What was the secret to the public health community’s triumph when past attempts to regulate the food industry failed?
There are three broad approaches to mediating the ruin of risky choices: inform people (like using labeling), nudge people (for example, by offering financial incentives), or directly intervene to make the activity less harmful. Which do you think prevented more car fatalities: mandating driver education, labeling cars about crash risk, or removing the human element altogether by just making sure airbags are installed? There are public education nutrition campaigns, ranging from “sugar pack” ads on public transit that inform consumers about the amount of sugar in soft drinks to “Hot Dogs Cause Butt Cancer” billboards that educate about the link between processed meat and colorectal cancer, as shown here and at 0:52 in my video How We Won the Fight to Ban Trans Fat.
But is there a way to make products nutritionally safer in the first place?
The ban on trans fats offers a useful lesson. In 1993, the Harvard Nurses’ Study found that high intake of trans fat may increase the risk of heart disease by 50%. That’s where the trans fat story started in Denmark, and it ended there a decade later with a ban on added trans fats in 2003. It took another 10 years, though, before the United States even started considering a ban. All the while, trans fats were killing an estimated tens of thousands of Americans every year, resulting in as many years of healthy life lost to conditions like meningitis, cervical cancer, and multiple sclerosis. If so many people were suffering and dying, why did it take so long for the United States to even suggest taking action?
One can look at the fight over New York City’s trans fat ban for a microcosm of the national debate. Opposition came down hard from the food industry, complaining about “government intrusion,” likening the city to a “nanny state.” Since trans fats can be naturally found in meat and dairy, the livestock industry echoed the Institute of Shortening and Edible Oils’ argument that everything should be eaten in moderation. Critics styled such proposals as the “rise of food fascism.” But it was the restaurant and food industry that limited consumer choice by so broadly fouling the food supply with these dangerous fats.
If “food zealots” get their wish in banning added trans fats, another argument went, what’s next? Vested corporate interests tend to rally around these kinds of “slippery slope” arguments to try to distract from the very real fact that people are dying. I mean, what if the government tries to make us eat broccoli?! This actually came up in a Supreme Court case over Obamacare. Chief Justice John Roberts suggested Congress could start “ordering everyone to buy vegetables,” a fear Justice Ruth Bader Ginsburg dubbed “the broccoli horror.” Technically, Congress could compel the American public to eat more plant-based food, Justice Ginsburg wrote, yet one can’t “offer the ‘hypothetical and unreal possibility’…of a vegetarian state as a credible reason.” As one legal scholar put it, “Judges and lawyers live on the slippery slope of analogies; they are not supposed to ski it to the bottom.”
New York City finally won its trans-fat fight, preserving its status as a public health leader. For example, New York banned lead paint 18 years before federal action was taken, despite decades of unequivocal evidence of its harm. Comparing stroke and heart attack rates before and after the rollout of the trans-fat ban in different New York counties, researchers estimate it successfully reduced cardiovascular death rates by about 5%. This then became the model for the nationwide ban years later. How was the public health community able to triumph when attempts in the past to regulate the food industry failed? If you had asked me about the odds of a national trans-fat ban, I would have said, “Fat chance.”
In Denmark, as a leading Danish cardiologist put it, “Instead of warning consumers about trans fats and telling them what they are, we’ve [the Danes] simply removed them.” But we’re Americans! “As they say in North America: ‘You can put poison in food if you label it properly.’” If people know the risks, the argument goes, they should be able to eat whatever they want. But that’s assuming they’re given all the facts, which isn’t always the case given the food industry’s “model of systemic dishonesty,” as one health ethics professor put it. Given the predilection for predatory deception and manipulation, government intervention was deemed necessary, but how was it going to get passed?
First, there was a labeling requirement. Manufacturers had to start adding trans-fat content to products’ nutrition facts labeling. This was ostensibly to influence consumers, but it may have had a bigger impact on producers. Now that they had to divulge the truth, companies scrambled to reformulate their products to gain a “no trans fat” competitive edge.
Within years of the mandatory disclosure, more than 5,000 products were introduced touting low or zero trans fats on their labels. Kentucky Fried Chicken went from being sued for having some of the highest trans-fat levels to running an ad campaign where mom tells dad in front of kids that KFC now has zero grams of trans fat, and the father yells, “Yeah baby! Whoooo!!” and begins eating fried chicken by the bucketful. That was the secret to passing the ban. Once the major food industry players had already reformulated their products and bragged about it—once there wasn’t so much money at stake—then there was insufficient political will to block the ban, and added trans fats were taken off the playing field.
Doctor’s Note
It’s important to note that the ban on trans fats didn’t affect the trans fats found in meat and dairy. See Banning Trans Fat in Processed Foods but Not Animal Fat.
If you missed it, in the video Do Healthy Fast Food Options Lead to Healthier Choices?, I discussed how listing calories on menus doesn’t actually get people to choose healthier options.
Stay tuned for Ultra-Processed Junk Food Put to the Test.
