When every newspaper in the country from Atlanta, GA to Ft. Wayne, IN, every major network from CNN to MSNBC, and virtually every local television and radio station in between simultaneously deliver the same story about a new study, it's no accident. In fact, it's a stunning feat, especially when we realize there are tens of thousands of scientific studies released every year that we never hear about. It's also our clue that what we're hearing is the result of a carefully orchestrated marketing campaign and it might be wise to take it with a healthy dose of skepticism.
Last Tuesday, the Center for Science in the Public Interest (CSPI) released a study of chain restaurants that claimed kids' menus offered few healthful choices and that without labeling parents were unaware that what they were ordering was high in calories, bad fats, and salt. It coincided with Sen. Tom Harkin's (D-Iowa) introduction of a bill requiring point-of-purchase labels for calories, fat and salt at all chain restaurants. He joined CSPI in its press release justifying government intervention because of the "obesity epidemic" and charging restaurants with a role, especially when it comes to our children, saying "kids get a third of their calories in restaurants."
That's in keeping with CSPI's ongoing attack on the food industry and with what CSPI's executive director Michael Jacobson, PhD. wrote last year in an editorial, Time to Sue: "Chain restaurants' failure to list calories and other nutrients on their menu boards contributes to obesity and other chronic diseases."1
"Relying solely on personal responsibility and the bully pulpit is too low a dose of treatment to cure this serious health problem," said Margo Wootan, CSPI's director of nutrition policy.2 "What is needed is substantial involvement of and investment by government at all levels," wrote Jacobson and former CSPI Board member, Marion Nestle.3 Consequently, CSPI has repeatedly commandeered public officials.
"After the California State Senate passed a menu labeling bill that used the language of CSPI word for word, it was only a matter of time before a menu labeling bill written by CSPI would end up on Capitol Hill," the Center for Consumer Freedom (CCF) predicted. Sure enough, in the companion legislation to Harkin's that Rep. Rosa DeLauro's (D-Conn.) introduced last fall, "aside from a few minor differences... the language is identical," CCF noted.
CSPI has "long encouraged legislation, regulations, and education," wrote Jacobson in that same editorial, "but I also think that lawsuits [against the food industry] have a place....Litigation works" as it did against tobacco companies. Jacobson revealed their goals involve more than government action, saying he was "glad that lawyers have begun to consider litigation" and "foods that are deceptively labeled...deserve their attention." This sheds new light to CSPI's latest "for the children" argument, a strategy tobacco litigators found successful in bringing sympathy to their side.
A "Study" in Name Only
CSPI's study was an egregious example that anything can be called a "study" nowadays. It wasn't a clinical trial that proved restaurant meals cause childhood obesity or have anything to do with it -- there's no evidence of that. It wasn't published in a peer-reviewed journal, but in a CSPI fund-raiser, their Nutrition Action Healthletter. Most appalling, their sampling wasn't impartial or representative of restaurant meals; nor were their evaluation criteria based on sound nutrition.
Claiming to reveal "what table-service restaurants are feeding our children," CSPI reported it's mostly fried, greasy "junk" food that's "cheap for the restaurant...[but] cost children who face a greater risk of obesity, diabetes and eventually heart disease and cancer." Their study proceeded with a litany of restaurant dishes that compare unfavorably to fast food in calories and "bad" fat. Their conclusion about restaurants was "their family-friendly reputations aren't worth the crayons and color-your-own placemats they hand out at the door."
But going directly to actual menus and nutritional information (available at most chain restaurants and their websites) reveals a surprisingly wide range of healthful choices -- not nearly the dire picture CSPI paints. Many allow their adult items in smaller portions for children. Most offer any vegetable side dish, however for their analysis CSPI chose French fries to accompany nearly every entree. CSPI not only carefully selected the most caloric and fat-laden main dish on each menu to illustrate restaurants' unhealthy food, but when even those weren't sufficiently heinous -- such as a typical macaroni and cheese entree at 430 calories -- CSPI added 12-ounces of whole milk to bring calories up to a whopping 650 and fat to 41 grams -- a clear ploy as even they note most restaurants serve 2% milk, and a serving is 1 cup.
Does CSPI honestly believe parents are incapable of making good decisions for their children or that a 4-year old would eat an entire platter of fries with a burger, tumbler of milk and a sundae? Apparently. "Parents today can't make informed choices on feeding their children well," said Wootan.4
Given kids eat 3 meals a day, CSPI's admonition that typical restaurant meals supply a third of their calories is hardly worrisome. So they went a step further to heighten their claim that restaurants are making kids fat. In assessing their devised meal selections, CSPI's index for determining a "day's worth of calories or artery-busting fat" was dietary recommendations for sedentary 4 to 8 year olds. Those are more restrictive than USDA guidelines and 2000-2001 Dietary Reference Intakes updates from the Food and Nutrition Board of the National Academy of Sciences for typical 4 to 8 year olds.
Finally, while claiming to be concerned about health and nutrition, CSPI didn't look at any foods' nutritional benefits. Yet the USDA/ARS Children's Nutrition Research Center urges parents to compare nutrient values in foods, noting many children fall short on calcium, iron and protein needed for growth. For example, macaroni and cheese or hamburger entrees also supply significant portions of calcium, iron, protein and other minerals.
Low-Fat Does Not Equal Good Nutrition
CSPI isn't calling for labeling of healthful nutritional information such as calcium, vitamins and minerals. Instead, CSPI's historic fear of fat and salt dominates their recommendations. But even with fat they dealt consumers a sleight of hand. CSPI's ten-year campaign to pressure the FDA into labeling transfats and include these "dangerous stealth fats" in recommended daily values got a hard blow last year when the FDA refused to establish specific guidelines for dietary intake due to lack of evidence.5 So CSPI took it upon themselves to do it anyway, adding transfats to saturated fats in this study making their higher levels invalid comparisons with government saturated fat recommendations.
David Klurfeld, Ph.D., professor and chairman of the Department of Nutrition and Food Science at Wayne State University, editor-in-chief of the Journal of American Clinical Nutrition and Nutrition New Focus, has repeatedly written that scientists don't agree on how bad trans fatty acids are and the associations for them being harmful are weak. "The recommendation that any amount is unhealthy is not justified by strong evidence," he's said.6,7 Steven Milloy, adjunct scholar at Cato Institute and publisher of Junkscience.com agreed in a critical examination of the scientific evidence.
For years CSPI has led the war against "artery-clogging" fat but science and nutrition experts do not support all fat as "bad." Fats have a vital role not just in making foods more palatable, but to utilize fat-soluble vitamins, produce and regulate hormones, protect organs and cell walls, for temperature regulation and energy. Even about a third of "bad" saturated fatty acids are stearic acid, found largely in red meat (beef tallow) and cocoa butter (chocolate), and have been shown to act like favored monounsaturated fats in nuts, avocados and olive oil. Coconut oil, which CSPI worked to eliminate from movie popcorn, is believed by many lipid researchers to be especially healthful, fighting infections, heart disease and cancers.8 A nutritious diet is not the same as low-fat, especially for children who need fat for normal growth and development. In fact, children and adults who eat both high- and low-fat foods have higher intakes of calcium, iron, minerals, fiber, and most vitamins according to recent American Dietetic Association (ADA) research.
Even the American Heart Association (AHA) now recommends diets moderate in fat for healthy Americans of all ages. While it may seem instinctive to CSPI that fat makes children fat, dietary fat and saturated fat intakes aren't higher in obese children, according to the AHA, but low-fat diets can be harmful for all ages, raising triglycerides, lowering HDL cholesterol and worsening insulin resistance.9 Dr. Ronald Krauss, head of the AHA Nutrition Committee, admitted that for two-thirds of consumers low-fat diets increase the risk of heart disease or don't help.
Where's the Evidence?
Wootan outlined CSPI's case for restaurant labeling in the paper, Anyone's Guess, noting obesity rates have doubled over the past twenty years while people are increasingly eating out.10 But a correlation -- no matter how intuitive -- doesn't prove culpability. The pretense is that "poor, ill-educated people are duped by duplicitous restaurant franchises into biting into greasy hamburgers and french fries," said Todd Bushholz and Ruth Kava, PhD, RD in a recent report for the US Chamber Institute, a nonprofit federation representing businesses and chambers of commerce. "The data, however, tell us that this theory is wrong."11 As Wootan noted, "people with higher incomes eat out more often than those with lower incomes." Yet better incomed and educated people are the least likely to be obese, according to the Agency for Healthcare Research and Quality, the U.S. Department of Health and Human Services' agency for research on health care quality, costs, outcomes, and patient safety.12 The prevalence of obesity is highest among the poor and ethnic and racial minorities, according to the Surgeon General.13
And where's the proof that labels will reduce obesity or change American's eating habits? Nutrition labels on processed food were first used in the 1970s according to New Mexico State University, but haven't made us slimmer yet. Researchers who study food psychology such as Brian Wansink, professor of nutritional science and marketing at the University of Illinois, and Paul Rozin, food psychologist at the University of Pennsylvania, don't believe nutritional information in restaurants will make much difference. "I don't think, even if you put it there, people will read it," Rozin told the Kansas City Star.14
A recent USDA Economic Research Service report found that food labeling isn't necessarily effective in educating consumers or changing their consumption behavior. It notes labels have proven poor ways of advancing social objectives, especially when scientific opinions differ about the health consequences of consumption or people don't value or prefer the same things or have different nutritional needs and concerns. "For example, a consumer on a low-fat...diet may have different definitions of "good" and "bad" foods than one on a high-protein diet."15
What CSPI thinks is healthy may also not be what you believe is best for you or your children, and is certainly not best for everyone. As the ADA noted, the National Academy of Sciences' Institute of Medicine concluded: "Just as no two people are alike, there is no one-size-fits-all approach to healthful eating."
The fine print
In this regard, a little-publicized measure in DeLauro's legislation, modeled after CSPI's sample legislation, calls for more than nutrition labels. It states: "Such regulations shall require the required information to be conveyed to the public in a manner which enables the public to understand its relative significance in the context of a total daily diet."
That means someone must first determine what all of us should be eating each day, regardless of our differing sizes, ages, health conditions, activity levels and dietary preferences. Then, the calories, fat and salt amounts have to be compared to those acceptable levels. Perhaps that will be modeled after CSPI, too: "This supplies half a day's worth of calories and a full day's artery-clogging fat."
But do we really need a label warning us that cheeseburgers have calories or that eating nothing but fried foods might not be healthy? And do we really want CSPI, who legislators turn to for nutritional guidance, determining what foods are admissible?
CSPI and legislators also aren't revealing who will pay for all of this. As the Economic Research Service researchers cautioned, the costs and benefits of government intervention in labeling must be weighed carefully. Labeling costs much more than new labels and menu boards, but includes the creation of standards, testing, certification and enforcement which the government has to provide or pay others to perform. They stated: "As a result, consumers who do not particularly value the information are forced to pay for it."
1. Jacobson MF. A Time to Sue? Nutrition Action Healthletter, March 2003: 2.
2. Wootan M. CSPI On Rising Obesity Statistics CSPI Press Release, October 8, 2002.
3. Nestle M, Jacobson M. Halting the Obesity Epidemic: a public health policy approach, Public Health Reports; January-Feb 2000; 115: 12-24. http://www.cspinet.org/reports/obesity.pdf
4. Barclay E. Children's menus lack healthy food choices. UPI, Feb 25, 2004.
5. Trans Fat Coming to Food Labels, CSPI Press Release, July 9, 2003. http://www.cspinet.org/new/200307091.html
6. Klurfeld D. Trans Fat on Your Food Label. Nutrition News Focus, August 8, 2003.
7. Klurfeld D. Soft Fat Hard Fat. Nutrition News Focus, July 2, 1999.
8. Enig MG. A New Look at Coconut Oil. Weston A. Price Foundation, 2003.
9. Gidding MD, Samuel S. etal. American Heart Association (AHA) Medical Scientific Statement, "Understanding Obesity in Youth." Circulation, 1996; 94: 3383-3387.
10. Buchholz TG, Kava R. Case File -- Burger, Fries and Lawyers: The Beef Behind Obesity Lawsuits. US Chamber of Commerce and US Chamber Institute for Legal Reform, July 2, 2003.
11. Wootan M. Anyone's Guess: The Need for Nutrition Labeling at Fast Food and Other Chain Restaurants, CSPI, November 2003.
12. Rhoades JA, Altman BA, Cornelius LJ. Statistical Brief #37: Trends in Adult Obesity in the United States, 1987 and 2001: Estimates for the Noninstitutionalized Population, Age 20 to 64. Medical Expenditure Panel Study, Jan 2004. Agency for Healthcare Research and Quality, Rockville, MD.
13. The Surgeon General's Call To Action To Prevent and Decrease Overweight and Obesity, November 20, 2003.
14. Mann J. Proposal for nutrition info. on menus meets resistance. Kansas City Star, Nov 4, 2003. http://www.centredaily.com/mld/centredaily/news/7178203.htm
15. Golan E, Kuchler F, Mitchell L. Economics of Food Labeling. Economic Research Service, USDA, No 793, Dec 2000.