Looking for health advice? Dr. Coca-Cola will see you now

When the American Academy of Family Physicians announced it had received a substantial grant to enhance educational information about nutrition on its FamilyDoctor.org site, you’d think health experts would have been happy.

But the money was earmarked to focus on the role of beverages and sweeteners in a healthy diet. And it came from the world’s largest beverage maker, the Coca-Cola Co.

No, “happy” isn’t exactly the word to describe the way some health experts feel about this deal. “Distressed” and “disappointed” are more like it, according to a sharply worded letter sent Wednesday to Dr. Douglas E. Henley, the academy’s chief executive.

“We urge the AAFP to regain its credibility by rejecting the deal with Coca-Cola,” the letter stated. “If the AAFP declines to do that, we urge your organization to reassert its support for the public health (and its own independence) by supporting a warning label on caloric sugar-sweetened beverages and a federal tax on soft drinks to support health promotion or health insurance programs.”

The letter was signed by 22 doctors, nutritionists and health advocates, including obesity experts Dr. George Bray of Louisiana State University’s Pennington Biomedical Research Center, Dr. Matthew Gillman of Harvard Medical School, and Barry Popkin, director of the University of North Carolina's Interdisciplinary Obesity Center. It asks Henley to respond to Michael Jacobson, executive director of the advocacy group Center for Science in the Public Interest, a leading proponent of a soda tax.

The letter noted that soda is “the only food or beverage that has been demonstrated to promote overweight and obesity.” (Click here for an L.A. Times story on the scientific studies that support this claim.) But the signatories warned that the six-figure grant from Coca-Cola will prevent the doctors group from “criticizing sugar-sweetened beverages in the strongest language.”

In its own statement, Jacobson's group noted that Coca-Cola – which sells 1.6 billion servings of beverages each day – has a track record of partnering with health groups:

“In 2003, the American Academy of Pediatric Dentists took a $1 million payment from Coca-Cola. Before the payment, the dentists' group acknowledged the connection between sugary drinks and dental disease. But after the payment, the president of the AAPD told reporters that the ‘scientific evidence is certainly not clear’ on the role soft drinks play.”

American Family Physician, the academy's journal, published an article last year recommending that children and teens “consume no more than one serving of sweetened beverages (e.g., fruit juice, fruit drink, regular-calorie soft drink, sports drink, energy drink, sweetened or flavored milk, sweetened iced tea) per day.”

But today, FamilyDoctor.org advises parents of overweight children only to cut down on fast food and dessert. It makes no mention of soda or other sweetened drinks.

Henley told Food Navigator-USA.com that the academy was aware of the letter. But he stood by the partnership with Coke.

“We will move forward with this commitment together by providing educational materials on sweeteners and how to maintain a healthy, active lifestyle while still enjoying many of the foods and beverages consumers love,” he said in a statement.

Celeste Bottorff, Coca-Cola North America’s vice president of living well (yes, that’s actual her title), told FoodNavigatorUSA.com that the company has a long history of philanthropy that includes “many health organizations.”

-- Karen Kaplan

Photo: Would you trust health advice from the makers of this drink? Credit: Amy Sancetta / Associated Press

Aquarium looks to the future of the oceans -- and seafood consumers

The nutrition experts say eat more fish. But then marine scientists say the oceans are being depleted and many species are increasingly threatened. What's a healthful eater who cares about the planet to do?

One answer is to eat from the Monterey Bay Aquarium's "Super Green" list of seafood that's good for people and the planet. It's part of the aquarium's "State of Seafood" report issued today. The report says that prospects for the oceans are improving with a growing consensus of how to manage wild and farm fishing.

The report sets out significant problems that remain for the oceans, and the primary factor in the oceans' decline is the human demand for seafood, the report says. Industrial-scale fishing has threatened commercial fisheries and threatened populations of animals including whales, tunas and sharks, it says. It notes that "bycatch," the unintentional capture of animals in fishing gear, is the single greatest threat for nearly 250 species of ocean animals.

"Ocean life is still in decline and we clearly need to take urgent action to turn things around," says Julie Packard, executive director of the aquarium. "The good news is that we know what it will take and that key players are working more closely than ever to solve the problems."

The report notes some positive developments: a consensus set of principles for restoring ecosystems and commercial fish populations; commitments from major seafood buyers to sustainable sources; and improved government policies to manage fisheries and fish farming. And, the report says, there is a growing public awareness of the need to take action.

The report says that the world seafood supply was 110 million tons in 2006 -- eight times what it was in 1950, with Asia accounting for more than half the global catch. And in the next year, people will eat more farmed seafood than wild for the first time.

Farmed fish, the report says, can help fight hunger, but aquaculture also can cause pollution and disease among other problems. It cited some success stories, including arctic char, eaten as an alternative to salmon and raised on land in tank systems that don't harm the oceans.

While the health benefits of seafood have been well documented, seafood also contains risky toxins such as mercury. The aquarium's report says no accepted methodology exists for quantifying the risks and benefits of eating seafood with high contaminant levels, though U.S. authorities have recommended that children, pregnant women and others avoid certain fish, including shark and swordfish.

The "Super Green" list was developed in conjunction with the Harvard School of Public Health and the Environmental Defense Fund.

This year is the 25th anniversary of the aquarium and the 10th anniversary of its Seafood Watch program, which advised people on what fish to buy and to avoid for their health and that of the oceans. The aquarium says it has distributed 32 million Seafood Watch pocket brochures.

-- Mary MacVean

Aquaculture photo courtesy of Monterey Bay Aquarium

Check the expiration date on foods

A study of Los Angeles food markets has found high numbers of products with expired freshness dates. The study was conducted primarily in markets in low-income neighborhoods in Los Angeles, but it's possible the sale of expired foods is a problem elsewhere, said author of the study LaVonna Lewis, a professor of Policy, Planning and Development at USC.

The study, which began in April 2008, and ended in February, enlisted 90 members of the community to keep checklists of what they encountered during their food shopping trips. A total of 657 checklists were submitted. The surveyed stores were primarily in the South Los Angeles area, but some checklists were submitted on stores in other communities. The stores included small markets and large supermarket chain stores.

The shoppers found at least one expired poultry, beef of dairy product in about one-third of the stores visits made over the study period. In 18% of the visits, residents found at least three expired poultry, beef or dairy items.

In an analysis of five stores that were heavily surveyed, the rates of expired poultry ranged from 19.2% to 39.5%. The range for expired beef was 20% to 41.8% and for dairy products, 26% to 45.4%.

The shoppers, however, found sufficient access to special diet foods, such as low-salt, low-sugar and lactose-free foods.

The study was sponsored by the Community Health Councils Inc., a project that addresses healthcare inadequacies in communities in a partnership with USC. Lewis presented the data last month at the 2009 California Reach Us Conference and is preparing her findings for publication in a scientific journal.

Future studies will try to determine if expired food products are found more often in low-income areas, Lewis said.

"It's a quality question," she said. "Shouldn't people have access to fresh, healthy foods no matter where they live? It's also a resource question. If you have limited resources, aren't those resources used less effectively if the food you purchase in your neighborhood is quickly out of date?"

-- Shari Roan

Photo credit: Tim Boyle  /  Getty Images

Not all takeout food is created equal

We all know that if we want to be healthy eaters, we should ditch fast food and other restaurant fare and prepare our own meals at home. But that’s easier said than done. Considering that takeout food is simply too tempting for many people to pass up, it’s worth asking whether all takeaway fare is created equal.

It turns out that when it comes to ordering to go, some meals are more equal than others.

In general, people with only a high school education were less likely to get takeout in the previous day than people who were college graduates. However, the takeout food ordered by the less-educated cohort was much less healthy than the meals ordered by their better-educated counterparts, according to a study published in the October issue of the Journal of Epidemiology and Community Health.

Researchers in Australia used government survey data from 7,319 adults and grouped their responses according to their level of education. They wanted to see whether nutritional choices could explain why people from lower-income brackets are more likely to suffer from chronic diseases.

In Australia, the least educated diners were more than 2.5 times as likely to make “less healthy” choices compared to people with more education. For instance, they were about twice as likely to buy potato chips, hamburgers and full-calorie soda. They were also four times less likely to order fruit and three times less likely to order salads. For these diners, takeout food was higher in total calories, saturated fat and total fat, the study found.

The researchers speculated that food cost was a bigger factor for high-school-educated eaters than for diners with college degrees.  Plenty of studies have shown that cheaper foods are typically big on calories and low on nutrients.

The study authors also wondered whether consumers with less education put more emphasis on tastiness. The college-educated eaters might share the same craving for a burger with fries, but perhaps they were more disciplined about balancing that with concerns about nutrition and weight gain, the researchers said.

-- Karen Kaplan

Photo: Some takeout choices aren’t as healthy as others. Credit: Irene DeBlasio

More study needed to determine whether adding calorie counts to menus curbs obesity, researcher says

Going to McDonald's or KFC? What if you see the calorie counts posted on the menu? Would you change your plans? Researchers in New York tried to answer the question. You can read about their study here.

It’s no surprise that eating habits are hard to change. But the lead researcher also notes that it’s hard to assess the many anti-obesity public health efforts underway. Brian Elbel of New York University says more research is needed into the effects of putting calorie counts on menus.

It’s possible, he says, that the labels -- required in New York since July 2008 -- need more time to make a difference. Or perhaps the effect is hard to track at fast-food outlets. The researchers surveyed customers and examined receipts from several fast-food places. But what if the labels have kept some people away all together?

Elbel and other researchers are still evaluating the data they collected. And they’re planning another study, this time in a city (still to be decided) that’s about to adopt labeling laws, so they can look at the before and after.

Menu labeling is just one effort to combat obesity, and the diseases associated with it -- such as high blood pressure and diabetes. And Elbel says it may take several programs in conjunction. In L.A., the City Council banned new fast food spots in South Los Angeles -- an effort that isn't likely to help, according to a Rand Corp. study.

-- Mary MacVean

Photo: Mel Melcon / Los Angeles Times

This weight-loss message was brought to you by the makers of Oreos

The makers of Haagen-Dazs ice cream, Chef Boyardee canned pasta, Oreo cookies and Snickers bars are joining forces to combat … obesity.

That’s right. Nestle USA, ConAgra Foods, Kraft Foods Inc. and Mars, Inc. – along with the Coca-Cola Co., PepsiCo Inc., Hershey Co., Sara Lee Corp. and other giant food manufacturers – today announced the launch of the Healthy Weight Commitment Foundation. The goal of this new initiative is to reduce obesity, particularly in kids, by an unspecified amount over the next six years.

Eating less junk food may – or may not – be part of the solution. Participating companies are welcome to reformulate their products and reduce portion sizes, but they’re under no obligation to do so.

Instead, the emphasis is on the notion of “energy balance.” Regardless of what you eat, you’ll gain weight if the total number of calories consumed is greater than the number of calories burned through exercise and other activities. As David Mackay, the chairman of the foundation’s board, put it, kids and adults could do a better job of balancing their “calories in and calories out.”

It’s a convenient message for Mackay, who is also the president and CEO of Pop-Tart, Cheez-It and Keebler cookie-maker Kellogg Co. (Its Froot Loops and other cereals may or may not be considered health foods, depending on who you ask.)

Safeway Inc. and other large grocers are also part of the coalition, which has pledged $20 million to the don’t-necessarily-eat-less-but-definitely-exercise-more effort. As one skeptical consumer commented on a CBC News website: “$20M doesn't seem like very much for these huge companies. What is that, like 6 Super Bowl commercials?”

The foundation also includes several nonprofits, such as the American Council for Fitness and Nutrition Foundation, PE4life and the American Dietetic Assn. Foundation. The ADA was in hot water recently for appearing to back – and then backing away from – the controversial Smart Choices food labeling system.

Dr. Risa Lavizzo-Mourey, president of the Robert Wood Johnson Foundation, said she would be keeping the new initiative honest by tracking its progress and evaluating whether it is making “a significant difference for our nation’s children.” RWJF has committed $500 million – or roughly 150 Super Bowl commercials – to reducing childhood obesity by 2015.

The Healthy Weight Commitment Foundation does not yet appear to have sprung for a website detailing its efforts, but a news release can be found here.

-- Karen Kaplan

Photo: Can you eat like this if you just exercise more? Photo credit: Bryan Chan/Los Angeles Times

WIC program gets its first overhaul -- to include fresh produce

There is rejoicing today at agencies that work with recipients of food vouchers through the Women, Infants and Children program.

"We're in seventh heaven," said Laurie True, executive director of the Cal WIC Assn., based in Sacramento.

Starting Thursday, WIC recipients -- more than 8 million of them -- will be able to use vouchers to buy fresh fruit and vegetables, under a program revision that has been years in the making.

"We're extremely excited," said Pina Hernandez, outreach manager for the Public Health Foundation Enterprises WIC Program, which provides WIC services to 316,000 people in Los Angeles and Orange counties.

"It's a much-needed change," said Elizabeth Pivonka, president of the Produce for Better Health Foundation, a nonprofit behind a national public health initiative to get people to eat more fruit and vegetables.

"That's the one food group consumers are eating so little of," she said.

When WIC was devised more than 30 years ago, hunger and vitamin deficencies were problems, and the WIC foods reflected that -- eggs, cheese, protein, milk, juice. Today, of course, obesity is the top food-related health problem.

WIC also provides education to recipients, and Pivonka said the emphasis on the reasons people need fruit and vegetables might help families develop good eating habits. And for families who might have felt that fresh produce was too expensive, the targeted funds will "give them permission to eat fruits and vegetables," she said.

The provision is $6 a month for children, $8 for pregnant women and mothers of children 5 and under, or $10 for mothers who are exclusively breast-feeding.

"Is it sufficient? No, but it's just a supplemental program," Pivonka said.

-- Mary MacVean

Your tax dollars at work ... for your diet

Let’s say you’re about to dig into a quarter-pound cheeseburger dripping with ketchup, mustard and mayonnaise. Then you hesitate. Is this a nutritious choice?

Luckily, you can find the answer at MyFood-a-pedia, a new online service from the U.S. Department of Agriculture that lets you search for nutritional information on more than 1,000 items.

According to MyFood-a-pedia, the naked cheeseburger on a bun contains 552 calories and includes 1.5 ounces of meat, 3 ounces of grains and half a cup of milk. But 195 of its calories come from “extras” like solid fats and added sugars. Factoring in all the condiments boosts the total calories to 669. Adding lettuce and tomato raises it slightly more, to 673, but then the burger gets credit for containing a quarter cup of vegetables.

A medium-sized fast-food order of French fries adds an additional 457 calories to the meal, including 224 from fats and sugars, MyFood-a-pedia says. A can of soda contains an additional 155 calories, all but one of which is in the unhealthful “extras” category.

MyFood-a-pedia has nutritional information on a gamut of items, including raw apples (72 calories each); applesauce (97 calories in a half-cup serving); apple pie (356 calories a slice); apple cider (117 calories in a cup); Apple Jacks (also 117 calories a cup); and Waldorf salad (121 calories in each half-cup scoop).  

Nutritional information on two foods can be compared side by side. (Turns out a serving of Froot Loops has one fewer calorie than Apple Jacks.) The service was unveiled last week in a tweet from the USDA.

-- Karen Kaplan

Image: USDA

Soda flows freely in California

The stereotypical Californian may sip chai lattes or guzzle green tea, but we actually drink lots of soda.

In fact, 24% of California adults drink at least one soda or other sweetened beverage each day, and an additional 36% imbibe occasionally, according to a report released today by the UCLA Center for Health Policy Research and the California Center for Public Health Advocacy.

That’s nothing compared with kids. The report -- "Bubbling Over: Soda Consumption and Its Link to Obesity in California"-- says that 41% of children between ages 2 and 11 drink at least a soda a day, along with 62% of teens. An astounding 13% of 12-to-17-year-olds drink three or more sodas on a daily basis.

Obviously, this can’t be good for us. But how bad is it? The average daily intake for teens is 1.2 sodas. Assuming that each “soda” is a mere 12-ounce can – and many servings are much larger – that works out to 39 pounds of sugar a year.

Not surprisingly, the report links soda consumption to excess – and unhealthy – body weight. For instance, 62% of adults who drink soda daily are overweight or obese, compared with 52% who don’t drink soda at all (another surprisingly high figure). Put another way, adults who drink soda occasionally are 15% more likely to have a weight problem than those who abstain, and adults who drink it daily are 27% more likely.

The researchers ranked California counties according to soda consumption. Imperial County boasted the highest rate of daily soda-drinking among children (60.7%); Tulare County took top honors for teens (71%), and Kings County topped the list for adults (39.1%). On the other end of the spectrum, Marin County had the lowest rate of kids (18.4%) and adults (10.6%) who drank at least one soda per day. The lowest rate for teens was in Mendocino County (39%).

Why should we care? Carrying around extra pounds is associated with an increased risk of diabetes, heart disease, stroke, some types of cancer and other causes of premature death. The annual cost of being overweight and obesity is $21 billion in California alone, according to another study by the California Center for Public Health Advocacy.

The results are based on data collected from the 2005 California Health Interview Survey, which included more than 4,000 adolescents and 43,000 adults. Participants were asked about drinking soda, “such as Coke or 7-Up,” and about “fruit-flavored drinks such as lemonade or Sunny Delight.” The survey did not ask specifically about sports drinks like Gatorade – which have recently joined the ranks of sugary beverages that public health experts like to discourage – so the results probably understate the number of calories Californians consume in liquid form, said the report’s lead author, UCLA research scientist Susan Babey.

Interviews were conducted in English, Spanish, Mandarin, Cantonese, Vietnamese and Korean. The survey was funded by state agencies, the National Cancer Institute, the Centers for Disease Control and Prevention and private foundations.

-- Karen Kaplan

Photo: Soda fuels California teens, according to a new report.

Credit: Los Angeles Times

Soda taxes back in the limelight

Consumption – many would say overconsumption – of full-calorie soda and other sugar-sweetened beverages has undoubtedly fueled the rise of obesity in the U.S. The number of colas, sports drinks and fruit punches guzzled by the average American doubled between 1977 and 2002. Study after study has demonstrated a link between the amount of liquid calories consumed and the number of pounds gained.

If only the reverse were true as well.

It certainly stands to reason that switching from Coke to Diet Coke – or better yet, to water – would cause people to lose weight. Surprisingly, this connection is difficult for researchers to make. In some studies, people who knew they were saving calories on soda wiped out that advantage by taking extra helpings of food. Perhaps others saw less need to exercise. For whatever reason, cutting back on sugar-sweetened beverages is just not as good for the waistline as you’d expect.

And yet, advocates of a soda tax keep pressing their case – most recently in a Health Policy Report to be published in Thursday’s edition of the New England Journal of Medicine. They insist that raising the price of sugary drinks by means of a tariff will prompt people to buy less, consume less and consequently gain less.

Many researchers have made the case that a soda tax would indeed eat into soda purchases. In multiple studies, they have found that a 10% tax on sugar-sweetened beverages would reduce consumption by 8% to 11%. But, as reported recently in The Times, researchers have almost universally failed to close the loop by showing that reduced consumption leads to lower body mass index.

In their policy report, the soda tax advocates cite four long-term, randomized, case-control trials – the kinds of studies considered the gold standard in medical research. But these trials pretty much fail to show that drinking fewer sugary drinks leads to widespread weight loss. Consider:

•  A British study of 644 kids between the ages of 7 and 11 found that the ones who drank fewer carbonated beverages had lower BMIs after one year compared with kids who didn’t. But the difference in BMI wasn’t statistically significant. That means the difference could easily be explained by random chance. This study did find that kids who drank fewer sodas were slightly less likely to become obese.
• A Brazilian study of 1,140 9- to 12-year-olds found that a program to discourage kids from drinking sugary drinks had no effect on overall BMIs. The only group with a statistically significant benefit was overweight girls.
•  A Boston study of 103 high schoolers found that those who consumed diet drinks for 25 weeks didn’t lose weight compared with kids who drank regular soda, though there was a statistically significant difference for the one-third of kids with the highest BMIs.
•  A Chilean study of 98 overweight children found that those who drank milk instead of sugary beverages didn’t have a statistically significant reduction in body fat, though there was a bona fide increase in lean mass.

None of these shortcomings should be interpreted to mean that soda is some kind of health food. But perhaps it would be useful to explore other public health interventions that are proven to reduce BMI broadly among the two-thirds of Americans who are overweight or obese.

Even if soda taxes don’t cause anyone to slim down, some people say they’re a good idea anyway because the money they raise could be spent on measures aimed at reducing childhood obesity, overhauling the healthcare system, or other worthy objectives that would counteract their regressive impact. President Obama recently told Men's Health magazine that a soda tax could be useful in the fight against obesity.

The authors of the policy report suggest a tax of 1 penny per ounce of sugar-sweetened beverage. For a 20-ounce drink, that works out to a price increase of 15% to 20%. If implemented on a nationwide basis, such a tax would raise $14.9 billion in one year. In California alone, it would generate $1.8 billion, including $188 million in Los Angeles.

Want to dream on? Check out this online calculator to see how much money could be raised by imposing taxes of up to $2 per ounce on a variety of drink categories in each of the states as well as in 25 major cities.

-- Karen Kaplan

Photo: Full-calorie soft drinks and other sugar-sweetened beverages are a persistent target for fat-tax advocates.

Credit: Justin Sullivan/Getty Images