Diet and nutrition education is given short shrift in medical school. During the 2008-09 academic year, only 27 percent of medical schools met the 25-hour classroom minimum for the topic set by the National Academy of Sciences. About 38 percent of schools met the standard four years earlier, meaning the trend is going in the wrong direction. The doctors most likely to know much about nutrition have made a personal commitment to follow a healthy lifestyle themselves.

Americans usually believe they exert a high level of personal control over their health habits. A survey by Foodminds showed otherwise. A surprising 38 percent said others were responsible for what they put in their mouths. About 14 percent blamed food companies, 12 percent pointed to the government, 9 percent said the health-care system was somehow responsible and 3 percent blamed the educational system.

Nearly 90 percent of Americans said they were eating a healthy diet, according to a Consumer Reports telephone survey in November 2010.

What did they eat? Only 30 percent said they eat five servings of fruits and vegetables a day, 43 percent drank at least one sugared drink daily and only about half attempted to limit consumption of sweets and dietary fat.

The absurdity of fast-food calorie labeling

A study of the usefulness calorie listings on fast-food menus reflects lack of regard for customers, sloppy legal compliance and the futility of corralling the compliance of companies who do not want to be transparent.

Researchers studied calorie counts for 200 food items on menu boards in the Harlem section of New York City, where a menu-labeling ordinance has been enforced since 2006.

For the most part, the labeling was useless. For example, a bucket of chicken was listed as having 3,240 to 12,360 calories. That is quite a range, and the calorie count did not indicate how many pieces were in that count. A submarine sandwich had between 500 and 2,080 calories. It was up to the customer to figure out what that meant and how to get into the lower range. Combination meals had the same problem. The menu assumed you would eat everything you ordered.

Few of us take calculators to fast-food restaurants and attempt to discern exactly what we are eating. Calorie listings should be for individual items and be as specific as possible. The study reflects a poorly written ordinance and businesses that disrespect their clients.

Fast-food imperialism

You knew this was true. You just needed proof.

Researchers compared the number of fast-food restaurants per-capita to the obesity rate in 26 wealthy nations. They used Subway as a proxy, given that it had the most outlets worldwide in 2010.

The U.S. and Canada led the way with 7.52 and 7.43 outlets per 100,000 people respectively. About 32 percent of Americans and about 23 percent of Canadians are obese. Conversely, Japan and Norway had .13 and .19 outlets per 100,000 and obesity rates of about 3 and 6 percent respectively.

Researchers emphasized it was a correlation, not a causation.

The New York Times published an excellent piece in 2008 about how fast-food joints, pizza places and ice cream parlors have overtaken the birthplace of the Mediterranean diet in Greece.  Two-thirds of the children and three-quarters of the adults there are overweight or obese.

Greece, Italy, Spain and Morocco asked Unesco to designate the diet as an “intangible piece of cultural heritage,” which speaks to its historical importance and that it now appears to be a thing of the past in that region.

It is no coincidence that worldwide fast-food expansion coincided with the world’s expanding obesity rate. Activists used to complain about U.S. “cultural imperialism,” primarily referring to the ubiquity of U.S. movies and television shows. This kind of imperialism has caused far more damage.

The feds flunk the American diet

Americans are still flunking when it comes to eating a healthy diet, according to a federal government grade card.

The Health Eating Index gauges consumption of several nutritional categories such as whole fruits, brightly colored vegetables, meat and added sugar. The aggregate national score was about 60 out of 100.

Americans are eating more from all of the major food groups – even fruits and vegetables – at the same time that the obesity rate has doubled since 1970. However, many are not meeting dietary recommendations. To do so, they would have to cut back significantly on added fats, refined grains and added sweeteners while increasing consumption of fruits, vegetables, whole grains and low-fat dairy products.

The typical Western diet – fried foods, salty snacks and generous portions of fat-laden meat – accounts for nearly a third of the heart-disease risk worldwide, according to a study of dietary patterns in 52 nations.

What constitutes an ideal diet continues to be elusive. Diets rich in lean meat, poultry and beans keep weight off best, according to a November 2010 New England Journal of Medicine study.

An analysis of 21 studies involving 350,000 people found “no significant evidence” that long-maligned saturated fat increases heart risk. But refined carbohydrates – white bread, white pasta and processed baked goods – do.

Another study compared the effectiveness of low-fat vs. low-carbohydrate diets. The verdict: Either works. Both groups lost about 7 percent of their body weight. A 2009 study was even more detailed, creating four groups with diets of varying amounts of fats and carbohydrates. For example, one diet consisted of 40 percent fat and 35 percent carbohydrates. Another had 20 percent fat and 65 percent carbohydrates. The same result: They also lost equal amounts of weight.

The safest way of eating for nutrition and weight control is what is known as the Mediterranean diet. It is more of a dietary pattern than a specific list of foods. Its key elements: fruits and vegetables, whole grains, nuts, olive oil and beans; moderate amounts of red wine, low-fat dairy, poultry and fish, and not much meat or added unhealthy fats. Experts say the diet contains thousands of vitamins, minerals and micronutrients that guard against heart disease and cancer, protect mental health and lengthen life. The diet even has the ability to change the genes that influence heart disease.