David Kessler, Board Chair at the Center for Science in the Public Interest and Professor of Pediatrics and Epidemiology and Biostatistics at the University of California, San Francisco, gave the keynote address. Kessler began by describing the important role that the Food and Nutrition Board (FNB) played for him. He noted that the report Diet and Health: Implications for Reducing Chronic Disease Risk (NRC, 1989) shaped the government’s thinking in creating the Nutrition Facts Panel food label (NFL). He reflected on the challenges to creating the NFL, noting opposition that came from within the U.S. Department of Agriculture as well as the food industry. Kessler related a personal story that influenced acceptance of the label by the federal government. He had worked with a fast-food chain to place a prototype of the NFL on its placemats. Upon returning from a family trip, he brought back one of the placemats and asked the Secretary of Agriculture, when faced with opposition from the U.S. President to implementing the NFL, to “take out the placemat.” He added that the Secretary should tell the President that if it is good enough for this fast-food restaurant it would be good enough for the U.S. Department of Agriculture. In further relating the importance of nutrition to public policy, Kessler shared a personal quote from a news interview: “In times of public health crisis, let the politicians move to the background. Let your scientists … lead the process. Trust is essential.”
Kessler went on to raise questions and challenges to the science of food and nutrition. He began by noting that in the time since the NFL was released in 1992, obesity rates have doubled in the United States. He went on to state that the evidence shows that young people with obesity may appear healthy, but the consequences of carrying excess weight catches up with age, and can lead to disease states such as diabetes and cardiovascular disease. Kessler then described how changes in processed foods may be contributing to excess caloric intake. He noted that some 60 to 70 percent of today’s processed foods are primarily starchy carbohydrates, and contribute about 1,000 calories to the average daily intake. An additional 500 calories come from fats and oils that are added to those products. He went on to explain that, although the NFL provides updated information about the nutrient content of a product, the ingredient panel has not been changed to reflect changes in the composition of processed foods. To illustrate the point, Kessler described the work of Gannon and Nuttall (2004), who developed a high-protein/low-carbohydrate, weight-maintaining, non-ketogenic diet for individuals with diabetes. In a controlled clinical setting, Kessler said, this would be an effective way to control diabetes. He went on to say that the science of obesity is “anything but simple.” Kessler described the human gut as a complex organ with its own network of nerves and sensors and that communicates with other organs, noting that the structure of food has a major impact on the digestive system, including how calories affect metabolism. He stressed that highly processed foods are extremely low in fiber, which affects the absorption and metabolism of sugars, causing spikes in blood glucose and insulin. He noted that only 12.2 percent of Americans today meet acceptable standards for weight, blood glucose, blood lipids, and blood pressure. Kessler showed data from randomized trials about the risk of cardiovascular disease related to elevated low-density lipoproteins (LDLs) (see Figure 3-1). Although the data were based on drug trials, Kessler noted, diets high in saturated fat increase LDL by about 10 percent. “I want to get LDL down,” he said. The combination of modifying dietary factors and engaging in moderate intensity exercise was an opportunity to change health, he noted. In closing, Kessler called for a new investment in robust independent science as “likely to be one of the most cost-effective approaches to address the poor health, spiraling health cost, declining quality of military recruits, and other pressing societal and sustainability challenges for the U.S.”
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