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August
14, 2002, 9:00 a.m. By Henry I. Miller, M.D. |
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nation's ever-worsening epidemic of obesity is a silent plague. It kills
300,000 a year, almost as many as tobacco-related conditions, and it makes
life miserable for millions more. Excess weight predisposes to adult-onset
diabetes, high blood pressure, certain cancers, and heart disease, and
it's hard on the joints.
Senators Bill Frist (R, Tenn.) and Jeff Bingaman (D, N.M.) have introduced an "Obesity Bill," which authorizes federal agencies to spend more money to educate the public about the dangers of being overweight.
Where does Bush administration come down on the issue? Characteristically, all over the place. Federal officials' solutions are unimaginative and muddled: They tell us to eat less and exercise more, while at the same time drastically limiting the availability of an important tool for controlling calories.
In 1996, following an exhaustive eight-year review, the Food and Drug Administration approved a potentially formidable weapon in the war against dietary fat — a cooking oil called olestra, which adds no fat or calories to food. (It is simply a molecule of table sugar linked to soybean or cottonseed oil that is too large for the body to absorb or digest.) But they approved only for use in chips, crackers, and other ''savory snacks.'' Since then, fat-free and low-fat olestra versions of five of the most popular chip brands in the United States have been introduced by Frito-Lay, the world's largest chip manufacturer, and by Proctor & Gamble, the maker of olestra and Pringles potato chips.
Americans have bought more than three-billion servings of snacks cooked with olestra. If they had chosen to eat regular, full-fat chips instead, they would have consumed an additional 245 billion calories and 36,000 tons of fat.
Olestra is a potential boon to public health in this country, where diets are dominated by fat and three of the top four biggest health concerns — heart disease, cancer, and elevated blood cholesterol — are related to fat consumption. Four of the top five lunch and dinner entrees consumed in American homes could be made lower in fat with this versatile fat substitute: Pizza (#1) could be made with olestra oil; ham and turkey sandwiches (#s 2 and 5, respectively) could contain olestra mayonnaise; peanut butter, on a sandwich (# 3), could be made with olestra substituted for peanut oil; and hot dogs (# 4) could contain leaner meat, with olestra added for the mouth-satisfying ''feel'' of fat.
Olestra is not a magic bullet, but made more widely available, it could be an important adjunct to the surgeon general's admonition to eat fewer calories and exercise more. Olestra could enable more people to adhere to the American Heart Association's recommendation to consume less than 30 percent of calories from fat. As a solution to our constantly expanding waistlines and fat consumption, it is the closest thing to a free lunch.
Although olestra causes mild gastrointestinal symptoms in a small number of consumers, the frequency is no greater than with regular, full-fat chips. A large clinical study by Johns Hopkins University, for example, showed no statistically significant differences in reports of digestive symptoms in 1,000 moviegoers who (without knowing which they were eating) consumed either olestra-cooked potato chips or full-fat chips.
Beyond the issue of safety, recent research reveals that eating snacks containing olestra correlates with various measures of improved health. A study by researchers at the Fred Hutchinson Cancer Center found that people who eat olestra snacks ate lower levels of both total dietary fat and saturated fat. Moreover, they had lower levels of unfavorable LDL cholesterol. The level of cholesterol reduction (8 percent) was similar to that of a high-fiber diet. Thus, more olestra in our diets could be tantamount to the recognition that lowering blood pressure reduces heart disease and stroke.
The bad news is on the political front. FDA regulators have been far too conservative with this boon to public health. They granted limited approval, permitting olestra only for fried snacks, although the product is uniquely versatile and can be used instead of margarine, lard, butter, and other oils in frying, baking, and sautéing. The agency has been unenthusiastic about additional uses, even though the safety and usefulness of the product are unquestioned. Olestra is also the most-tested food substance in history, having undergone far more animal studies and human clinical trials than most prescription drugs.
But the FDA continues to require labels on foods containing olestra, warning about possible gastrointestinal symptoms, in spite of repeated demonstrations that such problems are no more frequent than for full-fat snacks. Such labels mislead consumers and discourage wider use of olestra products. In 1998, an FDA advisory committee criticized the warning label, and the FDA promised to fix or eliminate it by the end of last year.
The agency has not kept its word, and the misleading label remains. If regulators refuse to be advocates for wider use of this aid to improved health, they should at least ''do no harm.''
The FDA's failure to promote — let alone to permit — wider use of olestra is irresponsible. The regulators have shown themselves to be cavalier toward public health, preemptive of consumers' freedom to choose and punitive to an innovator that spent hundreds of millions of dollars in good faith to develop a safe and effective product.
Is it likely that FDA will act responsibly on olestra? Fat chance!
— Henry Miller, a physician, is a fellow at the Hoover Institution and the author of ''To America's Health: a Proposal to Reform the FDA.'' He was an official at the FDA from 1979 to 1994.