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FDA preps nutrition policy blitz
The FDA is gearing up for an unusually busy year on the nutrition front.
Now, you might be thinking: Wait, isn’t the FDA always kind of busy on the nutrition front? Well, yes … and no. The agency – which has jurisdiction over roughly 80 percent of the U.S. food supply – has long been criticized for not paying enough attention to food as drugs and other medical products tend to take center stage. Even within FDA’s food mission, nutrition has played second string to tackling foodborne illnesses (think Salmonella), which though tragic and preventable, drive far, far fewer deaths and illnesses than diet-related diseases.
To be clear, FDA is not shying away from its focus on food safety – the vast majority of its resources are dedicated to it – but in the past year the agency has made strides to elevate its nutrition agenda, with several big initiatives in play. On Tuesday, I wrote about the agency’s work to create new front-of-pack nutrition labels for food products – the idea being that a label on the front might help consumers make better snap decisions about what food to buy. (Sidenote: Saturday Night Live poked fun at this idea last year.) FDA Commissioner Robert Califf has been quite vocal about FDA’s need to focus on its nutrition efforts, including keeping an eye on the impact of ultra-processed foods. On Thursday, Jim Jones, FDA’s new deputy commissioner for human foods, held a roundtable with reporters to highlight all of the nutrition work in the agency’s pipeline for the coming months.
“Right now, all of the health metrics related to diet-related preventable diseases, like cardiovascular disease, diabetes and obesity, are going in the wrong direction – and unfortunately, some communities experience the toll of diet-related diseases at higher rates,” Jones told reporters.
“Poor nutrition plays a key role in chronic preventable diseases, which are leading cause of death and disability in the United States,” he continued. “Improving nutrition offers us one of the best public health interventions for reducing chronic illnesses and premature death and closing the disparities gap.”
Labeling: The agency is in the final stages of updating the official definition for what can be labeled as “healthy” – a crackdown on a term that’s currently used on an estimated 5 percent of food products. After FDA finalizes the definition (likely this spring), it hopes to develop an FDA “healthy” logo that companies can use on products that meet the revamped criteria, Jones told reporters. Next, FDA plans to unveil its initial front-of-pack proposal over the summer, Jones said (though, as with everything in Washington, timelines are squishy).
Salt: At some point in 2024, FDA aims to issue another round of short-term sodium reduction goals – another crack at trying to cajole food makers to gradually and voluntarily cut back on salt in packaged foods. The goal: Improve cardiovascular health at the population level. Jones said that FDA’s preliminary data on whether its voluntary strategy is working is, “for the most part encouraging.”
Sugar: FDA is also in the early stages of determining the best approach to help reduce added sugars consumption. During the Obama administration, then-first lady Michelle Obama played a key role in updating the Nutrition Facts panel (the back-of-pack nutrition labels we all know) to include a mandatory disclosure of added sugars. Though it was a controversial idea at the time, it’s really not anymore. Still, we don’t know whether this labeling has worked to reduce consumption, either by consumers making different choices or by food makers stealthily reformulating products for a better showing on the Nutrition Facts labels.
Sen. Cory Booker (D-N.J.), the most vocal lawmaker on nutrition issues in the Senate, has called on FDA to set sugar reduction targets much like have already done for sodium. I asked Jones about this and he flagged several challenges with added sugars reduction targets. “We are still in the preliminary stages of trying to figure out: What would the right strategy be?” Jones replied. “We have not landed a strategy.”
Zooming out: Altogether, this is a much beefier nutrition agenda than FDA has pursued in some time. Part of this, no doubt, has been driven by the Biden administration’s 2022 White House conference on food, which spurred a government-wide plan to tackle both food insecurity and diet-related diseases. Other parts of the federal government, including USDA and HHS, are working on all sorts of food-related policies, like updating school nutrition standards and integrating nutrition into Medicaid and Medicare.
One big, big question: Of course, if you take an even bigger step back from all this, it’s important to ask whether any of these policies will work, and by work, I mean actually move the needle to make Americans healthier or better off. It might sound obvious, for example, that giving consumers more information will result in better outcomes, but we don’t have a whole lot to go off of here. We’ve had Nutrition Facts labels on the back of food packages for decades, and diet-related diseases in the U.S. have only worsened. That’s not to say it’s not a good idea to give consumers nutrition information, it’s just not clear that it changes behavior very much. Calorie labeling on restaurant menus hasn’t had the impact that public health folks hoped it would, either.
We really don’t have a lot of U.S. policy examples to point to that successfully impacted diet-related diseases – it’s one reason why I have been following the Ozempic conversation so closely. While the pharma treatment is very expensive, can be hard to access, and has unknown long-term effects, it does appear to be incredibly effective compared to anything else that’s come along. It’s so effective, in fact, that some in the food industry are spooked about what it could mean for business. A story in Bloomberg this week caught my attention: Lars Fruergaard Jorgensen, CEO of Novo Nordisk (a company whose market cap has recently surpassed the GDP of its home country of Denmark) said that some food industry CEOs have called him to ask about how the drugs work and how fast they will roll out. “They are scared about it,” he said.
What I’m reading
Listeria outbreak prompts recall of cheese, other dairy products: What to know (Washington Post). “California-based Rizo Lopez Foods has recalled dozens of its cheese and dairy products after federal health officials linked the company to a decade-long listeria outbreak that has led to two deaths and more than 20 hospitalizations across the country,” reports Niha Masih. “The Food and Drug Administration advised consumers not to eat the recalled brands of cheese, sour cream or yogurt and to discard any such products they have purchased. It added that people or businesses that have bought the recalled products should clean and sanitize any surfaces or containers the products touched. Pregnant and immunocompromised people, as well as newborns and adults over the age of 65, are most at risk of falling seriously ill from a listeria infection, according to the FDA.”
Sports leagues, White House partner to drive exercise in U.S. (Associated Press). “More than a dozen sports leagues and players’ associations, from the NFL to the PGA Tour, have promised the White House that they will provide more opportunities for people to be physically active and learn about nutrition and adopting healthy lifestyles,” reports Darlene Superville. “The White House announced Thursday that the leagues and associations are participating in the White House Challenge to End Hunger and Build Healthy Communities. The challenge was launched last year as a follow-up to the 2022 White House Conference on Hunger, Nutrition, and Health.”
Food insecurity is a source of toxic stress (JAMA Pediatrics). “Food insecurity is a pervasive and persistent issue in the United States that disproportionately affects families with children and Black, Indigenous, and other people of color,” write Cindy W. Leung, Angela Odoms-Young, and Kofi Essel. “Identifying pathways by which food insecurity affects children’s health is critical to informing intervention efforts to eliminate childhood food insecurity. We posit that toxic stress is a prominent pathway underlying food insecurity and children’s health and advocate for research, clinical, and policy approaches to better address the root causes of food insecurity and promote lifelong health.”
‘We are in for a bumpy time’ with Prop 12, says Vilsack (FERN’s Ag Insider). “Agriculture Secretary Tom Vilsack told state agriculture directors to fasten their Prop 12 seat belts on Wednesday because ‘we’re going to have to get to a point where … chaos becomes really prevalent” in the meat market before there’s a decision on who regulates interstate trade. “We are in for a bumpy time,’ he said,” reported Chuck Abbott. “The Supreme Court upheld the constitutionality of California’s Proposition 12 animal welfare law last May, with Justice Neil Gorsuch writing in the court’s primary opinion, ‘While the Constitution addresses many weighty issues, the type of pork chops California merchants may sell is not on that list.’ The pork industry wants Congress to override the decision. A pork processor has filed suit against a similar law in Massachusetts in hopes of winning a reversal in court. Voter-approved Prop 12 requires farmers to provide 28 square feet of room for each breeding sow — more than the industry standard — and bars the sale of whole, uncooked cuts of pork, such as bacon and ribs, from hogs raised on farms outside of California that do not meet that standard.”
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