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item Klurfeld, David

Submitted to: Journal of American College of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/23/2004
Publication Date: N/A
Citation: N/A

Interpretive Summary: This is an editorial written in my capacity as Editor-in-Chief of the Journal of the American College of Nutrition in response to a commentary I accepted for publication that calls for government action to encourage or discourage consumption of certain foods as snacks by children.

Technical Abstract: In a provocative commentary in this issue of JACN, Anderson and Patterson suggest that children should eat fruits, vegetables and low fat dairy for snacks while avoiding typical snack foods such as candy, chips, cookies and so forth. They believe the government should identify 'good' and 'bad' snacks and create economic conditions to promote those choices. Although the basic premise that choice of snacks will affect both micronutrient and total energy intake is sound, the suggestions that follow are based on emotional appeal rather than on evidence. The authors of the commentary ignore the view that snacks, by definition, should represent only a minor portion of daily energy intake. Small portions of energy-dense, nutrient-poor foods can be added to a sound diet without harm if energy balance is maintained. The authors also ignore that fact that energy intake among children has not increased between 1971 and 2000 even though obesity has. In fact, longitudinal data from the Bogalusa Heart Study shows that children were eating dessert and candy less in 1994 than in 1974 but more beverages, snacks of all types including fruit (excluding candy) and larger portion sizes of most foods. Recent data from a prospective study of 15,000 children indicates that snack food intake does not predict weight change. A basically sound diet that meets nutrient requirements has room for discretionary calories designated by the 2005 Dietary Guidelines for Americans Advisory Committee as representing calories above those needed from foods that provide essential nutrient requirements. For most people those discretionary calories are approximately 100 to 200 kcal/day. It is probably irrelevant if those extra calories are provided by extra servings of nutrient dense foods or low-nutrient foods. A diet that is not well constructed will not benefit much from healthy snacks. One could make the same observations as the authors have for snack foods and conclude that eating in restaurants should be banned, or at least taxed at a level to discourage it, since eating away from home correlates strongly with increased body weight, higher fat, sugar and sodium intake. While there is a certain puritanical appeal of taxing candy bars, paying 20-30 percent or more extra for a meal in a restaurant is certainly not a position that would garner widespread support from scientists or the public. Adequate physical activity is required to have a flexible calorie allowance and too many Americans, children included, do not expend enough energy in physical activity due to societal changes in lifestyle, recreation, and employment. The authors also ignore the lack of evidence for the changes they suggest. Economic disincentives, i.e., taxes, do not have much impact on alcohol or tobacco consumption in this country; public health education and social mores interact with the increased taxes on these items so determining a cause and effect relationship is not possible. Both tobacco and alcohol are special cases, as well. Tobacco is the only consumer product that is unhealthy when used as intended. Alcohol is beneficial when consumed in light to moderate amounts but has the potential for abuse with concomitant social and health problems. In fact, virtually everyone who smokes or consumes excess alcohol knows these are unhealthy so education is also not a panacea. When food continues to cost a smaller and smaller percentage of our income, only a punitively high tax might have an effect but there are no data to support a major effect on consumption. Such a tax would have a disproportionate impact on people in lower socioeconomic strata and the wealthy would continue their eating habits. In addition, studies have shown repeatedly that when children are told they should not consume particular foods, those foods become more desirable to the children, having an effect o