Tuesday, November 16, 2010

An Unexpected Oasis

Today, instead of pointing out yet another dreary problem that confronts our country, I'd like to offer up some good news. For years, we have been hearing about "food deserts," those urban areas that lack sources of healthy foods, but have unhealthy convenience food in abundance. You can see these food deserts everywhere - in inner cities, in small towns along interstate highways, and even in some suburbs where fast food chains and convenience stores line the streets and grocery stores are few and far between. All the nutrition guidelines in the world will not help individuals and families living in food deserts eat as well as they could.

That's why it is exciting to learn that Walgreens is doing something about this lack of healthy food options.  I remember Walgreens as being a Midwestern old-timey five-and-dime chain, best known for its luncheon counters. In recent years, I have noticed more Walgreens stores opening on corners in my Southern city as the chain successfully expanded to become the largest drug store chain in the United States. And now, Walgreens has taken that revitalization to a new level - that of offering groceries and fresh foods in some of its urban Chicago stores.

Food deserts are a big problem in Chicago. The US Centers for Disease Control and Prevention estimates that about 600,000 Chicago residents live in neighborhoods that are either lacking or too far away from conventional grocery stores. And Walgreens has a large presence in inner-city Chicago, making it an ideal partner to get groceries, such as milk, meat, eggs, fruits, and vegetables, into those areas. Of course, this move isn't entirely altruistic - after all, Walgreens is a publicly traded company (NYSE, NASDAQ: WAG) that has shareholders to consider - but it does carry more than a whiff of civic responsibility. You see, Walgreens was founded in Chicago more than 100 years ago and, according to its press release, was asked by Mayor Richard M. Daley's office to start offering groceries in some neighborhoods where grocery stores were scarce. Taking this concept even further, Walgreens has created a partnership with local medical entities to pilot a program designed to educate residents about the link between healthy food choices and preparation and better management of chronic illnesses like diabetes.

This all sounds like a win-win situation to me, one that combines a basic tenet of capitalism of being the first to enter a niche market, and the do-good-ness of a hometown hero. The short-term outcomes may be that individuals and families living near these Walgreens will have expanded food choices and Walgreens may increase its market share over competitors.  It will take awhile to see the longer-term result of better health due to access to healthy foods, but it's not a leap to envision that those results will occur. Research has already shown that people who live in food deserts are more likely to become ill with conditions like diabetes, high blood pressure, and obesity - all conditions that can be helped or prevented with proper nutrition. So it stands to reason that the availability of appropriate foods could counteract or even prevent those conditions.

If you want to read more about food deserts, especially in Chicago, here is a report by Mari Gallagher and Associates, the firm that coined the term. It has some interesting facts, such as many who live in food deserts have incomes over $100,000, as well as important implications for our built environments.

Northwestern University's Medill School of Journalism pulled together a nice video in which residents of food deserts in Chicago are interviewed. The video highlights the lack of access to real food that many people face and allows us to see the type of establishments that residents must frequent if they are limited to shopping in their neighborhoods.

So kudos to Walgreens, the City of Chicago, Northwestern Medicine, and Near North Health Service Corporation for this innovative partnership. Walgreens is keeping a close eye on the initial 10 stores that are offering groceries. If they work well, meaning if they make money from the groceries, the concept could be expanded to other stores, and other cities. Keep your fingers crossed.


Friday, November 12, 2010

Can This Be True?

Earlier this week, Yale University's Rudd Center for Food Policy and Obesity released a report Evaluating Fast Food Nutrition and Marketing to Youth. Faster than you can say "drive-through window," some startling statistics were racing around the Internet and hitting the mainstream media. The most compelling of those statistics was that 84% of parents taking part in this survey reported feeding their kids fast food in the week prior to their interview.

When I read the 84% statistic, my first thought was, "That can't be true." I thought perhaps it was a sampling error - maybe the researchers asked only parents who lived across the street from a McDonald's, or who didn't know how to cook, or who were employed by Burger King. Or maybe there was some other reason the findings were skewed.

So I dug up the report, certain I would spot some methodological weakness. And, I'm sad to say, I was wrong. It's a whopper (sorry) of a report, but a good, thorough one. The methods section (on page 33 for those who care) convinced me that the sample of parents was, in fact, nationally representative. The researchers took pains to include appropriate racial/ethnic diversity and had a reasonable sample size.

The next thing I wanted to know was why. Why would all those parents take their kids to fast food restaurants so frequently? I thought the answers might be cost and convenience, two factors that could influence any parent's decision on where to eat. This time I was partially correct. A useful bar chart (page 118) shows the main reason parents take their kids to the following restaurants:

  • McDonald's and Burger King: the kids like it
  • Wendy's: convenience
  • Subway: nutrition (as an aside, of the 3,039 food combinations evaluated, Subway had the most choices that met the nutritional criteria for kids. Burger King didn't do so badly, either. But scoring well means choosing milk or juice with the meal, substituting fruit for french fries, and eschewing cheese, among other choices.)

This brought up another question: How did the kids know about the restaurants?

And this time, I got the answer correct. Kids know about these restaurants because of amazingly effective advertising and marketing.

Check this out: In 2009, preschoolers saw an average of 2.8 fast-food television commercials each day, kids aged 6-11 saw an average of 3.5, and teens saw 4.7. And that's just TV, not exposure to radio, billboards, online banner ads or pop-ups, bus ads, airport kiosks, and all the other places that fast food is advertised.

So what's a parent to do?

Even though I'm not a big proponent of TV, especially for small kids, I don't think isolating your kids from popular culture is the answer. Sure, sitting around watching the tube is obviously not exercise, and the exposure to the noxious advertising makes the kids want what they don't have  - clothes, food, and toys included. I also don't think we can sit around and wait for government regulations that would limit marketing to kids. After all, it took almost a decade before Congressional pressure and private lawsuits brought about the retirement of Joe Camel despite his obvious intention of selling cigarettes to kids - intentions that were pointed out by a 1991 article in the Journal of the American Medical Association that showed that 5 and 6-year-old kids could identify him more readily than Mickey Mouse or Fred Flintstone. This wasn't a benign situation. A companion article noted that during Joe Camel's reign, one-third of all cigarettes sold illegally to underage buyers were Camels - up from less than one percent before Joe Camel.  So even though it was clear (and later proven by internal RJR Nabisco documents) that tobacco was being marketing to kids, lawsuits and government action still took years to be effective.

Therefore, I think the most important thing parents can do to counteract the marketing messages targeting our kids is to teach them, from a very young age, that they are being manipulated. Put your kids in the driver's seat and teach them how to make choices. PBS has a "Question the Commercial" guide that is a good start to opening conversations with young kids about commercials.

And don't forget moderation. There is room in a healthy diet for treats: a donut here, couple of cookies there, an outing to a fast food restaurant every once in a while. But when 8 out of 10 parents willingly tell researchers that they took their kids to fast food restaurants in the past week, we know that kids aren't the only ones who need to learn moderation.

The reality is that we live in a world where marketing is everywhere. We can't keep our kids away from it. So we have to teach our kids - and ourselves - how to live with it.


Monday, November 8, 2010

Not Really a Surprise, But Still...

A super shout-out to Michael Moss's excellent investigative reporting on how conflicted the government is when one of its agencies is charged with both promoting business and promoting health. Moss's article, published on the front page of yesterday's New York Times, focused on the United States Department of Agriculture's schizophrenic mission of encouraging consumption of US agricultural products while also being in charge of nutrition guidelines.

 In his article, Moss explains how the USDA created an organization called Dairy Management, which is a marketing entity charged with increasing the consumption of dairy products in the United States. Dairy Management has achieved its goals magnificently - it is the group responsible for the brilliant marketing campaigns that have boosted Domino's pizza sales, convinced Americans that drinking milk is part of a good weight-loss strategy, and  ingrained "Got Milk?" into our national consciousness. All while one of the main contributors to obesity is saturated fat - yes, the fat found in dairy products.

Therein lies the conflict. You can't encourage Americans to eat more fat and address the obesity epidemic at the same time.

The story is not new. The USDA has long been conflicted about its role in business versus health. Remember the four basic food groups that the USDA touted until 1992? Meat, dairy, grains, fruits and vegetables - the foods most grown by American farmers (disclosure: I grew up on an American grain farm).  The food pyramid came next. This fascinating article, written by a nutritionist who worked on the original food pyramid, shows just how overt the USDA has been in promoting certain foods regardless of their effect on health.

It's unfortunate that we can't look to our government to provide unbiased nutrition information. That's why others, such as the good docs at Harvard's School of Public Health, have created their own food pyramid. Harvard's pyramid and the USDA's pyramid are similar in that both have their foundations in science. But Harvard stops there, without adding the heaping helping of influence from special interest groups that can sour even the best intentions.


Saturday, November 6, 2010

Don't eat the oil

Sorting through my kids' candy bounty after the recent national holiday of Halloween got me to thinking about how slowly change comes to the food industry. It's been fairly well accepted for years now that some food dyes cause adverse reactions, especially in children. After all, children may weigh a fraction of what an adult weighs, but still consume the same level of artificial chemicals in a bag of Skittles. Way before  the EU mandated that foodstuffs carry warning labels if they contain certain artificial colors, the Feingold Association has been publicizing the sensitivities some kids have to artificial colors, flavorings, and preservatives - sensitivities that have been misdiagnosed as conditions as severe as ADHD, bipolar disorder, and obsessive-compulsive disorder. More recently, the Center for Science in the Public Interest has adopted artificial colors as a project, and is lobbying the US Congress to remove some of them from our food supply.

But still, here I sit at my kitchen table, sifting through the Nerds, Skittles, and Starbust Chews for some good old chocolate that hasn't been too adulterated with artificial flavorings (synthetic vanillin is cheaper than vanilla) or colorings. The rub is that having travelled overseas many times in the past few years, I've eaten Starbusts and M&Ms made with natural colors so I know that we don't have to settle for foods that are colored with dyes made from petroleum products.

It bewilders me why the United Kingdom is way ahead of us on this issue. Mars, the company that makes M&Ms, was so sensitive to the public's concerns over red dye #2's possible link to cancer that it removed red M&Ms in 1976, despite the fact that its candies did not contain that specific dye.  However, the company seems resolute in in its use of red #40, the synthetic chemical that has colored its red candies since the late 1980s, even though red #40, is not recommended for consumption by children in Europe and is outright banned in Denmark, Belgium, France, Germany, Switzerland, Sweden, Austria, and Norway.

And it's not just candies that are affected by the regulations in Europe. The syrup in a strawberry sundae from McDonald's in London is colored with real strawberries, whereas a strawberry sundae in Atlanta carries a hefty dose of red #40. Nutri-Grain bars, a snack food many parents consider healthy, are vastly different here and abroad, as the illustration below shows.

Kellogg's Nutri-Grain Cereal Bars ingredients. From Britian compared to the US.

                                                    Illustration: Center for Science in the Public Interest                                                       

The issue isn't just one for little kids. Research is showing that you don't outgrow these sensitivities. Teens may act aggressively. Adults may get headaches. The list goes on and on. One of the most compelling real-life examples of the link between poor food and negative behaviors comes from Appleton, Wisconsin. By replacing typical cafeteria fare, sodas, and processed foods in its high school lunchroom and vending machines, this school - which serves troubled youths - has experienced drops in truancy and aggression, as well as increases in attention and learning. Foodie Alice Waters wrote about this school in The Nation, and it has received coverage on Good Morning America as well as numerous other places.

There really is a lot of research out there showing that some people are sensitive to artificial flavorings, colors, and preservatives, and that those sensitivities can be so extreme that they interfere with normal functioning. That's why it is upsetting that the pace of change in this industry is so glacial.   My point is that we don't have to accept impurities in our foods - our European counterparts don't. I encourage everyone to read the labels on their foods and evaluate what is in them. The Center for Science in the Public Interest maintains an excellent food coloring database that lists the synthetic colorings found in common foods. Bagels, cake mixes, cereals, you name it. Most foods that are prepackaged have been tarted up with a rainbow of colors intended to fool us into thinking the foods are purer, freshers, and healthier than they are. Then let your Congressional representatives know that you would rather have the more natural alternative that our friends across the pond enjoy.