Even for consumers who know better, highly processed and adulterated grain can be challenging to avoid. Cereal and milk is the number one breakfast served at many schools. LAUSD offers a range of breakfast choices each day, but cereal and milk remains the most popular option, with many kids skipping the milk and opting to eat the cereal as a snack. The same holds true for other school breakfast initiatives, such as Breakfast after the Bell.
Today the New York Times reports that federal health officials are disappointed as Americans continue to get fatter despite all the effort to demonize fast food, soda, and sugar, as well as the continuous harping everyone to eat less and exercise more. The report stated that, “Ab0ut 38 percent of American adults were obese in 2013 and 2014, up from 35 percent in 2011 and 2012.” Surprised? Not me, for two reasons.
First, too much of the weight loss propaganda out there sets people up for failure. Basically the energy balance equation is dead, yet most diets pivot on some angle to get people to eat less without adequately addressing hunger, satiety, and a multitude of other lifestyle factors that can effectively help their body burn fat for fuel.
Over decades, Americans have navigated mostly on their own in a quest to lose weight, mostly because we never made nutrition counseling a cornerstone of conventional medicine. In addition, just about anyone who eats thinks they are qualified to offer nutrition guidance.
From doctors, nurses, therapists and most health professionals, to fitness trainers, coaches and health teachers, and now the ubiquitous but less than adequately prepared life coaches and food bloggers, everyone wants to believe that they have the goods to offer food and nutrition counseling. To add to the confusion, anyone who has ever lost weight has a story to tell and advice to offer. I don’t blame all these well meaning people, they’re just stepping into a void created by a medical establishment that failed to acknowledge the central role of food and nutrition in both health and disease. Dietitians and qualified nutritionists have never been adequately staffed nor reimbursed in formal medical settings such as hospitals, clinics, and doctor’s offices.
Second, we measure a completely unreliable metric, weight–or its evil twin, body mass index (BMI) and pretend we are measuring health. Why? Because it is easy. Period.
Weight is a poor measure of health, but try telling that to the legions of health care providers, public health workers and policy wonks that insist on measuring a notoriously unreliable number and pretending it is a valid indicator of anything.
Ideally we would measure true bio-markers of health or more reliable measures assessing risk of disease. But even with better metrics, we may still lose the war on obesity because we have failed to commit adequate resources. We want to believe that lives and eating habits change with enough information, with enough cheer leading, or just because it is the right thing to do. Good luck with that.
If we were to get serious about improving the overall health of Americans, we have a lot of work to do. Here are a few suggestions:
- Stop subsidizing crops used to produce the junk (think corn and soy)
- Subsidize fruits and vegetables, as well as animal products grown in a biodynamic fashion, allowing for the efficient nutrient cycling in nature to work for us
- Fund every school lunch program to build or open a kitchen and cook whole foods from scratch–and then make sure the kids have enough time to eat.
- Eliminate use of antibiotics in food animals
- Ban use of artificial pesticides, herbicides and other agents that compromise life: human, animal and microbial and the health of the planet. We know what we need to do; stop waffling and pretending we need more studies.
- Establish a moratorium on genetic engineering and genetic modification in the food supply until studies can assess potential risk to all life forms, not just humans. We are interdependent and connected to all.
- Reward farmers and ranchers for employing sustainable and regenerative methods that restore soil ecology, minimize use of chemical inputs, enhance water flow and increase organic matter via carbon sequestration.
3. Simplify dietary guidelines and make them meaningful
- Stop making calories the enemy. Let’s teach people how to honor hunger and satiety. People want to feel good and enjoy good energy. Effective nutrition counseling can help consumers connect the dots between what they eat and how they feel.
- Emphasize whole foods and stop demonizing animal foods. There is no good data for current recommendations to limit saturated fat and red meat.
- Most critically, step away from the idea that there is one best way to eat, and more specifically one best way to lose weight. There are too many factors that influence energy metabolism, hunger, satiety, and energy partitioning for any one approach to work for all of us. Ideally we support each consumer as they figure out what approach to food works best for their personal metabolic needs and fitness goals.
4. Make meaningful nutrition education and counseling available to all
- Require all health care plans to reimburse nutrition counseling by qualified professionals to their members right along with other preventative screening and treatment. Current underwriting for most insurance companies routinely covers only diabetics.
- Require Medicare to reimburse RD’s and qualified nutritionists for nutrition counseling for obesity and all other conditions influenced by diet and metabolic health–and reimburse the professionals adequately. Why are we asking doctors and other primary care providers–the most expensive people in the room– to provide counseling to obese patients in 15 minute time slots with an abysmal $27.50 of reimbursement? To make matters worse, most PCP’s admit they don’t have the counseling skills, subject matter expertise, nor time and capacity to do the job in the first place.
5. Reset expectations: We don’t value the skills required to eat well, and then ridiculously assume that people are just going to figure it out on their own. Even if one learns all there is to know, knowledge is not the same as behavior.
We need to come clean and acknowledge the time required to plan and shop regularly for fresh food, cook from scratch and clean up. Pretending it is simple or takes no time at all sets up everyone except the dedicated foodies. If we are truly serious about tackling poor metabolic health, we need government, private industry, non government agencies, and educational institutions to demonstrate a value for the time, energy, and skills required to eat well.
- Integrate life skills education in the classroom–including budgeting, savvy food shopping, food preparation, and eating mindfully– both in middle and high school, and college, too. There is no greater skill set to enhance one’s quality of life as an independent adult.
- Re-establish a more modest work day so that consumers can enjoy food’s rightful place, along with adequate physical activity, recreation and a better quality of life
- Require that institutions and extracurricular activities honor time to prepare and consume regular meals and healthful snacks.
It’s times like this I think we need to revisit the notion of nuclear families. Does every household need to dedicate the resources, time and energy to do what could be accomplished so much more efficiently –and maybe more enjoyably– together?
Maybe tribal culture could teach us a bit about tapping into community resources so the benefits of eating well reach everyone, regardless of means or circumstances. Until then, it will be up to each of us to dedicate the time tending to one of our most basic needs, and hopefully appreciate what it takes to eat well every day.
I remember picking up Joel Salatin’s book, Everything I Want To Do Is Illegal soon after I finished The Omnivore’s Dilemma by Michael Pollan. I wanted to learn more. Joel’s reverence for growing grass captured my imagination. His explanation of bio-dynamic farming confirmed my suspicions. Animals and plants are meant to be cultivated together.
Our visit to Polyface Farms, located in Virginia’s Shenandoah Valley, fit perfectly into our spring break excursion– but was a little too early in the season to see the farm in full production. No chickens pecking around the chicken mobile or cows grazing on pasture. Still, Brie Aronson walked us through the property and answered all our questions. The picture that sticks in my mind is the early greening of the Polyface pastures compared to the distinct brown of his neighbor’s land. Bio-dynamic farming feeds the land, the animals and the farmer in a way that conventional farming just can’t.
We saw chicks pecking in the brooding house, and were told how pigs contribute by disturbing the land. The thrashing of the pasture and paddocks allows seed to be spread, nutrients to till, and the rich ecosystem of the soil to thrive. Resting the pastures allows them to regenerate and grow the grass that feeds the cows far longer than conventional farms. Polyface relies on hay feed for a mere 40 days of the year while more conventional local operations feed hay an average of 120 days.
The exquisite execution and overall efficiency of each farming operation impressed us the most. Every season allows work to be done that prepares for the next. We saw how the cows feeding in the barn were actually busy building the layers of manure, fermented corn and hay that the pigs next door churned into rich compost and fertilizer. (Boy, are they rambunctious. I remember seeing docile pigs in crates at the LA County Fair and cringe. I have a new appreciation for Joel Salatin’s intent to honor the “pigness of a pig”. ) We saw the chicken mobiles that allow the chickens to range and peck on the fly larvae maturing in cow pies that ultimately creates the delicious omega three rich eggs. The cycle of life hard at work.
CONVENTIONAL FARMING IS UNSUSTAINABLE
The current industrialized model for farming and raising animals is unsustainable. Conventional farming doesn’t optimize the synergy between the grass, animals and plant foods. Waste in the conventional model is considered a resource in the bio-dynamic model.
Conventional farming depends on cheap energy and subsidized products, horribly distorting food costs in the marketplace. The cheap stuff at our local markets is subsidized by our taxes, so we do pay more for this food, just not directly. Ironically all this cheap food is more than we can afford. Treating diabetes, heart disease, cancer, and the myriad of other diseases linked to our abundant and highly adulterated food supply only continues to cost all of us–individually and collectively. There is another way to produce the food we need. Thanks to Joel Salatin and sustainable farmers everywhere, more and more of us have a choice. What do you do to eat closer to the earth?
Probably the most stated and universally accepted nutrition sound bite is this one: Fast Food makes you fat. People believe all the public health hype. If you frequent a fast food establishment, you are inherently eating bad food, food that will have your cholesterol soaring and your waistline expanding. Hog wash.
What makes perfectly intelligent and often well educated people accept and believe such a ridiculous sound bite? How does one sector of the food environment get so much grief about its food when obesity and health issues linked to food are so enormous (pun intended)? The incidence of obesity in America– and child obesity in particular– is a bigger and more complex problem than any one food source.
GOVERNMENT GOVERNING BADLY
I have sat in a few city council as well as Planning and Land Use Meetings (PLUM) in Los Angeles the last few years. I was invited to speak at a high school event in San Francisco with Supervisors Eric Mar and Bevan Duffy. I may be naïve, but I am appalled at the lack of transparency and the hidden agendas.
The government types seem to universally accept that fast food is the culprit. Fast food is making everyone obese. This argument wouldn’t be so specious except lots of thin people eat fast food. Many obese people don’t eat fast food. Even the “average” customer at McDonald’s frequents the restaurant just over 2 times a month. Are those two meals a month really making so many people obese?
My cynical self sees the elephant in the room. Government types have jumped on the fast food bashing bandwagon to further their agendas. They see a universally misunderstood, emotionally charged issue that can be manipulated for their own benefit. They are running fast and loose with the facts. Overwhelmed, underfunded and outgunned by the food industry, desperate public health entities lunge at any opportunity they can to gain a foothold.
PEOPLE WANT TO BELIEVE THE MYTH: SIT DOWN RESTAURANT FOOD IS HEALTHIER
Earnest public health advocates as well as dedicated clinicians continue to pound the point home: Fast food makes you fat. Avoid fast food. Avoid fried food. Avoid sugar. Cut down on salt. Too bad fast food establishments aren’t the only places you can buy “fast food”, food high in sodium, sugar, and fat.
In 2005 I looked at what the so called “healthier” sit down restaurants were feeding the kids. After reviewing 14 kid’s menus from local neighborhood cafes and chain restaurants the evidence was clear. These sit down restaurant served children the same food as their quick service counterparts.
Overwhelmingly the menus offered hamburgers and fries, some form of fried chicken strips and fries, pizza, and the like. Less than 7% of the restaurants offered a fruit or vegetable on the menu. Often milk wasn’t an option for the lower cost meal. Resorts and hotel restaurants fared even worse. Less than 5% of their kid’s menu options offered a fruit or vegetable.
Sit down restaurants often offer all you can drink sodas and free dessert. I did not assess serving size, but at a glance I know that most restaurants do not following USDA guidelines regarding calorie intake suitable for a child. When he was young, my child ordered his share of kid’s meals. My guess is that very few of these establishments put any thought into the amount of energy they serve the kids.
NUTRITION ON THE MENU: WILL IT CHANGE BEHAVIOR?
In January of 2011 we are supposed to see nutrition information available on every menu of every restaurant with at least 20 sites in California. Early evidence shows that this information could be a game changer.
Many popular chain restaurants serve meals or entrees that hover between 1000-2000 calories each. Early in the game, one popular national chain known for generous portions jumped the gun and listed their four digit entrees, noting the calories directly on their menu and website. Entrees offered anywhere from 1000, 2000, even 3000 calories each!
Rumor has it that sales dropped dramatically. Within months new menus without the calorie amounts were printed. Most calorie information was removed from the website. Now a separate reference book is available with the information for those who ask.
Some establishments have devised ingenious and disingenuous ways to deceive the public. I have seen menus list all the items separately—even when they are usually served together. It is common that the 900 calorie sandwich is listed in one location. The 700 calorie French fries are listed someplace else. The beverage calories are listed but ultimately unknown. There is no telling how many free refills you will accept.
Typical portions today are enormous. We have a distorted sense of value. We want to believe more is better. It is not unusual to be served food on a platter. The platter for my meal at one local bistro looks suspiciously similar to the platters my mom would use to serve a family of eight.
One restaurant chain had the nerve to try to identify their 1000+ calorie meals as “2 servings”.
EATING OUT MAY NOT BE THE ONLY PROBLEM
The National Restaurant Association reports that 50% of every food dollar is spent away from home. Research says people eat more calories at restaurants than at home, but I wonder.
Does the research consider just the meals eaten at home? What about the snacks? We are no longer a country that eats at a table. Snacking accounts for 40% of food intake for children and many adults. I suspect that most people probably eat a modest meal at home. I think most people don’t cook much. They are probably assembling a quick or simple meal because they don’t have the time, energy or desire to put together a full dining experience.
Breakfast is a bowl of cereal, a yogurt, a muffin or a piece of toast. Lunch may be a sandwich or a salad, possibly with a piece of fruit. At their first session most of my clients report that eat very little food before “the witching hour”, about 3 or 4 o’clock in the afternoon.
When you eat very little throughout the day, the body provides additional energy from stored carbohydrate (glycogen) in the liver. Every time you feel hungry during the day and put off eating your body ends up tapping into this reserve. By the witching hour, the calorie cheaters have tapped out the stored energy and hunger hits and sticks with a vengeance.
Sometimes the feeding frenzy begins before anyone even thinks of dinner. Snacks come out of hiding in a desk drawer or purse. The office kitchen is scanned for leftover bagels or donuts. Somebody’s desk has a jar of candy available for the taking. There is an organized run for “coffee”, a euphemism for the highly caloric beverages that are served at coffee houses everywhere.
I know many clients who come home from work and start eating the minute they enter the doorway. There are snacks before dinner. Anyone who cooks and assembles food can be found munching on the ingredients while they prepare their plate. All too often dinner extends into the living room after dinner with a serial intake of snacks in front of the television. I wonder if the researchers are counting all the calories consumed at home or just those consumed at the dinner table. For these folks “dinner” lasts from 5 until 10 PM.
ABUNDANT, HIGHLY ADULTERATED FOOD IS EVERYWHERE
Every supermarket, convenience store, liquor store, pharmacy, hospital cafeteria, entertainment venue, and vending machine sells food that is highly refined and adulterated.
Increasing rates of obesity, diabetes, heart disease and cancers are true public health crises. Children born today will likely not live as long or with the same health as their parents. We cannot afford children with type II diabetes. We cannot afford young adults on dialysis. Medical care is not cheap. We cannot afford the excessive amount of cheap, tasty food that we are offered everywhere, all the time.
FOOD IS (relatively) CHEAP
Our food supply has radically changed during the last half century. In 1947 the average household spent 27% of their after tax dollars on food. Today families spend between 9-12% of their net income on food. Food is relatively cheap. But not all food is cheap in the same way.
Fresh fruits and vegetables cost more. Between 1985 and 2000, USDA data tells us that the cost of fresh fruits and vegetables increased 118%. During that same time period the cost of sodas increased 20%.
USDA farm policy continues to subsidize wheat, corn and soy. The exact ingredients used to make highly refined and adulterated foods. It is government policy that makes bread, cookies, candy and soda so cheap. How ironic that these refined carbohydrates are now considered to be the problem, driving the obesity epidemic even more than fat intake.
Even beef and milk are relatively cheap to buy. Subsidized corn and soy are used as animal feed in order to maximize profits at the feed lot. These animals are not allowed their natural diet in order to allow us a cheaper, fattier, less healthy product at the market. For years I have had a hard time trying to rationalize a national farm policy that flies in the face of national health policy.
BUYING FOOD AT THE SUPERMARKET DOESN’T MAKE IT HEALTHY
Supermarkets are no refuge. Average supermarkets offer 48,000 items. One study assessed the nutritional quality of supermarket food. Foods earned one star for good food choices, two stars for better choices and three stars for the best choices. The two nutritionists who designed the program did not assess candy, gum or alcohol. Still, less than 25% of the products offered earned even one star.
Supermarkets cater to our fast paced, busy lives. Convenient and pre-prepared food is the fastest growing sector in the marketplace. Over ten years ago I started asking my clients if they cook or “assemble”.
Less floor space is dedicated to basic whole foods. Raw produce, dairy and meats fill up a miniscule percentage of a market’s footprint. Even markets that cultivate a healthier image make most of their profit on the value added items, not to mention all the supplements and so call “health foods” that are highly refined and processed themselves.
CONFUSING THE ISSUES
The truth is that the obesity and health challenges we face as a nation are daunting. It is seductive to latch onto absolute sound bites declaring “fast food is fat food” like a tenacious bull dog. But there is trouble ahead. In the face of mounting evidence that dispels the myths, public health and government bull dogs are not letting go.
When undue resources are directed towards demonizing fast food, little attention is paid to the dismal state of our food supply everywhere. I have clients wanting to lose weight, diagnosed with any number of metabolic diseases, who don’t understand why they are struggling. Sometimes they boast, sometimes they lament: “But I don’t eat fast food.”
Fast food doesn’t inherently make anyone fat. Fast food is not inherently more caloric, higher in fat or more refined sugar than food served anywhere else. It is not even served in the largest portions.
When fast food restaurants serve vegetable and fruit salads, grilled chicken sandwiches, one percent milk and other “healthy” fare, how can people continue to believe that fast food inherently serves food that is less healthy than every other food venue?
EMBRACING EDUCATION, CELEBRATING CHOICE
People with influence continue to misinform the public at their own peril. They will soon be exposed as the opportunistic and short sited “man behind the curtain that they are. We can only hope the shrill pundits attacking fast food are as gracious in their exposure as The Wizard of Oz.
Current research is already questioning the high carbohydrate, low fat mantra. Renown nutrition epidemiologist Walter Willet has stated that the research shows refined sugars and starches are likely much more of the problem. There is even rumbling that saturated fats are not as problematic as once thought, especially the saturated fats derived from animals that consume their natural diet. These fats are rich sources of omega 3 fatty acids, conjugated linoleic acids and other healthful nutrients.
FOOD QUALITY STARTS ON THE FARM, FINISHES IN THE KITCHEN
We are learning that the quality of food, how animals are fed and how crops are grown impact the nutrient density of that food. When soil is nurtured will the full spectrum of nutrients from composted foods and waste products, the entire soil ecology improves. The activity of worms and other insects enhances the viability of the soil. Grass grows better, animals feed better, crops grow better, and we feed better.
I appreciate that eating food in its most natural state reduces intake of problematic ingredients like high fructose corn syrup and partially hydrogenated oils (trans fats). I have learned that telling people to avoid salt during cooking is futile. Salting foods appropriately when cooking is not the problem.
Seventy percent of all sodium consumed comes from highly processed and refined items. Some the most significant sources of sodium don’t even taste salty. Bread, pastries and cereal contribute surprising amounts of sodium in the diet because people eat these foods frequently.
In sum, every fast food establishment has the opportunity to prepare and serve excellent food. There is nothing inherently unhealthy about fast. While the slow food movement has its merits, my guess is that most proponents of eating “close to the earth” have been stuck eating on the run. There is no reason to shun fast food done well.
THE NUTRITION MESSAGE NEEDS TO CHANGE
Convenience and taste are the two top factors driving people’s food choices. Quick service restaurants are here to stay. The message needs to change. We need to encourage fast food patrons to make judicious food choices at fast food restaurants. We need to encourage everyone to make judicious food choices everywhere. We need to help people avoid a polarized relationship with food.
It serves no one to make people feel guilty about eating anything other than “healthy” food. Guilty people end up pretending. They become opportunistic eaters, taking advantage of every treat and extra serving offered. They become closet eaters, even their best friends don’t know. They lie to their doctors, they lie to their dietitians, they lie to their families, and to themselves.
It’s time to be far more honest about food. It’s not where you eat. It’s what you eat when you get there.
Evan Kleiman elegantly interviewed Michael Pollan and Eric Schlosser at the Vision and Voices presentation at USC last week. The conversation was mostly a celebration of the current food movements that emphasize eating “close to the earth.” Mr. Pollan’s mantra: “Eat food. Not too much. Mostly plants.” prevailed throughout the evening.
I celebrate so much of this message. The Omnivore’s Dilemma was a seminal read for me. I went on to read a half dozen related books and continue to step up my game. As a dietitian it was confronting to realize how little attention I paid to how food is raised.
Today I am mostly horrified at the deterioration of our food supply. Only the staunchest of USDA conformists clamor that we have the safest food supply in the world. The word safe in used in the narrowest of contexts, and we fall down even in the realm of minimizing food contamination and food born illness. Big agriculture and corporate food interests have created an abundant and adulterated food supply that no longer keeps us healthy, but is easily over consumed and contributes to poor health.
The quality and sheer quantity of highly processed foods that are subsidized by USDA Farm policy is a big part of the problem. This is the arena that Michael Pollan and Eric Schlosser effectively argue for change.
CONSUMERS CAN FOCUS ON THREE IMPORTANT FACTORS TO DRIVE CHANGE IN OUR FOOD SUPPLY
1. Avoid human antibiotics in animals. Purchase meats that state no hormones or antibiotics used as growth enhancers. Let your dollars make a statement.
2. Press for better access for everyone. I am privileged to access farmer’s markets 4 days a week. Other regions have nothing close by. I visited a new farmer’s market in South Culver City last Saturday. It is a fabulous press into an under served neighborhood. I hope the community supports this effort.
3. Pay attention to next year’s farm bill. It will be time for all of us to speak up. It is not OK that a few farm states drive this bill. These states depend on federal subsidies to overproduce crops that contribute to our abundant and adulterated food supply.
Lastly, as we work to improve our food supply, it is important to not let proponents of the status quo distort the conversation. Pollan and Schlosser make some key points.
KEEP THE CONVERSATION FOCUSED
1. American farmers grow about 4000 calories per capita annually–twice as much as is needed
2. Hunger is about food access, not yield
3. Our current food supply does not prevent hunger. There are about 1 billion people hungry, and about 1 billion people obese.
4. We consume about 12.5% of what is grown. 12.5% is wasted. The rest feeds livestock. For many reasons it is time to let the animals eat their natural diet.
Each of us needs to ask ourselves, “What can I do to promote a more sustainable and nutrient dense food supply?” Please share what is your next step in Eating Close to the Earth?