Junkfood Science: June 2008

June 29, 2008

This wasn’t meant to be a Sunday funny

You’ll never guess the latest idea enacted by public officials to get people to eat less salt.

Gateshead Council in the UK came up with what they believe the solution to getting people to reduce their salt intake: Salt shakers with fewer holes!

They commissioned a company (at taxpayer expense) to make salt shakers with fewer holes and are giving them away to fast food restaurants. As the Daily Mail reports:

Now health and safety cut number of holes in chip shop salt shakers

Pot-holed roads, crumbling schools, litter-strewn streets – there’s no shortage of problem areas crying out for their attention. But councils believe they have found a better use for their money: reducing the number of holes in chip shop salt shakers... They decided that the five-hole pots would reduce the amount of salt being used by more than 60 per cent yet give a ‘visually acceptable sprinkling’ that would satisfy the customer. The council commissioned Drywite Ltd – a catering equipment company based in the West Midlands – to make five-hole shakers and bought 1,000 of them at a cost of £2,000, giving them away to fast-food outlets in their areas...

Cllr Chris Hobson, leader of the Conservatives, said: ‘This is just silly, a total waste of money in an area where council tax is very high... [People will] just shake it for longer.’ Beryl Scott, who owns the Chipchase Chippy in Linthorpe in the city, said a council worker had visited the previous week to explain the merits of less salty fish and chips... I thought it was a joke. It doesn’t matter how many holes it has, people are going to put on as much salt as they want. Another local chip shop owner [said] ‘In fact, we have had some people unscrewing the lids to do so.’

Gateshead Council defended its decision... ‘We believe the cost to be a small price to pay for potentially saving lives.’ The scheme is being promoted by the Local Authorities Coordinators of Regulatory Services... [whose] spokesman said: ‘Heart disease costs taxpayers £7billion a year so to say that projects such as this are a waste of money is mind-boggling.’

The LACORS (the Local Authorities Coordinators of Regulatory Services) is the organization that coordinates councils’ food safety regulations. Just last month, it launched measures to mandate that salt, sugar and fats in food be within acceptable levels to tackle obesity. Among their chief initiatives is to lobby for Traffic Light food labels.

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From the archives: What is junk food?

Per reader request, here is the link to the classic article, Junk-foods and empty words, by Dr. Johan H. Koeslag, head of the Department of Medical Physiology at the University of Stellenbosch, Tygerberg, South Africa, explaining what junk food really means. This delightfully entertaining article captured the disconnect between science and beliefs about food and what it means to eat healthy. This was first covered in Mythology of health food and junk food, which revealed the real brain food.

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June 28, 2008

Government diet plan for girls

The U.S. Department of Health and Human Services has an obesity prevention program for tween girls and their parents to teach them to adopt healthy eating and lifestyle habits. Called BodyWorks, this program is the most powerful demonstration to date of how far astray from soundness public advice for “healthy eating” has become. When you see the reality of this eating plan in action, you’ll fear for our young girls.

Few consumers have probably ever heard of this program, even though it’s now being taught by 1,700 government-accredited Bodywork instructors across 43 states. The BodyWorks program was advertised in a Reuters Heath article yesterday. Before we look more closely at what the program teaches girls and their parents, here’s the media’s brief overview:

U.S. program targets obesity at grassroots level

A new program developed by the U.S. government is tackling the obesity epidemic by helping "tween" girls and their parents make small but important changes to build a healthier lifestyle. The Department of Health and Human Services' (HHS) Office on Women's Health launched BodyWorks in 2006 by training instructors in the hopes that they would bring the program home to their communities. All materials are provided free, but communities must find the resources to pay trainers and a place to offer the program...

Girls 9 to 13 years old who are overweight or obese are referred to BodyWorks through their pediatrician, or by word of mouth. Parents and caregivers attend 10 weekly 90-minute sessions, and girls are expected to show up for at least three. The goal is to give parents and caregivers "hands-on tools to make small behavior changes to prevent obesity and help maintain a healthier weight"...

The goal is not for girls to lose weight, Jones and Richter say, but for families as a whole to begin making healthier choices at the grocery store, to become more active and to spend less time in sedentary activities like watching TV or playing computer games...

This is an obesity myth-driven program. Preteen and teen girls whose heights and weights place their BMIs above the 85th percentile are targeted. In accordance with popular stereotypes, their size indicates they must have unhealthy diets and lifestyles and warrant education on how to eat right and exercise. But, far from the claims made in the news, this program isn’t teaching girls to make small changes, nor can it claim to not be about weight loss.

The BodyWorks program includes an instructional manual for girls, one for their parents, and a large recipe book to enable parents to put the healthy eating guidelines into action. We’ll look at each of these manuals.

For girls

The instruction book for girls — called BodyWorks 4 Teens: Eat right, move more, feel great — teaches them what it means to be “a healthy teen girl.” They define this as being “physically and mentally fit.” The opening chapter is on “healthy foods.” To eat healthfully, the girls are given this Daily Eating Plan:

A teen girl needs each day: 2 cups fruits, 2 ½ cups vegetables, 3 cups fat-free or low-fat dairy, 3 ounces whole grains, 5 ½ ounces protein. Limit fats, sugars and salt.

This is what girls are being taught “healthy eating” means.

Do you see a the missing food groups and major ingredients? Nowhere are girls told that even by the government’s weight-focused 2005 Dietary Guidelines, they need about one-third of their calories to come from fat, and that low-fat eating is not recommended for growing young people. They aren’t told that there is no nutritional guide that they should or need to limit sugars or salts, or fear these foods. Nowhere in the book is it mentioned that active girls their age need 2,400 calories a day — and we can be certain that, among the talk in this manual of portion control, monitoring and controlling what they eat to be a “healthy weight,” girls are counting calories. [These issues have been covered extensively at JFS; using the Google search tool on the sidebar, you can find posts corresponding to any questions.]

The Q&A section on how nutrition affects their health offers a string of diet speak and misinformation. The answers are provided by dietician, Jessica Donze-Black, R.D., MPH. [Disclosures below.*] Teen girls are told that if they’re worried about acne, it’s a good idea to “drink plenty of water, eat lots of fruits and vegetables and limit excess fat.” Foods can make you feel lazy if you eat too much, Donze-Black says. To avoid overeating, the girls are told, “one trick to avoid eating too much is to eat slowly.”

[Of course, acne is not caused by food, as the American Academy of Dermatologists points out. That’s one of the oldest myths, but disproven long ago. There is no evidence that greasy foods or any food causes acne, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases at the NIH. The C.S. Mott Children’s Hospital offers a webpage on acne for teens and reassures them that acne is not caused by their diet or anything they’re doing wrong. Young people with acne “do not have to avoid eating fried foods, chocolate or any other food,” they tell teens.]

BodyWork’s instructions to girls on how to eat “healthy” and live a healthy lifestyle are indistinguishable from weight loss advice found in any diet book. Essential to a healthy lifestyle, the girls are told to keep a food and exercise diary: “Write things down as soon as possible. Write down everything you eat, even if it’s just one cookie. Be honest. Includes drinks. Write down how you were feeling.” Addressing emotional eating is said to help them figure out their moods and other issues that made them want to eat. They are also told they should drink plenty of fluids and be sure to eat 19 grams of fiber every day because it will lower their risk for heart disease.

When eating out, the girls are advised to limit fried foods and order the garden salads with low-fat dressings, always pick the low-fat choices, get the smallest serving or sandwich on the menu, avoid mayonnaise and use mustard or ketchup because they have less fat, order water or fat-free/low-fat milk to drink, and “try pizza without cheese.”

And we wonder why so many young women today have no idea how to eat normally and have come to believe they are eating “healthy,” when they are really dieting. What must certainly add to their confusion, the girls in the BodyWorks toolkit are also told that “dieting is not the answer,” and to avoid going on very-low calorie diets, eliminating food groups or skipping meals. BodyWorks is not a diet, the girls are told. This is "healthy eating."

Food mustn’t be seen as tasty or tempting. For some reason, food stylists’ techniques for making food look good enough to eat in photography, and to enable the props to withstand hours under hot camera lights, is a key part of “media literacy.” Food that looks good is somehow bad. Think about that one. [Was it a coincidence, then, that the photo accompanying the beef recipes in the accompanying recipe book was gray and unappetizing?]

Exercise can help you keep a healthy weight, the book says, and the girls should try to exercise for one hour on most days. “Vigorous active is best for getting and staying fit.” Vigorous was described as so intense you’re “sweating, breathing hard and can’t talk or sing.” And add resistance exercises 2 or more days a week.

The book closed with this reminder: “A healthy mind = A healthy body.”

Parental manual

The longer version of the book for parents — BodyWorks Body Basics: A toolkit for healthy girls and strong women — has “7 simple steps to healthy living.” This government program tells parents how their families should live to have a trim and fit family. The steps families are to follow are:

1. Decide to live a healthy lifestyle — make a commitment to healthy eating and physical activity. This tells families that too many teens are “overweight” or “obese” and at risk for serious health problems of old age, that teens are more sedentary and watch too much TV, and that they eat too much junk. It tells parents that a healthy weight is determined by children’s BMI. An entire section is devoted to “weight and emotions” reinforcing the belief that emotional eating leads females to overeat and get fat.

2. See where you are now — by recording eating and activity habits. Girls are to keep food and exercise journals and turn them into their parents weekly for review. This should continue until the parents have seen positive changes.

3. Understand healthy eating. It repeats the diet plan given girls in more detail; gives meal suggestions and portion control measures; heightens concerns about bad fats and hidden fats and sugars; suggests parents eat out less often and check the menu first for choices that are low in sugar, fat and salt; and instructs them to have family meals each night. The accompanying recipe book puts healthy eating into action.

4. Recognize the benefits of physical activity, especially of vigorous-intensity. Recommended sports activities and exercises are ranked according to their intensity. This section also tells parents that fits kids have higher school grades; remember that one?

5. Set goals and plan. To effect change, in addition to the girls’ daily food and activity journals, the family should hang a weekly planner on an erase-board to write down meals and physical activities the family is to do each week.

6. Shop, cook and eat together. Parents are told how to shop to limit salt, calories, sugar, and fats; with a focus on fresh produce, dried beans and grains, and eliminating packaged foods and snacks.

7. Support a healthy lifestyle for your family. Parents are encouraged to change the home environment to support healthy eating and regular physical activity, as well as become active in changing schools and communities. For resources, they are referred to Center for Science in the Public Interest (CSPI) and Food Trust, a key “obesity-fighting grantee” of Robert Wood Johnson Foundation that created the School Nutrition Policy Initiative.

These steps are all with an eye towards achieving a “healthy weight” for their girls. Parents are told to teach healthy eating habits and “help your child learn to control her own eating.” A “healthy weight” can be achieved, according to BodyWorks, by also stepping up physical activity and limiting and monitoring television time. [Which, of course, have all been proven ineffective in childhood obesity prevention programs.]

Healthy eating in action

The 132-page recipe and menu book, BodyWorks Healthy Recipes, will vanish any remaining beliefs that “healthy eating” being taught to young people and families is healthful or nourishing. It IS dieting. In fact, this eating plan is the most extreme, punitive and restrictive diet I’ve seen published for healthy, growing girls.

Contained in this book are a large number of recipes choices for every meal of the day, including dessert. Most are inclusive one-dish meals and nowhere are parents advised to fill out meals with breads or other foods. This book supposedly demonstrates healthy eating in action, not only for girls 9 to 13 years of age, but for the whole family.

Breakfast recipes include those for cereals, egg white omelets, austere fruit dishes, French toast and pancakes, with an average 226.50 calories and 4.3 grams of fat per serving. Among 63 servings represented in the recipe choices, they contain a total of 5 tablespoons oil and 3 whole eggs.

Lunch recipes offer a range of vegetable salads, sandwiches and soups. Each serving averages 0.25 teaspoon oil and 0.02 teaspoon salt. Lunches average 227.25 calories and 8.2 grams of total fat per serving.

Dinner is an enormous collection of vegetable-intensive recipes dishes that are equally ascetic, with a mere 1 ½ teaspoons salt total for 191 servings and 0.07 tablespoon of oil per serving. The dinner recipes average 264.2 calories and 2.18 grams of total fat per serving.

The “healthy desserts” are fruit-based, averaging 1 teaspoon added sugar per serving. Desserts average 184.5 calories per servings, with 2.69 grams total fat.

Even if the girls are allowed dessert, a full day following this “healthy” meal plan would provide them with 902.45 caloriesabout one-third (37.6%) of the daily calories needed by girls this age and activity level, according the USDA/ARS Children’s Nutritional Research Center at Baylor, used by the Dietary Guidelines.

Equally troubling, even if the girls are allowed dessert every day, this “healthy” eating plan provides a total of 17.37 grams of fat each day, about 7% total fat, based on their daily calorie requirements. This is about one-fourth of the total fat they need each day. Remember, even according to the Dietary Guidelines, children this age need 25-35% of their calories to come from fat. The total fat in a day’s worth of these “healthy” meals is less than the saturated fat advised by the government for adults with heart disease.

Not only is this extreme diet plan nutritionally unsupportable, it has no credible medical evidence of effectiveness for improving the health of growing children or for preventing obesity. Worse, by all evidence, the messages it teaches and food fears it reinforces, put young women at risk for physical and emotional harm.

Yet this program is being promoted as “healthy eating” by our government, targeting young girls and their families, and paid for by us.

This program’s “healthy eating” messages are the same as those popularly believed by many young people today and the same ones being widely taught in schools and through childhood obesity programs. Young people would be much healthier without such “nutrition” education at all.

© 2008 Sandy Szwarc

* Not disclosed in the BodyWorks literature, Ms Donze-Black is the Executive Director of the Campaign to End Obesity, a coalition of leading obesity stakeholder organizations and individuals, including Johnson & Johnson, NIKE, Inc., American Heart Association, Discovery Health, CSPI, Partnership for Prevention, Sanofi-Aventis, Shaping America's Health, Trust for America's Health and others. [These will all be familiar to JFS readers.] She was also the lead contact for National Alliance for Nutrition and Activity’s (NANA) policy papers for School Nutrition Standards and “Obesity and other diet-related diseases in children,” which said unhealthy eating habits, inactivity and obesity in children are the root causes for two-thirds of deaths in the United States from heart disease, cancer, stroke and diabetes. NANA is the key lobbying group for more than 300 groups, working to promote government policies and programs for healthy eating and activity. Its nutrition initiatives were founded and coordinated by Margo Wootan at CSPI, who is also on the Steering Committee and co-chair of the Policy Subcommittee for the National 5-A-Day Partnership.

BodyWorks is a project of various obesity, bariatric, health and wellness, and fitness partners.

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June 27, 2008

What if it never was the tomatoes?

How were tomatoes pinpointed as the source of the latest salmonella outbreak that, as of today’s count, infected 810 people across the country between April 10th and June 15th? Nearly 2,000 tomato samples across the country and in Mexico have been tested and not a single tomato has been found to be contaminated with salmonella. The FDA has cleared 41 states and most of Mexico from being a source of tainted tomatoes.

What if tomatoes never were the source?

More than a week ago, there was a tiny footnote in a New Mexico news story that hinted at another source that made a bit more sense, but there has yet to be any notice of it. Before revealing that, let’s review the background on this outbreak, a bit of science, and how the source of foodborne illnesses are tracked down.


It will hopefully be reassuring to know that no new salmonella cases have been reported since June 15th. The growing numbers being reported in the news are because state laboratories are completing their previously submitted testings and state health departments have been testing more people in response to the outbreak, according to the Centers for Disease Control and Prevention.

The FDA’s Center for Food Safety and Applied Nutrition has a special website that is being updated daily, with news and everything you might want to know about the recent salmonella outbreak.

As frightening as 810 people getting sick is, it pales to the 40% of Americans who died from diarrhea and enteritis in 1900, just before our Grandparents were born. Back then 142.7/100,000 people DIED from foodborne illnesses — a rate that would equate today to nearly half a million people a year. Our food is 100 times safer today, as modern food production has incorporated science, sanitation, and safety practices at each step in the food processing to help protect us. The FDA randomly tests samples of produce, domestic and imported, from various growers, packers and shippers to identify lapses in safety procedures.

No food producer, organic or conventional, can ever provide sterile food, though. As the USDA’s Food Safety and Inspection Service (FSIS) has reiterated throughout this episode, there is also no valid scientific support that any type or source of such products (organic, free-range, Kosher or natural) is lower in salmonella. Over recent weeks, some organic or local growers have claimed their foods were safer, but there’s no evidence that smaller farms are inherently more immune to contamination, said Martha Robert, a microbiologist at the University of Florida Institute of Food and Agricultural Sciences and a safety adviser to the Florida Tomato Growers Exchange and the Center for Produce Safety at the University of California. “Mistakes can happen along the line with any size farm.” In fact, large packers are extremely stringent with sanitizing techniques and measures to prevent cross-contamination, where sometimes a small grower has been doing the same thing for years, she said. The key is that everyone is following good safety practices.

Helping to keep safe

But, what may be surprising, is that we play the biggest role in the food chain when it comes to preventing foodborne illnesses. As the CDC reports, 55% of foodborne illnesses are due to people not washing their hands, contaminating food during preparation, not cooking food properly and drinking raw milk. There’s a reason our Grandparents cooked most homegrown produce; or processed it with high amounts of sugars, salt and vinegars, to kill bacteria and reduce illness. The increasing popularity of fresh and raw foods today comes with added responsibilities on our part and an understanding of the risks. Food doesn’t come from nature sterile.

Salmonella been known as the most common cause of foodborne illness since first identified by Dr. Daniel E. Salmon more than 100 years ago. There are over 2,300 serotypes of the bacteria, according to the FSIS. Salmonella lives in the intestines of humans and animals and is commonly found in raw foods of animal origin, including chicken, eggs, fish, and dairy products, as well as produce. [That’s why consumers, especially anyone with a compromised immune system, infants, elderly and pregnant women, are urged not to eat raw protein foods.]

The bacteria can also contaminate other foods and surfaces that come in contract with it, which is why safe food handling is important. The FSIS, CDC, FDA Center for Food Safety and Applied Nutrition, Extension Services and other websites offer simple food preparation techniques that can help us keep our food safe. And the Be Food Safe for Consumers brochure, with four easy steps to safe food handling is available here.

Tomatoes have been identified as a source for salmonella infections since 1990, according to the CDC, with nine outbreaks between 1990 and 2004. Although the source has been found most times, the source for foodborne illnesses isn't not always identified.

The University of Florida Institute of Food and Agricultural Sciences wrote a consumer guide early on in this Salmonella outbreak linked to tomatoes, which can be downloaded here. You can’t tell by looking or smelling tomatoes if they’re contaminated, they say, but it’s best to avoid fruit with soft rot or damage; and store them in the refrigerator until needed. Wash produce but don’t soak it in water, although that won’t remove salmonella that may have gotten inside the produce. They also described the agricultural practices that have been instituted by the produce industry to reduce contamination.

Consumer alerts

A point that was never widely reported during this outbreak is that salmonella is easily killed with normal cooking, at temperatures above 150 degrees, as Al Wagner, Jr., Extension Food Technologist with the Texas Agricultural Extension Service noted. But we never heard advisories to simply cook tomatoes — even though roasted and grilled tomatoes, tomato sauces, and baked tomato dishes are quite delish.

At the FDA’s media briefing nearly two weeks ago, Dr. David Acheson, Associate Commissioner for Foods, was asked by one reporter if tomatoes could be safe if they were simply cooked. He replied that the science shows salmonella is easily killed with cooking. “There’s no question that you can kill salmonella if you cook it,” he said. It’s just like why we cook chicken, eggs, fish, and lots of other foods that are regularly contaminated with salmonella, he said.

The FDA’s messages were “a question of what’s the simplest consumer message,” said Dr. Acheson. We felt the simplest consumer message was to tell consumers that cooking wasn’t the best solution because we couldn’t know that they would cook them adequately, he told the press. “It just adds another of potential confusion to consumers. Well, yes, you can cook it,” he said, but then they’d have had to explain for how long and how. “So we try to stick with the ‘throw it out’ message as being simpler.”

It’s a soundbyte world. Nuances take time. Not understanding science is costly. Had the government not taken that precautionary stance, consumers would likely have blamed them for not keeping them perfectly safe.

The FDA advised consumers to limit their raw tomato consumption to those varieties not linked to this outbreak (cherry, grape and on-vine) and to avoid eating the most common varieties — raw round, plum and roma tomatoes — from any sources that hadn’t been ruled out as a source of the contamination. Consumers, and even some of the media, quickly took that to mean all round and roma tomatoes were not safe to eat, and farm stores and markets had soon taken all round and roma tomatoes off their shelves.

Everyone’s been hearing “tomatoes and salmonella,” said a spokeswoman for the Florida Department of Agriculture and Consumer Service. Perception is everything.

Amidst the fear and messages to avoid eating the most common varieties of fresh raw tomatoes, millions of pounds of tomatoes have been destroyed and the tomato industry has been devastated. Florida’s $500-$700 million industry and its tomato farmers, alone, have continued to endure unfathomable economic losses, even after their entire crop has been certified by the FDA as safe to eat. Farmers are now wondering how long it will be before tomatoes won’t be viewed as rotten by the public.

Did tomatoes get a raw deal?

We may never know the source of this latest outbreak, but maybe it never was the tomatoes. Readers may find it interesting to learn how public health agencies track down the source of foodborne illnesses. It’s detective work and exemplifies epidemiology in action.

As the FDA explains, when a person gets sick and goes to the doctor, foodborne illnesses are reported to the local health department. State labs test stools and look for pathogens with DNA fingerprints that are common among all of the people who got sick. If they find the same foodborne bug made all the people sick, the sickened people are interviewed and asked about everything they ate before they got sick. The epidemiologists then they look for a food they’d all eaten in common and the hunt begins for the source of that tainted food.

On May 22nd, state departments of health and the CDC announced that there had been an outbreak of salmonellosis in New Mexico and Texas, and the sick people were all positive for the Salmonella SaintPaul strain. They said the illnesses had been linked to round, plum and roma tomatoes.

Public warnings went out and investigators got busy trying to find the source of tainted tomatoes. People who subsequently got sick were, no doubt, especially asked if they’d eaten any tomatoes before they got sick (recall bias).

Did you just catch that?

Yes, this outbreak is clearly diagnosed as a salmonella SaintPaul infection, because all of the people have tested positive for this bacteria in their stool or blood. But the link to the tomatoes came from asking them what they had eaten and looking for a food that they had all eaten in common. Not a single tomato was or has yet been found to actually test positive for the bacteria. That’s what the FDA and health departments have deployed all possible resources trying to do for more than two months: find a tomato that is actually contaminated to confirm a link so they can begin other testing to find the cause.

As the University of Florida Institute of Food and Agriculture Sciences noted, about 30% of Americans eat tomatoes on a daily basis. And the most commonly eaten tomatoes are round, plum and roma. As of today’s count, about one out of every million people who eat tomatoes has gotten sick.

Do you think that every contaminated tomato has been eaten and not a single one has remained in anyone’s kitchen or any grocery store across 36 states, in any delivery truck, packing and distribution center or farm in the country or Mexico, even though testing in earnest had begun in May and hundreds of people were getting sick through mid-June? Yes, it's possible that the errant tomatoes have still gone undetected, but the longer this goes on, the more unlikely that sounds and the more likely the case is to go cold.

Or, could there be a confounding factor — something that shares an association with tomatoes — that might point to another food these people ate along with tomatoes?

It’s been a week since a tiny footnote appeared in a news story with a comment made by a public health nurse at the Indian Health Services that suggests just that. Data collected by her team and other New Mexico health officials “led the state Department of Health to draw a prompt conclusion that tomatoes were the source of contamination,” the Albuquerque Journal reported. This was the origin of tomatoes being linked to the nationwide outbreak of salmonella.

The Navajo reservation had the highest concentration of state residents who came down with this rare and virulent strain of salmonella early on. The very first case in the country is believed to have been treated in Gallup, New Mexico. “We always jump when there is something unusual,” said Kimberlae Houk, a 24-year veteran epidemiologist and public health nurse at Northern Navajo Medical Clinic in Shiprock.

As the Albuquerque Journal reported on June 20th:

Salmonella Saintpaul hammered the Navajo Nation, which claimed at least 30 percent of the 78 New Mexicans who were sick, a state Department of Health official said. The reason for the concentration of illnesses at the Navajo reservation remains a mystery, said Paul Ettestad, the state's epidemiologist. "I'm not sure we're ever going to know why such a high proportion of cases come from the Navajo reservation," Ettestad said Thursday.

Tests on tomato samples by New Mexico and other states have so far turned up no evidence of the source of the salmonella outbreak... Technicians have tried for weeks to grow salmonella cultures from tomato samples purchased randomly at stores. "Nobody's been able to do it yet."

New Mexico health officials have a long history of experience with dangerous diseases, such as Hantavirus and plague. Houk told the Journal that IHS workers applied many of the same epidemiological techniques to investigate the salmonella outbreak. “Our job is to drop whatever we're doing and take care of a communicable disease,” she said.

Much of that job involved performing detailed surveys to determine what foods salmonella patients had eaten in the week preceding the onset of symptoms, Houk said. Many people lack telephones on the Navajo reservation, requiring health workers to drive huge distances to administer the surveys. Similar techniques have been used to identify the source of Hantavirus, plague, measles and other diseases, Houk said.

On May 23, Houk said she informally polled about a dozen nurses at the Shiprock clinic about which food might have caused the outbreak. "Half the nurses thought it was tomatoes and half the nurses thought it was lettuce," she said.

Officials went with the tomatoes.

Lettuce and tomatoes, they go together as a side with practically every Southwest dish and most raw tomatoes are most often eaten as part of a lettuce salad. Lettuce is also pulled up from the ground where salmonella can persist in the soil and the roots are suspected as being especially attractive to the bacteria. Lettuce has lots of little creases and crevices that make it harder to clean, it’s often soaked in water baths to refresh it prior to shipping or selling which can absorb the bacteria into the leaves. And in the past 35 years, the CDC reports that leafy greens are a growing source for foodborne disease outbreaks, accounting for about 6.5% of illnesses, with 10% caused by salmonella. It’s a challenge that they’ve already identified at this year’s International Conference on Emerging Infectious Diseases in Atlanta, Georgia, and are busy working on.

Or, is it another ingredient in salsa, guacamole or pico de gallo, or something else also enjoyed in Southwest dishes? This detective story isn’t over yet.

But, the FDA has confirmed that these states and countries (practically everywhere we get tomatoes) are not a source of contaminated tomatoes, and their raw plum, raw roma and raw round tomatoes are safe to eat:

It’s tomato season and tomatoes are back on my menu -- although, between us, they never left, in some form. :-)

© 2008 Sandy Szwarc

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Diet Speak

How to design a forced choice poll to reinforce a dieting mentality of controlled eating, and public perceptions of how people ‘should’ eat.

As seen at the Los Angeles Times:

If a restaurant you frequent begins posting the fat and calorie content of its menu items and you discover your favorite dish is a diet disaster, you:

· Stop ordering it.

· Order it and split it with a friend or bring home half for a later meal.

· Ask the restaurant if the chef can substitute some ingredients to make the dish lower in calories and fat.

· Order it less often, enjoy it when you do, and try to compensate by exercising more or eating less that day or the next.

Missing choice: Order your favorite dish and enjoy it with relish. And, thank the cook for making such a fabulous meal!

How many Los Angeles readers could see the diet speak? How many will truly enjoy the meal and trust their body to tell them when it's hungry again and eat according to their appetite? How many aren't counting calories and fat grams, controlling their calories, and trying to figure out how many minutes they must exercise to purge the calories they just ate?

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June 26, 2008

Traffic tickets for salt — Does healthy eating mean low-salt?

Salt makes food taste good. Therefore, it must be bad for us. Enjoying food means people might eat too much and get fat.

Believe it or not, that is the logic behind beliefs that everyone — from children to adults — should reduce their salt intake as an important part of ‘healthy’ eating.

Fears of salt have become so widespread, even little kids are being told it’s bad for them and given low-salt diets. Even a lot of adults believe that lowering their salt intake will prevent high blood pressure and heart disease. But salt is another food ingredient where the science and the voices of medical experts have had a hard time breaking through myths, fears and pop ideologies.

What may seem inconceivable, given the Red Lights being given to salt, is that there is no credible evidence low-salt diets can help prevent heart disease, high blood pressure or premature death. Nor is there any sound evidence to support fears that we’re eating too much salt and that high salt diets increase our risks for cardiovascular disease and deaths. Nor can we assume that putting everyone on low-salt diets “can’t hurt” and are benign. In fact, the medical research suggests the very opposite.

From the stack

From the stack of studies that didn’t receive much media attention, comes a recent detailed analysis of data from the National Health and Nutrition Examination Surveys (NHANES), trying to sort out the relationships between our sodium intakes and cardiovascular disease and all-cause mortality. As JFS readers know, the National Health and Nutrition Examination Surveys, under the Department of Health and Human Services, have gathered clinical information on representative samples of U.S. adults for decades. They provide what is viewed by healthcare professionals as the most accurate data on our diets, lifestyles and health. Since these are paid for by your tax dollars and the information is supposed to be used to help guide public health policies, you deserve to know the results.

This study, published in the Journal of General Internal Medicine, is the third in a series of examinations of NHANES data evaluating the effects of our sodium intakes on cardiovascular disease, blood pressure and deaths. It is also the most detailed to date by these investigators — none of whom have ever received financial reimbursements by any entity associated with salt. Researchers at the Department of Epidemiology and Population Health at Albert Einstein College of Medicine in New York, used the dietary assessments and detailed health exams from NHANES III (which ran from 1988 – 1994), representing 99 million non-institutionalized U.S. adults. They then followed these adults through the year 2000, using vital statistics on deaths and causes of death from the National Death Index.

To rule out possibilities that the results could reflect the affects of cancers or illnesses, the authors excluded those Americans who’d died within the first 6 months; those who’d had a previous heart attack, stroke or heart failure; and the outliers with extreme intakes of calories or salt. [If someone is eating fewer than 500 calories a day, something else is going on!] So, those put on low-salt diets for medical problems were excluded (16%) because their medical conditions could account for why they might be at greater risk for dying prematurely.

Average sodium intake among Americans was about 3,200 mg/day. To identify the effects of higher and lower intakes, the researchers divided salt intakes into quartiles. The raw data showed that those in the lowest quartile (average 1,500 mg/day) were more likely to be older, not smoke, be normal weight and have higher systolic blood pressures. The highest sodium quartile group (average sodium 5,500 mg/day) was more likely to be men, heavier, smoke and have higher diastolic blood pressures. Over about 9 years of follow-up, there were more deaths among those eating the lower amounts of salt.

Heart disease, high blood pressure and deaths were inversely related to salt intakes: the higher the sodium, the lower the risks; the lower the dietary salt, the higher the risks.

As with all observational studies, correlations cannot provide evidence of a cause, but the authors did their best to rule out potential factors that could account for these correlations.

So, to parse out the effects of dietary sodium intake itself, they factored for confounding influences, including: age, gender, race, education, added table salt, exercise, alcohol use, smoking, history of diabetes, history of cancer, systolic BP, cholesterol, dietary potassium, weight, treatment for hypertension, and calories. The associations between low-salt diets and higher rates of cardiovascular disease and all-cause mortality held.

The lowest sodium intakes — the 1500 mg/day amount some are saying we should all be eating — were associated with an 80% higher risk of cardiovascular disease compared with those consuming the highest salt diets. The lowest salt intakes were associated with a 24% higher risk of all-cause mortality. While these correlations aren’t tenable for these types of population studies, they clearly show that low-salt diets don’t reduce risks. The findings also show no increased risks associated with those among us eating the highest sodium diets.

Try as they might, these researchers were unable to show that among the general population, low-salt diets are associated with lower risks for developing cardiovascular disease or high blood pressure or premature death.

Try as they might, they were unable to show that the highest salt intakes among Americans are associated with higher risks for developing cardiovascular disease or high blood pressure or premature death. They even did a secondary analysis among just fat adults, adjusting for age, gender and calories, and still found no statistically significant correlations between salt intake and mortality.

Are our salt fears real?

Is there any support that we should worry that we or our children are currently eating too much salt? And is there any support for beliefs that the general population could benefit from public health recommendations to trim the salt in their diets in order to lower risks for developing cardiovascular disease, hyigh blood pressure or premature mortality?

This study’s findings are consistent with what has been seen among the other NHANES surveys of the American public. It’s also consistent with more than 17,000 studies published on salt and blood pressure since 1966, following populations for up to decades [reviewed here], none of which has shown that low-salt diets offer noticeable benefits. As Dr. David Klurfeld, Ph.D., professor and chairman of the Department of Nutrition and Food Science at Wayne State University, editor-in-chief of the Journal of the American College of Nutrition, said, “the better controlled studies fail to show a significant benefit on blood pressure for large groups with sodium restriction.” [Addendum: Low-salt diets have also been shown in randomized clinical trials to date, to offer no benefit in preventing high blood pressure during pregnancy (pre-eclampsia).] The evidence behind popular claims that salt is dangerous and that lowering salt is healthful, was examined here.

When we see a low-salt diet being prescribed as part of the treatment for an elderly Grandparent suffering from heart or kidney failure, it’s easy to think that if we eat low-salt it might prevent us ending up with those health problems. As logical as this simplistic notion might seem, it doesn’t work that way. Treatments can’t be confused with preventions. It would be like advocating chemotherapy for everyone to prevent cancers. Or, believing that if everyone ate less sugar it could prevent diabetes, since regulating blood sugars is part of diabetes management.

Cochrane recently released a systematic review of the clinical trial evidence on recommendations to reduce dietary salt for the prevention of cardiovascular disease. They examined randomized, controlled clinical trials studying low-salt diets, lasting at least 6 months and recording the short-term or long-term effects on cardiovascular disease, blood pressure and mortality. The eleven quality trials they identified had studied healthy people with normal blood pressures, people with high blood pressure and people being treated for high blood pressure.

Deaths didn’t differ between the low-salt intervention groups and the control groups. The same number of people died over time, whether they were on low-salt diets or not. After 1 to 5 years on low-salt diets, those who’d gotten advice to eat low-salt diets and intensive behavioral interventions, saw their systolic blood pressures reduced by a mere 1.1 mmHg, and diastolic blood pressures by 0.6 mmHg, even while successfully lowering salt intakes as confirmed by urinary 24-hour sodium excretions by 35.5 mmol.

Most of the public has no idea that the salt in our diets has such a nominal effect. As the reviewers wrote: “This reduction was not enough to expect an important health benefit.” Changes in blood pressures were also unrelated to the degree sodium had been reduced — in other words, more wasn’t better.

The Cochrane reviewers concluded that even “intensive interventions, unsuited to primary care or population prevention programmes, provide only minimal reductions in blood pressure during long-term trials.” For patients on antihypertensive medications, if future clinical trials can show that low-salt diets help reduce need for blood pressure medications without increasing cardiovascular events, they said, then "targeting low-salt diet interventions might be justified among patients with elevated blood pressure requiring drug treatment.” But there is no clinical evidence to support a benefit for the general public.

Remember that the Dietary Guidelines are about dietary advice for the general population, ages 2 years and up, not those suffering from certain medical conditions such as kidney disease and under the care of their doctor.

The flip side

If there’s no support that salt reduction improves health among the public, can such advice potentially harm people?

There’s a reason that the human species has always craved salt and gone out of its way to get it. But the idea that salt is actually good for us has become antithetical to today’s ideologies of healthy eating.

Our tastes for salt have an innate purpose, yet we rarely think about the benefits of salt or why we need it. As cardiologists have pointed out, our bodies are designed for salt and to compensate for excess intakes. When most of us eat a lot of salt, we just get thirsty and drink water, and our bodies excrete the excess sodium, while maintaining the balance of sodium in our blood and maintain our blood pressures. Having too much salt in our bodies, called hypernatremia, is extremely rare and occurs in about 1% of debilitated hospitalized patients as a symptom of an underlying disease or inability to drink water.

When we eat low salt diets, however, our sodium reserves are lower. So, if we get sick, exercise or go out in the hot sun and then drink water essential to avoiding dehydration, the amount of sodium in our body can more quickly become diluted to dangerously low levels.* That’s called hyponatremia. It’s the most common electrolyte disorder and a special risk for infants and elderly, according to Dr. Sandy Craig, M.D., at the Department of Emergency Medicine, University of North Carolina at Chapel Hill. It’s also dangerous and can result in swelling of our brain, seizures, coma, heat stroke, leg cramps, heart arrhythmias and circulatory collapse.

Not surprisingly, some of the longest-living people in the world also have the highest salt consumptions. Salt not only makes food taste better, it also improves the flavor of foods for those whose tastes or appetites are diminished, helping to prevent nutritional deficiencies especially among vulnerable populations, such as children and elderly. Salt has also had invaluable roles in food preparation and preservation, baking, culturing cheese, and making our food safer to eat since the earliest days of mankind. The healthful benefits of salts, discussed here, also include the importance of the very first functional food: iodized salt.

It’s also become popular to believe that we’re eating dramatically more salt over recent decades, because of all that processed food and all. The evidence doesn’t support this oft-repeated claim, as was covered in the salt shaker article.

There are growing numbers of studies in the medical literature suggesting low-salt diets might risk negative effects on our health in other ways, such as activating the rennin-angiotensin system and the sympathetic nervous system and increasing insulin resistance. These effects could actually raise risks for cardiovascular disease, according to the European Society of Cardiology Guidelines. In contrast, these experts reported randomized clinical trial evidence suggests that “an abundant sodium intake may improve glucose tolerance and insulin resistance, especially in diabetic, salt-sensitive, and or medicated essential hypertensive subjects.”

The importance of sodium to the survival of patients was dramatically shown in a study just published in the American Journal of Respiratory and Critical Care Medicine. Cardiologists followed 40 patients with pulmonary arterial hypertension (PAH), examining the role hyponatremia might play in their prognosis and right heart function. As they noted, hyponatremia is already known to be associated with decompensated heart failure and poor prognosis in patients with left ventricular systolic dysfunction. They found that those with hyponatremia were more likely to be hospitalized, have poorer right heart function, and a ten-fold higher risk of death than those with normal sodium levels. Hyponatremia remained a predictor of PAH outcomes after adjusting for World Health Organization class, diuretic use, right atrial pressure, and cardiac index. Among the patients in their study with hyponatremia, about 15% had survived two years, compared to 85% of those with normal sodium levels.

There are a lot of urban legends about salt, from “salt kills” to “cutting salt can add years to your life.” The scariest thing isn’t salt, though. It’s that scare-based legends and myths, rather than good science, are guiding public health policies, the “nutrition” education being given children, and the public health messages teaching everyone to fear salt. Agendas that are not about health.

© 2008 Sandy Szwarc

* Sam McManis at the Sacramento Bee just wrote an article trying to clear up some of the confusion and fears about hyponatremia and hydration for healthy people exercising and enjoying outdoor sports this summer. His helpful article is Knowledge for thirst.

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    The Second Amendment is preserved

    The Supreme Court has just issued its decision on whether to repeal the Second Amendment to the United States Constitution. [Background material on this case can be found here.]

    It held that our Constitution protects an individual's right to bear arms and that the District of Columbia's "ban on handgun possession in the home violates the Second Amendment, as does its prohibition against rendering any lawful firearm in the home operable for the purpose of immediate self-defense."

    The full text of the decision is available here, courtesy of Junkscience.com

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    June 25, 2008

    Australia’s fat bomb is defused

    Far from a crisis of poor health in Australia from a ticking FAT BOMB, the Australian Institute of Health and Welfare just released the country’s latest flagship health statistics report, Australia Health 2008. Australians have the second highest life expectancy in the world — 81.4 years — second only to Japan. And death rates are falling for the leading causes of death and health concerns, including cancer, heart disease, strokes, injury and asthma.

    The population is aging. Men at age 65 years, can now expect to live to about 83 years and women to age 86.

    Even so, deaths from chronic diseases of aging, popularly attributed to obesity or lifestyles, continue to drop.

    Children are being vaccinated in very high numbers — more than 90% are fully covered — and rates continue to increase. Death rates among children and young people have been cut in half in the past two decades, with fewer injury-related deaths. Illicit drug use continues to fall. Smoking rates are among the lowest for OECD countries and continue to drop.

    The percentages of Australians whose BMIs, calculated from their heights and weights, fall into the “obese” category is 19% for men and 17% for women. Those labeled “overweight” are 41% and 25%, respectively. A total of 50.1% of Australians’ BMIs fall into the “overweight” or “obese” categories. This compares to countries in the UK (51.1%), Oceania (59.3%), northwest Europe (50.9%), and southern and eastern Europe (59.5%).

    Far from any evidence that body sizes are the major health problem facing the country, the report highlights health disparities among those of social and economic disadvantage. It turns attention to these priorities. Life expectancy among Indigenous persons, while continuing to rise, is lower than the general population. They are exposed to higher rates of poverty, social disadvantage and violence. The prevalence of age-adjusted chronic health conditions is lower than the general population for cardiovascular circulatory problems (12% versus 18%), endocrine and metabolic diseases (9% versus 12%), arthritis (9% versus 15%), eye/sight problems (30% versus 52%), and digestive diseases (4% versus 7%). But they are nearly twice as likely to die, with the leading causes of morbidity and mortality including injuries, cardiovascular-circulatory conditions, diabetes and cancers. Higher death rates are in remote, rural areas, compared to metropolitan areas, influenced by fewer healthcare services available.

    As one Australian reader wrote about the cognitive disconnect pervading media and public health messages, with incessant warnings that everyone is going to die any minute because they’re too fat, while they’re the second-longest-lived on earth! “Can everyone please tone down the hype and scaremongering now? Our kids - and we - need support and good medicine.”

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    Diet drug guidelines issued

    New obesity clinical guidelines, that doctors in the UK must follow as part of their national contracts with the National Health Services, have just been issued by NICE (the National Institute for Health and Clinical Excellence). They recommend rimonabant (Acomplia) for all ‘overweight’ and ‘obese’ people who can’t tolerate or haven’t had success with two other weight loss drugs.

    Acomplia is the same drug that had been banned by the Food and Drug Administration in the United States over safety and efficacy concerns, and the European Medicines Agency had issued safety warnings concerning risks for mental health side effects. The safety and effectiveness problems raised in the four main randomized controlled clinical trials of Acomplia, and the postmarket adverse events being reported, were covered in detail here. A number of international scientific reviews have also raised concerns about the drug. Just weeks ago, it was announced that 5 deaths and 720 adverse events in the UK had been linked to Acomplia since it had been made available there in 2006.

    Despite the international controversies, Acomplia has been given the go-head in Britain. Today’s final Guidance was not unexpected, however, as it followed the draft technology appraisal report, verbatim. In that report, reviewed in detail here, the NICE reviewers had said they’d been persuaded to reverse the earlier draft appraisal not recommending the drug, after they had received information from the manufacturer, Sanofi-Aventis, and stakeholder testimonies. The manufacturer’s evaluation of the effectiveness of rimonabant focused on those four clinical trials, which the NICE report said had shown a statistical association with a greater weight loss over a placebo (with diet and exercise) of 4.6 kg after 1 year of use. But, “after rimonabant treatment was stopped at 1 year,” the report stated, “there was a gradual increase in weight until there was no statistically significant difference from placebo at 2 years.”

    Unresolved safety concerns; no proven, sustained clinical benefits for patients; and costs for the public that are likely to surpass all estimates, as described in the draft, all remained unanswered. Towards the back of the new guidance, NICE wrote that “future research is recommended to assess:

    · the long-term clinical effectiveness and safety of rimonabant

    · the short- and long-term effectiveness of rimonabant if continuation rules are imposed

    · the effect of rimonabant on hard clinical endpoints, such as cardiovascular events, the development of diabetes and mortality

    · the link between BMI changes and HRQoL [quality of life]

    · the effectiveness of rimonabant in adults who have had an inadequate response to, are unable to tolerate or have a contraindication to orlistat and sibutramine.”

    Yet, remarkably, with such fundamental scientific and medical issues remaining unresolved, NICE recommended its use and released this Guidance to be followed by NHS doctors and used with Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children (NICE clinical guideline 43). According to the Guidance:

    Rimonabant, within its licensed indications, is recommended as an adjunct to diet and exercise for adults who are obese or overweight and who have had an inadequate response to, are intolerant of or are contraindicated to orlistat and sibutramine. Rimonabant treatment should be continued beyond 6 months only if the person has lost at least 5% of their initial body weight since starting rimonabant treatment. Rimonabant treatment should be discontinued if a person returns to their original weight while on rimonabant treatment. Rimonabant treatment should not be continued for longer than 2 years without a formal clinical assessment and discussion of the individual risks and benefits with the person receiving treatment.

    NICE develops guidance for public health policy. Its Centre for Clinical Practice writes clinical guidelines, which it says “are recommendations, based on the best available evidence, on the appropriate treatment and care of people.”

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    June 24, 2008

    Tick Tock, Docs are building bomb shelters

    Australia’s largest and most prestigious medical professional associations found the FAT BOMB report so startling, they actually issued media releases.

    The Royal Australian College of General Practitioners’ media statement said that these “startling new figures on the obesity epidemic,” show that this crisis is “the ticking bomb for Australia’s health.”

    "We support the call of the Baker Heart Research Institute, in their report Australia's Future Fat Bomb,” said Dr Kelly Seach, GP and RACGP Registrar Representative. "We have to act now to address this critical health issue. The link between obesity and cardiovascular disease, and other health conditions, makes this one of Australia's number one health priorities," said Dr Seach. "This is not only an issue for the health of our patients; it is also about the health of our medical system, which is nearing breaking point. Unless the obesity epidemic is halted, it may tip the scales.”

    The Australia Medical Association’s press statement said the report “shows that Australia has become the fattest nation on earth, and we need to take immediate action to change that.” The AMA is behind the government in doing the right thing to help Australia lose weight. According to AMA President, Dr. Rosanna Capolingua, “We must now aggressively tackle this problem on a number of fronts, with tangible, concrete strategies that strike at the causes of obesity and help reverse the growing trend.”

    The proposal she highlighted?

    Front-of-pack “traffic light” food labeling should be mandated, she said, to help Australians to make informed, ‘healthy’ food choices. “Compulsory simple colour-coded labels that clearly state the sugar, fat, and salt content of food would take the confusion out of choosing food, and help Australians change their diet for the better,” she said.

    Did these professional organizations of medical doctors read the FAT BOMB report, do you think?

    Which answer scares you the most?

    Traffic light diet

    What is the evidence that traffic lights lead to healthier diets and reduce obesity?

    Traffic lights label foods green that are “healthy,” which is defined as low-fat, low-sugar and low-salt. Bad foods are given a red light and supposed to “stop” you from eating them. The traffic light diet was developed in the late 1990s by professor Leonard H. Epstein, Ph.D., and colleagues at the Behavioral Medicine Laboratory at State University of New York at Buffalo, for their childhood obesity treatment program. Most of the published papers advocating this behavioral change technique have come from these authors.

    JFS will remember professor Epstein from the recent study of TV allowance — those devices installed on televisions and computers that monitor usage and turn off when the time allotted fat children was up. The studies for traffic lights have followed the design used in that study with amazing similarity and include calorie controlled diets and keeping food and weight records, reducing sedentary behavior, exercise programs, and positive reinforcement and rewards for compliance. The small studies have been done primarily on white, upper income families who applied to participate or were referred to a clinical weight program, and none have been randomized trials. No long-term studies are in the literature, although previous studies of other behavioral change weight loss programs by Epstein and colleagues have shown that weight returns to baseline by 5 years and increases at 10.

    As with any intensive weight loss program, with traffic lights, there’s initial weight loss or, in the case of children, slowed growth, with weight regain over time. The published traffic light studies, however, have all ended before weights had returned to baseline but while they were still on an upward regain trajectory. These research studies have also thrown in all of the other diet and exercise interventions used in diet programs, including restricting calories for children to 800-1,200/day, so one cannot make any conclusions as to any particular benefit for traffic light labels in the real world setting. More importantly, not one of the studies has examined the short-term or long-term health effects of their programs or shown any benefits let alone that they outweigh potential harmful effects.

    Last year, researchers at the Department of Pediatrics and Nutrition at Baylor College of Medicine and Clinical Child Psychology at the University of Kansas published the results of their study evaluating the feasibility and effectiveness of the traffic light diet (TLD) in a clinical setting.

    As they had noted: “Despite the abundance of support for [Epstein’s traffic light diet], an outside research team has yet to replicate these results.” The restrictive inclusion and exclusion criteria, the fact that participants were self-referred or doctor-referred for treatment, decrease the generalizability of research interventions to applied settings.

    Their study was on 41 children — 90% white, 18 boys/23 girls, average age 12.3 years, all >85th percentile on growth charts, and average family income $85,000 — all of whom had been referred to their for-profit weight loss clinic. The children were all taught to eat consistent with the traffic light diet, per Epstein. Families were also instructed to change their food environment to limit the number of red foods and increase the green foods in the home. The weight loss interventions included reducing sedentary activities and increasing exercise. A physical trainer assisted the families in implementing exercise and sports into their lifestyles, as well as provided an exercise plan and 45-minute training sessions each week. This study went on for 10 weeks.

    They compared the results of this treatment group to archival data from kids who had gone through standard, nonbehavioral treatments at their weight loss facility before the authors arrived, with similar time spent with the participants each week. In other words, they didn’t have a control group with each variable the same except for the use of the traffic lights to isolate the effects of the traffic lights. They concluded that after 10 weeks, the traffic light kids had reductions in projected BMI growth, losing 1.2 to 2 pounds/week. But a closer look finds that only 2 kids had moved from “overweight” to the “at-risk category” — exactly the same as in the traditional weight loss compare group. So, while the authors concluded that traffic lights could feasibly work for use in intensive, for-profit clinical weight loss programs, even they were not able to conclude any long-term effectiveness or recommend it. As they noted:

    Long-term data for this sample are currently unavailable... A specific consideration is the cost of the program. In fact, the main reason for the length of the program was the cost restrictiveness. Whether similar results can be obtained in less-expensive settings (e.g., community, family service, and primary care centers) remains to be seen.

    [S]everal limitations are worth noting. First, follow-up data are not yet available... a demonstration that these children either maintain this weight loss or have a continued decrease in BMI is needed before effectiveness can be completely assessed... Epstein’s research also suggests a fairly high number of children and families relapse into overweight... Similar to other studies, most of the children completing this intervention remained overweight and, for some, significantly overweight.

    A specific limitation for this investigation is that participants were not randomly assigned.... further evaluation of the TLD using randomized clinical trials is needed before the TLD would be considered effective. A final limitation of the present investigation involves the income level of the participants. The cost of the intervention may explain the small number of participants from a lower socioeconomic status (SES) that received services in this study...

    The most critical cautionary note before jumping ahead of the science for traffic lights was the need for “examination of the long-term impact of treatment on physical and mental health outcomes,” which they said “is especially important.”

    Of course, as has been covered at JFS extensively, children need a variety of all foods for health and optimal growth and development, not just “green” foods. Teaching children to avoid fattening foods or that certain foods are bad and to be avoided or restricted has no evidence to support a benefit to young people’s health, or effectiveness in reducing obesity. Even “moderation” nutritional messages are beyond their cognitive abilities and they think in black-and-white when encountering information beyond their understanding. They react emotionally, with growing fears of foods they believe are bad for them. So, if something is bad enough to restrict and eat only in moderation, then it’s felt safer to avoid it completely. This has been shown even among college women, restricting dietary fat to 4% of their diets. Even seemingly harmless good-bad food messages have also been shown to backfire.

    When a school traffic light nutrition tool — that encouraged school children to freely eat green food, eat amber food in moderation and stop and think before eating red food — was tested among 5-7 year olds in an elementary school in the UK, their negative behaviors and attitudes about green foods increased after ‘nutrition’ education, so did the numbers of kids refusing to eat red foods. In other words, the effect was an increase in nutritional misinformation and dysfunctional relationships with foods, not normal eating.

    Traffic light labels have been promoted by groups such as the British Food Standards Agency and authors from Baker Heart Research Institute, Menzies Research Institute, Dairy Australia and Australian Division of World Action on Salt and Health who wrote a letter in support of traffic lights last year in the Medical Journal of Australia. In it and their supportive webpage, they made their case for red-yellow-green labels, saying they would make “healthy” foods more easily identifiable, especially for “the less educated, and the economically and socially disadvantaged... poor readers... the less motivated... sick and elderly who have little time and/or energy for shopping, and parents who can tell demanding children ‘no foods with red lights for fat.’”

    [ Children, sick and elderly are those who often most benefit from calories, fats, sugars and salt in red light foods. These controversial ideas raise nutritional and medical concerns, and regrettably, the words illustrate the myths that fat and lower-income people must be eating badly and are too stupid to know how to eat right.]

    Red lights are a warning of the risk of preventable diseases due to nutrient excess,” they wrote. “Some red/amber boundaries might start fairly high, becoming progressively stricter over the years (like the Heart Foundation ‘Tick’).”

    They added that it will be natural for people to see red lights as a warning, red is for danger... “Thus, for FAT green means low fat and good health... for SUGAR red warns of sugar-related health problems like obesity... for SALT green means low enough to prevent and/or treat over a dozen salt-related health problems...and red puts you at high risk.”

    In their supplemental paper, they said Australia needs traffic light labels because Australian children are heavier than ever and “all children need to be protected from foods with red lights.” To meet the “Australian government’s national campaign to arrest the growing epidemic of childhood obesity,” they concluded:

    “Food choices to control obesity involve a radical change in shopping behaviour, and traffic-light labels are expressly designed to promote radical change. They need to be mandatory, and they need to replace industry-sponsored schemes, which we believe are less likely to alter a customer’s buying patterns.”

    To scare kids from eating, the government could just go ahead and put monsters labels on them. Artist, Andrew Bell’s Do Not Eat! monster illustrations might be just the ticket. It makes just as much sense.

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