LEVERAGING

FOOD

TECHNOLOGY

------------for------------

OBESITY PREVENTION
AND REDUCTION EFFORTS

Workshop Summary

Leslie Pray and Laura Pillsbury, Rapporteurs

Food Forum

Food and Nutrition Board

INSTITUTE OF MEDICINE

                OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu



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LEVERAGING FOOD TECHNOLOGY for OBESITY PREVENTION AND REDUCTION EFFORTS Workshop Summary Leslie Pray and Laura Pillsbury, Rapporteurs Food Forum Food and Nutrition Board

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This study was supported by Contract No. AG-3A94-P-10-0144, OEM-10-DC-1, and CNPP/IOM-10-01 (U.S. Department of Agriculture), N01-OD-4-2139 (National Institutes of Health), and HHSF22301020T (Food and Drug Administration) with the National Academy of Sciences. Additional support came from the University of Mas- sachusetts Amherst, Abbott Laboratories, Campbell Soup, Cargill, Coca-Cola Company, ConAgra Foods, General Mills, Kellogg Company, Kraft Foods, Mars, McDonalds, Mead Johnson Nutrition, Monsanto, and PepsiCo. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-21261-8 International Standard Book Number-10: 0-309-21261-8 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2011 by the National Academy of Sciences. All rights reserved. Cover credit: Image designed by Casey Weeks (2011). Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2011. Leveraging Food Technology for Obesity Prevention and Reduction Efforts: Workshop Summary. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a man- date that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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PLANNING COMMITTEE ON LEVERAGING FOOD TECHNOLOGY FOR OBESITY PREVENTION AND REDUCTION EFFORTS1 FERGUS M. CLYDESDALE (Chair), University of Massachusetts, Amherst, Massachusetts GARY D. FOSTER, Temple University, Philadelphia, Pennsylvania VAN S. HUBBARD, National Institutes of Health, Bethesda, Maryland CAROL KELLAR, Kraft Foods, Glenview, Illinois MOLLY KRETSCH, U.S. Department of Agriculture, Beltsville, Maryland MARGARET LEAHY, The Coca-Cola Company, Atlanta, Georgia BARBARA SCHNEEMAN, U.S. Food and Drug Administration, College Park, Maryland Study Staff LAURA PILLSBURY, Study Director CAITLIN BOON, Study Director (through August 2010) LEANN BARDEN, Intern (through June 2011) GERALDINE KENNEDO, Administrative Assistant LINDA MEYERS, Director, Food and Nutrition Board 1 Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. v

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FOOD FORUM1 MICHAEL P. DOYLE (Chair), University of Georgia, Griffin, Georgia MARK ANDON, ConAgra Foods Inc., Omaha, Nebraska SUSAN BORRA, Food Marketing Institute, Arlington, Virginia FRANK BUSTA, University of Minnesota, St. Paul, Minnesota CELESTE A. CLARK, Kellogg Company, Battle Creek, Michigan DAVID B. COCKRAM, Abbott Laboratories, Columbus, Ohio SUSAN J. CROCKETT, General Mills, Minneapolis, Minnesota ERIC A. DECKER, University of Massachusetts, Amherst, Massachusetts CAROLINE SMITH DEWAAL, Center for Science in the Public Interest, Washington, DC SAMUEL GODEFROY, Health Canada, Ottawa, Ontario, Canada DAVID GOLDMAN, U.S. Department of Agriculture, Washington, DC CINDY GOODY, McDonalds Corporation, Oak Brook, Illinois BRENDA HALBROOK, U.S. Department of Agriculture, Alexandria, Virginia JERRY HJELLE, Monsanto Company, St. Louis, Missouri KATE J. HOUSTON, Cargill Incorporated, Washington, DC VAN S. HUBBARD, National Institutes of Health, Bethesda, Maryland GORDON L. JENSEN, Pennsylvania State University, University Park, Pennsylvania GENE KAHN, Bill & Melinda Gates Foundation, Seattle, Washington CAROL KELLAR, Kraft Foods, Glenview, Illinois CHOR-SAN KHOO, Campbell Soup Company, Camden, New Jersey MICHAEL M. LANDA, U.S. Food and Drug Administration, College Park, Maryland MARGARET LEAHY, The Coca-Cola Company, Atlanta, Georgia DONNA PORTER, Library of Congress, Washington, DC ROBERT C. POST, U.S. Department of Agriculture, Alexandria, Virginia URVASHI RANGAN, Consumers Union, Yonkers, New York STEVEN W. RIZK, Mars Chocolate North America, Hackettstown, New Jersey SARAH ROLLER, Kelley Drye & Warren LLP, Washington, DC 1 Institute of Medicine forums and roundtables do not issue, review, or approve indi- vidual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. vi

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PETER VAN DAEL, Mead Johnson Nutrition, Evansville, Indiana PARKE E. WILDE, Tufts University, Boston, Massachusetts DEREK YACH, PepsiCo, Purchase, NewYork BARRY L. ZOUMAS, Pennsylvania State University, University Park, Pennsylvania Food Forum Staff LAURA PILLSBURY, Director GERALDINE KENNEDO, Administrative Assistant ANTON BANDY, Financial Officer LINDA D. MEYERS, Director, Food and Nutrition Board vii

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Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this report: Susan J. Crockett, General Mills John W. Erdman, Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign Gary D. Foster, Center for Obesity Research and Education, Temple University Connie M. Weaver, Department of Foods and Nutrition, Purdue University Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by ix

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x REVIEWERS Melvin Worth. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authors and the institution.

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Contents Overview, 1 Trends in Overweight and Obesity: From the Mid-1970s to the Present, 3 Changes in Eating Behavior Since the Mid-1970s: Three Illustrative Trends, 7 Identification of Targets for Intervention: Evidence from Behavior Studies, 11 Regulation of Eating Behavior: Theoretical Considerations, 12 Portion Size, Energy Intake, and Obesity, 15 Energy Density, Energy Intake, and Obesity, 21 Food Properties, Satiety, and Energy Intake, 28 Consumer Decision Making and Energy Intake, 32 Lessons Learned and Best Practices, 34 Reducing Calories by Reducing Fat, 35 Reducing Calories by Reducing Sugar, 39 Using Portion-Controlled Frozen Meals to Reduce Calorie Intake, 40 Increasing Fruit and Vegetable Intake, 42 Increasing Micronutrient Density, 43 Major Challenges, 44 Taste, 45 Affordability, 47 Product Formulation and Ingredient Costs, 48 Regulatory Issues, 49 Consumer Trust, 49 xi

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xii CONTENTS Potential for Innovation: Next Steps, 50 Bridge Building with Consumers, 50 Government-Industry Collaboration, 52 Innovation: There Is No Magic Bullet, 55 Need for More Consumer Education on Eating Behavior Norms, 58 Possibilities for Influencing Consumer Decision Making, 60 A Primary Prevention Approach, 61 Need for a More Systematic Analysis of Obesity, 62 Need for Long-Term Data, 63 Promotion of “Good” Science by the Food Industry, 66 Wrap-Up, 67 References, 70 APPENDIXES A Workshop Agenda 81 B Speaker and Moderator Biographical Sketches 85 C Abbreviations and Acronyms 95 D Workshop Attendees 97