“A calorie is not a calorie,” explained Dr. Robert Lustig, pediatric endocrinologist and advisory board member for the new film Fed Up. As he spoke, Lustig sliced into a juicy steak, accompanied by a green salad and a glass of red wine. “However,” he quipped in reference to food industry sniping against public health advocates’ sugar intake recommendations, “I am not the food police! By all means, order dessert!”
Robert Lustig at the recent UCS forum on Science, Democracy, and a Healthy Food Policy.
Lustig was speaking over dinner with UCS staff members following a pre-release screening of the film last Monday in Minneapolis held in conjunction with our forum on Science, Democracy, and a Healthy Food Policy. The film, as my colleague Gretchen Goldman wrote, features the compelling stories of several overweight teens trying to lose weight through diet and exercise. As their stories unfold, it becomes clear they’re up against a great many obstacles out of their control.
Sugar, as we have noted, is at the top of the list of their obstacles as it is for many Americans.
It’s not about personal choices
The kids — who are brave for telling their stories publicly — are also affected by where they live and what kind of food is available at home, at school, and at the grocery store. They are affected by cultural values and attitudes about food and weight in their families and communities. And they are affected by knowledge — and lack thereof — about nutrition and cooking.
Despite exercising, the kids featured in Fed Up are still having difficulty losing weight because it is so difficult to eliminate sugar from their diets. The point the film is making is that, when it comes to sugar, a calorie in is not a calorie out.
As they count their calories and get regular exercise, they’re trying to make good choices and do the things everyone is telling them to do that supposedly will help them lose weight and get healthy. And yet they’re still ending up fighting a losing battle because, ultimately, they are affected by the policies that govern the availability, affordability, and accessibility of food.
Simply put, the current policies framing our food environment favor commodity crops like corn, sugar beets, and soy — and the food and beverage manufacturers that use them — rather than public health. It is no accident that a walk down the cereal aisle is easier on our wallet than a stroll through the produce section, and these kids and their struggles are the casualties of those policies.
Manufacturing doubt
The food industry’s response to the film, while not surprising, has been disturbing. Taking a cue from the tobacco industry’s now well-known strategy of casting doubt on science that supports policies that undercut profits, the Grocery Manufacturers Association has attacked the film for not getting the facts right. In order to convey what it claims are the “correct” facts, the trade group has designed a website mirroring the film’s website with the express purpose of combating what it contends is the film’s mischaracterization of the food industry.
Landing page for the real Fed Up site.
Landing page for the GMA’s “dummy” site.
The website does things that ought to make consumers cringe. For starters, what the GMA considers the “correct” facts are cherry-picked. The first question in a quiz visitors are invited to take asks whether it is true or false that “Food companies have caused the obesity rate to ‘skyrocket.’” Checking the “true” box brings up a grade of “incorrect” followed by the statement that “childhood obesity rates have dropped by as much as 43 percent.” However, the source for this information (which, to the GMA’s credit, it links to) is a New York Times article that actually says something quite different.
While a new federal study has indeed found a 43 percent drop in obesity rates among 2-5 year olds, scientists cited in the NYTimes story — both the authors of the study and others — cautioned against overly optimistic interpretations of the findings. They noted that this demographic makes up only a tiny percentage of the American population, that a third of adults and 17 percent of teenagers are still obese, that obesity rates among women 60 and older have increased, and that even among 2-5 year olds, obesity rates for blacks and Hispanics are much higher than for the rest of this age group.
The study itself concludes, “Obesity prevalence remains high and thus it is important to continue surveillance.” Another study published a few months later also in the Journal of the American Medical Association, concludes that although “the prevalence of obesity may be stabilizing … there is an upward trend of more severe forms of obesity.” As my colleague Michael Halpern pointed out, it is important to interpret both recent studies with caution. Neither supports the optimism towards obesity that the GMA “facts” encourage.
Finessing the evidence
Other questions on the GMA’s quiz receive similar treatment. Support for the Healthy Hunger Free Kids Act, for example, is touted as evidence the food industry is advancing nutrition over fast food, but public comments on the USDA’s proposed rule to implement HHFK show significant food industry influence — influence that has led to a weaker final rule on sugar.
Comments from public health professionals and advocacy organizations argued in favor of limiting sugar in school meals as a percent of total calories. Through 70 comments, they reasoned that this more restrictive option better aligns with recommendations from the American Cancer Society, American Heart Association, and Institute of Medicine, and that it is more consistent with the official Dietary Guidelines for Americans developed by the USDA.
It is not surprising that members of the Grocery Manufacturers Association, such as General Mills, supported weaker policy on sugar. Many of their most familiar and popular brands — marketed as healthy — are loaded with it.
By contrast, limiting sugar by weight — a less restrictive option — received support from many commenters who reasoned that it was consistent with the measurement methods currently relied upon and would be easier to implement, allowing the sale of more products. The Food and Nutrition Service reported that the 1,165 comments in favor of limiting sugar by weight included trade associations and food manufacturers. General Mills, a member of the GMA, went so far as to state, in its comment, that “sugar intake has not been shown to be directly associated with obesity or any chronic disease or health condition except dental caries.”
Guess which sugar option won out in the final rule? Guess which substance is missing from the GMA’s description of how school “chefs” are working to provide healthier meals?
The need for media literacy
Understanding that “a calorie is not a calorie” will not necessarily stop Americans from eating lots of sugar. UCS staff members, it should be noted, are well-informed about the science of sugar and yet are not opposed to enjoying it now and then, as these leftovers from our annual cultural heritage lunch illustrate. However, it is impossible to have a transparent, honest public dialogue about real choices for our food system as long as the prevailing illusion of choice – supported by our current food policies – persists.
Along with the GMA’s mischaracterization of scientists’ efforts to understand trends in the obesity epidemic, the format of the website itself is intended to mislead the public. So-called “dummy” websites are deceptive by their nature and exploit what UCS’s forum working group experts agreed was a major barrier to changing Americans’ food environment: namely, a lack of media literacy.
While a calorie is not a calorie, facts are facts. As a society, we need to get better at separating science from spin. Improving Americans’ media literacy skills from an early age, along with implementing better food policies, is essential to fighting obesity and improving overall public health.