Studies support Nutrition Labeling

number of calories determined for a "normal" person of the individual's height and activity level. The "normal" diet is maintained 'a fter reaching the desired weight. There are no restricted foods,and Gener,al Mills has no plans to create a line of Counterweight food products such as those of Weight Watchers. The advantage of Oounterweight is that the individual has the opportunity to lose weight in the framework of his own lifestyle. However, the ,true test is whether there can be a permanent change in eating habits without a reversion to familiar habits. Medical Weight Control in San Francisco seeks to change physical activity as well as eating habits (4, 5). It is a paraprofessional organization that provides supervision and support which doctors are not able to give. Diet and exercise are basic to the program. The American Diabetic Association's exchange method of dieting is used for the initial 7-week diet period. During the first week, the patients eat only high-protein foods. For each of the six weeks thereafter an additional exchange group is added. By the seventh week, all foods including fruit, vegetables, fats, and milk can be included. Concurrently, there is a graded program of aerobic exercises including jogging, walking, swimming, and cycling. This emphasis on exercise is important for weight reduction. However, the diet is not nutritionally well-balanced initially. Medical Weight Control costs $200 for an unlimited period of time. Although Medical Weight Control and Counterweight appeal to higher income clientele, obesity is also a problem of low-income persons. A marked inverse relationship between prevalence of obesityand socioeconomic status has been shown (6) . In Denver, the Department of Health and Hospitals' Nutrition Section offers nutrition counseling to lowincome obese and overweight patients referred by physicians through a Neighborhood Health Program (7). Economic resources, education levd, degree of motivation, and food preferences are considered to determine individual diet and exercise programs. There are periodic visits. Physicians interested in the study and treatment of overweight have formed the American Society of Bariatric Physicians, Inc., to &tudy the problem collectively (8) and publish a journal Obesity and Bariatric Medicine,l in which the I. Published by American Society of Bariatric Physi. cians, 333 W. Hampden Ave., Suite 307, Englewood, CO SOl 10, bimonthly, subscription $12.00 per year; single copies $4.00.

VOL. 5, NO. I, JAN.·MARCH, 1973

roles of medication , diet, and exercise in weight control are discussed. Popular magazines also have a role in the dissemination of weight control information. The current emphasis has a more ,r ational than emotional appeal. Di&cussion of misoonoeptions about weight control has been presented more frequently than fad diets (9, 10). Perhaps the publishers are responding to a demand by the public for more reliable and valid nutrition informtaion. The value of these publications for nutrition eduoation should not be discounted by nutritionists.

Current Research Much research in weight control is aimed at obesity prevention. The effects of meal frequency during weight reduction have been studied, but there is no conclusive evidence associating weight maintenance with more frequent mealeating (11, 12). Current work on fat cell count and size suggests that childhood is a critical period in the developmen.t of obesity (13). The number of fat cells is determined early in life. In overweight adults, there are increases in cell size and number of cells. Weight reduction leads to a decrease in cell size, but the number of cells remains constant. Therefore, an increased number of fat cells formed in childhood may be a factor in adult obesity. Perhaps a necessary factor in obesity prevention is a change in social values. In the Western culture, a fat baby is a symbol of "a healthy baby." In the Egyptian culture, excess weight in women is sod ally desimble. The question, therefore, becomes one of standards for optimal nutrition as prevention rather than weight reduction as a cure. It is here that nutrition education has a role. Obesity is a complexpwblem involv,i ngmany disciplines which must be integrated to reach a solution. Weight reduotion is unique for each individual. Carolyn A. Raab, Food and Nutrition Specialist, Agricultural Extension, University of Wy oming, Laramie.

REFERENCES 1. Van Itallie, T. B. and Campbell, R. G., Multidisciplinary approach to the problem of obesity. 1. Amer. Dietet. Assoc., 61: 385, 1972. 2. Stunkard, A. J., The success of TOPS, a self-help group. Postgrad. Med., 51: 143, 1972. 3. Anon., The General Mills way to reduce, Business Week, p. 6, Sept. 23, 1972. 4. Anon., Overweight comes from our 2000 years of trying to get enough to eat, California's H ealth, 30 (No.3): 6, 1972.

5. Murray, J.,They deal in diet sense, not magic, p. 3-5, Oakland Tribune, November 26, 1972. 6. Goldblatt, P. B., Moore, M. E., and Stunkard, A. J., Social factors in obesity, 1. Amer. Med. Assoc., 192: 1039, 1972. 7. Weight reduction neighborhood health program, 1. Amer. Med. Assoc., 218 : 1049, 1972. 8. Anon., Helpless heavyweights, Tim e, p. 51 , June 26,1972. 9. Knox, G. M., Ten common misconceptions about overweight and dieting, Better Homes & Gardens, p. 10, June, 1972. 10. The truth about the 25 most common weight control myths, Good Housekeeping, p. 205, November, 1972. 11. Fabry, P. and Tepperman, J., Meal frequency : a possible factor in human pathology, Amer. 1. Clin . Nutr., 23 : 1059, 1972. 12. Effects of meal frequency during weight reduction, Nutr. Revs., 30: 158, 1972. 13. Hirsch, J., Can we modify the number of adipose cells? Postgrad. Med. 51: 83, 1972.

Studies Support Nutritio,n Labeling The Consumer ReseaTch Institute/ Food and Drug Administration, Nutrient Labeling Research Program l was developed to determine what was the best way to communicate nutritional value to the consumer public. This program was just one of several used in the development of guidelines for nutrient labeling. CRI found it did not make much difference whether the nutrition information w.as portrayed by a numerical percentage, verbal adjectives, or a pictorial system-though the consumers seemed to prefer the numerical system. They considered this to be a more precise expression of nutrient labeling. It was found that oonsumers will switch to products that are nutri,tionally superior.

Educational Aspects While the CRI survey was primarily to help the FDA on deciding the most appropriate information to be included on the label, there were several questions in it of signi,ficance to nutrition education. One segment of the program was carried out through a grocery mail order company. Those people purchasing through a catalog were given an opportuni,ty to use nutrition labeling in their choice-making. The other segment of the survey was face-to-face with shoppers. Those part,icipating in the purchase behavior experiment (mail order catalogs) said nutrition in food purchasing decisions was very important. Two-,thirds considered it of first importance over I. Consumer Research Institute, Inc., Interim Report of the First Two Phase's of the CRI/FDA Nutritional Labeling Research Program, Working Paper, Augu st, 1972.

Journal

of

NUTRITION EDUCATION / 7

price, taste or flavor, and ease .of preparati.on. Of th.ose interviewed face-t.o-face , 40% .of the black segment listed price as first, 35% listed nutriti.onal value as first. The white segment of the survey listed price and nutriti.onal value in .alm.ost exactly the same way. Taste .or flav.or was listed first in 19% and 21 % .of these segments. Th.ose pers.ons participating in the purchase behavi.or experiment were asked the questi.on: Which of these statements comes closest to expressing your feelings about nutrition? Answers included: 1) "I kn.ow a l.ot about nutriti.on in food, and I make sure my family has a nutriti.ous diet." (Bef.ore the experiment, 26% rated this questi.on first; after the labeling experiment, 20%.) 2) "Alth.ough I d.on't kn.ow a l.ot about nutriti.on, I try t.o plan my meals so that I feel my family is getting proper nutriti.on." (54% bef.ore; 63% after.) 3) "I feel that if I give my family a wide variety .of foods, they will get proper nutriti.on." (18% bef.ore; 16% after.) 4) "I ·t hink there is entirely too much fuss being made ab.out nutriti.on." (1.1 % bef.ore; 1.4% after.) On nutriti.on kn.owledge questi.ons, it was felt that a fairly high percentage .of the I.ow-inc.ome, uneducated, underprivileged segment .of .our populati.on had a certain am.ount .of "c.omm.on sense" kn.owledge .of what nutriti.on is all ab.out. C.onsumer awareness .of the existence .of vitamins increases sharply uP.on exposure t.o nutritional labeling.

Other Labeling Studies Another study, c.onducted by undergradua,t e nutriti.on students f.or the Consumers Cooperative, Inc., Berkeley, Calif., indicated that a nutriti.on educati.on program al.ong with labeling will increase the usefulness .of the labeling pr.ogram. This study als.o found there is very litde understanding of the differences between minimum daily requi.rements (MDR) and recommended daily all.owances (RDA). The shoppers, wh.o have been exposed t.o home ec.on.omics c.onsumer education pr.ograms f.or 11 ye.ars, stil~ had many misc.oncepti.ons ab.out nutrient content .of f.o.od. The label can help t.o bring ab.out understanding but will n.ot s.olve the problem (unpublished data). Still another study conducted by FDA and C.ornell pointed out that consumers feel they have a right to have nutriti.on inf.ormati.on available. Several fact.ors may explain the strong c.onsumer supP.ort for a nutrition labeling program: 8

I

Journal of NUTRITION EDUCATION

1. Consumel1S felt the program was "for" them and in their intere!>t; 2. Labeling is a general protecti.on against industry dishonesty .or concealment, acc.ording t.o consumers; 3. The pr.ogram might influence industry t.o improve the nutritional c.ontent .of f.o.od pr.oducts; and 4. Consumers als.o viewed labeling as a f.orm of acc.ountability .of the f.o.od industry.l Certainly the advent of nutrition labeling will be additi.onal m.otivation f.or nutrition education. Nutriti.on labeling cann.ot take the place of nutriti.on educati.on pr.ograms but will be a useful educational tool. H.D.U.

The Nitrite Dilemma: Pink and Preserved? Recently there has been controversy about the use .of nitrates and nitrites in the processing of meat and fish. This c.oncern .originated wi,t h the incidence of sympt.oms of nitrite t.oxicity in babies and the pr.oduction .of cancer in experimental animals (1). These animals had Teceived certain nitr.osamines formed from nitrite and amines. In view of the tenuous evidence, scientists have urged that the use of nitrates and nitrites in human foods n.ot be pr.ohibited until such aotion is justified .on the basis .of reliable data (2, 3, 4). The Nati.onal Academy .of Sciences established a Committee .on Nitrate Accumulati.on to examine problems associa.t ed ,vith nitrate nitrogen in the environment and to recommend c.ourses of acti.on (5). An overall review .of the use .of nitra>te and nitrite is being c.onducted by the FDA, USDA, and n.on-g.overnmental parties. In the N.ovember 3, 1972, Federal Register, FDA c.oncluded tha't "in view of the possible health hazard .of nitro samines, the use of nitrites and nitrates in fo.od sh.ould be limited to only th.ose uses which are essential in inhibiting the growth of C. botulinum and f.or obtaining the essential char.acteristics .of cured meats at this time" (6). Nitrites and nitrates are used in pr.ocessingcertain meats and fish t.o produce the characteri!Ytic pink c.olor, the "cured" flav.or, and most imp.ortantly, inhibit the gr.owth of the Clostridium bacteria. The am.ounts used ·are under g.overnmental regulation. In cured meat such as ham, bacon, frankfurters, and ,lunche.on meat, t.olerance limits are 500 ppm nilr.a te and I. Padberg, D. 1., a nd Taylor, D., Con sumers like but don't use nutritional labels, Focus on the Food Markets, New York State Cooperati ve Extension, Sept. IB, 1972.

200 ppm nitrite (5). Nitfa'te, in these am.ounts, is not c.onsidered toxic because it is excreted virtually unchanged. Infants Vulnerable In inf.ants of three months .or less, the I.oW acidity in the intestinal tract favors the gr.owth .of micr.o-organisms that c.onvert dietary nitrate t.o nitrite. After absorpti.on, the nitrite .oxidizes hem.ogl.obin's ir.on moiety t.o create methem.ogl.obin. The impairment .of oxygen transport by methemoglobin was rec.ognized as a health problem many years ag.o. Infants are deficient in two enzymes needed to convert the methem.ogI.obin back t.o hemoglobin. Therefore, y.oung infants are particularly sensitive to nitrate and nitrite from pr.ocessed meat .and fish in baby fo.ods. Such food additives .are justified only as preservatives and n.ot f.or "c.osmetic" value in infant foods. It is alS.o known that certain vegetables-suchas spinach, beets, brocc.oli , and collards-have a high content .of naturally .occurring nitrate (2, 6). The nitrate c.ontent varies with several factors including genetics, environmental stress, balance .of nutrients in the soil, and availability of nitrogen fr.om fertilizers. Under certain storage conditi.ons, the nitrate may be 'c.onverted t.o nitrite. It would be wise t.o av.oid the use of these highnitrate vegetables for baby f.oods. Nitrate Accumulation The Committee on Nitrate Accumulati.on states that man's urbanization, industrialization, and new agricultural practices have had an impact on nitrate accumulati.on in the environment (5). Nitrate is .often in high concentrati.on in drinking water. The Public Health Service recommends a limit .of 10 mg nitrate nitrogen per liter of water (7). Yet, there are pe.ople using well water in which this level is exceeded (2). This is of concern f.or infants, wh.o c.onsume more water per kg body weight than do adults. However, the Committee on Nitrate Accumulati.on believes that "Infant methemoglobinemia fr.om nitrate or nitrite in food or water, although of concern in special circumstances in the past, is not a major or widespread prDblem at present (5)." However, the issue of nitrosamine formation fr.om nitrite and sec.ondary or tertiary ,amines is still .of concern. Principal s.ources .of nitrite in the diet are cured meat and preserved fish. Cases of nitrite toXicity in adults are rare, but certain nitrosamines have carcin.ogenic, terat.ogenic, and mutagenic properties. The Committee Dn Nitrate Accumulati.on c.oncluded that "N.o evidence exists that the f.oodsconsumed by humam and VOL. 5, NO. I, JAN.-MARCH, 1973