Healthy Food & Healthy Living by Dr. Ayala

To sell kids on veggies do what the food industry does

Advertisements sell. Companies wouldn’t be spending so much money on them had they not delivered. To parents’ dismay – and to public health advocates’ alarm – most of the ads and marketing efforts targeted at our kids and teens promote fast and junk foods.

According to a report from the Yale Rudd Center for Food Policy & Obesity the fast-food industry spent $4.6 billion on ads in 2012, mostly for their unhealthiest products, and most of it targeted to kids and teens. Kids are encouraged to snack by a plethora of ads: According to another report from the Rudd Center preschoolers (2-5 years) see 1.6 ads each day, that number only increasing as kids grow older, and kids' exposure has increased by double digits from 2010 to 2014. Again, most of the ads are for sweet or savory highly processed snacks, but on a positive note, ads for nuts and fruit doubled from 2010 to 2014 -- but still made just 6 percent of what kids saw.

School food in undergoing a significant transformation and better options and more fruits and veggies are being served in cafeterias, with the hope that serve-a-healthier-meal-and-they-will-come. Which I actually believe will happen, eventually.

But what if healthy food could get a little help -- of the kind that unhealthy food gets by the bucket load?

Market, don’t nudge

This is the premise of a new study just published in Pediatrics. The researchers, led by Andrew Hanks, randomized 10 elementary schools to 3 types of veggie marketing exposures: A banner ad with veggie cartoon characters wrapped around the base of the salad bar, a short TV ad with those veggie characters, or both of the above experiences.

The salad bars were a hit during the 6-week field experiment, with an overall increase of 135 percent in veggie selection. Looking more carefully at the 3 types of interventions, the kids exposed to just the salad-bar banner increased their veggie selection by 90 percent, while those exposed to both a TV ad and the banner increased it by 240 percent!

Which really proves what marketing experts already know: Exposure across several types of media increases its effectiveness, and branded characters make food more attractive to young kids.

Unless we can make junk-food marketing to kids disappear altogether – good luck with that – we should try to somewhat level the playing field by giving veggies a bit of a marketing boost.

Dr. Ayala

Drink like a music celebrity?

What do the fit, beautiful music celebrities whom our teens admire eat and drink? According to the ads they help make it’s junk food and sugary drinks that got them into the great shape they’re in.

Which I seriously doubt. I’d bet that they actually treat their health as a great asset, and protect that asset by being very, very careful with what they eat.

A new study, led by Marie Bragg, in the journal Pediatrics, compiled a list of top music celebrities associated with the Billboard Hot 100 Chart, and then looked at foods and drinks these musicians endorsed and helped advertise.

Sixty-five of the 163 music celebrities in the study endorsed foods and drinks. Fifty-one of them endorsed beverages, mostly full-calorie sugary drinks. Most of the foods endorsed (80 percent) were energy dense and nutrient poor, i.e. junk food. Baauer, will.i.am, Britney Spears, Justin Timberlake, Maroon 5, Pitbull, and Jessie J were the most prominent food and drink endorsers. And the food and beverage companies are certainly getting their money’s worth: There were 312 million You-Tube views of the 94 celebrity food and soft-drink ads in the researchers’ sample – and that’s just one media channel.

Does Justin Timberlake really drink soda? Here’s what he told Bon Appetit about how he eats:

“I’m such a Type A personality–when it comes to a road trip, I plan my food so far in advance. I roll hard with a cooler. I don’t mess around. I want to avoid ending up eating fast food. I try to stay away from that.”

Britney Spears recently stunned the world with her amazing abs, and she, too, didn’t get there by drinking soda, but rather, as her trainers report, by eating clean, unprocessed food and good carbs. This is how Spears describes the way to her beach body:

“I’m really into raw food — sushi, basically…any kind of fruit.”

The authors admonish the practice revealed by this study:

“Obesity has become such a pressing public health issue that society must acknowledge the human suffering and costs associated with diabetes, obesity, and associated comorbidities. Musicians, actors, and other celebrities can be tremendously influential, particularly for the young fan base that may be swayed by their endorsements. Celebrities should leverage their influence to promote more healthful messages, and more effort should be made to reduce the exposure of children and adolescents to marketing, particularly for unhealthy food and nonalcoholic beverages."

The same author headed another study in Pediatrics several years ago that similarly showed the extent and reach of star athlete endorsed junk food. That study found that 24 percent of all the top athlete endorsement deals were for foods and beverages, almost all for junk food and sugary drinks. 

Associating junk food and sugary drinks with fitness, strength, vigor, success, health and beauty is pretty ironic. But I guess that as long as we’re buying into it, these endorsements will continue.

Dr. Ayala

Full disclosure: I co-founded Herbal Water, which makes organic herb-infused waters that have zero calories and no sugar or artificial ingredients. I’m also a pediatrician and have been promoting good nutrition and healthy lifestyle for many years.

The food ads that teens make

Millennials are both credited and accused of being obsessed with food. The younger generation is recognized as a driver of healthy eating trends, as the generation that photographs its food until it’s cold, that spends its discretionary money on eating out, and one that admires celebrity chefs.

Social media is where this preoccupation manifests most vividly.

A new study led by Christopher Holmberg in the journal Appetite set out to see what kinds of foods teens share with their friends. The Swedish research team picked Instagram because of its popularity.

A sample of more than 1000 Instagram accounts belonging to teens aged 14 year-old was analyzed.

High calorie low nutrient foods dominate

Food photos were found in about 85 percent of teen accounts, and food was the central feature in 96 percent of these uploaded images (it was placed in the center of the photo, and featured in the description).

The most common foods were cookies and pastry (20 percent of images), soda and lemonade came second (18 percent), followed by chocolate (16 percent), ice cream (11 percent), and candy (11 percent). Fruits occupied 9 percent of images, as did veggies. Overall, two thirds of food photos were of food the researchers categorize as high calorie low nutrient food.

Almost 40 percent of food images prominently displayed a brand name – much like an ad. Food brands that received lots of images were sodas, with Coca Cola in the lead, followed by Ben and Jerry’s and Starbucks.

Teens promote sugary drinks to their friends

The authors note that many of the photos that contained brands mimicked the existing ads the brands themselves produce.

It might be that teens agree with the brands, or, perhaps more likely, that they’re not aware that they’re participating in what becomes an ad. As mentioned above, several brands received a lot of uploads, and this was not by chance, the researchers found out: Many of these uploads were in response to campaigns such as Coca-Cola’s “Share a Coke”; Starbucks and Ben and Jerry’s had similar hashtag related campaigns.

The authors suggest that food photos are part of the teen's identity profile on Instagram. Association with food brands plays this role, but then, so does sharing a photo depicting healthy foods such as freshly picked berries

According to a recent report from the University of Connecticut Rudd Center for Food Policy kids are seeing more unhealthy snack ads than ever before as food brands increased their ad spend on TV and on social media. The report says that companies are moving to newer forms of digital marketing: “As social media sites enlist teens to market unhealthy products virally to their friends this form of marketing raises additional concerns among health experts.”

Social media spreads ideas, behaviors and habits. Brands are already paying attention and capitalizing on the word-of-mouth or, more accurately, the selfies, emojis and hashtags by teens as brand ambassadors.

Not all food is equally photogenic, but fruits, veggies, and many other plant-based ingredients and preparations of healthy foods certainly are – and they need all the free advertising they can get.

Dr. Ayala

Can we train our brain to dislike the food we crave?

What makes ice cream so very tempting? Let’s start with the obvious: It’s sweet, and humans – even babies – naturally prefer sweetness. We’re also naturally drawn to foods that have high caloric content; this probably served our species well during the majority of our food-scarce existence. 

If that weren’t enough, the next layers of desire rely on ice cream being paired repeatedly with pleasure and positive feelings, conditioning us to crave it. We learn to want certain foods from advertising, food placement in the supermarket, from the product’s packaging and visual appeal, from its association with characters and places that we're fond of. 

If ice cream were associated with filth, disease and desolation, rather than with long summer days, azure beaches and beautiful, fit, thin, sun-kissed people could we overcome our sweet tooth and like it just a little less?

That’s exactly what a new study published in the American Journal of Clinical Nutrition tried to find out. The researchers from the university of Colorado, led by Kristina Legget, went for visceral, automatic responses – implicit ones – rather than conscious ones, such as associating high calorie food with obesity. Volunteers were shown disgusting images of cockroaches, vomit and unclean toilets for an ever-so-brief moment – below the level in which they could consciously recall they’ve seen anything or what they’ve seen – followed by the image of high calorie foods, while low calorie foods were primed by positive images of happy babies and kittens. The 22 people that were primed with disgust rated the highly caloric food lower – they wanted it less – when compared with the 20 people in the control group, who were primed with neutral images before the 90 food images.

We can learn to eat better by thinking our way through nutrition education and the food-disease connection, but this study shows that there’s potential for changing our eating habits with the shortcut of contextual food cues. Mind you, that’s exactly what food marketers use to push our buttons. 

When New York City's health department employed disgust in the service of curbing soda consumption (see below) the reaction was pretty strong, suggesting this approach really does get to us.

 

Dr. Ayala

Working off a Coke: Warped logic at its finest

Coke has a new online ad, beautiful, happy, clever, and logically twisted.

The ad (see below) imagines what would happen if people paid for their can of Coke by working off the calories it contains. It shows that people are different, but on average, working off a can of soda takes just 23 minutes of cycling.

In this imaginary world soda makes thin people exercise -- and imaginary worlds are a nice respite. But it also distorts human physiology on many levels.

You don’t really burn 140 extra calories in 23 minutes

The time it takes the riders to burn their 140 calories varies, and depends on the speed of their pedaling and their weight (the heavier and larger a person is, the more they burn). These of course are just estimates – calorie trackers don’t really measure the calories you burn.

But the important thing to remember is that that estimate on the treadmill or the bike is for the total you burned during those 23 minutes, not for what you burned extra during the exercise session. If you were sitting at your computer you’d burn 40 calories during that time. If you were shopping you’d expend about 54 calories. The amount of extra calories you burn, what you really ‘earned’,  is the number of calories you exerted minus what you would have spent on an ordinary day, and we burn quite a few calories even in our sleep (50 per hour). In the best case scenario, I’d say those 23 minutes of biking add to the daily expenditure tally just 60-100 calories, and that’s if you're careful not to compensate by a little more couch time that day -- and you'll really have to be careful, as our body aspires to a steady state and resists change in energy.

140 calories aren't the problem, soda is

Let’s put numbers in context: 140 calories are just 7 percent of the daily caloric allowance for an average person. A large banana has as many calories as can of soda, and a handful of nuts have more, and most health experts highly recommend you do eat those. Soda isn’t on the ‘don’t’ list because it’s a calorie bomb, but because its calories are entirely empty. One can of soda has more sugar than what we should consume in an entire day. And there is something unique about liquid calories, as they don’t count towards satiety; we’re therefore advised to cut these specific calories to a minimum.

Soda is linked to obesity and disease not because it’s the most calorically dense food of them all – it isn’t – but because these are added-sugar calories that are conducive to overconsumption and poor metabolic health.

Exercise won’t solve obesity

Most people will not lose weight when they start an exercise program. To lose weight they’ll need to also watch what they eat, i.e., eat less.

Researchers have puzzled over why this is the case and I won’t go into it right now, but at this point it’s clear: there’s no way ordinary people whose day jobs don’t involve physical labor can exercise to the level in which they could eat as much as the food industry suggests they do.

We need to be active for our health and well being, not so that we’ll be rewarded with eat-less-of food. Exercising for a sweet reward usually leads to weight gain, because we tend to overestimate caloric expenditure, and underestimate intake.

The math just doesn’t work, and neither does the myth. Exercise will not solve our obesity crisis, nor will it allow us to eat whatever we wish. 

Dr. Ayala

Full disclosure: I'm vice president of product development for Herbal Water, where we make organic herb-infused waters that have zero calories and no sugar or artificial ingredients. I'm also a pediatrician and have been promoting good nutrition and healthy lifestyle for many years. On top of that, I really enjoy Coke ads, and wish the talent behind them would be used to further health.

Are diet pills an aggressively marketed scam?

In his latest op-ed in the New York Times, Frank Bruni admits that he, too, is occasionally lured by the promises of effortless slimming, and that Dr.-Oz-endorsed Garcinia Cambogia pills are languishing in his kitchen cupboard – because they don't seem to work. Bruni applauds the recent interest in fighting aggressively marketed junk-that-makes-us-fat, and wants to remind us that we should also pay attention to aggressively marketed pills, because Rapid Belly Melts” and “Mega Metabolism Boosters are getting a free pass.

I’d like to revisit a paper in Obesity Reviews that looked at the dynamic fat metabolism boosting market. The review explores how much evidence – or lack of it – is behind some of these popular nutritional supplements.

What is a ‘fat burner’?

A fat burner is a substance that is claimed to increase energy expenditure, make you lose weight, or somehow promote fat breakdown.  Many fat-burning supplements combine several ingredients, claimed to work in concert.  Is there such a thing as a fat burner?  The article examines some of the most popular such miracles, and I’ll discuss just a few of those.

Fat burners on the market

Caffeine

The ultimate functional ingredient, caffeine appears naturally in coffee, tea and cocoa and is also added to many foods and drinks.  Anyone who drinks coffee knows that coffee does have active ingredients that increase alertness – that’s why I love my morning cup.  It makes loose dreamy words stick into lucid sentences.  But does it increase energy expenditure and promote weight loss? 

A few studies showed that high doses of caffeine increased metabolic rate, however, longer-term studies tracking dieters taking caffeine or placebo showed caffeine performing no better than the dummy pill.  Overall, the authors conclude:

“Caffeine on its own has not been shown to be effective in reducing body weight and if caffeine increases fat metabolism, the effects are generally small”

Carnitine

Carnitine, which occurs naturally in meat, and is produced by our own liver and kidneys, is claimed to improve fat metabolism and increase muscle mass. 

Most of the carnitine in our body is in our muscles, and our muscle takes up carnitine from our blood against a huge concentration gradient (sorry for the flashback to high school chemistry, but it’s needed in order to understand how little sense this makes).  Studies have shown that the enzyme that is responsible for transferring carnitine into the muscle is at maximum capacity, and therefore ingesting extra carnitine doesn’t raise muscle carnitine at all.

The only way in which muscle carnitine could be elevated was by increasing blood levels of both carnitine and insulin at the same time – by insulin intravenous drip or very large amounts of ingested sugar.  This impractical scenario is quite counterproductive from the weight-loss point of view.

Carnitine supplementation for weight-loss just doesn’t make sense!

Tea

Tea contains catechins, which are thought to stimulate fat metabolism.  Green tea, which is non-oxidized and non-fermented tea leaves, has especially high levels of catechins, the most interesting of which is EGCG (epigallocatechin 3-gallate).  The authors review the green-tea weight burning studies and find them inconclusive:

“Green tea has the potential to increase fat metabolism at rest, also during exercise, and may help to lose body fat and body weight.  As with caffeine, the effects appear to be relatively small…”

Chromium

Chromium is added to many “functional” foods and drinks (Vitamin Water, Fuze) and is sold as part of many supplements as a fat burner and muscle builder.  Chromium occurs naturally in broccoli, red wine, mushrooms, brewer’s yeast, wheat germ and other foods, and was reported to increase lean body mass during exercise. 

The excitement was dampened by further, better studies that found chromium had no effect – overall, the majority of studies find it useless – and the authors also caution that a few studies on cell cultures found chromium can cause chromosomal damage.

Want to burn calories?

The authors, A. E. Jeukendrup and R. Randell, conclude with an overall impression that most of the supplements marketed as fat burners have little or no science to support their claims, and that among the group, caffeine and green tea have some effect, but it is small, and more consistent in habitual caffeine users.  They write:

“The ever increasing list of fat-burning supplements is industry driven, and is likely to grow at a rate that is not and cannot be matched by similar increase in scientific underpinning” 

In other words, marketers are quick to announce miracle solutions based of the flimsiest of evidence collected on a few lab mice or a cell culture; if and when scientists manage to amass enough research that more often than not doubts the substance’s merit, sellers are ready with the next new fat-burning sensation.

How can we end this? Silly and optimistic as I am, I’m hoping for an end to health claims on foods and supplements.  Health claims were introduced in 1994, have been so miserably abused and have become so utterly misleading that it’s just time to say goodbye. 

The other more realistic scenario is that consumers will start rejecting the hype and express their skepticism with their wallets.

Let’s end with the age-old solution to fat burning.  We know it works.  It’s healthy and inexpensive, too.  It’s called exercise.

Dr. Ayala

Should parents worry about advergames?

Weirdly enough, health professionals need to prove time and time again that ads promoting junk food actually affect kids' intake of these foods. A Super Bowl ad costs 4 million dollars for just 30 seconds of airtime, so clearly someone has already looked at the numbers, yet many believe – or want to believe -- that ads don’t impact their kids.

Ads can’t be blamed for the obesity epidemic of course, but despite some recent progress, food commercials support mostly energy-dense foods, high in sugar fat and salt -- those we’re advised to eat less of -- and contribute to overeating. Several years ago the Institute of Medicine reviewed the scientific literature and found that ads influence kids' preferences, purchases and short-term consumption, may contribute to less healthful diets, create an environment that puts kids’ health at risk, and that ads and marketing messages reach kids through a wide variety of new media, and are present almost everywhere they go.

And the data keeps piling up.

Who’s most susceptible to ads?

In a new study published online ahead of print in Pediatrics, 261 2^nd and 3^rd graders played an advergame – a video game created to advertise, almost identical to those designed by food companies – that promoted either energy-dense snacks or toys. The game was a memory game with 16 cards on which brands and products were featured. While playing, the kids could reach out to 2 bowls of snacks, one with jelly candy, the other with milk chocolate candy shells.

Not surprisingly kids who played the advergame with the snack foods ate significantly more snacks: on average they ate 50 percent more than the kids who played the game that had no food cards!

In some of the test conditions the kids were told that although they can eat as much as they want, if they ate nothing they’ll get a reward. That seemed to work: overall kids that played the snack-foods game reduced their snacking by half when promised a different reward. 

But here’s the most interesting part: Impulsive children among the group were identified through a computer test that checked for kids’ ability to control behavior. While these kids did not eat more than less impulsive kids when playing the snack-food game, they did have a harder time refraining from eating when they were promised a reward for not eating – they practically ate about the same.

Parents are the antidote

We’re all quite impulsive when it comes to food, and even more so when it comes to high reward foods. Long-term benefits pale compared to the instinct to satisfy momentary cravings. Kids are even more vulnerable, and this study shows that kids with higher impulsivity are a great target audience for advertisers. All the more reason to try and limit kids’ exposure to these ads.

But parents can reduce the effectiveness of advertising – in just the same way the authors of this study did – and train kids to ignore and self-regulate snacking.  I’m not suggesting a reward for not snacking, but rather a rational explanation of the long-term consequences of mindless eating. This study showed that telling kids to ignore the underlying message-to-snack works – at least for the kids that were less impulsive.

The other great trick – don’t have these snacks at home. The cue in the ad triggers eating a snack, but in its absence the cycle is broken. You can also offer a replacement and place it in a tactical position; when the desire to munch hits, kids will reach for some carrots or apples in the bowl right nearby.

Dr. Ayala

Do star athletes eat the junk they endorse?

What do star athletes eat? I’d bet they view their bodies as a temple and treat it with great care.

Yet for the right price role models of health and fitness will recommend junk food. 

A new study in Pediatrics shows the extent and reach of athlete-endorsed junk food. The study looked at the 2010 Bloomberg Newsweek 100, a list that ranks top athletes on the basis of prominence in their sport and the earning potential of their endorsement contracts. The researchers, led by Marie Bragg, then generated a list of the brands these athletes endorsed, and sorted the brands to 11 categories, including food and beverage, automotive, finance, airlines etc. 

Best endorsers for worst foods

Of the 512 brand endorsements, 122 were for food and beverage, and these made up about 24 percent of all the deals. LeBron James (Sprite, Vitaminwater, McDonald’s, Powerade), Peyton Manning (Gatorade, Wheaties, Pepsi) and Serena Williams (Oreo, Gatorade, Nabisco) had more food and beverage endorsements than any other athlete. 

Sports drinks toped the list of food and drink deals, followed by soft drinks and by fast food. And here’s the nutritional profile of athlete endorsed food: About 80 percent of the foods were energy dense and nutrient poor, and 93 percent of the beverages were sugar water, receiving 100 percent of their calories from added sugar.

What do athletes eat?

LeBron James might not need to care about calorie counts –  he probably burns 3 times the energy most men his age do -- but his food doesn’t come from a factory; it is carefully prepared by his personal chef, Brandon.

When asked about her diet Serena told Body & Soul “My goal is to have a healthy lifestyle so I can live a long life. I don’t eat a lot of meat. I eat a lot of natural food – a lot of green stuff like spinach and cucumber. And I drink lots of water.” 

Marketing junk leads to eating lots of junk. Junk endorsed by sport idols -- the very picture of health and fitness -- removes barriers of judgment, and leads to eating even more junk. And the most talented marketers and endorsers are promoting the worst foods.

Yet in the real world, eating fast food and drinking sugary drinks leads to obesity and disease, not to winning super bowls and grand slams.

An athlete isn’t just a celebrity. His endorsement carries with it a healthy halo, associating the food and drink he’s supporting with fitness, strength and vigor, and creating a confusing mixed message. Although junk food and cigarettes are not the same, the Pediatrics article reminds us that Babe Ruth, Joe DiMaggio and Lou Gehrig appeared in tobacco ads, and it was only public pressure that did away such practices. Until such pressure is applied to junk food, we’ll continue to see the world’s premiere sports competitions like the Olympics, brought to us by McDonalds and Coca-Cola, and the athletes our kids admire suggesting to them that junk food makes you strong.  

Dr. Ayala

Immunity boosting foods? Really?

I have a summer full of travel (mostly work but also family time and pleasure) and will be writing new posts infrequently. Meantime, I'll be reposting a version of some of the most popular posts I’ve written over the past years so that new readers have a chance to catch up. Wishing you a happy and healthy summer!

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The connection between diet and health was proposed some 24 centuries ago by Hippocrates, and I can imagine he first heard of it from his mom, who heard it from her ancestors.

Today, grandmas, moms and physicians have piles of scientific evidence supporting their observations and advice. It’s true: Diet does play an important role in health. We’re learning more each day and the discovery is fascinating.

Unfortunately, scientific discoveries are being overly interpreted to promote the sale of foods, and scientific jargon appears all too often as buzzwords on packaged goods.

Every Flu season has given rise to a new barrage of immunity claims shouting at us from every supermarket shelf and commercial. It’s a perfect time to look at the diet/health connection and these claims.

A short introduction to food label claims

There are several types of claims allowed by the FDA on foods.

A health claim describes a relationship between a food or food component and adisease, and it must:

• Be pre-approved by the FDA. There are currently slightly more than a dozen of these approved claims.

• Be phrased in the specific language the FDA requires. The claim must indicate that the disease may be caused by a variety of causes, and must state that the food should be consumed as part of a healthy diet.

• Appear on food that meets certain nutritional requirements.

A structure/function claim is quite a different animal. 

Structure/function claims describe a role of a nutrient, a substance in food or a food supplement in affecting the normal structure or function in the body. Unlike a health claim, it doesn’t relate to a disease or a health-related condition. The verbs “support”, “improve”, “boost” and “maintain” are often a telltale sign of a structure/function claim.

A Structure/function claim: 

• Requires no FDA pre-certification.

• Can be attached to any food, including junk food (there are no overarching nutritional requirements).

• Can be phrased in many ways.

• Is the manufacturer’s responsibility. While the claim “must be truthful and not misleading”, there’s no specification about how much evidence is needed to make the claim.

A few quick examples: 

“Calcium reduces the risk of osteoporosis” is a health claim; “calcium builds strong bones” is a structure/function claim. 

“Fiber may reduce the risk of some cancers” is a health claim; "fiber maintains bowel regularity," is a structure/function claim. 

Confused? You’re in good company. Most consumers can’t tell the difference.

Even the pros in the food industry can’t necessarily make sense of structure/function claims. They consult expert lawyers whose entire practices are devoted to advising companies on the language of the label. Creative marketing devises the claim and legal counsel makes sure it’s defensible and at least somewhat based on reality.

What’s clear is that the structure/function claim has been a boon to food manufacturers. Since there are so few limitations on its use and the trusting public can’t distinguish between a health claim and a structure/function one, why not be creative, develop a claim that meets your goals and slap it on the package? Market research shows these structure/function claims really help with sales.

What's the evidence backing these “immunity” claims?

There are, in fact, no approved health claims related to immunity.

What does that mean? It means that no one has presented to the FDA enough evidence of a relationship between a food, a food ingredient or a dietary supplement and reduced risk of contracting or of treating an immune mediated or infectious disease such as the flu to warrant a health claim.

That means the immunity claims you see everywhere are all structure/function claims.

What are the claims based on? The immune system is very complicated, and its integrity depends, among other things, on good nutrition. States of vitamin, mineral or protein deficiency lead to reduced immunity and correcting the deficiency does improve immunity.

But while it’s true that if you had a vitamin C or zinc deficiency you could improve your health and immunity by eating a vitamin-fortified cereal or a vitamin supplement, it’s clear that shouting “Immunity!” from the cereal box is misleading. Vitamin deficiencies are rare, and therefore the cereal might be yummy, but it’s not doing much for your immune system.

Most food contributes to one’s health, so by that token we can add a structure/function claim to pretty much anything:

• Sleep, for example, is very important to immunity; should we advertise mattresses as immunity boosters? All mattresses or only some brands?

• Exercise improves immunity. Maybe “immunity now!” should be painted on sidewalks?

• Stress reduction improves immunity; how about an “immunity massage”?

• Why, even breathing air supports immunity. 

These immunity claims are all without much substance I’m afraid, but it’s especially outrageous to see them on junk food. Cocoa Krispies is 40 percent sugar, but hey, don’t you need to maintain normal sugar levels for good immunity? Correcting potential hypoglycemia is critical for good immunity, isn't it?

Thankfully, after receiving a letter from San Francisco’s city attorney last November, Kellogg's announced it would phase out the immunity claims on Cocoa Krispies.

Will misleading claims ever end?

Two scenarios I can imagine:

• Consumers will start rejecting these claims, viewing them as a hyped and misleading insult to their intelligence, and move toward products that are marketed in a more sensible and honest way.

The only reason these claims abound is because we’re buying them.

And here comes my question: Do people really believe that they can buy immunity in box? Or are they buying it knowing that an easy fix is a fantasy, but it still feels good to dream?

• The second option is the litigious route: A few really big class action suits, representing misled consumers who saw no health benefits from investing their hard-earned money in products that failed to deliver can change everything. In that respect, the recent FDA warning letters to manufacturers who post misleading or false claims could act as important evidence and actually make a difference.

I prefer the first scenario.

There’s actually a third possibility.

The FDA can overhaul the whole health-claim structure/function scene, crackdown on false and misleading claims and help consumers understand that good health (and building a strong immune system) has nothing to do with buying products that make health claims. People need to just eat well by consuming healthy, real foods over a long period of time.

Sorry, but that’s the truth—eating well is about good habits and good food, not about sprinkling vitamins, anti-oxidants and omega 3 on processed food. The Center for Science and Public Interest (CSPI) is urging the FDA to do just that in a report it recently sent. (It’s 158 pages, but well worth a read, and it includes lots of pictures.)

So, what to make of these medicinalized foods?

I think it’s best to simply leave them on the shelves and opt for good, healthy choices. As Hippocrates said, “To do nothing is sometimes a good remedy.”

Dr. Ayala

“Fun food:” Is it nutritious? Is it even fun?

I have a summer full of travel (mostly work but also family time and pleasure) and will be writing new posts infrequently. Meantime, I'll be reposting a version of some of the most popular posts I’ve written over the past years so that new readers have a chance to catch up. Wishing you a happy and healthy summer!

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Most parents are aware of the marketing efforts directed at their kids through advertising. Besides direct advertising on television and in internet games, packaging of food in a way that appeals specifically to kids is another way food is marketed to our kids. All of these tactics affect our kids’ choices (at least their nagging choices).

How does packaged food target kids?

Manufacturers introduce “fun” in their packaging. Specific colors, iconography (including cartoons), graphics, language and shapes (animal and cars) allure the kids, beckoning them to take a look. Packages offer free games, tie-ins with popular kids’ programs and films, and “lets have fun” messaging. Kids know immediately that this is a food playfully designed for a kid.

Professor Charlene Elliott from the University of Calgary, Canada, studied 367 products targeted specifically at kids to assess their nutritional value. The results appeared in the journal Obesity Reviews.

Before we get to the findings, a few words about the method of this study:

• The 367 products were selected from a Canadian supermarket, and included only “regular” foods within the dry goods, dairy, produce and frozen food categories. The study excluded typical “junk food”—confectionary, soft drinks, cakes, potato chips etc., as these are expected to be of poor nutritional value, and don’t need testing.

• Assessment of nutritional value was done using the criteria outlined by the Center for Science in the Public Interest (CSPI): Healthy food should not derive more than 35 percent of its calories from fat (excluding nuts and seed and nut butters), should have no more than 35 percent added sugar by weight, and upper limits for sodium levels are defined depending on the food category.

Regarding the nutritional value of fun foods, the study found:

• 89 percent of the kids’ products studied were classified as having poor nutritional quality” (PNQ)

• Within the dry goods kids foods (including granola bars, cereal bars, pasta, soups), high sugar levels were the main culprit.

• Within the refrigerated and frozen foods (packaged lunches, pizzas), many products had high fat or sodium.

• Less than 1 percent of the foods specifically targeted at children in a Canadian supermarket are fruits and vegetables; the only kids’ foods in the produce section were small apples and baby carrots.

Health  claims abound

Fun foods don’t portray just happy drawings and cartoons. The majority of these foods (62.7 percent) had nutrition claims on the box. Examples range from the Smart Spot™ (a logo with a check mark in the middle, designed by PepsiCo, and displayed on those products from this company supposedly meeting nutritional standards), to phrases like “low fat,” “good source of calcium,” “trans-fat free,” etc.

The interesting finding was that among the 326 fun foods that were of poor nutritional quality, 202 (62 percent) had nutritional claims.

So while the nutritional claim of “low fat,” “no trans-fat” or “good source of iron” might lead one to think the whole product is nutritious, that isn’t necessarily the case—the product may be full of sugar, non trans-fat or sodium.

Another hidden message of health on products marketed to kids is the healthful physical activities the cartoon images are engaged in—many of the cartoons are depicted playing some kind of sport.

The strange world of food designed for kids

Elliott comments:

“Fun food products are no longer contained within the cereal aisle; they pervade the entire supermarket and are available for every eating experience (breakfasts, snacks, lunches, dinners). Fun food marketing suggests that children should be served 'special' foods made uniquely for them, that family meals should be reconfigured into foods for children and foods for adults, and that children's fare should be more interactive, more colourful, increasingly removed from the 'natural'.

All of these suggestions can create a problematic relationship between food and children, working to create a space in which children become accustomed to the 'unnaturalness' of food and learn to appreciate the value of food as fun, sport or distraction (instead of focusing on nutrition). As I discuss elsewhere, in consistently emphasizing a food's play factor, artificiality and general distance from 'regular' foods, fun food marketing can work to create a particularly unnatural relationship with food in children.

Food becomes framed as entertainment, and this entertainment is both premised on and emphasizes the artificiality of what is being consumed. (Remarkably, it is only in the world of children's food that artificiality is actually framed as a selling feature.)”

I agree.

Dr. Ayala

Eat Healthy! Everybody’s Doing It!

What do you think is going to lead more students to the salad bar, telling them that most of their friends eat vegetables, or stating that eating vegetables is good for you?

We know that peer pressure can push people to do the right – or wrong – thing. What we think is “normal” or “typical”, and our perceptions of what others have and do, influences our decisions. Many campaigns encourage us to join the majority: “Four out of five dentists surveyed recommend…" and “billions and billions of people served” led us to believe the decision has already been made by everyone, so it must be a good idea. Social psychologist Robert Cialdini showed in a series of studies that when hotel guests were told that the majority of guests reused their bath towels, they were more likely to reuse them, too. This social norm message outperformed environmental reasoning and even a promise to donate money if guests helped reduce towel laundry.

Educational information about nutrition could appeal to those seeking to eat better, but on the other hand telling kids what’s good for them might seem like unwelcome pressure, and might backfire and cause resistance rather than adoption of the good habit.

So which approach, if any, would you use?

Your friends eat here

A new study in Appetite (online ahead of print) conducted an experiment in an on-campus food court in an eastern American university. The experiment took place in an area with two food stations: a salad bar and a grill area serving hamburgers, chicken tenders and fries. The 220 students who participated in the study saw one of three signs:

1. “Every day more than 150 [name of university] students have a burger for lunch here”, accompanied by the university’s logo and photos of the grill area.
2. “Every day more than 150 [name of university] students have a tossed salad for lunch here”, accompanied by the university logo and photos of the salad bar.
3. “Have a tossed salad for lunch”, accompanied by a picture of the salad bar and the university’s logo.

In the control condition no signs were posted.

Message 2 resulted in more students choosing salad compared with the control condition. Message 3, surprisingly, did not lead to significantly more salad choices compared to the control condition. Message 2 and 3 did increase the number of salad choices when compared to the message 1 condition.

What if the norm isn’t healthy?

The sign telling students that salad is a popular choice outperformed the message suggesting that eating salad is what they should do.

But in order to use social norm messaging people need to believe the norm described is indeed true and real. In other words, we need to reach a point in which a majority is indeed following a positive habit in order to market the healthy choice as what everyone’s doing.

When it comes to healthy eating this is rather hard to do. Eating unhealthy, calorically dense foods is very common in many social circles, and research even suggests weight gain ‘spreads’ in social groups, perhaps because people tend to follow the choices of their peers.

So how can we support an “everybody’s doing it” healthy behavior? 

Perhaps we should look at admired groups of people in which this behavior is indeed the norm. Do actresses eat a lot of veggies? Do tennis players follow a healthy diet? I’m sure we can find a trendy group of people in which “four out of five” or at least the majority are role models for healthy eating.

And let’s not forget that perceived social norms (some of them not normative at all) are also created – quite intentionally – by clever, repeated depiction in movies, TV, music and ads. I’d love to see healthy eating inserted into media in place of alcohol, junk food and sugary drinks.

Any suggestions?

Dr. Ayala

 

Study shows what foods supermarkets promote most

Advertisements sell and --- as much as we hate to admit it -- food ads do shape the way we eat. That’s why more than $7 billion are spent each year on food ads in the US.

Much has been said about the ubiquity of junk food and fast food ads on TV and their effect on eating habits, especially kids’ eating habits.

Newspaper and mailed circulars receive much less attention, despite the fact that they are an important advertising channel for food and grocery retailers, and food advertisers spend nearly $1.6 billion on these outlets yearly. Consumers pay quite a lot of attention to them, and a recent survey showed that shoppers change their meal plan according to which products are on promotion, with young people even more susceptible to eating-on-promotion.

A new study (published online ahead of print) in Appetite is among the first to evaluate the types of foods promoted by US supermarkets and compare them with current dietary guidance. The study analyzed sales circulars issued in 2011 by supermarket top chains and included a sample from each of the 50 states and Washington, D.C. The proportional ad area devoted to each food group was compared to the area allotted to that food group in the MyPlate icon.

Meat, soda and cereal

The most heavily promoted food group on the front page of supermarket sales circulars was meats: beef, poultry, and pork, and about 40 percent of ads were for these foods; MyPlate suggests 20 percent of the plate be devoted to ‘protein’.

Foods in the fruits and vegetables groups each were given about one-tenth of the sampled advertising space; compare that to the half-plate devoted to fruits and veggies on MyPlate.

Grains, half of these being breads, cereals, and crackers, occupied a fifth of the advertising space. This is pretty much in proportion with MyPlate.

A tenth of the ad space was allocated to sweets – mostly sugary drinks. These are not represented on MyPlate at all.

Selling soda to obesity stricken states

Supermarkets promote different foods in different regions, and the researchers looked to see how the obesity rate of a state correlated with foods on its supermarket circulars.

And indeed, in states with under 25 percent obesity (such as Massachusetts and Colorado) supermarkets devoted significantly more space to fruits than in more obese regions. (Shocking note: no state has an obesity prevalence of less than 20 percent.)

On the other hand, sweets occupied significantly more ad space in the states with over 30 percent obesity, and significantly more space was given to sugary beverages in these states. 

The south regions of supermarkets tended to allocate more ad space to sweets, predominantly sugary drinks, which were given 2 to 6 times as much ad space when compared to other regions.

Can we affect supermarkets?

Although supermarkets promote the items that give them the best profit margins, they also sell what we consumers want to buy. This is evidenced by the difference this study saw between regions. I guess it’s harder to appeal to Connecticut customers and lure them into stores with a special on soda.

Ads affect our behavior – we’d like to think we’re immune to their influence but nobody really is – but our purchasing power also affects what’s on shelf and what’s on promotion. When consumers seek healthier foods it does often lead to a decrease in the price of those foods, and to chains making shelf space for better options.

As Michael Pollan often says, we get to vote with our fork 3 times a day. Each addidional vote has the potential to change the food-world around us.

Dr. Ayala