Hello! Thanks for reading Food Fix. Four weeks in, I continue to be amazed at how much interest there’s been in the newsletter. Even though it’s August and many of you have been offline or on vacation, every edition of Food Fix has had between a 61 and 77 percent open rate. This is very, very high – in the newsletter world, anything above 20 percent is considered pretty good. It tells me that we are onto something here. Please do keep writing and letting me know what topics you want to see covered. Your feedback has been incredibly thoughtful and helpful!
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Alright, let’s get to it –
Helena
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Today, in Food Fix:
– Why the White House conference’s outside taskforce is divided on SNAP
– USDA has not decided on extending imported formula in WIC
– Social media revolts over a suggestion that formula shortage is ‘perception’
– Adult obesity increased in first year of pandemic
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The big, outside taskforce is divided on SNAP
A major outside taskforce created to inform the White House conference on hunger, nutrition and health is unveiling its recommendations this morning. Food Fix got an early look at the 130-page report, which calls for a rethink of how the federal government handles food and nutrition policy – but it does not offer up recommendations on how to leverage billions of dollars in Supplemental Nutrition Assistance Program benefits to improve nutrition.
As I reported previously, some close observers in the food industry were nervous, while others in public health were hopeful, that this task force would endorse restricting purchases of unhealthy foods (for example, sugar-sweetened beverages), or at least a test-run of such restrictions. But, as predicted, the taskforce was not able to find consensus on this thorny issue. There was also a lack of agreement on other big questions, like whether to recommend nixing all work requirements from SNAP or whether major nutrition programs should be open to undocumented immigrants.
The panel “chose to present some of the points that were raised by members rather than make a formal recommendation on these issues.” Instead, you can find a summary of these differences of opinion on page 27 of the report.
Pro-restrictions testing: The report notes that some panel members “indicated support for state-level pilot programs to test combining incentives for more nutritious foods in SNAP with restrictions on SNAP benefits being used for purchases of sugar-sweetened beverages (SSBs).”
Some taskforce members pointed to the “high levels of diet-related illness and health care costs caused by SSB intake in the United States” as well as “the corresponding dietary intake disparities and health disparities among SNAP recipients.” Those supporting the idea of testing restrictions along with incentives would allow a careful assessment of “a range of outcomes including effects on psychological endpoints and stigma.”
Anti-restrictions testing: On the other side, individuals on the panel noted that SNAP is a crucial anti-poverty program for low-income households and that there are already restrictions on what benefits can be used to purchase (think: no toiletries, no hot prepared foods).
They argued that restrictions “could increase stigma and psychological stress; that low-income Americans already have their lives constrained in many ways that wealthier people do not; and that additional restrictions could send an implicit message that government and society do not trust low-income Americans to make the decisions that are best for them.”
Soda tax divide: There was a similar lack of consensus on the question of whether to recommend taxes on sugar-sweetened beverages to reduce consumption (see page 38).
Food is medicine: The report has plenty of other interesting food and nutrition recommendations. For one, it calls for Congress and the Department of Health and Human Services to work with the health care sector to include “medically tailored meals, medically tailored groceries, and produce prescriptions” among the covered benefits under Medicare and Medicaid for certain populations where evidence shows a corresponding improvement in health outcomes.
“These programs have rapidly gained interest among health care providers, health systems, payers, and patients as potential tools to improve clinical care for diet-related illness, especially for patients experiencing food and nutrition insecurity,” the report notes.
Nutrition science: The report also calls for a new National Institute of Nutrition as part of the National Institutes of Health. NIH has historically spent very little time or money on studying human nutrition, particularly compared to the outsized costs of diet-related diseases.
“Nutrition research is currently funded through more than 10 government departments and agencies, without sufficient coordination or authority for harmonized goals, data-sharing, or translation,” the report notes. “Total federal funding for nutrition research is less than $2 billion annually, while total estimated direct medical costs and productivity losses attributable to diet and/or food total $1.1 trillion.”
Leadership roster: The Task Force on Hunger, Nutrition, and Health – an effort led by the Chicago Council on Global Affairs; Food Systems for the Future; the Friedman School of Nutrition Science and Policy at Tufts University; and World Central Kitchen – also sent its report to the White House Monday. (Important to note that this outside effort is not formally associated with or endorsed by the administration).
The group plans to host a public webinar on its report to the White House on Aug. 31.
Funding: The task force noted in a release today that its efforts were also financially supported by the Bia-Echo Foundation, the HAND Foundation and World Central Kitchen, with additional support for the convenings and listening sessions from The Rockefeller Foundation and the Yun Family Foundation.
Reading: As you read the taskforce report this week, what jumps out at you? Shoot me a note: helena@foodfix.co.
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USDA undecided on extending imported formula in WIC
Coming back to the infant formula saga, I want to correct something that was wrong in Friday’s edition and explain how the confusion happened. I reported that the Biden administration confirmed during a White House call that imports would be phased out of WIC. This was broadly expected to happen, at least eventually, but USDA immediately got in touch after the newsletter went out to clarify that there haven’t been any formal announcements or decisions about waivers ending or timing, nor an end to payment for imported formulas.
“We are very much continuing to look at this,” a USDA official said on Friday. “We have not made any decisions.”
Why did several folks on the White House call think that the administration had signaled that imports (and other flexibilities) are set to phase out? The confusion stemmed in part from a state WIC leader who presented during the briefing and emphasized repeatedly that if, or rather when, the current flexibilities granted to WIC agencies end, there should be a long phase-out to help the program adjust.
Returning to normal? One of the overarching messages from WIC agencies has been that returning to “normal” times – when states are mostly supplied through their sole source contracts with Abbott, Mead Johnson or Gerber – is something that is going to take time. They essentially are advocating for a wind-down period, or some sort of slow return to more normal operations.
Current extension: USDA in late July extended a funding flexibility that has the department covering the cost of formulas that are outside of a state’s normal sole-source contract, if needed, in states that do not have Abbott contracts. This is a big deal for states financially, and it’s allowed some imported products to help fill holes in the formula supply (thanks to FDA’s enforcement discretion, which has made it easier to get foreign products on the market during the shortage). The current flexibility runs through Sept. 30. State leaders want to see this extended again.
The Abbott factor: The USDA funding flexibility has been particularly crucial for states that have contracts with Gerber and Mead Johnson, because during the ongoing crisis Abbott has been on the hook for the cost of substitutes in states where it has contracts. Abbott on Friday indicated to states that it would extend its coverage of these substitutes through the end of October. Now the question is: Will USDA do the same for non-Abbott states?
Stay tuned: It sure seems like a safe bet that the Biden administration wouldn’t want to upset the apple cart here, especially considering how long this crisis has lasted. But states are really craving certainty about what lays ahead, and when. “We are very much continuing to look at this,” the USDA official said.
(To be clear, state leaders and others are still confused about the timeline for when flexibilities might end. I did suggest to USDA that allowing press on these calls might help cut down on some of the confusion, but they have so far not taken me up on this.)
How imports could stay in the program: Over the longer term, if FDA continues to keep these imported products on the market through the current enforcement discretion or some other means, “they could certainly compete to stay in WIC,” the USDA official said.
When state contracts are up for rebidding in the next few years, could we see foreign suppliers jumping in to compete? It’s certainly something to watch. If you work for a company mulling this possibility, get in touch: helena@foodfix.co.
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Social media revolts over suggestion formula shortage is ‘perception’
Speaking of that White House formula briefing last week, well, there was a suggestion from an FDA official that the ongoing infant formula shortage is more of a “perception” of a shortage than a real shortage, according to multiple participants on the call.
On one hand, you can understand where FDA is coming from here. Retail data suggests that sales volumes are way up compared to normal times. Also, infant formula companies are still sending promotional packs to pregnant patients in the mail, unsolicited – so how short can supplies really be? It’s also true that the number of unique types of formula being manufactured is down, which means that formula makers are cutting down variety to be more efficient in their production (thus making shelves appear less stocked over time).
On the other hand: If you talk to anyone working in formula or infant nutrition world, in WIC, or in a hospital or dietetics, they will tell you that there is absolutely still a shortage, that supplies are difficult and disrupted, and that, yes, many stores still have bare shelves that can’t just be chalked up to less variety.
Some of these voices are taking FDA to task on social media. One recent video from a dietitian accused the agency of gaslighting parents. Another post, from an NICU dietitian who has been all over this crisis, posed the question “Is the Formula Shortage Over?” to her followers – and the replies are pretty uniformly like, “Nope, there is still a shortage.” Build Up Dietitians has also been posting messages from dietitians on the front lines. They aren’t buying it, either.
Metabolic and other specialty formulas – which thousands of people and children need to live – are all still difficult to come by. “I still haven’t received a full shipment of #metabolic medical nutrition since March… and no shipments at all since May,” said Sarah Chamberlin, executive director of PKU News, a group that supports families living with the rare disease of phenylketonuria.
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Adult obesity increased in first year of pandemic
In case you didn’t know, the USDA Economic Research Service has a great mobile app that shares charts from USDA in an easy-to-digest way. This week, the app featured a chart showing that the adult obesity rate went up between March 2020 and March 2021.
The ERS researcher analyzed the change in adult obesity prevalence during the pandemic by looking at data from the Behavioral Risk Factor Surveillance System. The researcher also examined “four behaviors that can influence the risk of obesity – exercise, hours of sleep, alcohol use, and cigarette smoking – to help explain changes in adult obesity prevalence rates,” per USDA.
Bottom line: The study found that the adult obesity prevalence was 3 percent higher after the first year of the COVID-19 pandemic.
Complicating factors: The research found statistically significant changes in each of the four obesity-related behaviors during the COVID-19 pandemic, per USDA – revealing a somewhat complicated picture of changing behavior.
“Participation in exercise rose 4.4 percent, and people slept 1.5 percent longer. Meanwhile, the number of days in the period of a month in which alcohol was consumed was 2.7 percent higher, and cigarette smoking dropped by 4 percent. Research shows that increased use of alcohol and reduced cigarette smoking can lead to obesity and therefore may have contributed to the higher rates of obesity among U.S. adults during the pandemic.” More from USDA here.
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What I’m reading
Free school lunch program is ending, leaving families scrambling (NBC Nightly News). This NBC News segment on Monday highlighted the broad impact of universal free meals ending this fall – something a lot of parents are not yet aware is coming. It touches on the debate about whether the benefit should have been made permanent.
Burger King tests plant-based chicken sandwich from Impossible Foods as frozen patties hit stores nationwide (Food Navigator). Impossible Foods is expanding a collab with Burger King with tests of a plant-based chicken patty at 47 restaurants in Cincinnati, Elaine Watson reports. The company recently tested nuggets in Burger King restaurants across a handful of cities and is currently rolling out frozen “chicken” patties at retail.
USDA to invest millions of dollars in organic farming initiative (The Hill). The USDA on Monday announced details of an up-to-$300 million investment in the Organic Transition Initiative, a move aimed at boosting revenue streams for farmers and producers. While organic demand is increasing, the number of farms transitioning to organic production has declined, the story notes. The new infusion of money – including funds from the American Rescue Plan – “aims to reverse this trend and increase production of organic food.”
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Who’s who
Brandon Chaderton will serve as White House Liaison in the Office of the Secretary at USDA. Chaderton previously was USDA’s Deputy White House Liaison.
Samantha Joseph has been appointed Senior Advisor for Faith-Based Initiatives in the Office of Intergovernmental Affairs at USDA. Joseph most recently was Head of Community Outreach and Vaccine Equity at the Cambridge Innovation Center in Boston.
(USDA has more details here on both of these moves).
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