How was England able to so successfully lower sodium intake, which was accompanied by dramatic drops in stroke and heart disease deaths?
Successful Government Dietary Regulations
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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
The public health community appears to have all but given up on eliminating obesity. The latest World Health Organization goals include a 2025 obesity target of just trying to shoot for no further increase. Even such a modest-sounding “low bar” may represent one of the greatest challenges facing global health––one in which we are failing. Though there have been isolated pockets of patchy progress, no country has yet reversed the epidemic. Blame has laid at the feet of the food industry lobby.
The promotion of the overconsumption of high-calorie, low-nutrient foods and beverages has been identified as the major driver of the obesity pandemic. Now that we have rid much of the world of pestilence and famine, some public health proponents have gone as far as to suggest that the “new vectors of disease” are taking the form of “trans-national food corporations that market salt, fat, sugar, and calories in unprecedented quantities.” It’s considered the world’s biggest industry. The processed food makers may alone bring in trillions. “Put simply,” concluded a senior director at global health institute, “the enormous commercial success enjoyed by the food industry is now causing what promises to be one of the greatest public health disasters of our time.”
But it’s not their fault. Corporations just do what they’re set up to do. Their goal is not to make people fat, just to make people money. The food industry manipulates ingredients such as salt, sugar, and fat, and spikes in caffeine and flavor-enhancing chemicals, for reasons no more nefarious than maximizing profits. It’s just to exploit our natural biological vulnerabilities. Markets often incentivize companies to cater to and take advantage of human weaknesses. The food and beverage CEOs are not out doing victory laps in children’s hospital halls to revel in their handiwork. They may simply have a fiduciary responsibility to maximize quarterly profits for their shareholders. It’s just how the system works.
But why do the corporations sell Apple Jacks instead of apples, or Orange Crush instead of oranges? To quote from the apocryphal Slick Willie Sutton answer on why he robbed banks: “That’s where the money is.” The reason some of the unhealthiest foods are marketed is one of simple economics: real food goes bad. Fruits and vegetables are perishable. What shareholders want is a snack cake that lasts for weeks on the shelves. Real food doesn’t have brand names. Why would even a broccoli grower put an ad on TV for broccoli when you’d likely just buy their competitor’s broccoli? The system is just not set up to reward the sale of health-promoting food. What kind of profit margins can you get on a sweet potato?
Real food costs money to grow. Shareholders don’t want dirt; they want dirt-cheap commodities, discounted by taxpayer subsidies they can mix with carbonated water, and sell for a few bucks a bottle. Dollar-menu burgers are thanks in part to hundreds of billions of dollars of federal subsidies for cheap feed. Those who resist calls for “heavy-handed” government regulation may not realize those heavy hands are already pressing down the scale on the side of big business.
Even without regulations, the market can be rapidly responsive, but only within certain parameters. The gluten-free craze is a great example. How many people had even heard of the word ten years ago? And now, some surveys suggest as much as 30 percent of the population is trying to avoid it. This has led to a 10,000+ explosion in products labeled gluten-free, including from major players such as Tyson Foods launching gluten-free bacon and lunch meat. Ironically, gluten-free products may be less healthy, with more sugar and salt, and less fiber, but mostly just different shades of the same processed junk. A gluten-free doughnut is still a doughnut. A nutritional analysis of foods marketed to children found that about 90 percent of products—both gluten-free and not—were classified as “unhealthy.”
That’s the limit of the market. The invisible hand is more than happy to hand us any kind of junk we want—low-fat junk, low-carb junk, non-GMO organic junk (and especially ironic: processed paleo junk). They can make money off of any fad, except food. Shareholders can profit off of any kind of Funyuns, but can’t do much with real onions. Within a narrow scope of commodity components and chemicals, endless reformulations can fit any fashionable flavor of the month. But produce will never be as profitable.
The market even prevents food manufacturers from taking small steps to make their products less detrimental, such as lowering salt or sugar content. Any deviation from the levels perfectly engineered for maximum craveability will get you immediately undercut by your competitors.
How then was England able to so successfully lower sodium intake, associated with a dramatic drop in stroke and heart disease deaths? Because they did it across the board. McDonald’s Chicken McNuggets have two and one-half times more salt in the U.S than in the U.K., but that’s because Burger King was cutting down, too.
In the best-documented population-level sodium reduction to date, the British government formed public-private partnerships with major food manufacturers, retailers, and restaurant chains to simultaneously reduce sodium levels so slowly over the years no one would notice. The secret sauce may be the level playing field, so no company could gain a commercial advantage by out-salting competitors. Analogous proposals have called for the stepwise, gradual, unobtrusive reduction in sugar in soft drinks, to affect a similar shift in taste preferences on a population-wide scale.
If this all sounds a bit Big Brothery, realize that people can still season and sweeten to their heart’s desire (or, rather, detriment). You can salt your nuggets all you want. Dump the whole shaker on, chug a bottle of corn syrup—it’s all still your body, your choice. It’s like the proposed cap on soft drink sizes. You can still drink all the soda you want; it’s just trying to make the default options a little healthier. It’s easier to add salt to food on your plate than it is to remove it.
The life-saving success of the trans-fat ban and society-wide sodium reduction may lie in the convenience of improving consumers’ diets without them having to change their behaviors. Some view this as government overreach, but the slipperiest slope may be that of inaction. As the director of Yale’s Center for Food Policy and Obesity has pointed out, governments initially defaulted to business interests in the case of tobacco to try to counter all the industry lies with weak and ineffective attempts at consumer education. And look what happened. “The unnecessary deaths could be counted in the millions. The U.S. can ill afford to repeat this mistake with diet.”
Until the political will is summoned to make industry-wide changes in our food supply, we need to take personal responsibility for our own health and for our family’s health, because it may be a matter of life and death. So, what does that personal solution look like in the interim? That’s exactly why I wrote How Not to Diet. Check it out at your local public library.
Please consider volunteering to help out on the site.
- Global NCD target: halt the rise in obesity. World Health Organization. 2016.
- Global status report on noncommunicable diseases 2014. World Health Organization. 2014.
- Roberto CA, Swinburn B, Hawkes C, et al. Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking. Lancet. 2015;385(9985):2400-9.
- World Obesity Day: ‘All countries significantly off track to meet 2025 WHO targets on Obesity.’ World Obesity.
- Neal B. Fat chance for physical activity. Popul Health Metr. 2013;11(1):9.
- Murray S. The world’s biggest industry. Forbes. November 15, 2007.
- Packaged Food Market Expected to Reach $3,407.2 Billion by 2030. Cision. July 23, 2015.
- Marlow ML. Weight loss nudges: market test or government guess? Mercatus Center. September 3, 2014.
- Kirkwood K. Lipids, liberty, and the integrity of free actions. Am J Bioeth. 2010;10(3):45-6.
- Popkin BM. Agricultural policies, food and public health. EMBO Rep. 2011;12(1):11-8.
- Jargon J. Gluten-free craze: is it healthy? Wall Street Journal. June 22, 2014.
- "Gluten Free" Claims in the Marketplace. Agriculture and Agri-Food Canada. November 10, 2017.
- Fry L, Madden AM, Fallaize R. An investigation into the nutritional composition and cost of gluten-free versus regular food products in the UK. J Hum Nutr Diet. 2018;31(1):108-20.
- Elliott C. The nutritional quality of gluten-free products for children. Pediatrics. 2018;142(2):e20180525.
- He FJ, Pombo-Rodrigues S, Macgregor GA. Salt reduction in England from 2003 to 2011: its relationship to blood pressure, stroke and ischaemic heart disease mortality. BMJ Open. 2014;4(4):e004549.
- Dunford E, Webster J, Woodward M, et al. The variability of reported salt levels in fast foods across six countries: opportunities for salt reduction. CMAJ. 2012;184(9):1023-8.
- Coyne KJ, Baldridge AS, Huffman MD, Jenner K, Xavier D, Dunford EK. Differences in the sodium content of bread products in the USA and UK: implications for policy. Public Health Nutr. 2018;21(3):632-6.
- Wyness LA, Butriss JL, Stanner SA. Reducing the population’s sodium intake: the UK Food Standards Agency’s salt reduction programme. Public Health Nutr. 2012;15(2):254-61.
- Roehr B. US tops salty fast food league table. BMJ. 2012;344:e2769.
- Ma Y, He FJ, Yin Y, Hashem KM, MacGregor GA. Gradual reduction of sugar in soft drinks without substitution as a strategy to reduce overweight, obesity, and type 2 diabetes: a modelling study. Lancet Diabetes Endocrinol. 2016;4(2):105-14.
- Hill JO. Can a small-changes approach help address the obesity epidemic? A report of the joint task force of the american society for nutrition, institute of food technologists, and international food information council. Am J Clin Nutr. 2009;89(2):477-84.
- Brownell KD. Government intervention and the nation’s diet: the slippery slope of inaction. Am J Bioeth. 2010;10(3):1-2.
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
The public health community appears to have all but given up on eliminating obesity. The latest World Health Organization goals include a 2025 obesity target of just trying to shoot for no further increase. Even such a modest-sounding “low bar” may represent one of the greatest challenges facing global health––one in which we are failing. Though there have been isolated pockets of patchy progress, no country has yet reversed the epidemic. Blame has laid at the feet of the food industry lobby.
The promotion of the overconsumption of high-calorie, low-nutrient foods and beverages has been identified as the major driver of the obesity pandemic. Now that we have rid much of the world of pestilence and famine, some public health proponents have gone as far as to suggest that the “new vectors of disease” are taking the form of “trans-national food corporations that market salt, fat, sugar, and calories in unprecedented quantities.” It’s considered the world’s biggest industry. The processed food makers may alone bring in trillions. “Put simply,” concluded a senior director at global health institute, “the enormous commercial success enjoyed by the food industry is now causing what promises to be one of the greatest public health disasters of our time.”
But it’s not their fault. Corporations just do what they’re set up to do. Their goal is not to make people fat, just to make people money. The food industry manipulates ingredients such as salt, sugar, and fat, and spikes in caffeine and flavor-enhancing chemicals, for reasons no more nefarious than maximizing profits. It’s just to exploit our natural biological vulnerabilities. Markets often incentivize companies to cater to and take advantage of human weaknesses. The food and beverage CEOs are not out doing victory laps in children’s hospital halls to revel in their handiwork. They may simply have a fiduciary responsibility to maximize quarterly profits for their shareholders. It’s just how the system works.
But why do the corporations sell Apple Jacks instead of apples, or Orange Crush instead of oranges? To quote from the apocryphal Slick Willie Sutton answer on why he robbed banks: “That’s where the money is.” The reason some of the unhealthiest foods are marketed is one of simple economics: real food goes bad. Fruits and vegetables are perishable. What shareholders want is a snack cake that lasts for weeks on the shelves. Real food doesn’t have brand names. Why would even a broccoli grower put an ad on TV for broccoli when you’d likely just buy their competitor’s broccoli? The system is just not set up to reward the sale of health-promoting food. What kind of profit margins can you get on a sweet potato?
Real food costs money to grow. Shareholders don’t want dirt; they want dirt-cheap commodities, discounted by taxpayer subsidies they can mix with carbonated water, and sell for a few bucks a bottle. Dollar-menu burgers are thanks in part to hundreds of billions of dollars of federal subsidies for cheap feed. Those who resist calls for “heavy-handed” government regulation may not realize those heavy hands are already pressing down the scale on the side of big business.
Even without regulations, the market can be rapidly responsive, but only within certain parameters. The gluten-free craze is a great example. How many people had even heard of the word ten years ago? And now, some surveys suggest as much as 30 percent of the population is trying to avoid it. This has led to a 10,000+ explosion in products labeled gluten-free, including from major players such as Tyson Foods launching gluten-free bacon and lunch meat. Ironically, gluten-free products may be less healthy, with more sugar and salt, and less fiber, but mostly just different shades of the same processed junk. A gluten-free doughnut is still a doughnut. A nutritional analysis of foods marketed to children found that about 90 percent of products—both gluten-free and not—were classified as “unhealthy.”
That’s the limit of the market. The invisible hand is more than happy to hand us any kind of junk we want—low-fat junk, low-carb junk, non-GMO organic junk (and especially ironic: processed paleo junk). They can make money off of any fad, except food. Shareholders can profit off of any kind of Funyuns, but can’t do much with real onions. Within a narrow scope of commodity components and chemicals, endless reformulations can fit any fashionable flavor of the month. But produce will never be as profitable.
The market even prevents food manufacturers from taking small steps to make their products less detrimental, such as lowering salt or sugar content. Any deviation from the levels perfectly engineered for maximum craveability will get you immediately undercut by your competitors.
How then was England able to so successfully lower sodium intake, associated with a dramatic drop in stroke and heart disease deaths? Because they did it across the board. McDonald’s Chicken McNuggets have two and one-half times more salt in the U.S than in the U.K., but that’s because Burger King was cutting down, too.
In the best-documented population-level sodium reduction to date, the British government formed public-private partnerships with major food manufacturers, retailers, and restaurant chains to simultaneously reduce sodium levels so slowly over the years no one would notice. The secret sauce may be the level playing field, so no company could gain a commercial advantage by out-salting competitors. Analogous proposals have called for the stepwise, gradual, unobtrusive reduction in sugar in soft drinks, to affect a similar shift in taste preferences on a population-wide scale.
If this all sounds a bit Big Brothery, realize that people can still season and sweeten to their heart’s desire (or, rather, detriment). You can salt your nuggets all you want. Dump the whole shaker on, chug a bottle of corn syrup—it’s all still your body, your choice. It’s like the proposed cap on soft drink sizes. You can still drink all the soda you want; it’s just trying to make the default options a little healthier. It’s easier to add salt to food on your plate than it is to remove it.
The life-saving success of the trans-fat ban and society-wide sodium reduction may lie in the convenience of improving consumers’ diets without them having to change their behaviors. Some view this as government overreach, but the slipperiest slope may be that of inaction. As the director of Yale’s Center for Food Policy and Obesity has pointed out, governments initially defaulted to business interests in the case of tobacco to try to counter all the industry lies with weak and ineffective attempts at consumer education. And look what happened. “The unnecessary deaths could be counted in the millions. The U.S. can ill afford to repeat this mistake with diet.”
Until the political will is summoned to make industry-wide changes in our food supply, we need to take personal responsibility for our own health and for our family’s health, because it may be a matter of life and death. So, what does that personal solution look like in the interim? That’s exactly why I wrote How Not to Diet. Check it out at your local public library.
Please consider volunteering to help out on the site.
- Global NCD target: halt the rise in obesity. World Health Organization. 2016.
- Global status report on noncommunicable diseases 2014. World Health Organization. 2014.
- Roberto CA, Swinburn B, Hawkes C, et al. Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking. Lancet. 2015;385(9985):2400-9.
- World Obesity Day: ‘All countries significantly off track to meet 2025 WHO targets on Obesity.’ World Obesity.
- Neal B. Fat chance for physical activity. Popul Health Metr. 2013;11(1):9.
- Murray S. The world’s biggest industry. Forbes. November 15, 2007.
- Packaged Food Market Expected to Reach $3,407.2 Billion by 2030. Cision. July 23, 2015.
- Marlow ML. Weight loss nudges: market test or government guess? Mercatus Center. September 3, 2014.
- Kirkwood K. Lipids, liberty, and the integrity of free actions. Am J Bioeth. 2010;10(3):45-6.
- Popkin BM. Agricultural policies, food and public health. EMBO Rep. 2011;12(1):11-8.
- Jargon J. Gluten-free craze: is it healthy? Wall Street Journal. June 22, 2014.
- "Gluten Free" Claims in the Marketplace. Agriculture and Agri-Food Canada. November 10, 2017.
- Fry L, Madden AM, Fallaize R. An investigation into the nutritional composition and cost of gluten-free versus regular food products in the UK. J Hum Nutr Diet. 2018;31(1):108-20.
- Elliott C. The nutritional quality of gluten-free products for children. Pediatrics. 2018;142(2):e20180525.
- He FJ, Pombo-Rodrigues S, Macgregor GA. Salt reduction in England from 2003 to 2011: its relationship to blood pressure, stroke and ischaemic heart disease mortality. BMJ Open. 2014;4(4):e004549.
- Dunford E, Webster J, Woodward M, et al. The variability of reported salt levels in fast foods across six countries: opportunities for salt reduction. CMAJ. 2012;184(9):1023-8.
- Coyne KJ, Baldridge AS, Huffman MD, Jenner K, Xavier D, Dunford EK. Differences in the sodium content of bread products in the USA and UK: implications for policy. Public Health Nutr. 2018;21(3):632-6.
- Wyness LA, Butriss JL, Stanner SA. Reducing the population’s sodium intake: the UK Food Standards Agency’s salt reduction programme. Public Health Nutr. 2012;15(2):254-61.
- Roehr B. US tops salty fast food league table. BMJ. 2012;344:e2769.
- Ma Y, He FJ, Yin Y, Hashem KM, MacGregor GA. Gradual reduction of sugar in soft drinks without substitution as a strategy to reduce overweight, obesity, and type 2 diabetes: a modelling study. Lancet Diabetes Endocrinol. 2016;4(2):105-14.
- Hill JO. Can a small-changes approach help address the obesity epidemic? A report of the joint task force of the american society for nutrition, institute of food technologists, and international food information council. Am J Clin Nutr. 2009;89(2):477-84.
- Brownell KD. Government intervention and the nation’s diet: the slippery slope of inaction. Am J Bioeth. 2010;10(3):1-2.
Motion graphics by Avo Media
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Title
Successful Government Dietary Regulations
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
For more on personal vs. corporate responsibility, see:
- The Role of Personal Responsibility in the Obesity Epidemic
- The Role of Corporate Influence in the Obesity Epidemic
- The Food Industry Wants the Public Confused About Nutrition
- A Political Lesson on the Power of the Food Industry
My videos on the trans fat ban:
- Controversy Over the Trans Fat Ban
- Banning Trans Fat in Processed Foods but Not Animal Fat
- How We Won the Fight to Ban Trans Fat
Find out more about my book, How Not to Diet, here.
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