‘Food Is Medicine’ Report Outlines Menu Of Options

Originally published by WBUR/CommonHealth on June 18, 2019. Written by Colin A. Young, State House News Service.

At a time when consumers are paying more attention to nutrition and the source of their food, the state could do more to integrate food into health care as a way to address chronic conditions and avoid some health care spending, a new report found.

The Food is Medicine State Plan, a joint effort of the Center for Health Law and Policy Innovation of Harvard Law School and service provider Community Servings, focused on nutrition’s link to chronic diseases like diabetes or cardiovascular disease, and the notion that food can act as medicine when meals are tailored to meet the specific needs of people living with or at risk for certain serious health conditions.

The report was released Tuesday at an event featuring Sen. Julian Cyr and Rep. Denise Garlick.

About one in 10 households in Massachusetts struggles with food insecurity, or not having consistent access to enough food for a healthy and active lifestyle, leading to $1.9 billion in annual health care costs that could be avoided, the report said.

(Courtesy Massachusetts Food Is Medicine Coalition)
(Courtesy Massachusetts Food Is Medicine Coalition)

Though Massachusetts has programs that try to address the issue of food insecurity and inaccessibility of fresh foods, the report said access to food as medicine programs remains limited in the state and across the country. But as consumers think more about the food they eat, and as Massachusetts shifts its Medicaid program into an Accountable Care Organization model, the report says the time is now to integrate food and medicine.

“We can build a system that reliably identifies individuals who are food insecure, connects them to appropriate Food is Medicine interventions, and supports those interventions via sustainable funding,” the report concluded. “In doing so, Massachusetts will establish itself as the first state in the nation to ensure that patients have access not only to affordable, effective medical care but also to the foods they need to live healthy, happy and productive lives.”

The report said there are 736 food pantries, meal programs, food rescue organizations and produce voucher programs in Massachusetts, but only 63 of them work with health care providers or tailor meals to meet specific medical needs.

The new ACO system, the report said, provides a ripe opportunity to integrate food is medicine policies because program requirements and financial incentives are changing to leverage community-based resources.

“For example, MassHealth will require ACOs to screen patients for health-related social needs, including food insecurity,” the report said. “Starting in January 2020, ACOs will also receive Flexible Services funding that can be used to provide access to services that respond to health-related social needs, including Food is Medicine interventions.”

The report’s authors recommend that professional medical societies and providers work together to increase provider nutrition education and referral capacity, that MassHealth issue guidance on food insecurity and malnutrition screening protocols, and that insurers incentivize provider networks to screen for food insecurity and make resource referrals part of patient care.

The Legislature should “explicitly recognize Food is Medicine as a priority through legislative action and within the state budget” by funding a pilot program to evaluate the impact of Food is Medicine within the MassHealth population, providing enough funding to meet the demand of the Healthy Incentives Program and by funding the Prevention and Wellness Trust Fund.

To build on the report, its organizers in the coming months plan to convene three task forces within the Massachusetts Food is Medicine Coalition to focus on strategies to address some of the issues identified in the report.

One task force will look at ways to improve the capacity of health professionals to identify and address the need for food is medicine interventions in patients. Another will “lead a statewide effort to establish standards for Food is Medicine interventions in the Commonwealth” and the third will develop research plans to advance the public health and medical understanding of food insecurity and food is medicine programs.

This Man Ate ‘Expired’ Food for a Year. Here’s Why Expiration Dates are Practically Meaningless.

Originally published by The Washington Post on June 17, 2019. Written by Daron Taylor.

Last year, Mom’s Organic Market founder and chief executive Scott Nash did something many of us are afraid to do: He ate a cup of yogurt months after its expiration date. Then tortillas a year past their expiration date. “I mean, I ate heavy cream I think 10 weeks past date,” Nash said, “and then meat sometimes a good month past its date. It didn’t smell bad. Rinse it off, good to go.” It was all part of his year-long experiment to test the limits of food that had passed its expiration date. In the video above, we interviewed Nash about his experiment and examined where expiration dates come from and what they really mean.

It turns out that the dates on our food labels do not have much to do with food safety. In many cases, expiration dates do not indicate when the food stops being safe to eat — rather, they tell you when the manufacturer thinks that product will stop looking and tasting its best. Some foods, such as deli meats, unpasteurized milk and cheese, and prepared foods such as potato salad that you do not reheat, probably should be tossed after their use-by dates for safety reasons.

Tossing out a perfectly edible cup of yogurt every once in a while does not seem that bad. But it adds up. According to a survey by the Harvard Law School Food Law and Policy Clinic, the Johns Hopkins Center for a Livable Future, and the National Consumers League, 84 percent of consumers at least occasionally throw out food because it is close to or past its package date, and over one third (37 percent) say they always or usually do so. That food waste in landfills generates carbon dioxide and methane, a greenhouse gas 28 to 36 times more effective at trapping heat in the atmosphere than carbon dioxide. And you are not just wasting calories and money. You are wasting all the resources that went into growing, packaging and transporting that food.

The FDA, researchers and the grocery manufacturing industry largely agree on an initial solution to this particular part of the food waste problem: clearer package-date labels. In 2017, the grocery industry, led by the Grocery Manufacturers Association and the Food Marketing Institute, announced a voluntary standard on food-date labeling. They narrowed the plethora of date-label terms down to two: “best if used by” and “use by.” “Best if used by” describes product quality, meaning the product might not taste as good past the date but is safe to eat. “Use by” is for products that are highly perishable and should be used or tossed by that date. The FDA announced in May 2019 that it “strongly supports” the GMA and FMI efforts to use the “best if used by” label to designate food quality. When it comes to food safety, the FDA said manufacturers can put whatever terminology they want to convey health risk. But while the FDA is encouraging manufacturers to use “best if used by” as a best practice, it is still not required by law. There is no federal law that requires dates on food, except for infant formula.

Emily Broad Leib, of the Harvard Law School Food Law and Policy Clinic, says that to have an effect, these changes need to be federally mandated. “We’re going to need the main government agencies that regulate food to be able to say: These are what these labels mean. When you see these on products, here’s what you should do, here’s how you should interpret them,” she said.

Others who advocate replacing current food date labels suggest using language that indicates shelf life after opening or the date on which the product was packed. Nash, of Mom’s Organic Market, argues for something more unambiguous.

“They’re trying to bring clarity to the descriptor of the date. Okay that’s great, that’s better than what we have now,” he said. “But I think some things just shouldn’t be dated.”

The Best Way to Tell When Food Goes Bad isn’t By Looking at its Label

Originally published by Quartz on June 12, 2019. Written by Adam Rasmi.

If you’ve ever found yourself in your local grocery store wondering what the difference is between “sell by,” “best by,” “expires by,” or “use by” food labels, you’re not alone. That confusion contributes to American consumers trashing $161 billion in food each year. Yet most people might be surprised to know that these labels often have very little to do with food safety.

Both the food industry and the US Food and Drug Administration are trying to change that, by encouraging companies to just use “Best If Used By” labels on groceries if the purpose of that label is “to indicate the date when a product will be at its best flavor and quality.” The FDA believes this standardized wording will help convey that foods “do not have to be discarded after the date if they are stored properly,” the FDA recently wrote in a recent open letter (pdf) supporting this change.

“We expect that over time, the number of various date labels will be reduced as industry aligns on this ‘Best if Used By’ terminology,” Frank Yiannas, the FDA’s Deputy Commissioner for Food Policy and Response, said in a statement. The FDA doesn’t want consumers to rely on date labels alone to judge when to throw away food. Instead, the agency advises people examine food after its “Best If Used By” date for a noticeable change in “color, consistency, or texture,” and make the call about its quality. Consumers can also consult the agency’s FoodKeeper App, and its refrigerator and freezer storage chart.

That’s partly because most major food illnesses are a result of contamination issues, not freshness ones. “Weirdly enough, the taste or smell of a food doesn’t necessarily mean that it’s contaminated with a bug that’s going to make you sick,” Dr. Natalie Azar, a medical contributor at NBC, told TODAY. The FDA also acknowledges that manufacturers apply labels to foods for a variety of reasons, and usually not for safety.

Food date labels emerged decades ago in the US as a way for manufacturers to advise retailers on how long they could ideally stock an item. Americans flocking from rural areas with local stores, to cities with supermarkets stocked with pre-packaged foods, began to take more interest in freshness. As labels proliferated, confusion ensued: so much so that in 1977, New York state published a booklet guiding shoppers on how to decipher the codes. Most states now require date labels to indicate quality, while many even ban the sale of food after the labeled date.

Apart from infant formula, which is required by law to have a “use by” date, there has never been federal oversight over date labels. According to Emily Broad Leib, the director of the Food Law and Policy Clinic at Harvard Law School, one way large companies set dates is by hiring taste testers to sample a given product over different periods, and then report when they think something tastes stale or slightly off. And, “in states that require date labels on a lot of different foods, some small food companies that we talked to said, ‘We don’t have any money to do taste testing. We just pick a date out of thin air,’” Leib says.

These estimates are typically conservative, so the quality of food may still be fine long past the various best-by dates, Leib explains. While Leib welcomes the FDA’s push for standardization, she would ideally like to see federal guidelines for labels indicating quality and safety. “Federal legislation should require that manufacturers and retailers that choose to use date labels use only one of two standard labeling phrases: ‘BEST If Used By’ to indicate quality or ‘USE By’ to indicate safety,” she recently wrote.

In the past, she’s even recommended removing the labels from some foods—items like bottles of water, vinegar, or canned goods don’t expire for years. In the case of items where “nothing changes over time,” she says, “you don’t need a date on them.”

A Helpful Move on Food Date Labels

This blog was originally published by NRDC on June 6, 2019. Written by: Emily Broad Leib and Katie Sandson, Jackie Suggitt at ReFED, and JoAnne Berkenkamp at NRDC.

Toss it after the date on the label or keep it for later? That’s the question consumers face on a daily basis when confronted with the date labels on food. Confusion about what date labels do and don’t mean is a leading contributor to food waste and efforts to streamline date labels have become a core tenet of the food waste reduction playbook. 

In a helpful move in that direction, U.S. Food and Drug Administration (FDA) Deputy Commissioner for Food Policy and Response, Frank Yiannas, recently penned an open letter to the food industry promoting the benefits of a streamlined food date labeling system. Yiannas’ letter encourages the food industry to use the standard labeling phrase “Best If Used By” on food products to indicate food quality, consistent with other recent government and private sector date labeling initiatives.

FDA’s letter also helpfully points out that, “If stored properly, a food product should be safe, wholesome, and of good quality after the quality date.” If you live in a household where some members want to pitch everything past the quality date and others want to keep it, the “keepers” can now cite the FDA in making your case to save that food for later.

NRDC and Harvard Food Law and Policy Clinic (FLPC) have advocated for standardizing date labels at the federal level since the release of our 2013 report, the Dating Game. In the 2016 Roadmap to Reduce U.S. Food Waste by 20 Percent, ReFED identified standardized date labeling as one of the top three solutions to reduce food waste. As a group, we welcome FDA’s statement. We also believe that federal legislation continues to be vital for establishing a consistent, uniform labeling system nationwide. 

In the absence of federal regulation, consumers face a dizzying array of date labels on the foods they purchase. Forty-one states require a date label on at least some food products, and twenty states prohibit or restrict the sale or donation of food past the labeled date.  Those inconsistencies make it tough for manufacturers to comply and sow the seeds of confusion among consumers.

Also, manufacturers typically use date labels to indicate quality, but many consumers and businesses mistakenly believe they are indicators of food safety. This confusion leads consumers to unnecessarily throw out food once it reaches the quality date. An estimated 20 percent of consumer food waste is caused by confusion about the meaning of date labels.

FDA’s letter builds on various recent initiatives, including those spearheaded by the Food Marketing Institute, the Grocery Manufacturers Association, USDA and ReFED, to standardize date labeling language and better communicate to consumers when date labels are meant to indicate quality and when they indicate food safety. FDA regulates approximately 80% of foods in the United States, making their recent statement particularly welcome.

However, the steps taken to date are not sufficient to achieve uniform date labeling across the country given the patchwork of state requirements and other factors.(See this issue brief for more information about state law conflicts). Also, FDA recommendations do not address the use of a standard term to indicate when food has been date labeled for safety and should be discarded once the date has passed. 

Federal legislation will be needed to truly tackle this issue.  Federal legislation should require that manufacturers and retailers that choose to use date labels use only one of two standard labeling phrases: “BEST If Used By” to indicate quality or “USE By” to indicate safety. Federal legislation should also override state laws that restrict the sale or donation of food past the quality date and support a national campaign to educate consumers.

NRDC, FLPC and ReFED are pleased to see FDA take this step to advance date label uniformity. We hope that federal legislation can be enacted to further reduce consumer confusion and keep more good food from going to waste.


FLPC Releases Issue Brief Calling for Federal Legislation to Standardize Date Labels

The Harvard Law School Food Law and Policy Clinic (FLPC) released an issue brief today that outlines the need for federal legislation to standardize date labels on food products. Date Labels: The Case for Federal Action describes existing government and industry efforts to standardize date labels and presents the case for why federal action is needed.

40% of the food in the United States goes uneaten. This wasted food has significant impacts on the economy, food insecurity, and the environment. The majority of food waste happens in consumer homes and consumer-facing businesses, and confusion over date labels is a significant cause of food waste.

Federal law does not regulate the use of date labels on food products, with the exception of infant formula. In the absence of federal regulation, states have developed their own date labeling laws. 41 states require date labels on at least some food products, and 20 states prohibit or restrict the sale or donation of food past the labeled date. Even in states that require date labels, manufacturers have broad discretion over how the dates on foods are selected. Most date labels are indicators of quality; however, many consumers and businesses mistakenly believe they are indicators of food safety. According to a survey conducted by FLPC, the Johns Hopkins Center for a Livable Future, and the National Consumers League, 84 percent of consumers at least occasionally discard food close to or past the date on its package, and one-third of consumers report they always do so.

Recognizing that confusion over date labels leads to unnecessary food waste, government and industry actors have made significant efforts in recent years to standardize date labeling language on food products. At the state level, eleven states introduced bills in the 2017-2018 legislation session that seek to standardize date labels or eliminate unnecessary date labeling requirements. On the industry side, the most significant industry action was the voluntary Product Code Dating Initiative, launched in 2017 by the Food Marketing Institute (FMI) and the Grocery Manufacturers Association (GMA). This initiative encourages manufacturers and retailers to use standard date labeling phrases on consumer-facing food packages to indicate quality and safety (read FLPC’s blog post about the initiative here). Most recently, FDA released a letter encouraging the food industry to use the phrase “Best if Used by” on food products to indicate quality. This is the same standard quality date phrase used by the Product Code Dating initiative.

These initiatives represent significant progress, but as the issue brief demonstrates, they are not sufficient to achieve standardization of date labels nationally. Due to the continuing patchwork of state date labeling laws, voluntary initiatives cannot fully cure inconsistent date labeling language. FLPC’s analysis found that the Product Code Dating Initiative conflicts with state laws in 27 states for at least one food product, meaning that manufacturers cannot use the voluntary standard in those states.

Moreover, state and industry initiatives cannot provide consistent education to consumers across the country. Because manufacturers cannot use the same date labeling language everywhere due to state laws, it remains difficult to educate consumers about what date labeling language means.

This issue brief demonstrates that federal legislation is necessary to achieve true standardization of date labels nationally. Federal legislation should require that manufacturers or retailers who choose to use date labels on foods use one of two prescribed labeling phrases: “BEST If Used By” to indicate quality, and “USE By” to indicate safety. These terms are consistent with the voluntary Product Code Dating Initiative. Federal legislation should also preempt state laws that ban the sale or donation of food past the quality date, and create a national consumer education campaign to inform the public about the meaning of these labeling terms.

FLPC has been advocating for the standardization of date labels since the release of its 2013 report, The Dating Game. We are pleased to see so much progress towards standardizing date labels at the state and industry level, but these efforts have limitations. As this issue brief demonstrates, it is time for a federally standardized date labeling system, and we look forward to working with federal and industry partners to develop such a system.

Read Date Labels: The Case for Federal Action.