Suchergebnisse

Taxes to reduce the consumption of sugar-sweetened beverages (SSBs) such as soda drinks have been endorsed by the World Health Organization and are now in place in France, Hungary, and Mexico, and scheduled for Portugal, South Africa, and Great Britain. Such taxes have so far been impossible to enact in the United States at the state or federal level, but since 2014 seven local jurisdictions have put them in place. Three necessary conditions for local political enactment emerge from this recent experience: Democratic Party dominance, external financial support for pro-tax advocates, and a political message appropriate to the process (public health for ballot issues; budget revenue for city council votes). Roughly 40 percent of Americans live within local jurisdictions where the Democratic Party dominates, so room exists for local SSB taxes to continue spreading.

POLICY POINTS: Suboptimal intake of fruit and vegetables is associated with increased risk of diet‐related diseases. A national retail‐based fruit and vegetable subsidy program could broadly benefit the health of the entire population. Existing fruit and vegetable subsidy programs can inform potential implementation mechanisms; Congress's powers to tax, spend, and regulate interstate commerce can be leveraged to create a federal program. Legal and administrative feasibility considerations support a conditional funding program or a federal‐state cooperative program combining regulation, licensing, and state or local options for flexible implementation strategies. Strategies to engage key stakeholders would enable the program to utilize lessons learned from existing programs. CONTEXT: Suboptimal intake of fruit and vegetables (F&Vs) is associated with increased risk of diet‐related diseases. Yet, there are no US government programs to support increased F&V consumption nationally for the whole population, most of whom purchase food at retail establishments. To inform policy discussion and implementation, we identified mechanisms to effectuate a national retail‐based F&V subsidy program. METHODS: We conducted legal and policy research using LexisNexis, the UConn Rudd Center Legislation Database, the Centers for Disease Control and Prevention Chronic Disease State Policy Tracking System, the US Department of Agriculture's website, Congress.gov, gray literature, and government reports. First, we identified existing federal, state, local, and nongovernmental organization (NGO) policies and programs that subsidize F&Vs. Second, we evaluated Congress's power to implement a national retail‐based F&V subsidy program. FINDINGS: We found five federal programs, three federal bills, four state laws, and 17 state (including the District of Columbia [DC]) bills to appropriate money to supplement federal food assistance programs with F&Vs; 74 programs (six multistate, 22 state [including DC], and 46 local) ...

Dariush Mozaffarian and colleagues review strategies governments can use to improve nutrition and health

Food systems lie squarely at the intersection of several overarching goals of the UN and member states, as embodied in the Sustainable Development Goals, including eliminating poverty, hunger, and malnutrition in all its forms, achieving good health and well-being, while promoting environmental sustainability. The need for radical transformation of current food systems is inescapable if the world is to achieve one, let alone all, of these goals. Meeting this challenge will inevitably be disruptive to current food systems, carry costs, and be politically onerous. But the projected benefits far outweigh these difficulties. This commentary spells out the complexity of issues that need to be tackled to design and implement food systems that improve diets, nutrition, and health in an equitable fashion, while simultaneously respecting planetary boundaries. Six critical domains are identified that must be addressed for the successful transformation of food systems: 1) reinvent agriculture, 2) transform food environments for healthy diets, 3) mitigate climate change, 4) productively engage the private sector, 5) influence public policy priorities, and 6) establish true cost accounting of food. Because science is crucial for each of these domains, a research-driven strategy, emphasizing a collaborative process, is outlined. Bold, new, but technically and politically feasible actions are needed to effectively transform current food systems.

OBJECTIVES: This study aimed to assess expert stakeholder perceptions on the impact and feasibility of 21 national, state, and local nutrition policies for cancer prevention in the US. METHODS: We distributed a survey to members of professional groups in the field of nutrition, cancer prevention, and public policy through direct email contact, organizational email/e-newsletter, and listservs. The survey asked participants to rank the health impact and political feasibility of 21 nutrition policies across 5 domains: (a) taxes/subsidies, (b) labeling, (c) nutrition standards, (d) nutrition education, and (e) nutrition promotion in healthcare, based on a Likert scale (1 = least; 5 = most impactful or feasible). We compared the impact and feasibility scores for each policy and by levels of implementation (federal, state, or local). RESULTS: A total of 170 respondents provided complete responses, representing civil service employees (n = 92, 54.1%), employees of advocacy groups (n = 31, 18.2%), researchers (n = 19, 11.2%), healthcare professionals (n = 18, 10.6%), and others (n = 10, 5.9%). For perceived impact, policies with the highest impact scores were Medicare/Medicaid coverage of nutrition counseling for people with chronic conditions at the federal and state levels (mean ± SE: 4.25 ± 0.10); and policy with the lowest impact score was local tax on processed meat (2.90 ± 0.13). For perceived feasibility, policy with the highest feasibility score was federal subsidies on fruits, vegetables, and whole grains in Medicare/Medicaid (4.13 ± 0.09); and policy with the lowest feasibility score was federal tax on processed meat (1.86 ± 0.10). When the impact and feasibility were evaluated jointly, Medicare/Medicaid subsidies for fruits, vegetables, and whole grains and coverage of nutrition counseling received the highest scores, whereas taxes on processed meats or junk food received the lowest scores. CONCLUSIONS: Based on expert stakeholder perceptions, specific federal, state, and local government nutrition policies ...

Purpose: In line with epidemiological and sociocultural changes in Korea over the past decades, reliable estimation of diseases as a result of dietary and metabolic risks is required. In this study, we aimed to evaluate the contributions of dietary and metabolic factors to cardiometabolic diseases (CMDs) in Korean adults (25–64 years old) during 2012–2013. Materials and Methods: Distribution of risk factors and cause-specific mortality by gender and age per year was obtained from the Korea National Health and Nutrition Examination Survey and Statistics Korea, respectively. The association between the two was obtained from published meta-analyses. The population-attributable fraction attributable to the risk factors was calculated across gender and age strata (male and female, age groups 25–34, 35–44, 45–54, and 55–64) in 2012 and 2013. Results: The results showed that during the period studied, high body mass index [5628 deaths; uncertainty intervals (UIs): 5473– 5781] and blood pressure (4202 deaths; UIs: 3992–4410) were major metabolic risks for CMD deaths, followed by dietary risks such as low intake of whole grain (4107 deaths; UIs: 3275–4870) and fruits (3886 deaths; UIs: 3227–4508), as well as high intake of sodium (2911 deaths, UIs: 2406–3425). Also, males and the younger population were seen more prone to be exposed to harmful dietary risk than their female and older counterparts. Conclusion: The findings provide the necessary information to develop targeted government interventions to improve cardiometabolic health at the population level.

POLICY POINTS: High‐profile international evidence reviews by the World Health Organization, the World Cancer Research Fund, the American Institute for Cancer Research, and the American Cancer Society concluded that processed meat consumption increases the risk of cancer. The red meat and processed meat industries are influential in the United States and in several other nations. The US federal government supports public‐private partnerships for commodity meat promotion and advertising. Four potential policy options to affect consumption of processed meat are taxation, reduced processed meat quantities in school meal standards, public service announcements, and warning labels. Feasibility of these options would be enhanced by an explicit and science‐based statement on processed meat in the 2020‐2025 Dietary Guidelines for Americans. CONTEXT: The World Health Organization, the World Cancer Research Fund, and the American Cancer Society have each in recent years concluded that processed meats are probable carcinogens. The 2015‐2020 Dietary Guidelines for Americans did not separately evaluate health effects of processed meat, although it mentioned lower processed meat intakes among characteristics of healthy diets. METHODS: We summarized the international scientific literature on meat intake and cancer risk; described the scientific and political processes behind the periodic Dietary Guidelines for Americans; described the US red meat and processed meat industries and the economic structure of government‐supported industry initiatives for advertising and promotion; and reviewed and analyzed specific factors and precedents that influence the feasibility of four potential policy approaches to reduce processed meat intake. FINDINGS: Based on a review of 800 epidemiological studies, the World Health Organization found sufficient evidence in humans that processed meat is carcinogenic, estimating that each 50‐gram increase in daily intake increases the risk of colorectal cancer by 18%. Among the four policy responses we ...

OBJECTIVES: Excess caloric intake is linked to weight gain, obesity and related diseases including type 2 diabetes and cardiovascular disease (CVD). Obesity incidence has been on the rise, with almost 2 of 3 people being overweight or obese in the US. In 2018, the US federal government passed a law mandating the labeling of calories on all menu items across chain restaurants, as a strategy to support informed consumer choice and reduce caloric intake. Yet, potential health and economic impacts of this policy remain unclear. METHODS: We used a validated microsimulation model (CVD-PREDICT) to estimate reductions in CVD events, diabetes cases, gains in quality-adjusted life-years (QALYs), costs, and cost-effectiveness of two policy scenarios: (1) implementation of the federal menu calorie labelling (menu calorie label), and (2) further accounting for corresponding industry reformulation (menu calorie label + reformulation). The model utilized nationally representative demographic and dietary data from NHANES 2009–2016; policy effects on consumer intake and BMI-disease effects from published meta-analyses; and policy effects on industry reformulation, policy costs (policy administration, industry compliance and reformulation) and health-related costs (formal and informal healthcare costs, productivity costs) from established sources. We conservatively modeled change in calories to change in weight using an established dynamic weight-change model. Findings were evaluated over 10 years and lifetime from a healthcare and societal perspective. Costs were inflated to constant 2018 USD, and costs and QALYs were discounted at 3% annually. We performed probabilistic analyses and a range of one-way sensitivity and subgroup analyses to assess the robustness of our findings. RESULTS: Sample statistics were shown (Table). American adults (35+) consume ∼21% calorie from restaurants (Figure) that would be reduced by 2% due to this law at the population level. Government administration costs were estimated at 11.6$M, industry ...

BACKGROUND: Excess caloric intake is linked to weight gain, obesity, and related diseases including type 2 diabetes and cardiovascular disease (CVD). Obesity incidence is rising, with nearly 3 in 4 US adults being overweight or obese. In 2018, the US federal government finalized the implementation of mandatory labeling of calorie content on all menu items across major chain restaurants nationally as a strategy to support informed consumer choice, reduce caloric intake, and potentially encourage restaurant reformulations. Yet, the potential health and economic impacts of this policy remain unclear. METHODS: We used a validated microsimulation model (CVD-PREDICT) to estimate reductions in CVD events, diabetes cases, gains in quality-adjusted life-years (QALYs), costs, and cost-effectiveness of the menu calorie labeling intervention, based on consumer responses alone, and further accounting for potential industry reformulation. The model incorporated nationally representative demographic and dietary data from NHANES 2009–2016; policy effects on consumer diets and BMI-disease effects from published meta-analyses; and policy effects on industry reformulation, policy costs (policy administration, industry compliance and reformulation) and health-related costs (formal and informal healthcare costs, productivity costs) from established sources or reasonable assumptions. We modeled change in calories to change in weight using an established dynamic weight-change model, assuming 50% of expected calorie reductions would translate to long-term reductions. Findings were evaluated over 5 years and a lifetime from healthcare and societal perspectives, with uncertainty incorporated in both one-way and probabilistic sensitivity analyses. RESULTS: Between 2018–2023, implementation of the restaurant menu calorie labeling law was estimated, based on consumer response alone, to prevent 14,698 new CVD cases (including 1,575 CVD deaths) and 21,522 new type 2 diabetes cases, gaining 8,749 QALYs. Over a lifetime, corresponding values ...

Objectives. To assess stakeholder perceptions of the impact and feasibility of 21 national, state, and local nutrition policies for cancer prevention across 5 domains in the United States. Methods. We conducted an online survey from October through December 2018. Participants were invited to take the survey via direct e-mail contact or an organizational e-newsletter. Results. Federal or state Medicare/Medicaid coverage of nutrition counseling and federal or state subsidies on fruits, vegetables, and whole grains for participants in the Supplemental Nutrition Assistance Program were the policies rated as having the highest perceived impact and feasibility. Overall, the 170 respondents rated policy impact higher than policy feasibility. Polices at the federal or state level had a higher perceived impact, whereas local policies had higher perceived feasibility. Conclusions. Our findings might guide future research and advocacy that can ultimately motivate and target policy actions to reduce cancer burdens and disparities in the United States.

BACKGROUND-: Sugar-sweetened beverage (SSB) taxes are a rapidly growing policy tool and can be based on absolute volume, sugar content tiers, or absolute sugar content. Yet, their comparative health and economic impacts have not been quantified, in particular tiered or sugar content taxes that provide industry incentives for sugar reduction. METHODS-: We estimated incremental changes in diabetes and cardiovascular disease (CVD), quality-adjusted life-years (QALYs), costs, and cost-effectiveness of three SSB tax designs in the United States, based on (1) volume ($0.01/oz.), (2) tiers (20 g/8 oz.: $0.02/oz.), and (3) absolute sugar content ($0.01/tsp added sugar), each compared to a base case of modest ongoing voluntary industry reformulation. A validated microsimulation model, CVD-PREDICT, incorporated national demographic and dietary data from NHANES; policy effects and SSB-related diseases from meta-analyses; and industry reformulation and health-related costs from established sources. RESULTS-: Over a lifetime, the volume, tiered, and absolute sugar content taxes would generate $80.4 billion, $142 billion, and $41.7 billion in tax revenue, respectively. From a healthcare perspective, the volume tax would prevent 850,000 CVD (95% CIs: 836,000–864,000) and 269,000 diabetes (265,000–274,000) cases, gain 2.44 million QALYs (2.40–2.48), and save $53.2 billion net costs (52.3–54.1). Health gains and savings were approximately doubled for the tiered and absolute sugar content taxes. Results were robust across for societal and government perspectives, at 10 years follow-up, and with lower (50%) tax pass-through. Health gains were largest in young adults, Blacks and Hispanics, and lower income Americans. CONCLUSIONS-: All SSB tax designs would generate substantial health gains and savings; tiered and absolute sugar content taxes should be considered and evaluated for maximal potential gains.

PURPOSE OF REVIEW. Suboptimal diet is a leading cause of cardiometabolic disease and economic burdens. Evidence-based dietary policies within 5 domains – food prices, reformulation, marketing, labeling, and government food assistance programs – appear promising at improving cardiometabolic health. Yet, the extent of new dietary policy adoption in the US and key elements crucial to define in designing such policies are not well established. We created an inventory of recent US dietary policy cases aiming to improve cardiometabolic health and assessed the extent of their proposal and adoption at federal, state, local and tribal levels; and categorized and characterized the key elements in their policy design. RECENT FINDINGS. Recent federal dietary policies adopted to improve cardiometabolic health include reformulation (trans-fat elimination), marketing (mass-media campaigns to increase fruits and vegetables), labeling (Nutrition Facts Panel updates, menu calorie labeling), and food assistance programs (financial incentives for fruits and vegetables in the Supplemental Nutrition Assistance Program (SNAP) and Women, Infant and Children (WIC) program). Federal voluntary guidelines have been proposed for sodium reformulation and food marketing to children. Recent state proposals included sugar-sweetened beverage (SSB) taxes, marketing restrictions, and SNAP restrictions, but few were enacted. Local efforts varied significantly, with certain localities consistently leading in the proposal or adoption of relevant policies. Across all jurisdictions, most commonly selected dietary targets included fruits and vegetables, SSBs, trans-fat, added sugar, sodium and calories; other healthy (e.g., nuts) or unhealthy (e.g., processed meats) factors were largely not addressed. Key policy elements to define in designing these policies included those common across domains (e.g. level of government, target population, dietary target, dietary definition, implementation mechanism), and domain-specific (e.g., media channels for food ...