COVID 19 - Take Precautions - Avoid Panic

As most readers or former readers of the blog know, I haven't been writing in any regular sense since 2016 or 2017. But I felt it important to post something about the current global health crisis.

I am a college professor with degrees in public health and that means I have training in disease transmission and prevention. My faculty appointment is with the College of Public Health at Temple University. This post refers to the strain of coronavirus (one word!) that began affecting people in December 2019, or COVID-19. There is a lot of information available about the virus and not all of it is accurate. I encourage you to follow the guidance of trusted sources - people who speak from science and medical backgrounds. Authorities, such as the WHO and the CDC -even my colleagues at Temple.

So do be prepared, do take precaution, and don't panic.

COVID19 is not the flu or a cold, it is more serious because it is likely to spread more broadly (no wall of protection from a vaccine), but the symptoms may FEEL like a bad cold or the flu. Most healthy people, those without chronic disease or compromised immune systems, can fight off the virus within 5 or so days just like they do with colds or flu. People who have been exposed to the virus, with or without symptoms, could transmit it to others and those others may not be able to fight it off in a few days. The severe cases - when the virus goes from upper respiratory to lower respiratory (lungs) - require hospitalization and it appears, have a higher mortality rate or case fatality rate, than the flu.

Social distancing - not hanging out with people - is what you do when you are well - quarantine is what you do when you are exposed - and isolation is needed when you are sick. Please please don't go around anyone if you have symptoms. Many work places are closing and the US Congress is working on a emergency resolution that will provide sick pay to people who do not have it with their jobs.

And you have probably heard that we are trying to flatten the curve - that is what these social distance measures are for... stopping a spike in cases and mortality. It is spreading the disease out - so COVID-19 might be around longer, but less people get sick and die - and less people get sick at the same time. It also prevents us from over burdening the health care system. If we have a lot of cases in the hospital, then doctors cannot treat everyone and all the other reasons people go to the hospital are still happening - it would overwhelm the system. Read more here. 

I don't need to repeat or try to say things differently than the CDC so you can read the latest info at this website. I will say, there are 5 steps for washing hands and the last one is important too.
1) wet hands 2) use soap 3) rub and scrub hands, 4) rinse hands 5) DRY YOUR HANDS thoroughly with a paper towel/clean towel.  Wet hands are NOT clean hands.  If you cannot wash your hands this way, use hand sanitizer.

Take care of yourselves and try to avoid the hysteria and false information.

The 'new' Physical Activity Guidelines for Americans, and what they got wrong

Early this month, the Department of Health and Human Services released an update to the 2008 Physical Activity Guidelines for Americans. The recommended amount of physical activity needed to maintain good health really hasn't changed. Children should get 60 minutes of physical activity a day and most of it should be moderate to vigorous aerobic activity (i.e., increased heart rate, hard to carry on a conversation) and they need muscle strengthening exercises, too.  Little children, and their caregivers, should stay active throughout the day. That is subjective, but it means less screen time!

The amount of moderate to vigorous physical activity and strength training that adults need is still 150 to 300 minutes of aerobic activity a week, less if it's vigorous (like running at a 10 m/m pace or faster), and twice a week weight training. The Guidelines say that this amount of physical activity is beneficial, but to really improve health and prevent disease MORE is necessary. That goes for strength training (e.g., lift weights), too. The least amount Americans need to do is twice a week for 20 minutes. Older adults, say 50+ should consider weight training imperative, as it will slow age related muscle loss (i.e., sarcopenia). Read more from the DHHS here. And for an announcement on the changes from NPR, read here.

So what has me all riled up... so much so I am writing a blog post when I have pretty much stopped making time for them? Well, the Guidelines now claim that any large muscle motor activity/movement can count toward your aerobic goal. So if you walk from your car to a building and it takes 5 minutes, good for you!! Only 295 more to go. If you mop the floor for 10 minutes - you are AWESOME, 285 more to go. And so forth.

As I perceive it, that is not exercise. And here is why I think the DHHS wants to say it is. Because, as a nation, we have been woefully behind in meeting the PAGA (physical activity guidelines). According to the CDC, less than 1/4 (25%!) meet the combined aerobic and strength training minimum goal. But if the government says all those little things DO count, then when they ask people about meeting the per week aerobic goal, more can say yes. So the next time the CDC reports results form a survey, the percent of the population meeting the aerobic goal might jump from 50% to 75%, only because the definition has changed, not because people became more active. 

Imagine our trend lines - there could be a sudden spike in the number of Americans who meet the goals, but it won't be because people are exercising more, it will be because they are counting things that probably shouldn't count. Be wary when looking at trend data when the definition of the behavior being tracked or the question being asked, has changed.

I absolutely 100% believe we need to move more and sit less and that by doing so, we will be healthier, but come on.  If you get up and go to the toilet at night, can you count that too?!? Lowering the standards is not going to reduce chronic illnesses related to sedentary behavior.

It is happening!

It has been eight years, but the National Restaurant Menu Labeling Law (part of the Patient Protection and Affordable Care Act) will be in effect on Monday. Restaurant chains with over 20 locations will be required to post the calorie content of their standard offering on menu boards and print menus. The goal is to raise awareness of the amount of calories in the items we choose - and to do so before we make that choice. This law has the potential to change our behavior as consumers as well as the behavior of those providing us with food and beverages. Will the calories available to purchase decline? Will we purchase AND consumer fewer calories? If the answers are yes, will the country's obesity rate plateau or decline? I sure hope so - but that's a lot of ifs. 

Meanwhile, the recommended changes to the Nutrition Facts Panel have been delayed to 2020 - here we go again. The main change on those labels is an emphasis on total calories and added sugar and a de-emphasis on total fat. 

On a personal note, sorry I don't post much anymore, but my students require a substantial amount of my time!

Eating for the 'wrong' reasons and important links

Even though I don’t have time to maintain my blog, I am reluctant to shut it down. So today I am writing for two reasons. The first is to remind readers about the danger of eating when you aren’t hungry and the second is to share a couple of health news sources. These news sources will be of particular interest to those who have enjoyed my blog topics, and I will share the links at the end. The sources have free email subscriptions and I believe they are two of the best (i.e., credible, relevant, current) out there.

As I thought about writing (my posts often percolate in my head a few days), I remembered that I started my blog as a newsletter back in 2004 (approximately) when I was working at a hospital and taking classes to earn my Master’s in Public Health. Many readers followed my journey from that point (i.e., to Florida as a Tobacco Treatment Specialist, to UNCG for more graduate studies in Public Health, to Beasley School of Law to complete a post doc in Public Health Law Research) to now – 13 years later.

Today, I am an Assistant Professor at Temple University in the Department of Social and Behavioral Sciences. My teaching responsibilities include a course about substance use disorders and addiction (that should make sense if you’ve read the blog over the years) and a course on nutrition as it relates to the health of populations (i.e., I am still not a registered dietician and do not give individual diet advice). I teach additional courses and conduct research/program evaluations, but this blog has foremost been about behaviors that impact our health and the laws that make those behaviors harder or easier to accomplish (e.g., that darn national menu labeling law that can’t seem to be implemented, soda taxes, new food labels). 

Dietary intake and health status (including obesity) has probably been of most interest to my readers, and to me. So, I want to talk about a specific area of risk regarding dietary intake. Eating for non-hunger reasons. It is often when we eat for the ‘wrong’ reasons that we gain weight. I think what sets me apart from a lot of people is that I don’t do that. I primarily eat to fuel my body when I am hungry. Or better put: I do not eat to socialize. I do not eat because I am bored. I do not eat because I am sad. I do not eat because I am high (haha, just kidding – bc I don’t get high). I do not eat just because everybody else is eating or to be polite. To be clear, I LIKE food, and enjoy meals and snacks and alcoholic beverages, but I don’t respond to social (including work meetings) or familial pressure to eat for the sake of fitting in.

Now that I think about it, I did blog about this many years ago – about how to eat in a social context without gaining weight. I suggested that when you are going to an event (family traditions included) where it is expected that you ‘eat to be social,’ or you know your favorite foods will be available, you plan it so that the food you eat at the event is part of your daily intake (and if its occasional, maybe it’s a little more than your daily intake). But eating when you are sad, bored, or unexpectedly confronted with someone’s ‘oh I had to get these out of my house, please have some’ cookies is a sure path to over consumption/excess calories. This over consumption is especially likely because the food associated with those ‘eating but not for hunger’ reasons are usually high in sugar, saturated fat, salt and calories. So, just think about that – and decide how you want to handle it.

That’s all I have for you on diet and health today. Most importantly are the links I promised you at the start of this post. Here they are:

STAT News Morning Rounds

ConscienHealth blog   (the subscribe option is on the top right of the page)

Diet and Health: The Big Picture

After teaching an undergraduate public health nutrition course (i.e., not a course for aspiring dietitians) for a couple of years, I realize that there are a few points that are most important. The first is that healthy is a very squishy word and must be defined when used. In fact, at this very minute the FDA is taking public comments as they consider whether food companies can continue to use the word on their products and what exactly it would mean if they did (same for the word natural). I define healthy in the spirit of the Dietary Guidelines for Americans. Therefore, a healthy food would be high in nutrients that we need and do not get too much of (e.g., we need sodium/salt but we easily get plenty, so a food high is sodium is not considered healthy), and low in calories and things we need less of (e.g., solid fats and added sugars). So healthy foods are usually whole foods (i.e., produce, whole grains), lean proteins (e.g., some fish, legumes), certain oils (e.g., olive oil, omega 3, flaxseed) and some low fat dairy products. Unhealthy foods would be ones likely found in a box or bottle (e.g., sugar sweetened beverages) with high calories, high sodium (e.g., 10% or more of the daily value on a food label), and added sugar. Unhealthy would also include whole foods that were prepared in a way that adds excess calories, sugar or sodium, and cooking with healthy oils instead of adding a small portion (less than a tablespoon) of raw oil after preparing the food.

The remaining points are these:

• Just because something is good for you (aka healthy) does not mean it is free of calories and that you can eat as much of it as you like.

• Just because something is bad for you (aka unhealthy) doesn't mean you should NEVER eat it (with a few exceptions, e.g., raw fish or unpasteurized milk).

• Calories matter no matter what you tell yourself and its important to have a general idea of how many you need and how many are in the foods and beverages (including alcohol) that you consume. On that note, the national calorie disclosure law for restaurant chains and vending companies has NOT BEEN REPEALED and is due to take effect in May.

Start the New Year Informed

Like many or most of you, I am preparing for the new year. What might be different is that to be healthy I simply (or not so simply) need to keep doing what I have been doing. Whereas, many others start every year pledging - resolving - to do things differently. With that in mind, I want so share some truths with you.

The most important things that any of us can do are these (listed, not necessarily, but maybe, in order of impact):

1. Do not smoke tobacco (don't start or do quit).
2. Exercise - everyday (30 to 60 minutes of activity that increases your heart rate).
3. Maintain a healthy weight (this is relative, but for most people it means losing weight).
4. Eat within a calorie appropriate (controlled) recommended dietary pattern, e.g., the Mediterranean Diet, which is plant based.
5. Get some sun, but not more than 10 minutes without protection (also relative to time of year, your skin pigmentation and where you live).
6. Avoid alcohol in excess (for some this means any alcohol, for others excess means more than 1 or 2 a day or 7 to 14 a week (never more than 3 or 4 in one day).
7. Get vaccinated according to the CDC recommendations for your sex and age (and take your children in for their shots).
8. Practice safer sex - i.e., use condoms and discretion.
9. For those suffering from any substance use disorder, SAMHSA can direct you to supportive services
10. Do not fall for diet and supplement scams - nutrition comes from food and weight control comes from balancing intake with expenditure. If whatever supplement or plan you are hearing about was as much of a break through as the ad says, we would NOT have an obesity epidemic. Please believe me.. there is NO pill for you. Reread numbers 1 - 9 above, this is the key to health.
11. Remember these final words of truth:
1. Non-GMO only means something does not contain genetically modified ingredients, not that its low calorie or necessarily good for you.
2. Organic means something has been raised according to specific standards, and so the plant or animal was not treated with chemicals or antibiotics. Organic foods are not scientifically better for you than conventional foods (though there IS concern about antibiotics in the food chain). Organic foods are not necessarily or ever lower in calories than similar non-organic foods.
3. All natural is finally being defined by the FDA - but stay tuned for the final rule and then years before companies have to comply.  Even if something is truly natural - not at all processed - that does not mean it is good for you, wont' hurt you, or is low in calories.
4. There are legal definitions for low calorie, low fat, low sodium, etc.. and 'lower' means something different than low.
5. Read the nutrition facts panels, think about serving sizes.. pay attention to calories (usually a lower calorie item will also be low in sugar). Hopefully, the added sugar declaration will be added to labels this year and that will lead manufacturers to reformulate their products.
6. Some fat is good for you! Especially consider adding omega 3 fatty acids from food, like salmon.
7. ONLY 1% of white people in the United States have CELIAC DISEASE, and even fewer people of other races/ethnicities do. That means, YOU probably don't need a gluten free diet.
8. Gluten free does NOT mean low in calories or good for you.
9. The health promoting property of olive oil is destroyed when you cook in it. To get the nutrition you are seeking, drizzle a teaspoon over your cooked veggies instead.
10. Get your fiber from plant based foods and whole grains, not mixes and pills.

On a sad note, the national vending and menu labeling law which is NOW set for compliance in May of 2017 is part of the Affordable Care Act - and may or may not survive the next presidency. That means that local and state laws could once again begin to populate which could be better for us and a nightmare for industry. Stay tuned

Lastly and sincerely,  I wish you the healthiest of New Years....remember, though I focus on food, physical activity is the sine qua non of health... make sure you get plenty this year... all year.

~ Deirdre

Added sugar and other changes to the back of the pack nutrition label

     I wrote this post on May 20 -21, 2016 after the FDA announced new labeling requirements for packaged food manufacturers. The manufacturers will be required to provide additional information and modified information on the Nutrition Facts Panel (NFP). This applies to all companies, but smaller ones have longer to comply. The FDA announced July 2018 as the official effective date, but we know from past FDA associated labeling initiatives that this date could change.
     The FDA press release - which you can access here - offers highlights of the changes, and many news sources have covered the story. What I want to do is put the changes in the context of my blog re: nutrition disclosures that help us consume fewer calories across venues.
     So does this change help? Probably - or to some extent. First, the revised labels have an increased 'reference serving size'. The noted serving size may merely be a declaration to allow the nutrient content to be calculated, because people rarely (if ever) dole out cups, ounces, or grams and even if they did, it would be more cups, ounces, or grams than the label suggests. The update, a slightly larger serving size, appears to be a compromise between what people are actually eating and what they are supposed to be eating. In other words, it is probably still not realistic.  One example of a serving size change involves ice cream. Instead of a 1/2 cup, a label will say 2/3 cup. I imagine most people scoop out more than 2/3 a cup of ice cream for themselves, therefore, if a person wanted to know the actual calories or sugar they consumed, they'd have to do the math (just as before). Also people may think that the label refers to an actual cup of some sort, not a measuring cup. 
     A similar issue with serving sizes is unchanged. They are not exactly uniform across similar products - the serving sizes may all be a 1/2 cup but the weight - the precise measurement - will vary. Boxes of cereal and cartons of ice cream, as opposed to say, a can of soda, are actually figured by weight, grams usually. So a serving size might be 2/3 cup on five cartons of ice cream but the weight of each 2/3 cup could be different. So to be frugal with our calories like we are with our dollars, we  need to know the calories per unit. You don't get to see an orange shelf tag with this information but you can do the math, e.g. calories per serving divided by grams in a serving gives you the calories/gram.
     Another change on the NFP is that sugar grams will come with a % DV. I've never been much of a fan of the % daily value disclosure on a label. It is based on a 2000 calorie/day diet and the majority of women, myself included, require less, say 1500 to 1800, so again, math is required. There is a trick that can make the percentages useful. If the item on the label is a nutrient of concern (meaning we get too much of it, like calories, sugar and sodium), look for a low %DV.  Low is 10% or less. There are very few nutrients that Americans lack, but for those, look for high %DV. For example, it would be great to have products with vitamin D and calcium at 20% or higher.
    Small packages, ones that people are likely to consume all at once even if they 'technically' contain 2 or 3 servings, will now have dual labels. There will be a column with the serving size nutrient information and a column with the whole package nutrient information. For items like a 20 ounce soda, where the expectation or custom is to drink the entire bottle in one 'sitting' the nutrient and calorie content will only be for the entire package (who drinks 8 ounces of a 20 ounce soda and saves the rest for tomorrow?). BTW, that is why I go for diet sodas in 12 ounce cans, I do not need 20 ounces, its too much; and for some diet sodas, the trace calories will become meaningful beyond 12 ounces.
    There are a couple more changes, which are not as relevant to the theme of my blog. You can review them by clicking on the above link.
    I'll end with two important things the new labels do not address. The information is still on the back of the package and the rule doesn't amend the new vending machine law to include sugar grams with the point of purchase calorie disclosure. Because the Nutrition Facts Panel is still on the back of the package the prospective buyer has to pick up and turn each product around (the new rule does not mandate or standardize front of pack labels and this is a disappointment). And consequently, this rule won't help us purchase low 'added sugar' snacks from vending machines because we can't see the back of the package at the time of purchase.

Why we focus on food deserts and not food swamps

Most people have heard the term food desert. A food desert is a place where people live and do not have reasonable access to whole foods, or fresh produce. Often this is measured by some distance to a grocery store. For example, in some places people live close to convenience stores and fast food restaurants, but would have to travel several miles, sometimes 10 or 20, to get to a grocery store. In these same areas, there may be high rates of obesity - however, there are high rates of overweight and obesity across the USA. Some speculate that not living close to a grocery store where one can access produce is a 'cause' of obesity (i.e., they associate food deserts with obesity). And it is not just availability, it's affordability, too. If the fresh produce costs more than processed foods, they are less accessible. If children have to try foods several times to like them, and a parent is on budget, it makes it hard to buy more expensive items that might not be eaten.

Access and affordability are things that public health advocates work to change AND that the electorate/society supports. Right? Of course we should make sure everyone has access to nutritious foods that are often low in calories. YAY! Let's do it.

Research has not always supported the intuitive, however, and sometimes people who have access to fruits and vegetables still don't purchase or consume them. Why not? Well, my educated/informed opinion is because a good many people live in food swamps. I am not sure where I first heard or read the phrase, but I describe a food swamp as an area where high calorie foods - often low in nutrients - are in abundance, are cheap, easy to locate, highly advertised, branded (e.g., KFC, Doritos, Pepsi) and popular among children, adolescents and adults. Actually, these foods and their promotions (e.g., all you can eat buffets, $1 hamburgers, 3 for 1 honeybuns, 32 ounce sodas) are hard to avoid.  

As noted above, the popular strategy for dealing with a food desert is to bring more fresh foods in - build a grocery store or a farmers market, add produce to the convenience store checkout, send in a mobile produce truck - and hope people will purchase, prepare wisely and eat more nutritious foods. Oh and here is the most important part... eat them instead of the high calorie non-nutritious foods they have been eating. Every one agrees, yes - those are all good strategies... yay, lets fund them! [They don't work so well, but they seem smart and non-paternalistic, therefore, it must be right.]

The strategy for food swamps (which is as unpopular as the food desert strategy is popular) is policy and regulation. I believe that food swamps are the bigger problem and that regulation and policy are our best bet at trying to reduce over consumption of calories (often occurring passively, i.e., not intentionally eating extra calories). Examples include, limiting the number of fast food/quick casual restaurants that can surround neighborhoods, schools, and worksites (zoning laws), putting a sales tax on high calorie, low nutrient items, like sugar sweetened beverages (specifically I say a sales tax because consumers are more likely to notice a sales tax than an excise tax and sales taxes cannot be 'eaten' by the manufacturer unless they literally lower the prices of their products), putting calorie counts out in front on everything, everywhere (menu boards, front of packages, sodas) and educating people on what is considered a 'high' amount of calories (e.g, a dinner entree over 500 calories is high, if it is part of a days worth of meals), portion caps - like suggested in NYC might work, and limiting ads for high calorie foods or ad space (e.g., TV, public transit, magazines, websites, social media). I think our grocery stores should have makeovers as well. The cheap, high calorie foods should not get prominence and promotion. This is one of the main reasons I believe that strategies to add fruits and vegetables to neighborhood stores or whole grocery stores to neighborhoods, fail. It is hard to get through the mire of junk - physically, emotionally, socially, parentally - to the better for you items. 

And before anyone points out that the food swamp policies I mentioned are regressive (i.e., they will have a bigger impact on persons of lower income) I say YES, and obesity and its related disease conditions is also regressive and has a greater impact on persons of lower income. 

My point is, that though it might sound good (especially politically) to make fruits and vegetables and other nutritious foods available and accessible, what we really need is to make low nutrient (junk) foods and drinks LESS available and accessible (less cheap, less popular, less in our face).  And as that annoying prince on the TV show Outlander says, "mark me" I am right about this.

Exercise for Weight Loss?

No.
Exercise for exercise. Exercise for a long, healthy, active live.
Exercise for functional capacity, mood stability, improved attention and learning.
Exercise to prevent disease. Exercise to improve your quality of life.
Exercise because not exercising increases your risk of all causes of death and all disease states.

If you exercise only because you think it will help you lose weight, and exercise is your only weight loss strategy, chances are you won't lose weight. And then you will think exercise failed you. You will be wrong. Exercise is the sine qua non of health; it will never fail you. if you do it for the right reasons.  There are many reasons, see the first paragraph and the research studies below.

If you want to lose weight, change your eating patterns. Many people need to lose weight.
If you want to be healthy, exercise - daily.. Everyone, regardless of their weight status, needs to do this.

(NB. this was posted a few weeks later http://www.vox.com/2016/4/28/11518804/weight-loss-exercise-myth-burn-calories)

Janssen, I., & LeBlanc, A. G. (2010). Review Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. International Journal of Behavioral nutrition and physical activity, 7(40), 1-16.

Nocon, M., Hiemann, T., Müller-Riemenschneider, F., Thalau, F., Roll, S., & Willich, S. N. (2008). Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis. European Journal of Cardiovascular Prevention & Rehabilitation, 15(3), 239-246.

Penedo, F. J., & Dahn, J. R. (2005a). Exercise and well-being: a review of mental and physical health benefits associated with physical activity. Current opinion in psychiatry, 18(2), 189-193.

 Warburton, D. E., Nicol, C. W., & Bredin, S. S. (2006). Health benefits of physical activity: the evidence. Canadian medical association journal, 174(6), 801-809.

February Reminder: You said you would eat 'better' this year!

It's the middle of February, how are you doing with your goals to eat healthier in 2016?

Here are a few reminders and helpful hints:
Remember that calories still count and there are plenty of ways to eat delicious, full plates of food if you make some clever choices. For example, when eating out you can order your fish or meat with little to no oil, butter, glaze or sauce and ask for your vegetables to be steamed without butter. (note, pasta is never low calorie and bottomless bowls of it are a mistake) At home, you can prepare your food the same way - without lots of sauces, breading or butter.

Some vegetables are more nutritious than others - high in nutrients but not high in calories, as long as you do not bread, fry or coat them in butter.  For example, summer squashes, spaghetti squash, eggplant, cauliflower, broccoli, asparagus, butternut squash, Brussels sprouts, green beans, greens (kale, broccoli rabe, etc). Use this link to find other low calorie foods, and remember just because they start out low calorie doesn't mean they end up low calorie (how you or the chef prepares them is a crucial factor).

Alcohol and caffeine(particularly in coffee) can be a part of a health promoting diet, but be mindful of two things: 1) excess alcohol and caffeine can have adverse effects on your health (excess is more than one or two drinks a day depending on your sex and size, and probably 3 to 4 8-ounce cups of coffee); 2) both alcoholic beverages and coffee that is flavored with cream and sugar, bring in calories and those calories count towards your individual daily requirements. 

I enjoy a good cup of arabica coffee, black no sugar in the morning (okay 2) and decaffeinated, almond milk infused cappuccino in the evening. (sugar free milk ~ 30 cals a cup). For alcohol, I stick to one 12 ounce light beer, one 4 to 6 ounce glass of wine OR one shot of liquor mixed with a no calorie beverage. I recently made a batch of limoncello which I am enjoying several nights a week! Pictured above.

I hope this post has helped get you back on track or keep you on track and given you some new information for meeting your goals.

What we eat still matters

Obesity is a complex disease. I have come to appreciate this even more over the last 5 years, and what I am about to say in this post is NOT a refutation of that complexity. Instead, I want to make a point that though obesity [whether becoming obese in the first place or remaining obese after an effort to lose weight] is an intricate mess of bad decisions, bad environment, genes, social pressure, family customs (not traditions, but the every day way of preparing foods or eating that we learn from our families), lack of physical activity, metabolism, gut microbes, infections, injury and things we haven't even discovered yet - even though this is true, on its own, what we eat still matters.

Yesterday, I  was waiting for my train to arrive at 30th St Station in Philadelphia PA. I had been traveling over the weekend. I had an hour wait and was standing - standing - at a table, eating a salad that I had prepared and carried with me. I am a small person, slight of build, low weight. I am this way purposefully, not genetically; I share the same food environment, social pressures, and family cooking practices as most of you - some of whom are normal weight, and if the CDC is to be trusted, most of whom are not. As I ate my salad (which I found delicious with its ample amount of lean protein), I looked across the room and saw a person who was not slight of build and they were also eating. Eating from a box. A box of dunkin donuts. This is not a judgement, several of the things I listed in the first paragraph factor into the decision for that person to buy donuts. My point is, the food we eat still matters and even if it is not that simple in the grand scheme, it certainly is at some level. The small person was eating the salad. Maybe the small person routinely eats low calorie foods and doesn't exceed the calorie requirements to maintain a normal weight - and the large person routinely eats calorically dense foods and does exceed the amount they need.

NB: I didn't post this right away, its been a week since I was at the train station. So I have another observation to add. I was at dinner with friends the other night where I ordered a beautiful steamed seafood and vegetable entree. The man to my left, who is somewhat overweight (we had to trade seats at the movies recently because he was too large to sit comfortably unless in the aisle seat) was the first to request and be disappointed that the restaurant did not serve dessert. Not a judgment, an observation.

USE BY and other interesting package DATES

Year ending. Year beginning. So let’s talk about calendar dates – not weight loss goals or New Year’s resolutions, but dates on packages, cans, cartons of food and what they may or may not mean for you.

The information that I am providing today (the upshot) is freely available in more detail from the USDAs Food Safety and Inspection Service. I am not covering infant formula which has separate rules, and I notice that tuna and other canned fish are not specifically mentioned in the fact sheet. If you want more info on those products you might have to use the AskKaren.gov feature.

Here are the take home points on those package dates, some may surprise you:

There is no federal – or country wide – law regarding dates on food packages. Meaning, they ae not required at all, by the federal government.

Around 20 states have laws regarding dates on food items, but the laws vary.

An open date – just the date, no words to describe it – and a sell by date – are not meant for use by us. These are more a message from the manufacturer to the store owner letting them know that the foods will be of the highest quality if sold by – displayed until – whatever that date is.

If a package has a date and with that date are the words USE BY, you should – use it by that date. The food will be of better quality if you use it by then, and if you are not going to use it by that date, you can freeze it. Foods can stay in the freezer indefinitely, but be mindful of how you package them so they don’t get freezer burn.

Eggs are interesting. A few states require sell by or expiration dates and some others forbid them! If an egg carton has USDA stamped on it, you will find a package date. The date the eggs were put in that carton. And it’s a little unusual. It only contains 3 numbers. This 3 digit date indicates the number of days since the start of the year that the eggs have been packaged. So if you buy a carton of eggs and it says 145, the eggs were put in the carton on the 145^th day of the year – year starting January 1^st. If there is a sell by date on this same USDA carton of eggs, it cannot be after that package code date.

Also interesting, eggs can be stored in the fridge and used for 3 to 5 weeks while maintaining great quality – even after a use by date. Of note, the eggs should remain in the carton and at the coldest part of the fridge (so much for all the refrigerator egg gadgets!)

If there is not a use by date, the USDA provides advice on when to use the food by, and offers a chart here. The thing that stood out to me when I looked at the chart is that opening the product is the kiss of death, and that almost everything should be used within 2 days of breaking the seal (except milk and produce). It’s like time is suspended until the seal is broke and then it rapidly accelerates.

Other important food safety and shelf life considerations: If you leave a product out of refrigeration, like hot dogs you are waiting to grill, the use by date is void, they are not safe anymore. Thawing something out at room temperature for over two hours is also frowned upon. Notice this is not about quality anymore, it’s about safety via contamination. Other safety issues mentioned in the handout involved not washing ones hands before preparing foods.

BTW, there was no specific mention of yogurt, milk or cheeses, but USDA/FSIS indicated that the foods should be fine if kept refrigerated– and until you notice an off odor, color or perhaps mold J

How The 2016 Federal Budget impacts nutrition, dietary advice and calorie labeling

If you are confused about what foods to eat and which constitute a healthy routine diet, you are not alone. In fact, this year has been extraordinary for its confusion and contention surrounding nutrition science and dietary guidelines. In fact, the experts - nutrition and public health – do not agree. The controversy was simmering even before the release of the 2015 Dietary Guidelines Advisory Committee Report, an update to the Guidelines I meticulously explained and passionately promoted 5 years ago – before I joined the rank of researcher (i.e., became a more critical reviewer).

Did the uproar over the Committee’s recommendations make its way into your daily news briefs? If so, you’ll know that the contention was strongest around the recommendation to lower meat intake, not just for health, but for the planet – for sustainability.

After the report was released, a non-scientist, nutrition journalist published a scathing article on the recommendations, which led to a crusade by the Center for Science in the Public Interest and a point by point response letter signed by over 100 experts, researchers and scholars (myself included) that was posted just about a week ago.

There is not just dissent on the recommendations, which include less salt, less saturated fat, less sugar, but also on the scientific evidence used and the scientific process itself. So much so, that the recently passed Omnibus Appropriations Bill 2016, delays the release of the guidelines! Read for yourself (selected text from the Congressional directives):

Congress continues to be concerned about the quality of scientific evidence and extraneous factors that were included in the 2015 Dietary Guidelines Advisory Committee's Scientific Report.

To ensure the guidelines adhere to the nutritional and dietary scope of the law and are based upon sound science, bill language has been included clearly stating that the final guidelines cannot be released or implemented unless they are based upon significant scientific agreement and adhere to the statutory mandate.

Questions have been raised about the scientific integrity of the process in developing the dietary guidelines and whether balanced nutritional information is reaching the public. The entire process used to formulate and establish the guidelines needs to be reviewed before future guidelines are issued. It is imperative that the guidelines be based upon strong, balanced science and focus on providing consumers with dietary and nutritional information that will assist them in eating a healthy and balanced diet. At a minimum, the process should include: full transparency, a lack of bias, and the inclusion and consideration of all of the latest available research and scientific evidence, even that which challenges current dietary recommendations.

The agreement (the Budget) provides $1,000,000 to review the dietary guideline process.

And that’s not all! The Omnibus Appropriations Bill takes aim at school nutrition and calorie labeling as well. The federal government by enactment of this bill, further delays calorie postings for grocery stores and ‘similar retail establishments,’ which I am assuming are the bowling alleys, movie theatres and convenience stores. My colleagues tell me that the FDA had already made those postponements and the Budget Bill just makes it a mandate. I might have been too focused on vending – which was already set for 2016 – to have noticed. What I am thinking is 1) this calorie labeling is never gonna happen and 2) if the federal law is not in place, state and local laws can’t be pre-empted, thus they can remain more restrictive… good for Philadelphia.

With regard to the school lunch program, schools can have more time to figure out how to increase the whole grain content of meals – though 95% of schools haven’t suggested that they need more time, so this is dumb. Also, the rule to lower the sodium content to a new lower goal has been halted pending scientific evidence that it is necessary to do so for health.

Here are a couple of links re the budget that was just passed.

Summary

Pretty much the whole thing

USDA-FDA specific budget language

Food as tradition vs Food as reward

Food has many meanings and purposes. Food can soothe the soul as well as sustain the body. It may even heal and restore. It is a source of nourishment, especially, or perhaps only – when it contains protein, carbs, fats and nutrients, not empty calories (e.g., high sugar, high salt and high saturated fat). And food is a source of pleasure, helping us to recall happy moments, favorite people, and traditions.

For many of us, the act of preparing, cooking and serving food is an expression of love: familial, social, charitable. Within cultures, broad and refined, certain foods celebrate, symbolize, crystalize (as in rites of passage, milestones). There is room in all our lives for these occasions[1], these moments of food as something more than or other from, sustenance. There is no room in any of our lives for abandoned consumption of even our cherished foods. To be honest, gluttony sort of ruins the whole appeal. But this blog post is not about moderation or counting calories. I am hoping that in time, soon, it will no longer be necessary to even mention calorie moderation, not because we have found a magic pill that lets you eat whatever you want, or because exercise suddenly causes easy weight control, but because we will have learned, as a nation, that calories MUST be part of the strategy.[2]

These other than sustenance reasons for eating that I described above, fall into the appropriate practices of most societies throughout time. But there are less salubrious reasons for eating and sadly, these unhealthy, psychologically damaging reasons are often situated and cemented in childhood: pacification, reward, boredom. Recently, I observed one of these unhealthy uses of food, which I’ll describe in a moment, and that scene triggered a few other memories of the misuse of food, memories that are at least 20 to 30 years in the past – I’ll share them too.

The first and recent example uses food as reinforcement. This particular example can be thought of as either negative or positive reinforcement, which is unusual and psychologists might disagree with me, but I’ll explain my reasons and why I call it negative reinforcement. Negative reinforcement is an action that takes away an unpleasant thing, while positive reinforcement provides a reward or something pleasant when a particular behavior is exhibited. In my interpretation, one is meant to extinguish and the other is meant to encourage. I think that using food to take away an unpleasant emotion would be using it for negative reinforcement – a really bad idea. In the case I witnessed, a child was crying – throwing a pretty good tantrum – and the dad said to the mom, “Give her a lolly pop.” WHOA. – I most certainly did cringe. More distally, when I was a young adult babysitter, I observed what the parents clearly meant to be positive reinforcement when they gave their child a cookie for using the potty. To this day I have wondered if that girl grew up to have an eating disorder. And a little more recently, but still 20 or more years ago, I remember watching a friend constantly hand her son food to eat as they rode around in the car – visiting people. He was bored and eating chips and drinking soda kept him occupied. He is a (heart breaking) morbidly obese young adult now.

Food is not meant to drown out our feelings, teach us to do things, or keep us from being bored.  Parenting is hard -  I get that, but food as a parenting strategy is a dangerous mistake. Though I am firm in my belief that food not be a reward, food can certainly be a pleasure and serving it rewarding. When foods become embedded with our culture, our traditions, and our families it is a good thing. But using food to treat a bad mood, stress or mental illness is ineffective and it’s unhealthy. If you’ve found yourself using it this way, instead, try exercise, talking to confidants or professionals, writing, meditating, praying, and other positive coping mechanisms. Heck, even medicine if all else fails, but not food. Food is not the answer nor the treatment for emotional or physical pain.

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[1] Note: this is not the same thing as having style of cooking that consistently creates excess calories or uses large amounts of nutrients/substances of concern (i.e., sugar, fatty and or fried/breaded foods and salt/sodium)

[2] Forgive me for another small aside, but as I wrote the sentence above regarding the pill that lets you eat whatever you want, I had a little epiphany. The ads for pills and supplements do say, ‘eat whatever you want and lose x pounds.’ And that is not the real issue. It is less about WHAT one eats and a lot about HOW MUCH; so the magic pills have to let us eat what we want, as much as we want and keep us thin and metabolically healthy – good luck waiting on that.

Resisting a challenging food environment

As the years have progressed and research findings amassed, it has become obvious to most people – experts and non-experts – that obesity is not caused by one thing. However, certain factors seem to have a greater impact on whether or not a person consumes more calories than they need or burn than others. For example, genetics have less of an impact than lack of physical activity. And a combination of risk factors intensifies the impact of any one. For example, a genetic risk, not exercising (or being sedentary), being female and using antidepressants is a perfect storm for gaining weight.

The risk factor that my research and my public health efforts focus on is the environment – the food environment, which I define as anywhere we make a decision about what to eat immediately or what to buy to cook or eat at home.  Within this huge food decision space, individual level factors (knowledge, stress, social and family norms, income) interact to make it harder for some to ‘resist’ what is sometimes called a toxic or obesogenic (obesity causing) environment.

To advance my goals – reducing caloric excess in the population - I support policy that aims to change the environment. Policy that changes the space where we make so many food (and beverage) decisions. I have spoken a lot about information policy, but that doesn’t directly change the environment (indirectly it could lead restaurants to supply lower calorie meals through a change in recipes or serving sizes). Strategies/laws that directly change the environment would include the failed NYC serving cap on sodas.  Other strategies, softer ones some will say, fall into the category of ‘choice architecture.’ In other words, someone (and this someone can be a contentious issue) decides that in order to help a person choose the healthier (? – definition pending) option, this healthier option needs to be easier to access or displayed more attractively than the non-healthy one. For example, instead of the huge display of 50 cent white bread at the front of the store, the owner places a display of whole wheat bread. Strategies that I am particular enamored with include taxes (price manipulations), zoning restrictions (do we need 10 fast food restaurants w/in a mile of a neighborhood or school?), and advertising constraints (do transit busses really need to advertise 2 dozen donuts for the price of 1?). The point of these efforts is to change perceptions about food consumption and the pressure to consume more food than we need. The changes of what is normal developed in response to our environment over the past 30 years. We have new social norms.

Changing the environment means reducing the amount of or display of ‘desirable’ foods.

I hadn’t realized that what I was talking about is also called ‘desire reduction.’ In other words, if the things – no the triggers - that lead us to overconsume calories are taken away, then our desire to overconsume is reduced. Take my donut example. If the ads for donuts are taken off the bus, then this might reduce my desire to go buy donuts. Certainly, if your work place bans junk food at office meetings, this would reduce the desire to eat those junk foods. I like these strategies because they attempt to reverse something that happened without our asking it to happen. The environment changed around us and what was normal changed. Now it is ‘normal’ to be served supersized meals. It is ‘normal’ to sit for hours. It is ‘normal’ to drink a 20 ounce sugary beverage or an 8 ounce glass of wine. And pushing back against the new normal in our social context is often met with shock and disapproval. Still, this push back, this resistance, is yet another strategy – an individual level strategy that some people promote. I am not convinced. 

The ‘new’ term for this type of individual level strategy or intervention is ‘desire resistance.’ I became familiar with both of these terms (desire reduction and desire resistance, but not the concepts) only recently, when I read an article by Dutton, Fontaine and Allison (abstract here).  I am a pretty big fan of Dr. Allison, he is the co-director along with Dr. Fontaine, of the Nutrition Obesity Research Center at the University of Alabama, and I pay attention to what he has to say. This is one of the few times I disagree with him.

In their discussion of desire resistance, the authors offer this example of the skills an individual might need to posses in order to resist their ‘internal desires’ or ‘external challenges’ (eg those brownies someone left in the break room):

“Desire resistance skills include strategies such as self-monitoring, meal planning, asking for social support, wearing a physical activity monitor, cognitive restructuring, making a public social commitment, and preparing oneself to anticipate, tolerate, and accept feelings of deprivation when they are encountered.”

I understand that the authors are advocating for both desire reduction and desire resistance, but desire resistance, to me, is going back to the individual focus that others have already found to be extremely challenging. Programs that work at this level usually do not produce lasting change. Yes, there is some evidence that teaching people to count calories or plan their meals will work for the short term and maybe in the long term, for some people, but it is rare. In my experience and in the literature, finding people who can actively, consistently and perpetually resist this 'in your face, food pushing society’ is unusual. I AM one of those people, so if I am against desire resistance as an obesity prevention strategy, it’s worth noting!

This idea of resisting cues to eat calorically dense foods or drinks, or any food or drink when you are not hungry, reminds me of the time I spent teaching people how to resist the trigger to smoke a cigarette when they were trying to quit. What worked the best was when there were LESS triggers. In other words, successful quitters are more likely to be around others who did not smoke, work and recreate in smoke free environments and live in a ‘space’ where smoking is not ‘normal.’ The environmental changes – and taxes on tobacco – have done far more to assist in smoking cessation than all the desire resistance programs!

It’s also ironic to me that in the Allison article, where the authors introduce the desire reduction and desire resistance terms, that they also point to the 2010 Recommendations from the US Surgeon General regarding obesity prevention as misguided. They note that most of the strategies are in the desire reduction category, as if that were a bad thing. I see it as a response to the years – decades – of efforts that did not include the environment at all. Still, in the end, the authors suggest that both strategies – reduce desire by modifying the space and increase resistance by teaching skills – be employed. And in their closing comments they make a valid, important point. The same point is true with smoking or in their example, managing anger, and it is: there is no world in which all temptation or triggers will be absent at all times. In those situations where temptations exist, a person will either indulge, relapse or resist.

Personally, I plan to do a little indulgence in a few days…. Thanksgiving here I come!

What do you think 'natural' means?

Remember past blog posts where I discussed the meaningless ‘all natural’ label declaration (see here and here, for example)? Well, it looks like enough people, or I should say, industries, have voiced similar concerns and with their clout, have moved this issue into the FDA action phase.

The FDA comments portal opens tomorrow and you can participate by clicking on this link.  The three main questions posed are:

Is it appropriate (for the FDA) to define the term “natural”?

If so, how should natural be defined (in regards to food/beverage products)?

How should the FDA determine if a manufacturer is using the term correctly on its food or beverage labels?

I have had two broad concerns with the labeling of an item as all natural (because that is the point of this, food companies want to boast a product as all natural, not just natural or containing natural ingredients). The first is that the term gives the product a ‘health halo’ that may not be justified. In other words, all natural just means all natural (except of course we don’t KNOW what that means). It does not mean health promoting, or nutrient rich, or low sodium/salt, or trans-fat free, or low calorie. None of the things that I want my purchases to be are described by the term natural - though I certainly want minimal processing. My second concern is within the parenthetical comment above- we don’t know what natural means! The old standard, but unenforced ethos from the FDA, was that it meant minimally processed, free of artificial dyes and such. That is far too subjective a definition. For something to be truly all natural, I believe it has to be a whole food, maybe it can contain preservatives, but surely it can’t come in a box. There are so many things that natural isn’t that I am of the mind that the word should NOT be allowed on any labels and thus it doesn’t have to be defined by the FDA. I think that is going to be my official comment. Instead of defining the term, I think that it should be banned from labels altogether.

What would your comment be? Speak up here… or the food industry will speak for you!

Update - 11/15/15 Oh my goodness, how could I have forgotten my favorite All Natural product - YES, peanut butter that isn't fortified or processed, that counts :)

Front of Pack Labels vs Labeling Laws

There is a difference in the requirements for vending operators when they post calorie counts for all items in their machines, starting December 2016, and what some candy, chips and pastry manufacturers are doing now - voluntarily.

According to the law, the font type, size and color have to be large enough and stand out enough to get the attention of the customer while the customer is deciding what to buy. I suppose if you go to the snack machine with nothing but Reese's peanut butter cups on your mind, you may not slow down to read calorie counts, but if you are browsing.....

The snack manufacturers, likely because they make their snacks for grocery and convenience stores too, have begun placing industry designed - industry criteria based - front of pack labels on their packages. On the face, this sounds really good. I love calorie disclosures as a general rule. And it looks like the manufacturers are giving counts for the full packages. 

From the pictures below, you can see some problems.

1. The labels are too small
2. The numbers do not stand out on the packages
3. If the package is not placed in the spiral correctly (especially this happens with beverages) you can not see the label at all
4. Sometimes the spiral actually covers the label
5. Only some of the items have labels - how can you compare? 
6. The labels are not in the same spot, so you can't really scan efficiently, and
7. In this particular machine, the snacks with the most calories do not have labels (eg honey buns and tasty kake)

By the way, there doesn't seem to be any detectable pricing scheme - two items of equal calories or 'healthiness' can cost from $ .60 to $1.00. Or maybe there is, the chips or salty snacks in the machine below are 60 cents and the higher calorie items, the honey bun and pop tarts, are a dollar. Contrary to what we are told - the worse items cost more, not less.

Here the Cheetos and Oreos are labeled, possibly the pop tarts too

Notice the different label placements, upper right hand corner and lower right hand corner, and even the small side of a package

Health Halos, Calorie Labeling, and Vending Machines

     Vending Times, a trade magazine for, you guessed it, the Vending Industry (machines, coffee service and micromarkets), recently announced that Mrs. Freshley’s has a new product, 7 Grain Cookies. You can read a little about them here, but the important information (i.e., nutrition content) is not yet posted. Other cookies by this company have, on average, 200 to 300 calories per package – the serving size.

     Without my explaining, can you guess the problem with a 7 grain cookie? Here is a hint and a term nutrition and obesity prevention researchers often use – “health halo.” You probably figured it out. By saying that this high sugar, high calorie item has 7 grains, people are distracted from the fact that it is still an item that should be consumed in extreme moderation. Cookies, pastries and such are in the discretionary category and I believe the latest version of US Dietary Guidelines suggest that discretionary calories take up no more than 10% of a day’s worth of calories (actually the new guidelines refer to added sugar not being more than 10% of calories). Therefore, if you were a small, active women consuming 1800 calories a day, this pack of cookies would be all you were allotted in discretionary calories for the day. The fact that the cookies might supply you with some whole grains, a positive thing, doesn’t change the fact that they are cookies. (BTW, other health halos you might see on discretionary food and beverage items, REAL sugar, raw sugar, honey, molasses– it’s all sugar, and in this context, not different than corn syrup or table sugar).

     Label declarations such as these (e.g., 7 grains) can give us a false sense of the healthiness of an item. Of course, healthiness is a moving target, but let’s stick with sugar and calories – we do want to limit them across the board, throughout each day. In a similar fashion to label 'nutrient disclosures', researchers have found that some Front of Pack labels (of which I am a huge fan) can also create a health halo! Hamlin, McNeill and Moore(2014) conducted an experiment on choices people make after seeing different types of Front of Pack labels and found that across all types (2), having a label led people to buy that product more often than if it did not have a label, regardless of what the label said. This is only one study, and others show that the labels can be helpful in leading to a reduction in calories, salt or sugar purchased, but it is definitely something that should give us pause, especially because one of the label formats tested was my favorite, the multiple traffic light. 

      When I think of this in the context of our soon to be implemented calorie disclosure law for vending machines, it occurs to me that maybe, simpler IS better. In other words, if every single product has a label and the only thing on the label is calorie content – then choosing the smallest number would be the (usually) right thing to do. I have that parenthetical usually, because a 100 kcal pack of cookies might not be a better choice than the 200 kcal package of granola bars, BUT – it would still be the least caloric.

      Lastly, the 2016 calorie label law (passed in 2010) is very specific about the placement, color, font and size of the calorie disclosure. If you take a look at the pictures below, you can see why that is important.

I took these photos at vending machines where I work and offer some comments in the captions.

This is industry criteria, notice the calorie, sugar and sodium limits to be called a Choice Plus snack

Notice the sodium  - its too high to be a Choice Plus but the snack is in a Choice Plus Slot. Also this snack has a Front of Pack label which could be a health halo.

Great example of how different a Choice Plus snack can be and if you look closely you see some calorie disclosures on the package. You have 250, 190 and 100 here.  Importantly, they are ALL the same price ~ busting that myth.

In my opinion, this is not as helpful as the machines with the calories on the front inside the picture of the sodas. I was within inches of this display when I took the picture and you can barely read the calories on these sugar sweetened ice teas (120 per 20 oz)

Food Purchases and a Right to Know

Some while back, I listened to an interview of Richard Cordray, head of the Consumer Financial Protection Board, on the Diane Rhem Show. During the conversation, he said something about consumers having a right to full information when they were making a purchasing decision, whether that was an appliance, house or a loan. I made a note to myself to go back and find the transcript when time allowed, because what he was saying also made sense as an argument for why we should disclose information about the foods we purchase, even if  - or especially if - they are completely prepared by a third party. I do not focus on vaguely defined terms like All Natural or Organic, and though I don't think a product with GMO (genetically modified organisms) is bad simply because it contains GMOs, I do concede to my friends who insist the products be labeled as such.

Instead, my labeling interests are about ingredients (and their amounts) and caloric content - at the very least calorie amounts, because that seems to be the best place to start with regard to weight control. I did find the recording and transcript of the interview, you can view both here, and I believe it is this excerpt that caught my attention back in July.

For consumers, the ability to understand more clearly what the costs and risks are that they face as they make choices, I have great confidence in consumers' ability to make decisions for themselves. Nobody can stand in their shoes and understand their circumstances as well as they do themselves. But at the same time, there are things they need to know about what the choices really are and whether the choice that's being presented to them is the deal that they will actually be able to live with next year or the years after or whether it will have changed in ways that are not clear to them in the fine print.These are all ways in which consumers, if they have their eyes open and if they can clearly see the futures, will make pretty good choices for themselves. But if the future is obscured, if they're being tricked and if there's deceptive marketing, as was often the case, then they will make bad decisions and they'll regret them and none of us wants to see that and consumers most of all. 

A lot of what Mr. Cordray discusses has to do with loans - its a great interview regarding financial protection and regulation. I encourage you to listen.

But if you think about all the decisions we make regarding food - every day - the same message applies. Do we know what will happen to our future selves if we eat, for example, meals with very high calorie, sugar or salt content? And if we do know what will happen - for example, that we might gain weight or our blood pressure become dangerously high - shouldn't we be able to make an informed choice? A choice made by easily identifying the foods and beverages that are high or low in those things? It is our future 1) to understand and 2) to protect.

Full disclosure is a purchasers legal right.