LACMA’s Public Health Council Impacting Obesity & More (Part I of a Two-Part Series) | Formed in 2021 to forge a stronger partnership with the Los Angeles County Department of Public Health, local institutions, and non-profits, the Public Health Council is tackling public health issues with action. The following is a conversation with Dr. Jeffery Lee (LACMA’s immediate past president) and Dr. Vivek Gupta, LACMA member, both leaders of the PHC:
Q: What is the mission, goals, and purpose of the PHC?
The mission of the LACMA Public Health Council is to promote the physical, social, and mental health of the people of Los Angeles County through advocacy, policy development, and partnership with public health and community-based organizations. Our values are to support evidence-based, future-focused, equitable, feasible, and patient-centric public health policy and initiatives while respecting an individual’s personal health goals to promote their own best possible health outcome.Our specific goals are as follows:
Goals:
Q: Who are the PHC members?
Aileen Arevalo, Sheila Bonilla, MD; Shivani Dayal, MPH; Vivek Gupta, MD, MPH; Dayna Isaacs, MD, MPH; Sharon Jakus-Waldman, MD, MPH; Jefferey Lee, MD (Tri-Chair); Diana Shiba, MD (Tri-Chair); Heather Silverman, MD (Tri-Chair); Roxana Yoonessi, MD, JD; Evelyn Baghdasraian, MD
Q: What are the key issues the PHC is addressing?
Food Insecurity, Obesity, Mental Health
Q: Would you say, front of package labeling is your top priority? If so, why?
Obesity-related conditions including heart disease, stroke, type 2 diabetes, and certain types of cancer, are the leading cause of preventable, premature death. As of 2020, the prevalence of obesity was 41.9% with total medical expenditures exceeding $173 billion. While obesity is a multi-faceted issue, one of the factors involved is the prevalence of high sugar and high foods are more addictive than cocaine. It is important to understand that the addictive nature does not mean that all of us can't control ourselves at all times, but it does mean that when we experience stress, anxiety, depression, boredom, celebration, happiness, etc. the prevalence of these foods makes them much harder to resist.
Every year food companies spend trillions of dollars to overwhelm our natural evolutionary systems of metabolic and weight balance by studying how to alter the macromolecules or the mouth feel of these ultra-processed foods to make us want them more and more. One way to address this issue is to provide front-of-the-label packaging which serves as mental heuristics to easily help consumers to make better decisions. Given a lot of these cravings are hard-wired in our minds, the simpler the information, the more effective.Various countries, most prominently Chile, have shown the effectiveness of front-of-the-package labeling with simple labels (high sugar, high fat, high calories), and we believe bringing that intervention to the United States will help all of us tremendously.
Q: What progress has been made to date on this issue and what do you hope to accomplish in the longer term?
The FDA is considering front-of-the-label food packaging as part of a larger initiative on food insecurity and nutrition, but we know that the food industry will try to push back and try to dilute the regulations. Our hope is to provide a countervailing force of public opinion to pressure the FDA to enact bold and effective changes. Right now, we are submitting a letter of testimony to the FDA, we are submitting a resolution to CMA supporting front-of-packaging labeling. We are also engaging with local cities such as Arcadia to pass ordinances showing support for these measures and plan to engage multiple physician and health organizations throughout the country. We also want to work on a public and community relations campaign to continue increasing awareness around this extremely effective intervention.
Q: Chile’s Law of Food Labeling and Advertising, implemented in 2016, was the first national regulation to jointly mandate front-of-package warning labels, restrict child-directed marketing, and ban sales in schools of all foods and beverages containing added sugars, sodium, or saturated fats that exceed set nutrient or calorie thresholds. How effective have these interventions been and why doesn’t the US have such a law?
In 2016, Chile introduced and implemented Law 20.606 which among other provisions, established nutritional profile limits for energy and nutrients of concern and mandated warning labels on the front of packaged food items. Studies in the succeeding years demonstrated purchases of sugar-sweetened beverages significantly declined and companies reformulated products to meet the new standards and decreased total energy, sugar, and fat in the foods they sold. Additionally, many citizens responded positively to the changes and felt the law was changing perceptions and healthier eating amongst their children and, interestingly, the economic impact has been negligible with the affected industries showing no reduction in employment or decrease in wages. This evidence in Chile has objectively shown shockingly positive changes from the passage of adding simple FOLP requirements. This intervention is not only effective but does not infringe on consumer rights but instead front of the labeling marketing seeks to increase transparency in the marketplace and allows consumers to easily know what they are putting into their bodies
In the US, as above, the FDA is considering implementing similar changes, but we predict it will phase significant challenges from the food industry and this is why it is important LACMA devotes its efforts to help push these changes into law.
Q: Are there other best practices such as the Chilean model?
While Chile was the first country to adopt these innovative measures in 2012, since then Peru (2013), Mexico (2014 with re-design 2020), Ecuador (2014), Bolivia (2017), Brazil (2020), Venezuela (2020, 2021), Columbia (2021), and Argentina (2021) adopted front of the label packaging. Canada also recently passed similar laws and manufacturers in our Northern neighbor have until Jan 1, 2026, to change labels to comply with the regulations.Early research is very promising for all of these interventions and provides further evidence of the urgent need to implement FOLP in the United States.
Q: Why might some be opposed to front labeling even with evidence-based data?
While it is always best to consider all sides to an issue to understand its impacts, in this case, all research shows only positive effects. In Chile, the food industry's arguments against Law 20.606 were a lack of rationale for the measure; violation of international commitments; criticisms of the warning system; discrimination against industrialized packaged food; criticisms of the nutrient profile model; other criticisms of aspects specific to the draft decree; and adverse economic effects. In the succeeding year, the research has debunked these fears and even the economic impact, perhaps the most valid criticism, has borne out to not have materialized. A few years after the law, there was no difference in labor market rates in the markets affected by the regulations. Even those opposed to governmental overreach should be comforted that no specific food item is banned and the consumer choice is not infringed.
Q: What do you want members to know? To do?
FOLP works, as evidenced by the experience of many other countries in the Americas. Too many of our calories come from ultra-processed foods with too many calories and too many grams of fat and sugar. The important thing to know is that this isn't a willpower or personal responsibility issue, 70 percent of us struggle with weight and the reason for that is our bodies for one hundred thousand years were forged for ice ages, starvation, famine, war, and poverty; 70 years ago the world changed, and now we are constantly surrounded by incredibly addictive foods. The problem is not the discipline of 7 out of 10 of Americans, but instead, we are stressed, tired, overworked, and overburdened and it makes logical sense why we may be drawn to momentary escapes from these difficult experiences. The only way to counter-act this is to fundamentally change our food environment which of course is a much more arduous task. Until then, FOLP packaging can at least provide simple mental heuristics to guide our current world and help us easily make good nutritional decisions for ourselves and our families.
Therefore we encourage members to join us, and let us know what else we could be doing and/or any other partners we should be engaging with.
Next week we will share the PHC’s work relative to food insecurity including Assembly Bill 1644, CalAIM(medically supported meals, food prescriptions), Assembly Bill 679 (Childcare Ask), Senate Bill 600 (Increase CalFresh minimum benefit to $50)and Assembly Bill 605 (CalFresh fruit and vegetable, EPT card for grocery stores).
To learn more, visit: https://www.lacmainteractive.com/lacma-public-health-council or email us: info@lacmanet.org.
LACMA Partnership with CESLAC |LACMA partnered with the UCLA Center for Latino Health and Culture during the pandemic to identify key issues facing Latinx healthcare professionals, specifically physicians and those entering the medical profession. The result is the creation of the first Latinx Leadership Institute to engage and empower the future of medicine in Los Angeles County through learning, mentoring, teaching, and more. We are proud to work closely with Dr. David Hayes Bautista and his team at CESLAC and special thanks to Dr. Hector Flores, LACMA executive committee member for his devotion to this project which will make a difference in the lives of current and future Latinx physicians as they navigate change, imposter syndrome, systemic bias and more. Stay tuned for details on the institute unveiling, locations, and schedule.
Cesar Chavez Day on March 31, 2023 |Cesar Chavez Day on March 31 is a federal commemorative holiday and a state holiday, celebrated to honor the enduring legacy of the American labor rights activist. Chavez was a Mexican-American farm worker, who along with Dolores Huerta, co-founded the National Farm Workers Association.
Healthcare Burnout Symposium Highlights and New Clear as Mud Episodes | For those who missed the Healthcare Burnout Symposium in February, please CLICK HERE to catch highlights of the well-attended conference that took place at the UCLA Luskin Conference Center. Please also check out the 2 new special Clear as Mud episodes recorded at the symposium.
If you were unable to attend the event, please CLICK HERE to access the on-demand Healthcare Burnout Symposium sessions as well as the entire network of on-demand content. CME credits are available for select sessions. LACMA members may reach out to Stephanie Mares for the coupon code that will take $200 off the full price of the 6-month subscription.
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Chief Executive Officer
Los Angeles County Medical Association
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