There has never been a more important time to be an advocate for nutrition and its role in preventing the many chronic diseases that afflict our country. Once a year, the Academy of Nutrition and Dietetics holds a Public Policy Workshop (PPW) where they invite registered dietitian nutritionists (RDNs) from across the nation to learn about advocacy and participate in Hill visits with their states’ legislators. I had the honor of receiving a scholarship from the Minnesota Academy of Nutrition and Dietetics to attend this year’s PPW in Washington, D.C. This powerful and energizing event starts before you even reach D.C. with a series of 5 webinars that take you on a crash course in effective advocacy and brief you on the issues you will be addressing in your Hill visits. The real fun begins when you arrive in Washington. This year 350 RDNs from all 50 states attended PPW to represent the profession and advocate for the services RDNs provide. The first day includes a workshop that recaps what was discussed in the webinars and gives you an opportunity to meet your fellow state constituents. Together you share stories and formulate how you will present the issues to your legislators the next day. Most meetings are structured in a way that they are conversational but still have the following structure to them:

  1. Clearly state your reason for being there
  2. Provide facts and data that support your cause
  3. Share a personal story
  4. Ask them what you would like them to do
  5. Send a follow-up email within a few days

What surprised me most about this structure was the inclusion of a personal story. But the saying goes, “Data makes you credible, stories make you memorable.” During the Hill visits, I found this absolutely to be true. Personal stories were more relatable and tugged on the heartstrings in a way that reinforced what we were asking the legislators to do.

I had the privilege of meeting with staff members from the offices of Representatives Keith Ellison (D-MN) and Jason Lewis (R-MN), as well as Senators Al Franken (D-MN) and Amy Klobuchar (D-MN). This year’s advocacy work at PPW revolved around two very important topics:

  1. Nutrition education programs in the Farm Bill

What is the issue? 75% of Americans have a diet that is low in fruits and vegetables, which strongly correlates to their risk of developing a chronic disease. A large contributor to poor fruit and vegetable intake is food insecurity and access to affordable nutritious foods. The Supplemental Nutrition Assistance Program (SNAP) is the leading national program in providing nutrition support for families that have food insecurity. In addition to the SNAP program, the Farm Bill authorizes funding toward nutrition education programs, like the SNAP Nutrition Education and Obesity Prevention Grant (SNAP-Ed) and Expanded Food and Nutrition Education Program (EFNEP). These two programs provide funding for local nutrition education initiatives that are designed to meet the needs of the local population.

What did we ask? We asked legislators to fully fund SNAP-Ed and EFNEP in the 2018 Farm Bill.

  1. Value of Nutrition Services in Prevention

What is the issue? Currently, U.S. healthcare costs are $9,990 per person, rendering 3.2 trillion dollars annually. Heart disease, diabetes, and cancer are the leading chronic diseases that contribute to annual healthcare costs. These diseases can be managed or even prevented with evidence-based nutrition interventions provided by trained RDNs. However, insurance companies are not required to provide coverage for nutrition services that have been proven to prevent the onset of these diseases. Currently, Medicare only covers outpatient nutrition services for diabetes, chronic kidney disease, and kidney replacement.

What did we ask? We asked legislators to ensure coverage for nutrition services for all nutrition-related chronic diseases.

On my way back to Minnesota, I reflected on the wonderful connections I made with RDNs from many different states, the stories I heard about the work they do, and the meetings I had with legislator’s staff. After my experience at PPW 2017, I know that advocacy will be a large part of my endeavors when I become a RDN. As Donna Martin, the Academy of Nutrition and Dietetics President-elect, said, “If dietetics is your profession, make policy your passion.” If you even have the slightest interest in advocacy, I urge you to get involved with American Society for Nutrition and other professional organization’s advocacy efforts. You will be happy you did.

 

 

 

By: R. Alex Coots
For scientists, the benefits of nutrition and health research are immediately apparent. It’s easy for us to see how the general public and policymakers alike can benefit from a better understanding of health and nutrition. Few of us would argue that we need less health research or fewer grants, but this is exactly what’s been happening since the NIH budget doubling ended over a decade ago. Decreasing budgets means fewer studies, and fewer studies means less progress on today’s pressing health problems. To help address this problem, I spent a day on Capitol Hill with professors, patients, and other stakeholders to advocate for a more sustainable and predictable funding schedule for health research.
Given the abundance of high quality research institutions in New York, I thought it would be easy to get legislators to support science. How wrong I would be. At best, congressional staff received us with apathy and at worst, hostility. During one particular meeting, an elected representative went so far as to say “All you people want is more and more and more rather than try to make what you have go farther.” And this was said by someone who co-sponsored the 21st Century Cures Act!
What became clear to me during the meetings was that the science profession was not viewed as one that provides answers to today’s most pressing questions; rather, it was viewed as just another (expensive) special interest group. While many scientists do advocate for use of scientific information in the formation of policy, not many of us advocate for the resources we need to carry out our work. Professor Lawrence Goldstein at UCSD has previously advocated for a phone call with each grant written and each grant reviewed. I’d extend this model to include a call with each paper published so that policymakers can hear the scientific progress being made in their district or state. Ensuring that scientific information is used in policy formation is only part of the advocacy battle. We scientists must ensure that our discoveries are limited by our imaginations, not by a lack of grants.

By Chris Radlicz

Marion Nestle, PhD, MPH is Paulette Goddard Professor in the Department of Nutrition, Food Studies, and Public Health at New York University, which she has chaired from 1988-2003. Additionally, she is Professor of Sociology at NYU and Visiting Professor of Nutritional Sciences at Cornell. Dr. Nestle earned her PhD in molecular biology and MPH from University of California, Berkeley. Her research examines scientific and socioeconomic influences on food choice, obesity, and food safety, with an emphasis on the role of food marketing. She is the author of several prize-winning books, and in her latest, Soda Politics: Taking on Big Soda (and Winning), Dr. Nestle provides insight on the soda industries tactics to gain consumers and addresses what is now working in the fight against ‘Big Soda’. I recently had the opportunity to ask Dr. Nestle some questions relevant to her newest book.

1. How has your background in molecular biology lead you to your career interest in public health, and particularly food politics?

The direct story is that I was teaching undergraduate molecular and cell biology in the Biology Department at Brandeis University and was assigned a nutrition course to teach. Undergraduate biology majors wanted a course in human biology and it was my turn to take one on. From the first day I started preparing that course, it was like falling in love. I’ve never looked back. Politics was in the course from day one. It’s not possible to understand how people eat without understanding the social, economic, and political environment of food marketing and food choice.

2. What lead you to write your newest book, “Soda Politics: Taking on Big Soda (and Winning)”?

I’ve been writing about soda marketing since the late 1990s when I learned about “pouring rights” contracts–soda company arrangements with educational institutions for exclusive sale of their brand. These started with colleges but had just gotten to elementary schools when I learned about them.  Since then, I’ve followed Coke and Pepsi marketing with great interest.  I teach food politics and food advocacy at NYU and was well aware of all the advocacy groups working to reduce soda intake as a public health measure.  When my agent suggested that I ought to write a book about sodas, it seemed like a terrific idea to encourage readers to engage in advocacy for healthier food systems.  Sodas are a good example of how to do this.

3. The title is provocative. Why do you say that those taking on ‘Big Soda’ are in fact ‘winning’?

That’s the best part.  Soda sales are way down in the United States. The soda industry thinks public health advocacy is responsible, and who am I to argue?

4. What has influenced the slow but successful decline in soda consumption seen today?

Excellent public health advocacy. Think of New York City’s poster campaigns over the last four or five years. These illustrated the amount of sugar in sodas and how far you would have to walk to work off the calories in one vending machine soda

5. The Coca-Cola funded non-profit, “Global Energy Balance Network”, recently shut its doors. Do you think this is evidence of gaining momentum?

Reporters from the New York Times and the Associated Press were shocked to discover that Coca-Cola was funding university research to demonstrate that physical activity is more effective than eating healthfully in preventing weight gain.  This idea is patently false. Investigations revealed that the researchers worked closely with Coca-Cola executives to craft the research, conduct it, interpret it, publish it, and present it at meetings. This too seemed shocking. Now Coca-Cola is scrutinizing who it supports and many organizations know they need to be more careful to avoid such conflicts of interest.

6. In what ways do you see parallels in tactics used by ‘Big Soda’ and those previously used by cigarette companies in defending their respective products?

Soda is not tobacco but the tactics sure look similar. The soda industry follows the tobacco industry’s playbook to the letter. It too attacks inconvenient science, buys loyalty, funds front groups, lobbies behind the scenes to get what it wants, and spends fortunes to oppose public health measure that might reduce soda intake.

7. Where can people follow your current work and get involved in this fight against ‘Big Soda’?

I write an (almost) daily blog at www.foodpolitics.com where I cover such issues. Soda Politics has an Appendix that lists the principal advocacy groups working on soda issues and provides links to their websites.  It’s easy to get involved in food advocacy and well worth the time.

By Emily Roberts

For nutrition professionals, deciphering the Nutrition Facts labels on food packages may be second nature. However, for the general public it is often difficult to understand and interpret this information. The FDA took this into consideration when proposing new requirements for Nutrition Facts labels in 2014 (1). Two main changes were proposed: new information on labels as well as design changes and new serving and package size requirements (2). The appearance of the label will be quite different if they are accepted.

This is of course to be the biggest change since 1993. The only alteration in the past 20 years has been the requirement of the amount of trans fat to the label in 2006 (1). This month the FDA proposed two more changes to the label. The one getting the most attention is the percent daily value of added sugars.

The most notable changes issued in March 2014 were (1):
• increased font size of calories
• changing of serving size requirements
• placement and update of percent daily value
• including added sugars
• removing calories from fat
• including the gram amount of micronutrients
• including vitamin d and potassium
• making vitamin C and vitamin A voluntary

As of this July 2015, two new changes were proposed (1):
• require the percent daily value of added sugars
• change the footnote to help consumers understand daily values

What are considered added sugars?
Simply stated added sugars are not naturally occurring and are added to the product. ChooseMyPlate says they are sugars that are added when processed or prepared. USDA lists some common sources of added sugars seen on ingredient lists including corn syrup, honey, fructose and lactose. However, for many manufactures this can be quite difficult to quantify because fructose and lactose are naturally occurring in fruits and milk. Yet, when they are added during processing they are now considered an “added sugar”. The current requirements from the FDA states in The Code of Federal Regulations Title 21 (101.60 c) that manufactures can use the claim “No added sugars” if “no sugar or sugar-containing ingredient is added during processing” (3).

Why does the FDA want percent daily value of added sugars?
Currently, there is no percent daily value of sugars because the FDA recommends that consumers limit their sugar intake to as low as possible. Things changed this month when the FDA argued that the percent daily value helps consumers understand how much is too much added sugars. Added sugars provide no nutrient value, increase caloric intake and replace nutrient dense foods. Susan Mayne, director of the FDA’s Center for Food Safety and Applied Nutrition, argued this change will help consumers reduce their intake of added sugars (4).

How much is too much of added sugars?
FDA recommends that daily intake of added sugars should not exceed 10% of total calories (1). If you are eating a 2,000 calorie diet you can easily exceed this 10% mark by consuming one 20 fl oz Minute Maid Lemonade.

How are food manufacturers reacting?
Food companies argue that including added sugars and a percent daily value could be misleading because the body utilizes added sugars the same as natural sugars and question the amount and quality of scientific evidence the FDA used to support their new proposal. Manufacturers claim that nutrition information seldom alters consumer’s food intake, so these changes would be more costly than they would be beneficial (5).

When can the public see these new changes?
The two new proposed changes will go through a comment period before they are accepted.

References
1. http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm385663.htm#supplemental
2. http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm387533.htm
3. http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm064911.htm
4. http://www.npr.org/sections/thesalt/2015/07/24/425908798/no-more-hidden-sugar-fda-proposes-new-label-rule
5. http://www.wsj.com/articles/fda-proposes-listing-added-sugar-on-food-labels-1437774370
6. http://www.natlawreview.com/article/calorie-count-delay-fda-extends-compliance-date-menu-labeling-rules
7. http://www.choosemyplate.gov/weight-management-calories/calories/added-sugars.html
8. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm
9. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=101.9
10. http://www.minutemaid.com/content/minutemaid/en/home/products/lemonade/lem

The other day I was sitting in class and the professor showed us a music video that compared sugar to drugs, which really got me thinking about the types of nutrition messaging. There are many campaigns out there targeting nutrition-related areas for change, particularly in the childhood obesity arena. However, many of these campaigns use bold images and scare-tactics to convey the message. Is this the approach we should be taking to create a healthier change?

The obesity epidemic has sparked an urgent need for preventative action. The Institute of Medicine released a report in 2012, Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation, which expressed the need for transformative approaches to changing the environment, especially for “messaging environments.” Due to the increased use of social marketing, product marketing and labeling, and public media campaigns, the potential for utilizing communication in the prevention of obesity is great (1). There have been many campaigns floating around the media in the past decade. A memorable one was Strong4Life, which was created in 2011 by Children’s HealthCare of Atlanta, a leading pediatric hospital. This initiative used “in-your-face advertising” to aggressively fight Georgia’s childhood obesity problem (1). The initial advertisements featured somber children describing their struggles with obesity (1).

These advertisements generated concern among public health experts due to the fear that the portrayals of overweight children could intensify the weight-based stigma (1). This type of message emphasized the negative health and social consequences of obesity. Health communications can be framed to emphasize either the benefits of participating in a type of behavior (a gain-frame), or the consequences of not participating in a type of behavior (a loss-frame) (2). There is evidence that suggests non-stereotypical, positive media portrayals of obese and overweight individuals can effectively decrease weight-based stigma, while negative portrayals may even worsen the stigma (3). Further, gain-framed communications seem to be more effective than loss-framed communications in endorsing prevention behaviors (2). When the message is framed to stimulate core values, the persuasion factor increases, since the person is more likely to pay attention and accept the message (4).

Campaigns should highlight information that is new to the desired audience and necessary for behavior change (5). It would be useful for health communications to incorporate the “how to” and “when to” knowledge in order to support behavior change (5). Also, misconceptions about the issue may need to be addressed, along with other real and perceived barriers to behavior change (5). Ideally, before public release, communication strategies should be evaluated to determine how effective they would be in supporting the target outcome and without exacerbating any sort of stigma (1). As the use of technology continues to increase, there certainly will be no shortage of health campaigns. Hopefully, the messages will be effective in inspiring positive health changes without creating negative stigma or fear.

References
1. Barry CL, Gollust SE, McGinty EE, Niederdeppe J. Effects of messages from a media campaign to increase public awareness of childhood obesity. Obesity, 2014; 22: 466–473. doi:10.1002/oby.20570
2. Gallagher KM, Updegraff JA. Health message framing effects on attitudes, intentions, and behavior: A meta-analytic review. Ann Behav Med, 2012; 43: 101–116. doi:10.1007/s12160-011-9308-7
3. Pearl RL, Puhl RM, Brownell KD. Positive media portrayals of obese persons: impact on attitudes and image preferences. Health Psychol, 2012; 31: 821–829. doi:10.1037/a0027189
4. Gollust SE, Niederdeppe J, Barry CL. Framing the consequences of childhood obesity to increase public support for obesity prevention policy. Am J Public Health, 2013; 103: e96–e102. doi:10.2105/AJPH.2013.301271
5. Snyder, LB. Health communication campaigns and their impact on behavior. J Nutr Educ Behav, 2007; 39: S32–S40. doi:10.1016/j.jneb.2006.09.004

By Brett Loman

Carbs increase belly fat. Gluten-free diets cure cancer. Artificial sweeteners cause diabetes. It seems like the more we hear about nutrition, the less we actually “know.” Facts and data give way to beliefs and assumptions. In the hands of the media and laypeople even solid research is boiled down to broad sweeping generalizations about marvelous miracles and perilous poisons. Since my last blog post(1) I’ve been contemplating this dilemma and paused on a thought – can we blame them?

There are three key players at work here: scientists, media, and laypeople. As I discussed last time, scientists are sensationalizing their work under the stress of the current scientific machine. As a result, scientists relay eye-catching yet complicated messages to the media. Members of the media generally aren’t scientists. Plus, to receive newly published studies requires a subscription or email request. Just like any other industry, the media’s ultimate goal is to make a profit. To make this profit they need to sell advertising and to sell advertising they need to capture viewers/listeners/web surfers (the laypeople).

This throws a wrench into things. Detailed data turns into 25 seconds of broad reaching conclusions spoken over images of test tubes and lab coats.

Audiences everywhere hear “drinking more coffee could prevent diabetes, a new Harvard study reveals.” Joe Schmo, who has limited scientific interpretation skills, type I diabetes, and no healthy dose of skepticism, runs out for a Frappuccino. We’ve not accomplished the goal.

So who is to blame, and what can we do to fix it? As scientists, we need to take ownership of our work and ensure that we deliver our findings to the public in a way that is both responsible and comprehensible. To take it a step further, scientists need to become a bigger part of the mechanism by interacting with the media. Public service announcements and PBS specials aren’t going to cut it. We need charismatic scientists who are committed to expressing complex scientific information in an interesting and accessible way. However, this isn’t traditionally part of our training. This will take some work to acquire a new skill set, but the payoff will be instrumental to society.

As a population, we need to make sure that scientific reasoning is a skill that is stressed in our schools prior to higher education and that information is made publicly available. Science is not a body of static facts as it is presented to children today, but a fluid system of critical thinking that asks you to sort through good and bad information and decide the facts for yourself. A good discussion and suggestions for accomplishing this feat can be found at Science Direct.

We all share the blame, but there are definite steps that we can make to repair the system. It may take a little ingenuity, but I have the confidence that we can adapt. What do you think?

By Brett Loman

Now more than ever before, the world of academic science is a competitive place. However, does the current environment promote good research? Could the current system from pipette to publication create an environment that incubates bad science? The pressure is on to produce high quality, impactful data in order to climb the academic pyramid, but why is this becoming the rule rather than the exception?

The obvious first place to point fingers is at the evaporating pool of funding. The NIH, a principal funding source for many of us in the life sciences, experienced a budget cut of 5% equaling $1.55 billion below the previous fiscal year. Concurrently, grant success rates dropped to a historic low of 16.8%. Approximately 10% of all submissions to journals are accepted, with top tier publishing groups such as Nature maintaining rates under 8%. Quality control (a very important part of the publication process) can be attributed to a large chunk of these rejections. However, like all businesses, profit and competition rule and questionable research still makes it through the overloaded and poorly regulated peer review process.

Under a publish or perish credo where deans and provosts often value quantity over quality, how likely is it for researchers to overexaggerate and tweak results? Given human nature, it doesn’t seem likely that an Olympic-sized group of inflated egos is going to play nicely in the kiddy pool. Should we then be pointing the fingers at ourselves and taking a good look in the mirror? Are these pressures leading to bad practice, and in turn, potentially misleading publications? In a world where the goal line is productivity and that line keeps inching forward, salami slicing, HARKing, positive result bias, cherry picking, and a whole tidal wave of biases are threatening to wipe out the credibility of science and the people who conduct it. What happened to the pursuit of knowledge being noble and objective? Who is to blame and how do we plug up the leak before it becomes a flood?

Certainly the competition isn’t going away anytime soon as the number of investigators continues to grow annually. Personally, it seems like a vicious cycle where every faction needs to take responsibility to amend the issues and hold themselves to higher standards. Passing higher values and standards on to the next generation of budding scientists is crucial.

The ASN symposium at Experimental Biology 2014 in April titled “Unscientific Beliefs about Scientific Topics in Nutrition” brought to light these higher values. It was reassuring to hear Drs. Andrew Brown (UAB) and Mark Cope (Solae) point out that these biases and poor practices were not going unnoticed. More importantly, they offered potential solutions. Dr. Brown discussed the importance of honestly reporting the results of other studies. Even if we dutifully report our results, we can only hope that other scientists do not misconstrue these outcomes or condemn us for them. Dr. Cope echoed a common theme raised throughout the session that accessible study registries and approval databases could help curb some of these unethical practices. The missing component in these talks was the role of current culture in publishing groups, which is why I have mentioned it here. Watch the recorded lectures from this session that struck a chord with me. I invite your personal comments and insights below!

The May and September issues of Advances in Nutrition (AN) will feature selected proceedings from the 20th International Congress of Nutrition, held in Granada, Spain in September 2013. The proceedings are being published in supplements to AN; supplement coordinators were Angel Gil, Ibrahim Elmadfa, and Alfredo Martinez.

According to Dr. Gil, “For 2014 we planned a comprehensive Congress under the theme Joining Cultures through Nutrition to promote nutrition and healthy lifestyles to people on a sustainable planet. Hence, the 20th ICN offered a modern and attractive Congress, joining different cultures, traditions, and knowledge with respect to new aspects of nutrition research, development, and innovation around the world.”

The scientific program included 6 plenary lectures, 32 special lectures, 4 debates, 90 parallel symposia, 38 sponsored symposia, and 16 satellite symposia. A special effort was made to ensure the involvement of speakers and participants from all continents and countries, including nutrition and food specialists in research, academia, and industry, as well as policy makers, with a gender balance and applicability for all societies. During the 6-day meeting of the ICN, more than 4,000 delegates and 650 internationally renowned nutrition scientists, researchers, and clinicians from 120 countries were actively engaged in discussions, attended sessions and joined networking events. This year the planning committee was especially pleased with the participation of young investigators and nutrition professionals from developing countries.

The IUNS and the 20th ICN wish to thank the California Walnut Commission and Mead Johnson Nutrition for generously providing educational grants to support the publication and distribution of proceedings from the 20th ICN. The contents of this supplement are solely the responsibility of the authors and do not necessarily represent official views of the IUNS.