In the most recent report from the World Health Organization on mortality and burden of disease attributable to major risks (Global Health Risks), nearly 1.7 million deaths were attributed to low intake of fruits and vegetables globally in 2004 (Table A3 WHO report 2009). In that report, insufficient intake of fruits and vegetables was estimated to have caused 14% of stomach cancer deaths, 11% of ischemic heart disease deaths and about 9% of stroke deaths world wide. The primary health benefit identified as relating to fruit and vegetables intake is its impact on reducing cardiovascular disease but also on the reduction of risk of specific cancers.

Despite the well-known understanding that fruits and vegetables should be included in a healthy diet, Americans are still falling far short of the recommended intake.  A recent report in the CDC Morbidity and Mortality Weekly Report (MMWR) released Sept 10, 2010 shows that not a single state in the U.S. met the national Healthy People 2010 targets for fruit & vegetable consumption. The CDC report estimates that in 2009, about a third (32.5%) of adults in the U.S. consumed fruit two or more times a day, and just over a quarter (26.3%) consumed vegetables three or more times a day – both far less than national targets. These data were developed from the analysis of the CDC Behavioral Risk Factor Surveillance System and underscore the need for more drastic national, state, and community action to increase fruit and vegetable intake.

It is clear that more needs to be done to improve access, availability and affordability of fruits and vegetables. Some of the challenges the public health community faces are:

• How do we increase the fruit and vegetable food supply (our supply chain) with the limited and shrinking availability of agricultural land?
• How do we overcome the barriers such as accessibility, affordability, taste and convenience to consuming fruit and vegetables?
• How can we deliver the goodness of fruit and vegetables in minimally processed forms that deliver the positive health impact of whole fruits and vegetables?
• How can we educate people, starting at a young age about the benefits of fruits and vegetables and encourage children to make eating fruits and vegetables a lifetime habit?

At PepsiCo we are taking a new look at these complicated issues and subsequent blogs will address the challenges listed above. Are there any other issues that you, our readers, would like us to consider?

A recent report from the U.S. Centers for Disease Control and Prevention (CDC) shows that 9 out of 10 Americans exceed the limit recommended for daily sodium intake. In fact, for the group of Americans whom a lower dietary intake of sodium is important, the amount of sodium consumed was more than double the recommended limit.

The CDC report also showed that only 9.6% of U.S. adults were below the recommended dietary limit of 2,300 mg per day for sodium; and only 5.5% among the group recommended to limit sodium intake to less than 1,500 mg per day achieved that target.  Overall, the average sodium consumption for U.S. adults was 3,466 mg per day, far in excess of the 2,300 mg per day recommended.  In the group of adults recommended to limit sodium intake to less than 1,500 mg per day, the actual intake averaged 3,366 mg per day. Excess dietary intake of sodium is not just an American issue but a genuine global health concern as emphasized by the World Action on Salt and Health and the World Health Organization.

Why is an excess intake of sodium a concern?  The scientific evidence is compelling that excess dietary sodium is associated with major adverse health outcomes, and that reducing this excess can be a cost-effective action that leads to a lower rate of new heart attack and stroke, as well as a lower death rate in all Americans, especially black men and women.

It has been estimated that 77% of dietary sodium intake in the U.S. comes from processed foods while another 11 percent comes from salt added at the table or during cooking. In the CDC report, most of the daily sodium consumed came from grain products such as yeast breads (36.9%) and meats, poultry, fish, and mixtures (27.9%), followed by vegetable products (12.4%).  The USDA has produced a list of the top products that contribute the most to daily sodium intake.

For any large scale sodium reduction strategy to be effective, it must engage all members of the entire food system including ingredient manufacturers, retailers, restaurants and especially the food industry.  PepsiCo has set a global goal and has made a commitment to reduce the average amount of sodium per serving in key global food brands, in key countries, by 25 percent by 2015, with a 2006 baseline. Given the capability we have today and substantial investments planned over the next 5 years, we believe we can achieve this goal.

For PepsiCo to achieve sodium reductions of 50% and greater, significant scientific and technological breakthroughs will be required and engagement of the broader scientific community is crucially needed. However, discussions of dietary sodium reductions today have typically been limited to public health officials, policy makers, health care providers and food industry scientists.  Conversations need to be broadened to include more than just these professionals. ‪

Input of scientists with expertise in taste perception; neurosensory receptor activation and signal transduction mechanisms; molecular and biophysical structure; and physiological properties of sodium salts is required to drive innovation.  We also need to engage scientists with expertise in socio-ecological determinants of lifestyle choices, behavioral economics, and choice architecture who can help nudge the public towards requesting and choosing foods and snacks with a reduced sodium content.‪

In the interim, we at PepsiCo are taking action today to increase the use of fruits, vegetables, whole grains, seeds, legumes, and nuts for which scientific evidence of health benefits exist.  In addition to our attention to sodium, we continue to invest in research and development and explore other opportunities (such as reducing added sugars, the saturated fat content, and calorie-density) to expand our product offerings.  We look forward to continuing the conversation on sodium and receiving input that may lead to even greater sodium reduction in foods without compromising taste, quality, and food safety.

References

1. CDC. Sodium Intake Among Adults — United States, 2005−2006. Morbidity and Mortality Weekly Report; June 25, 2010; 59(24);746-749. URL: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5924a4.htm.
2. World Action on Salt and Health (WASH). Salt & Health. URL: http://www.worldactiononsalt.com/health/salt_health.htm.
3. World Health Organization. Sodium intakes around the world. Background document prepared for the Forum and Technical meeting on Reducing Salt Intake in Populations (Paris 5-7th October 2006). URL: http://www.who.int/dietphysicalactivity/Elliot-brown-2007.pdf.
4. Bibbins-Domingo K, et al. Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease. The New England Journal of Medicine February 18, 2010; 362(7):590-599. URL: http://content.nejm.org/cgi/content/abstract/362/7/590
5. PepsiCo. 2009 Annual Report. Performance with Purpose – The Promise of PepsiCo. URL: http://www.pepsico.com/annual09/human_sustainability.html.
6. USDA.  National Nutrient Database for Standard Reference, Release 18; URL: http://www.nal.usda.gov/fnic/foodcomp/Data/SR18/nutrlist/sr18w307.pdf.
7. Mattes RD, Donnelly D.  Relative contributions of dietary sodium sources. Journal of the American College of Nutrition 1991;10(4):383-393.  URL: http://www.jacn.org/cgi/content/abstract/10/4/383?ijkey=7496e0ca4e5e9caa2531f3ceebdcad5cb082678c&keytype2=tf_ipsecsha
8. USDA. Could Behavioral Economics Help Improve Diet Quality for Nutrition Assistance Program Participants? DR Just, L Mancino, B Wansink (eds); Economic Research Report no. 43, June 2007. URL: http://www.ers.usda.gov/publications/err43/err43.pdf.

Note: The views expressed here represent the personal views of the authors and not necessarily the views of PepsiCo, Inc.

The highly-regarded Robert Wood Johnson Foundation and the Trust for America’s Health this week published the seventh annual edition of “F as in Fat”, a report on obesity in the U.S.  The report includes commentary by a variety of notable public figures.   Among them is PepsiCo Chairman and CEO Indra Nooyi.

The fact that the report would include comments from the leader of a food company, particularly one whose product portfolio includes treats like soft drinks and potato chips, has drawn some criticism.  The critics seem to feel there is no place for a food industry viewpoint in such a report.

I disagree.

To suggest PepsiCo and other food companies should not have a voice in the discussion of how to address global obesity seems counterproductive.

The UK Foresight Report on Obesity and the White House Report on Obesity both have spelled out roles industry can play in preventing obesity in children.  And leading food companies, including PepsiCo, have made specific commitments to obesity prevention.

Industry efforts include: reducing portion sizes and energy density through reformulation and replacement; altering marketing to make healthy choices easier; improving labeling; replacing certain products in schools; investing in research on satiety; and evolving business models to shift focus from volume to nutrition quality.

Before turning a cold shoulder on the food industry, consider how other large-scale problems have been addressed.  In my 10 years at the World Health Organization I saw private-public partnerships tangibly improve people’s lives by helping to tackle challenges ranging from AIDS and polio to motor vehicle injuries and child survival.  In every case, initial mistrust gave way to new solutions with real benefits.

What is World Health Day?

World Health Day 2010 is today, April 7. The theme this year is ‘1000 cities, 1000 lives’ and the focus is on opening up public spaces to health – via things like activities in parks, town hall meetings, clean-up campaigns, or closing off portions of streets to motorized vehicles. The World Health Organization aims to collect 1000 stories of urban health champions who have taken action and had a significant impact on health in their cities. Events are being held this week in cities all over the world in order to promote health in urban areas.

Why the focus on urbanization and health?

Currently over 3 billion people live in cities and over the next 30 years virtually all population growth will be in urban areas. The urban poor also suffer disproportionately from a wide range of diseases and other health problems. Health outcomes are determined from environmental, social and physical infrastructure conditions and other factors that are often affected by rapid, unplanned urbanization. From the diet and physical activity point of view, urban environments tend to discourage physical activity and promote unhealthy food consumption. Issues such as overcrowding, pollution and lack of safe public spaces make physical activity difficult in many cities. Urban environments also have a greater supply of energy-dense, nutrition-poor foods with high levels of fat, sugar and salt. A fast paced, urban lifestyle also usually increases the amount of fast foods available. In 2003, the date of the last WHO World Health Survey, at least half the countries studied reported about a 70% prevalence of insufficient intake of fruits and vegetables in urban areas.

What is PepsiCo doing to help?

PepsiCo is one of the largest food and beverage companies in the world and serves people in over 200 countries. We have a responsibility to serve our diverse consumer base – including of course those who live in urban areas. Performance with Purpose – our promise to deliver sustainable growth by investing in a healthier future for people and our planet – drives our work. As part of our PwP commitment we recently announced a number of global goals to guide us over the next decade.

While all of our global goals can have a direct impact on the health of people in urban areas, there are some additional opportunities as highlighted by the World Health Organization where PepsiCo can play a critical role. For example, the major drivers of health in urban settings go beyond the health sector. Social determinants – such as infrastructure, access to social and health services, local governance, educational opportunities and distribution of income – often converge in urban settings to strongly influence health status. Chronic health issues such as heart disease, diabetes, obesity are all driven by these social determinants that can’t be solved by the health sector alone.  This makes it critical that companies such as PepsiCo are participants – along with municipalities, civil society and individuals – in the solution for healthier cities. PepsiCo is committed to engaging with global partners, and is taking a proactive role in dedicating resources that allow us to address the nutritional needs of underserved and lower income communities.

Another important way PepsiCo contributes is by supporting its own employees in their efforts to be healthy. We aim to provide an environment that encourages healthy eating and physical activity. Our corporate headquarters are on a beautiful campus complete with running and walking trails and an onsite gym. We encourage people to recognize World Health Day by doing something active today at work, or on the way home and to think about ways they can make the environments where they live healthier.

PepsiCo has made steady progress in addressing the issues surrounding obesity by continual enhancement of our portfolio. There are many examples of this including the introduction of new products that offer improved nutrition. We continue to reduce portion sizes and reformulate some of our existing products to reduce calories, fat, saturated fat, salt and sugar. In fact, over the time period from 2003 to 2008, total US beverage 8oz servings increased 7.2%, and total US beverage 8oz caloric intake decreased by 5.2%. Essentially, this means that total calories per average 8oz serving of US beverages are down 11.6%. In addition, we are expanding and strengthening our expertise to include physicians, nutritionists, scientists, public health experts, policy analysts and advocates to enable breakthrough innovation that can effectively address obesity and other serious diseases affected by overall diet and lifestyle.

Globally, Indra joined the CEOs of seven other major food and beverage companies in May 2008 in committing to WHO Director-General Margaret Chan to take specific steps in support of the 2004 WHO Global Strategy on Diet, Physical Activity and Health. We are making tangible progress in explicitly addressing our commitments, some of which focus on obesity. These include new approaches to addressing marketing to children worldwide; promoting physical activity in many countries, including Mexico (through the PepsiCo creation of Vive Saludable) and the US (through a partnership with the YMCA); beginning to tackle chronic malnutrition in India, South Africa and Nigeria through a UN commitment supporting MDG1; and, finally, through our own PepsiCo Foundation, supporting community-based research aimed at developing evidence-based solutions to chronic disease prevention in the USA, UK, Mexico, India and China (Tufts University’s program ‘Shape Up Somerville’ being one such example).

There is much that still needs to be done. Obesity remains the only major public health problem for which we have no example of a sustained decline in any large population anywhere. That alone suggests we need a new and innovative plan of action to enable more sustainable partnerships that would draw upon all of our unique capabilities and expertise. In the June 2008 Pacific Health Summit meetings on nutrition, Dr. Margaret Chan (WHO D-G), Tachi Yamada (Gates Foundation), Ann Veneman (UNICEF) and Sir William Castell (Wellcome Trust) echoed recent calls by Director of NIH Dr. E. Zahouni for private-public partnerships to address global nutrition challenges. PepsiCo is committed and already engaged in such partnerships and we are confident that they will yield outcomes of benefit to health. Sustained progress requires that we build a firmer basis for private-public collaboration. Only through new and innovative partnerships can we make a difference.