The Trans-Fat Ban as a Model of Slow Health Policy

Yesterday the FDA announced plans to take trans fats off its list of GRAS, or generally recognized as safe, foods. To some, like the New York Post with its “FAT-WAH” cover headline, this is a vicious new outcropping of nanny state-ism and an intrusive, sudden national ban that will sweep dozens of treasured foods off supermarket shelves. To the people who have been following this for the years it's been in the making, like Marion Nestle, it's closing an important loophole: that manufacturers could put "zero trans fat" on the label of a food that contained less than 0.5 grams of trans fats per serving. Taking trans fats off the GRAS list won't remove them from the food supply. Manufacturers can still petition the FDA for exceptions. But it goes a long way toward getting them out.

It's an occasion for high-fiving, and there's plenty of that. "The FDA is back," Nestle told the Times reporter—and the agency has indeed been AWOL when it comes to matters it should be regulating faster and more forcefully, some of them, like food safety inspections, excusable because of constantly shrinking budgets, and others, like the national menu calorie labeling that should have been in force a year ago, are explicable only by political caution that with time looks like cowardice. Center for Science in the Public Interest, which first petitioned the FDA to require putting trans fats on food labels in 1994, has been getting and deserves a good deal of credit for its persistent campaign.

But what the announcement really shows is how public health works: slowly, based on mounting scientific evidence, against constant and mounting headwinds of public ridicule and, much more important, industry lobbying and advertising.

Companies seldom change unless they have to, which they say means unless consumers ask them to. If you don’t want trans fats or gluten or genetically modified organisms, fine with us! Just tell us with your food dollars! This is of course a way of saying that they don’t want government telling them what to do, and gives them a chance to shape the public opinion they say they simply obey, with millions of dollars in ad campaigns and lobbying.

Just the most recent example is Tuesday’s defeat of Washington state’s Ballot Initiative 522, the latest of several statewide initiatives to require GMO labeling to fail. Here the overwhelming imbalance in campaign spending got spelled out, as Helena Bottemiller Evich at Politico and others reported, when the Grocery Manufacturers Association was forced to name the companies that had helped contributed $22 million to fight it, as opposed to the $8.4 million raised by Whole Foods, the Center for Food Safety [editor's note: an earlier version incorrectly listed CSPI as a donor], and Dr. Bronner’s, among others. The main soda makers were among the larggest donors to the anti-labeling campaign. (Even Bloomberg View is telling GMO-labeling advocates to give up and move their energies elsewhere.)

Though in my reporting I in fact frequently encounter companies that take it upon themselves to make helpful changes, for example related to environmentally and socially responsible practices, you don’t get companies to re-make their core products from scratch, risking disastrous consumer desertion sales drop-offs, unless their hands are forced. Today Olga Khazan charmingly illustrates a history of just how popular trans fats were with both manufacturers and consumers from their invention, in the early 1900s—and how they were advertised as health-promoting.

The lesson, though, is not that the public shouldn't trust science, because one year’s saturated-fats-are-evil message will eventually become next year’s hey-butter-is-great-when-you-look-at-Crisco. The road to strong public recommendations isn't clear, as scientific research is slow and zigzags. Both food makers and scientists can be guilty of jumping the gun, depending on what they think they can sell or who they can get to fund big studies and endowed chairs.

In the case of trans fats, scientific consensus about the damage they caused steadily mounted starting in the 1970s. As I wrote in an article in this magazine tracing the progress of trans fats bans, a 2002 consensus report from the National Academies of Sciences’ Institute of Medicine called the relationship between trans-fat consumption and coronary heart disease “linear,” and stated that the only acceptable level of trans fats in the diet was zero; in 2003, the Food and Drug Administration required food processors to list trans-fat levels on nutrition labels along with saturated fat.  In 2006, Walter Willett, Meir Stampfer, and colleagues at the Harvard School of Public Health published a New England Journal of Medicine review article saying that trans fats caused anywhere from 72,000 to 228,000 heart-disease events a year.

That December, the New York City board of health, led by Michael Bloomberg and the city health commissioner, Thomas Frieden, now head of the Centers for Disease Control, voted to ban trans fats from restaurants, school cafeterias, pushcarts, and every other establishment it regulated.  When I visited Frieden at his New York office, he laid out the larger goal. “We don’t want to exhort people to look at labels for trans fat,” he told me. “We want people to walk into a restaurant and not worry there’s an artificial chemical in their food” that is killing them.

The path he saw was that one city’s regulation would force the hand of McDonald’s and every other large food maker: once they reformulated for one important market, the way would be clear to reformulate for the rest of the country. By that time McDonald’s had solved the problem, but Dunkin' Donuts hadn’t, and was resisting the removal of trans fats, which gave doughnuts the consistency consumers wanted. It turned out, though, that consumers didn’t mind retooled fats. Dunkin' solved the problem once it had to. So did the other companies that saw no reason to invest huge sums in risking markets.

The analogy I'm building toward is, of course, sugar-sweetened drinks. Scientific consensus has built to practically the bursting point that sodas make kids fat. Soda makers deride the officials who try to do something about it, and work as hard as they can to cast doubt on science. Mayor Bloomberg, though fairly trim, was their fattest target, in the Mrs. Doubtfire costume they dressed him up in when he tried to impost a portion limit on sodas in restaurants and movie theaters. Now that he’s leaving, they’ll find another target.

But opinion will change, national bodies start to fall into line as they did on trans fats and are doing with sugary drinks. The most outspoken enemies of sugar, like Robert Lustig, are trying to take it off the GRAS list--something that CSPI petitioned the FDA to do last February, asking it to study and determine safe levels of high-fructose corn syrup. The chance of an FDA announcement of that in six years seems pretty unlikely now. But soda makers already have more than dozens of low-sugar and sugar-free drinks: they have scores and scores of them. They’ve quietly been working to solve the problem, while spending (often literally) untold sums not to risk their core products. The advocates against trans fats who seemed so crazy even six years ago, when the New York trans fat ban went into effect, are seeming a lot less crazy today.