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Transparency for Food Consumers: Nutrition Labeling and Food Oppression

Published online by Cambridge University Press:  06 January 2021

Andrea Freeman*
Affiliation:
Assistant Professor, University of Hawai‘i William S. Richardson School of Law

Extract

Transparency for consumers through nutrition labeling should be the last, not the first, step in a transformative food policy that would reduce dramatic health disparities and raise the United States to the health standards of other nations with similar resources. Nonetheless, transparency in the food system is a key focal point of efforts to improve health by providing consumers with necessary information to make good nutritional choices, as well as to achieve sustainable food chains and ensure food safety and quality. In fact, nutrition labeling on packaging and in restaurants is the centerpiece of policy designed to decrease obesity, a condition many health advocates consider to be the most urgent public health crisis of the twenty-first century. The resulting increased transparency about food ingredients has led to some changes in industry practices and allowed many middle- and upper-income consumers to make informed choices about the products they purchase and consume. Unfortunately, however, research reveals that increased nutritional information does not improve health.

Type
Articles
Copyright
Copyright © American Society of Law, Medicine and Ethics and Boston University 2015

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References

1 See generally Archon Fung et al., The Political Economy of Transparency: What Makes Disclosure Policies Effective? 16 (2004); Gerhard Schiefer & Jivka Deiters, Transparency for Sustainability in the Food Chain: Challenges and Research Needs (2013); Derr, Laura E., When Food is Poison: The History, Consequences and Limitations of the Food Allergen Labeling and Consumer Protection Act of 2004, 61 Food Drug L.J. 65 (2006)Google ScholarPubMed. Groups that advocate for transparency in the food system, with a recent emphasis on GMO labeling, include: Food Integrity Now, Just Label It, Food Democracy Now, Massachusetts Right to Know GMOs, Project Transparent Food, Center for Food Safety, Project on Government Oversight, Non GMO Project, Food Integrity Campaign, Right to Know GMO, and Food and Water Watch. See, e.g., Lydia Zuraw, Food Industry Association Plans to Make GRAS More Transparent, Food Safety News (Aug. 29, 2014), http://www.foodsafetynews.com/2014/08/gma-plans-to-make-gras-more-transparent/#.VFPpS8npdrV. Michelle Obama's “ Let's Move” campaign also incorporates nutrition labeling. See A.J. Pearlman, Helping Families Make Healthier Choices: FDA to Update Nutrition Facts Label, Let's Move Blog (Feb. 27, 2014), http://www.letsmove.gov/blog/2014/02/27/helping-families-make-healthier-choices-fda-update-nutrition-facts-label.

2 See e.g., Snejana Farberov, Genesis of a National Plague: How Modern America's Obesity Epidemic Began in the 1950s and How Charting the Weight Loss Struggles of a 205lb Aspiring Nurse Helped Bring the Problem to the Forefront, Daily Mail, July 19, 2013, available at http://www.dailymail.co.uk/news/article-2371051/How-modern-Americas-obesity-epidemic-began-1950s.html; An Epidemic of Obesity: U.S. Obesity Trends, The Nutrition Source, Harvard School of Public Health, http://www.hsph.harvard.edu/nutritionsource/an-epidemic-of-obesity/ (last visited March 23, 2015); Obesity (Gerald Litwack ed., Amsterdam: Elsevier Academic Press, 2013); Obesity (Scott Barbour, ed., Farmington Hills, MI: Greenhaven Press, 2011); Mabel Blades, Obesity, Bradford Emerald Group Publishing (2005); Alexandra A. Brewis, Obesity, Piscataway, N.J.: Rutgers University Press (2010); Gilden Tsai, Adam and Wadden, Thomas A., Obesity, 159 Annals Internal Med. ITC3-1-ITC3-15 (2013)Google Scholar; Haslam, David W. and Phillip, W. James, T., Obesity, 366 Lancet 1197-1209 (2005)CrossRefGoogle ScholarPubMed; Yanovski, Susan Z. and Yanovski, Zack A., Obesity, 346 New England J. Med. 591-602 (2002)CrossRefGoogle ScholarPubMed; Barnett, Richard, Obesity, 366 Lancet 984 (2005)CrossRefGoogle ScholarPubMed; Arterburn, David, Obesity, 66 Am. Fam. Physician 1279-80 (2002)Google ScholarPubMed; Rosenbaum, Michael, et al., 337 New England J. Med 396-407 (1997)CrossRefGoogle Scholar; Björntorp, Per, Obesity, 350 Lancet 423-26 (1997)CrossRefGoogle ScholarPubMed; F. Sassi, Obesity and the economics of prevention: fit not fat, Paris: Organisation for Economic Co-operation and Development (2010); A.H. Barnett and Sudhesh Kumar, Obesity and diabetes, Hoboken, N.J.: John Wiley & Sons (2004); Koplan, Jeffery, et al., Preventing Childhood Obesity: Health in the Balance, Washington, DC: National Academies Press (2005)Google ScholarPubMed; Expert Panel on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults (U.S.), Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report, Bethesda, M.D.: National Institutes of Health, National Heart, Lung, and Blood Institute (1998); Koplan, Jeffery, Progress in Preventing Childhood Obesity: How Do We Measure Up?, Washington, D.C.: National Academies Press (2007)Google Scholar.

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6 See Menu and Vending Machines Labeling Requirements, FDA, http://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm217762.htm (last updated Mar. 12, 2015). A chain restaurant is one that has twenty or more locations. See id. The requirements also apply to vending machines operators with more than twenty machines and allows for restaurants or vendors with fewer than twenty locations to register for voluntary regulation. See id. Other nutrient information must be provided to consumers upon written request. In 2014, coverage expanded to movie theatres and grocery stores. See Food Labeling; Nutrition Labeling of Standard Menu Items in Restaurants and Similar Retail Food Establishments, 79 Fed. Reg. 71,156, 71,157 (Dec. 1, 2014) (to be codified at 21 C.F.R. pt. 11, 101).

7 See Food Labeling; Nutrition Labeling of Standard Menu Items in Restaurants and Similar Retail Food Establishments, 79 Fed. Reg. at 71,229.

8 FDA, Nutritional Labeling and Education Act (NLEA) Requirements (8/94 – 2/95) 17 (1994), available at http://www.fda.gov/iceci/inspections/inspectionguides/ucm074948.htm; FDA, Guidance for Industry: A Food Labeling Guide (7. Nutrition Labeling; Questions G1 Through P8) 2 (2013), available at http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm064894.htm.

9 FDA, Guidance for Industry, supra note 8, at 2-3.

10 Sabrina Tavernise, New F.D.A. Nutrition Labels Would Make ‘Serving Sizes’ Reflect Actual Servings, N.Y. Times (Feb. 27, 2014), http://www.nytimes.com/2014/02/27/health/new-fda-nutrition-labels-would-make-serving-sizes-reflect-actual-servings.html.

11 See id.

12 See, e.g., Bryan Bollinger et al., Calorie Posting in Chain Restaurants 2 (Nat'l Bureau of Econ. Research, Working Paper No. 15,648, 2010) (observing a 6% drop in calories per transaction at Starbucks locations that posted nutritional information, but suggesting this would only have a small impact on obesity, although it may encourage restaurants to offer more low calorie options or accustom consumes to calorie counting); Lisa Mancino & Jean Kinsey, USDA, Is Dietary Knowledge Enough? Hunger, Stress, and Other Roadblocks to Healthy Eating 2-4 (2008), available at http://www.ers.usda.gov/publications/err-economic-research-report/err62.aspx#.UyON3YXpdrU (finding that eating away from home and with long period between meals reduces the influence of cognitive dietary information). See generally Elbel, Brian et al., Calorie Labeling and Food Choices: A First Look at the Effects on Low-Income People in New York City, 28 Health Aff. w 1110 (2009)CrossRefGoogle Scholar, available at http://www.ncbi.nlm.nih.gov/pubmed/19808705; Elbel, Brian et al., Child and Adolescent Fast-Food Choice and the Influence of Calorie Labeling: A Natural Experiment, 35 Int'l J. Obesity 493 (2011)CrossRefGoogle ScholarPubMed [hereinafter Child and Adolescent Fast-Food Choice]; Rosanna Mentzer Morrison et al., USDA, Will Calorie Labeling in Restaurants Make a Difference?, USDA (Mar. 11, 2011), http://www.ers.usda.gov/amber-waves/2011-march/will-calorie-labeling.aspx#.UyN6d4XpdrW.

13 Elbel, Child and Adolescent Fast-Food Choice, supra note 12, at 496-97.

14 See, e.g., Wilcox, Keith et al., Vicarious Goal Fulfillment: When the Mere Presence of a Healthy Option Leads To an Ironically Indulgent Decision, 36 J. Consumer Res. 380, 381 (2009)CrossRefGoogle Scholar; Wisdom, Jessica et al., Promoting Healthy Choices: Information Versus Convenience, 2 Am. Econ. J.: Applied Econ. 164, 165 (2010)Google Scholar.

15 Wisdom, supra note 14, at 164.

16 Id. at 170.

17 Wilcox, supra note 14, at 382.

18 Id. at 381.

19 See Morrison, supra note 12; Variyam, Jayachandran N., Do Nutrition Labels Improve Dietary Outcomes?, 17 Health Econ. 695, 701, 704 (2008)CrossRefGoogle ScholarPubMed.

20 See Jayachandran N. Variyam, Nutrition Labeling in the Food-Away-From-Home Sector: An Economic Assessment, USDA, ERS (2005), available at http://webarchives.cdlib.org/sw1tx36512/http:/www.ers.usda.gov/Publications/ERR4; Wisdom, supra note 14, at 164.

21 See Driskell, Judy A. et al., Using Nutrition Labeling As a Potential Tool for Changing Eating Habits of University Dining Hall Patrons, 108 J. Am. Dietetic Ass'n 2071, 2072 (2008)Google ScholarPubMed; Misra, Ranjita, Knowledge, Attitudes, and Label Use Among College Students, 107 J. Am. Dietetic Ass'n 2130, 2131 (2007)Google ScholarPubMed.

22 See Aaron, Jacqueline I. et al., Paradoxical Effect of a Nutrition Labeling Scheme in a Student Cafeteria, 15 Nutrition Res. 1251, 1256 (1995)Google Scholar; Conklin, Martha T. et al., College Students' Use of Point of Selection Nutrition Information, 20 Topics Clinical Nutrition 97, 98 (2005)Google Scholar; Harnack, Lisa J. et al., Effects of Calorie Labeling and Value Size Pricing on Fast Food Meal Choices: Results from an Experimental Trial, 5 Int'l J. Behav. Nutrition & Physical Activity 1, 3 (2008)Google ScholarPubMed.

23 Elise Golan et al., Food Policy: Check the List of Ingredients, USDA Amber Waves (June 2009), available at http://webarchives.cdlib.org/sw1tx36512/http:/www.ers.usda.gov/AmberWaves/June09/Features/FoodPolicy.htm.

24 See Mancino, Lisa et al., Getting Consumers to Eat More Whole-Grains: The Role of Policy, Information, and Food Manufacturers, 33 Food Pol'y 489, 494 (2008)Google Scholar.

25 See Keystone Ctr., The Keystone Forum on Away-From-Home Foods: Opportunities for Preventing Weight Gain and Obesity 73 (2006), available at http://archive.oxha.org/knowledge/publications/us_keystone-center-obesity-forum_may-2006.pdf (“ Between 1991 (before the implementation of the NLEA) and 1995 (after implementation), the number of available fat-modified cheese products tripled, and the market share for fat-modified cookies increased from zero percent of the market to 15%.”).

26 See Bleich, Sara N. et al., Calorie Changes in Chain Restaurant Menu Items, 48 Am. J. Preventive Med. 70, 73 (2015)CrossRefGoogle ScholarPubMed.

27 See id. at 75.

28 See, e.g., Michael Pollan, Omnivore's Solution, Otis Lecture at Bates College (Oct. 27, 2008), available at http://www.bates.edu/food/foods-importance/omnivores-solution.

29 See generally Nina Teicholz, The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet (2014).

30 See Can Changes in Nutrition Labeling Help Consumers Make Better Food Choices?, Elsevier (Jan. 23, 2013), http://www.elsevier.com/about/press-releases/research-and-journals/can-changes-in-nutrition-labeling-help-consumers-make-better-food-choices; Lando, Amy & Lo, Serena, Single-Larger-Portion-Size and Dual-Column Nutrition Labeling May Help Consumers Make More Healthful Food Choices, 113 J. Acad. Nutrition & Dietetics 241 (2013)CrossRefGoogle ScholarPubMed, available at http://www.sciencedirect.com.eres.library.manoa.hawaii.edu/science/article/pii/S2212267212018187; Nutrition Facts Food Labels Are Too Confusing for Most People, FDA Researchers Say, N.Y. Daily News (Jan. 24, 2013), http://www.nydailynews.com/life-style/health/food-labels-confuse-people-fda-study-article-1.1246816 (reporting on an FDA study recommending that labels state the nutritional content per package instead of per serving to reduce consumer confusion).

31 See Lando & Lo, supra note 30, at 244.

32 See Kessler, David A., Toward More Comprehensive Food Labeling, 371 New Eng. J. Med. 193, 194 (2014)CrossRefGoogle ScholarPubMed.

33 See Bleich, Sara N. et al., Reducing Sugar-Sweetened Beverage Consumption by Providing Caloric Information: How Black Adolescents Alter Their Purchases and Whether the Effects Persist, 104 Am. J. Pub. Health 2417, 2417 (2014)CrossRefGoogle ScholarPubMed.

34 See Bleich, Sara N. et al., Diet-Beverage Consumption and Caloric Intake Among US Adults, Overall and by Body Weight, 104 Am. J. Pub. Health, e72, e72 (2014)CrossRefGoogle ScholarPubMed; Sara N. Bleich et al., supra note 33, at 2417; see also I Have To Walk How Many Miles to Burn Off This Soda?, Johns Hopkins Bloomberg Sch. Pub. Health (Oct. 16, 2014), http://www.jhsph.edu/news/news-releases/2014/i-have%20to-walk-how-many-miles%20to-burn-off-this-soda.html. It is still problematic, however, that almost 90% of teenagers entering the store purchased an unhealthy sweetened beverage.

35 See Sue McGreevey, Mass. Gen. Hosp., Enlightened Eating: Color-Coded Labels, Rearranged Items Encourage Healthy Choices in Study, Harv. Gazette (Jan. 19, 2012), http://news.harvard.edu/gazette/story/2012/01/enlightened-eating.

36 Id.

37 Id.

38 Id.

39 See, e.g., Nicole Larson & Mary Story, Robert Wood Johnson Found., Menu Labeling: Does Providing Nutrition Information at the Point of Purchase Affect Consumer Behavior? 1, 3 (2009) (“Although consumers want nutrition information to be available, several other factors, aside from nutrition concerns, influence their menu selections. Most notably, food prices, taste and convenience are frequently reported as important influences on menu selections, and these factors are often at odds with healthful eating.”); see also Knoll, Melissa A. Z., The Role of Behavioral Economics and Behavioral Decision Making in Americans' Retirement Savings Decisions, 70 Soc. Sec. Bull. 1, 2 (2010)Google ScholarPubMed, available at http://www.ssa.gov/policy/docs/ssb/v70n4/v70n4p1.html (noting in the context of retirement savings that “[e]ven if decision makers had complete and accurate information … empirical findings suggest that they would still make suboptimal savings decisions as a result of issues related to the second category, heuristics and biases”).

40 See David R. Just et al., USDA, Could Behavioral Economics Help Improve Diet Quality for Nutrition Assistance Participants? 14-15 (2007), available at http://www.ers.usda.gov/publications/err-economic-research-report/err43.aspx#.UyNeyoXpdrV; Stroebele, Nanette & DeCastro, John M., Effect of Ambience on Food Intake and Food Choice, 20 Nutrition 821, 821 (2004)CrossRefGoogle ScholarPubMed.

41 Downs, Julie S. et al., Strategies for Promoting Healthier Food Choices, 99 Am. Econ. Rev.: Papers & Proceedings 159, 159 (2009)CrossRefGoogle ScholarPubMed, http://www-personal.umich.edu/∼prestos/Downloads/DC/pdfs/Downs_Sept22_Downsetal2009.pdf.

42 See Michael Moss, Salt Sugar Fat: How the Food Giants Hooked Us xxv-xxvi (2013).

43 See Gurley Lambert, Kelly et al., Food-Related Stimuli Increase Desire to Eat in Hungry and Satiated Human Subjects, 10 Current Psychol.: Res. & Revs. 297, 297-98 (1991)CrossRefGoogle Scholar, available at http://link.springer.com/article/10.1007%2FBF02686902#page-1.

44 Id.

45 See generally Albright, Cheryl L. et al., Restaurant Menu Labeling: Impact of Nutrition Information on Entree Sales and Patron Attitudes, 17 Health Educ. Q. 157 (1990)CrossRefGoogle Scholar; Harnack et al., supra note 22, at 1 (finding that including calorie information and value size pricing did not significantly impact fast food meal choices); Kolodinsky, Jane et al., The Use of Nutritional Labels by College Students in a Food-Court Setting, 57 J. Am. C. Health 297 (2008)CrossRefGoogle Scholar (finding that price, convenience, calories, fat, and nutrition labels play roles in food purchases); Lando, Amy M. & Labiner-Wolfe, Judith, Helping Consumers Make More Healthful Food Choices: Consumer Views on Modifying Food Labels and Providing Point-of-Purchase Nutrition Information at Quick-Service Restaurants, 39 J. Nutrition Educ. & Behav. 157 (2007)CrossRefGoogle ScholarPubMed (finding that more studies are necessary to determine whether alternative presentations of nutrition information would be helpful); O'Dougherty, Maureen et al., Nutrition Labeling and Value Size Pricing at Fast-Food Restaurants: A Consumer Perspective, 20 Am. J. Health Promotion 247 (2006)CrossRefGoogle ScholarPubMed.

46 See Freeman, Andrea, Fast Food: Oppression Through Poor Nutrition, 95 Calif. L. Rev. 2221, 2226 (2007)Google Scholar (“While the growth of fast food in poor urban neighborhoods has increased steadily, supermarkets stocking fresh, high-quality food have simultaneously relocated to the more spacious and affluent suburbs.”).

47 See Sarah Treuhaft & Allison Karpyn, The Grocery Gap: Who Has Access to Healthy Food and Why it Matters, Food Trust 8, http://thefoodtrust.org/uploads/media_items/grocerygap.original.pdf (“Residents in many urban areas (including Seattle, Central and South Los Angeles, and East Austin, Texas) have few transportation options to reach supermarkets. Inadequate transportation can be a major challenge for rural residents, given the long distances to stores.”); see also id. at 21 (“Until more systemic solutions are instituted, transportation barriers to fresh food markets need to be removed. Community groups and planners should evaluate existing transportation routes and improve coordination of bus routes, bus stops, and schedules or add vanpools or shuttles to maximize transit access to grocery stores and farmers' markets.”).

48 See generally Brookings Inst., The Price is Wrong: Getting the Market Right for Working Families in Philadelphia 24 (2005) (explaining what causes higher grocery prices in Philadelphia); Erik Eckholm, Study Documents ‘Ghetto Tax’ Being Paid by the Urban Poor, N.Y. Times (July 19, 2006), http://www.nytimes.com/2006/07/19/us/19poor.html?_r=0 (discussing added costs that low income communities often pay for essential goods and services).

49 See Andrea Freeman, Behavioral Economics and Food Policy: The Limits of Nudging, in Behavioral Economics, Law & Health Policy (forthcoming Fall 2016) (on file with author.) Ingredients banned in other countries but still legal and commonly used here include petroleum-based artificial dyes, olestra, brominated vegetable oil, potassium bromate, azodicarbonimide, butylated hydroxyanisole (BHA) and butylated hydroxytoluene (BHT), synthetic growth hormones rBGH and rBST, and arsenic. Susanna Kim, 11 Food Ingredients Banned Outside the U.S. that We Eat, ABC News (June 26, 2013), http://abcnews.go.com/Lifestyle/Food/11-foods-banned-us/story?id=19457237#10.

50 See Freeman, Fast Food: Oppression Through Poor Nutrition, supra note 46, at 2225.

51 The USDA is responsible for both agricultural commodities and the federal nutrition programs, including school lunchrooms. See Freeman, Andrea, Farm Subsidies and Food Oppression, 38 Seattle U. L. Rev. __ (forthcoming 2015)Google Scholar; Cohen, Juliana F.W. et al., Impact of the New U.S. Department of Agriculture School Meal Standards on Food Selection, Consumption, and Waste, 46 Am. J. Preventive Med. 388, 392 (2014)CrossRefGoogle ScholarPubMed.

52 See U.S. Census Bureau, Living in Near Poverty in the United States: 1966–2012 (2014), available at https://www.census.gov/prod/2014pubs/p60-248.pdf; How Many People Are Poor?, UC Davis Ctr. for Poverty Res., http://poverty.ucdavis.edu/faq/how-many-people-are-poor (last visited May 14, 2015).

53 Andrea Freeman, Transparency for Food Consumers & Food Oppression 33, n. 90, in UCLA-Harvard Food Law and Policy Conference, Transparency in the Global Food System: What Information and to What Ends? (Oct. 24, 2014) (unpublished article), available at https://www.law.ucla.edu/∼/media/Files/UCLA/Law/Pages/Publications/RES_PUB_Panel%203Oct2014.ashx [hereinafter Transparency for Food Consumers & Food Oppression] (internal citation omitted) (“While only 9.7% of whites lived below the poverty line in 2012, 27.2% of Blacks, 25.6% of Latinos, and 11.7% of Asian Americans did.”); id. (internal citation omitted) (“In 2013, 26% of Black households and 24% of Latino households had higher rates of food insecurity than the national average.”). People who have ever received food stamps through the Supplemental Nutrition Assistance Program are 31% Black, 22% Latino, 18% other, and 15% white. See id. (citing Rich Morin, The Politics and Demographics of Food Stamp Recipients, Pew Res. Ctr. (July 12, 2013), http://www.pewresearch.org/fact-tank/2013/07/12/the-politics-and-demographics-of-food-stamp-recipients). Additionally, “Black women and children make up 19.8% of WIC participants and only 12.6% of the population; Latinas represent 41.5% of WIC recipients but only 16.3% of the population.” Id.; see also USDA, WIC Participant and Program Characteristics 2012 Final Report 1, 27 (2013), available at http://www.fns.usda.gov/sites/default/files/WICPC2012.pdf [hereinafter WIC Participant Report].

54 Freeman, Transparency for Food Consumers & Food Oppression, supra note 53, at 25; Freeman, Andrea, The Unbearable Whiteness of Milk: Food Oppression and the USDA, U.C. Irvine L. Rev. 1251, 1253 (2013)Google Scholar.

55 See Freeman, Andrea, “First Food” Justice: Racial Disparities in Infant Feeding As Food Oppression, 83 Fordham L. Rev. 3053, 3054 (2015)Google Scholar.

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57 See Office of Disease Prevention & Health Promotion, Disparities, HealthyPeople.gov, http://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities (last updated May 14, 2015).

58 Benforado, Adam et al., Broken Scales: Obesity and Justice in America, 53 Emory L.J. 1645, 1659 (2004)Google Scholar.

59 Id. at 1658-68.

60 When grouping people by race in the context of health disparities, I do so with an awareness that these disparities arise from social factors, not to suggest that there is any biological basis for racial grouping. See generally Dorothy Roberts, Fatal Invention: How Science, Politics, and Big Business Re-Create Race in the Twenty-First Century 64-66 (2011) (noting that among multiple genetic studies, “ none support dividing the species into discrete, genetically determined racial categories”); Fullwiley, Duana, Race and Genetics: Attempts to Define the Relationship, 2 BioSocieties 221, 224 (2007)CrossRefGoogle Scholar (describing the “ myriad problems” that arise when “ racial generalizations” are drawn from genetic data); Haney López, Ian F., The Social Construction of Race: Some Observations on Illusion, Fabrication, and Choice, 29 Harv. C.R.-C.L. L. Rev. 1, 1314 (1994)Google Scholar (describing the history behind racialized groups); Richman, William M., Genetic Residues of Ancient Migrations: An End to Biological Essentialism and the Reification of Race, 68 U. Pitt. L. Rev. 387, 388 n.3 (2006)Google Scholar (explaining differences between racialized groups).

61 See generally Agency for Healthcare Research & Quality, Disparities in Health Care Quality Among Racial and Ethnic Minority Groups: Selected Findings from the 2010 National Healthcare Quality and Disparities Reports 1 (2011), available at http://www.ahrq.gov/qual/nhqrdr10/nhqrdrminority10.htm (providing detailed statistics regarding racial groups and health status); Race, Ethnicity, and the Health of Americans: ASA Series on How Race and Ethnicity Matter, Am. Sociological Ass'n (2005), available at http://www.asanet.org/images/research/docs/pdf/race_ethnicity_health.pdf (explaining how race plays a role in health status).

62 See, e.g., Adult Obesity Facts, CDC, http://www.cdc.gov/obesity/data/adult.html (last updated Sept. 9, 2014).

63 See, e.g., Alonso, Alvaro et al., Dairy Intake and Changes in Blood Pressure over 9 Years: The ARIC Study, 63 Eur. J. Clinical Nutrition 1272, 1274 (2009)CrossRefGoogle ScholarPubMed.

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65 See, e.g., Who Gets Angina?, Speak from the Heart, http://www.speakfromtheheart.com/who-gets-angina.aspx (last visited May 14, 2015).

66 Freeman, Transparency for Food Consumers & Food Oppression, supra note 53, at 24; see, e.g., Am. Cancer Soc'y, Cancer Facts & Figures for African Americans 2011-2012 1, 16 (2011), available http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-027765.pdf; Cervical Cancer Rates by Race and Ethnicity, CDC, http://www.cdc.gov/cancer/cervical/statistics/race.htm (last updated Aug. 27, 2014).

67 Freeman, Transparency for Food Consumers & Food Oppression, supra note 53, at 25; see, e.g., Laurie Kaye Abraham, Mama Might Be Better off Dead: The Failure of Health Care in Urban America 179-97 (1993); Bullard, Robert D. et al., Toxic Wastes and Race at Twenty: Why Race Still Matters After All of These Years, 38 Envtl. L. 371, 371 (2008)Google Scholar; Cabana, Michael D. & Flores, Glenn, The Role of Clinical Practice Guidelines in Enhancing Quality and Reducing Racial/Ethnic Disparities in Paediatrics, 3 Paediatric Respiratory Revs. 52, 52 (2002)CrossRefGoogle ScholarPubMed; Fiscella, Kevin et al., Inequality in Quality: Addressing Socioeconomic, Racial, and Ethnic Disparities in Health Care, 283 JAMA 2579, 2579 (2000)CrossRefGoogle ScholarPubMed; Flores, Glenn et al., The Impact of Ethnicity, Family Income, and Parental Education on Children's Health and Use of Health Services, 89 Am. J. Pub. Health 1066, 1067 (1999)CrossRefGoogle Scholar; Liu, David M.K.I. & Alameda, Christian K., Social Determinants of Health for Native Hawaiian Children and Adolescents, 70 Haw. Med. J. 11 Supp. 2 (Nov. 2011)Google ScholarPubMed; Massoglia, Michael, Incarceration, Health, and Racial Disparities in Health, 42 L. & Soc'y Rev. 275, 285 n.6 (2008)Google Scholar; Noah, Barbara A., Racial Disparities in the Delivery of Health Care, 35 San Diego L. Rev. 135, 138 (1998)Google ScholarPubMed; Watson, Sidney D., Race, Ethnicity and Hospital Care: The Need for Racial and Ethnic Data, 30 J. Health L. 125, 125 (1997)Google ScholarPubMed; Weitzman, Michael et al., Black and White Middle Class Children Who Have Private Health Insurance in the United States, 104 Pediatrics 151, 151 (1999)Google ScholarPubMed; Wenneker, Mark B. & Epstein, Arnold M., Racial Inequalities in the Use of Procedures for Patients with Ischemic Heart Disease in Massachusetts, 261 JAMA 253, 253 (1989)CrossRefGoogle ScholarPubMed; Williams, David R. & Rucker, Toni D., Understanding and Addressing Racial Disparities in Health Care, 21 Health Care Financing Rev. 75, 75 (2000)Google ScholarPubMed.

68 See Ctr. for Responsive Politics, Influence & Lobbying: Food & Beverage, OpenSecrets.org, http://www.opensecrets.org/industries/indus.php?ind=N01 (last visited May 14, 2015). In the 2008 campaign cycle, food and beverage companies donated over $16 million to political candidates. In 2013-14, the top campaign contributors in these industries were the National Restaurant Association, Coca-Cola, McDonald's, Darden Restaurants (including the Olive Garden), Pepsi, Bloomin' Brands (including Outback Steakhouse), CKE restaurants (including Carl's Jr. and Hardee's), Wendy's and the American Beverage Association. See id.

69 In 2014, the industry spent over $15.7 million on lobbying. The top lobbyists were Coca-Cola, Pepsi, the National Restaurant Association, McDonald's and Mars. See id.

70 See generally Ctr. for Responsive Politics, Revolving Door, OpenSecrets.org, https://www.opensecrets.org/revolving/index.php (last visited May 14, 2015) (explaining how a revolving door forms and functions).

71 See Marion Nestle, Food Politics: How the Food Industry Influences Nutrition and Health 48, 126 (2007).

72 See Mary Clare Jalonick, Pizza Is a Vegetable? Congress Says Yes, NBC News (Nov. 15, 2011), http://www.nbcnews.com/id/45306416/ns/health-diet_and_nutrition/t/pizza-vegetable-congress-says-yes/#.VCn3AxbpdrU (“Food companies that produce frozen pizzas for schools, the salt industry and potato growers requested the changes, and some conservatives in Congress say the federal government shouldn't bet telling children what to eat.”).

73 See Freeman, Farm Subsidies and Food Oppression, supra note 51.

74 For example, on the island of Kaua'i in Hawai'i, the mayor vetoed a law regulating pesticide use after the city council passed the controversial bill by a vote of six to one, despite substantial lobbying efforts by the affected corporations, Syngenta Hawaii, DuPont Pioneer, Dow AgroSciences and BASF. See Natasha Lennard, How the Monsanto Protection Act Snuck into Law, Salon (Mar. 27, 2013, 4:44 PM), http://www.salon.com/2013/03/27/how_the_monsanto_protection_act_snuck_into_law. See generally State & County QuickFacts: Kaua'i County, Hawai'i, U.S. Census Bureau (Feb. 5, 2015), http://quickfacts.census.gov/qfd/states/15/15007.html. The Kaua‘i ordinance also sought to protect its residents from potential health hazards from genetically modified (GM) crops. See Kaua'i Mayor Vetoes Popular Ordinance Safeguarding Public from Pesticides, EarthJustice.org (Oct. 31, 2013), http://earthjustice.org/news/press/2013/kaua-i-mayor-vetoes-popular-ordinance-safeguarding-public-from-pesticides. Large agricultural corporations have been very successful at blocking local and federal regulation of genetically modified organisms (GMOs). In March 2013, President Obama signed into law the Farmer Assurance Provision, also deemed the ‘Monsanto Protection Act’ as section 735 of H.R. 933, the Consolidated and Further Continuing Appropriations Act, 2013. See Consolidated and Further Continuing Appropriations Act, 2013, Pub. L. No. 113-6, § 735, 127 Stat. 198, 231-32 (2013). The provision allows major agricultural corporations to bypass standard regulatory requirements regarding new GM crops by instructing the Secretary of Agriculture to “immediately grant temporary permit(s) or temporary deregulation” upon a farmer, grower, farm operator or producer's request. Id. at 232. The provision eliminates judicial review, even upon a finding that a crop poses health harms. See id.

75 See William Saletan, Don't Touch Anything But My Junk, Slate (Apr. 5, 2011), http://www.slate.com/articles/health_and_science/human_nature/2011/04/dont_touch_anything_but_my_junk.html; Menu Labeling, State of Obesity, http://stateofobesity.org/menu-labeling (last visited May 14, 2015).

76 See Tavernise, supra note 10 (stating that Kessler's changes have faced opposition, especially his push to place nutrition labels on the front of food items).

77 See infra pp. 14-15.

78 See Julie Guthman, Weighing In: Obesity, Food Justice, and the Limits of Capitalism 52–55 (2011).

79 See generally Benforado, supra note 58, at 1689-1742.

80 See Fee, Elizabeth & Krieger, Nancy, Understanding AIDS: Historical Interpretations and the Limits of Biomedical Individualism, 83 Am. J. Pub. Health 1477, 1478-79 (1993)CrossRefGoogle ScholarPubMed.

81 See Alice Mah, Lessons from Love Canal: Toxic Expertise and Environmental Justice, Resilience (Aug. 9, 2013), http://www.resilience.org/stories/2013-08-09/lessons-from-love-canal-toxic-expertise-and-environmental-justice; Cancer Alley, Louisiana, Pollution Issues, http://www.pollutionissues.com/Br-Co/Cancer-Alley-Louisiana.html (last visited May 14, 2015).

82 See Greenberg, et al., Portrayals of Overweight and Obese Individuals on Commercial Television, 93 Am. J. Pub. Health 1342, 1342 (2003)CrossRefGoogle ScholarPubMed; see also Fouts, Gregory & Burggraf, Kimberley, Television Situation Comedies: Female Weight, Male Negative Comments, and Audience Reactions, 42 Sex Roles 925, 927 (2000)CrossRefGoogle Scholar; Himes, Susan & Kevin Thompson, J., Fat Stigmatization in Television Shows and Movies: A Content Analysis, 15 Obesity 712, 713 (2007)CrossRefGoogle ScholarPubMed.

83 See e.g., Sonita Moss, The Big C's Big Black Problem, Jezebel (Jan. 17, 2012), http://jezebel.com/5876914/the-big-cs-big-black-problem; Tami Winfrey Harris, When Will Glee Stop Ignoring Race?, Racialicious (May 4, 2011), http://www.racialicious.com/2011/05/04/when-will-glee-stop-ignoring-race; Sassy Black Woman, TV Tropes, http://tvtropes.org/pmwiki/pmwiki.php/Main/SassyBlackWoman (last visited May 14, 2015).

84 What's Happening!!, IMDB, http://www.imdb.com/title/tt0074071 (last visited May 14, 2015) (starring Mabel King as “Mabel ‘Mama’ Thomas”).

85 Good Times, IMDB, http://www.imdb.com/title/tt0070991/?ref_=fn_al_tt_1 (last visited May 14, 2015) (starring Esther Rolle as “Florida Evans”).

86 Gimme a Break!, IMDB, http://www.imdb.com/title/tt0081869/?ref_=fn_al_tt_4 (last visited May 14, 2015) (starring Nell Carter as “Nellie Harper”).

87 How I Met Your Mother, IMDB, http://www.imdb.com/title/tt0460649/?ref_=nm_flmg_act_6 (last visited May 14, 2015) (starring Sherri Shepherd as “Daphne”).

88 The Big C, IMDB, http://www.imdb.com/title/tt1515193/?ref_=nv_sr_1 (last visited May 14, 2015) (starring Gabourey Sibide as “Andrea Jackson”).

89 Glee, IMDB, http://www.imdb.com/title/tt1327801/?ref_=nv_sr_2 (last visited May 14, 2015) (starring Amber Riley as “Mercedes Jones”).

90 See Tongan American Aims to Eliminate Stereotypes, Promote Wellness Within Pacific Islander Community, Community Health for Asian Americans (Jan. 7, 2011), http://www.chaaweb.org/news/20110165/tongan-american-aims-eliminate-stereotypes-promote-wellness-within-pacific-islander-co.

91 Id.

92 Id.

93 See Emmett Aluli, Noa, Prevalence of Obesity in a Native Hawaiian Population, 53 Am. J. Clinical Nutrition 1556S, 1559S (1991)Google Scholar; McCubbin, Laurie D. & Antonio, Mapuana, Discrimination and Obesity Among Native Hawaiians, 71 Haw. J. Med. Pub. Health 346, 346 (2012)Google ScholarPubMed (finding that discrimination is a risk factor for obesity in Native Hawaiians).

94 See Robert Ji-Sun Ku et al., Eating Asian America: A Food Studies Reader 326 (2013) (stating that SPAM has particular importance due to its association with the American militarization of Hawaii); see also Noa Helela, Ha, Genius, http://genius.com/Noa-helela-ha-annotated (last visited May 14, 2015) (“We are boxed up/like a can of spam./Ingredients: ham, pork, precooked native people, separated chicken fat, suffocation, and sodium nitrate./Nutrition facts: happiness, air, self-respect 0 grams/bloody fists, alcohol, destruction,/It's over 9000!/Basically, nothing worth breathing./But I don't want to be an emergency food,/farm-raised in immersion schools/to preserve the flavor of my native tongue,/and used in time of war,/so they can serve us up/in bite sized body bags.”).

95 See generally Ange-Marie Hancock, The Politics of Disgust: The Public Identity of the Welfare Queen (2004); Rose Ernst, Localizing the “Welfare Queen” Ten Years Later: Race, Gender, Place, and Welfare Rights, 11 Race, Gender & Class 181 (2008); Hayden Foster, Carly, The Welfare Queen: Race, Gender, Class, and Public Opinion, 15 Race, Gender & Class 162 (2008)Google Scholar; Hancock, Ange-Marie, Contemporary Welfare Reform and the Public Identity of the “Welfare Queen,” 10 Race, Gender & Class 31 (2003)Google Scholar; Johnson, Karen, Myth of the Welfare Queen, 25 Essence 42 (1995)Google Scholar; Nadasen, Premilla, From Widow to “Welfare Queen:” Welfare and the Politics of Race, 1 Black Women, Gender & Families 52 (2007)Google Scholar.