FLPC Releases Report Calling for Greater Nutrition Education in the Medical Field

The Harvard Law School Food Law and Policy Clinic (FLPC) released a new report today identifying policy approaches to increase nutrition competency of U.S-trained physicians. Doctoring Our Diets: Policy Tools to Include Nutrition in U.S. Medical Training highlights the current lack of education on diet-related diseases and nutrition that doctors receive over the course of their medical careers. The report illustrates the impact of this knowledge-gap on healthcare costs and patient health, and provides a number of recommendations for federal, state, and non-governmental policymakers to tackle this issue.

Diet is the most significant risk factor for disability and premature death in the United States, and diet-related diseases, such as heart disease, cancer, stroke, and diabetes affect an unprecedented number of Americans. Patients turn to doctors for advice on how to avoid or mitigate these and other health risks arising from poor diet and nutrition. Yet, unbeknownst to patients, many doctors are no more equipped to provide this advice than patients themselves: an average medical student spends less than one percent of total classroom hours learning about food and nutrition, and seventy-three percent of physicians reported that they received no or minimal instruction on nutrition during their medical training. This gap in medical education not only represents a violation of the public trust but a missed opportunity to invest in better population health.

To bridge this divide, Doctoring Our Diet calls for relevant policymakers to take action, recommending specific policy solutions applicable at each stage of medical education. For example, policymakers can condition non-grant funding on the inclusion of nutrition education in medical school programs and residency programs, offer performance-based incentives to medical schools and residency programs that provide a baseline amount of nutrition education, and amend accreditation standards to require baseline competency in nutrition. For each recommendation, the report features a brief feasibility analysis, addressing the benefits and potential challenges associated with implementation.

As one example of the types of policies recommended in Doctoring Our Diet, the report shines a special spotlight on the government’s failure to use existing Medicare funding of GME programs to leverage nutrition education for doctors. Medicare is the single largest contributor of graduate medical education (GME) in the United States, providing $16 billion in 2015. At the same time, Medicare spending accounts for nearly 15 percent of all federal spending. As the prevalence of preventable, but costly, diet-related diseases continues to rise, so too will this percentage: over the next 10 years, Medicare spending is expected to increase from $630 billion to a projected $1.3 trillion—or more than 18% of the federal budget. Doctoring Our Diet explains that requiring Medicare-funded GME programs to educate physicians on nutrition is a logical and necessary approach to mitigating diet-related diseases and saving healthcare costs in the long-term.   

This report is a product of FLPC’s ongoing involvement with the Nutrition Education Working Group (NEWG), a group of leaders in nutrition science, education and policy from FLPC, Harvard T.H. Chan School of Public Health, Harvard Medical School, and the Gaples Institute for Integrative Cardiology. FLPC has collaborated with NEWG to raise awareness about the lack of nutrition education provided in medical training, presenting the issue to policymakers, writing comments to the Accreditation Council for Graduate Medical Education (ACGME), and working with various medical boards to add nutrition-focused questions to exams. This initiative represents the latest effort in FLPC’s ongoing commitment to policy development at the intersection of food and health.

 

CHLPI Welcomes New Team Member Aiza Khan

The Center for Health Law and Policy Innovation is excited to welcome Aiza Khan to the team as a Staff Assistant!

Aiza received her B.S. in Communication Studies from Emerson College in 2016. At school she had two focuses in Leadership & Management and Psychology. Prior to arriving at Harvard, Aiza managed business operations at a healthcare practice and a biopharmaceutical company. She is passionate about supporting organizations that improve health outcomes among disadvantaged populations.

FLPC Welcomes New Team Member Ariel Ardura

The Harvard Law School Food Law and Policy Clinic (FLPC) is excited to welcome Ariel Ardura to the team as a Clinical Fellow!

Ariel received her JD in 2019 from Georgetown University Law Center, where she gained a range of experience in food and health law and policy through internships with the DC Food Policy Director, USDA’s Agricultural Marketing Service, and as the Emily Spitzer Intern for the National Health Law Program. She also worked as a student attorney on the Health & Food Team of Georgetown’s Public Policy Clinic and as a research assistant for Georgetown’s Health Justice Alliance. Ariel got to know FLPC as a summer intern there and later as a research assistant for the clinic. During law school, she was president of Georgetown’s Food Law Society and Projects Chair for the National Food Law Student Network.

Prior to law school, Ariel worked for an organization that helps schools implement food recovery programs. She received a Bachelor of Urban and Environmental Planning from the University of Virginia in 2013.

Table Scraps: Pets Aren’t Garbage Disposals, but They Can Help Combat Food Waste

Originally published by Phoenix New Times on September 18, 2019. Written by Lauren Cusimano.

The idea of feeding animals, domestic or otherwise, our uneaten food is not new. It is, most likely, better understood, that our domestic pets are not four-legged garbage disposals, but there are ways to treat yard animals and neighborhood pets to food scraps that might otherwise become food waste. That is, if it’s done safely and lawfully.

Our good pals at the U.S. Environmental Protection Agency have a section about reducing wasted food by feeding animals. Feeding animals is high, in fact, the third tier, of EPA’s Food Recovery Hierarchy — an inverted pyramid of actions organizations can take to prevent and divert wasted food.

“With proper and safe handling, anyone can donate food scraps to animals,” the EPA website reads. That’s  followed by, “There are many opportunities to feed animals, help the environment, and reduce costs.”

According to a Natural Resources Defense Council report, “Wasted: How America Is Losing Up to 40 Percent of Its Food From Farm to Fork to Landfill,” we all need to find potential secondary uses for food trimmings and peels.  “Trimmings and peels contain nutrition and should be considered for their value,” the report says. “A concerted effort should be made for scraps and by-products to go to their highest use — as other food products, if possible, or as animal feed, compost, or energy feedstock.”

So, if you or someone you love has a desert tortoise, or some other fun backyard animals, they might appreciate your kitchen scraps. And spoiler, those scraps will have to mostly be vegetable trimmings.

But first, I am by no means an expert on animals. However, I have talked to some people who know the score for this story. What it comes down to is what you can feed animals food you’re otherwise not going to eat that will be safe and healthy.

Some History

The report “Leftovers for Livestock: A Legal Guide for Using Excess Food as Animal Feed” was put together by the Harvard Food Law and Policy Clinic and the Food Recovery Project at the University of Arkansas. It starts, cruelly enough, with the fact that the United States wastes approximately 160 billion pounds of food each year. The guide shoots to encourage the appropriate and lawful diversion of food scraps to animals, but if comes with a bit of a history lesson slash warning.

Apparently, “the practice of feeding food scraps to animals has declined precipitously since the 1980s, when several disease outbreaks were linked to animal feed (specifically, animal products in livestock feed), including foot-and-mouth disease in swine and bovine spongiform encephalopathy (BSE), commonly referred to as mad cow disease, in cattle. In an attempt to prevent the spread of such diseases, federal and state laws and regulations that restricted what is often pejoratively referred to as ‘garbage feeding’ were enacted.”

The decline was contributed to overcorrecting the practice of feeding leftovers to livestock. Therefore, the report goes on (for another 60 pages) on how, “Using food scraps as animal feed in a safe, resource-efficient way can be an environmentally friendly and energy-efficient alternative with multiple benefits for farm and food businesses, consumers, and communities.”

Dogs, Cats, and Other Domestic Guys

Veterinarian James H. Maciulla — or Jim — is an associate dean at the University of Arizona College of Veterinary Medicine. He says dogs are prone to multiple problems (pancreatitis, colitis, gastroenteritis) from leftovers.

“This is due in large part to the high fat and protein content, and the inability for the dog’s gastrointestinal system to accommodate the deviation from a commercially produced ration,” he says via email. “Food scraps like vegetable trimmings in judicious amounts (10 percent or less of total intake) are generally okay.”

In other words, domestic pets like cats, dogs, birds, reptiles, etc., may take in some vegetable scraps, but not much else.

Desert Tortoises

The Arizona Game and Fish Department offers some helpful information on the captive desert tortoise diet. The AFGFD site states desert tortoises are completely herbivorous, and even a captive tortoise should be allowed to graze on grasses, leafy plants, and flowers, as those foods meet tortoises’ nutritional needs.

But rest easy, many tortoise owners probably don’t have favorites dichondra, hibiscus, wild grape, mulberry, and globemallow blooming in their backyards. In this case, produce will do — but not just any produce.

“Produce can serve as a supplemental food source if you are unable to establish plants within the enclosure,” it reads. “Dark greens rich in minerals and vitamins such as collard, kale, mustard greens, turnip greens, cilantro and parsley can be offered as a short-term alternative or as a supplement to grasses.”

This should all be cleaned, certainly not rotten, and chopped into small pieces. And much like for humans, iceberg lettuce provides little nutrition and should be avoided entirely — according to the AFGFD.

Restaurant owners are free to do this, too.

Lori Hassler, owner of Farish House, which opened in February 2019, found a tortoise upside down on her back porch. “It was only about this big,” she says, cupping her hands. “Now he’s this big,” she says, circling her arms in front like she’s carrying a giant pumpkin.

Hassler took it to her neighbor, who she knew had a breeding of tortoises, and said, “I think this is yours, and instead of taking it back she said, ‘Here, have another one.’” Now, Sandy Sam and Lollipop Sugarface (a 6-year-old had the honor of naming them) have free roam of the backyard at Hassler’s ranch-style Arcadia home.

“They are really cool pets,” Hassler says. “It’s like having little dinosaurs in your backyard.”

Sometimes they forage around the backyard, but they often eat vegetable scraps from Hassler’s own kitchen and from Farish House. There’s even a designated tortoise bin.

The little bin in the walk-in refrigerator will collect wilted radicchio, trimmings from endive leaves, arugula, but no romaine or iceberg lettuce. And on special occasions, “They love hibiscus flowers, that’s like a treat or candy,” Hassler says. “And a little piece of fruit here and there.” That checks out with the AFGFD, which says fruits should only be offered as a special treat.

This is all a happy coincidence, as reducing food waste is an important issue to Hassler personally, who says waste is minimal at Farish House. “You want to make use of everything,” she says, “and I think that’s a classic cooking ethic.”

Pigs

“Raw scraps fed to pigs carries significant zoonotic risk,” Maciulla says.

To remedy this, pigs get their own act. On this subject, the EPA states, “Be sure you know how to handle your food scraps properly. Refer to the Swine Health Protection Act.” I’ll let you root through that on your own.

The EPA also recommends the report, “Leftovers for Livestock: A Legal Guide for Using Excess Food as Animal Feed.” The 60-plus-page document describes different federal and state laws, regulations, and requirements for feeding food scraps to animals.

“Arizona allows the feeding of animal-derived waste to swine provided that it has been properly heat-treated and fed by a licensed facility. All other waste may be fed to swine without heat-treatment,” it reads. “Individuals may feed household garbage to their own swine without heat-treating it and without a permit.”

Chickens

Oh, the dream. A backyard full of chickens. Fresh eggs — not those sweatshop eggs. And, they can munch on some of those cucumber butts or uneaten broccoli stems. But again, there can be too much of a good thing.

“Poultry tend to do well with vegetable scraps, again in judicious amounts,” Maciulla says.

Goats

Freelance writer and large-animal veterinarian Christy Corp-Minamiji wrote a 2018 article about feeding goats. The overall message: Goats “cannot ‘eat anything.’ In the broadest designation, goats are herbivores. Translation: they eat plants, not tin cans; not animal products; and not Twinkies.” Turns out goats are fascinating, beautifully complicated creatures. Give “Nutrition for Goats” — written by Corp-Minamiji  — a read for further information.

Goats can, however, eat bread. Though, as with most things, not a ton.

A recent article from The Spruce,  “How to Feed and Tend Goats on the Small Farm,” has a small section on kitchen and garden scraps. “Raisins and corn chips, just a few, or a slice of bread, make nice treats for goats but don’t overdo them,” it reads.

Ducks

The staple animal of the neighborhood park, ducks usually take down whatever bread products we have sitting in the pantry. Instead of tossing that mostly empty, twist-tied bag of bread in the trash, people usually visited the nearest pond.

However, that’s apparently wrong.

Maciulla can weigh in on this, too. He says overall, bread is no good for ducks. It’s not a natural feed, and is prone to cause crop impactions on the animals.

In addition to this, a simple Google search pulls up enough information to back up almost any version of this claim. But a palatable piece from Popular Science breaks it down pretty well. In summation, bread is junk food (sounds familiar?), and you don’t want ducks filling up on something without nutritional value.

However, certain kinds of food scraps are A-okay. The list includes kale and lettuce, corn, peas, seeds, and oats.

So, Pretty Much Just Vegetable Scraps … Maybe

Overall, I found that sensible amounts of vegetable scraps can be tossed to our animal friends. That and the occasional piece of bread or fruit as a treat.

A final note: This is not a guide of what food scraps you should or should not feed your animals. This is more of a collection of my findings, and a conversation starter.

Before you do anything, please be sure to speak with your veterinarian.

Apeel Sciences Has Developed Longer-Lasting Avocados, and They’re Coming to Stores

Originally published by USA Today on September 18, 2019. Written by Kelly Tyko.

Tired of throwing away spoiled produce?

Apeel Sciences says it has gotten to the root of the problem and developed a technology that can double or possibly triple the shelf life of many types of produce, including avocados.

Apeel CEO James Rogers, who founded the Santa Barbara, California-based company in 2012, said Apeel’s plant-derived technology gives produce an extra “peel” that slows the rate of water loss and oxidation, the primary causes of spoilage. “We use food to preserve food,” Rogers said of the edible coating that’s applied to produce. “You can’t see it, you can’t taste it, you can’t feel it, but by precisely controlling the combination of plant materials that we use with these formulas, we’re able to slow down the rate that a piece of fruit ages.”

Apeel’s longer-lasting avocados will soon be available in more than 1,100 Kroger stores. On Wednesday, Apeel and the Cincinnati-based grocer jointly announced the expansion of its Midwest avocado pilot at 109 stores to a coast-to-coast roll-out. Additional stores will be added as more of Kroger’s suppliers install Apeel application systems. The two also announced Apeel limes and asparagus will be piloted in Cincinnati locations.

Frank Romero, Kroger vice president of produce, said in a statement that this was a milestone in the retailer’s Zero Hunger | Zero Waste plan, which is to eliminate waste across the company by 2025 and end hunger in its communities.

According to Kroger, 40% of food produced in the U.S. is thrown away and households waste more than $1,300 in unused food annually.

About 160 billion pounds of discarded food ends up in landfills each year, according to Harvard Law School’s Food Law and Policy Clinic.

“Apeel’s innovative food-based solution has proven to extend the life of perishable produce, reducing food waste in transport, in our retail stores and in our customers’ homes,” Romero said.

Walter Robb, former CEO of Whole Foods Market and a member of Apeel’s board of directors, said the company “represents an extraordinary breakthrough in reducing food waste” by using food to preserve food. “As a fresh grocer for over 40 years, I can truly say that I have never seen anything like Apeel, and I believe it has the potential for global impact on the food system,” Robb said in a statement to USA TODAY.

Apeel is working to expand to additional retailers and adding more fruits and vegetables into its mix including berries and tomatoes, Rogers said. “I believe that in the future you’re going to be able to walk into a grocery store and there will be a section of Apeel produce and you’ll shop for them the same way we shop for organic today,” he said.

 

FLPC’s Emily Broad Leib Joins Board of Cohort for Industry-First Nonprofit Food Recovery Accelerator

Today, ReFED announced the cohort of ten organizations that will participate in its Nonprofit Food Recovery Accelerator. Thanks to the generous support of the Walmart Foundation, in partnership with +Acumen and in collaboration with a world-class, 50-member Expert Network, the Accelerator aims to catalyze ideas and inspire actions that lead to a doubling of healthy food available to the 40 million Americans facing food insecurity. “The Accelerator’s nationwide Open Call for Applications confirmed ReFED’s hypothesis that this type of program will provide value in the form of helping food recovery organizations overcome some of the biggest barriers to increasing the amount of nutritious food they can deliver in a dignified manner,” explains Alexandria Coari, Director of Capital and Innovation at ReFED. “Some of these barriers include funding models dependent on grants versus earned revenue, a reliance on volunteers instead of paid staff, underutilization of technology solutions, and a lack of collaboration and best practice sharing across the sector. These are just a few of the topics we’ll tackle throughout the Accelerator.”

The Accelerator’s one-of-a-kind, highly customized curriculum will combine a virtual classroom with in-person ReFED Learning Labs that focus on co-creating earned revenue models and technology-enabled solutions using human-centered design. More than 125 candidates applied for the Accelerator. The selected cohort range from long-standing food recovery organizations with hundreds of employees servicing thousands of donors, to newly formed innovative organizations that leverage concepts from the sharing economy and apply them to food rescue. What unites them is the desire to work together on a shared mission — to become operationally sustainable and deliver more impact at scale in a dignified and convenient way.

“Growing awareness about the scale of senseless food waste in this country has catalyzed existing organizations to innovate their paradigms and inspired energetic entrepreneurs to launch creative new models that use this surplus food as a resource,” notes Emily Broad Leib, Assistant Clinical Professor of Law and Director of the Harvard Law School Food Law and Policy Clinic. “As an Expert Network member, it has been incredible to see the response to ReFED’s Nonprofit Food Recovery Accelerator, which will build the needed network and resources for these innovators. I am excited about the announcement of the 2019 cohort, and cannot wait to see them take the next steps to address this major societal issue of our era.”

The cohort for the first-ever Nonprofit Food Recovery Accelerator includes:

  • 412 Food Rescue, Pittsburgh, PA: 412 Food Rescue’s Food Rescue Hero is a real-world solution combining technology, last-mile logistics and community engagement to create a new food recovery and redistribution network that responds to the donation challenges of food retailers and the food access barriers of those experiencing hunger.
  • Boston Area Gleaners, Waltham, MA: Boston Area Gleaners’ Surplus Commodity Crop Program (SCCP) is the only gleaning model in the country that compensates farmers for making timely donations by charging a service fee to food banks, who still receive high quality product at a lower price compared to the wholesale market.
  • Brighter Bites, Houston, TX: Brighter Bites sources fresh, seasonal, and primarily donated produce, and systematically distributes it to underserved communities using evidence-based nutrition education and fun food experiences.
  • Community Food Bank of Southern Arizona, Nogales, AZ: Community Food Bank of Southern Arizona is exploring technology solutions to manage inventory, logistics, and data flow to move 100 million lbs of produce from donors in Nogales, AZ (a major port of entry) to food banks nationwide.
  • Eat Greater Des Moines, Des Moines, IA: Eat Greater Des Moines’ initiative combines software, shared-use refrigerated vans, and a paid-driver program to make the food rescue network more dynamic, effective, and equitable while providing support to organizations throughout the food system.
  • Philabundance, Philadelphia, PA: Philabundance reduces hunger and food insecurity by providing food access to approximately 90,000 people per week in the region. An established food bank operating since 1984, the organization aims to transform the traditional food banking model by leveraging both the scale of the established system and the flexibility of new technology startups.
  • Plentiful, New York, NY: Plentiful is a digital platform improving client dignity and efficiency at food pantries. Plentiful eliminates lines through reservations, reduces data redundancies, and creates access to real-time service information so more food can be recovered and delivered effectively.
  • Replate, Berkeley, CA: Replate’s technology platform enables businesses to schedule on-demand pickups for their surplus food and the organization’s paid food rescuers bring the donated food directly to those experiencing food insecurity in the community.
  • Rescuing Leftover Cuisine, New York, NY: Rescuing Leftover Cuisine is a national nonprofit organization with a mission to rescue and donate food that would otherwise be wasted. The organization charges only $20/pickup with no weight minimum, and employs a web application to engage members of the community to volunteer and be a transportation solution.
  • Seeds That Feed, Fayetteville, AR: Working with regional farmers and healthcare providers, the Seeds That Feed ‘pHed’ initiative (pronounced ‘fed’) provides direct-to-door access to free fresh produce and other healthy foods for home-bound and at-risk populations experiencing chronic illness.

“We are a small nonprofit with a big vision,” explains Alyssa Snyder, Co-founder and Chief Seeder at Seeds That Feed. “The opportunity to work alongside nine other like-minded organizations, and in conjunction with an Expert Network of more than 50 leaders in the field, is an absolute game changer. Improving the lives of our neighbors through food is what drives us forward, and the opportunities ReFED is creating are quite literally providing the fuel that we’ve so desperately needed.”

Each participating organization will receive $30,000, plus an additional $100,000 will be awarded to a selected winner at the end of the Accelerator. In addition, organizations will have access to a world-class group of food business and technology executives, capital providers and subject matter experts who make up the Accelerator’s Expert Network, which includes Afresh, Albertsons, Aramark, Baldor Speciality Foods, Blue Apron, Bon Appetit Management Company, CalRecycle, Center for EcoTechnology, Chick-fil-a, Cisco, Claneil Foundation, ClimateWorks Foundation, Closed Loop Partners, Compass, DoorDash, Draper Richards Kaplan Foundation, EPA, Fast Forward, FDA, Feeding America, Fink Family Foundation, Food Donation Connection, Food for Soul, FoodMaven, General Mills, GoodR, Harvard Law School Food Law & Policy Clinic, HelloFresh, Imperfect Produce, Nestle, Next Course LLC, Ovio, Pisces Foundation, Posner Foundation, Rabobank, Sodexo, Spoiler Alert, Starbucks, Taylor Farms, The Ajana Foundation, The Kroger Co. Zero Hunger | Zero Waste Foundation, The Leonardo DiCaprio Foundation, The Rockefeller Foundation, The Wonderful Company, Tyson Foods, USDA, Village Capital, Wells Fargo, Whole Foods Market, and World Wildlife Fund.

Overall, the more than 125 applicants to the Open Call reported statistics that indicate the impressive impact they’re already having on the food recovery space. Collectively, these organizations: Employ more than 5,600 full-time employees, Mobilize 190,000 volunteers, Run a total annual budget of $240 million, and Need $30 million in additional funding in the next 12 months. Additionally, and consistent with trends previously identified in ReFED’s Innovator Database: 71% operate locally (reach within one city or state) versus regionally or nationally, 32% receive the majority of their funding in the form of grants from foundations, and 63% have female or underrepresented minority leadership.

“We are committed to help innovate and strengthen the food system through philanthropy, and this includes a focus on the reduction of food waste,” said Eileen Hyde, Director of Strategic Initiatives for the Walmart Foundation. “ReFED’s Nonprofit Food Recovery Accelerator is a key part of this strategy and we’re proud to be involved in the project.” The three-month Accelerator kicks off in September 2019.