Mexico, where surging obesity rates have leaders scrambling for answers, just took a radical step to beat back the tide of fat: High-calorie sugary soda ads are now banned from TV at times when kids are likely to be watching.

A novel idea you think?

In 2012, in the U.S., in New York City under former Mayor Michael Bloomberg, NYC  tried to take the modest step of banning extra-large sugary drinks — and preventing food stamp purchases of the swill. Both steps were invalidated by policymakers and courts.

To combat New Yorkers’ rising obesity rates, Bloomberg tried to prohibit sales of 16-ounce soft drinks in the city’s restaurants, movie theatres and street carts.  But you could buy one (or as many as you’d like) at a grocery store.  Or, for that matter, you could buy two 8-ounce soft drinks in restaurants, theatres or on the street – just not 16 ounce drinks.  Exempted from the ban were 16-ounce fruit juices, milkshakes, and lattes, though each of these could easily contain more calories than a soft drink. These contradictions contributed to the court decision that shot down the ban – though the big mistake was in trying to regulate consumer choice by government fiat.

The regulation of the serving size of SSB’s (Sugar Sweetened Beverages) would have been a positive move for New York City, one that would have induced behavior change. There is now substantial scientific evidence available that lend credence to the idea that limiting access to SSB’s or replacing SSB’s with sugar-free substitutes or water can help reduce obesity. However, such behavior change involving reduction in the intake of liquid calories from SSB’s will not be seen immediately but rather over time. Future studies following the implementation of this new policy in NYC might reveal the associated decrease in obesity and obesity related diseases.

There exist lingering concerns that consumers’ reaction to policies restricting access to SSB’s could have unintended consequences. Taxing of sodas could result in consumers buying fewer fruits and vegetables so as to afford soft drinks. Consumers might even purchase two glasses of SSB instead of one glass .  However, these actions would entail the consumers consciously and deliberately making those choices, which would adversely influence their health despite the government’s efforts to curb poor health outcomes. In entertaining the possibility of such counterproductive changes in consumer behavior in response to the new ban, it is important to also pay heed to the notion that, although, the current policy change may potentially not improve existing consumer behaviors; they will impact the choices of the generations to come. Future generations might not find the need or see the logic in purchasing two glasses of soda instead of one, if 16 ounces is the standard large serving. Hence, the banning of the sale of supersize sugar-laden drinks in restaurants and movie theaters by city health officials in New York City amid fervid criticism is in fact a positive step in the fight against obesity and obesity related disease.

It is further argued that, because there exist several factors driving the obesity epidemic, changing one facet is not worth engaging in. According to statistics, the consumption of SSB’s is the highest in low income neighborhoods, among young adults and those already classified as being obese.This puts these already vulnerable populations at a greater risk for disease and death. It must be understood that even though the consumption of SSB’s is just one factor, it does have a compounding effect when put together with lack of physical exercise, poor diet, stress, socio-economic and behavioral factors, and education. Therefore, it might be worthwhile to consider the socio-ecological framework and the pressures that act on individual choices in determining the effectiveness and validity of this ban.

Despite such concerns about the limitations of these initiatives, these policies can be viewed as a start in making attempts to regulate the aggressive practices of the food industry. The current restriction on SSB’s might serve to provide a strong impetus to develop future recommendations and policy decisions to not merely limit consumption of just SSB’s but perhaps also target industries involved in the production and sale of large serving portions of high calorie food, refined foods that use toxic chemical preservatives (many of which are carcinogens), and hormone enriched foods and drinks. Sodium nitrate, bromates, sulfites, Propylene Glycol, and Caboxymethylcellulose are a few examples of common chemical food preservatives that are in desperate need of regulation as they have been found to increase the risk of chronic diseases such as cancer and cardiovascular disease.

In the light of the growing global burden of chronic diseases, having the government step in to take action in addressing the current and future health and consequent economic catastrophe due to rising health care costs is commendable and must  hence be encouraged. The involvement of the government is viewed by consumers as an infringement upon their basic rights. But this view might change when studies following this ban reveal an improvement in health outcomes. It is important to acknowledge that the creation of permanent or long-term changes such as these in the existing food environment would influence long-term changes in body-weight of children and adults.

Policies related to the serving size of SSB’s, can be perceived as being synonymous to policies pertaining to seat belt laws, smoking ordinances, dumping chemicals into a stream bed and Labor Laws, which have all had huge impacts on the lives of the public and were all designed and created to save lives and prevent tragic outcomes.

The global controversy and mass hysteria, particularly in the United States, centered on the health effects of Bisphenol A (BPA), an industrial chemical invented nearly 120 years ago has lasted several decades. There are concerns about the effects of the production and use of BPA and its follow-up products on the environment. Numerous studies by scientists, opinions of environmental activist groups and politicians, and publications by journalists confirm the existence of a public health threat. However, these views are contradictory to those of major international authorities such as, the European Commission, the European Food and Safety Authority (EFSA), the US Food and Drug Administration (FDA), the Japanese Ministry of Health, Labor and Welfare, and the World Health Organization (WHO).

In the midst of these relentless and powerful debates, wrapped in controversy, and fueled by aggressive media coverage, where do the consumers stand? Whom should they believe? What choices are best for them? What is the industry not telling them? These questions have left the consumers in a state of unremitting panic and utter confusion. The debate over BPA has further added to the list of the decisions to be made to live healthy: expensive organic foods or cheaper chemically processed foods, soy milk or whole milk or almond milk, tuna or salmon, Splenda or Equal, and the list goes on. It is necessary to look at the views of different stakeholders and their impact on consumers and the choices consumers make.
Bisphenol A (2, 2-bis(4-hydroxyphenyl) propane, CAS No. 80-05-7), a monomer also commonly referred to as BPA, is an industrial chemical that is used in the production of polycarbonate (PC) and epoxy resins. At a global consumption level of over 95% for PC and epoxy resins, it is one of the most widely used chemicals in the world (14). BPA is present in food contact materials: infant feeding bottles, tableware, microwave ovenware, food containers including those used for infant formula, water bottles, milk and beverage bottles, processing equipment, water pipes, protective linings for canned foods and beverages, as a coating on metal lids for glass jars and bottles, adhesives, dental fillings, medical devices, and recently in point of sale receipts at fast food restaurants, grocery stores, gas stations, post offices, and automated teller machines. The levels and patterns of consumer exposure to BPA vary, but oral exposure from the diet is the primary cause of concern. However, the level of concerns, or in some cases even the acknowledgement of the mere existence of concerns regarding BPA consumption, varies in the opinions of the different stakeholders involved.

The reason BPA has sparked numerous debates and scientific studies, as well as extensive media coverage, is that this chemical, which was earlier categorized as a weak environmental estrogen, is now defined as a known human endocrine disruptor, similar in potency levels to estradiol in its ability to stimulate a myriad of molecular and cellular pathways in the human body (8). This chemical has been found to leach into food and water from polycarbonate containers. According to a study conducted by the researchers at the Harvard School of Public Health, BPA migration from polycarbonate bottle use increases at extreme temperatures, indicating a higher dose intake when consuming food or beverages from hot or cold containers (3). Over the years, as a result of both in vitro and in vivo studies, BPA exposure has been linked to adverse effects on the male reproductive system, such as the effects on male sex hormone levels, androgen receptors, and organs such as the testes, epididymis, sperm, seminal vesicles, the prostate gland, and sperm production (15). Additionally, reported adverse effects include the early onset of sexual maturation in females, altered development and tissue organization of the mammary gland, induction of pre-neoplastic mammary gland and reproductive tract lesions (3), risk of chronic disease development (such as, cardiovascular disease, diabetes, and obesity due to metabolic disorders resulting in alterations of insulin/glucose homeostasis and liver enzymes)(9), carcinogenicity, genotoxicity, acute and repeated dose toxicity, immunotoxicity, neurotoxic, neuroendocrine, and neurobehavioral effects (1,15,10,5). Even though BPA has the potential to cause harm in all age groups, the more vulnerable groups in the population are pregnant women, infants and children (5).

From the perspective of scientists and researchers of the world’s leading academic and governmental institutions in the fields of endocrine disruption, endocrinology, neurobiology, reproductive biology, genetics, and metabolism, BPA must be regulated.

In stark contrast to the deductions of scientific experts, international regulatory bodies have repeatedly declared BPA to be a safe chemical. Their deductions are based on separate risk assessments and government reviews conducted by individual countries worldwide. Risk assessments conducted by Germany (German Federal Institute of Risk Assessment Bundesinstitut für Risikobewertung- BfR), UK (Food Safety Authority –FSA), France (Agence nationale de sécurité sanitaire de l’alimentation, de l’environnement et du travail- ANSES), Spain (Agencia Espanola de Securidad Alimentaria y Nutrición- AESAN), Switzerland (Bundesamt für Gesundheit- BAG), The Netherlands (Voedsel en waren autoriteit –VWA), Denmark (Danish Minister for Food, Agriculture and Fisheries and Danish Environmental Protection Agency,) Ireland (Food Safety Authority), USA (Food and Drug Administration- FDA), Canada (Government of Canada and Health Canada), New Zealand and Australia (Food Standards Australia New Zealand FSANZ) and Japan (National Institute for Advanced Industrial Science and Technology-AIST) reached the same consensus that “human BPA exposures are low and within safe limits set by government authorities (4).” These major regulatory bodies worldwide have discounted many of the scientific studies conducted on the basis of “lack of sufficient evidence,” “no clear effect,” “still an emerging area of research,” “design and data analysis issues that limit utility,” “no health concern at current low dose levels,” and “considerable uncertainty regarding the validity and relevance of these observations (2, 12).” Previous studies have been criticized for focusing too much on injected effects of BPA on the body instead of on the effects of oral consumption, as ingestion is the primary mode of transmission of BPA into the body (2, 12).

In the light of these two strongly opposing views, the matter still remains unsettled and the world continues to be obsessed with BPA. Despite decades of continuous research by scientists, resulting in the production of a vast array of studies covering a dizzying range of potential ways BPA might be toxic to humans and the relentless assurance by major government agencies, the tension and turmoil created by the health effects of BPA has still not ended. News reports, media coverage and scientific publications continue to surface for this environmental estrogen. The decision of several states and local governments in the US (Minnesota, Chicago and Connecticut in 2009, Washington, Wisconsin, Massachusetts, Maryland, New York and Vermont in 2010), as well as of governments worldwide (Canada in 2008; Denmark in 2010; China; all of the EU and Malaysia in 2011) to ban BPA in products for infants, especially baby bottles, is contradictory to their original claim that BPA is safe.

However, the fact that BPA does in fact leach into food and beverages is undisputed between these two opposing groups of thinkers. It is the level and existence of severity that is disputed. BPA is claimed to be safe for human consumption as the dose levels are very low and because it has a half- life of less than 6 hours, allowing it to be excreted from the body nearly completely within 24 hours (3).

Despite claims of BPA being safe for human consumption, there are certain elements of concern and unresolved questions that continue to lurk and must be contemplated upon and perhaps addressed in the future. The effects of not only continuous and widespread exposure to BPA but also the potential effects of BPA interactions with other synthetic chemicals in our environment and diet should be considered. This is important because chemical interaction with BPA may result in further manifestation of the impact of BPA exposure several fold no matter how low the dose might be. Additionally, given the ubiquitous nature of BPA, individuals might be subjected to multiple exposures of BPA on any given day. For instance, the exposure to BPA starts for many with the first cup of hot morning coffee, the paper receipts handed out at retail stores and dollar bills used to pay, drinking of bottled water during the day, and eating take- out for lunch served in styrofoam boxes that are BPA reserves. Again, as individuals are not exposed solely to BPA but several other synthetic chemicals, the morning coffee is more than just coffee and requires plenty of forethought as a consumer. It is a milieu of unidentifiable chemicals and toxins- coffee (organic grown or chemically processed?), milk (are there synthetic hormones present?), sugar (Is it chemically processed?) and the infamous BPA.

The BPA controversy has encouraged consumers to use alternate materials that are BPA free. Since there is no single replacement for BPA; the new alternative plastics involve replacement of BPA with chemicals such as polypropylene, polyethersulfone, polyethylene terephthalate, high-density polyethylene, PVC, polyamide, silicone, Tritan copolyester, polyesters, polyacrylates, vinyl resins and oleoresins. However, what if its replacement turns out to be more toxic? BPA has been subjected to extensive research to arrive at present day conclusions and a partial ban of its use by countries worldwide, but the new replacements are yet to be put to the test. So, should consumers now be more concerned? Should uncertainty in findings of health effects of BPA be translated to no health risks? Is this trade-off worth making?

Comic Strip highlighting the constant dilemmas of ” us” – The Consumers

REFERENCES
1.Allsopp Michelle, Santillo David and Johnston Paul. 1997. “Poisoning the Future-Impacts of Endocrine-Disrupting Chemicals on Wildlife and Human Health.” 1997. Available at: http://archive.greenpeace.org/toxics/reports/ptf/ptf.html

2.Butterworth Trevor. 2009. “Science Suppressed: How America became obsessed with BPA.” STATS Investigation. Available at:

http://stats.org/stories/2009/Science%20Suppressed_%20America’s%20Obsession%20with%20BPA_June30_09.pdf

3.Carwile Jenny L., Luu Henry T, Bassett Laura S, Driscoll Daniel A., Yuan Caterina, Chang Jennifer Y., Xiaoyun Ye, Calafat Antonia M., and Michels Karin B. 2009. “Polycarbonate Bottle Use and Urinary Bisphenol A Concentrations.” Environmental Health Perspectives. Volume 117;number 9.

4.European Information Center on Bisphenol. 2011. “The safety of Bisphenol A-based consumer products – what the authorities say.” Available at:http://www.bisphenol-a-europe.org/uploads/EN_Regulatory%20Assessments.pdf

5.Houlihan Jane, Lunder Sonya, and Jacob Anila. “Timeline: BPA from invention to Phase-out.” Environmental Working Group. 2011.
Available at: http://www.ewg.org/reports/bpatimeline

6.Huang YQ, Wong CK, Zheng JS, Bouwman H, Barra R, Wahlström B, Neretin L, Wong MH. “Bisphenol A (BPA) in China: A review of sources, environmental levels, and potential human health impacts.”2011. Environmental Int. 10.1016/j.envint.2011.04.010.

7.International Food Safety Authorities Network (INFOSAN). “BISPHENOL A (BPA) – Current state of knowledge and future actions by WHO and FAO”. 2009. Available at: http://www.who.int/foodsafety/publications/fs_management/No_05_Bisphenol_A_Nov09_en.pdf

8.Rubin BS. “Bisphenol A: an endocrine disruptor with widespread exposure and multiple effects.”2011. J Steroid Biochem Mol Biol. ;127(1-2):27-34.
9.Saal vom Frederick and Myers Peterson John. “Bisphenol A and risk of Metabolic Disorders.” 2008. JAMA. Vol 300, No. 11. Available at:

http://jama.ama-assn.org/content/300/11/1353.full.pdf+html

10.Stump Donald G., Beck Melissa J., Radovsky Ann, Garman Robert H., Freshwater Lester L., Sheets Larry P., Marty M. Sue, Waechter John M. Jr, Dimond Stephen S. ‖, Van Miller John P. , Shiotsuka Ronald N. ‖, Beyer Dieter, Beyer Anne H. Beyer and Hentges.Steven G. 2010. “Developmental Neurotoxicity Study of Dietary Bisphenol A in Sprague-Dawley Rats”. Toxicol. Sci. 115 (1): 167-182.

11.U.S. Food and Drug Administration. “Update on Bisphenol A for Use in Food Contact Applications” .2010 Available at:

http://www.fda.gov/downloads/NewsEvents/PublicHealthFocus/UCM197778.pdf

12.WHO. “Toxicological and Health Aspects of Bisphenol A”.2010. Available at: http://whqlibdoc.who.int/publications/2011/97892141564274_eng.pdf

13.WHO. “Sources and Occurrence of Bisphenol A Relevant for Exposure of Consumers”. 2010. Available at:

http://www.who.int/foodsafety/chem/chemicals/3_exposure_assessment.pdf

14.Yoot Mo Lee, Min Jae Seong,Jae Woong Lee, Yong Kyung Lee, Tae Myoung Kim, Sang-Yoon Nam, Dae Joong Kim, Young Won Yun, Tae Seong Kim, Soon Young Han, Jin Tae Hong. “Estrogen receptor independent neurotoxic mechanism of bisphenol A, an environmental estrogen.” 2007. J Vet Sci.; 8(1): 27–38.

15.Zhou D. Li. Z., Qing D, Y. He, Wu T, Miao M, J. Wang, Weng X, Ferber J.R, Herrinton L.J, Zhu Q., E Gao, Checkoway H. and Yuan W. 2010.
“Occupational exposure to bisphenol-A (BPA) and the risk of Self-Reported Male Sexual Dysfunction.” Human Reproduction, Vol.25, No.2 pp. 519–527.

Copyright UNICEF

The burden of stunting exists worldwide. However, most people have never heard of stunting. Stunting is one of the least reported, least recognized and least understood issues facing humanity today. Stunted growth, wasting and being underweight are all consequences of undernutrition. However, stunting affecting 165 million children under five years old (one out of every four.), presents itself as a problem of greater magnitude than wasting or being underweight.

The increased nutritional needs and greater vulnerability of children puts them at the greatest risk of stunting and mortality when they lack access to a diet that meets all their nutrient needs. However, in addition to decreased fetal nutrition during pregnancy and child nutritional deficiencies there are several other factors that cause stunting either directly or indirectly- poor sanitation and hygiene, poverty, teenage pregnancy, maternal dieting, poor health care, poor knowledge and care practices, uterine vascular problems and frequent attacks of infectious disease. Prevalence of undernutrition exists in both developing and industrialized countries but to different degrees and in different forms.

Stunting or low height for age, caused by chronic undernutrition in children, does not only affect a person’s growth or height. It causes irreversible damage to physical and cognitive development, especially during the first two years of a child’s life. It presents both short-term and long-term consequences.

Stunting prevents children from growing up to live long and productive lives. The lack of access to an adequate diet during the first 1,000 days between conception and age results in poor brain development, IQ, and scholastic achievement in school-age children leading to future income reductions as adults. The effects of stunting are irreversible, long term and intergenerational. Impaired intellectual development, infectious diseases and chronic diseases such as cardiovascular diseases, obesity and diabetes further exacerbate poverty through lost wages and increased health care costs that further hinder earning capacity. Therefore, stunting traps people into a vicious cycle of poor nutrition, illness, poverty and inequity, holding back the development of not just individuals but entire societies and nations at large.

So, how to win this battle against undernutrition and stunting? Given that undernutrition has a range of immediate, underlying and basic causes, efforts to tackle it must be multi-disciplinary and engage multiple stakeholders. The designing of program interventions must include:

•Promoting the use of micronutrient and vitamin supplements

•Raising awareness that children throughout the world can achieve their growth potential. The common misconception is that children belonging to certain ethnic and racial groups are “naturally” short.

•Promoting exclusive breastfeeding

•Treating severe and acute malnutrition

•Including measurements of height, not just weight in routine program evaluations: Policymakers should be encouraged to use stunting as an indicator of overall child health and nutrition, rather than monitoring only being under¬weight to circumvent the complexities of the “nutrition transition”- a growing trend leading to populations with high rates of overweight, low rates of underweight but persistently high rates of stunting.

•Improving access to education and safe drinking water, promoting hygiene, preventing and treating diseases, and strengthening social safety nets.

Proper nutrition helps give every child the best start in life. Tackling the issue of stunting should be viewed as an opportunity both for personal health and national development. Children should not be condemned to a life of deprivation – especially when we know how to prevent it.

Check out this video by UNICEF on the First 1,000 Days of a Child’s Life

Copyright Samantha Kozikott