Examination of Witness (Questions 461-479)
30 OCTOBER 2003
PROFESSOR MARION
NESTLE
Q461 Chairman: Good afternoon. My
colleagues and I welcome you to this session. We are particularly
delighted to welcome our witness Professor Nestle and to thank
her for appearing before us. This will be the last meeting of
our second clerk, Jenny McCulloch, who has been with us for a
while now, and has contributed to many important reports. We thank
her and wish her well in her new role. No doubt we will be seeing
you on a regular basis, but we appreciate what you have done.
Professor Nestle, would you briefly introduce yourself to the
Committee and also put on record some of the issues that we talked
to you about last week in the USA?
Professor Nestle: I am Marion
Nestle, Professor and Chair of the Department of Nutrition, Food
Studies and Public Health at New York University. I appreciate
the invitation to make an opening statement, although I do some
with some trepidation because I understand the last time somebody
made an opening statement he was beheaded soon afterwards! I hope
we are not following historical tradition. I am very pleased to
be here and to see those of you I have seen before, because I
think you have an extraordinary opportunity in looking at rates
of obesity, particularly among children, to do something about
it and not make the same mistakes that we have made in the United
States. You have an opportunity to make an active intervention,
and you are looking at ways in which you can do it. My personal
belief is that governments have a quite extraordinarily important
role to play in the development of high rates of obesity. Depending
on what policies you choose to make, you can make a big difference.
Obesity is a tremendous health problem in the United States. I
am sure you have heard the current estimate that it will be responsible
for about $177 billion annually in healthcare costs, some of it
from heart disease, and a lot of it from rising rates of type
2 diabetes. Because the increase in rates of obesity is so recent,
just within the last 10 to 15 years, we know that this matter
cannot be a matter of genetic change. We also know that it cannot
be a matter of changes in people's attitudes as in, let us say,
personal responsibility, because that has not had time to change
just within the last few years. So we have to look at the causes
of the increasing rates of obesity in environmental factors. The
science of obesity is extremely simple. It is a matter of calories:
if people take in more calories than they expand, they are going
to gain weight. We have to look at the causes of food intake or
the causes of increasing rates of sedentary behaviour. My understanding
is, from the review of the available data, is that rates of sedentary
behaviour have not changed very much within the last 10 to 15
years, whereas we can find many sources of data that indicate
that people are eating more. Therefore, we have to look at the
reasons why people are eating more. The root cause, I believe,
is food over-production. Although it may sound counter-intuitive,
the United States over produces food, and the amount of food that
is available in the country, less exports plus imports, amounts
to about 3,900 calories a day for every man, woman and child in
the country, which is roughly twice what the average need is in
the country. Even if some of that is wasted, it means that there
is a tremendous over-abundance of calories in the food supply.
That means that the food industry and a food company has only
three choices about how to deal with that enormously competitive
situation. They can either produce less food and raise prices,
which, as I am sure we will talk about, is politically inexpedient.
They can cause people to buy their foods instead of somebody else's
foods, or they can get people to eat more in general. They are
extremely good at getting people to eat more in general, and I
believe that that is at least partially responsible for rising
rates of obesity. Food companies encourage people to eat more
through advertising and health claims, but those are only the
most obvious ways. More important, their advertising and marketing
methods have changed society in ways that make it much, much too
easy for people to over-eat. For example, food is extremely cheap
in our country, and there are many, many driving forces keeping
the cost of foods extremely low. Low-cost food encourages people
to eat more. Food is extremely convenient; it is ubiquitous; it
is available all day, 24 hours a day, 7 days a week; and it is
available in larger and larger portions. Every single one of those
aspects encourages people to eat more, and there is a considerable
amount of research that demonstrates that. We have created a societal
environment in which it is considered totally acceptable for people
to eat anywhere, to eat all day long and to eat in larger and
larger quantities; all of which encourages people to eat more
and to gain more weight. If, in fact, the environment is changed
and is conducive to people over-eating, then we need to look at
the policies that have led to those kinds of environmental changes
and introduce some new policies that will change that environment.
I have a list of suggestions of things that I think governments
could do that would make it much easier for people to eat more
healthfully, and in particular I would focus on children first
and say that we must stop marketing to children. In the States
food companies spend billions and billions of dollars to market
foods directly to children. I think we need to take commercials
and food commercials out of schools. That may not be so much of
a problem here, but it is a very big problem in the States. We
need to take a very hard look at television advertising of food
to children during children's television hours. Then, I think,
it is quite possible to look at tax strategies, pricing strategies,
and issues related to farm supports, all of which are responsible
for creating a food supply that is extremely inexpensive, particularly
as related to the kinds of foods that are high in calories, fat
and sugar, which is where the calories come from. Much of the
marketing is directed at these very profitable foods that are
probably the least healthful, particularly for our young people.
The point that I want to make here is not that this requires new
policy development, but it requires a tweaking of existing policy.
We already have policies in place in the States that support the
current food system, and the idea would be to tweak and modify
those, in order to make it easier for people to eat more healthfully.
I will stop there: I think I have given you plenty to talk about.
Q462 Chairman: Thank you. We want
to get on record in a formal session some of the information you
have given us. We found the session with you last week in the
States extremely useful, and there was a great deal that we thought
about afterwards, in view of the points you made. Can I begin
by picking up this issue of the over-abundance of calories. Has
there been any wide political discussion in the States about this
issue? Is there any consciousness in government about the need
to address this? It might seem over-simplistic and may be over
naive to say we have this over-provision of calories, and if it
is impacting , as it clearly is, on the health of significant
numbers of people in the States, is there not a way of addressing
the fact that we have a country here that is over producing and
a number of countries not that far away are in need of those calories?
Professor Nestle: Yes, it is one
of the great ironies of food production these days, that food
is over produced and over available in developed countries and
under available in places that need it. It is not a question of
quantity; it is a question of distribution. It is actually one
of the deep, dark secrets of American agricultural policy. As
far as I can tell, it is never discussed in public. It is discussed
behind closed doors in the presence of only of agricultural economists
who are well aware of the problem but do not know what to do about
it for political reasons. Where I hear it discussed is only at
agricultural economics meetings, where you will find people saying
that the United States should not be producing food at all; we
should be outsourcing our food supply and use our land for recreation
and housing, and let countries do it that can do it cheaper and
better. The question that comes up immediately is the question
of cheap food and the pressure to keep the cost of basic foods
down as low as possible.
Q463 Chairman: Has there been any
political debate about the issue of the way agricultural subsidies
directly contribute to the problem of over-production and over-eating?
Professor Nestle: Yes, there is
a lot of talk about agricultural subsidies because it is so obvious
that $20 billion a year is spent in subsidies, particularly of
soy beans and corn, because it puts so much pressure on the American
economy. On the other hand, if those subsidies were not there,
the way it has been put to me is that farmers in Iowa would go
bankrupt in an hour and a half. So the political problems related
to agricultural subsidies is a very large one, and it is one that
the European Union is quite familiar with.
Q464 Dr Naysmith: In your book Food
Politics you stated, and you said to us last week, that because
of the way in which the food industry gives grants to research
institutes, universities and so on, and they have paid consultants,
that this in some way influences the advice that they are able
to give. It is not a new thing. You have things like a graduate
student who has a little bit of money coming in from a grant,
and this immediately distorts the research and the conclusions
they come to. Do you have any evidence that this plays a part
in issues like slimming and obesity and various other aspects?
Professor Nestle: Most of the
evidence is indirect and would go under the heading of "guilt
by association". The evidence that has been looked at, in
the ways that corporate sponsorship influences opinion, mostly
comes from studies of drugs, cigarettes and alcohol. Looking at
the food industry in the way that I did in Food Politics
it is a new industry following exactly in the pattern of those
other industries. But the parallels are exact. If I talk to my
colleagues who receive grants from food companies, they will deny
vehemently that those grants influence their opinion in any way
whatsoever. On the other hand, if you look at the research results
of sponsored research, the proportion of that research that is
beneficial to the sponsors' outlook on life is very, very high.
That cause is often close.
Q465 Dr Naysmith: Do you think it
may deliberately cause confusion that companies fund research
that suits them and not research that might turn up findings that
would be against them?
Professor Nestle: It certainly
biases nutrition research in a quite profound way; and of course
the companies argue that they cannot get people to do the kind
of studies they want because the kind of studies that they want
show that their particular product is harmful or not harmful,
when it is actually diets that matter. The nutrition position
is complicated because of diet. All the parallels with drugs,
cigarettes and alcohol are there, and there is no reason to think
that the food industry is any different.
Q466 Dr Naysmith : Does that apply
in Europe and the UK as well as the USA, do you think?
Professor Nestle: I am not familiar
with that, but I cannot imagine that it is any different.
Q467 Dr Naysmith: It is complicated
because a few years ago in this country under a previous government—and
I know in America—there was a lot of research that would
not get done unless there was money coming from outside of government,
and that must be a real problem for you in America as well.
Professor Nestle: I think it is
a terrible problem. We have government-funded research, but the
amount of money is small and not adequate for everybody's research,
so many people will look to the food industry not only for research
funds but also for the funding of journals, meetings, conferences,
and other kinds of largesse. It might seem as if it is quite benign,
but somehow it is always tied in some way to outcome.
Q468 Dr Naysmith: Can we switch to
another topic. There are some people who argue that the best way
to tackle the problem of obesity is to give them information about
what they should eat and what activities they should take, and
that government does not really have a role much beyond that.
Do you agree with that?
Professor Nestle: I think in theory
that is fine; in practice, it does not work at all. We have government
dietary recommendations in the United States that are in some
ways compromised by the political situation. In a situation where
you are trying to advise people about what to do about their weight,
if they are overweight they have to eat less and move more, or
do both; and yet you will never find a government dietary recommendation
that says anything about eating less. If the government said that,
they would have to say what to eat less of; and it would immediately
have to talk about soft drinks, desserts, snacks, high-fat meat
and dairy products. Any one of those products has a lobbyist or
trade association that lobbies for it in Washington, whose job
it is to make sure that no federal agency every says such a thing.
They have been quite effective in that role, around dietary recommendation.
We have never had a nutrition education campaign in our country
that had any kind of money behind it. The example that I like
to give is the Five-a-Day for Better Health Campaign, which is
an alliance between the fruit and vegetable industry and the National
Cancer Institute. In its peak year of public education, $2 million
was given to that campaign. Well, the advertising budget for just
television, for Altoid Mints is $10 million a year; Hersey Foods
is $200 million; McDonalds is $1.5 billion; and food and beverage
companies spend $34 billion a year in advertising. So in the US,
nutrition education comes from the food industry.
Q469 Dr Naysmith: Do you think if
it could be properly funded and run in a way that could compete
with the big firms, it would be effective?
Professor Nestle: I do not know.
I would like to do that experiment. One of the ideas that I favour
very much is a very, very small tax on soft drinks. Soft drinks
are an easy target because they are sweeteners and water and nothing
else, and clearly not good for people. The idea is to put a tiny
tax, 1 cent or less, on a can or a bottle of soft drink. That
would generate $1 billion to $1.5 billion a year. If that money
were applied to educational purposes, it would be interesting
to see whether it did any good—it might. There is some indication
that those kinds of campaigns can be quite effective.
Q470 Dr Taylor: Professor Nestle,
we found your comments last week extremely helpful and very stimulating.
Some of us could not help commenting afterwards on the body language
of some of the people sitting just behind you, who you could not
see.
Professor Nestle: I missed that
completely! I have tenure!
Q471 Dr Taylor: I wanted to ask about
the independence of the scientific advisers to the big firms,
because we gather they employ dieticians and nutritionists. When
we went to Coca-Cola the nutritionist gave us a marvellous example
of using statistics to prove anything: she said: "There has
been a 15% fall in physical activity among children, and only
a 1% increase in energy intake; and therefore the fall in physical
activity was much more important than the intake of food."
Would you comment on that?
Professor Nestle: I do not know
where those data come from or what period of time she was describing.
I am not familiar with those data. The data that I have seen,
which come from a very large government report on physical activity,
which came out a couple of years ago and may already be a bit
out of date, indicated that there was no change in physical activity
levels, as far as could be measured, between about 1980 and 1990—or
it may be 1985 to 1995, I am not quite so sure. It is so difficult
to measure, I just do not know how we would do that; but I know
of at least three sources of data that demonstrate that people
are eating more calories. The increase in calories in the food
supply has increased by 600 since 1970, and it increased by 100
just between 2001 and 2002. People are reporting eating larger
amounts of calories, and there is much anecdotal observation that
people are eating more. Did you go to an Atlanta Food Court, as
I suggested that you do? Were you able to do that? Did you find
it an enlightening experience?
Dr Naysmith: I did not find it particularly
enlightening because I have lived in America for 18 months, so
I had an idea of what to expect, but I know the point you are
trying to make.
Dr Taylor: We had a lovely dinner to
eat. It was only after slaving through the starter that I realised
the starter was meant for two people.
Q472 Mr Burns: We have heard evidence
in the two previous hearings about UK crisp and confectionery
companies which support the purchase of books and equipment in
our schools. They usually do it through cutting out coupons from
packaging or, in the case of some of the supermarkets, you get
vouchers when you pay your food bill, and that goes towards acquiring
a computer for schools. Obviously, schools like getting free equipment,
but would you like to comment on this practice?
Professor Nestle: Yes, it is one
of those benign appearing practices that really does not become
insidious until you think about it a little bit. The example that
I like to use—it is a British company anyway, is it not—the
wonderfully clever thing that the Snapple company did, which I
believe is owned by Cadbury-Schweppes—the New York City
Board of Education was doing what was considered a great feat
of consumer advocacy and that was getting the soft drinks out
of vending machines in the New York City school system, only to
discover that the Snapple company had given the city $166 million
to allow Snapple in schools. I was called a week later, after
making some rude remarks about this in the newspaper, by the attorney
for the City Board of Education, who asked what my objection to
Snapple could possibly have been, because "it is just fruit
juice". I pointed out that it was not just fruit juice; it
was made from fruit concentrate, which meant that it was filtered,
de-ionised and treated with enzymes; it was basically sugar; and
that the amount of sugar is more than there is in Pepsi-Cola or
Coca-Cola. The other campaigns which seemed so benign are a way
of advertising to children. They are a form of advertising. They
look like they are public education or public sponsorship, but
they are actually just advertising of food products. There are
ways for a food company to do what they want to do with children,
which is to develop brand loyalty very early in life, to get children
to pester their parents in order to buy those products, and in
general to consume more of them.
Q473 Mr Burns: What about the practice
of supermarkets that will give you a voucher when you pay for
your food, groceries and other goods, but they are not giving
them to children, they are giving them to parents, simply for
the range of food and products that that person has bought in
a supermarket?
Professor Nestle: They are not
specifically targeted into a particular food; so it is just like
a discount.
Q474 Mr Burns: Yes. For example,
if your weekly shopping bill in that supermarket is, say, £100,
you will get 10 vouchers which, when put together with everyone
else's vouchers, comes to X amount of vouchers, and for Y amount
of vouchers you get a PC or a laptop or a printer or whatever.
Professor Nestle: That is not
tied to any specific food product, so no particular food company
benefits from that.
Q475 Mr Burns: The supermarket does.
Professor Nestle: Yes. They are
selling food. I spoke to a group of retailers after I met with
you in New York last week, who were extremely worried about what
their responsibility is in dealing with obesity, and I think they
are between a rock and a hard place. They are really caught in
the middle.
Q476 John Austin: You mentioned one
of the drivers in terms of agricultural subsidies of the vast
abundance of corn syrup, which has to be put somewhere, and presumably
gets fed into the American diet; but there are other drivers such
as advertising. Can you tell us what the key drivers are contributing
to the obesity epidemic, and could you also say something about
the role of TV advertising and the likely impact of its restriction
in the US? Can you explain to us where there has been restriction
on advertising?
Professor Nestle: I mentioned
advertising and marketing. There are two different kinds of advertising.
One is direct media, which is radio, television and print; and
the other are these more indirect methods such as the supermarket
campaigns—coupons, toys, books—just the whole range
of ways in which food companies market—and the toy issue
is a particularly big one. There were a lot of questions in there,
and I may be missing one or two of them. I should say that I have
read the Food Standards Agency extraordinary report on marketing
to children; it is really an amazing report. It only deals with
television advertising, but I think it takes care of any questions
about whether advertising affects children's behaviour. If you
had any lingering questions about it, that report should take
care of them. The last time that the United States Government
attempted to do something about television advertising to children
was in 1978/79, and the head of the Federal Commission lost his
job over it instantly, and nobody ever tried it again. There is
now a national movement to try to do something about it because
people are so upset about what has happened in the intervening
35 years. The number of commercials on children's television has
doubled, and the amount of time available for those commercials
has doubled—and we are just talking about Saturday morning
television programming. I see a national movement not only in
the States but in the community states and gradually trickling
up to the federal level, to remove vending machines from schools,
to do something about school lunches, to stop these contracts
with schools, and in general to try to do something about children's
marketing, particularly in relation to schools. That is a good
place to begin because it can be done on a school-by-school basis,
and you do not need national legislation to do something about
it. I think it is quite unlikely that there will be any profound
changes along those lines in our current administration, but administrations
change and a lot of people are working on these kinds of issues.
What I see at the government level now is the other part of this
which is focusing on the activity side of the equation—and
you were taken around to look at activity programmes. If you go
on the government website and look at what the United States Government
is doing about obesity, particularly childhood obesity, it is
focusing on the activity side of the equation, which is a very
good thing to do, and it is also completely uncontroversial. I
do not think it will work in the absence of programmes that do
something about food, but those are likely to be far more controversial
and may require political change before they can be implemented.
Q477 John Austin: Basically you are
saying that unless consumption of high calories is reduced, although
exercise may be very good for our health generally, it will not
be sufficient.
Professor Nestle: Well, you need
to walk a mile for 100 calories. Two Oriel cookies is 100 calories.
That is a lot of miles for the level of over-eating that people
in America are doing right now. We are not talking about 100 calories
a day; we are talking about hundreds of calories a day.
Q478 John Austin: Coca-Cola were
saying: "It is parental responsibility and the responsibility
of schools. We are prepared to offer alternatives." Some
alternatives have just as much sugar in them.
Professor Nestle: Yes. A 12oz
Coke is a mile and a half—think of it that way.
Q479 John Austin: Do you think at
the end of the day that the only way you are going to tackle is
this is by removal of the vending machines by action at state
level?
Professor Nestle: I would actually
start with soft drinks because there is considerable research
that demonstrates that children who drink soft drinks or juice
drinks, as opposed to children who do not, take in more calories,
are fatter and have worse diets than children who do not drink
these things. I am talking to paediatricians who are dealing with
very obese children, who say it is not unusual to find children
who are drinking 1,200-2,000 calories a day in soft drinks. I
would start with those. That is not going to make the Coca-Cola
company very happy—or Snapple for that matter!
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