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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11 Interview Bariatric Times • August 2017 w hich contains sugar and no other nutrients, does not. Sweetened beverages and candy products provide pleasure and reward, but not a high concentration of nutrients. R egarding pre-packaged food, it's hard to determine what products are healthy and unhealthy based on any criteria. The pre-packaged food industry is always forced into a corner b ecause of the three demands listed previously (taste, convenience, and safety). Food is pre-packed for convenience, but it also needs to have shelf stability. So, the food industry is t asked with developing a product that has those properties associated with it. Many pre-packaged foods have a high salt content for preservation and flavor. If an individual has been advised by his o r her doctor to cut back on sodium in their diet, then he or she might view this food as "unhealthy." The industry responds by producing products that are "reduced sodium," but often they d on't taste as good. For instance, soups without salts are really hard to manufacture. What is the chain of events that occurs between research conducted on food health and safety and the food industry's response? Dr. Levine: The food industry wants to sell food, and the public drives demand for the type of food. If nutritionists, doctors, and surgeons tell their patients to eat a certain kind of food based on the latest research, the food industry has to respond by modifying their offerings. If they do not give the public what it wants, they won't sell their products. For instance, there was a period of time when "low-fat" was "in." Many healthcare professionals recommended their patients stick to low-fat diets, and the food industry responded by making more low-fat products because they knew people wanted them. The dietary guidelines continue to emphasize ingesting fewer high-fat foods. 2 Another example can be seen in high-fiber products. Studies have shown that high-fiber diets might help in prevention of colon cancer. 3 Given this information, gastroenterologists might recommend high-fiber diets to their patients. The food industry responds by putting more fiber into the products they already produce and labeling them "high fiber." An example of food fads is the gluten-free diet. People with celiac disease are not able to eat gluten- containing foods, but gluten is not a problem for the general public. Within the past few years, we have heard the message that gluten is not good for you, whether you have celiac or not. The general public has bought into this message and as a result we have more gluten-free foods on the market. So, you see that the food industry does change its offerings based on research a nd/or public demand. The same holds true for the restaurant and fast-food industries. They understand that if they do not offer what the public wants, they will lose business. An example of this c an be seen in fast-food chains increasing their offerings of salads and lower calorie options like oatmeal. This all morphs into the questions, "What can we as clinicians and basic s cientists do to influence positive change in this area?" and "Why would an organization like The Obesity Society work with the food industry?" Why would an organization like The Obesity Society work with the food industry? Dr. Levine: It is important for us as clinicians, applied and basic scientists, and societies dedicated to prevention and treatment of obesity to understand why the food industry is producing certain products. Our goal is for those products to have a beneficial effect on societal health, and we must work with industry in order to reach this goal. I personally feel as a scientist and someone who has worked with patients, that you should engage with the food industry. If the public cares about the science and the physicians are recommending patients eat and drink a certain way, then the food industry has to also care about the science. We can help introduce and maintain foods that are healthier and lower in caloric density and thus impact what the public eats. How does TOS work with the food industry? Dr. Levine: As I said, scientists and physicians are very important to the food industry. We work with them through research and development to help improve their product lines, thus influencing what is being offered to the public. It's hard to control what the food industry is doing as a whole, but members of TOS are participating in a variety of ways. One major way we work with industry is via our research. For example, I was involved in a study on the effect of high-diet breakfast foods, such as cereal, on appetite control. 4 Another good example can be seen in the Healthy Weight Commitment Foundation (HWCF), funded by the Robert Wood Johnson Foundation. 5 The HWFC was a pledge signed by 16 food and beverage companies to remove one trillion calories from the marketplace by 2012, and 1.5 trillion by 2015. The 16 c ompanies committed to the HWCF calorie-reduction pledge included the following: • Bumble Bee Foods, LLC • Campbell Soup Company • ConAgra Foods (includes Ralston Foods) • General Mills, Inc. • Hillshire Brands (previously Sara Lee Corporation) • Kellogg Company • Kraft Foods Group/Mondelez • Mars, Incorporated • McCormick & Company, Inc. • Nestlé USA • PepsiCo, Inc. • Post Foods • The Coca-Cola Company • The Hershey Company The J.M. Smucker Company • Unilever The food industry is interested in what this research discovered, and so a company funded it. No aspect of food science is left untouched. There are people who study the agricultural products to learn more about stability and storage times. Others look at how the body absorbs nutrients from foods. Members of TOS are researching not only the nutritional content of food, but also how the way in which it is processed and labeled impacts its consumption, and the food industry is highly interested in these results. Discussions around whether the labels on food and drink products make a difference are happening all the time. Does nutrition education affect the way people eat? What should and should not be on a product label? Eye-tracking studies are also conducted to see where people's eyes go on a label. This information is mutually beneficial to the society and industry. Health professionals are interested in how these results impact individual choice pattern and consumption of calories/nutrients, while the food industry is interested in how these results might help them make their products more attractive and meet the demands of the consumer. Another area of interest to the food industry is food packing techniques that help patients lose weight. For example TOS Past President Dr. Barbara J. Rolls, Professor and the Helen A. Guthrie Chair of Nutritional Sciences at The Pennsylvania State University, is an expert in volumetrics, or how the volume of food that people eat affects satiety. 6 You can see industries' response to this research with the availability of low-calorie foods, which might contain more air, fiber, and w ater. This is a clear example of how a TOS member has worked with industry to develop certain product offerings that have a beneficial effect on patients with obesity. What might happen if the healthcare industry did not work with the food industry? Dr. Levine: I think there are a variety of ways we work with the food industry as scientists as I have already discussed. If we don't work with them, then there is the danger of the industry n ot introducing or maintaining more healthful products. Of course, the industry knows this and hire their own nutritionists and food scientists who have been trained by faculty at universities that include our members. REFERENCES 1 . Keys A, Menotti A, Karvonen MJ, et al. Diet and 15-year death rate in the seven countries study. Am J Epidemiol. 1986;124(6):903–915. 2. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at 5/guidelines/. Accessed May 30, 2017. 3. Weisburger JH, Reddy BS, Rose DP, et al. Protective mechanisms of dietary fibers in nutritional carcinogenesis. Basic Life Sci. 1993;61:45–63. 4. Levine AS, Tallman JR, Grace MK, et al. Effect of breakfast cereals on short-term food intake. Am J Clin Nutr. 1989;50(6):1303–1307. 5. Ng SW, Slining MM, Popkin BM. The Healthy Weight Commitment Foundation pledge: calories sold from U.S. consumer packaged goods, 2007- 2012. Am J Prev Med. 2014;47(4):508–519. 6. Rolls B, Hermann M. The Ultimate Volumetrics Diet: Smart, Simple, Science-Based Strategies for Losing Weight and Keeping It Off. New York, New York,Harper Collins Publishers; 2012. FUNDING: No funding was provided in the preparation of this manuscript. FINANCIAL DISCLOSURES: Dr. Levine reports no conflicts of interest relevant to the content of this article. ADDRESS FOR CORRESPONDENCE: Allen S. Levine, PhD; E-mail: The food industry wants to sell food, and the public drives demand for the type of food. If N UTRITIONISTS, DOCTORS, AND SURGEONS, tell their patients to eat a certain kind of f ood based on the latest research, THE FOOD INDUSTRY HAS TO RESPOND BY M ODIFYING THEIR OFFERINGS. If they do not give the public what it wants, they won't sell their products.

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