Nancy Glick

A message for National Minority Health Month: Take obesity seriously

Nancy GlickBy Nancy Glick, Director of Food and Nutrition Policy

As National Minority Health Month in April comes to a close, It is a good time to take stock of the health status of the more than 125 million Americans of color or 38.4 percent of the population now living in this country.

The good news is that improvements in disease prevention are saving lives. For example, more minority women are getting mammogram screenings for breast cancer, getting treatment with antibiotics earlier, and seeking counseling for smoking cessation.  As a consequence, Hispanic, American Indian, and Asian women all have lower death rates from heart disease when compared with white women and breast and lung cancer deaths have been declining steadily among African American women.

But while we can celebrate these advancements, now is the time to be even more mindful of the minority health problems that are often discounted and go untreated. And here, no problem needs our attention more than the disease of obesity, where people of color face an unequal burden of weight-related chronic conditions and premature death due to significant disparities in medical care.

In sheer numbers and its toll on death and disability, obesity has reached crisis proportions in the US. According to the Centers for Disease Control and Prevention, the adult obesity rate now exceeds 40 percent – the highest level ever recorded. And the costs are staggering.  Not only is obesity a serious disease by itself, but it worsens the outcomes of over 230 chronic conditions including type 2 diabetes, heart disease, and certain cancers. Thus, obesity is responsible for 300,000 premature deaths each year and costs the U.S. economy over $1.72 trillion annually in health costs.

But these statistics only begin to document the problem. Obesity disproportionately affects Black and Brown communities and is now one of the most serious health equity issues facing the nation. Due to higher rates of obesity among communities of color, Black adults are 1.5 times as likely to experience stroke, 40 percent are more likely to have high blood pressure and 60 percent are more likely to be diagnosed with diabetes than White adults. Additionally, Hispanics are 1.7 times more likely to have diabetes than Whites, Asian Americans are 40 percent more likely to be diagnosed with diabetes, and Native Hawaiians/Pacific Islanders are 2.5 times more likely to have diabetes and 3.9 times as likely to experience a stroke.

The threat is real, but hand ringing is not the answer. Obesity is a treatable disease, just like type 2 diabetes and hypertension. Yet obesity remains largely undertreated by healthcare providers.  As documented in a National Consumers League report issued in July 2022, 108 million adult Americans have obesity, but only 30 million adults have been diagnosed with the disease (source:  PharMetrics-Ambulatory EMR database, 2018. Novo Nordisk Inc.).

Compounding the problem, only 2 percent of those eligible for treatment with FDA-approved anti-obesity medicines (AOMs) have been prescribed these drugs. This means that very few Americans with obesity are benefiting from a new class of safe and effective medicines that control appetite and cravings to achieve significant weight loss. According to a study published in the New England Journal of Medicine, use of one of these drugs resulted in more than a 20 percent reduction in obesity when added to lifestyle modification.

While there are many reasons why obesity is going undiagnosed and untreated, the most pernicious are insurance barriers that keep people from getting the care they need. This includes government policy that allows states to define what are the essential health benefits that must be covered under any Affordable Care Act (ACA) marketplace plan sold on state health insurance exchanges. Yet, despite the ACA’s guarantees of providing all essential health benefits to consumers, a 2016 analysis by the Obesity Care Advocacy Network (OCAN) found that 24 states excluded coverage for weight/obesity management services in their benchmark marketplace plans, resulting in blatant discrimination against people with obesity.

An equally troubling situation involves the Medicare program, which prohibits coverage for FDA-approved anti-obesity medicines based on a policy dating back to 2003 when these drugs did not exist. This resistance to change leaves millions of seniors, particularly members of Black and Latino communities, vulnerable to disability, disease and premature death due to lack of treatment. Moreover, the extent of the disparities in obesity care will only get worse in the coming years if the status quo remains. As documented in a March 2023 report from AmerisourceBergen, the total number of Black, Native American, Asian, and Hispanics eligible for Medicare is predicted to more than double by 2038, many of whom will have obesity and a different set of chronic conditions than what Medicare is currently prepared to address.

Then, there is the Medicaid program operated by the states, which covers about three in ten Black, American Indian and Native Hawaiians/Pacific Islanders under age 65 and more than two in ten Hispanic adults. While Medicaid has helped narrow longstanding disparities in health coverage and access to care for people of color, this is not true for those Medicaid beneficiaries living with obesity. Today, only 15 Medicaid programs cover anti-obesity medications in fee-for-service Medicaid, and only four additional programs cover anti-obesity medications under at least one Medicaid managed-care plan. Moreover, only two states cover anti-obesity medications in benchmark Marketplace plans.

Adding to these coverage disparities, 15 million people on Medicaid – 30 percent of whom are Hispanics and 15 percent are African Americans  – could lose access to their health coverage in the coming months. This is due to the end of a federal program that paid states to add more low-income and disabled residents to the Medicaid rolls during the COVID-19 pandemic.

Already, five states – Arizona, Arkansas, Idaho, New Hampshire, and South Dakota – have begun to disenroll people and by the end of June, 34 states and the District of Columbia will cut their Medicaid rolls, either due to their income status or for procedural reasons, such as not completing renewal forms. For this reason, advocates are using all available levers to help enrollees keep their Medicaid coverage and to assist those dropped from the program to find coverage through the Affordable Care Act’s marketplace or other options.

While this is a short-term solution, it is part of the national commitment by the public health community, minority health leaders, clinicians, patient advocates, and consumer organizations to change outdated and discriminatory policies that restrict coverage and access to obesity treatments. Our message is clear: the health of all Americans depends on taking obesity seriously and ensuring that those with the disease receive timely, comprehensive obesity care.

Debunking the myth of prepared foods being cheaper and healthier

By Ryan Barhoush, Food and Nutrition Program Associate

As we finish the holiday season (maybe a few pounds heavier) and get ready to put in place our New Year’s Resolutions, we recommend making one of them NOT buying prepared foods. and Instead, commit to cooking up healthier, cheaper, and quicker meals from scratch. With minimal shopping and prep time, we can all feed ourselves and our families with healthier options. Let’s debunk a few of these prepared food myths.

Myth 1. It takes too much time to shop for healthy food 

Grocery stores in the U.S. can be overwhelming, and we all feel the stress of walking into these sometimes exceptionally large stores, but do not be intimidated!  You can easily tackle the task of shopping quickly and efficiently with some practice and shopping discipline. In fact, if you do it right, you can be in and out of the store in 20-30 minutes with a healthy grocery basket full of food for you and your family. Here is how:

  • Make a shopping list and stick to it
  • Shop online and get your groceries delivered, or
  • Identify your favorite grocery store, get to know where products are and get in and out efficiently.

Myth 2. Prepared and frozen foods have the same nutritional value as a home cooked meal.

Prepared frozen meals are loaded with sodium and sugar; home cooked meals typically have much lower levels of both, thus are healthier and more nutritional.

Let’s compare some labels to prove it.  Start with one of most popular frozen food items, pizza. We looked at the Red Baron brand and compared its nutritional content to a standard meal of baked chicken, broccoli, and potatoes.

The results are staggering. One slice of the pizza contains 810 mg of sodium. The Dietary Guidelines for Americansrecommends adults limit sodium intake to less than 2,300 mg per day—that’s equal to about 1 teaspoon of table salt!  For children under age 14, recommended limits are even lower.

So, one slice of pizza is one-third of the total recommended daily intake. High sodium in prepared foods contributes to the hypertension epidemic in the U.S. Nearly half of adults in the United States (47%, or 116 million) have hypertension, defined as a systolic blood pressure greater than 130 mmHg or a diastolic blood pressure greater than 80 mmHg according to the CDC. Hypertension can lead to stroke, heart attack and other serious illnesses.

Red Baron’s Frozen Pizza Roasted Chicken with Potatoes and Broccoli
One serving of Red Baron’s is 380 calories per slice!

 

Amount per serving 353 calories
39g of carbohydrates

 

29g of carbohydrates
18g of Total fat

 

 8g of Total fat

 

45mg of cholesterol

 

 89mg of cholesterol

 

810mg of sodium per slice* 106mg of sodium

 

* That’s 3240 mg of sodium per pizza! Almost 1000 mg over the daily recommended limit!

 

Myth 3. It takes too much time to cook healthy meals for myself or my family. 

Meal prep can be amazingly fast, efficient, and fun! There are many websites with healthy meals that can be prepared in 5-10 minutes, with cooking times of 30 minutes or less. For example, this one: The best meal of the day doesn’t have to take your whole day!  I have compiled a list of 25 easy weeknight dinners to get you in and out of the kitchen in a flash.”  

Myth 4. Prepared frozen foods are cheaper than shopping and cooking my own food.  

Wegmans and other grocery stores have suggestions for affordable nutritious meals, as low as $2.75 a serving. Each 20.6 oz. Baron Frozen Pizza costs from $4.99-6.25 plus tax and includes four servings. But if you look at the label closely, each serving is one piece of pizza and that is an unrealistic serving size for an adult’s meal. Let’s say one pizza feeds two people, that doesn’t include anything else besides the pizza, such as salad or other side dishes. That is at least $2.50 – $5 a person. Already the frozen prepared food option is more expensive than a tofu dinner with vegetables or a chicken dinner with potatoes and broccoli.

Another great place to find affordable, filling, healthy and easy recipes is the Delish website. The internet is full of great suggestions but stay away from sites that suggest using canned soups or packaged or frozen prepared foods, because they are often filled with elevated levels of sodium, sugar, and fat.

Myth 5. I only have a microwave, I do not have a kitchen, or the right kind of cooking utensils.

Do not be discouraged. With the unbelievable amount of cooking videos on social media you would think you would need a commercial kitchen just to have a normal healthy meal. Today with just a microwave you can still make many healthy meals. Check this out: 20 Easy to Cook Microwave recipes.

Also, electric stove tops are a terrific addition to any household. Even without a kitchen, just a few pots and pans and some YouTube videos; you could be well on your way to being a kitchen-less chef! Dried fruits and nuts are easy and healthy snacks that you do not have to store in the fridge. Apples and pears are great fresh fruit that do not need to be refrigerated.

As you can see, there are many ways to avoid processed foods and create healthy meals at a reasonable price. Here are a few links we include to create healthy, fast home-cooked meals that are reasonably priced. Plus, cooking for your family is fun and an effective way to get everyone together around the table. Good luck, eat healthy and enjoy!

Nancy Glick

Alcohol labeling: We’re in it to win it

Nancy GlickBy Nancy Glick, Director of Food and Nutrition Policy

For historians, 2003 will be remembered as the year that the space shuttle Columbia crashed, scientists finished sequencing the human genome, and the U.S. launched war against Iraq.

But 2003 also marks an important milestone for American consumers. In December of that year, three national consumer organizations – the National Consumers League (NCL), Center for Science in the Public Interest (CSPI), and the Consumer Federation of America (CFA) – first petitioned the federal government to require an easy to read, standardized “Alcohol Facts” label on all beer, wine and distilled spirits products. This sparked a 19-year battle that is finally paying off for the estimated 67 percent of Americans[1] who drink alcoholic beverages.

In 2003, the Nutrition Facts label on processed foods and non-alcoholic beverages had been in use for almost a decade (1994) and many consumers said they frequently or almost always read the label. Thus, public acceptance and use of the Nutrition Facts label created built-in public support for an Alcohol Facts label. In fact, polling NCL commissioned in both 2005 and 2007 showed overwhelming public support for comprehensive alcohol labeling. Now, polling consistently shows that 75 percent of Americans think alcoholic beverages should have standardized alcohol content labels and 72 percent say this labeling will encourage responsible alcohol use.

Even more significantly, not knowing what is in a beer, wine or distilled spirits drink increases the risk for overconsumption of alcohol, a serious and costly public health problem. According to the latest research findings, alcohol is a source of empty calories that contribute to obesity,[2] and can impact blood sugar control in people with diabetes.[3] Additionally, alcohol is a roadway killer accounting for about 30 percent of all traffic crash fatalities in the U.S.,[4] and excessive drinking increases the risk of liver disease, hypertension, cardiovascular disease, alcohol use disorders, certain cancers and severe injuries.[5] Consequently, an estimated 140,000 people in the United States die annually from alcohol- related causes,[6] which is why the cost of excessive alcohol use reached $249 billion in 2010 and is likely higher today..[7]

Based on this documented evidence, the 2003 petition, which was also signed by 73 nutrition/public health organizations and experts, called for a label that gives consumers the needed information to make responsible drinking decisions, such as the serving size, amount of alcohol and calories per serving, the percent alcohol by volume, and the number of standard drinks per container. And yet, the lead federal agency that regulates alcoholic beverages – the Alcohol and Tobacco Tax and Trade Bureau (TTB) – deliberated but failed to take meaningful action for almost two decades.

The arcane process started in 2005 with an advance notice of proposed rulemaking, which produced over 19,000 public comments. In 2006, TTB issued another notice of proposed rulemaking on allergen labeling followed by a notice in 2007 on alcohol and nutrition labeling. Unfortunately, however, TTB allowed these proposed rules to languish, ultimately deciding in 2013 to issue a voluntary rule allowing companies to decide what nutrition and calorie information to disclose – and what to keep hidden. Not surprisingly, many manufacturers opted out of TTB’s program so most alcoholic beverage products on the market remain unlabeled or carry incomplete information.

Even with these setbacks, the consumer community kept up the pressure on TTB because the need for alcohol labeling has only increased. This became apparent during the COVID-19 pandemic when a 2020 RAND study charted a 14 percent increase in alcohol consumption among adults over age 30 in one year.[8] Another national study found that excessive (binge) drinking increased by 21 percent during the pandemic, with the potential for 8,000 additional deaths from alcohol-related liver disease by 2040.[9]

And then, the sand started to shift. Also related to the pandemic, consumer demand skyrocketed for hard ciders, some types of beers, wine coolers and the other low-alcohol drinks sold in supermarkets and convenience stores and what consumers saw were complete alcohol labels on these products. This is because low-alcohol drinks fall under the purview of the Food and Drug Administration, not TTB. Armed with this evidence, NCL leaders met online with Department of Treasury and TTB officials in June 2021 and put TTB in the uncomfortable position of having to explain why often the same manufacturers who must put a standardized content label on brands regulated by FDA don’t bother to do so when their products are under TTB’s jurisdiction.

Not long after this meeting, the Treasury Department conducted its own review and on February 9, 2022, issued a report, Competition in the Markets for Beer, Wine and Spirits, that advanced the importance of labeling information to foster competition within the beverage alcohol industry. The report contains several recommendations, including the recommendation that “TTB should revive or initiate rulemaking proposing ingredient labeling and mandatory information on alcohol content, nutritional content, and appropriate serving sizes.”

This was encouraging news, so NCL doubled down, combining forces with CSPI and the Consumer Federation of America to get TTB to mandate alcohol labeling across the board. Recognizing that public pressure alone will not ensure success, the organizations turned to Congress, hosting briefings for lead staffers of the House and Senate appropriations committees with jurisdiction over TTB’s budget and sending a joint letter to key Congressional leaders from 23 consumer, health/nutrition, and alcohol policy organizations about the need for mandatory alcohol labeling. This led to report language in the draft House and Senate 2023 appropriations bills that encourages TTB to initiate a final rulemaking.

The last step was filing a lawsuit against TTB in the United States District Court for the District of Columbia on October 3, 2022, asking the court to direct TTB to grant or deny the 2003 petition within 60 days. The lawsuit was a gamble, but it worked: on November 17, 2022, TTB accepted the 2003 petition and committed to publish three rulemakings covering mandatory nutrient and alcohol content labeling, mandatory allergen labeling, and mandatory ingredient labeling within the next year.

However, this is not the end of the story. The proposed rules will be accompanied by open public comment periods where we can anticipate that segments of the alcohol industry will be aggressive in fighting robust consumer labeling.  Therefore, NCL will also be actively engaging a wide range of stakeholders to weigh in on behalf of consumers so the American public to have access to standardized and complete labeling information on beer, wine and distilled spirits. It has taken 19 years to get to this point, but our message is clear: alcohol labeling is long past due, consumers overwhelmingly want to see it, and we will stay in the fight until alcohol labeling is a reality.

[1] Gallup. Alcohol & Drinking. July 2022

[2] U.S. Department of Agriculture and U.S Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9Th Edition. December 2020.

[3] Emanuele NV, et al. Consequences of Alcohol Use in Diabetics. Alcohol Health Res World. 1998; 22(3): 211–219.

[4] National Highway Traffic Safety Administration. Risky Drunk and Drugged Driving Statistics.

[5] U.S. Centers for Disease Control and Prevention. Alcohol and Public Health. Last reviewed April 14, 2022. https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm

[6] U.S. Centers for Disease and Control Prevention. Deaths from Excessive Alcohol Use in the U.S. Page last reviewed April 14, 2021. https://www.cdc.gov/alcohol/features/excessive-alcohol-deaths.html . Accessed June 2, 2022.

[7] U.S. Centers for Disease Control and Prevention. Alcohol and Public Health. Page last reviewed April 14, 2022. https://www.cdc.gov/alcohol/features/excessive-drinking.html. Accessed June 2, 2022.

[8] Pollard MS, et al. Changes in Adult Alcohol Use and Consequences During the COVID-19 Pandemic in the US. JAMA Netw Open. 2020;3(9):e2022942.

[9] Julien J, et al. Effect of increased alcohol consumption during COVID-19 pandemic on alcohol-associated lover disease: A modeling study. Hepatology. Vol. 75; Issue 6; June 2022; 1480-1490.

Food safety tips this holiday season

By Ryan Barhoush, Food and Nutrition Program Associate

As we are gearing up for this upcoming holiday season, food safety  is something important to keep in mind. If this is your first time or even your 20th being the Thanksgiving head chef, it is always good to review some simple safety tips in the kitchen. There is nothing worse than getting your relatives sick…unless that is the only way to get your uncle to stop talking about politics at the table. Just kidding, of course. Here are some food safety recommendations from National Consumers League for Turkey Day tomorrow. Happy Holidays!

Roasting a Turkey this year? Don’t be intimidated but keep these ideas in mind.

  • Keep poultry separated from other items in the fridge.
  • If brining a turkey, make sure it is properly secured or in a cooler away from your other food items. Be careful of spillage or drippings from contaminating other items.
  • If thawing a frozen turkey in the fridge, allow about 24 hours for each 4 to 5 pounds of Turkey
  • Never thaw a turkey by just laying it out on the counter, this could lead to bacteria growth, even if it is frozen.
  • You can thaw in cold water, keep it in a bag to prevent contamination, and change the water every 30 minutes. It takes about 30 minutes per pound to defrost a frozen turkey.
  • Remember to wash your hands before and after handling the turkey. Every time!
  • Use separate cutting boards and scrub with warm, soapy water after use.
  • Use a thermometer and make sure your turkey has an internal temperature of 165 degrees.

Frying a turkey? Don’t be scared but be aware of the risks!

  • Never leave oil unattended, even a small amount of oil reaching a lit flame can cause a large fire.
  • Make sure your turkey is dry and completely thawed! Pat dry the inside and the outside of the turkey. Any kind of moisture can cause combustion when in contact with oil.
  • Do not overfill the fryer with oil. Pre-test the oil levels with something in the same weight range as your turkey.
  • Always fry a turkey outside, away from the house, and on level surfaces.
  • Keep children and animals away from the fryer, even after use, as oil can remain hot for hours.
  • Remember that the sides and handles will be dangerously hot.
  • Have an all-purpose fire extinguisher nearby.

Besides the turkey, here are few more things to keep your eye on in the kitchen.

  • Be mindful of the “danger zone”. Bacteria and germs can grow rapidly between 40 and 140 degrees.
  • Keep warm food with warm food and cold food with cold food!
  • Don’t leave out any food past two hours
  • Don’t put warm leftovers away in the fridge
  • Follow these steps and enjoy a safe and Happy Thanksgiving!

Consumer groups obtain TTB commitment to issue rulemakings on mandatory alcohol labeling

November 21, 2022

Media contact: National Consumers League – Katie Brown, katie@nclnet.org, (202) 823-8442

Washington D.C. — A coalition of consumer groups today announced an important victory for the American public: the Treasury Department’s Alcohol and Tobacco Tax and Trade Bureau (TTB) has agreed to issue proposed rules requiring standardized alcohol content, calorie, and allergen labeling on all beer, wine and distilled spirits products. TTB also agreed to begin preliminary rulemaking on mandatory ingredient labeling.

TTB’s decision comes after three national consumer organizations – the Center for Science in the Public Interest, Consumer Federation of America, and the National Consumers League – sued TTB on October 3, 2022, for failing to act on a 2003 petition to require alcohol labeling with the same basic transparency consumers expect for non-alcoholic beverages and food products. CSPI’s litigation department filed the complaint on behalf of the three organizations in the United States District Court for the District of Columbia.

Based on evidence that alcohol is a significant source of empty calories and increases the risk of certain cancers, alcohol use disorders, traffic accidents, and severe injuries, the 2003 petition specifically called for listing the amount of alcohol and calories per serving, the percent alcohol by volume, the serving size, the number of standard drinks per container, and other needed information to make fully informed drinking decisions. These consumer groups also petitioned for an ingredients listing on all alcoholic beverages, something that is a standard feature for other food products and particularly important to those with allergies or other chemical sensitivities.

As a result of the lawsuit, TTB committed to publishing three rulemakings covering mandatory nutrient and alcohol content labeling, mandatory allergen labeling, and mandatory ingredient labeling within the next year.

In addition to the lawsuit, the groups applauded the House and Senate Appropriations Committee for including report language in the FY23 Financial Services and General Government bill urging the agency to take action on this critical rule.

“This is a groundbreaking day for consumers,” said Sally Greenberg, Executive Director of the National Consumers League. “Consumer advocates have been trying for 19 years to get this far. Now there is light at the end of the tunnel. We thank the TTB for finally taking this action and look forward to working closely with the agency, the industry, and other consumer advocates to make sure this is done right and that consumers are the winners.”

“All we have requested over these two long decades is the kind of information that consumers expect when purchasing other foods and beverages,” said Peter Lurie, Executive Director of the Center for Science in the Public Interest. “We hope TTB can move quickly on this long overdue action.”

Better labeling requirements for alcoholic beverages will allow consumers to make more informed decisions,” said Thomas Gremillion, Director of Food Policy at Consumer Federation of America. “Consumers have a right to consistent, reliable, and relevant information about the products they buy. For too long, the alcohol industry has kept consumers in the dark, and TTB’s announcement is an important step forward.” 

The 2003 citizen petition was submitted to the Treasury Department by CSPI, CFA, and NCL and a coalition of 66 other organizations and eight individuals, including four deans of schools of public health.

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About the National Consumers League (NCL)

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit https://nclnet.org.

NCL applauds federal agency’s decision to require mandatory labeling on all alcoholic beverages

November 18, 2022

Media contact: National Consumers League – Melody Merin, melodym@nclnet.org, (703) 298-2614

Washington D.C. — Today the National Consumers League hailed the decision by the Alcohol and Tobacco Tax and Trade Bureau (TTB), the federal agency that oversees alcohol labeling, to require mandatory labeling on all alcoholic beverages as a “great consumer victory.” NCL is grateful to the agency for this welcome – albeit long overdue – decision.

In 2003, NCL and other consumer groups filed a petition calling on TTB to provide consumers with robust nutritional information about the alcoholic beverages they drink. Today, 19 years later, the agency acted to grant the petition. The November 17 letter from TTB can be viewed here.

NCL and other consumer groups pursued two avenues this year to get movement on the labeling of alcoholic beverages: filing a lawsuit this past fall against the agency and working with Congress.

NCL also thanks the Senate and House Appropriations Committees for their inclusion of language in the Fiscal Year 2023 Financial Services and General Government Funding Bill that urges the agency to move toward mandatory nutritional labeling of alcoholic beverages.

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About the National Consumers League (NCL)

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit https://nclnet.org.

Nancy Glick

At last: FDA is updating the definition of a “healthy” food

Nancy GlickBy Nancy Glick, Director of Food and Nutrition Policy

It is rare when new regulations from the Food and Drug Administration (FDA) warrant a song. But borrowing a phrase from Sam Cooke, FDA’s recent proposed rule changing the meaning of the term “healthy” has been a long time coming – 28 years to be exact. Yet, as the song goes “a change is gonna come.”

Why is this a good thing? Simply put, the term “healthy” is out-of-date, both with the state of nutrition science today and with the latest Dietary Guidelines for Americans, recommendations from experts on what to eat and drink to meet nutrient needs, promote health, and prevent disease.

Going back to 1994 when FDA’s old definition of “healthy” went into effect, the agency focused on individual nutrients in a food, not the actual foods we eat. Accordingly, foods now qualify as “healthy” if they are low in total fat, saturated fat, cholesterol and sodium and must contain a significant amount of fiber and at least two additional beneficial nutrients such as vitamins A, C, D, calcium, iron, protein, or potassium. This covers about 5 percent of foods, including white bread, highly sweetened yogurt, and sugary cereals.

The problem is that many healthy foods do not qualify for the use of a “healthy” claim based on FDA’s outdated standards. This includes avocados, nuts, seeds, olive oil, and salmon because they are high in fats now known to be heart healthy. And right now, plain, non-carbonated water and plain, carbonated water cannot be labeled as “healthy,” which makes no sense.

These absurdities have been apparent to consumer organizations for decades, but the impetus for change was the introduction of the KIND bar in 2015. KIND advertised its bars as healthy because they contain whole foods like nuts and grains, but because the nuts have more fat than what FDA now allows for a “healthy” claim, the agency sent a warning letter about the use of the claim.  When KIND responded with a Citizen Petition that documented the healthfulness of nuts, FDA permitted KIND to use the term “healthy” and issued a proposed rule change in 2016, signaling its intention to revise the definition.

At the same time, nutrition science has evolved over 28 years. Not only is it clear that not all fats and carbohydrates are the same but getting the nutrients needed for a healthy diet result from making food choices based on healthy dietary patterns. This understanding is especially noteworthy because more than 80 percent of Americans consume too much added sugars, saturated fat and sodium but aren’t eating enough vegetables, fruit and dairy, according to the Dietary Guidelines for America, 2020-2025.

Based on these developments, FDA’s proposed rule will do away with counting individual nutrients in a food. Instead, FDA’s plan is to define the term “healthy” on food packaging based on two criteria:

  1. The product must contain a certain “meaningful amount” of food from at least one of the food groups recommended by the Dietary Guidelines, such as fruits, vegetables, or dairy; and
  2. The food must stay within specified limits for certain ingredients, such as saturated fat, sodium and added sugar, based on a percent of the Daily Value (DV) of the nutrient. This includes a limit for sodium of 230 milligrams (mg) per day, or 10 percent of DV per serving – an important action by itself since Americans on average consume 50 percent more sodium per day than is recommended in the Dietary Guidelines.

The proposed rule is also consistent with recent changes to the Nutrition Facts label. For example, the Nutrition Facts label must now declare added sugars to help people maintain healthy dietary practices.

Applying these criteria, a cereal could only carry a “healthy” claim if contained ¾ ounces of whole grains and no more than 1 gram of saturated fat, 230 milligrams of sodium and 2.5 grams of added sugars. This would disqualify almost all breakfast cereals now marketed to children.

To help make the new “healthy” claim meaningful for consumers, the FDA is also researching a symbol that food manufacturers can use on the front of the package. The symbol would act as a quick signal that the food contributes to a healthy dietary pattern and is part of a labeling system the National Consumers League has long supported.

FDA’s proposed rule addresses several of NCL’s food policy issues. For many years, we have been pressing for a new definition of the term “healthy” that aligns with the latest nutrition science and we support a “Traffic Light” symbol to depict “healthy” foods on the front of the package. We also have been at the forefront in pressing for ways to lower excess sodium in the diet.

But while we believe FDA’s plan is a significant step forward for consumers, there are still some shortcomings. Although the Dietary Guidelines call on consumers to limit calories from added sugars and fats, FDA’s proposed rule fails to consider calorie limits.

Moreover, the new rules won’t stop “healthy” products from being loaded with artificial colors and will have the unintended consequence of incentivizing food processors to replace natural sugar with questionable artificial sweeteners and sugar alcohols without disclosing these ingredients. Even as NCL has advocated for a modernized definition of the term “healthy,” we have been supporting a Citizen Petition to ensure transparent labeling of substitute sweeteners, which have surged in use by more than 300 percent in the last five years and can produce digestive effects. The Citizen Petition asks FDA to add the term “sweetener” in parentheses after the name of all non-nutritive sweeteners in the ingredient list, and for children’s food and beverages, to indicate the type and quantity of non-nutritive sweeteners, in milligrams per serving, on the front of food packages.

FDA published its proposed rule, Food Labeling: Nutrient Content Claims; Definition of Term “Healthy,” in the Federal Register on September 29, 2022, and is encouraging anyone interested in the topic to submit written comments by December 22. NCL plans to use this opportunity to ensure the consumer’s voice is heard and to offer solutions that will advance better food and beverage choices. We all have a stake in labeling claims that are science-based and ensure that consumers have access to more complete, accurate, and up-to-date information about the foods they consume and serve their families.

National Consumers League releases its Top Food and Nutrition Policy Priorities for 2022

July 20, 2022

Media contact: National Consumers League – Katie Brown, katie@nclnet.org, (202) 207-2832

Washington, DC – At a time of significant change in the food industry, the National Consumers League (NCL) today released a food policy agenda to improve food safety, reduce sodium in the diet, achieve better portion control, increase transparency in food and beverage labeling, and promote a more sustainable food system. Additionally, NCL is calling for a national strategy to ensure there will be an ample supply of safe infant formula products in the US along with aggressive regulatory oversight.

“Currently, over 335 million people live in the US, and all are consumers who deserve to be represented in the regulation of the foods and beverages they consume and serve to their families,” said Sally Greenberg, NCL’s Executive Director. “Especially now when technology is changing food production, food safety protocols, and the composition of novel and reformulated foods and beverages, NCL will speak for consumers on strengthening the food safety system, filling the gaps in food labeling, alleviating food insecurity, and reducing food waste.”

Addressing serious food safety lapses and areas where regulation has not caught up to changes in food production, manufacturing, and market trends, NCL’s agenda concentrates on 11 priorities where education and changes in public policy will have a direct and positive impact on the American public:

1. Strengthen the Food Safety System

As the Food and Drug Administration (FDA) moves forward with its New Era of Smarter Food Safety Blueprint, NCL will press FDA to finalize its Food Traceability Proposed Rule, enabling rapid traceback to the source of a contaminated food. Similarly, NCL will stress the need for the U.S. Department of Agriculture (USDA) to modernize poultry safety rules and update food safety rules, such as expanded pathogen testing in meat and poultry products and updated safe handling instructions label for these products.

2. Ensure the Safety and Availability of Infant Formula

The critical shortage of infant formula in the U.S. requires a national strategy to ensure there will be an ample supply of safe infant formula products in the US along with aggressive regulatory oversight of the safety protocols at U.S. manufacturing facilities. NCL will also advocate for policies that increase the number of companies manufacturing infant formula, and changes in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program that allow for more flexibility in the range of infant formula products available through WIC.

3. Make Alcohol Facts Labeling Mandatory

Since 2003, NCL and the Center for Science in the Public Interest have taken the lead in pressing the federal agency that regulates most alcoholic beverages – the Treasury Department’s Bureau of Alcohol and Tobacco Tax and Trade Bureau (TTB) – to issue rules requiring an easy-to-read, standardized “Alcohol Facts” label on all beer, wine and distilled spirits products. Because this

labeling now appears on hard ciders, wine coolers, certain beers and other products regulated by the FDA, NCL, CSPI and the public health community are stepping up the fight to make mandatory alcohol labeling a reality.

4. Reduce Excess Sodium in the Diet

Because Americans on average consume 50 percent more sodium per day than is recommended, NCL will continue to raise awareness of the goal set by FDA to lower sodium intake to 2,300 milligrams (mg) per day and encourage consumers to use the Nutrition Facts label to choose products with less sodium, reduced sodium or no sodium added.

5. Require Labeling of Caffeine Content

While FDA considers 400 mg of caffeine per day as the amount not generally associated with dangerous side effects, the agency only requires food labels to disclose whether there is added caffeine in the food or beverage, not the total amount. Therefore, NCL is calling for new policy requiring all products containing caffeine to list the amount of caffeine per serving and per container.

6. Ensure Transparency in the Labeling of Plant-Based Meat Alternatives

In June 2022, NCL released a new report, Education and Transparency in Labeling Plant-Based Meat Alternatives: A Consumer-Focused Agenda to Improve Understanding and Decision-Making of Plant-Based Meats, which lays out seven priorities for regulatory action, including the requirement that labels on PBMAs are standardized and clarify the protein source and that nutrition/health claims for these products undergo FDA review and are supported by available scientific evidence. 

7. Improve the Labeling of Alternative Sweeteners

Although NCL applauds FDA’s decision to include “Added Sugars” on the recently updated Nutrition Facts Label, the organization supports a Citizen Petition to ensure transparent labeling of substitute sweeteners and is urging FDA to stop misleading claims, such as “No Added Sugars” and “Zero Sugar,” that imply the product is healthier than the original without disclosing that the sugar reduction resulted from reformulating with artificial substances and sugar alcohols. 

8. Modernize Food Standards of Identity

Because many “standards of identity” – recipes for what a food product must contain and how it is manufactured – are now 75 and even 80 years old and out of date, NCL supports FDA’s action plan to modernize food standards of identity. However, NCL urges FDA to focus on several food products where updating SOIs will lead to healthier offerings, such as olive oil, Greek yogurt, and canned tuna.

9. Improve Federal Nutrition Education and Food Labeling Policies by Elevating the Role of Portion Control and Balanced Food Choices, Revising the Definition of “Healthy,” and Developing Uniform Front of Pack Nutrition Rating Symbols

NCL is implementing a three-phased strategy to improve nutrition education and food labeling policies, which entails: 1) education and advocacy that emphasizes portion control and ensures consumers know the recommended daily intake of calories is 2,000 per day, 2) furthering FDA’s efforts to define the term “heathy” on food labels by addressing if and how added sugar content is calculated; and 3) encouraging FDA to adopt a “Traffic Light” labeling system to depict “healthy” foods on the front of the package.

10. Increase Funding and Access to Federal Nutrition Programs

NCL’s advocacy to enhance the Supplemental Nutrition Assistant Program (SNAP) during the COVID-19 pandemic helped to increase access to healthy food to people in need. Now, NCL is working with partners to broaden the public health impact of SNAP by reducing the eligibility requirements, strengthening the nutritional goal for SNAP and providing incentives for healthier foods sold in retail establishments.

11. Reduce the Amount of Food Waste

Because about 90 billion pounds of food goes uneaten every year in the US, NCL is working to help the nation meet the goal of reducing food waste by 50 percent by 2030. As such, we will continue working with USDA, FDA and the Environmental Protection Agency (EPA) to raise awareness of food loss and waste and inform consumers of how they can reduce food waste in their homes.

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About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

A New Patient-Centered Action Agenda calls for people with obesity to have the same rights and access to care as people with other chronic diseases

July 7, 2022

Media contact: National Consumers League – Katie Brown, katie@nclnet.org, (202) 207-2832

Washington, DC— The National Consumers League (NCL) today released A New Patient-Centered Obesity Action Agenda: Changing the Trajectory of Obesity Through Patient Empowerment, Health Professional Intervention and Supportive Government Policies, a new report with a blueprint to change how Americans think about obesity, empower people with obesity to get the best care, and afford those with obesity the same access to care as adults with other serious chronic diseases.

Issued as a call to action, the report was prepared in consultation with a panel of leading obesity specialists as a roadmap for overcoming one of the difficult challenges affecting US adults now living with obesity: despite significant advances in the understanding and treatment of obesity, only 10 percent of people with obesity get help from medical professionals,[1] meaning the disease remains largely undiagnosed and undertreated. Accordingly, only 30 million[2] of the estimated 108 million adults living with obesity[3] have been diagnosed with the disease and only around 2 percent of those eligible for anti-obesity medications have been prescribed these drugs.[4]

The consequences of undertreatment affect virtually every aspect of the healthcare system. Obesity not only has a negative impact on almost every aspect of health and well-being, but it worsens the outcomes of over 230 obesity-related chronic diseases, from type 2 diabetes and heart disease to some forms of cancer.[5] Accordingly, obesity is responsible for an approximately 300,000 premature deaths each year[6] deaths and costs the U.S. economy an estimated $1.72 trillion annually in direct and indirect costs.[7]

“Although obesity is one of today’s most visible public health problems, it is often ignored and discounted as a serious disease, resulting in a health crisis that has only worsened with time,” said
Sally Greenberg, NCL’s Executive Director. “This report focuses attention on the numerous public perception, provider and policy-related factors that preclude Americans with overweight and obesity from getting effective treatment and must be addressed if obesity outcomes are to improve in the US.”

To change the trajectory of the obesity epidemic, the report calls for a national mobilization to overcome the “human” factors– incorrect beliefs about the cause and treatment of obesity, prejudice towards people due to their size, lack of training for health providers, access barriers, and outdated government policies – that continue to prevent Americans from seeking and obtaining obesity care. Towards this end, NCL’s patient-centered action agenda identifies nine priorities for action:

  1. Redefine Obesity for the American Public as a Treatable Chronic Disease

Although the American Medical Association classifies obesity as a chronic disease requiring treatment, three-quarters of Americans believe obesity results from a lack of willpower. Thus, redefining obesity as a treatable chronic condition will provide a new context for health providers and patients to have a positive discussion about weight, leading to more people getting diagnosed and treated.

  1. Adopt Patient-First Language for Obesity

Unlike other chronic diseases where health professionals use people-first language that puts a person before a diagnosis, practitioners routinely use terms to describe obesity that can be off-putting and demoralizing. To change this situation, the National Consumers supports the agenda of the People-First Initiative launched by the Obesity Action Coalition, which advocates for widespread adoption of people-first language by practitioners in all healthcare settings.

  1. Make Combatting Weight Stigma a National Priority

Studies show that 40 percent of healthcare professionals –physicians, nurses, dietitians, psychologists and medical students – admit to having negative reactions based on a person’s size.[8]Addressing this pervasive problem requires a unified national initiative that makes the impact of weight stigma “real” for clinicians and the public and disseminates the latest information to health providers on strategies to reduce weight stigma.

  1. Elevate the Need for Physician Training in Obesity

A recent study of 40 US medical schools finds that 30 percent of these institutions provide little or no education in nutrition and obesity interventions while one third of schools reported no obesity education programs in place.[9] These findings underscore the urgency for US medical schools to change their priorities and develop curricula that comprehensively addresses the disease of obesity.

  1. Establish Excess Weight as a Vital Sign

Besides body temperature, blood pressure, heart rate and respiration, health providers routinely measure height and weight at each visit. Thus, if healthcare professionals were to calculate and provide patients with their Body Mass Index (BMI) at the time of the office visit, practitioners could have a tool to discuss excess weight when patients are most receptive to discussing their health status.  It is recognized that BMI is a crude measure and not the sole predictor of obesity but when combined with patient-friendly information that explains the level of weight and options for treatment, this interaction could initiate a positive, respectful conversation about obesity care.

  1. Provide the Tools for a Doctor-Patient Dialogue on Excess Weight

A major reason primary care providers (PCPs) are reluctant to provide obesity counseling is the lack of informational tools to have conversations with patients about their weight status and care options. Therefore, a unified effort to make available to PCPs evidence-based, patient-friendly content on obesity will facilitate a better dialogue between clinicians and patients and promote shared decision-making.

  1. Establish Coverage of Obesity as a Standard Benefit Across Insurers and Health Plans

Although employers and insurers are starting to cover treatment options for obesity in employee benefit packages, too many people continue to be denied coverage or face access barriers, such as step therapy and prior authorization, that delay treatment. Improving obesity outcomes therefore requires supporting legislative efforts, like the “Safe Step Act” that would require group health plans to provide an exception process for step-therapy protocols. It also necessitates collaboration among payers, providers, policymakers, and advocates to establish a standard, affordable benefit for the prevention and treatment of obesity that applies across plan types and payers.

  1. End Outdated Medicare Rules That Exclude Coverage for Necessary Obesity Care

Today, the many millions of Americans enrolled in the Medicare program are denied safe and effective obesity treatment due to outdated Medicare Part D rules that exclude coverage for FDA-approved obesity drugs and Medicare Part B policies that places undue restrictions on intensive behavioral therapy by allowing only primary care providers to deliver IBT and severely restricting the physical locations where this care can occur. Congress has the power to change this situation, which is why NCL has joined with the obesity, public health and nutrition communities is pressing for swift passage of the Treat and Reduce Obesity Act (TROA). The proposed legislation would expand Medicare coverage to allow access to IBT from a diverse range of healthcare providers while ending the exclusion for new anti-obesity medications that are improving the standard of care for adult Americans with obesity.

  1. Create a Patients’ Bill of Rights for People with Obesity

For too long, people with obesity have been stigmatized, discriminated against, and have faced significant hurdles and burdensome requirements to receive care. Changing this situation will require giving people with obesity the knowledge, skills and confidence to be advocates for their best obesity care. Therefore, NCL’s patient-centered obesity action agenda calls for the creation of a Patients’ Bill of Rights for People with Obesity based on the recognition that obesity is a treatable disease and everyone with obesity deserves the same level of attention and care as those with other chronic conditions.

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About the Report

To prepare the report, NCL partnered with the Obesity Care Advocacy Network (OCAN) to host a roundtable discussion in December 2021where public health specialists, leading professional societies, the minority health field and the obesity policy community assessed the state of the science on obesity today, the scope and cost of the disease in the US and the major barriers impeding quality obesity care with special attention to the “human” obstacles that keep people with obesity from seeking or obtaining treatment. Additionally, NCL conducted a literature review to gather additional insights, especially regarding how to change how people with obesity see themselves, so they become empowered to advocate for their care as patients with a chronic disease. Based on this assessment, NCL drafted the report, which was vetted by experts participating in the roundtable, and developed the policy recommendations included in the Patient-Centered Obesity Action Agenda.

 

About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

 

[1] Stokes A, et al. Prevalence and Determinants of Engagement with Obesity Care in the United States. Obesity. Vol. 26, Issue 5; May 2018, 814-818

[2] PharMetrics-Ambulatory EMR database, 2018. Novo Nordisk Inc.

[3] Hales CM,, et al. Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017-2018. Centers for Disease Control and Prevention. NCHS Data Brief. No. 360. February 2020.

[4] PharMetrics-Ambulatory EMR database, 2018. Novo Nordisk Inc.

[5] Obesity Care Advocacy Network. Fact Sheet: Obesity Care Beyond Weight Loss

[6] Allison DB, et al. Annual deaths attributable to obesity in the United States JAMA 1999Oct 27 282(16)1530–8.

[7] Milken Institute (October 2018), “America’s Obesity Crisis: The Health and Economic Costs of Excess Weight.”

[8] Fruh SM, et al. Obesity Stigma and Bias. J Nurse Pract. 2016 Jul-Aug; 12(7): 425–432.

[9] Butch WS, et al. Low priority of obesity education leads to lack of medical student’ preparedness to effectively treat patients with obesity; results from the U.S. medical school obesity education benchmark study. BMC Med Educ 20, 23 (2020)

NCL Director of Health Policy testifies at Senate Judiciary Subcommittee on Competition Policy, Antitrust, and Consumer Rights on how consolidation in the marketplace harms consumers

June 16, 2022

Media contact: National Consumers League – Katie Brown, katie@nclnet.org, (202) 207-2832

Washington, D.C. – On Wednesday, June 15, 2022, the National Consumers League’s Director of Health Policy Jeanette Contreras provided oral testimony to the Senate Judiciary Subcommittee on Competition Policy, Antitrust, and Consumer Rights on how consolidation in the marketplace harms consumers.

In her testimony, Ms. Contreras discussed the importance of consumers having choices for safe goods and services at a fair price, a core principle of NCL’s advocacy work. Touching on several issues impacting consumers in the U.S. – such as the infant formula shortage, consolidation of the airline industry, primary ticketing market for live events, and the unfair business practices of pharmacy benefit managers (PBMs) – Ms. Contreras reiterated the need for competition in the marketplace and enacting stronger antitrust laws, all of which help protect U.S. consumers.

Her testimony appears below.

June 15, 2022

Good afternoon Chairwoman Klobuchar, Ranking Member Lee, and members of the Subcommittee. My name is Jeanette Contreras. I am the Director of Health Policy at the National Consumers League. I appreciate the opportunity to testify remotely today- due to COVID.

Founded in 1899, NCL is America’s oldest consumer advocacy organization. A core principle of our advocacy is that the marketplace should encourage competition to guarantee that consumers have choices for safe goods and services at a fair price. Monopolies harm competition, leaving consumers with fewer options at higher prices. Monopolistic practices are especially harmful when they occur in the health care arena, where they can exacerbate health disparities.

We share the concerns of new parents regarding the recent shortage of infant formula. Our hearts go out to those parents who have lost babies or whose infants suffered devastating health consequences from contaminated formula. At NCL, we believe all goods and services sold to consumers should be safe and meet all legal requirements- including regulatory guidelines set forth by the FDA.

NCL applauds the FDA and the Administration for adopting a multifaceted approach to increase the supply of infant formula, including temporarily allowing foreign manufacturers to sell their products in the U.S. Additionally, we believe invoking the Defense Production Act to prioritize getting needed inputs to infant formula manufacturers was sound policy. These measures are helping to solve the immediate logistical problem of getting formula onto store shelves across the country.

While addressing the immediate formula shortage is most urgent, we are also troubled that it took the FDA almost four months to act on a whistleblower complaint sent to the agency. This complaint should have received immediate attention given the gravity of the allegations against the Abbott facility. We support a full investigation and, if warranted, bringing criminal and civil charges against those who falsified data. NCL also recommends that the U.S. create a single food safety agency and dedicate an office to overseeing the safety and supply of infant formula.

It should concern every American that one manufacturer controls 40% of the U.S. infant formula market. Only three companies — Abbott, Mead Johnson, and Nestle — control 98% of the industry.

Consolidation in the infant formula industry is a major contributor to the current crisis, but it is only one of many cases where market concentration in recent decades has limited competition and harmed consumers.

For example, NCL continues to raise concerns about the consolidation of the airline industry. Due to weak enforcement of existing antitrust laws, from 2005 to 2015, the number of major U.S. airlines declined from nine to four. And today they control more than 80 percent of the domestic U.S. market.

Our antitrust laws have also failed to protect consumers who attend live events. After merging with Ticketmaster in 2010, Live Nation Entertainment controls roughly 80% of the primary ticketing market in the U.S. As anyone who has purchased tickets recently can attest, this has led to an increase in add-fees and the basic price of tickets.

Stronger antitrust enforcement would be especially beneficial for curtailing anti-competitive conduct in the health care industry, where we’ve seen consolidation lead to higher costs for consumers without an increase in quality or access to care. We are pleased that the Biden administration is looking into how hospital prices increase after acquisitions. We are also hopeful that the ongoing review of DOJ & FTC merger enforcement guidelines will result in more action by those agencies.

NCL also applauds the recent FTC decision to open an investigation into the unfair business practices of pharmacy benefit managers or PBMs. NCL works tirelessly to raise awareness of the outsized role that PBMs play in driving up prescription drug prices for consumers. According to a recent report, the three biggest PBMs controlled roughly 77% of all U.S. prescription drug claims in 2020. And a recent Senate Finance Committee report found some PBMs are getting a 70% rebate on insulin, while out-of-pocket costs for this life-saving medication continue to rise.

These cases are just a few examples of how monopolies and anti-competitive practices have become a problem for consumers. To ensure crises like today’s formula shortage do not happen again, market consolidation must be addressed so that the temporary shutdown of a single factory does not result in the collapse of an entire supply chain.

Whether it is baby formula, airline travel, live event tickets, or pharmaceutical sales, the lack of competition is having increasingly negative impacts on consumer welfare and requires urgent action.

Chairwoman Klobuchar, Ranking Member Lee, thank you for holding today’s hearing and inviting NCL to speak about this important issue. I look forward to answering your questions.

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About the National Consumers League (NCL) 

The National Consumers League, founded in 1899, is America’s pioneer consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.