Arnold Van Huis / AP
This Feb. 20, 2008, photo provided by the United Nations Food and Agriculture Organization (FAO) shows insects for sale at a market in Chiang Mai, Thailand.
Arnold Van Huis / AP
This Feb. 20, 2008, photo provided by the United Nations Food and Agriculture Organization (FAO) shows insects for sale at a market in Chiang Mai, Thailand.
Andrew Gombert / EPA
A large soda is filled at a restaurant in New York. A judge invalidated New York City's plan to ban large sugary drinks from restaurants, movie theaters and other establishments one day before the new law was to take effect.
A court may have ruled against New York’s supersized soda ban, but many prominent nutrition experts applaud any effort to limit how many sugary drinks Americans gulp down.
“There is really very clear evidence now that soft drinks are related to weight gain and obesity and, most certainly, diabetes,” says Dr. Walter Willett, a nutrition expert at the Harvard School of Public Health.
“We are in the midst of an epidemic of diabetes and obesity. The evidence is very clear that soda consumption has a role in the epidemic,” Willett added in a telephone interview.
“The evidence of harm for soda is longer than for anything else that we normally consume,” Willett says. “And there’s absolutely no benefit. Most foods, even if they are not the healthiest foods, have some nutritional value. Here it is all harm, no nutritional value. And the amounts being consumed are massive.”
The American Heart Association says Americans take in an average of 22 teaspoons of added sugar a day -- about 355 calories’ worth. It can have not just the obvious results, like obesity and diabetes, but also indirect harms: People who eat more sugar are also more likely to develop high blood pressure and other heart risks.
With two-thirds of Americans overweight or obese, it’s clear there is a problem. And a new study out Tuesday found that the more sugar-sweetened drinks that kids consumed, the more calories they got from other sources, too. In other words, kids who drink sugary beverages also eat other foods high in calories, the team at the University of North Carolina found.
"This is concerning because many foods that are associated with higher sugar-sweetened beverage consumption (e.g., pizza, cakes/cookies/pies, fried potatoes, and sweets) are also top sources of solid fats and added sugars; components of the diet that the 2010 Dietary Guidelines recommends Americans should limit," said nutritionist Kevin Mathias, who led the study, published in the American Journal of Preventive Medicine.
There’s no doubt Americans like to guzzle sugary drinks -- not just sodas, but sports drinks, energy drinks and fruit juices with sugar added. Beverage Digest estimates that Americans each drink 714 eight-ounce servings of carbonated soft drinks in a year -- that’s close to two a day.
Several studies have shown that the rate of type-2 diabetes has soared at just the same rate as intake of high-fructose corn syrup -- the favored sweetener in many soft drinks -- has risen. Soft drinks such as Coca-Cola were sold in 6.5-ounce bottles in the 1920s. Now the 12-ounce can is standard but fountain drinks are sold in sizes up to 64 ounces -- or the equivalent of eight of these cans of soda. One 64-ounce drink carries more than 800 calories.
All these giant servings send a message to people that it’s not only OK, but desirable to pig out, says nutritionist Deborah Kennedy, CEO of Build Healthy Kids and a co-author of “Beat Sugar Addiction Now! For Kids”
“Kids are eating their weight in sugar every year,” Kennedy told NBC News. “And sodas, energy drinks and sports drinks are the No. 1 source of sugar in kids’ diets. The message we are sending is ‘Jump right in’. What it says when these drinks are available is ‘Party time’.”
New York mayor Michael Bloomberg has said he’ll appeal the judge’s ruling, which State Supreme Court Justice Milton Tingling Jr. called “arbitrary and capricious.”
The city’s ban had applied to “sugary beverages” larger than 16 ounces. “Sugary” is defined as a sweetened drink with more than 25 calories in eight ounces. Convenience stores, supermarkets and vending machine operators were exempted.
Willett says the ban was the right and proper thing to do. “It is the role of a health department to protect the public from these hazards,” he said.
Many experts would like to see much more regulation than this. Willett believes people should not be able to buy sodas with food stamps. “We published a paper recently showing the average adult on the (food stamp) program is consuming nearly three servings of sugar-sweetened beverages a day,” he said.
When he was still New York City's health commissioner, Dr. Thomas Frieden, now director of the Centers for Disease Control and Prevention, advocated for an extra tax on sugary sodas. He and Yale University’s Dr. Kelly Brownell wrote a 2009 commentary in the New England Journal of Medicine that called sugar-sweetened drinks the single largest cause of the U.S. obesity epidemic and argued that a 1 cent per-ounce tax would lower consumption by 10 percent.
The Center for Science in the Public Interest calls soft drinks “liquid candy” and wants rules that would label them the way cigarettes are labeled now -- with health warnings. "Parents and health officials need to recognize soft drinks for what they are -- liquid candy -- and do everything they can to return those beverages to their former role as an occasional treat," the group says.
“Kids know that too much sugar isn’t good for them,” she said. “But they don’t have the support in the community to help them make that healthy decision.’
Kennedy and Willett both noted that the beverage industry is fighting back hard against efforts to regulate soft drinks, both by lobbying lawmakers and with high-volume, expensive advertising.
“The ads suggest that drinking soda will make you congenial. You’ll be more athletic, while the real image should be losing limbs, losing vision and other images of diabetes,” Willett said.
“One of the newer things that soda companies are doing is they are putting vitamins in the soda, which to me is atrocious because it sends the message that it is a healthy drink,” Kennedy said.
Want to know how much sugar you’re getting in a drink? Harvard has a chart online here.
By Mary Clare Jalonick
Michelle Obama praised the food industry on Friday for its efforts to market healthier foods but said more needs to be done.
At a speech before a childhood obesity summit, the first lady encouraged the industry to put better labels on food, limit marketing of unhealthy foods, and do more to promote healthy foods.
She invoked her pre-White House years as a working mom who would run through the grocery store trying to make healthy decisions for her children.
"I didn't exactly have time to peruse the aisles, thoughtfully reading labels, and I know my experiences are not unique," she said.
She praised companies like Disney, Mars, Hershey and PepsiCo. that she said have made efforts to reduce marketing of unhealthy foods to children. But she said, "We have a lot of work to do."
Mrs. Obama encouraged companies not just to limit junk food marketing but to promote healthier foods.
The first lady did not mention a government effort to establish voluntary guidelines for marketing foods to kids. That effort was directed by Congress in 2009 and the Federal Trade Commission issued a draft of the guidelines in 2011, urging companies only to market foods to children if they are low in fats, sugars and sodium and contain specified healthy ingredients. The effort fizzled after food and advertising companies balked and conservatives on Capitol Hill criticized the effort.
On Friday, Mrs. Obama appealed directly to the food industry to limit marketing and promote healthy foods. She cited studies that showed kids would reach for vegetables if they were marketed with popular characters such as Elmo.
"When businesses step up it's important to applaud their efforts, but also to encourage them to do even more," she said.
Mrs. Obama also encouraged parents not just to feed their children well but to stay healthy themselves.
Reducing childhood obesity is "a moral obligation to our children" and "a patriotic obligation to our country," she said.
Mrs. Obama was joined by Newark, N.J., Mayor Cory Booker and New York Giants quarterback Eli Manning at the Partnership for Healthier America's summit. The private group was formed in conjunction with the first lady's Let's Move campaign to combat childhood obesity and works to secure commitments from industry and others for healthier eating and fitness.
"What inspires me now is that so many Americans are joining together and looking at the crisis of obesity in America," Booker said.
Iron supplements may help boost brain development and ward off behavioral problems in babies who are born a bit on the small side, a new study from Sweden suggests.
Low birth-weight babies are more likely to end up iron deficient, researchers said. They need more of the nutrient for catch-up growth and haven't stored as much as other babies if they're also born premature.
For that reason, very early-term and very small babies are often put on iron - but less research has looked at babies born just shy of normal weight, to see if they are also at risk.
"I think this further solidifies the evidence that it's a very good idea to give these (marginally low birth-weight) children iron supplements," said Dr. Magnus Domellof, from Umea University, who worked on the study.
The research was led by his colleague, Dr. Staffan Berglund. Their team followed 285 infants born between 4 pounds, 7 ounces and 5 pounds, 8 ounces.
When the babies were six weeks old, the researchers randomly assigned them to get iron drops - either one or two milligrams per kilogram of body weight - or iron-free placebo drops each day until they were six months old.
Then at age three and a half, Domellof's team brought the kids back for IQ tests and surveyed parents about their behavioral issues. The researchers compared kids in the iron- and placebo-drop study groups with another 95 children who were born at normal weight.
There were no IQ differences based on whether the smaller-than-average babies had been put on an iron regimen. All three low birth-weight groups had average scores between 104 and 105. ("Cognitive impairment" in this study was considered an IQ under 85.)
However, significantly more babies given placebo drops had behavioral problems, as reported by their parents. The issues included problems managing emotional reactions, anxiety and depression, as well as sleep and attention problems.
Almost 13 percent of the placebo-group babies scored above the cutoff for clinical behavior problems, versus about 3 percent of kids who had taken iron drops and kids from the normal-weight comparison group.
That suggests iron deficiency in infancy may be a direct cause of behavioral problems later in childhood, the researchers wrote Monday in the journal Pediatrics.
They are continuing to monitor the same group of kids as they get older, to see if new cognitive or behavioral problems develop or old ones get better as the children head into grade school.
Domellof said he and his colleagues didn't see any extra stomach problems in kids or delayed growth linked to the use of iron drops. Some research has suggested giving excessive iron to young kids who aren't deficient may stunt their development.
But, "I would not be afraid of recommending this to all children (born) below 2,500 grams (5 pounds, 8 ounces) at this dose," Domellof told Reuters Health.
"Here's where an ounce of prevention is worth a pound of cure," said Dr. Michael Georgieff, a child development researcher at the University of Minnesota in Minneapolis who had reviewed the study as part of Berglund's dissertation committee.
He said it's important for all parents to know their baby's iron requirements when they leave the hospital.
"The issue with these marginally low birth-weight infants is, people really haven't paid a lot of attention to them, but the evidence is accumulating that they are at risk for behavioral problems and less than ideal cognitive function," said Dr. Betsy Lozoff, who studies the effects of iron deficiency in infants at the University of Michigan in Ann Arbor.
For most babies in the United States, extra iron is recommended starting at four to six months, either through supplements if the mother is breastfeeding or through formula. Very small or premature babies typically have their iron monitored from birth.
But Lozoff, who wasn't involved in the new research, said that in many places, there are no recommendations for how to treat babies who are just below a normal birth weight.
"This would suggest that it should just be a routine supplementation, and it can be at a low level of iron," she said.
By Karen Rowan
Taking supplements is common among U.S. adults, and the most oft-cited reasons people give for taking them are wanting to feel better, improving energy levels and boosting the immune system, a new survey finds.
But these aims have little to do with measurable improvements to health, the researchers said. Moreover, most people taking supplements indicated that the supplements' proven effectiveness didn't matter to them — only 25 percent said they would stop taking a supplement if it was found to be ineffective, according to the survey.
"We call this the 'effective for me' attitude," said study researcher Kathleen Weldon, of the Harvard School of Public Health in Boston. "As long as something is safe, people think they are a better expert on whether it works for them, better than any clinical trial."
People who put stock in effectiveness data tend to be "taken aback" by such thinking, she said, and wonder why a person would keep taking a supplement that hasn't been shown to work. "It's a very interesting thing to think about, in terms of scientific validity," she said. "But it's hard to argue against —what if this person is the one in a million that it's doing something for?"
The findings are based on data from a nationally representative sample of about 1,600 adults.
Participants reported using a range of products, including herbal supplements such as ginseng, probiotics such as acidophilus, amino acids, garlic pills and supplements derived from algae. (The researchers told the study participants not to include vitamins or minerals they were taking.)
About 38 percent said they had taken a dietary supplement in the last two years, and 1 in 7 reported taking supplements regularly, the survey showed. These findings are in line with what other studies have found, Weldon said.
The most commonly used supplement was fish oil, or other omega-3 fatty acid supplements — about 24 percent of adults have used them in the last two years.
More than a third of participants said they hadn't told their doctor about their supplement use.
"People should tell their doctors what they're taking," Weldon said. Supplements may interact with a patient's prescription medications, he said.
Another reason to tell the doctor is to make them aware of health conditions the patient is trying to treat with a supplement, she said. "Sometimes, people take supplements to lower their high cholesterol, treat arthritis or high blood pressure, to treat digestive issues — as part of the picture of good care, that communication should be there."
The article was published Nov. 19 in the journal Archives of Internal Medicine.
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Shannon Stapleton / Reuters
Coca-Cola, Nestle and Unilever, all manufacturers of the type of food and soft drink products that nutrition experts say help cause obesity, are contributing to the Pan American Health Organization's effort to combat the epidemic in Mexico. But are they undercutting the organization's efforts?
GENEVA, Switzerland -- As the world's foremost health agency, the World Health Organization bills itself as an impartial advocate working on behalf of 194 member nations.
Its mission as the public health arm of the United Nations ranges from stanching communicable diseases such as malaria and AIDS to battling what the U.N. considers the latest "global epidemic": chronic ailments such as diabetes and heart disease caused primarily by unhealthy diets.
But to fight those diseases in Mexico, the nation with the world's highest rate of obese and overweight adults, a Reuters investigation found that WHO's regional office has turned to the very companies whose sugary drinks and salty foods are linked to many of the maladies it's trying to prevent.
The office, the Pan American Health Organization, not only is relying on the food and beverage industry for advice on how to fight obesity. For the first time in its 110-year history, it has taken hundreds of thousands of dollars in money from the industry.
Accepting industry funding goes against WHO's worldwide policies. Its Geneva headquarters and five other regional offices have been prohibited from accepting money from the food and soda industries, among others. "If such conflicts of interest were perceived to exist, or actually existed, this would jeopardize WHO's ability to set globally recognized and respected standards and guidelines," said spokesman Gregory Härtl.
But the Pan American office -- known as PAHO, based in Washington and founded 46 years before it was affiliated with WHO in 1948 -- had different standards allowing the business donations.
Even so, not until this February did PAHO begin taking industry money, Reuters found: $50,000 from Coca-Cola, the world's largest beverage company; $150,000 from Nestle, the world's largest food company; and $150,000 from Unilever, a British-Dutch food conglomerate whose brands include Ben & Jerry's ice cream and Popsicles.
The recent infusion of corporate cash is the most pointed example to date of how WHO is approaching its battle against chronic disease. Increasingly, it is relying on what it calls "partnerships" with industry, opting to enter into alliances with food and beverage companies rather than maintain strict neutrality. The strategy differs dramatically from WHO's approach to interacting with the tobacco industry - companies with which it is unwilling to partner.
The decision appears to stem in part from necessity.
Despite being tasked a year ago by the U.N. to direct the attack on what both groups now call a "global epidemic," WHO has cut its own funding for chronic disease programs by 20 percent since 2010 -- an even bigger decline than for the agency as a whole. These diseases cause 63 percent of premature deaths worldwide, but the WHO department that leads the effort to fight them receives 6 percent of the agency's budget.
The industry's cash donations, which have not been previously reported, were described by Irene Klinger, a senior adviser for partnerships in PAHO, as "a new way of doing business." She compared the closer cooperation with that of a couple who needs to discuss marital problems. She said PAHO spends about $30 million a year to fight chronic diseases. But amid WHO's budget cuts, Klinger said, the organization needed industry "money to make this happen."
Mexicans drink far more Coke than citizens of any other nation. But even as Coca-Cola denies that soda causes obesity, it says it is committed to solving the health crisis. The Atlanta-based company has placed a top official on the steering board for WHO's Pan American Forum for Action on Non-Communicable Diseases, a group that helps determine how WHO fights obesity in Mexico.
Klinger and other WHO officials who work with industry say they are careful to maintain control of policymaking. But on its website, the Pan American Forum touts the benefits of membership as helping businesses "avoid regulation" and "influence regulatory environments."
"WHO is getting hijacked," said Boyd Swinburn, an Australian professor and longtime member of WHO's nutrition advisory committees. "They're cash-strapped, and they're bringing the private sector in. That's very dangerous."
Coke sees the situation differently.
"It's about the convergence of the interests," said Jorge Casimiro, Coca-Cola's director of international government relations and public affairs. "What we're trying to say is we're ready to take action. We're companies who want to do this. We're ready to go."
Ties to industry
As part of its investigation into the influence of Big Food on WHO, Reuters reviewed thousands of pages of records, and interviewed more than a hundred experts and officials from industry, academia, health groups, trade groups, medical journals and national governments. Among those interviewed: more than 20 former and current WHO officials and leading advisers to the agency.
Although WHO wields no official regulatory authority, the agency relies on member nations to embrace its recommendations -- something that happens quite often in developing nations. "The standards and policies adopted by WHO basically become the laws and regulations and policies in many of these countries," said Daniel Spiegel, a former U.S. ambassador to U.N. programs in Geneva who now lobbies on behalf of the food and alcohol industries.
Reuters found that even when WHO takes special care to avoid entanglements with industry, the wall meant to protect WHO's impartiality is far from impermeable.
A small group at WHO headquarters here is helping a panel of nutrition experts draft new guidelines for sugar, salt and fat in the diet. Little known to the public, the guidelines are of intense concern to potentially affected companies, and they're particularly relevant to developing nations such as Mexico.
The Nutrition Guidance Expert Advisory Group was hand-picked by WHO staff members, who say they took the agency's strictest steps yet to avoid the industry conflicts of some advisers in the past.
"My main message is we're really taking this conflict of interest extremely seriously, as well as the solidity of the science, and we're trying to really change this perception," said Francesco Branca, director of the work.
Reuters found at least two of the 15 advisers had direct financial ties to the food industry. Murray Skeaff, a New Zealand professor, received research money from Unilever, the conglomerate with $60 billion sales last year. He could not be reached for comment. Esté Vorster, a South African professor, advised a sugar association and took travel and "after hours" money to judge a contest for Nestle. Vorster said she does not participate in discussing the sugar guideline.
A third, Nahla Hwalla, is a professor and dean of a food-sciences college at the American University of Beirut. The college is receiving $750,000 over three years from Nestle; $450,000 of that money goes to fund the work of a doctoral student whom Hwalla is supervising. Hwalla said the Nestle funding was disclosed to WHO. WHO will not comment on financial disclosures by members of its advisory group.
In addition, three members of the group -- Ibrahim Elmadfa of the University of Vienna, Anna Lartey of the University of Ghana, and Vorster -- are current, future or past leaders of a professional society, the International Union of Nutritional Sciences. The society solicits hundreds of thousands of dollars in industry funding for conferences.
Sponsors of next year's conference include Coca-Cola, PepsiCo, Kraft, Nestle and Unilever. A letter to sponsors from Angel Gil, a Spanish professor and conference president, says sponsors would "enjoy prime exposure and direct marketing opportunities with the key players and decision makers in the field."
The conference organizers advising WHO say they do not regard the ties as a conflict of interest because they don't pocket any of the money personally.
But the conference they lead has so many ties to industry that WHO itself will no longer help organize or donate money to it as it has done in the past, according to Chizuru Nishida, coordinator of the WHO nutrition policy and scientific advice unit.
Influence in Mexico
The industry's influence in Mexico is exemplified in the Mexican delegations to a group called Codex. The group works with WHO on food labeling and trade policies, and its guidelines serve as a reference for governments around the world.
At a meeting of the group's nutrition committee last November in Germany, the five-member Mexican delegation included officials from Coca-Cola and Kellogg -- but no one from the Mexican government. Many other nations also invited company representatives; a Coke official was part of the U.S. delegation. But all delegations except Mexico's were led by government officials.
Coca-Cola is a major player in Mexican politics, and dominates the soda market there. Vicente Fox, the nation's president from 2000 to 2006, was the president of Coca-Cola Mexico before entering politics.
Coke points to its contributions to public health. "Close to 26 million Mexicans benefit from the more than 4,000 sporting events we promote each year," said Rosalyn Kennedy, senior communications manager for Coca-Cola. In an email, she said Coke also signed the National Agreement to Prevent Obesity with the Mexican government. As part of the agreement, companies promise to reduce salt, sugar and fat and promote exercise and drinking water.
Swinburn, who directs the WHO Collaborating Centre for Obesity Prevention in Melbourne, remains skeptical of the industry's motives. He said food and beverage companies exert a huge influence on policies that affect the health of millions.
"Industry is buzzing all around," he said. "Even in things like nutrition guidelines, they're usually in the room at the policymaking table or buzzing around it and putting all sort of pressure on, bringing their huge conflicts of interest and their huge resources to it - and we're wondering why we don't get much public interest policy coming out."
In May 2011, an expert group impaneled by PAHO, WHO's regional office for the Americas, wrote perhaps the world's toughest plan to restrict junk-food marketing to children. The panel, including four Mexicans, recommended new government policies "in a time frame of no more than 18 months" -- that is, by November 2012.
To date, Mexico has yet to act on the findings. PAHO has yet to even formally present its report to the Mexican government, according to Alejandro Calvillo, a member of the expert panel and director of El Poder del Consumidor, or Consumer Power, a nonprofit group focused on obesity in Mexico.
Why not? Calvillo said public health officials with PAHO in Mexico "do not want to have any kind of conflict with the industry."
The view wasn't disputed by Enrique Jacoby, PAHO's regional adviser on healthy eating. "We have an opportunity to do more than we did in the past with Mexico, I'll put it that way," Jacoby said.
"We cannot act on our own," Jacoby said, "but in reality we can have a huge influence on Mexico insofar as the secretary of health in Mexico says, 'PAHO, come over and help us do this,' because we are the international health agency."
Some WHO officials and health advocates say the agency is doing the best it can -- with industry help -- to reduce chronic disease. The World Health Assembly in May set a target for a 25 percent reduction in global deaths from these illnesses by 2025.
"To do that, you have to reduce salt, reduce sugar, reduce fats; that's not going to happen without regulation and taxation," said Judith Watt, interim director of an alliance of global diabetes, heart, cancer and lung disease groups, which receive some industry funding.
WHO has repeatedly advocated for voluntary action over stronger, regulatory measures. And the major food makers have, in some cases, responded.
For instance, Coca-Cola now offers more than 800 no- or low-calorie drinks; the Mexican bakery giant Grupo Bimbo is cutting sodium in its leading bread and rolls; and Nestle and General Mills just announced further cuts by 2015 in the sugar and salt in Cheerios and other cereals. Further, these companies are promising to limit advertising aimed at children under 12.
WHO published global guidelines for controlling junk-food marketing to children in 2010. It suggested "industry-led self-regulation" as an alternative to legal requirements.
Corinna Hawkes, a British food policy expert and lead author of a seminal 2004 WHO report on marketing of food to children, said self-regulation alone continues to fall short, in Mexico and elsewhere. She was part of the panel PAHO convened last year to recommend what it called "concrete" policies.
Their report advocated restricting all forms of junk-food marketing that appeals to children under the age of 16. That included TV, radio, signs, cartoons, toy giveaways and event sponsorships, a Coke mainstay in Mexico. Further, it said governments should raise taxes on products high in sugar, fat and salt and on the advertising of these products -- policies anathema not only to fast-food and soda companies but to many in advertising and media.
Since then, Hawkes said, neither WHO, PAHO nor the Mexican government has done much.
In a speech last year in Mexico City, Margaret Chan, WHO director-general since 2007, talked about "the seductive marketing of foods and beverages that are cheap, convenient, tasty, filling, and very bad for health." But Chan didn't mention the solution being proposed by WHO's expert committee. She declined interview requests for this story.
Mexican President Felipe Calderón also championed a five-step anti-obesity program focused on exercise and healthy eating. He, too, didn't mention limiting marketing to children.
Calderón had appeared with Coca-Cola chief executive Muhtar Kent at the World Economic Forum in Davos, Switzerland, in January. Kent said Coke would invest another $1 billion a year to grow the Mexican market. Calderón praised the plan for adding jobs.
Coke has plans to double its sales in Mexico within a decade.
‘Recipe for disaster’
Mexican Coke is made with real cane sugar instead of corn syrup. And Mexicans love it.
So much so, they drink an average of 45 gallons of Coca-Cola products a year. That's almost eight times more than the world average and 70 percent more than Americans, who are the second biggest soda drinkers in the world.
"A recipe for disaster," said Kelly Brownell, director of Yale University's Rudd Center for Food Policy and Obesity.
Body measurements bear him out: Mexico now has the fattest adult population in the world, surpassing the United States in the latest surveys measuring body mass index, excluding some small South Seas Islands.
Studies show 69.5 percent of Mexicans 15 and older were overweight or obese in 2006 compared with 69.2 percent of similarly aged Americans in 2010. And Mexico's problem continues to grow while the situation in the United States has leveled out, health officials say.
A new survey is expected to show Mexico's obesity rates climbing about 2 percent since 2006, according to Simón Barquera, a professor of nutrition and researcher in the National Institute of Public Health.
"This is as high as you could get," Barquera said.
In its one significant government response, Mexico in 2010 began removing sugary drinks from elementary schools. But school children still lack water fountains, and soda marketing pervades the places they gather. The national government has rejected proposals to tax sugary drinks.
Nestle funds diabetes group
The food industry's influence is by no means limited to Geneva or Mexico. A Reuters investigation earlier this year revealed how food and beverage companies now dominate policymaking in Washington and in cities and states across America.
In Washington, the companies doubled their lobbying expenditures to $175 million during the first three years of the Obama administration, Reuters found, and defeated "soda tax" proposals in 24 states. As part of the National School Lunch Program, Congress even declared pizza a vegetable.
Food and beverage companies also are donating money to global nonprofit groups fighting the very diseases that their products have helped to create -- health advocacy organizations that are allowed to work with officials at WHO headquarters in ways that industry groups cannot.
In a precedent-setting move earlier this year, Nestle agreed to give 480,000 euros ($630,000) to the International Diabetes Federation over three years. The amount of the donation, provided to Reuters by Nestle, has not been previously reported. The federation previously took money from insulin makers but not food companies.
"We want to be part of the solution," said Robin Tickle, Nestle's head of corporate media relations. "We have various forms of partnerships with organizations all over the world at global, regional or local level. Some of these involve donations, others do not."
Ten of the largest multinational companies have joined forces in a nonprofit group in Geneva called the International Food and Beverage Alliance. The companies, with combined sales last year of $397 billion, are promising voluntary actions to reduce salt, sugar and fat. Their group, created four years ago, is trying to gain a status of "official relations" with WHO, which would give it additional access to agency meetings and shared work plans.
The global sugar industry, with U.S. government backing, reacted strongly against a WHO expert panel's report in 2003 to recommend limiting sugar to 10 percent of dietary calories. Since then, the report has not been mentioned in WHO's plans to fight chronic disease, and some of its most aggressive staff members have left the organization.
"Many of us have been complaining to Margaret Chan about why there are so few staff on this even if it is two-thirds of the mortality in the world," said Pekka Puska, WHO's director of non-communicable disease until 2003 and currently director general of Finland's National Institute for Health and Welfare.
"You can speculate why," Puska said. "The more you do non-communicable diseases, the more you run into commercial problems of marketed products like Coca-Cola."
Giants including Coke and Unilever take exception to such characterizations. "It's about working together," said Anne Heughan, external affairs director for Unilever. She said all such efforts to battle obesity and other diseases need "to be led by the government. They need to set the direction ... But obviously we are a part of that."
Focus on salt
The soda industry still disputes whether sugar causes obesity and its cavalcade of health problems. The underlying cause of obesity is consuming too many calories and burning too few. The industry argues that a calorie from soda is no different from a calorie from any other source.
Many health experts compare that argument to the longtime denial by tobacco makers that cigarettes cause cancer. Cause and effect has not yet been biologically established for soda and obesity. But sodas are the leading single source of calories in the American and Mexican diets. And they are "empty" calories -- devoid of nutritional value.
There is no such dispute over the harms of excess salt -- nor is the industry lobby as focused. Companies that add salt to food have agreed it can cause hypertension.
Accordingly, salt remains a target of WHO disease policies even as sugar has fallen off the table. The industry-funded Pan American group is focusing on salt reduction. An outline of policy options by WHO in March listed salt 28 times and sugar only once.
Since the industry's business alliance formed in Geneva in 2008, WHO has cut its annual spending for the branch dealing with chronic disease. Its budget went from $325 million for 2008-09 to $241 million for 2012-13; in the same period, the office's staff shrank from 182 to 131.
Chan's 2012-13 budget reflects more of the austerity that forced the agency to cut 250 staff members agency-wide last year. The budget, emphasizing "efficiencies" and "partnerships," is 12 percent smaller overall -- but 20 percent smaller in the chronic disease office than the previous spending plan.
WHO's entire budget is about half of what Coca-Cola spends on marketing alone. Although WHO spends about $2 billion a year and employs 8,000 people to fight disease, the vast majority of that money is earmarked by donors for projects related to communicable diseases such as malaria. That leaves relative crumbs for the diet-related illnesses that WHO says are the world's leading killers.
"Sixty-three percent of the deaths, and 5 (to) 8 percent of our budget," said Douglas Bettcher, acting director of the chronic diseases office. In an interview here, Bettcher described the handful of people at policy levels: "We've got one person on diabetes, two on cancer, one on cardiovascular disease, and we're recruiting one for chronic respiratory disease," he said.
That alone doesn't represent the entirety of WHO's effort. Bettcher said many other WHO employees are working on the risk factors of chronic disease (including smoking) around the world. Among them: about 200 technical officers. He said he remains positive about the potential to make progress.
"I'm optimistic we're well on our way to scaling up our efforts," Bettcher said.
Some of WHO's own employees, however, acknowledge the difficulties.
"Money has been cut back," Nishida said. "Today it seems like the only people that have money are industry."
Derek Yach, a former WHO assistant-director-general for chronic disease programs, said "WHO is really pushed into a corner" by its budget woes. Yach said he was driven out of WHO in 2005 after proposing to limit sugar consumption. Not long after, he made a dramatic career move that underscores just how ineffective he believes WHO has become.
After stints at Yale and the Rockefeller Foundation, Yach accepted a job as a vice president at PepsiCo. His reasoning: He said he thought he stood a better chance of improving public health by working for the sugary soft drink maker than by working for the world's leading health organization.
Under Chan, WHO has employed "partnership advisers" to seek closer relationships with food and beverage companies. One of them, Janet Voûte, left the health agency in 2010 to become a vice president at Nestle, which is based in Vevey, Switzerland -- two train stops from Geneva.
Nestle, Voûte said, agrees with everything WHO is doing and stands ready to help WHO and improve its own products. "I personally do not see any major conflict of interest," she said. "I see much more convergence of interests."
When WHO held a conference for health ministers last year in Moscow - which Voûte had helped to organize -- one session was chaired by Casimiro, the top Coca-Cola official. He said he was invited by WHO to chair it.
Speakers came from PepsiCo, Nestle and the World Federation of Advertisers. They called for voluntary action and offered their resources and influence.
When Chan spoke, praising them, an activist stood up and asked Chan about whether the relationship posed a conflict of interest for WHO.
Chan responded in her sometimes ebullient fashion.
She sang the opening lines of a show tune from the musical The King and I: "Getting to Know You."
Additional reporting by Stephanie Nebehay in Geneva.
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Treating scrap meat with ammonium hydroxide creates a pink goo that is used to extend meat products like chicken and beef and to kill bacteria.
McDonald's confirmed that it has eliminated the use of ammonium hydroxide — an ingredient in fertilizers, household cleaners and some roll-your-own explosives — in its hamburger meat.
The company denied that its decision was influenced by a months-long campaign by celebrity chef Jamie Oliver to get ammonium-hydroxide-treated meats like chicken and beef out of the U.S. food supply. But it acknowledged this week that it had stopped using the unappetizing pink goo — made from treating otherwise inedible scrap meat with the chemical — several months ago.
Besides being used as a household cleaner and in fertilizers, the compound releases flammable vapors, and with the addition of certain acids, it can be turned into ammonium nitrate, a common component in homemade bombs. It's also widely used in the food industry as an anti-microbial agent in meats and as a leavener in bread and cake products. It's regulated by the U.S. Agriculture Department, which classifies it as "generally recognized as safe."
McDonald's decision was first reported this week by the Daily Mail, a blaring British tabloid, which trumpeted it as a victory for fellow Brit Oliver against the monolithic U.S. food industry.
Oliver's campaign began in April, when he included a segment on what he called "pink slime" on his TV show, "Jamie Oliver's Food Revolution" (warning: some readers may find this video distasteful):
Celebrity chef Jamie Oliver demonstrated how mechanically separated meat — which McDonald's calls "select lean beef trimmings" — is made on his show "Food Revolution."
The use of treated scrap meat "to me as a chef and a food lover is shocking," Oliver said. "... Basically we're taking a product that would be sold in the cheapest form for dogs and making it 'fit' for humans."
Todd Bacon, McDonald's senior supply chain officer, told the Daily Mail that the decision "was not related to any particular event, but rather to support our effort to align our global beef raw material standards."
In a statement, McDonald's clarified that it stopped using "select lean beef trimmings" — its preferred term for scrap meat soaked in ammonium hydroxide and ground into a pink meatlike paste — at the beginning of last year.
"This product has been out of our supply chain since August of last year," it said.
Sarah Prochaska, a registered dietitian at Barnes-Jewish Hospital in St. Louis, said that ammonium hydroxide is widely used in the U.S. food industry but that consumers may not be able to know what products include it because the USDA considers it a component in a production procedure — separating scrap meat — and not an ingredient that must be listed on food labels.
"It's a process, from what I understand, called 'mechanically separated meat' or 'meat product,'" Prochaska told NBC station KSDK of St. Louis.
While the government considers it safe, it certainly "does not look anything like ground beef," she said. And since it's not on nutrition labels, the only way to avoid it "would be to choose fresher products, cook your meat at home, cook more meals at home," she said.
NBC station KSDK of St. Louis contributed to this report.
U.S. Center for Nutrition Policy and Promotion
The government issued a consumer brochure spelling out what the new guidelines mean. Click the cover for a full pdf version.
Federal guidelines meant to help Americans eat healthier foods are straining Meals on Wheels and other nonprofits already laboring to make sure the elderly get enough to eat at all.
Lanakila Meals on Wheels in Honolulu, Hawaii, already has a waiting list of 90 people, most of them elderly, who have asked for food the organization can't afford to provide.
The program can always use more volunteers, but what it really needs now is money.
"We're looking for $120,000 just to maintain our existing programs and another $170,000 to meet the needs of the 90 people who are on our wait list," Lyn Moku, the program's director, told NBC station KHNL of Honolulu.
"It's a real time of uncertainty," Moku said, because "everyone is having a hard time just with the way the economy is and unemployment."
Some Meals on Wheels programs in the U.S. support themselves solely through donations and fundraisers, but many — like Lanakila Meals on Wheels — also rely on government funding. The Hawaii program says it gets about 60 percent of its funding from government sources.
That government funding is also in question, for Lanakila Meals on Wheels and many other local chapters of the national nonprofit.
The Health Trust, a charitable foundation in Campbell, Calif., reported that it has lost more $100,000 for its Meals on Wheels program. Most of that loss has come from government sources, and small corporate sponsorships haven't made up the difference.
"It's tough. Times are very, very tough," said Enid A. Borden, president and chief executive of the Meals on Wheels Association of America.
Last week, Meals on Wheels volunteers abandoned the traditional delivery of hot Thanksgiving meals to homes across Silicon Valley in Northern California. Instead, needy individuals — most of them elderly — received a frozen meal two days in advance that they had to thaw and heat themselves, NBC station KTVU of San Francisco/Oakland reported.
Cut the salt; crunch the veggies
It's not just the economy that's squeezing government outlays for community programs in general. Some are also being restricted by new federal nutrition guidelines that set standards for assistance programs.
That means that when government agencies sit down to hand out community service grants, they have to consider the new guidelines when it comes to food programs like school lunches and Meals on Wheels.
The guidelines drew a lot of attention for calling for a drastic reduction in salt consumption, especially among those 51 and older. But they also significantly changed the recommended ratio of proteins to fresh fruits and vegetables — putting much more emphasis on the latter.
That requires new menus, new storage facilities to keep all that produce fresh and new ways to cook and deliver meals.
Meeting the new requirements could be cost-prohibitive for Meals on Wheels in Bailey County, Texas, which could lose its funding from the regional association of governments, NBC station KCBD of Lubbock reported.
Meals on Wheels for Lubbock itself isn't affected, said Lisa Gilliland, the program's assistant director, because it relies solely on donations and fundraisers. But in Bailey County, northwest of the city, and in many other areas across the country, funding could be at risk because "most of the smaller programs are government funded," she said.
Borden told msnbc.com she is confident that Meals on Wheels will figure out a way to keep handing out the 1.7 million meals it delivers every day.
"There are always things that are going to happen," she acknowledged. "We are always impacted when the price of anything goes up."
But "one of the things I know is that our program will do whatever it needs to do to feed those seniors who are hungry," she said.
"We are a resilient organization."