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Can Food Policy Impact Public Health Goals?

A conversation with Sean Cash, conducted by Friedman student, Lainey Younkin.

Trans fat bans, calorie postings, a proposal to limit the size of sugar-sweetened beverages and the First Lady's Let's Move campaign are all proof that obesity is a national concern. I spoke with Sean Cash, Associate Professor at the Friedman School for his perspective on the role of government food policy in determining our health.

Q. How is food policy being developed in the U.S., specifically with the goals of reducing obesity?

A. "In the past, the government's main nutrition concern was to guarantee nutritional sufficiency. Now we worry that some of these programs, like Supplemental Nutrition Assistance Program (SNAP), may be contributing to obesity. We still have real concerns around food security. There's a bit of a Goldilocks problem of getting things "just right" that policymakers need to consider.

In regard to the goals of reducing obesity, there are questions about how obesity is defined. Should we let obesity and obesity reduction be the sole measure of the success of nutrition policy in this country? With such a strong focus on obesity, do we undermine other important nutrition and physical activity goals? For example, at any weight, physical activity is important and protective against many adverse health outcomes. Perhaps we need to be talking about "misnourishment."

Q. Some people compare the obesity epidemic and food policies to smoking and tobacco policies. Is this a fair comparison? And would similar restrictions on food be effective?

A. It's an imperfect comparison because there is not the same dose response between intake and risk. The universe of substitutions for cigarette is small. Either someone smokes or they don't, but it's not the same with eating. When we try to tax food items or categorize them as "bad" or "good", we risk pushing people into substitutions. If we focus on very narrow categories of food, we leave open a big set of substitutions that may be no healthier.

One interesting point of comparison when we look at tobacco reduction efforts in the past is the cultural shift that eventually occured–taxes increased, and restrictions broadened. Over time, we denormalized smoking to a point where it was no longer a preferred social activity. Could the same happen with food and nutrition? Possibly. People talk about denormalizing soda drinking to decrease intake and we ask if taxes can be one way of reinforcing that larger cultural shift away from soda.

So it's not just about how people respond to price changes now, but also the reminder that it may be a socially non-preferred activity. However, imposing a goal on people that they may not have chosen for themselves is paternalistic and is not a universally welcome role for government.

Q. What's the future of food policy in the U.S.? What will be the areas of interest in the next five years?

A. There has been a real push for selective taxation of foods. I don't think this is a particularly fruitful way to change behavior, but I would not be surprised if some state and local taxes on foods are imposed, particularly on soft drinks. However, people respond marginally to price. Therefore, while taxes may yield a modest behavior change, they likely won't cause a large change in caloric intake or body weight.

An up-and-coming issue to watch is inaccurate or incomplete nutrition labeling. I believe over the next five years, we will see the accuracy of labeling improve.

Finally, we may see reformulations that may prove to be beneficial. For example, if we want to reduce sugar consumption across the board, we may find that reducing the sugar content of sugar-sweetened beverages by (for example) 10% is ultimately easier to do than to reduce consumption of beverages by 10% through taxation or marketing restrictions. The interplay of industry, NGOs, academia and the government can actually move us in healthier directions, even if sometimes the debate around these topics seems intractable.

Friedman Now

“Vitamin Sherpa” Ram Shrestha To Deliver Friedman School Commencement Address

Friedman School Alumnus, Ram Shrestha, N90, dubbed the Vitamin Sherpa by Time Magazine will be the Friedman School commencement speaker as 92 students received their masters degrees and 13 receive their doctorates.

Shrestha is best known for interventions in Nepal that provided vitamin A supplementation to Nepalese children, at a time when infant mortality rates and blindness were serious and unaddressed health concerns. For his work, he was recognized as a 2006 Global Health Hero by Time Magazine. Shrestha is also a recipient of the Friedman School “Frontline Award” for his involvement in cutting-edge work in nutrition.

Shrestha will also receive an honorary doctorate of science from the university. Read Time Magazine’s article on Shrestha’s work in Nepal.

 

Tribute to Scrimshaw

A gathering to remember the life of Dr. Nevin Scrimshaw was held at the Friedman School on April 20th in the Behrakis Auditorium. Scrimshaw was a pioneer in nutrition science beginning with work in Central America in the late 1940’s. In the words of University Professor, and former Friedman School Dean, Irwin Rosenberg, Scrimshaw was “…probably unchallenged as the most important nutrition scientist and nutrition leader in the world.” In 1991, he received the World Food Prize for “revolutionary accomplishments” that had improved” the lives of millions.” Scrimshaw founded the International Nutrition Foundation in 1982, and organization which he led for decades and is housed at the Friedman School. Read more about Dr. Scrimshaw and the Nevin Scrimshaw International Nutrition Foundation.

STUDENT NEWS

Student Research Conference

The 7th Annual Student Research Conference, held April 7th, was again host to approximately 200 presenters, attendees, faculty moderators and judges and attracted graduate students from nearly 30 universities and institutions across the United States. The conference, run by Friedman students is a unique venue for graduate students across disciplines to submit and present original research relating to the food system and/or nutrition science. The conference culminated with a panel of guest speakers on the topic “ Everyone at the Table: Multisectoral Approaches to Malnutrition” More about the conference on their website.

Undergrad Researcher

Jacquelyn Kercheval, a rising senior majoring in economics and in community health, has been awarded a fellowship from the Tufts Summer Scholars Program to work with Professor William Masters on policies to improve the market for nutrient-dense infant foods in developing countries.

She will collaborate with him and with Friedman School PhD student Marc Nene, building on work conducted through a grant to Masters from the International Food Policy Research Institute (IFPRI) to study the global market for infant foods needed to complement breast milk for children between 6 and 24 months of age. The project will construct a catalog of the complementary foods currently being manufactured and marketed all around the world, and it will subject a random sample of these to laboratory testing for nutrient density. Kercheval will start on this project in late May of 2013, and expects to use project data for her Senior Thesis in economics the following year, as a foundation for graduate school in public health.

Accolades & Awards

STUDENTS

Adela Hruby has been awarded the Stanley N. Gershoff, Simon J. Simonian and Arpi A. Simonian Prize for Research Excellence in Nutrition Science and Policy

Vicky Santoso is the recipient of the Joan Bergstrom Student Award for Excellence in Global Nutrition

Hruby and Santosa will receive their award at Commencement. on May 19th.

Becca Boulos, PhD Candidate has been selected as the student speaker for this year's Commencement.

Boulos was awarded a USDA Doctoral Fellowship in Obesity. Her dissertation investigated how interactions among health behaviors, stress, and coping strategies influence weight status in diverse populations.

Amelia (Fischer) Darrouzet-Nardi, a Friedman PhD student, has been awarded one of the inaugural Borlaug Fellowships in Global Food Security funded by USAID. The project will support her dissertation research through March 2015, investigating linkages between agricultural production, civil conflict and child nutrition in the Democratic Republic of Congo.

FACULTY

Jeff Blumberg received the Annual ACN Award from the American College of Nutrition for his "outstanding achievements as a research scientist, teacher and scholar in clinical nutrition".

Christina Economos was presented the President's Council on Fitness, Sports and Nutrition award from the Science Board at the Partnership for a Healthier America (PHA) Summit on March 6 in Washington, DC. She has also been chosen as the recipient of the Leah Horowitz Humanitarian Award.

Hugh Joseph, Jennifer Hashley: On April 4, the Harvard Pilgrim Health Care Foundation presented the New Entry Sustainable Farming Project with the 2013 Massachusetts Community Hero Award. The award recognizes extraordinary work done by a charitable organization to meet a specific need in its immediate community. New Entry was selected for award in recognition of the food justice work that its World PEAS Food Hub program engages in to provide low-income consumers in the Merrimack Valley and Greater Boston with access to locally grown farm fresh fruits and vegetables produced by New Entry's beginning farmer graduates.

Alice Lichtenstein, the Stanley N. Gershoff Professor of Nutrition Science and Policy has been selected to chair the American Society of Nutrition's Public Policy Committee. Lichtenstein succeeds fellow faculty member, Christina Economos who previously chaired the committee.

PUBLICATIONS & ARTICLES

Sean Cash and co-authors from the University of Alberta recently had their manuscript, "Impact of community-based HIV/AIDS treatment on Household Incomes in Uganda" accepted for publication in PLOS One. This paper is the first published study to quantify the impacts of successful antiretroviral treatment on the livelihoods of impacted households in rural patients in Africa.

William Masters was quoted in The Atlantic magazine on travelling to countries with hyperinflation. "Hyperinflation is among the most cruel forms of government expropriation,… Masters has various pieces of Zimbabwean currency framed on a wall in his office, for novelty, including a standard-issue note from January 2008 that says in small letters, 'Pay the bearer on demand ten million dollars on or before 30th of June 2008.'" Read The Atlantic article.

Parke Wilde's textbook, Food Policy in the United States: An Introduction. has just been published b Earthscan/Routledge. Based on Wilde's Friedman School course (NUTR 303), this book reaches out to readers in nutrition and public health who have become interested in broad issues related to food policy and economics.

Presentations

Soft Drink Taxation Panel: Sean Cash participated in a panel on soft drink taxation at the National Food Policy Conference in Washington, DC. Other panelists included leading advocates and the president of the American Beverage Association.

Chris Economos spoke in February at the Active Living Research Conference in San Diego on The Pathway to Impact: Translating Evidence to Policy and Practice.

Boston CGIAR WorkshopWilliam Masters chaired a workshop in Boston this January for 25 leading researchers in international agriculture, from which he produced a report for the Consultative Group on International Agricultural Research (CGIAR) on how trends in global agriculture affect the adoption and impact of new farming techniques in Africa and Asia. The project is described here.

Miriam Nelson spoke in February on Food and Nutrition Guidelines: Improving Practice, Improving Health for the Global Food Banking Network in Houston.

Schuman Speaks on Ethics in Communications Adjunct Lecturer, Jill Shuman was a featured presenter at the Regional Conference of the American Medical Writers Association, April 2013. Her topic was "Ethics in Medical Communication: A Case-based Approach".

Jennifer Sacheck presented at the Exercise and Sports Sciences and Athletics Symposium at Colby-Sawyer College in New London, NH, titled Youth Exercise & Sport - Relevance of "Sports" Nutrition?

Epi Doctoral Candidate is Finalist in Poster Competition at EB Jiantao Ma, Doctoral Candidate in Nutritional Epidemiology is a finalist in Nutritional Epidemiology RIS Poster Competition at this year's Experimental Biology conference. Her research is on sugar-sweetened beverage consumption and the association with relative distribution of abdominal adipose tissue in the Framingham Heart Study.