Responding to pressure from parents and consumer groups, McDonald’s announced on Tuesday its “Commitments to Offer Improved Nutrition Choices” and serve up more nutritionally-balanced meal options, particularly for children. Starting in September, Happy Meals will have apple slices and a smaller serving of French Fries (1.1 ounces instead of 2.4 ounces). The company stated that “[b]y adding fruit in every Happy Meal, McDonald’s hopes to address a challenge children face in meeting the recommended daily consumption of produce” and noted that “[f]or those customers who prefer a side choice of apples only, two bags of apple slices will be available, upon request.” McDonald’s vice president Ben Stringfellow has said that the company is considering other fruit choices such as “pineapple spears, raisins and carrot sticks.” Other planned changes in the next year include a 10% sodium reduction in chicken products, new beverage options of fat-free chocolate milk and 1% low fat white milk (in addition to the traditional sodas), and increased access to nutrition information through mobile apps for iPhone, iPad, Blackberry, and Android devices.
Once the nutritional changes take effect, a Happy Meal with chicken nuggets will shrink from 530 calories and 23 grams of fat to 435 calories and 17 grams of fat. Samantha Graff, director of legal research at Public Health Law and Policy, told Prescriptions, The New York Times health blog, that “McDonald’s has taken an extremely important step to help parents who want to please their kids while providing them with at least minimally nutritious food. We think it’s a terrific move.” In an opinion piece, Chris Woolston, a writer for Booster Shots, the Los Angeles Times health blog, wonders whether healthier McDonald’s meals are the answer as
[t]o reshape their kids’ diets, parents need to make more meals at home, where they can write the menus and control the ingredients and portion sizes. If more healthful Happy Meals translate into more trips to the golden arches — as McDonald’s obviously hopes — the end result may be something other than happiness.
Sure, for companies like McDonald’s, it’s about the bottom line. For parents, it’s about the health of their children. Good, responsible eating does start in the home… but why let it end there?
As a follow up to my previous post on junk food marketing to children and my earlier post on MyPlate — and any other post that I’ve written about children and fast food or junk food — I would like to direct your attention to a commentary recently published in the Journal of the American Medical Association which has caused quite a stir. In “State Intervention in Life-Threatening Childhood Obesity,” Dr. David Ludwig (Director of the Optimal Weight for Life Program at Children’s Hospital in Boston, Massachusetts) and lawyer Lindsey Murtagh (Research Associate for the Department of Health Policy and Management at Harvard School of Public Health) confront severe childhood obesity — which is “characterized by a body mass index (BMI) at or beyond the 99th percentile” — with what appears to be a wild and rash line of thought: remove severely obese children from their homes and place them into foster care.
In their commentary, Dr. Ludwig and Ms. Murtagh write that
[s]tate intervention may serve the best interests of many children with life-threatening obesity, comprising the only realistic way to control harmful behaviors. Child protective services typically provide intermediate options such as in-home social supports, parenting training, counseling, and financial assistance, that may address underlying problems without resorting to removal. These less burdensome forms of legal intervention may be sufficient and therefore preferable in many cases. In some instances, support services may be insufficient to prevent severe harm, leaving foster care or bariatric surgery as the only alternatives. Although removal of the child from the home can cause families great emotional pain, this option lacks the physical risks of bariatric surgery.
However, the authors also acknowledge that
removal from the home does not guarantee improved physical health, and substantial psychosocial morbidity may ensue. Thus, the decision to pursue this option must be guided by carefully defined criteria… with less intrusive methods used whenever possible.
Reading through the commentary, one senses an exasperated tone more than anything else. After all, the authors cite a mind-numbing statistic: there are approximately 2 million severely obese children in the United States. And how should we treat this epidemic? With bariatric surgery you say? And so the authors wonder aloud whether “removal from the home may be justifiable from a legal standpoint because of imminent health risks and the parents’ chronic failure to address medical problems.”
Let’s set aside the legal arguments for a minute and discuss the heart of the matter: America’s eating habits. Specifically, America’s childrens’ eating habits. In a response post on MSNBC, Arthur Caplan, Director of the Center for Bioethics at the University of Pennsylvania, criticized Dr. Ludwig and Ms. Murtagh by focusing on other obesity-causing factors, such as the unhealthy “food culture,” that pervades the United States. Professor Caplan wrote
I am not letting parents off the hook. But, putting the blame for childhood obesity on the home and then arguing that moving kids out of homes where obesity reigns is the answer is short-sighted and doomed to fail. We need the nation to go on a diet together and the most important places to start are at the grocery store, schools and media.
On Booster Shots, the Los Angeles Times health blog, Chris Woolston wrote that removing children from their homes and placing them into foster care will not fix poor eating habits because
[c]hildhood obesity is complicated. Fast food, sodas, TV, video games — many staples of modern life are pushing kids in the wrong direction. While researching a book on this topic a few years ago, I spoke with several moms who were tackling their child’s weight troubles with varying levels of success. One considered putting locks on her cabinets to keep her son from sneaking food in the middle of the night.
Her son was definitely on the large side — beyond that, really — but it’s not because his mom didn’t care. And even if someone had placed him in a foster home it wouldn’t have solved his problems. As a rule, those places have food in their cupboards, too.
Hear, hear. Wake up, folks. We need a food culture revolution with healthier and affordable alternatives. One which teaches our children to choose healthy foods and to eat in moderation. Because what else must we do before everyone finally, in the words of Professor Caplan, “[d]emonize[s] the companies that sell and market food that is not nutritious” and “[p]ut[s] exercise back on the menu for all school kids”? Institute state programs that remove severely obese children from their homes and place them into foster care? Oh, wait….
The Junk Food Marketing Debate: A First Amendment Right or Just Making Sure Kids Aren’t What They Eat?
Filed under: Advertising & Lobbying, Children, Public Health
Remember the Omnibus Appropriations Act of 2009 (H.R. 1105) that President Obama signed on March 11, 2009? No? Good, me neither, but my excuse is that I was busy applying to law schools. If you and I had been paying closer/any (take your pick) attention, we would have seen that the Act included, among other things, a provision calling for the Federal Trade Commission, the Centers for Disease Control and Prevention, the Food and Drug Administration, and the Department of Agriculture to create an Interagency Working Group on Marketed Food to Children (“Working Group”) composed of representatives from each agency. The Working Group would research and recommend standards for the marketing and advertising of food to children age 17 years and younger. These recommendations would be presented to Congress down the road.
Well, a couple of years passed, but in April 2011 the Working Group released its 26-page “Preliminary Proposed Nutrition Principles to Guide Industry Self-Regulatory Efforts” for public comment (which you can submit by clicking here before July 14). The Working Group notes that
… in the FTC’s 2008 study on Marketing Food to Children and Adolescents, three food categories — breakfast cereal, restaurant foods, and snack foods — represented approximately 70% of food marketing expenditures directed to children under 12. Similarly, three categories of foods — carbonated beverages, restaurant foods, and non-carbonated beverages — represented 69% of the food marketing expenditures for adolescents ages 12-17 year…. [Overall] [t]he categories most heavily marketed to children and adolescents, ages 2 -17 years are: breakfast cereals; snack foods; candy; dairy products; baked goods; carbonated beverages; fruit juice and non-carbonated beverages; prepared foods and meals; frozen and chilled deserts; and restaurant foods. The Working Group is therefore recommending that the food industry focus its efforts on ensuring that any advertising or marketing of food products within these ten categories meet the nutrition principles set out below. (Emphasis added.)
The Working Group focuses on two nutritional principles “that both improve the nutritional quality of foods marketed to children and can be feasibly implemented by industry with sufficient time to accomplish reformulation,” namely, “Meaningful Contribution to a Healthful Diet” (Principle A) and “Nutrients with Negative Impact on Health or Weight” (Principle B). Principle A ensures that foods marketed to children contain two or more of the following food groups: “fruit, vegetable, whole grain, fat-free or low-fat milk products, fish, extra lean meat or poultry, eggs, nuts and seeds, or beans.” Principle B ensures that foods marketed to children have limited amounts of saturated fat, trans fat, sodium, and added sugars. The Working Group makes sure to point out (several times in fact) that its recommendation are based on the 2010 Dietary Guidelines for Americans.
Really, this all sounds quite sensible, if not a little over-protective… but considering, as The Washington Post has reported, that Type 2 diabetes has significantly increased among people age 20 years and younger, what else can this country do to curb obesity and poor eating habits? Even if we could reduce the cost of nutrient-rich and quality foods so that everyone could afford them, how do we neutralize the marketing of junk food to children? In a report last month, NPR noted how
[the Working Group] broke from the past by seeking to include 12- to 17-year-olds in its guidelines. Traditionally, limits on marketing focused on the very young. But the government sought to expand them to older children, in part because they are heavy consumers of social media, cell phone messages and online games — the new frontier for ads.
That new frontier of advertising to children through online games — also known as “advergaming” (forgive my use of Wikipedia but Merriam-Webster doesn’t list the word) — includes Asylum 626 and Hotel 626, two advergames sponsored by Doritos. As NPR reported,
“[w]hat we’re talking about are very complicated and very subtle forms of marketing that aren’t always clear as such,” says Kathryn Montgomery, a professor of communications at American University and an advocate for limiting food ads to teens.
Montgomery says such ads work subliminally and use friends to influence other friends.
But efforts to restrict ads to teens draw lots of opposition from the food and advertising industries. The industries say the overlap between teen and adult audiences makes the proposed restrictions impractical.
Critics, including the U.S. Chamber of Commerce, have questioned the constitutionality and logic of the Working Group’s nutritional proposals. The Hill’s Healthwatch has reported that some critics see a First Amendment issue because
“[w]hat they’re doing is trying to simultaneously … suppress speech, while insulating it from judicial review,” said Northwestern law Professor Martin Redish, one of the panelists at a Chamber of Commerce discussion Thursday. “Because if these regulations were truly just advisory, there would be no case or controversy.”
“Industry’s rights are being violated here,” Redish said, “but there’s something deeper and darker that’s going on: The government is treating us like sheep.”
While constrained to commercial speech, Redish said that attitude has broader implications. People, he said, “can’t be sheep in the commercial realm and then all of a sudden, in the political realm, they’re free-thinking adults who can make basic choices.”
NPR has reported that other critics question the logic behind the proposal and the implicated age range.
Elaine Kolish directs an industry-funded program called the Children’s Food and Beverage Advertising Initiative. For the past five years this initiative sponsored its own voluntary standards that focus only on the 12-and-under set.
“You know, we let kids drive and we let them hold jobs when they’re 16. They can get married in some states, and they can join the military with permission, and they can be held criminally responsible for their actions in a number of situations,” she says. “So I think that the notion that you’d have to have nutrition standards that say you can’t let a kid see an ad for a french fry but you can let them join the military doesn’t really make a lot of sense.”
So where do we go from here? Is industry self-regulation the answer to making products that better fit on MyPlate? As I’ve noted in a previous post about McDonald’s Happy Meal toys, sometimes the answer can be stricter parenting (just say “no”). Yet how can parents instill and maintain healthy eating habits in their kids when advertisements for unhealthy food bombard them through television, social media, and online games?
Step aside, food pyramid, there’s a new dietary guide in town: MyPlate. During a press conference on Thursday, First Lady Michelle Obama and Department of Agriculture Secretary Tom Vilsack released MyPlate –whose color-coded quadrants of fruits, vegetables, grains, and protein — plus dairy circle — are intended to serve as “a quick, simple reminder for all of us to be more mindful of the foods that we’re eating.” MyPlate replaces the 2005 MyPyramid and the 1992 “old school” USDA Food Pyramid, both of which have been criticized as misleading or difficult to understand (I dare say that the MyPyramid color scheme was a little reminiscent of a similarly confusing color-coded federal government alert system). MyPlate complements the federal government’s 2010 Dietary Guidelines for Americans, released earlier this year, which reminds consumers about:
- Enjoy your food, but eat less.
- Avoid oversized portions.
Foods to Increase
- Make half your plate fruits and vegetables.
- Make at least half your grains whole grains.
- Switch to fat-free or low-fat (1%) milk.
Foods to Reduce
- Compare sodium in foods like soup, bread, and frozen meals — and choose the foods with lower numbers.
- Drink water instead of sugary drinks.
MyPlate is meant to be an “easy-to-understand visual cue.” Among the noticeable changes to the food guide are the absence of the “fats, oils, & sweets” section which once sat atop the 1992 food pyramid and the relabeling of the 2005 MyPyramid sections of “milk” to “dairy” and “meat and beans” to “protein.” The AP reports that
[t]he guidelines and the icon were subject of lobbying by food industries who want to see their products promoted and not discouraged. Fruit and vegetable growers were celebrating their victory over half of the plate Thursday, while dairy producers said they were also pleased with the cup beside it. The president of the beef industry group National Cattleman’s Beef Associaton, Bill Donald, said he is not concerned about the elimination of the word “meat” because beef is so associated with the word “protein.”
According to the New York Times, MyPlate is the brainchild of the Department of Agriculture, the First Lady’s Child Obesity Task Force, and other federal health officials. During the press conference, First Lady Obama noted that
[w]hen mom or dad comes home from a long day of work, we’re already asked to be a chef, a referee, a cleaning crew. So it’s tough to be a nutritionist, too. But we do have time to take a look at our kids’ plates. As long as they’re half full of fruits and vegetables, and paired with lean proteins, whole grains and low-fat dairy, we’re golden. That’s how easy it is.
Nutritionists cautiously welcomed MyPlate. For instance, Marion Nestle, a New York University professor, told the New York Times that
“[i]t’s better than the pyramid, but that’s not saying a lot”….
Dr. Nestle praised the plate for being generally easy to understand, but she said that labeling a large section of the plate “protein” was confusing and unnecessary, because grains and dairy products also are important sources of protein and most Americans get far more protein than they need.
But she said the emphasis on fruits and vegetables was a significant step.
Dawn Jackson Blatner, a registered dietician in Chicago, told The Wall Street Journal Health Blog that “we went from something that was complex and hard for people to remember to something that is very visual, clear and based in science. People don’t eat off a pyramid, they eat off a plate.” Except maybe for the people who designed the original food pyramid.
It’s early days yet, folks, but I agree with Ms. Blatner. At least the food guide finally looks more like my dinner plate and less like a jumble of colors and pyramidal fragments. Be sure to click here for an article from the Los Angeles Times to learn how other countries have visualized their food guides.
Listen up, Hoboken, Newark, and Orange residents. There’s a new prescription discount program in town: Coast2Coast Rx Card. Well, the program isn’t all that new to the area: Newark launched it last year and Hoboken launched it in January. However, I didn’t learn about Coast2Coast Rx Card until I filled a prescription at my local CVS last month. Since my prescription wasn’t covered by my health insurance (I always joke to the pharmacist that it kind of defeats the purpose of having health insurance, but I never get any laughs), I was bracing myself for the out-of-pocket cost. So imagine my surprise when the pharmacist said that I owed $35 instead of $50. When I pointed out the “mistake,” I was handed a Coast2Coast Rx Card.
While it isn’t a substitute for health insurance, the free Card does offer discounts on prescription drugs, laboratory tests, and imaging tests. Specifically, the Card boasts such features as:
- 59,000+ participating pharmacies including all major chains and most independents
- Over 60,000 drugs included in formulary
- Save up to 65% on a brand name or generic drugs
- Overall annual savings range from 30% to 45%
- Card is good for an entire family
- Cardholder pays no fees for the card
- No paperwork to fill out — card is ready to use
- There are no health, age or income restrictions; everyone qualifies
- Card has no expiration date and can be used as often as needed
- Card can be used to fill pet prescriptions at participating pharmacies
- Card is primarily for uninsured although insureds can use the card if they have a high deductible
- Insureds can use the card if their drug isn’t covered by their insurance
- In some instances the card can be used during the Medicare Part D “donut hole.”
- Cardholder information is held confidential and is not used for any other purpose.
- The card includes 50%-80% discounts on lab and imaging tests
According to The Florida Times-Union, Financial Marketing Concepts, Inc. (FMC), a Florida-based company, issues the Card on behalf of WellDyneRx, a national pharmacy benefit management company. In the past three years, FMC has secured agreements with 57 cities and counties in Alabama, Arizona, California, Florida, Illinois, Massachusetts, Mississippi, Missouri, New Jersey, New York, Ohio, Pennsylvania, Tennessee, and Texas (which may or may not look something like this.) These agreements give FMC a small fee for each prescription filled through the program. FMC in turn passes along a royalty to the city or county.
If you’re like me, you may already be in the habit of calling pharmacies and comparing the cost of prescriptions, regardless of whether or not your health insurance covers them — and it’s surprising how the cost can vary. So if you live in Hoboken, Newark, or Orange, be sure to check out whether the Card gives you any discounts. Can’t hurt.