At a time in history when we, as citizens of postindustrial societies, have unprecedented access to food (although not everybody can actually afford it), we appear to be saddled with growing anxieties about what we should actually eat and about what the food we eat does to us—and for good reasons. Weight excess, poor diet, high fasting plasma glucose levels, and alcohol-use disorders have a profound impact on the well-being of individuals and communities. Recent research identifies such food-related issues among the major health risk factors for adults in the United States.1 Although this trend is clear in most countries in the Global North, it’s also emerging in the rest of the world. Something is clearly wrong, and governments are taking action.2
Obesity, discussed with an increasing sense of urgency, has emerged as one of the most pressing issues.3 The World Health Organization (WHO) indicates it as a condition that increases the chances of developing noncommunicable ailments such as diabetes, cardiovascular conditions, osteoarthritis, and even some cancers, including breast, ovarian, liver, and colon cancers.4 A priority in public health policies, obesity is described as an “epidemic” and a costly burden on healthcare systems. The majority of nutritionists indicate overeating as the main cause for obesity, which nonetheless cannot be decontextualized from environmental factors such as the excessive use of cars and forms of entertainment that do not require physical efforts, as well as the tendency toward overproduction in a market dominated by large food corporations. The global food system produces cheap, calorie-rich, nutrient-poor food and underpays workers, who are then forced to buy cheap food (as many workers in other industries do as well). This vicious cycle keeps the economic system afloat, although in an unsustainable manner, while poorly paid wage earners are ultimately blamed for consuming the wrong kinds of food and therefore for gaining weight.
Accessible and cheap food constantly stimulates us to buy and eat more in a marketplace that is increasingly globalized, competitive, and fragmented. Food advertising and other forms of commercial promotion—from special offers to toys for children—also influence purchasing choices, advancing the food industry’s agenda. Yet attempts at curbing overconsumption and establishing sustainable forms of food production and consumption come up against the food industry’s ambitions to boost sales constantly to ensure financial returns to their investors.5 We are relentlessly stimulated to consume more food, and the consequences of such excess are in front of our eyes, both personally and socially.
However, in public discourse, obese people carry the stigma of lack of will and determination. Mainstream popular culture overall denounces large bodies as the consequence of misguided personal choices. Media strive constantly to provide apparently easy solutions to the issue, from piecemeal nutritional advice to diets with doubtful pedigrees. The debates about obesity show how scientific research, medical practices, and nutritional concerns get entangled with cultural bias, social structures, economic interests, and political negotiations. Opinions diverge between considering obesity as a personal matter and framing it as a systemic issue that requires public and political interventions. It’s increasingly getting harder for citizens to understand the complexities of public health dynamics that individual decisions simply can’t solve in terms of choice and responsibility within a free market.
In this chapter, we’ll explore how ideas, values, and practices surrounding a healthy diet are discussed, shaped, and diffused in contemporary postindustrial societies. We’ll start from the consumers’ experience, focusing on the contradictory advice consumers are exposed to through popular culture and marketing. We’ll then reflect on how the industry is trying to take advantage of such confusion to make health claims about its products and how consumers try to ease their anxieties by pinpointing specific ingredients to be avoided.
Against this background, governments try to provide reliable information through nutritional labels on packaged food, meant to guide purchasing choices, and food guides, which should offer clear dietary models based on sound nutritional science. However, both tools are enmeshed in political negotiations and are subject to pressures from the food industry lobbying. The chapter will finally explore how the tension between public health and private interests also has an impact on domains as diverse as choices about food in schools and food-safety policies.
What should we do, as consumers and citizens, to take good care of ourselves and our families? What sort of eating habits should we embrace to ensure our health and well-being? We are bombarded with an overwhelming amount of information coming from our peers, media, food producers, national governments, and international organizations. What’s worse, the pieces of advice we receive are often contradictory. What sources should we trust? Whose advice is more reliable?
The very nature of scientific research can create a sense of confusion among consumers if not properly explained because its conclusions and recommendations evolve over time by confirming, modifying, or refuting previous findings. Nutrition research is challenging because it is virtually impossible to control the myriad elements that can impact food consumption and behaviors for prolonged periods to isolate and observe specific factors. Human subjects can’t be studied like mice. Single-ingredient or single-nutrient studies are particularly difficult. Today salt is bad for you and doctors agree on recommending a reduction in its intake, especially in the presence of heart disease and other chronic conditions. Tomorrow a different report may come out that complicates this clear-cut advice. One day drinking wine is good for you. The next day new studies highlight its dangers. Perplexity caused by nutritional advice is amplified when it’s taken out of the context of scientific research and scholarly publications. Furthermore, the influence the food industry wields on researchers by funding studies that usually works in its favor only increases suspicion among the general public.6 For example, in the 1960s, the sugar industry contributed to studies that minimized the impact of sugar as a risk factor for coronary heart disease while pointing to fat as the main culprit.7
In the 1960s, the sugar industry contributed to studies that minimized the impact of sugar as a risk factor for coronary heart disease while pointing to fat as the main culprit.
Media play a central role in maintaining this state of confusion. Media organizations often carry news about health, nutrition, and dieting as concerns about these topics intensify among their audiences. Always looking for exciting stories, writers, bloggers, and newscasters are quick to relay research results without providing any background information. Scientific studies are turned into simple, digestible tips that fit well into forms of communication that favor easy, well-defined explanations of complex topics. Readers are offered bits of unrelated news about this specific nutrient or that substance, without any systematic and thorough explanations. Journalists may opt for clear, simple, ready-to-apply pieces of advice and do-it-yourself recipes, avoiding complex issues and providing a mass of information that often stokes health-related fears. The deluge of piecemeal—at times even contradictory—suggestions from the media gives the impression that science cannot be trusted, with the consequence that consumers may end up heeding the opinions of friends, family, bloggers, influencers, and self-proclaimed experts (often co-opted and paid by special interests and the food industry itself). Exhausted, some decide to just follow their own preferences, arguing that reading one’s body is more important than listening to the confusion in the news. Others proceed to “detox” themselves or embark on “full cleanses,” supposedly being proactive in taking wellness into their own hands but often subjecting their bodies to unnecessary stress.
Looking for easy-to-follow solutions, consumers end up demonizing certain substances (fat, carbs, gluten) while looking for the next great “superfoods.” Products like quinoa, açai, spirulina, goji berries, and moringa constitute a particularly interesting category. They come to the Global North from faraway lands, which increases their exotic charm and allows consumers to attribute them extraordinary nutritional characteristics, often blown out of proportion without the support of serious scientific research. They are sold at high prices, with little or no consideration for the impact that the sudden growth of demand for these products could have on the farmers that grow them, usually located in the Global South. They appeal as comfortable ways out from complicated and potentially stressful choices. Herbal products, traditional remedies, and even references to ancient medical theories, from humors to Ayurveda, provide the same appeasement of anxieties. Such practices are taken out of their cultural and historical context to be packaged and marketed for easy consumption.
Superfoods offer simple—and lucrative—answers to very complex problems: rather than dealing with changes of habits and diets or trying to understand intricate metabolic functions, their consumption assuages the concerns connected with ingestion. The attractiveness of superfoods and exotic or traditional remedies is also related to the diffusion of an approach to eating and health that has been described as nutritionism, characterized by “a reductive focus on the nutrient composition of foods as the means for understanding their healthfulness, as well as by a reductive interpretation of the focus of these nutrients in bodily health,” with little concern for the level of processing or quality.8 Consumers attuned to such approaches shift their attention from foods to individual nutrients: polyphenols in red wine are good antioxidants; lycopene in tomatoes can prevent certain kinds of cancer. Such nutrients also can be ingested outside their natural carriers. Why bothering to cook fish when you can simply ingest omega-3 capsules? Why worry about a balanced diet when you can make up for any deficiencies by consuming vitamins, fiber, or fortified foods? Because of the diffusion of such attitudes, which threaten consumers’ emotional and cultural connections with food, nutraceuticals—a largely unregulated category of dietary supplements that are attributed pharmaceutical-like effectiveness—have become a thriving business.
The food industry takes advantage of such confusion to market its products by touting their allegedly positive contributions to consumers’ well-being. Food packaging may carry marketing communication that ranges from health claims (“good for your heart,” “lowers your cholesterol”) to connections with popular diets (“Atkins-friendly”). Obvious pieces of information try to bank on trends and food fads (“gluten free” on olive oil, for instance), as well as on the addition of supposedly beneficial but unregulated ingredients (“contains activated charcoal”). In some countries, national authorities strictly control such claims and unfounded assertions can be contested in court; elsewhere, the rules are looser, allowing for more creativity on the part of food manufacturers and their marketing departments. Food companies take risks with health claims because they are aware that consumers are receptive, regardless of what nutrition, medicine, biology, and genetics—among other scientific disciplines—indicate as the best advice.
Just as consumers want to be reassured about what is good for them, they also need to identify well-defined culprits they can easily avoid. Public debates, media controversies, and consumers’ association campaigns have emerged around substances such as palm oil or high-fructose corn syrup (HFCS), which the food industry routinely adds to prepackaged products to increase their stability and shelf life. Palm oil, traditionally used in West African and Northeastern Brazilian cuisines, is a saturated fat, rich in vitamin A in its fresh form. As the health dangers of trans fats became clear, food manufacturers slowly replaced them with processed palm oil, which shares some of the same properties in terms of food stabilization but may increase risk factors for heart disease. The cultivation of oil palms has expanded from Africa to Malaysia and Indonesia, causing concerns about the environmental impact on forests, which are destroyed to make room for plantations, and on endangered species, such as orangutans in Indonesia. Land may be cleared without the permission of local communities, which become exploited labor in the plantations.
Ethical and health concerns also reverberate in the United States in the controversies surrounding HFCS, a sweetener obtained from cornstarch that is widely used in processing because of its low cost, determined by subsidies for corn production. HFCS, widely present in food of poor nutritional quality, is defended by the industry as a natural product that is not dangerous if consumed in moderation. However, in the public perception it has been tied to the increase in obesity rates and the incidence of heart disease, and it is suspected of retaining contaminants used during its production, such as mercury. The tone of the debate often turns heated, even frenzied, expressing deep-seated anxieties and precluding accurate and careful assessments of the issue.
The cultivation of oil palms has expanded from Africa to Malaysia and Indonesia, causing concerns about the environmental impact on forests, which are destroyed to make room for plantations, and on endangered species, such as orangutans in Indonesia.
Against this background of confusion and misinformation, governments have recourse to various tools to help citizens make sound dietary choices and embrace healthy habits. Nutritional labels on prepackaged food, which governments impose on the food industry, directly communicate with consumers to offer guidance in their purchases. Labeling regulations are constantly updated to respond to evolving scientific findings and to improve the clarity of the information provided to the public. However, the extent and effectiveness of such updates may vary greatly, as the food industry constantly pushes back on anything it perceives as a limitation on their business.
In 2013, Chile introduced logo-like marks to be added to packaging and containers together with the existing nutritional labels.9 Such marks immediately signal when products are high in calories, sugar, fats, or salt. If these parameters go beyond specific limits set by law, a product can be neither advertised to children nor sold in educational establishments. The EU also approved changes in the regulations concerning labels on prepackaged products in 2014.10 Beside the existing nutritional information, products must carry clear indications about the presence of allergens; mandatory origin information for fresh meat from pigs, sheep, goats, and poultry; the presence of added proteins and substitute ingredients for “imitation” foods; an indication for defrosted products; and a list of any engineered nanomaterials (flavor enhancers, gelation agents, and nanoparticles to remove pathogens from food or to ensure better availability of nutrients are being researched and tested).11
Within the EU, various countries are also experimenting with more direct information about the overall health characteristics of prepackaged foods. In 2013, the UK Department of Health introduced a voluntary “traffic light” system in which the content of salt, sugar, fats, and saturated fats is marked as red, amber, or green, according to nutritional guidelines.12 Foods with a prevalence of reds are to be consumed occasionally or as a treat, whereas those with more greens are to be considered better health choices. The food industry is strongly resisting the system. In 2017, France also adopted a voluntary traffic light model made up of five colors (dark green, light green, yellow, orange, and red), combined with the first five letters of the alphabet, A to E.13 The letters express the level of wholesomeness (A for most wholesome, E for least), taking into account the favorable characteristics of each product (e.g., the presence of protein, dietary fiber, vitamins, and minerals) in addition to salt, fats, and sugar.
In 2016, the US Food and Drug Administration introduced an updated labeling system it intended to be easier to understand while reflecting the now widely accepted links between diet and chronic diseases.14 The new labels take a more realistic stance on the serving sizes Americans actually consume (larger than in the past) and make the total number of calories more visible. They also eliminate the number of calories derived from fat, as research suggests that the type of fat consumed is more important than its quantity. Added sugars are clearly marked to avoid excessive consumption; vitamins A and C are no longer indicated because deficiencies are rare; and vitamin D, calcium, iron, and potassium are now signaled. However, these labels immediately caused a strong reaction in the food industry, which constitutes a powerful lobby in the United States. Consequently, the dates for compliance with the new labels have been moved from 2018 to 2020 for manufacturers declaring $10 million or more in food sales per year and to 2021 for those with lower sales.
The contrast between public health priorities and the financial interests of the food industry (and its investors) also emerges in the negotiations surrounding the development of national dietary guidelines. Based on current nutritional research and meant to direct public health policy and interventions, these guidelines are often very complex and technical. For this reason, governments also issue food guides for the general public that are more accessible and relate to the experience of individuals and their eating choices. Issuing food guides is not a small feat. Within national authorities, contrasting interests and political approaches make deliberations complex and lengthy. Large food businesses, which in many countries wield financial and political influence, also intervene to defend their profits. The result are food guides that often represent compromises among the stakeholders involved.
The United States constitutes an interesting case, as it was one of the first countries to embrace such tools. The US Department of Agriculture (USDA) started publishing food guides in the early 1900s. During World War II, the Guide to Good Eating was issued, defining seven food groups and the optimal quantities of each.15 The USDA went through several iterations of its recommendations, drawing particular attention with the launch of the Food Guide Pyramid in 1992. This model, reflecting nutrition research and consumers’ perceptions, introduced a dietary approach based on concepts of moderation, variety, and proportion among different food groups, clearly indicated by superimposed areas made progressively smaller toward the top to visually indicate what foods need to be consumed in limited quantities.16 In the following years, the visual pyramid model was also adopted by India and adapted to a pagoda model in China.17 The United States maintained the pyramid concept in the 2005 MyPyramid Food Guidance System, which underlined the relevance of physical activity by adding “stairs” up the side of the pyramid with a stick figure climbing them and added a new category for oils.18 However, images of food disappeared and the design changed the food groups from horizontal areas to parallel vertical stripes of different widths, mitigating the visual message that some elements need to be consumed in smaller quantities than others. This idea was reiterated with the launch of MyPlate in 2011, in which a dish is divided into four nearly equivalent areas corresponding to vegetables, fruits, grains, and protein (a nutrient, not a food), accompanied by a small glass that represents dairy.19
The plate-based model had already appeared in the United Kingdom with the Eatwell Guide in 2007. In its revision, issued in 2016, the areas dedicated to plant-based foods are visibly larger; moreover, the protein section also includes nuts, beans, and legumes.20 In 2005 (with revisions in 2010), Japan adopted instead the image of a spinning top, which is basically a pyramid inverted, with dairy and fruit at the bottom and increasingly larger areas moving up for meat and fish dishes, vegetable dishes, and grain dishes.21 The handle of the top is represented by a glass of water or tea to remind consumers to hydrate properly. A small figure is depicted running on the spinning top, to indicate the centrality of physical activity. The most interesting characteristic here is that the model refers to cooked dishes, rather than ingredients, to make choices easier and more intuitive for consumers. Conceptually similar to the pyramid is the mortar and pestle (pilon) chosen to represent good dietary choices in the Dominican Republic. The choice of a kitchen tool that’s crucial in many local food preparations is meant to make the representation more appealing to consumers—in particular, to those in the household who choose what to cook and eat.22
Among the measures that governments adopt to improve the diets of their citizens, efforts focusing on school food have multiplied to create healthy food environments for children and to provide nutritious meals by reducing or eliminating excessive fats, sugar, and processed items. (In chapter 6, we’ll discuss the relevance of these programs in addressing food insecurity.) In the United States, the National School Lunch Program, in place since 1946, was revised in 2010 with the Healthy, Hunger-Free Kids Act. The regulation required more whole grains, vegetables, and fruits in school meals, reduced sodium and fat intake, and put à la carte menus and vending machines (often a source of high-calorie drinks) under federal control. Such changes were partially rolled back in 2017 when a new administration came to power, demonstrating the relevance of politics and the influence of the food industry on children’s nutrition. The importance of national politics also has become evident in Poland, where the government in power since 2015 has softened the previous administration’s ban on sales of and ads for junk food—including popular drożdżówki sweet buns—on school premises.23
Similar initiatives also exist in countries where children struggle to have regular access to food. Since its launch in 1995, the School Lunch Program in India has delivered cooked, balanced meals to millions of primary-school-goers of all castes. Brazil’s National School Feeding Program, which provides quality food produced by local farmers and school gardens, offers an example of wide-ranging interventions that are connected with policies aimed at eradicating hunger but also are exposed to changes in the political climate.24 In 2015, Bolivia launched a law on school food that connects health and food security with food sovereignty (see chapter 7) by giving particular relevance to fresh local crops and ingredients.25 Such programs frequently draw criticism from political forces that do not believe that governments should meddle with how citizens eat, as well as from those who think that school food constitutes a burden for public finances and taxpayers.
As embattled as they may be, national policies on children’s health and nutrition risk missing their goals if they do not include food education, which can take place through dedicated lessons, meals in school cafeterias, gardening, and other food-related activities. Unlike nutrition and health education, which focuses on scientific information about foods that are better to eat and those to avoid, food education introduces children to new ingredients and dishes, their flavors, and their textures, which is not an easy endeavor. It can take several attempts, which can be a financial burden for families with limited incomes that can’t afford to throw out new foods that children don’t want to eat. As a result, a broad palate and curiosity in tasting new things may become a class marker. To avoid this, each year since 1990 in France, the Week of Taste offers a series of instructional but playful events as part of food education.26 The initiative is meant to improve children’s food behavior and health by educating their goût (taste) and familiarizing them with a wide range of foods and flavors—in particular, French culinary traditions.27 In this case, food education also reflects concerns about the survival of national culinary traditions, perceived as threatened by globalization, and shows political undertones.
Reflecting similar anxieties, in 2005 Japan introduced the Basic Law for Food Education (shokuiku) to prevent the abandonment of the Japanese dietary model, considered healthy and nutritious, as a consequence of the growing preference for fast and foreign foods and of changing lifestyles.28 In 2008, the international Slow Food association launched the Edible School Gardens initiative, geared toward sensory education, as well as instruction about environmental, food production, and local food cultures.29 It follows the example of chef Alice Waters, who started the Edible Schoolyard project in the late 1990s in California to introduce children to healthy eating and different vegetable varieties.30 Chefs also are getting involved. TV celebrity Jamie Oliver launched a “food revolution” in the United Kingdom through a show that aired in 2005 and showed the dismal state of school food in the country. The public reaction was so intense that the government invested sizeable funds into improving the situation, with mixed results.31
The tension between the interests of the food industry and the well-being of citizens is apparent when it comes to food safety, a central concern for governments with major political implications, as we discussed in the previous chapter. In 1986, twenty-three people died in Italy for ingesting methanol that had been added to wine illegally to raise its alcohol content. In 1996, the EU voted for a total ban on beef from the United Kingdom because of the diffusion of bovine spongiform encephalopathy (BSE, more commonly known as mad cow disease). In 2008, milk and infant formula in China were adulterated with melamine, causing a hundred thousand illnesses and a few deaths and prompting the national authorities to decree executions and life prison for individuals involved, including officials. In the same year, over seven hundred people fell ill from salmonella in the United States after eating peanut butter from the Peanut Corporation of America, triggering the most extensive food recall to date. In 2011, an outbreak of over 1,500 cases of E. coli in Germany and other European countries, many of which presented life-threatening complications, was blamed on organic cucumbers grown in Southern Spain; the outbreak damaged consumers’ trust in organic products. In 2017, consumption of processed meat caused one of the world’s worst listeria outbreaks in South Africa, with almost two hundred victims. These and other innumerable—and luckily less deadly—cases have changed perceptions about food-related risks and food-safety practices around the world.
National authorities embrace different approaches to the protection of consumers: some leave it to food producers to self-regulate, while others impose strict controls and procedures. A few countries are gearing up to mandate traceability—the possibility of tracing a product back through all stages of production, processing, distribution, and retail while identifying all actors involved—as a measure to organize quick recalls in case of emergencies such as salmonella outbreaks or food contamination. Ongoing conflicts can be observed between the need for public interventions and coordination among all stakeholders in the food system on the one hand and the desire of authorities to avoid burdening entrepreneurs and businesses with excessive regulations on the other. To address such tensions at the international level, since 1961 the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization published the Codex Alimentarius, a constantly updated and internationally accepted set of standards, guidelines, and recommendations to ensure food safety and safeguard consumers’ health.32 Furthermore, the World Trade Organization introduced the Agreement on Sanitary and Phytosanitary Measures (the SPS Agreement), concerning the application of food-safety regulations in international trade.
Behavioral changes in dietary habits, better nutrition, and food safety—although crucial—are not the only aspects that require public action at the national and international levels to contribute to individual and communal health. In the next chapter, we’ll discuss how food systems also need to prioritize the well-being of all stakeholders involved by embracing the ambitious goal of long-term sustainability from environmental, social, and economic points of view.