FDA considers additional food labels
Mon, 10 Sep 2007 20:23:51 GMT
By ANDREW BRIDGES, Associated Press Writer
WASHINGTON - Next month, General Mills Inc. and Kellogg Co. will begin emblazoning their breakfast cereals with symbols that summarize complex nutritional information — part of the growing use of logos to steer harried grocery shoppers toward healthier choices.
The proliferation of such symbols is a worldwide phenomenon, with government regulators in Britain, Sweden and elsewhere establishing logo systems that concisely indicate how nutritious food products are. In the United States, however, corporations have been left to devise their own schemes. That's led to a patchwork of systems that some fear further confuses consumers already unsure about how to eat wisely.
On Monday, the Food and Drug Administration took a first step toward clearing matters up, inviting food companies, trade groups, watchdog organizations, medical experts and its overseas counterparts to share how front-label symbols, like the "traffic light" system used in Britain, can improve public health.
The FDA stressed the meeting was a preliminary step as it considers whether to establish a national symbol system. Any action is likely years away — and, even then, any system is likely to be voluntary.
Absent federal action, food manufacturers and retailers have taken matters into their own hands. PepsiCo Inc. uses the "Smart Spot" symbol on diet Pepsi, baked Lay's chips and other products. Hannaford Bros., a New England supermarket chain, uses a zero to three-star system to rate more than 25,000 food items it sells. And in Britain, the government has persuaded some food companies to use a ranking system with green, yellow and red lights to characterize whether a food is low, medium or high in fat, salt and sugar.
"A whole range of consumers like it and can use it. And the important thing is that we know that it is actually changing what is happening in the marketplace," said Claire Boville, of Britain's Food Standards Agency, citing increased sales of foods flagged with the green and yellow symbols. Last week, Hannaford reported similar results.
Tesco PLC, Britain's largest grocery chain, uses a slightly different symbol system that lists percentages of guideline daily amounts for various nutrients. It too has had an effect, as consumers sent sales of products like Choco Snaps and prawn mayonnaise sandwiches plummeting in favor of more healthful options, the company's Breda Mitchell told the FDA.
The General Mills and Kellogg's versions will be similar, highlighting fat, sugar, salt and other nutrient levels, as well what percentage each contributes to what consumers typically require, officials said.
Overall, there is little consistency among the competing symbol regimes in use, according to the FDA, as it works to glean more information about them.
"We really don't have adequate information about the various programs to understand how their criteria work and how they are used and understood by consumers ... and how they may effect market choice," said Michael Landa, deputy director of the FDA's food office.
While Landa said the agency is in information-gathering mode, one lawmaker said he would move forward with legislation compelling the FDA to establish a single set of nutrition symbols. The push comes as obesity rates continue to climb in most states.
"The proliferation of different nutrition symbols on food packaging, well-intended as it may be, is likely to further confuse, rather than assist, American consumers who are trying to make good nutrition choices for themselves and their families. FDA should take meaningful steps to establish some consistency to these many different systems of nutrition symbols," Sen. Tom Harkin, D-Iowa, chairman of the Senate agriculture committee, said in a statement.
A petition filed in November by the Center for Science in the Public Interest also asked the FDA to create a national front-label symbol system. Such a system should complement but not replace the sometimes dizzying information packed into the nutritional labels most foods now bear, said Michael Jacobson, the advocacy group's executive director.
"You could send a child to the store with 20 bucks and say, 'Johnny, you can buy whatever you want as long as it has a green dot — and you can get one red-dot food,'" Jacobson said.
Absent congressional action, Jacobson said it could take a decade for the FDA to set up such a system.
National Dairy Council nutrition expert Ann Marie Krautheim said setting up a consistent system would be helpful, if grounded in science and tested with consumers to ensure it worked. Shoppers spend as little as two seconds evaluating food labels, research shows.
Krautheim said her Council's own research showed taste still trumped all for consumers when choosing what to eat, with convenience, cost and nutrition all vying for second place.
"The ultimate goal, of course, is that the overall dietary pattern that consumers select is a healthful dietary pattern," said Barbara Schneeman, director of the FDA's nutrition office.
But the corporate symbols now in use don't necessarily flag what's bad for you — or even what's good.
"This does not say 'healthy.' It says 'better for you,'" said Richard Black, Kraft Food Inc.'s vice president of global nutrition, of the "Sensible Solutions" logo used on more than 500 of the company's products.
The FDA already allows food companies to use "fat-free" and other claims on labels. Those claims are voluntary, but are subject to FDA regulation. Likewise, the Grocery Manufacturers Association and food companies want the use of symbols to remain voluntary.
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On the Net:
FDA public hearing information: http://www.cfsan.fda.gov/comm/registe6.html
Ark. kids holding own against obesity
Mon, 10 Sep 2007 20:13:56 GMT
By JILL ZEMAN, Associated Press Writer
LITTLE ROCK, Ark. - Arkansas schoolchildren appear to be holding their own in the battle against bulge. Body mass indices released Monday in the nation's first state to track the numbers showed 20.6 percent of schoolchildren tested last school year were overweight and 17.2 percent were at risk for being overweight. That's about the same as the year before.
State officials were optimistic but urged diligence.
"We've got to keep everybody engaged and working hard, or we're going to lose a future generation of kids to this epidemic," Arkansas Surgeon General Joe Thompson said.
Arkansas tested 366,801 students out of 472,000 last year. Thompson said absenteeism was the biggest reason why only 77 percent were weighed, though some families formally opted out of the program.
In the previous school year, 20.5 percent of 369,416 tested were overweight, with 17.1 percent considered at risk.
The state began measuring students' body mass indexes annually starting in 2003. The effort was championed by then-Gov. Mike Huckabee, now a Republican presidential candidate who lost more than 100 pounds after being diagnosed with diabetes. Many states have adopted similar programs.
But state legislators this year relaxed the standards. Pupils are now measured in kindergarten and in even-numbered grades, with high school juniors and seniors exempt.
Some lawmakers argued that requiring the BMI screenings could stigmatize youth, particularly teenagers whose eating and exercise habits were unlikely to change. During this year's legislative session, some lawmakers tried first to repeal the required BMI tracking and eventually ended up with a compromise bill that only weakened the law.
"If the children that opt out — or the parents who opt out — are the more overweight children, the data will be skewed," said Jim Raczynski, dean of the University of Arkansas for Medical Sciences' College of Public Health. "It will look like there are fewer overweight children when in fact there aren't."
Raczynski said the reliability of the reports will now depend on the number of students who don't want their BMI tracked.
When Arkansas adopted the BMI testing program, the state ranked third in the nation in obesity, according to the Centers for Disease Control and Prevention.
Even under the program's recent changes, Thompson said the state will still be able to reach out to children with its BMI reports and through other efforts to cut down on obesity among youth, such as limits on junk food sales at schools. He cautioned that parents must also step up.
"After four years of reporting to every parent, we are transferring some of the responsibility back to the parents," Thompson said. "That's an imbalance that's OK."
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Associated Press writer Andrew DeMillo in Little Rock contributed to this report.
Thousands of GIs cope with brain damage
Mon, 10 Sep 2007 07:41:24 GMT
By MARILYNN MARCHIONE, AP Medical Writer
NASHVILLE, Tenn. - The war in Iraq is not over, but one legacy is already here in this city and others across America: an epidemic of brain-damaged soldiers.
Thousands of troops have been diagnosed with traumatic brain injury, or TBI. These blast-caused head injuries are so different from the ones doctors are used to seeing from falls and car crashes that treating them is as much faith as it is science.
"I've been in the field for 20-plus years dealing with TBI. I have a very experienced staff. And they're saying to me, 'We're seeing things we've never seen before,'" said Sandy Schneider, director of Vanderbilt University's brain injury rehabilitation program.
Doctors also are realizing that symptoms overlap with post-traumatic stress disorder, and that both must be treated. Odd as it may seem, brain injury can protect against PTSD by blurring awareness of what happened.
But as memory improves, emotional problems can emerge: One of the first "graduates" of Vanderbilt's program committed suicide three weeks later.
"Of all the ones here, he would not have been the one we would have thought," Schneider said. "They called him the Michelangelo of Fort Campbell" — a guy who planned to go to art school.
As more troops return from the war, brain injuries are a growing burden — for them, for the few programs to treat them, and for taxpayers who pay for their care and disability if they cannot hold jobs.
Most TBIs are mild, and most of these patients recover within a year. But one-fifth of the troops with these mild injuries will have prolonged or lifelong symptoms and need continuing care, the military estimates. Nearly all of the moderate and severe ones will, too.
Though the full number of those suffering from TBI is still unknown, the problem is straining the U.S. Department of Veterans Affairs. Until now, "they were dealing with a cohort of aging veterans with diabetes, heart disease, lung disease," said Dr. Jeffrey Drazen, editor-in-chief of the New England Journal of Medicine and a VA adviser.
Now, these young, brain-injured troops need highly specialized care, and how much it will help long-term is unknown, he said.
People with TBI have frequent headaches, dizziness, and trouble concentrating and sleeping. They may be depressed, irritable and confused, and easily provoked or distracted. Speech or vision also can be impaired.
Some sufferers have been misdiagnosed with personality disorders. Others have lost jobs because of unrecognized and untreated symptoms.
"It's the so-called invisible injury. It's where a troop takes 10 times the normal time to pack his rucksack ... a complicated injury to the most complicated part of the body," said Dr. Alisa Gean, a neurosurgeon at the University of California, San Francisco.
Diagnosing it is imprecise — damage rarely shows up on CAT scans or other tests.
Treating it is even more difficult. Lacking a cure, doctors focus on symptoms — headaches, anxiety, vision problems, etc. But they lack good treatments for some of these, too, and are considering some experimental approaches being pushed by private companies with little proof they work.
Many troops get no care at all. Some are sent back to fight with their brain injuries undetected, especially if they had no obvious wounds.
What happened to Eric O'Brien and Bryan Malone shows the scope of this problem.
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O'Brien, a 32-year-old Army staff sergeant from Iowa's Quad Cities, was teasing Malone, 22, a specialist from Haughton, La., in a Baghdad gym last summer.
"I told him and his workout partner: 'Put some more weight on it,'" prompting the men to get up. Seconds later, a rocket hit where they had sat. They survived, but a pressure wave from the blast coursed through their brains.
"I patted myself down head to toe, making sure I wasn't missing a limb," and felt odd, like "I must be missing a chunk of my head,'" O'Brien said. He remembers little else except walking through debris to pick up his iPod and sunglasses.
As for Malone, an air conditioning vent had fallen on his head and he had shrapnel wounds. He had multiple surgeries, spent several months in Walter Reed Army Medical Center and now has titanium mesh reinforcing his skull.
O'Brien, however, had shrapnel removed from his scalp and then was sent back to his unit — "no antibiotics, no pain medication or anything. They just sent me on my way."
When he later complained of pain, doctors gave him Motrin. When he discovered a trickle of blood from his hip, they said he would be fine. Six weeks later, when he could barely walk, tests revealed shrapnel in his hip. By then, he was having headaches and trouble sleeping.
O'Brien had been through multiple previous explosions — troops average one a month, a study found — and each raises the risk that the next one will do harm. Soldiers and Marines are proud and reluctant to go "off mission" just because "they get their bell rung," said Dr. Michael Kilpatrick, a top Defense Department physician.
"Most of the treatment is explaining the situation and giving the tincture of time — giving it time to heal," he said. If no big symptoms appear in eight to 12 hours, "they're probably ready to go back."
Officers also face pressure to return troops to duty, said Jordan Grafman, a neuroscientist who studies TBI at the National Institutes of Health.
"People don't want to lose these guys from their command — they can't replace them fast enough," he said.
During a surprise visit to Iraq with President Bush on Labor Day, Gen. Peter Pace, chairman of the Joint Chiefs of Staff, said the military was "much smarter about this now," and urged troops to watch for signs of TBI and post-traumatic stress.
"They are every bit as much battle injuries as is a bullet or shrapnel. It is OK, it is OK to seek help for those kinds of war wounds, and I ask you all to help your buddies understand what you see in them," he said.
But that was long after O'Brien was hurt. His TBI was not diagnosed for months, until his hip injury landed him back at Fort Campbell in Kentucky. By then, the Army needed help treating TBI and was contracting with private rehab centers like Schneider's at Vanderbilt.
Malone and O'Brien had become friends, helping each other cope with wounds.
"They were sent to us together," Schneider said.
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"I'll need to get milk and bread and eggs. Milk and bread and eggs. Next thing you know, I drive right by Wal-Mart," O'Brien said.
"I can vaguely tell you what we talked about at the beginning of this conversation," Malone said.
Memory trouble is a common sign of TBI. It isn't like Alzheimer's disease, where people are so disconnected from reality that they forget things like how a key works or where they live. It isn't like amnesia, where a chunk of the past is missing.
"I don't have any problem remembering the past. I have trouble with now," O'Brien said.
Multiple or complex tasks confound and irritate people with TBI. Therapists challenge them through exercises, like a computer game where they run a hot dog stand and must manage inventory, set prices, do banking and anticipate demand according to the weather.
Other therapy focuses on life skills like following directions while paying attention to something else.
"I counted three trash cans," O'Brien announced after a scouting mission to find landmarks using a map and tally cans along the way.
"I counted five," said therapist Jenny Owens.
Improving these skills is key to living a normal life, especially driving.
"Most of them don't drive. A van brings them down. They were hitting mailboxes, they'd get lost. We draw them maps and they forget when they're supposed to be here," Schneider said.
The Army gives some injured soldiers Palm Pilots — handheld computers to help manage their lives.
"It costs them more for us to miss two appointments than to give us one of these," O'Brien explained.
But devices and mental exercises do only so much. Troops must be able to use information and reason, but TBI keeps many from being aware of their gaps.
"They don't realize their judgment is impaired," said Vanderbilt neuropsychologist Elizabeth Fenimore.
The training that helped them in combat situations is hurting them now.
"These guys are taught to be alert all the time," so they sleep poorly, Schneider said.
"Their nervous system becomes acclimated to being constantly on alert — fight or flight," Fenimore said.
Malone knows it well.
"I worry about every little thing — people breaking into my house, loud booms ... I'm jumpy," he said.
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"I'm going to Afghanistan next year," said O'Brien, determined to stay in the Army and support his two daughters, who live with his ex-wife in Texas.
"I'm trying," added Malone. "They're telling me they don't think my brain can take it. I think, 'Why don't you let me decide?'"
Doctors don't know whether either will return. But after all they've been through, if one does and the other does not, "it's going to be tough," Malone said. "It's going to be tough for whichever one stays back."
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Associated Press writer Christine Simmons in Washington contributed to this report.
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On the Net:
Centers for Disease Control:
http://www.cdc.gov/ncipc/factsheets/tbi.htm
National Institutes of Health:
http://www.ninds.nih.gov/disorders/tbi/detail_tbi.htm
