Bariatric Times

AUG 2017

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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10 Interview Bariatric Times • August 2017 Obesity Research and Its Influence on the Food Industry Bariatric Times. 2017;14(8):10–11. Thank you for taking the time to discuss this important topic. Please begin by providing a background on your careers and how they relate to the food industry. Dr. Levine: My career has provided me ample education and experience in the field of food science. I received my PhD from the University of Minnesota with a major in nutrition and minor in food science, and also completed a National Institutes of Health (NIH) post-doctoral fellowship in gastroenterology. Later, I joined the Minneapolis VA Medical Center and was appointed department head of Food Science and Nutrition at the University of Minnesota. In 2006, I b ecame Dean of the College of Food, Agricultural and Natural Resource Sciences at the University of Minnesota. Currently, I serve as Interim Vice President of Research at the University of Minnesota and President of The Obesity Society. For my entire research career, I have been involved in neuroscience research, specifically studying the rewarding circuits of the brain. We sought to learn the answers to the following questions, "What makes food taste good and why do we enjoy it?" and "What controls the regulation of food intake?" Throughout my career, I have been involved in and witnessed changes in research, which has in turn changed the food industry. What comprises the "food industry?" How does this industry relate to the disease of obesity and how did you become involved in working with it? Dr. Levine: The food industry is how we get fed. It is comprised of either agricultural products (fruits, vegetables, dairy, and meat) or pre-packaged foods. If you think about what the public asks of the food industry, they want to have access to products that 1) taste good, 2) are not too expensive, and 3) are microbiologically safe from food-borne illness. That is what was demanded of the food industry for most of its inception. The industry did such a good job that we now have food that meets all of these demands and, is for the most part, convenient—but it is not always healthy. I had to get involved and learn food industry processes in order to understand its evolution and role in human health, including obesity. I became interested in how we could work with the food industry to change some of the products and create ones that were healthier. Is there a definition or criteria of what constitutes "healthy" food and drink products? Dr. Levine: Defining "healthy food" is d ifficult because it might take a lifetime for a food to cause change in human health, and studying just one food in the human diet is almost impossible. For example, if I wanted to conduct a study to test whether a certain food caused cancer, I would have to account for many variables, such as the study participants' diet, lifestyle (e.g., tobacco use, physical activity level), and environment. This is why we use population studies to examine diet, health, and longevity. What the public views as "healthy food" changes with new research and trends. Take eggs, for example. The Seven Countries Study (SCS), 1 launched by Ancel Keys, conducted exploratory research on the relationship between dietary pattern and the prevalence of coronary heart disease. The SCS pointed out the cardioprotective effect of the Mediterranean diet and the "Keys equation" on the effect of different dietary fatty acids on serum cholesterol levels, which is still studied today. SCS suggested that individuals should not eat a lot of cholesterol containing foods or foods high in saturated fats, such as eggs or beef. So, did this mean that eggs were bad for you? Not necessarily, although this research and other studies impacted the public's view of eggs as a healthy or less-than-healthy food to consume. While defining what is healthy is complex, population health studies have revealed that cultures that seem to have less degenerative diseases and live longer have diets consisting of mostly vegetable matter with the animal products as an ornament rather than as the main dish—for example a pound of steak with mashed potatoes on the side. My personal guideline for "healthy" is consuming foods and beverages that are dilute in calories and concentrated in nutrients. I can say with security that fruits and vegetables, which contain nutrients, fiber, and water, fit this criteria but soda pop, A n I n t e r v i e w w i t h I n t r o d u c t i o n b y ALLEN S. LEVINE, PhD Vice President for Research and Professor, Department of Food Science and Nutrition, University of Minnesota, St. Paul, Minnesota; President, The Obesity Society STACY A. BRETHAUER, MD, FACS, FASMBS Associate Professor of Surgery, Cleveland Clinic Lerner College of Medicine; Program Director, Bariatric Surgery Fellowship; Director of Bariatric Surgery, Fairview Hospital; Medical Director, Supply Chain Management; Quality Officer, Digestive Disease and Surgery Institute. Cleveland Clinic, Cleveland, Ohio; President, American Society for Metabolic and Bariatric Surgery J ust as those of us in surgery work closely with the medical device industry, many of our medical colleagues work hard to create change within the food industry. There are many misconceptions about working with the food industry, especially among those who are not involved. The most obvious concerns are centered around relationships with companies that produce unhealthy products. It seems obvious to those of us outside that world that we should simply ask the companies to stop making high-sugar and high-fat food and drink products that are contributing to the obesity problem. Certainly, inviting the food industry—apart from company scientists who should be attending scientific meetings—to sponsor our conferences and symposia would create scenarios that might be problematic (e.g., ObesityWeek sponsored by a soda company). The reality, though, is that this is a much more nuanced issue than we might imagine. So, how can the societies dedicated to the treatment and care of patients with obesity, namely the American Society for Metabolic and Bariatric Surgery, The Obesity Society, and the Obesity Medicine Association, work with food industry partners in a constructive and productive way without compromising our mission to prevent and treat the disease of obesity? We need to listen to the experts who have experience working with the food industry and understand how doing research with and partnering with responsible companies in the food industry might lead to incremental changes.

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