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Farm Bill 2008: Childhood Obesity, Health Disparities, and Federal Nutrition Policy
Childhood Obesity, Health Disparities, and Federal Nutrition Policy
Neal D. Barnard, M.D.
Childhood obesity and the adult diseases with which it is associated are major threats to Americans. Overweight and obesity now affect the majority of the U.S. population, increasing the risk of diabetes, hypertension, and heart disease, and taking a disproportionate toll in African American, Native American, and Hispanic populations.
These conditions have reached epidemic proportions. Among children aged 6 through 19 years in 1999-2002, 16.0 percent were overweight.1 Childhood weight problems are a major predictor of adult obesity, which is associated with substantial morbidity. For adult women, obesity is especially common among African Americans and Hispanic Americans. In 1999-2002, the prevalence of obesity was 30.7 percent among non-Hispanic whites, 38.4 percent among Mexican Americans, and 49.0 percent among non-Hispanic blacks.1
Accompanying the obesity epidemic is a dramatic rise in diabetes rates. The Centers for Disease Control and Prevention estimate that children born in the year 2000 have a one in three lifetime risk of developing diabetes. Compared to non-Hispanic whites, prevalence is higher among Hispanics and is especially high among African Americans and Native Americans, both of whom have prevalence rates nearly double those of whites.2
Cardiovascular mortality is particularly high among African Americans. The 2004 death rates from cardiovascular disease were 34 percent higher among black men and 39 percent higher among black women, compared with whites.3 Cardiovascular mortality figures also reflect disparities in health care.
Cancer is the second leading cause of death. Recent scientific reviews show that much of our risk for colon, breast, and prostate cancer, among other types, is attributable to dietary factors.4 Prostate cancer takes a particular toll among African American men. The 2003 age-adjusted death rate for prostate cancer among African Americans was 60 percent higher than among whites.5 Prostate cancer is associated with obesity.6 It is also associated with increased consumption of animal fat7 and dairy products8,9 and insufficient fruit and vegetable intake.10-13
The Need to Improve Federal Food Programs
Federal nutrition policies aggravate these problems. Current federal agriculture policies ensure that foods high in fat, saturated fat, and cholesterol are cheap and widely available, while fruits, vegetables, legumes, and grains are not. Similarly, food assistance programs, such as the National School Lunch Program and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), provide insufficient vegetables, fruits, and other healthful foods, while over-emphasizing high-fat, high-cholesterol products.
In 2005, the U.S. Department of Agriculture spent a total of $837 million on direct support for meat, eggs, and dairy products. These included commodity purchases for meat and eggs ($552 million) and direct dairy subsidies ($284 million). Indirect support for these products, such as feed grain subsidies, would further increase this total. Meanwhile, expenditures for fruits, vegetables, beans, juices, and nuts totaled less than half this amount.
Within USDA, the Food and Nutrition Service works with the Agricultural Marketing Service and the Farm Service Agency, both part of the Commodity Credit Corporation, to purchase agricultural commodities for food assistance programs, such as the National School Lunch Program. The National School Lunch Act specifies that at least 12 percent of all school lunch assistance must be in the form of these agricultural commodity purchases.14 On average, 20 percent of foods served in schools now come from these commodities; and more than 94,000 schools receive commodity foods.15 In some poor districts more than 90 percent of children qualify for free or subsidized meals.16 About 26 million children eat subsidized school lunch every day.17
These commodity purchases are not selected for nutritional value. Rather, federal law requires that the Agricultural Marketing Service and the Farm Service Agency make purchases that support agricultural businesses by removing surpluses and providing price supports. Therefore, purchases over-emphasize high-fat, high-cholesterol products and de-emphasize vegetables, fruits, grains, and legumes. Until 2003, the Department of Agriculture routinely issued press releases indicating that a primary goal of these purchases was to alter the farm market, with little or no nutritional justification. School lunch menus reflect these purchases, with foods such as cheeseburgers, roast beef with gravy, and cheese pizza served daily, while low-fat and vegetarian options are virtually absent.
The School Meals Initiative for Healthy Children was created in 1995 to improve the nutritional quality of school lunches and breakfasts. The most recent School Meals Initiative Study found that, in the academic year 1998-99, 82 percent of elementary schools and 79 percent of secondary schools exceeded the fat requirement (no more than 30 percent of calories from fat). For saturated fat, 85 percent of elementary schools and 84 percent of secondary schools exceeded the limit of 10 percent of calories.18 The principal sources of saturated fat are dairy products and meat.
Although commodity purchases are intended to shore up agribusiness income, it is difficult to make a case that this is necessary, as the following examples from 2005 commodity purchases illustrate:19
- Tyson Foods, the largest meat producer in the U.S., received $46.6 million in commodity contracts. The company’s 2005 net sales totaled $26.0 billion, with after-tax income of $353 million, and net assets of $2.0 billion.
- Smithfield Foods, the fourth largest meat producer, received $18.2 million in contracts through two subsidiaries. Smithfield Foods revenues for 2005 totaled $11.4 billion. After-tax net income was $292.2 million, and net assets of $1.3 billion.
- Pilgrim’s Pride Corporation, the seventh largest meat producer, received $42.4 million in commodity contracts. The company’s revenues totaled $5.7 billion, with an after-tax net income of $265 million and net assets of $1.2 billion. In 2007, Pilgrim’s Pride bought Gold Kist, a meat producer which received $34.1 million in commodity sales during 2005.
- Hormel, the eighth largest meat producer, received $28.0 million in commodity sales through its Jennie-O Foods subsidiary. The company’s revenues totaled $5.4 billion, with after-tax net income of 253.4 million and net assets of $932.9 million.
These examples indicate that the commodity programs that skew school lunch menus have the effect of increasing already large agribusiness revenues.
Feed grain subsidies artificially reduce the price of foods high in fat and cholesterol, making fruits, vegetables and other healthful foods comparatively more expensive. If feed crop subsidies were removed, prices would change toward market levels. According to a study at the Center for Agricultural and Rural Development at Iowa State University, a 30 percent increase in the price of corn would increase egg prices by 8.1 percent, poultry prices by 5.1 percent, pork prices by 4.5 percent, beef prices by 4.1 percent, and milk prices by 2.7 percent.20
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is administered by the Food and Nutrition Service of the USDA. The program provides women up to 24 quarts of milk and four pounds of cheese every month, both of which are high in saturated fat and cholesterol. However, the program skimps on vegetables, allowing a monthly total of only two pounds of carrots (for breast-feeding women only), one pound of beans, and no other vegetables or fruits, except juice. An exception is WIC’s farmers’ market program, which has more variety, but only intermittent availability and limited funding. WIC officials are well aware that their offerings are high in cholesterol and fat, and counsel participants as follows: “To effectively control fat, cholesterol, and sodium intakes, participants must make wise choices for all the other foods consumed during the day.”21
In addition, although many children and adults of African American, Hispanic, Native American, and Asian American heritage are lactose intolerant, the WIC program does not provide soymilk or rice milk and instead, encourages affected individuals to use more cheese and lactose-reduced milk.
In response to an Institute of Medicine report, entitled WIC Food Packages: Time for a Change, the Food and Nutrition Service issued a proposed rule on August 7, 2006, that would align the WIC food packages with the 2005 Dietary Guidelines for Americans. The proposed rule would add fruits, vegetables, and whole grain products to some WIC packages, and make soymilk optional. No changes have been finalized.
Specific Reforms Needed
The Farm, Nutrition, and Bioenergy Act of 2007 is a renewal of the Farm Security and Rural Investment Act of 2002, often called the “Farm Bill.” It sets the legislative groundwork for many federal food and agriculture policies. The renewal process provides the opportunity to make the changes necessary for important health benefits.
The 2006-2007 Annual Report of the President’s Cancer Panel, released August, 2007, called for sweeping reforms:22
“For example, current agricultural and public health policy is not coordinated—we heavily subsidize the growth of foods (e.g., corn, soy) that in their processed forms (e.g., high fructose corn syrup, hydrogenated corn and soybean oils, grain-fed cattle) are known contributors to obesity and associated chronic diseases, including cancer. The upcoming reauthorization of the Farm Security and Rural Investment Act of 2002 (the Farm Bill) provides an opportunity that must not be missed to strongly increase support for fruit and vegetable farmers, improve the national food supply, and enhance the health of participants in the national school lunch, food stamp, and Women, Infant, and Children food assistance programs.”
The Panel called on the federal government to “coordinate U.S. agricultural subsidy and public health policy related to diet and nutrition to improve the food supply and help ensure that all people have access to affordable, healthy food.”
The American Medical Association called for reforms with the following resolution, passed by the AMA House of Delegates in 2007:
RESOLVED, That our American Medical Association support efforts (1) to reduce health disparities by basing food assistance programs on the health needs of their constituents, (2) to provide vegetables, fruits, legumes, grains, vegetarian foods, and healthful nondairy beverages in school lunches and food assistance programs, and (3) to ensure that federal subsidies encourage the consumption of products low in fat and cholesterol.
Based on the foregoing, the following changes to federal nutrition policies are advisable and timely:
1. Agricultural commodity purchases that provide foods for school lunches and other food assistance programs should be based on health considerations, favoring vegetables, fruits, beans, and grains, and products made from them.
2. Direct and indirect subsidies, such as those for feed grains, which promote the consumption of products high in fat and cholesterol, should be eliminated.
3. Vegetables, fruits, legumes, grains, vegetarian foods, and healthful nondairy milk alternatives should be provided in school lunches and other food assistance programs.
The provisions of the new legislation will influence the health of Americans for years to come. It is therefore essential that health considerations be foremost in new legislation.
1. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of Overweight and Obesity Among US Children, Adolescents, and Adults, 1999-2002. JAMA. 2004;291(23):2847-2850.
2. Heron MP, Smith BL. Division of Vital Statistics, National Center for Health Statistics. Deaths: Leading causes for 2003. http://www.cdc.gov/nchs/data/hestat/leadingdeaths03_tables.pdf#4, accessed March 14, 2007.
3. Lethridge-Cejku M, Rose D, Vickerie J. Summary health statistics for United States adults: National Health Interview Survey, 2004. Vital Health Stat 10. 2006; 228.
4. World Cancer Research Fund. Food, nutrition, and the prevention of cancer: A global perspective. American Institute of Cancer Research. Washington, DC: 1997.
5. Centers for Disease Control and Prevention. United States Cancer Statistics, 2003 Incidence and Mortality, December 2006. http://www.cdc.gov/cancer/npcr/npcrpdfs/US_Cancer_Statistics_2003_Incidence_and_Mortality.pdf
6. Kane CJ, Bassett WW, Sadetsky N, et al. Obesity and prostate cancer clinical risk factors at presentation: data from CaPSURE. J Urol. 2005;173:732-736.
7. Willett WC. Specific fatty acids and risks of breast and prostate cancer: dietary intake. Am J Clin Nutr. 1997;66(suppl 6):S1557-S1563.
8. Giovannucci E, Rimm EB, Wolk A, et al. Calcium and fructose intake in relation to risk of prostate cancer. Cancer Res. 1998;58:442-447.
9. Chan JM, Stampfer MJ, Ma J, Gann PH, Gaziano JM, Giovannucci E. Dairy products, calcium, and prostate cancer risk in the Physicians’ Health Study. Am J Clin Nutr. 2001;74:549-554.
10. Gann PH, Ma J, Giovannucci E, et al. Lower prostate cancer risk in men with elevated plasma lycopene levels: results of a prospective analysis. Cancer Res. 1999;59:1225-1230.
11. Wertz K, Siler U, Goralczyk R. Lycopene: modes of action to promote prostate health. Arch Biochem Biophys. 2004;430:127-134.
12. Cohen JH, Kristal AR, Stanford JL. Fruit and vegetable intakes and prostate cancer risk. J Natl Cancer Inst. 2000;92:61-68.
13. Kolonel LN, Hankin JH, Whittemore AS, et al. Vegetables, fruits, legumes and prostate cancer: a multiethnic case-control study. Cancer Epidemiol Biomarkers Prev. 2000;9:795-804.
14. Food and Nutrition Service, United States Department of Agriculture. Food distribution national policy memorandum, February 5, 2003. www.fns.usda.gov/fdd/policymemo/pmfd002_sch-entitlements.pdf, accessed August 7, 2007.
15. Story M, Kaphingst KM, French S. The role of schools in obesity prevention. The Future of Children 2006;16:109-142.
16. Brink L, Bambi Y. “Transforming Inner-City School Grounds: Lessons from Learning Landscapes.” Children, Youth and Environments. 2004; 14(1): 208-232.
17. Nicklas TA, Elkasabany A, et al. American Journal of Epidemiology 2001. 153(10):969-977.
18. Abraham, S., M. Chattopadhyay, M. Montgomery, D. M. Steiger, L. Daft, B. Wilbraham “The School Meals Initiative Implementation Study-Third Year Report,” Nutrition Assistance Program Report Series, CN02-SMI3, Project Officer, Patricia McKinney U.S. Department of Agriculture, Food and Nutrition Service, Office of Analysis, Nutrition and Evaluation, Alexandria, VA, 2002.
19. http://www.ams.usda.gov/cp/index.htm, accessed August 18, 2007.
20. Jensen HH, Babcock BA. Do biofuels mean inexpensive food is a thing of the past? Iowa Ag Review 2007;13:4-11.
21. FNS/USDA. WIC Food Package: Benefits and Services. http://www.fns.usda.gov/wic/benefitsandservices/foodpkggenfaqs.HTM, accessed March 14, 2007.
22. President’s Cancer Panel, National Cancer Institute, U.S. Department of Health and Human Services. Promoting Healthy Lifestyles: Policy, Program, and Personal Recommendations for Reducing Cancer Risk. 2006-2007 Annual Report. August 2007.
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