By whose definition?

Among the efforts to convince us all of a childhood obesity epidemic are expressions of dismay that parents are failing to recognize that their children are “overweight.”

This has been a real thorn in the side for those trying to advance anti-obesity programs and anti-fat sentiment. For years the medical journals and media have lamented this “troublesome” problem because, as they've noted repeatedly, getting parents to recognize and accept childhood obesity as a health risk is vital before anti-obesity initiatives can be successful. Parents have been accused of being in denial, being “blind to the realities of childhood fat,” being “guilty of overlooking the obvious,” and failing to appreciate the problem and dangers childhood obesity.

A member of Australia’s National Health and Medical Research Centre working panel on obesity told the Australian News on February 22, 2005, that “so often parents interpret children who look well-covered as being healthy, rather than interpreting that they are at risk of becoming obese and having a range of diseases.” Earlier this month, UK health authorities launched their Health Living Initiative targeting parents, beginning with those of lower socioeconomic status, who “often have no idea their child is overweight and know little about the damage that could do to their health.”

A 2003 issue of Obesity Research, the journal for the North American Association for the Study of Obesity, a trade association for obesity researchers, reported that only 10.5% of parents of “overweight” children understand that their child is too fat. The pediatricians concluded: “Given that most parents of overweight children fail to recognize that their child has a weight problem, pediatricians should develop strategies to help these parents correct their misperceptions.”

Another survey of 99 mothers of “overweight” children published in the Pediatric Nursing Journal, found that 79% failed to identify their children as too fat. And a survey of 277 “overweight” children, aged 7-8 years old, published in the British Medical Journal reported 75% of parents didn’t realize their children were fat. This report, led by a senior research nurse at Derriford Hospital in Plymouth, did debunk what many incorrectly believe, however, that parents who are fat, uneducated or poor are less aware of childhood obesity. They found no difference in parents’ ability to recognize “overweight” in their children based on social class, education or weight status. But their conclusions do give us better insight into what the real issue here is:

The layperson’s perception of average weight, however, now conflicts with the clinical definition of normal weight, and a label of overweight from a health professional may be insufficient motivation for a change in lifestyle. The apparent lack of parental concern about their child being overweight probably stems from a lack of awareness. Until this is resolved, we are missing critical partners in our efforts to stem an impending health crisis.

While it has become popular to indict parents of “overweight” children for being irresponsible and to hype a "crisis of childhood obesity," those eagerly doing so are often the ones who don’t understand childhood obesity. Perhaps, many have come to believe the media hype and marketing, and actually think that those extreme examples being trotted out on television are representative of “the problem.”

As a Cleveland, Ohio columnist wrote this morning while talking about the 500-pound teen being profiled in Al Roker’s “Childhood Obesity: Danger Zone” for Food TV, it’s a “sobering look at what is shaping up to be a real national crisis. His story mirrors the childhood obesity story for the 12.5 million kids in America who are considered overweight or obese.”

This exemplifies the difference between what vested interests are trying to convince us is “childhood obesity” and the reality — that "conflict" mentioned by the British researchers.

So let’s start with a few basics. Body weight and size is nothing more than a description of a body characteristic. Obesity, including childhood obesity, is not a disease like polio or something you catch like strep throat. It is no different than trying to say that ear lobe creases or balding are diseases simply because some may find them unattractive or because they are associated with some chronic disease, and hence a “risk factor.”

What many don’t realize is that the definition for what is “too big” — “overweight” and “obese”— is a totally arbitrary thing, with various cultures and historical times seeing it very differently. We’ve already looked at some of the ways childhood obesity has been redefined over the years to include more children. Also popularly misunderstood is that the prevalence of overweight and obesity being used to define the "crisis" merely describes the numbers who have crossed the line of these arbitrary cut-offs for the labels of “overweight” or “obese.”

When we hear scary statistics that, for instance, childhood obesity among children aged 2-5 years has soared from 5% in 1971 to 13.9% in 2004, that doesn’t mean that children’s weights have ballooned by nearly 9% over the past 33 years. Nor does it mean that 13.9% of children today weigh 500 pounds. It means that 9% more children today have crossed that arbitrary threshold to receive the clinical label of being “overweight.”

A recent Voices of America article reported on the “alarming number of obese children worldwide at risk for heart disease” and the “disturbing global trend.” To illustrate the “20 million children under the age of five considered ‘too fat,’” they showed this adorable little girl:

We’ll look more at the creation of an epidemic of childhood obesity Monday, but for our discussion today, we are trying to get a more realistic picture of what “childhood obesity” and this supposed epidemic looks like. For our illustration, we’ll even use the CDC’s latest BMI growth charts and calculator for the cutoffs for “overweight” and “obesity” in children. Remember, children who are at or above the 85th percentile on the new BMI-based growth charts are considered clinically “at risk for overweight” (or “overweight” by the term popularized in the media). And at the 95th percentile, they become “overweight” (or “obese” in popular terms).

If we have a 6-year old girl who is 3 foot, 9 inches tall she would be considered to be a “healthy, normal weight" at 49 1/4 pounds (BMI 17.1).

If she gained 1/4 pound more, however, she becomes “overweight” at 49 1/2 pounds. For untold numbers of children classified as “overweight” they are within a fraction of a pound or few pounds of “normal.”

However, if this little girl grew a mere 1/8 inch, she would be considered to be a “healthy, normal weight” again!

At 54 1/2 pounds (BMI 18.9) she crosses the 95th percentile cut-off and is now labeled “obese.” A very different picture of childhood obesity than the mainstream media is portraying.

However, if this little girl was a mere 1/8 inch taller, at 3-9 1/8 inches tall, she would be merely “overweight” again.

So, for a 6-year old girl who theoretically isn’t growing taller, around a mere 5 pounds makes the difference between being labeled as a “normal” weight or all the way to being “obese.”

It’s no wonder that most parents aren’t readily able or willing to “recognize” that their child is overweight or obese.

And it’s no wonder that parents aren’t readily accepting the notion that this is a health crisis.

It also appears that parents have more common sense and wisdom than many experts and journalists in understanding the genetic component to the natural diversity of sizes that’s always been evident among children. They see that their children take after the other members of the family, aren’t eating or behaving any differently than the other kids, and are just as healthy. Increasing numbers of parents are not readily buying into the belief of a need to medicalize their healthy, active children based on such a spurious label.

© 2007 Sandy Szwarc

[The wonderful opening photo is courtesy of Deb Lemire of Queen Bee Productions.]

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Skepticism in action

Sometimes we find a journalist who is thinking. Saskatoon Star Phoenix columnist, Les MacPherson, takes a skeptical eye to warnings of impending doom surrounding the obesity crisis in today’s paper:

Dealing with the weighty subject of obesity

...The latest warning of impending doom comes from the House of Commons, always a reliable source of grim tidings. This time the deadly threat is childhood obesity. According to a Commons health committee, it could be the deadliest threat we've ever faced. So widespread and so unhealthy is childhood obesity, warns a committee report, that we could be raising the first-ever generation of Canadians whose life expectancy is less than that of their parents.

This would be a terrible setback. Life expectancy is a measure of health, prosperity and progress. For it to be rolled back is a major failure of our society.....But wait a minute. Tubs of lard though we may be, Canadians' life expectancy has been going nowhere but up. Today, the average is age 80. Ten years ago it was 79. Ten years before that it was 77. And so on. This continuing improvement in life expectancy is among the greatest achievements of western civilization. It also puts to rest the myths that we're awash in deadly industrial toxins, or that capitalism is inherently unhealthy. This does not exactly correspond with more and more people living into their 100s.

What's unhealthy, if you ask me, is nature. The record seems to confirm it. Life expectancy for our prehistoric ancestors was about age 20. Living in a state of nature would appear to be worse for you than smoking three packs a day....There's plenty of evidence of increased waistlines. But where's the evidence of increased mortality? If obesity is going to kill our kids early, it should be killing their obese grandparents right about now. And yet, life expectancy is only increasing.

Meanwhile, deaths due to cardiac and circulatory disease are down. This is the opposite of what you'd expect if a deadly plague of obesity was descending upon us. Maybe it's not the killer we've been led to believe.....

Great howl, Mr. MacPherson.

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Our kids are doomed — not!

This week, every mainstream media outlet in the country reported on the Kaiser Family Foundation study looking at children’s exposure to television food advertisements. The stories were all taken from a carefully-worded press release but reporters failed to critically examine it or the study and leapt to fill in the blanks. The stories they created did nothing more than frighten parents and perpetuate myths about fat children.

In “Big Food Kills,” syndicated columnist, Maria Cocco, with the Washington Post Writers Group, reported:

If we are what we eat and we eat what is advertised, then American children are facing death by junk food.

Half of all the advertising time on children’s television shows is devoted to food ads, according to a Kaiser Family Foundation study of food advertising aimed at kids. And what do the commercials pitch? Candy, cereal, fast-food and other restaurants, soda and other sweetened drinks. Just as surely as the tobacco industry tried for years—and succeeded—in hooking young kids on its deadly weed, the food industry is spending billions to advertise products that will make the next generation look and live like its porky parents: overweight, and at great risk of debilitating disease and early deaths linked to obesity....

The combination of saturation advertising for junk food and the sedentary lives that today’s kids lead already has caused an unprecedented jump in childhood obesity...The food industry [must] voluntarily change the content of the ads it produces for children. Otherwise it too could stand accused of killing our kids for profit. There’s no way to sugarcoat that.

The New York Post published “How Kids ‘Ad’ on Pounds:”

Children are getting fat because artichokes, broccoli and cucumbers get less TV advertising than pizza, burgers and sweets, a new study says.

More than 70 percent of food advertising is for candy, snacks and fast food, says the study by the Kaiser Family Foundation....City Health Commissioner Thomas Frieden said inundating youngsters with junk-food ads was scandalous given the "terrible epidemic of childhood obesity."

Headlines across the country were similarly disturbing, such as the Washington Post’s “Forced Feeding: Researchers say commercials for candy and fast food hit kids in the gut” and CBS News’ “Steady TV diet makes children obese.” One reporter at the Murfreesboro Post in TN posed a question of the study’s significance but then went on to make the very same logical fallacy as every other journalist. A believed correlation was turned into a causation, leading him to conclude: “While no scientific proof exists, it doesn’t take much thought to link these food commercials to America’s childhood obesity problem.”

As is clear to readers, there are politics afoot and what’s really behind these stories and the sweeping dissemination of the press release (through very effective marketing) are efforts to impose more restrictive regulations on the food industry. The food industry can defend itself. That is not the worry here. While most people would probably feel it’s unconscionable to use children to promote a political agenda, the primary concern for parents and heathcare providers is the welfare of children and factual information. Yet the full story was not to be found in the media.

For young parents, these articles reinforced the same myths that they hear everywhere and may have come to believe: that today’s children are eating the worst diets ever, that bad food makes children fat, and that fat children and their parents are not only lazy and irresponsible but their children are in peril of succumbing to chronic disease and early death.

The Kaiser study, however, did not find that TV ads were making children fat and it most certainly didn’t find anything remotely like they’re killing them. What this study and press release — and hence the media — craftily didn’t say is where you’ll find the information needed to bring balance to this situation and recognize it's all spin.

Since the first days of television, children have been exposed to ads for candy, sugary cereals and toy promotions. Babyboomers will fondly remember growing up during the 1950s, 1960s and 1970s with Tony the Tiger promoting Frosted Flakes as “Great!”, Freddie Flintstone dancing for Fruity Pebbles, Dubble Bubble gum, cartoon leprechauns enjoying colorful marshmallows in Lucky Charms, Captain Crunch, Twix the rabbit, Tweety Bird, Bugs Bunny and Daffy Duck all eating sweet stuff kids love. Ads for healthy eating were nonexistent. Never mind that we managed to survive childhood just fine, today’s parents without this historical balance are being led to believe that their children are being exposed to incredibly more commercials for these “bad” foods and that it is harming them.

The Kaiser study reported that in 2005, young children, ages 2-7, saw about a dozen food commercials a day — 4,400 a year. Of these food commercials, 34% were for candy and treats and 28% were for cereals. And tweens saw the most food ads, at about 21 a day. But the study failed to mention if this is more or less than in past generations! They simply made a note about rising rates of childhood obesity and left the public to make a connection.

As we’ve noted previously, with the variety of media options available to kids today, they are spending less time watching television. And, as Todd Zywicki, professor of law at Georgetown University Law Center, in a presentation on Obesity and Advertising Policy for the Federal Trade Commission, confirmed, the evidence shows the percentage of children watching excessive amounts of TV has continued to drop since 1990.

Kids are seeing fewer commercials, too. Be careful about concluding the opposite based upon reports on the escalating amount of money spent on television advertising to children because those could reflect the skyrocketing costs of advertising today, not the volume! According to Pauline M. Ippolito with the Bureau of Economics at the FTC, children today are spending fewer minutes than in 1977 viewing television advertising. She adds that since 1977, food ads on television are down 34% on kids shows and 50% on family shows. Since the 1970s, the FTC has had limits on the amount and types of advertising that could appear in children’s programming.

And the Kaiser report itself admits that since their study was done, the country’s top food companies have initiated even more new policies for advertising to children under 12 years of age and have been phasing out ads to children. “These policies include devoting at least half of their advertising across all venues to healthier foods or to messages that encourage fitness or nutrition, as well as reducing the use of licensed characters in advertising less healthy food options,” they write. This point never made the news.

“There is no indication that the percentage of food ads has risen versus other products,” over the decades, either, said Dr. Zywicki.

In fact, despite fears that the amount of “junk” depicted in food ads is soaring, the composition of ads has also “remained remarkably stable since the 1970s,” concluded Dale Kunkel, Ph.D. in a paper, “Children and television advertising,” published in 2001. Dr. Kunkel is a professor of Communication at the University of Arizona who has conducted extensive research on children’s advertising.

A study by researchers at the University of Delaware in Newark, published in the American Journal of Health Behavior, carefully analyzed the commercial content of television advertising targeting children in the United States since 1972 and concluded that “the types of products advertised have remained constant over 25 years.” They found that breakfast cereals are the most advertised food and has remained constant since 1972 (38.5% in 1972; 41% in 1976; 31% in 1987; 39.3% in 1994; 37.8% in 1996).

Sugary foods have appealed to kids for as long as kids have been kids.

Many papers claiming to have evidence that television advertising to children has gone to the dark side also use inadequate sampling strategies, according to Brian Young, BSc, Ph.D., economic psychologist at Exeter University, Devon, UK. It is easy to manipulate data by selectively sampling data. His research has found, for example, dramatic seasonal variations in advertising content. Toys dominate before the Christmas holidays while food treats are higher in the summer months when kids are home. And while children’s programming is popularly targeted by policy makers, he said, kids are exposed to more advertising during prime time when the family is watching TV. “An ‘adequate’ sampling strategy should take into account possible geographical variations within a country as well as weekly and seasonal variations,” said Dr. Young in a 2003 review of existing research on food advertising and obesity for the European Association of Communications Agencies. The Kaiser study sampled only during the summer months but still found a lower percentage of food products advertised to children than the 63% found in the historical perspective conducted at the University of Delaware.

The Kaiser study admirably tallied all of the commercials aired between 6 am and midnight for a week on each of the top networks and divided them by the number of hours children of various ages watch television. But, of course, this says nothing about how many of these commercials the children actually paid attention to. As any parent knows, kids are not sitting glued to the tube. “ It is well-known that people, including children, do not just sit and watch TV but talk, walk around, and time-share with various other activities like reading or doing homework,” said Dr. Young. Another Kaiser Family Foundation study on media usage examined here, confirmed this. It found that kids today are multi-tasking and doing their homework, playing a multiplayer online role playing game, talking on the phone, listening to iTunes, watching a DVD and IMing friends all at the same time!

Finally, despite all of these “positive” trends, concerning the question of whether television food advertising influences what kids eat or the onset of obesity, this new Kaiser study specifically states it didn’t address any of that. Junkfood Science readers know that eating right and exercising are the wrong things to focus on anyway, and won’t ever eradicate childhood obesity because the research has consistently shown that what children eat and do isn’t the cause for the diversity in sizes among children.

Even the Institute of Medicine’s 2005 report, “Food Marketing to Children and Youth: Threat or Opportunity,” repeatedly stated that the evidence is insufficient to claim a causal relationship from television advertising to fatness in children.

This was the same conclusion reached by Dr. Young: “After a careful and thorough examination of the published literature on the role of advertising in obesity, we can conclude that there is no evidence for a direct causal relationship between food advertising and obesity levels.” Some reports have found correlations, he noted, but none have “demonstrated a link between exposure to advertising for certain types of foods and an increase in consumption of those foods amongst adults and children.” And none have gone on to show that eating differences result in obesity.

Do junkfood ads really have kids surrounded?

But the most flagrantly misleading aspect of this report is its assertion that children’s “exposure to countervailing health messages on TV is minimal.” They use the fact that public service announcements (psas) promoting nutrition and exercise are far fewer in number than food ads.

They appear to honestly want us to believe that the only healthy eating messages children hear are in PSAs. By looking only at commercials, they fail to look at the CONTENT of children’s programming.

Decades of children grew up with the only cartoon character eating anything remotely “healthy” being Popeye the Sailor Man who chomped down spinach by the can.

For years now, our kids have been inundated by their favorite animated characters and programs devoted to telling them to eat right and exercise. But we are not to see messages as marketing when they are for "good" food. On Nickelodeon, SpongeBob SquarePants and Dora the Explorer are promoting fruits and vegetables, thanks to a partnership between Nickelodeon and the Alliance for a Healthier Generation. Back in 2005, Nickelodeon said it was spending $20 million and 10% of air time on health and wellness messages, such as a spot to encourage breakfast called “It’s Breakfast Time” with singing spoons and forks. Nickelodeon’s “Lazy" Town” has Robbie Rotten as a villain because he’s lazy and an athletic hero, Sportacus, who can be defeated if he eats sugar.

A few years ago, Sesame Street kicked off new programming, “Healthy Habits for Life.” Bert, Elmo and Grover are now teaching the importance of eating “healthy,” more fruits and vegetables, and being active. Big Bird, Elmo and the rest of the characters have been joined by vegetable Muppets encouraging kids to “eat your colors” and play the “healthy foods name game.” The Cookie Monster’s song is now “A cookie is a sometime food.”

Oh, a cookie is a sometime food

There are plenty of other fruits and veg'tables

That are healthy for you all the time

They're delicious, they are yummy

Try an apple, peach, or plummy

'Cause......

A cookie is a sometime food

Yes, a cookie is a sometime food

Oh, a cookie is a sometime food

If you're looking for a-something to snack on

For somethin' sweet, you're in the mood

Try an orange or some cherries

Try a melon or some berries

'Cause......

A cookie is a sometime food

But an apple is an any time food

Yes a banana is an any time food

Yes, a fruit is an any time food!

Yes, a fruit is an any time food!

It appears cartoon characters in the UK are also being employed to get kids to eat more fruits and vegetables. The BBC reported “Elffy foods” features a team of elves who earn themselves special powers every time they pick up healthy food.

PBS’ Boohbah and the Disney Channel’s JoJo’s Circus invite young viewers to get off the couch and move with the characters. “The Wiggles” tells kids to eat healthy food and teaches health with songs such as “Fruit Salad, Yummy Yummy.”

And Veggie Tales run for what seems like hours during the weekend on our local station.

As one parent wrote:

Disgusting. Obesity is the tobacco use of the millennium. When I was a kid, we were bombarded at school to avoid cigarettes. The after school specials warned against tobacco use. Cartoon characters talked about hating smoke, etc. Now, there’s “Lazy Town” and Barney’s song.... Every kids’ commercial I see talks about balanced nutrition. My son is constantly asking me, “Mommy, is this healthy?” So no, kids are not oblivious to healthy eating. They are certainly getting the message that ‘healthy eating’ and exercise are important.

And this is just a glimpse of children’s programming. Prime time is filled with shows featuring the biggest weight losers, make-overs, and nonstop news about the obesity epidemic and need for healthy lifestyles. Of course, we’d never realize any of this from reading the news this week. Instead, we are to uncritically accept that “bad” food has our children surrounded and we are to fear for them. And worse, that it is something our sweet children should grow up worrying about. Missing is balance, calmness and common sense. Based on all available credible evidence, we really can dare to let kids be kids and simply enjoy their childhoods.

© 2007 Sandy Szwarc

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The “O” word

Penn & Teller looked at the obesity epidemic this past week. Behind their rather lascivious, attention-getting style is some hard-hitting truth. In revealing the myths behind obesity and dieting, they also exposed the profit motives behind the creation of a crisis. Their points were illustrated in typical P&T style by visitng an obesity conference to talk with the experts and holding a “Fat Guy Olympics.” Fat women at a NAAFA social describe the discrimination faced by fat people.

According toTV Squad:

Penn & Teller come at their subjects with a mix of profanity, humor and moral righteousness. Like Houdini, who spent the latter part of his life exposing fraudulent spiritualists, Penn & Teller are men on a mission. Their collective heart is in this because, more often than not, they see people being exploited or taken advantage of by those who would perpetuate any number of falsehoods for personal gain. They're like potty-mouthed superheroes - fighting for truth, justice and the American way so long as the American way includes naked chicks and carnival barkers.

You’ve been warned: Watch at work at your own risk, unless “you’ve always wanted a paper route.”

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Behind the locker room door

We typically think of girls and young women in sports such as gymnastics, with its recognized focus on weight management, when we consider sports' role in eating disorders. But a study published in this month’s issue of the Journal of the American Dietetic Association indicates we might need to give added consideration to the effects sports are having on young males.

In this study, researchers at the University of Minnesota who have been following 4,746 Minneapolis-St. Paul teenagers as part of Project EAT (Eating Among Teens), surveyed teens who said they were in a sport or activity where it was important to stay a certain weight. Twenty percent of the males reported participating in sports emphasizing their weight. Perhaps surprisingly, that was more males subject to sports-related weight concerns, than females.

And in contrast to girls, where participation in weight-related sports activities rose with their family’s income level, among boys it was the reverse, with nearly half from low and low-middle income brackets.

The increased risks for eating disorders found among sports participants has been widely documented. The significance of these concerns was highlighted in an especially troubling finding among these growing teenagers. The researchers found that 17% of the young people, of both genders, involved in these sports activities were underweight — that’s considerably higher than the 3.3% of underweight kids among the general population.

As the researchers noted, adolescents can feel pressure to lose weight or maintain a certain weight due to the demands of the sport as well as society’s expectations of successful sports participants. They noted studies documenting that coaches, teammates, parents, and even a young participant’s drive to achieve, increase risks for unhealthful weight-control behaviors.

But the degree to which participating in these activities increased the risks for unhealthful weight-control behaviors among the young males was startling. Compared to those not engaged in sports, there was about a six-fold increase each in vomiting, laxative use and diuretic use in the past week among male participants. And they had a 3.7 times higher steroid usage and nearly 3 times more diet pill usage. Overall, more than 10% of the young male sports participants had engaged in some type of extreme weight control behavior during the past year. These significant associations remained despite their BMI, economic status, education level and other possible factors.

While the effect of sports participation in increasing the chances for such risky behaviors among the girls was less than the boys, the researchers noted it was mostly due to the higher prevalence of such weight-control behaviors among the general population of females regardless of if they were participating in sports. In fact, overall, about 17% of female sports participants as compared with 11.5% of nonparticipating girls had engaged in some extreme weight-control behavior during the past year.

The researchers did consider the seasonality of certain activities, which is why they looked at these behaviors over both the past week and year long periods, and the results were nearly the same. What was especially helpful about this study was that the researchers didn’t set out to pre-define what sports activities young people might feel pressure to control or lose weight, but let them define it based on their perception of weight pressure.

Although, as with any population study, they couldn’t untangle the associations to demonstrate causation — perhaps those more preoccupied with their weight are drawn into these sports activities, for example, rather than just the sports increasing the weight-controlling efforts — but this information can still serve as a helpful heads up to parents, teachers and healthcare providers to be especially on the alert for unhealthful efforts to control weight among these teens and help promote their body acceptance.

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If we passed out grades for science

Americans were given poor marks this past week for not eating their fruits and vegetables, but the news got the story wrong. The “F” should have gone to the experts.

A report conducted by epidemiologists at Johns Hopkins in Baltimore, Maryland, was published in the American Journal of Preventive Medicine, just as another public health initiative to encourage Americans to eat more fruits and vegetables was launched by the Produce for Better Health Foundation and Centers for Disease Control and Prevention.

This study examined data from national dietary surveys (NHANES) conducted in 1988-1994 and 1999-2002. Its goal was to evaluate the success of national efforts — namely the 5-A-Day for Better Health Program launched in 1991 which included public health messaging and advertising; education; and school, community and workplace programs — to encourage Americans to eat more fruits and vegetables, in compliance with the Dietary Guidelines to help reduce risks for cancer, heart disease and obesity.

What the data showed was that after 15 years, the entire campaign has been a dismal failure.

Americans were eating 3.06 servings of fruits and vegetables a day when the initiatives began and are eating 3.04 servings today. These unfavorable findings were also confirmed in a CDC report issued last week, using random telephone survey data from the 2005 Behavioral Risk Factor Surveillance System.

There was “no indication of improvement,” said the John Hopkins researchers. “New strategies are necessary to help Americans make desirable behavioral changes to consume a healthy diet that includes a variety of fruits and vegetables.”

To coincide with this report, the Produce for Better Health Foundation (PBH) issued a press release announcing another new program called “Fruit & Veggies—More Matters.” It’s the next rendition of their 5-A-Day program.

Once upon a time…

Before we delve into the evidence on this issue, to help us think critically and understand the significance of all of this, let’s trace back 15 years. The National Cancer Institute began a program to promote the 5-A-Day message to increase consumption of fruits and vegetables as part of a low-fat, high fiber diet. It sent out notices that NIH research grant money was available for programs that implemented and evaluated these interventions and put up $4 million for each of the first four years. Grants would only be issued, said the NCI’s Guide, to applicants whose interventions used “a model of behavioral change, integrating constructs from appropriate theories such as...social marketing, social cognitive theory, health belief model, stages of change and diffusion of innovations.” Part of every plan was supposed to include evaluating the effectiveness of the objectives to increase daily consumption of fruits and vegetables among the target populations.

A nonprofit group was formed in May, 1991, consisting of 76 produce-related interests, such as growers, shippers, producers, suppliers, commodity boards, supermarkets and manufacturers. Calling itself the Produce for Better Health Foundation, it co-sponsored 5-A-Day with the NCI which gave it the license to use the 5-A-Day logo and trademarked materials. In turn, PBH could issue sublicenses to their partners. By February 1992, according to the NCI, more than 80 retailers, representing more than 25, 000 stores, had signed licensing agreements, and more than 50 merchandisers were licensed.

PBH says it is now the country’s largest public-private nutrition education initiative with coordinators in every state, territory, and the military. PBH coordinators are also part of state food stamp programs, U.S. Dept. of Agriculture-funded school classroom nutrition curriculums, and school lunch initiatives. PBH has grown to become an organization with over 700 members that now include trade associations, food industry organizations, health insurers, medical and nutrition professional groups, and retailers for 30,000 national supermarkets. Members pay a minimum of $1,000 to use the 5-A-Day logo and graphics, with Platinum members paying upwards of $100,000. PBH also receives contributions from various interests, which this year total $7,753,626. In addition, its 90-member Board represents every produce-related interest imaginable, from ConAgra Foods, Inc. to Alberts Organics; Wild Oats Markets, Inc. to Safeway, Inc.; Gerber Products Co. to Wegmans Food Markets.

PBH also now chairs a National 5-D-Day Partnership, consisting of government agencies, non-profit organizations and industry groups. Its national partners include the CDC and U.S. Dept. of Agriculture; trade and lobbying organizations such as the American Cancer Society, American Diabetes Association and American Heart Association; and the National Alliance for Nutrition and Activity (NANA). NANA may be unfamiliar to many, although it may be the most influential. PBH partners support NANA’s initiatives, which include national and state nutrition, physical activity and obesity programs; and School Wellness Policies under the Child Nutrition and WIC Reauthorization Act of 2005, which mandated that schools receive federal funds to address nutrition and physical activity. NANA has been a key lobbying group for national policies and programs to promote healthy eating and exercise in order to reduce “diet and inactivity-related diseases,” such as heart disease, cancer, high blood pressure, diabetes and obesity. NANA’s nutrition policy initiatives were founded and coordinated by Margo Wootan, director of nutrition policy at CSPI (Center for Science in the Public Interest), who is also on the Steering Committee and co-chair of the Policy Subcommittee for the National 5-A-Day Partnership. A recent PBH National Excellence Awards honored Ms Wootan’s leadership as being “largely responsible for elevating nutrition and physical activity policy to today’s current position as major components in the ongoing national health care debate.”

The lobbying has paid off. In a 2001 statement, Ms Wootan said NANA had successfully lobbied to increase the budget of the CDC’s Division of Nutrition and Physical Activity 8-fold in just 2 years: from $2 million in 1999 to $16 million in 2001. They were urging Congress for $50 million for 2002.

In 2005, the CDC rather than the NCI, became the lead federal agency for Better Produce for Health programs and its national fruit and vegetable initiatives. In addition to the 5-A-Day program, the CDC’s Division of Nutrition and Physical Activity now funds programs promoting healthy eating and physical activities, obesity prevention, public health research, communication campaigns and national surveys.

NANA has grown now to more than 300 state and national organizations, agencies and nonprofit groups all interested in promoting healthy lifestyles, exercise and fitness, nutrition and wellness. The vast moneys these nonprofits have collected and poured into healthy eating and exercise initiatives is incomprehensible. NANA has also led the way to increasing current CDC funding to $41 million a year. Its 2007 National Health Priorities paper, available through CSPI here, has asked Congress to appropriate $65 million for 2008, with $5 million specifically for fruit and vegetable programs.

Since 1999, the CDC budget for healthy eating and activity initiatives has grown 2,000 percent. PBH’s programs, membership and partnerships have grown along with it, as have an enormous throng of organizations revolving around healthy eating and exercise..

The point here is not to demonize anyone. Ad hominum attacks are for junk scientists. The point is to help us realize that it’s not just direct financial ties to industry that can bring conflicts of interest or bias. Professional careers, growing budgets and staff, prestige and recognition, and being part of a group perceived as doing good important work, can all cloud objectivity even more than financial rewards alone. Many come to passionately believe in the right and good of what they are doing.

But now that we understand the bigger picture, we can ask ourselves: How likely is it that this massive machine and momentum might suddenly grind to a halt, disband, end careers, and say “Never mind, we were wrong?”

Not likely at all — no matter how flawed the evidence for their initiatives and how many decades it is shown to be ineffective. And because we’ve come to believe these nonprofit groups, professionals and agencies are the good guys, we’ve also come to believe that eating “right” and having a healthy lifestyle is the right and necessary thing to do. So we similarly fail to question or consider if they are presenting the science objectively, or if they might have an interest in spinning the research, exaggerating or putting the best light on things possible.

In the beginning

The fact that no healthy eating and lifestyle educational effort has been effective in changing behavior is not surprising at all, given the evidence, as we’ll see in a moment. But how strong was the evidence for such an initiative from the very beginning?

A review of available case-control and prospective epidemiological studies on fruits and vegetables and healthy eating, published through 1991, was done for the NCI. Back then, the reviewers found a very large body of evidence showing a relationship between fruit and vegetable intake and cancer risks, but they noted that few investigators had looked at the strength of the evidence and had, instead, tried to identify some special factor in the food. But it is impossible to be confident that benefits come from a particular food or factor, they cautioned in the paper. They found that the vast majority of studies reported their results in terms of relative risks and while many found strong associations, others had found none. But because a biological rationale for a possible protective effect of fruits and vegetables was believed to be strong — such as antioxidants like vitamin C and vitamin E, and folate and fiber — they concluded it wasn’t necessary to understand the science before taking action for public health.

A later examination of the scientific literature published since 1999 to 2001 was done for PBH by Dianne Hyson, Ph.D., MS, RD. Her report, “The Health Benefits of Fruits and Vegetables —A Scientific Overview for Health Professionals,” was carefully written, but the actual evidence to support the special benefits of produce continued to be built on a series of correlations found in case-control studies. However, “the results of the new prospective trials have been less conclusive,” she concluded in her overview. On breast cancer, for example, “data from 8 prospective trials found no association between intake of fruits and vegetables and reduced risk of breast cancer.” Throughout the report are notes finding that some population and case controlled studies have found positive correlations, but confounding factors, such as socioeconomic status, that might influence health discrepancies might explain the findings. “It will be important to see if dietary intervention studies confirm the potential benefits,” she cautioned repeatedly. The trials to date suggesting benefits have looked at biomarkers associated with risks for certain diseases (surrogate endpoints), rather than actual diseases, health outcomes or mortality. And that, as we've seen, is what matters most.

She also reported on the inconsistency of various findings looking for correlations among populations. “However, results from several recent prospective investigations have not consistently shown this effect...in reducing risk of colorectal cancers...stomach cancers...” For instance, while a small number of studies have suggested that fruit and vegetable consumption is associated with reduced risk of developing diabetes and improved control of blood sugar levels, she writes, these analyses “must be viewed cautiously...these results are in contrast to another prospective study published recently in which fruit and vegetable intake was not directly associated with incidence of type 2 diabetes in older women followed prospectively for 6 years.”

Examining the conflicting studies on produce and bone health, she concluded, “current available data suggest that there may be a link between bone health and fruit and vegetable consumption, although further investigation is needed to confirm the mechanisms and specific constituents in fruits and vegetables that might account for the association. [italics added] One can almost read the difficult tightrope she was walking.

Looking at longevity claims, she examined a 26-year prospective study of longevity among men in Sweden. She notes it found “no relationship between vegetable consumption and mortality or other major diseases... and at 26 year, the protective association with fruits was no longer statistically significant.” Her lengthy paper references 125 papers, all with similar findings and caveats. She concluded:

The most convincing data for a relationship between fruit and vegetable intake and disease prevention would be provided by large randomized trial or intervention studies providing fruits and vegetables to defined populations for a period of time and assessing health-related outcomes....such trials have not been conducted...Collectively, the current evidence supports a significant association between fruit and vegetable intake and health.

While a varied diet, complete with a beautiful array of fruits and vegetables, has been soundly shown to help prevent nutritional deficiencies, have we perhaps exaggerated the magical abilities of certain foods, diets and ingredients to help keep us youthful, healthy and prevent diseases? The evidence continues to appear to suggest so. Dare we even consider the possibility?

Looking back at the NCI’s original 5-A-Day for Better Health guide to NIH grants, the “Scientific Rationale” included the review already noted above, as well as a 1990 review conducted by Walter Willet, M.D., DrPH, professor of epidemiology and nutrition at Harvard School of Public Health in Boston, MA. Dr. Willet was also one of the individuals who wrote the PBH’s current National Action Plan. The NCI wrote that according to Willet “the inverse relationship between the intake of vegetables and fruits and the risk of lung cancer represents one of the best established associations in the field of nutritional epidemiology.” But looking at the study itself, which was actually a study of vitamin A and lung cancer, it appears the author’s enthusiasm was considerably more tempered:

Although initial studies suggested that persons with lower levels of serum retinol have higher future rates of lung cancer, this idea was not confirmed in subsequent investigations. Prediagnostic levels of beta-carotene in blood, however, have been inversely related with risk of lung cancer. Available data thus strongly support the hypothesis that dietary carotenoids reduce the risk of lung cancer, but the data are also compatible with the possibility that some other factor in these foods is responsible for the lower risk. Even if ultimately shown to be casual, the relation between diet and lung cancer is modest compared with the deleterious effect of cigarette smoking.

And most of us heard nothing of the latest NCI study, led by Dr. Willet in 2004, which set out to better define the relationship between fruits and vegetables and risks for major chronic diseases. Prior to beginning their study, the authors wrote that to date, “studies of fruit and vegetable consumption in relation to overall health are limited.” After examining the data on 71,910 women and 37,725 men followed for 15 years, they found no relationship between fruits and vegetables and cancer and no statistically significant associations with major chronic disease or cardiovascular disease.

Evidence in action

It appears, however, that evidence alone might not be enough to deter today’s growing fixation with “healthy” eating and exercise.

Over the past 15 years, as the fruit and vegetable public health education strategies have repeatedly been shown to be ineffective, the result has been larger budgets and bigger, more comprehensive programs. Each time a national health survey has found that consumption of fruits and vegetables among Americans has failed to change, or has even declined slightly, calls have gone out that “additional efforts and new strategies are needed.” For example, a CDC study published in the American Journal of Public Health in 2004 found little change in product consumption from 1994 to 2000.

According to its most recent National Action Plan, PBH’s 5-A-Day and healthy eating strategies have expanded to include innumerable programs and encompass over 75 strategies, targeting every conceivable setting:

• Marketing to children

• Supermarkets and retailers

• Fruit and vegetables growers, processors and shippers

• Cafeterias, restaurants and other food establishments

• Schools, daycare centers and youth camps

• Worksites

• Health care industry and health organizations

• Communities

• Research entities

• Federal policies

- Food and nutrition assistance programs

- Centers for Disease Control and Prevention

- Food and Drug Administration

5-A-Day related programs continue to grow and it’s hard to imagine something that hasn’t been tried. In 2005, PBH partnered with the USDA and 30 industry groups to unveil its Phytochemical Information Center, to encourage consumers to eat more produce by promoting special qualities and emerging science on phytochemicals, making it a top nutrition news story, and creating an online food composition database. PBH partnered with Sesame Street for programming for preschoolers, and Dreamworks and Walmart to create its Over the Hedge programs to teach kids to eat more colorful produce.

Marketing to children and initiatives that include billboards, direct mailings, supermarket and retailer messagings, restaurant and food establishment merchandizing and promotions, and school programs fill their action plan. Yet, their own paper noted (and ignored) that the 2003 Roper Youth Report found that among all ages of children and teens, parents have the primary influence on their food choices, with advertisements and teachers almost none.

Which brings us to the latest $3.5 million campaign: “Fruits & Veggies — More Matters.” There’s an interesting story behind its creation that was described in a publication of PBH Board member, the Florida Fruit and Vegetable Association. In 2005, realizing that their 5-A-Day campaign was no longer working or viable, PBH looked to create a new campaign to motivate people to eat more fruits and vegetables. PBH partners brought in experts from leading professional branding agencies across the country. They chose Sterling Brands, based in New York. A task force of PBH representatives working with Sterling shadowed families for days. They reported that: “the moms told us, ‘we think we’re doing okay for our families. We don’t want you to preach to us.’” Their research found that most mothers already know the benefits of eating fruits and vegetables and a healthy diet. So, when developing their new brand, did they acknowledge the evidence their own research found? You decide.

The Washington Post described the just-released campaign in an article this week titled, “Look for a juggler:”

Despite this effort, the public is not consuming the recommended amount of fruits and vegetables...Yet research clearly shows that a diet rich in fruits and vegetables can help control blood pressure, reduce risk of heart disease and stroke, cut the incidence of diabetes and lower the odds of developing some types of cancer. ...Eating more fruits and vegetables may help prevent some age-related vision problems, and it even helps improve bone density, key to staving off osteoporosis....

A bright green juggler tossing colorful fruits and vegetables through the air is likely to make it a bit easier for consumers to spot healthy foods and drinks that can help them meet their nutritional goals. The icon will appear on fresh produce as well as canned, frozen and dried products that meet nutritional criteria set by the CDC. About 21,000 supermarkets and 170 companies are already licensed to use the icons, according to PBH. To earn the juggler icon, a product needs to contain at least one serving of fruit or vegetables per portion....The program sets strict limits on the amounts of added sugars or sugar substitutes, fat and sodium.

While the new program is designed to boost fruit and vegetable intake throughout the population, it specifically targets mothers who make the most food choices for their families....“All are designed to make healthy choices easier choices,” said William Dietz, director of the CDC's Division of Nutrition and Physical Activity.

The overwhelming message I hear in these initiatives, and the claims made in the article in support of them, is a paternalistic belief that we are all making bad choices, eating wrong, and unable to feed ourselves or our children without the growing involvement of experts to help us make the right choices. Eating right is a matter of good versus bad foods, and the “healthy” choice is perceived as the good one. The pursuit of health must be our paramount concern in everything we do.

But can the need for this popular imperative and the intense fixation on healthism be credibly supported?

We’ve already examined that, contrary to beliefs and fears about junk food and our modern diets, we have the safest and most abundant supply of wholesome food ever in our country’s history.

And every annual report on the actual health of Americans that’s been issued over recent decades by the CDC has brought better and better news. Headline were made in 2002 as the CDC reported that in the past fifty years, death rates among children and adults had been cut in half and even dropped by a third among our eldest citizens. By the year 2000, Americans enjoyed the longest life expectancy in U.S. history. And the most recent report,Health United States 2006, reported that life expectancy for our population has continued to rise from 1990, reaching a record of 77.9 years.

Since 2000, age-adjusted mortality from heart disease had dropped another 16% and cancer another 8%.

The actual evidence on the state of our health is good news! It calls into question any apparent health crisis because we haven’t increased our fruits and vegetables, or complied sufficiently with some other prescribed lifestyle choice, for the past 15 years.

According to the CDC data, however, certain health inequities are still in evidence, notably among the poorer, minority members of our society. Interestingly, this past week’s study by the John Hopkins epidemiologists also found that fewer poor people met national recommendations for fruits and vegetables. But it is a fallacy in logic to conclude that produce or poor diet is, therefore, the cause for those health inequities. As is common with many associations between health and certain foods, diets and lifestyles, they often turn out to be markers for socioeconomic status, social inequities, stress or other life factors that impact health. This highlights the harm and waste of limited resources when associations are mistakenly taken as causations. Of course, it is far easier to direct energies to a nonproblem that sounds good, is fashionable and makes loads of money, than to face really hard problems such as food insecurity, discrimination and poverty.

The biggest failure of all

Is there any evidence for the effectiveness of efforts to counsel, advise, educate and motivate people into eating more fruits and vegetables or eat “healthy”? The answer may surprise you.

Remember the U.S. Preventive Services Task Force? As we’ve noted, it is sponsored by the Agency for Healthcare Research and Quality, the Federal government’s lead agency under the U.S. Health and Services Department, and is charged with examining the soundest research and issuing careful, evidence-based findings that are supposed to be used in all aspects of government healthcare spending and public health policies. But, as we’ve seen, its findings and recommendations aren’t always followed.

What has the USPSTF advised about counseling to promote a healthy diet?

The USPSTF, in updating its 1996 findings, again concluded in 2003 that there is insufficient evidence to recommend routine behavioral counseling to promote a healthy diet in adults.

They found that the evidence was only fair that even medium-intensity dietary counseling could produce small to medium changes in diet. “The strength of this evidence, however, is limited by reliance on self-reported diet outcomes, limited use of measures corroborating reported changes in diet, limited followup data beyond 6 to 12 months, and enrollment of study participants who may not be fully representative of primary care patients. In addition, there is limited evidence to assess possible harms.”

And concerning even high-intensity interventions, they found studies showing changes in the diet among patients with specific diet-related diseases or highly selected patient populations with specially trained providers, but that these findings couldn’t point to effective interventions addressing diet or broader lifestyle interventions for wider use in the general population. They concluded that “existing studies do not provide sufficient evidence to recommend these interventions for widespread use due to a number of limitations such as modest overall patient recruitment/participation rates, reliance on self-reported outcome measures, relatively short followup periods, uncertainty about the health effects of small and medium changes in diet, and the lack of evidence about possible adverse effects of counseling.” They found no controlled trials of routine behavioral dietary counseling of any intensity for children or adolescents to indicate effectiveness in the primary care setting.

If decades of research had presented any convincing evidence for the benefit and long-term effectiveness of behavioral counseling to get people to eat healthfully, it would have caught the attention of experts by now. So, it was actually not surprising — even after 15 years and throwing every possible tactic into the efforts — that the 5-A-Day campaign has continued to demonstrate no success in increasing fruit and vegetable consumption.

Despite this lack evidence, however, professionals working in medicine, preventive health, nutrition, education, and public agencies are being especially targeted and encouraged to be agents of change in compelling healthy eating and behaviors — by the government, our professional organizations and even insurers (compliance used as reimbursement measures). As the PBH action plan advises:

Train health care providers such as pediatricians, nurses and family pracitioners [sic] to deliver effective, behaviorally-focused programs and messages about fruits and vegetables to all populations and subgroups. Provide appropriately tailored messages for specific populations such as children and persons with particular health conditions such as overweight, hypertension, high cholesterol and/or diabetes.

• Include consistent, behaviorally-focused messages about dietary recommendations for fruits and vegetables and practical tips for increasing consumption in guidelines and materials produced by professional and health voluntary organizations

• Develop an incentive-based approach for public and private health insurers to promote fruit and vegetable intake among subscribers (Medicaid, Medicare, state children’s health insurance programs, and federal, state and local, and private insurers).

As professionals, we might ask ourselves if our credibility is jeopardized among those we care for and advise when we become messengers in social agendas that may not be sound or in the best interest of our patients. Beyond making available basic nutritional information and guidance when medical needs dictate, do we damage people’s trust when we try and tell them how they must eat and live their lives? Might most people be perfectly capable of feeding themselves without our intervention? This isn’t a political question, but one of people’s welfare. Today's pervasive message of panic over “bad” foods, beliefs surrounding “good” foods, and urgency in the admonitions that we all must eat healthy and exercise a certain way lest we become diseased and doomed to an early grave, or that there is some ideal diet everyone must abide by before good health is even possible, have simply gone beyond the available science and into speculation and myth. A worrisome effect is that growing numbers of people are afraid for their health, fear for the safety and wholesomeness of their food and its ability to provide adequate nourishment unless every morsel is proper, and are scared that every “bad” thing they do might be a reason for blame, guilt and condemnation. Choices made in fear and emotion are less apt to use careful reasoning. Yet nowhere in public discussion has the harm resulting from these incessant messages even been considered. In this climate, less is more. It may be most helpful and healthful for ourselves and everyone if we step back and let our own common sense guide us.

There's another result from today's healthism. By furthering the idea that only experts and authorities know what’s best and fostering a sense of dependence, rather than empowerment, these messages also have a slow, steady effect of undermining people’s confidence in their own ability to decide what is best for themselves.

So this past week, we were presented with more evidence of 15 years of failure of a massive public health initiative that was based on well-intentioned, but unresolved medical evidence, and utilized methods with no evidence at all. Now, what will we do with it?

© 2007 Sandy Szwarc

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Science is so inconvenient to food scares

The Christian Broadcasting Network finally wrapped up its series on the oft-repeated health fears surrounding MSG (monosodium glutamate), adding a newer claim that it could be what’s making us all fat.

Their Science and Medical Reporter wrote that MSG is being secretly hidden in our foods to get us addicted to them, and every fast food and restaurant meal is loaded with the stuff. According to his reports, MSG is taking years from our lives and every bite of MSG-containing food we eat raises the amount in our bloodstream higher and higher, clogging arteries and causing heart attacks and strokes (cardiologists supposedly don’t know about this); silently damaging the lungs, contributing to rising rates of asthma; damaging the pancreas and leading to diabetes; and causing cancers. Unborn babies and young children, readers read, were most threatened.

As one of the world’s longest lasting food scares, the internet has given MSG hoaxes added life. These same scary claims have been repeated for decades, accusing MSG of causing everything from migraines, ADHD, autism, diabetes, Alzheimer’s to cancers. One website says that it’s never been tested on humans because researchers have been reluctant to expose humans to MSG because of the toxic effects it causes on the central nervous system and other bodily functions. “In fact, neuroscientists have been known to use MSG specifically to kill nerve cells in the lab. YIKES!”

Before getting caught up in fear, information to the rescue. From the “it keeps on going and going” bunny files....

MSG is simply glutamate, water and sodium. It dissolves into these three things the moment it hits our tongue. With a scary chemical name, many people believe it’s made from chemicals. But it’s a “chemical” only in the same way that everything in nature is chemicals — like water and oxygen. MSG is made by fermenting foods such as sugar beets, sugar cane or corn and has been made for more than a hundred years. Similarly, for more than a thousand years humans have been cooking up food products and flavorings to enjoy the flavor-enhancement that comes from glutamate. Think dashi, the soup stock made from seaweed; Thai fish sauce from fermented fish broth; and soy sauce (shoyu) made from fermented soybeans and grains.

Glutamate is one of the most common amino acids (building blocks of protein) found in nature. It was first isolated in 1866 and is found in virtually every food we eat, including natural protein foods such as meat, fish, milk and some vegetables like tomatoes, seaweeds and mushrooms. Glutamate is so essential to our metabolism, growth and brain function, that it’s even produced by our own bodies, to the tune of about 50 grams of free glutamate a day. Our muscles, organs and tissues naturally contain about 4 pounds of glutamate and it’s also abundant in breast milk (at levels ten times that of cow’s milk).

Glutamate is found bound with proteins and is broken down during digestion into free glutamate. While some claim that free glutamate, as is found in MSG, isn’t found naturally and try to frighten us into thinking it’s uniquely dangerous, that’s incorrect. Free glutamate is also found in nature in lots of foods and is formed as vegetables naturally ripen and mature. Free glutamate is in tomatoes, broccoli, mushrooms, peas, grapes, walnuts, milk, eggs, potatoes and chicken. It is also formed when certain foods are processed. This is what brings out the flavors in foods — and the free glutamate — which our glutamate taste receptors sense. Here again, it’s easy to believe that “processed foods” means an unnatural act. It is nothing more than cooking or fermenting foods — as in making cheeses, beers and soy sauces — things that humans have been doing for countless generations!

Believe it or not, the “processed foods” with the highest amounts of free glutamate include:

soy sauce (1,090 mg/ml)

parmesan cheese (1,200 mg/ml)

roquefort cheese (1,280 mg/ml)

marmite (1,960 mg/ml)

Countless scientific expert panels have examined the evidence on glutamates and found that the body handles all glutamate the same way, regardless of the source. When we eat a meal, the amount of glutamate that might come from MSG is a tiny fraction of the glutamate in the food itself. There’s a reason for that. It’s the “a little dab will do you” phenomenon. The taste of MSG is self-limiting, meaning once the optimum level is added to foods (usually around 0.3%), more doesn’t make it taste better, but worse. “Results of taste panel studies on processed foods indicate that an MSG level of 0.2-0.8 % of food by weight optimally enhances the natural food flavour,” according to Wageningen University in the Netherlands, one of the leading areas for Food Technology and Nutrition in the world. While the average person eats between 10 and 20 grams of glutamate a day, the amount from MSG in our diet is a mere 0.5 to 1.5 grams.

Japan has one of the highest daily intakes of MSG in the world, according to Wageningen scientists, at 1.5 grams per day, three times that of Americans. If MSG was really so dangerous as to shorten lives, then Japan probably wouldn’t have the longest healthy life expectancy (number of years in "full health") among 191 countries of the world, at 74.5 years, as the World Health Organization recently reported.

Marmite is a yeast extract spread that’s been one of the UK’s most popular savory spreads for more than a hundred years, and sought after for its nutritional properties. England ranks 14th in the world’s healthiest life expectancies, at 71.7 years, far ahead of the U.S. at 24th at 70 years.

And then there’s roquefort cheese. It’s one of the oldest known cheeses in the world and considered one of the greatest cheeses of France. And the celebrated cheese of Italy, Parmigiano-reggiano, is viewed as a symbol of culture and civilization. Yet both France and Italy are in the world’s top ten healthiest countries. Even common sense would tell us that if these foods were really harming people, it’s unlikely they would have grown to become the core ingredients in what are considered some of the world’s “healthiest” cuisines.

Strangely absent in all these countries, too, are fears of incapacitating syndromes from eating glutamate, even though their most prized foods have the highest free glutamate levels around. Epidemiological evidence simply does not offer support for extreme fears over free glutamate or MSG.

There’s also been so much biochemical, toxicological and medical studies that have shown and shown again that MSG, and the hydrolyzed proteins used in the same way as MSG, is safe for the general population, including pregnant and nursing mothers and children. In fact, there have been so many reviews of the evidence by expert scientific agencies around the world, that it is becoming redundant. In 1958 the U.S. Food and Drug Administration designated MSG as a Generally Recognized As Safe (GRAS) ingredient and has conducted ongoing reviews of glutamates used in processed foods ever since. The Federation of American Societies for Experimental Biology (FASEB) examined the evidence in 1980 and again in 1995 for the FDA and again concluded it was safe. MSG is actually one of the most intensely-studied food ingredients in our food supply and found safe by the Joint Expert Committee on Food Additives of the United Nations Food and Agriculture Organization and World Health Organization, which placed it in the safest categories of food additives. In 1991 the European Community’s Scientific Committee for Food confirmed the safety of MSG. The Food Standards Australia New Zealand conducted a review in 2002 and said the evidence confirms the safety of MSG.

And just this month, the European Journal of Clinical Nutrition has published an update of the Hohenheim consensus meetings where experts met at the University of Hohenheim, Stuttgart, Germany, and examined the evidence since 1997. They reiterated that MSG “can be regarded as harmless for the whole population.” The amount consumed in European countries has been stable and well under the amount considered safe, and even in unphysiologically high doses (i.e., inedible), they found that the science showed it does not enter the fetal circulation.

While there is so much evidence disproving concerns, we know that junk scientists will continue to try and find something to hang their scares on. Rather than dissect every one of the claims and poor studies that have been thrown out trying to support scares, as an illustration, we’ll take the latest one being used to claim it causes obesity.

Researchers at Aschauhof Altenhof, Germany, published a study in the European Journal of Clinical Nutrition in which they concluded that their study “for the first time demonstrates that a widely used nutritional monosubstance—the flavouring agent MSG—at concentrations that only slightly surpass those found in everyday human food, exhibits significant potential for damaging the hypothalamic regulation of appetite, and thereby determines the propensity of world-wide obesity.”

In this study, they fed Wistar rats 2.5 grams and 5 grams of MSG — amounts so large they were, respectively, 10 and 20% of the dry weight of their daily food ration! Not surprisingly, they reported that the rats drank three times more water and were hungry and wanted more food (no doubt trying to get enough nutrients). This is exactly the tactic used in other studies claiming glutamate causes neurological or vision damage: the amounts of MSG fed or injected into the rats are such extremely high amounts they are irrelevant to human diets because the food would be inedible.

Trying to scare us to believe that if toxic levels in rats are harmful, then lower intakes for us could be dangerous, too, also ignores the most fundamental principle of toxicology: the dose makes the poison.

Per this study, for example, the average-size woman would have to eat 62 ounces (1770 grams) of pure MSG a day to replicate those effects seen in the rats! That’s 3,540 times more than the average American eats in a day.

Evil motives have been implied by the fact the MSG makes food taste better and, therefore, people might eat more. How sad that the idea of enjoying food has become something sinister among some people today. The illusive, savory taste that made glutamate foods so delicious was first identified and isolated by Kikunae Ikeda, Ph.D. of Japan in 1908. He called the taste “umami,” meaning “deliciousness.” His paper was finally translated into English nearly a hundred years later and published in the journal Chemical Senses in 2002. Umami — the fifth taste — was finally added to the quartet of sweet, sour, salty and bitter taste receptors and became the buzz among gourmands. Food writers and chefs rushed to demonstrate their sophisticated appreciation of this new taste and outdo each other with poetic descriptions.

MSG doesn’t make bad food taste good, it only brings out the natural umami tastes in foods. This can be a plus for those of us without hours and days to spend cooking, concentrating and extracting flavors, from ingredients. MSG also has important benefits for many people whose sense of taste and smell are impaired, as is common with aging and during cancer treatments. Its ability to bump up flavors can be critical to making food more palatable and helping ensure enough nutrition for good health. Flavor is a good thing for all of us. Most children and adults find it yucky to choke down broccoli, peas or grains without some salt or flavorings. For those with medical conditions that necessitate low-salt diets, MSG also contains about one-third the sodium of table salt, enabling foods to have less salt without sacrificing flavors.

When it comes to MSG and glutamates in our food, this is a case where the wisdoms of ancient cultures make good sense.

© 2007 Sandy Szwarc

Click here for complete article (and single page version).