The Demise of Artificial Trans Fat: A History of a Public Health Achievement.

Policy Points This article describes a strategic combination of research, advocacy, corporate campaigns, communications, grassroots mobilization, legislation, regulatory actions, and litigation against companies and government to secure a national policy to remove artificial trans fat from the US food system. Sharing lessons we learned can help inform policymakers, academics, policy practitioners, and students across disciplines. Some of our lessons are that system change means that all consumers benefit without the need for individual behavior change; research can both identify opportunities to improve health and support policy adoption; policy efforts can serve as public education campaigns; policy campaigns can drive marketplace changes; and engaging forward-thinking companies can diffuse opposition to passing a policy. CONTEXT: For many decades, partially hydrogenated vegetable oil (PHO), the primary source of artificial trans fat in the American diet, was used widely in processed and restaurant foods. In the early 1990s, studies linked the consumption of artificial trans fat with heart disease. This article details how research and advocacy led to eliminating artificial trans fat from the US food supply. METHODS: We synthesized published studies of the health impact of trans fat, the legislative history of state and local trans fat bills, the Food and Drug Administration's (FDA) regulatory docket on trans fat labeling and its declaration that PHOs are no longer Generally Recognized as Safe (GRAS), and our own files, which included strategy documents, notes from meetings with the FDA staff, correspondence between advocates and the FDA, fact sheets, press releases, news clips, and other materials. FINDINGS: This history of trans fat provides insights into policy strategy and advocacy best practices that resulted in the removal of trans fat from food in the United States, preventing an estimated 50,000 premature deaths a year. The lessons we learned are that system change benefits all consumers without the need for individual behavior change; research can both identify opportunities to improve health through policy and support policy adoption; policy campaigns can serve as public education campaigns; policy can drive changes to products and the marketplace; and engaging forward-thinking companies can help diffuse opposition to passing a policy. Securing this policy required the persistence of scientists and health advocates in first discovering the risks and then using the science to secure policies to mitigate the identified harm. CONCLUSIONS: An understanding of the tactics used to help attain the targeted policies and how challenges were addressed (such as through communications, leveraging an expanding research base and expert reports, showing that a national policy was feasible through voluntary corporate changes and state and local policy, and litigation against companies and government agencies) may provide a model for scientists, students, advocates, and policymakers. We hope this account will inform efforts to address other public health challenges, such as the current threats of excessive exposure to sodium and added sugars, which persist in the US food system.

Palm oil and health: a case of manipulated perception and misuse of science.

In the 1980s, a combination of forces came together to convince the public that food products containing tropical oils contributed to their risk of coronary heart disease. Tropical oils were competing with the U.S. soy bean oil market as an alternative vegetable oil, yet they were higher in saturated fat, which had become the target of the health promotion community for its theoretical association with coronary heart disease risk. Successful national campaigns were undertaken to force food manufacturers to remove tropical oils, including palm oil, from their products and to replace them with hydrogenated vegetable oils, resulting in increased intakes of trans-fatty acids, which later became the target of the same advocacy groups. Today palm oil is being touted as a suitable replacement for hydrogenated vegetable oils.

The trans fatty acid story in Denmark.

The Danish story started with the publication of Willett's Lancet paper in 1993, and ended when industrially produced trans fatty acids (IP-TFA) were reduced at the Danish market following a ban in 2003. The Danish Nutrition Council, established in 1992, was the driving force behind a campaign that convinced Danish politicians that IP-TFA could be removed from foods without any effect on taste, price or availability of foods. The Nutrition Council argued that as no positive health effect of IP-TFA had ever been reported, then just the suspicion that a high intake exerts harmful effects on health could justify a ban. The Danish success story might be interesting for other countries where this unnecessary health hazard could be eliminated from their foods.

Is the quality and cost of food affected if industrially produced trans fatty acids are removed?

Since the start in Italy and Denmark more than 10 years ago the application of fats and oils without trans fatty acids (TFA) has increased all over the world. Today the food industry uses enormous resources to decrease the content of TFA in existing and new products. The food industry has in most cases succeeded in making consumer accepted products without TFA-most of the quality issues have been related to the technological properties of the fat- and oil-based ingredients. The change from the traditional process of selective hydrogenation to fractionation and interesterification has caused a change in the demand of vegetable oils and process capacities in the market, but until now most of these changes has been absorbed by the market without significant changes in the cost of the raw materials.