MR. KOJO NNAMDIFrom WAMU 88.5 at American University in Washington, welcome to "The Kojo Nnamdi Show," connecting your neighborhood with the world. It's a stunning statistic. Soft drinks are now the single biggest source of calories in the American diet. No wonder these drinks are weighing on us. This increase is right in line with increases in obesity, diabetes and a whole lot of other health problems. And while a lot of the debate is about kids and soda, kids aren't the only ones gulping down the liquid calories.

MR. KOJO NNAMDIThere's been an explosion in the number of beverage choices aimed at adults. There are drinks that promise energy, drinks to help you relax, there are sports drinks, a whole range of bottled teas and at least 20 kinds of water. Many of them sound healthy, green tea and vitamin infused water, but unless you read the nutrition labels carefully, you might be surprised to find that most bad calories are in the triple digits and as much sugar as a couple of servings of dessert. We'll discuss the smartest ways to sip these sweet drinks with our guests.

MR. KOJO NNAMDILisa Katic is a registered dietitian and the principal of K Consulting. She's a nutrition advisory to the food and beverage industry. Lisa Katic, thank you for joining us.

MS. LISA KATICIt's a pleasure to be here, Kojo, thank you.

NNAMDIAlso with us is Scott Kahan. He is the co-director of George Washington University's weight management program. And he is on the facility at John's Hopkins School of Public Health. Scott recently co-authored an 800 page nutrition guide for physicians distributed free to all medical students in the country. Scott, thank you for joining us.

MR. SCOTT KAHANPleasure to be here, Kojo.

NNAMDILisa, there seem to be a lot more choices out there now. Has the soft drink market actually expanded from, say, a decade ago?

KATICWell, that's a good question, Kojo. Actually, soft drink sales, regular soft drink sales, are down since the year 2000 by almost 10 percent. However, we do have more choices in the marketplace. Whether they be no calorie, low calorie, full calorie, you've got a portion serving size for everybody.

NNAMDIDid we need so many new drinks and new categories of drinks?

KATICWell, yeah, absolutely. I think, you know, it's what people want. We have more waters on the market, which is one of the fastest selling categories in the -- or products in the category. We're basically delivering what consumers are demanding.

NNAMDIAnd you can tell us what you're demanding by calling 800-433-8850. What do you choose when you feel thirsty? 800-433-8850 or you can go to our website at kojoshow.org and join the conversation there. Scott, drinking sweetened beverages has increased 300 percent since the 1950's. What does that tell us about the American diet?

KAHANWell, we're eating unhealthier over time. That's certainly true. We're having more sugar, more fat, more calories and so forth. What Lisa says about the soft drinks being -- fewer soft drinks being drunk. It's actually the carbonated sodas that are going down a little bit in frequency but that's being replaced by the energy drinks and the sports drinks, which have just as much sugar as the sodas, but are being drunk in much higher amounts.

NNAMDILet's talk for a moment about the sweeteners in soft drinks. High fructose corn syrup has gotten a very bad rep these past few years. What exactly is it?

KAHANHigh fructose corn syrup is a sweetener. It comes from corn syrup and it's chemically modified just a little bit to raise the fructose content in it. So it has about the same amount of fructose as table sugar and it has the same amount of calories as table sugar. It's just as unhealthy as table sugar.

NNAMDIWell, Lisa, you think that the name, high fructose corn syrup, is misleading and part of its image problem and the industry is looking to change its name.

KATICWell, I mean, I think it's a misnomer, actually. It's not so much misleading. It was derived in the '50s when people didn't really focus that much on sugar or ingredients in foods and beverages. And now, with the heightened awareness of everything, people have thought that it is high in fructose and fructose is, in fact, digested differently in the body than table sugar. So why I say it's a misnomer is it's simply a little bit higher in fructose by -- it's 55 percent fructose, 45 percent glucose, which Scott said, it's really the same as table sugar. It's not digested any differently in the body and it's in foods for a lot of reasons.

NNAMDIWhat's the name change that the industry is considering?

KATICWell, I actually don't know that. But, I mean, they're looking at a lot of different things and they're working with FDA on that right now. But the reason they want to change it is because it -- because it is a misnomer and it's something that's garnered a lot of negative attention unnecessarily.

NNAMDIScott, why has high fructose corn syrup gotten such a bad name? Is it because it's the same, in essence, as plain ol' table sugar or are they different in terms of how the body processes them?

KAHANWell, for one, there's a perception that it's more unhealthy because it sounds bad, high fructose corn syrup. But actually, again, the fructose level is about the same as table sugar. There's also an association with rates of obesity occurring over the past three decades when high fructose corn syrup consumption rates have increased. That said, the studies are pretty mixed. Most of the studies don't really show that it's any worse than table sugar. And it's certainly not any better. It's just as unhealthy as table sugar and we should be decreasing our consumption of high fructose corn syrup as well as table sugar given our obesity epidemic.

NNAMDIWhat...

KATICBut I...If I could add...

NNAMDI...oh, please (word?) .

KATIC...I just don't want to leave people with the idea that it's any different. There's nothing that it does unique in the body or in digestions. So, yes, it's true. We want to decrease sugar content, but it really is virtually the same as table sugar.

NNAMDIScott, what do you see in terms of your patients and the calories they get from beverages? Are calories and sugars you drink absorbed any differently than foods?

KAHANThey are. So we have a little bit of data on this. And it shows that liquid calories tend to be not responded to very well by our appetite centers. So when you drink, say, 200 calories of a sweetened beverage, you tend to not be as full afterwards, as satiated afterwards, as if you drink the same amount of calories -- same amount of sugar in a solid food.

NNAMDISodium is another ingredient that many people don't notice in their bottled drinks. But some of these drinks do contain a lot of sodium?

KAHANSome of them do.

NNAMDIA lot of people feel that juice, for instance, can be an easy way to get fruit into their diets. You could eat a piece of fruit or you could drink a glass of juice. what's the difference?

KAHANWell, first of all, many of the drinks on the market are actually juice drinks rather than true juice so it's not actually the juice. It's just sugar and flavored water. But when you're drinking even real juice, most of the healthy vitamins and fiber and such is taken out. And so you're just getting basically sugar water.

NNAMDILisa, a lot of us are surprised to learn that fruit juices aren't really all that different in terms of sugar from sodas.

KATICWell, it, you know, Kojo, depends on the product. There's all kinds of information available on the food label to consumers. They need to look at the carbohydrate content. I mean, it'll tell you right there on that line of the food label what the sugar content is. I think people -- a lot of times, juices will say 100 percent juice so you know that it is derived from a 100 percent fruit source. But I got to go back and say, you know, we have to be careful here. Yes, some fruit juices might be sugar and water and flavoring and vitamin C and other things.

KATICHowever, they really do fit into a healthy diet. It really depends on how many calories you take in and how many calories we burn. And I know that gets down to basics and people want to make it, you know, more convoluted than that. But it really does come down to that. So any beverage that people enjoy can fit into a diet as long as they're balancing it with everything else that they're doing.

NNAMDI800-433-8850 is the number to call. Do you read the nutrition labels when you buy a bottled beverage? 800-433-8850 or you can go to our website, kojoshow.org and join the conversation there. We're talking with Lisa Katic. She's a registered dietician and the principal of K Consulting. She's also a nutrition advisor to the food and beverage industry. Scott Kahan is the co-director of George Washington University's weight management program. He's also on the faculty of John's Hopkins School of Public Health. We go the telephones now. First, with Tony in Alexandria, Va. Tony, you're on the air. Go ahead, please.

TONYHi. I have a one quick aside. I think it's kind of odd that for labeling purposes, the industry would be allowed to decide what they want to call something rather than the FDA would decide what it should be called. But the reason I called is that talking about a (unintelligible) ...

NNAMDIUh-oh, you're -- Hey, Tony, you're breaking up. I'm going to have to put you hold until you're in a more secure location. And in the meantime, let's try Linda in Washington, D.C. Linda, you're on the air. Go ahead, please.

LINDAOh, Kojo, thank you. My question is for Lisa. There is no government oversight to water, bottled water. And I have heard that the advertisement Pure Spring water bottles is basically meaningless because you don't know where that water has come from or how it's been processed. And I have also read that 43 percent of that bottled water is simply municipal tap water. Could she address that, please?

KATICWell, I'm not sure where you're getting your information, but I can assure you that bottled waters are, in fact, definitely regulated by FDA, just as any other beverage on the market is. Claims, again, are regulated on water. There are things that companies can and can't say. I just want to reiterate to the caller before that got disconnected, companies are not allowed to call things just anything that they want to. They have to go by FDA standard. As a matter of fact, companies want to call ingredients by different names and they're not allowed to because they are regulated, which is why we have to work with FDA before we want to change anything on the food label and it takes a really long time to do so.

NNAMDILinda, thank you very much for your call.

LINDAThank you. Bye.

NNAMDIYou, too, can call us at 800-433-8850. If in fact some food juices have more calories than a similar amount of a soda pop, Scott, what's the difference for your body between drinking 100 percent juice and drinking a soda?

KAHANIn terms of the obesity epidemic, there's really no difference. If it has more calories, it's going to contribute to weight gain over time. Perhaps 50 years ago when there was more malnourishment, it might have been somewhat helpful. But today, there's really no difference.

NNAMDILisa, we've heard a lot about proposals for soda taxes, including here in Washington, D.C. And now, New York is piloting a program that prevents people from buying soda with food stamps. Higher prices reduce consumption?

KATICNot necessarily. I honestly really think, Kojo, that's missing the point. We do have a serious problem in the country right now. And by taxing foods really is not going to deter people or teach them how to fit it into a healthy diet. I really believe we need to get down to offering services, like from a dietitian or a known nutrition professional to help people understand how many calories they need, what foods fit into that calorie amount and how to offset some of that with activity. We are more sedentary in our country now than we ever have been. And I think we talk a lot about what's changed over 30 years.

KATICAnd high fructose corn syrup has been introduced and sugar's been introduced, but we fail to talk about computers have been introduced, cell phones, video games, hand gadgets. Our whole society has changed. Women are out of the home more working. Our population is ageing and more diverse. I mean, we've got a lot of things going on that have changed in 30 years so you certainly can't point just to one beverage and say that's the cause of some of these problems.

NNAMDIThe thought of comparing this with cigarettes popped into my head only because with the issue of tobacco, we have both put taxes on it and engaged in a fairly aggressive education campaign to make people aware of its harmfulness.

KATICWell, I think -- well, first of all, I mean, there's nothing to show that soft drinks or sugar or any beverage is harmful such as tobacco. I think that's a false argument. So, you know, I think that's really not fair. But we know that taxing doesn't change or deter behavior because you almost couldn't even tax anything enough, you know, at a high enough level to really deter it. And, again, I think that's not educating people and that's demonizing a particular food. What's to say they couldn't go and start eating some other food, you know, that's candy or desserts or, you know, even something fatty that could...

NNAMDIScott Kahan?

KATIC...make them gain weight.

KAHANI would actually disagree with that. We have more -- better evidence right now for the unhealthful effects of sweetened soft drinks and other sugary junk foods in terms of weight gain, obesity, diabetes and decrease healthy nutrients than we did for tobacco several years ago before we started initiating policy and environmental interventions to try to decrease that. And it's had much success.

KAHANWe also, I think, have better evidence in terms of taxation today, in terms of sweetened beverages compared to what we had in terms of tobacco when we started increasing the tax on it about 30 years ago. So I think this is actually a pretty good avenue. And it certainly won't solve the obesity epidemic and nobody says that it will, but it's one of a number of avenues that can address this, just like we took a number of avenues in terms of tobacco and had really fantastic results over the course of the last few decades.

KATICWell, Kojo, I have to say...

NNAMDIPlease go ahead.

KATIC...that literally the science on soft drinks and sweetened beverages is not conclusive. The current dietary guidelines committee, which is a conglomeration of some of the most reputable nutrition scientists in this country, did not support that there is evidence to show or say that sweetened beverages cause diabetes or any other ill effect. I think that it's just -- that's not there.

NNAMDICan we say used to excess there's a relationship?

KATICAnything -- but that's the point. Anything at excess. We are saying, as dietitians and nutrition professionals, I think we have to get away from this argument because we're missing the point. And we're not helping people understand that it's much bigger and broader than just soft drinks. It's over consumption of calories and it's under, you know, it's lack of activity. I mean, look at our daily lives, are sitting all day long. We get in our cars. We sit at our desks most of the day. Manual labor has been almost completely taken out of our everyday lives.

NNAMDIWe got an e-mail from Matt in Columbia, Md., Scott, who writes, "We have a tough time getting my two-year-old son to eat vegetables. Is having him drink V8 Fusion, which advertises that it includes vegetable juice, a good supplement?"

KAHANCertainly having him drink V8 would be a very healthy way to get vegetables. There's a number -- unfortunately, a number of drinks that say that they have fruits in them or vegetables in them that don't have that much in and have lots of sugar in addition. I don't know specifically the V8 Fusion, but you got to read the labels.

NNAMDIHere is Jenny in Rockville, Md. Jenny, you're on the air. Go ahead, please.

JENNYYes. I wanted to talk about the ubiquitous nature of high fructose corn syrup. It's in almost any food you find in the grocery store, except the fresh vegetables and fresh fruits. And the subsidization of farmers to create corn that is used for high fructose corn syrup, I think Congress can do a lot better job, as far as, like, the whole food chain line, if they were to stop subsidizing farmers to produce corn that isn't edible except for things like high fructose corn syrup. I'll take my comment off the air.

NNAMDILisa.

KATICActually, I have to say that the largest amount of corn grown in this country goes to animal feed. So we're not necessarily -- I think that's an argument -- it's a myth that's been out there for a long time that this subsidization is causing, you know, all these problems in our diets. I think we have to go back to there's a lot of reasons why high fructose corn syrup is used in foods. It's not just for taste, although that is one of them. It's for browning purposes. It's for water moisture, content control. It's for shelf stabilization. There's a lot of reasons that it's in there. It's not just, again, for being sweet.

NNAMDIJudith from Silver Spring, Md. asked, "If corn used to make corn syrup is genetically modified, but is sugar more natural?"

KAHANSugar is natural, corn is natural.

KATICWow, there's a lot there. (laugh)

KAHANBut ultimately, they both have lots of calories. And when a part of a diet -- when a part of the diets that we have today in such excess, they're both going to cause weight gain over time if we don't balance that out.

NNAMDIHere is Tony in Alexandria, Va. Tony, you're on the air. Go ahead, please.

TONYHi. My question I was trying to ask is, first, why does the industry get to change what it wants to call something in its product, rather than the FDA regulating what that should be called? But my main comment was the industry saying they're trying to encourage people to use smaller portions by making smaller bottles available is a little bit counter indicated by the fact that when you go to the store, a six-pack or a 12-pack of those smaller bottles of water or soda usually cost significantly more than a six-pack or a 12-pack of the bigger bottles of the same product. So it's like they're saying, here, if you really want this, you can pay a lot of extra money for it, but we're still going to encourage you to buy the bigger portions with the way we price things.

KATICYeah, Tony, I appreciate that comment. First of all, the first one that you said I already iterated, companies are not allowed to call ingredients in foods anything they want to. If that were the case, high fructose corn syrup would already be called something different on the label so that's just not true. And secondly, pricing is generally done by the retailer and the industry has nothing to do with that. We don't really have a lot of say in that. I think sometimes companies wished that they did. So...

NNAMDIBut...

KATIC...it's all different and it's left up to retail operations.

NNAMDI...another issue that companies do have something to do with is bottled beverages that contain two or even three quote/unquote servings. What does that mean when you're looking at a nutrition label, Scott?

KATICWell actually, if I may, I'm not trying to interrupt, but, I mean, that's going to change as we speak. It is changing as we speak. And the company just launched -- thank you for bringing that up, an initiative clear on calories, that they've teamed up with Michelle Obama's first -- sorry, let's move initiative, and they will now list the total amount of calories on all of their packaging, bottles, cans, vending and fountain drinks to reflect the total calories, not just by serving.

NNAMDIYeah, because even savvy label readers may miss that one.

KATICWell...

KAHANAnd if that happens, that would be a very good thing, certainly. That said, portion sizes, in terms of drinks, have increased significantly over the past few decades.

NNAMDIYeah, we're the big gulp nation.

KAHANAbsolutely. In 1960, 80 percent of sales of sweetened beverages were 6.5 ounce cans. Today, the default is 20 ounce cans so it's tripled in size over the past four decades.

KATICAnd I...

NNAMDISo if you have your basic vitamin water and it contains 2.5 servings, you have to multiply the sugar, carbs and calories by 2.5 to know how much you're getting from that one bottle.

KAHANAbsolutely.

KATICIf you drink the entire bottle, yes.

NNAMDIYeah, 'cause that bottle is not in and of itself a serving. We have Donna in Annapolis, Md. Donna, you're on the air. Go ahead, please.

DONNAHi. Thank you. I have a question and a comment. The question is how is the so-called glycemic value compared between sugar and corn? And the comment is that, we've got these obese babies and they certainly aren't a function of not enough exercise. They're getting stuff through the food supply. And then, for feeding our livestock corn instead of grass, isn't that a possible hint about why these babies are coming out so fat? I'll take my answer off the air.

KAHANThe big picture that she's saying is that virtually everybody in our society is gaining weight. Certainly, the people who are already overweight and obese are gaining weight at a rapid pace. But even people in the normal distribution of body weight are gaining weight over time. And even kids as young as two to five years old and even infants are gaining weight on average. And we live in this society that predisposes to that. And, you're right, that we need to address that from an environmental view, looking at some of the defaults and some of the predispositions to eating so much and to some degree -- and certainly moving too little.

NNAMDIThank you.

KATICWell, and I have to say, if somebody's feeding an infant, you know, some -- whatever it is in a bottle, that's completely inappropriate and nobody would advocate for that or say that that's okay.

NNAMDIWe're going to take a short break after which we will come back to our conversation with Lisa Katic and Scott Kahan about liquid calories and take your calls at 800-433-8850. During the course of that break, we'll, of course, be encouraging you to become members of WAMU 88.5. I'm Kojo Nnamdi.

NNAMDIWelcome back to our conversation on liquid calories with Scott Kahan. He is co-director of George Washington University's weight management program. He's on the faculty at Johns Hopkins School of Public Health. Scott recently co-authored an 800-page nutrition guide for physicians distributed free to all medical students in the country. He joins us in studio along with Lisa Katic.

NNAMDIShe is a registered dietician and the principal of K Consulting. Lisa is a nutrition advisor to the food and beverage industry. Joining us now in studio is Ben Moscovitch. Ben is an associate editor with Inside Health Policy. His area is the FDA and healthcare reform. Ben, thank you for joining us.

MR. BEN MOSCOVITCHThanks for having me.

NNAMDIBen, if the calorie and sugar counts we have been discussing previously in this broadcast caught anyone by surprise, that would be because apparently they're not reading the labels on what they drink.

MOSCOVITCHWell, the FDA is actually examining this issue and how much people look at labels, both on the back of the panel, but more importantly on the front of the panel. They're looking at this. And Congress has also asked the Institute of Medicine, which is prestigious research group funded by Congress, to also look at front of package labeling.

NNAMDIGo ahead.

MOSCOVITCHAnd IOM released their report last week and they recommended only that a certain few things would be listed on the front of the package for consumers, and those include fats, sodium content and calories. But none of the -- what we generally consider positive attributes, such as fiber and the like.

NNAMDIWhy is that? Because the positive attributes sometimes either are A, exaggerated or B, cannot be verified?

MOSCOVITCHI think what the IOM was looking for was really what can help consumers make quick decisions at the grocery store and improve their waistlines. And so what the IOM did was, in order to have a concise panel, they only listed these three areas, instead of adding these other factors which could then complicate consumer choices.

NNAMDIThe issue there, Scott, is of what's on the label. Some of the drinks out there call themselves energy or relaxation drinks and contain supplements. What should people know about them?

KAHANIn general, they have just as much sugar and calories as other drinks do, as the colas and the carbonated beverages. And you have to look at the labels. There are some out there, certainly, that have much fewer calories, but you got to read the labels because you can't tell just by how the name sounds.

NNAMDIOne beverage that we saw has a label that mentions goji fruit and acai berries, but it also contains melatonin and other supplements. And it carries a warning label that says you should not operate heavy machinery and that pregnant women shouldn't drink it.

KAHANAnd so the -- in 1994, there was a law passed that said that these companies can put in many different supplements and herbs into drinks and foods. And unless there was overwhelming evidence that these things are unhealthy, they're allowed to put it in. They don't have to prove that they are healthy and they don't have to necessarily do extensive studies to show that they're safe. And so that's why these things are in there. But they aren't necessarily evaluated by the FDA.

NNAMDILisa, do you think that the health information should be clearer on these products?

KATICWell, I mean, I think, first of all, we need to clear up that anything that's in a beverage is regulated by FDA. I think that's just an incorrect statement. We are seeing a lot of newer things on the market. I think, you know, we -- you know, it's an area that's -- I don't know if you want to call it the wild west, but I mean, let's face it. These are safe. There's nothing harmful. I think, you know, the question is whether some of the claims that are made are really valid or not and, you know, I think that's something that we need to look at.

KATICAnd clearly, FDA is trying to stay on top of that and I know has sent out warning letters to companies if a claim they're making is, in fact, misleading or not truthful.

NNAMDIHow about something that calls itself water, but has a lot more than water in it? It's got names like energy and focus. Anything wrong with that labeling?

KATICYeah. And I think it has to -- again, it has to still abide by the nutrition facts panel. Any claim that you make on a label has to be truthful and not misleading. You can't have, I mean, an unregulated ingredient in your product. Everything that's in a product is regulated. I can assure your listeners of that.

MOSCOVITCHWhat's interesting about FDA regulation...

NNAMDII was about to get to that for a second, FDA regulations and the nutrition label, Ben. The Nutrition Labeling and Education Act took effect nearly two decades ago. What did it require? And then, you can add what you were going to say.

MOSCOVITCHSure. Well, the -- a lot of consumer groups have criticized the nutrition facts label, that it's old, that it doesn't represent what we're eating today, that serving sizes today are much larger. People are eating different types of food and therefore this doesn't reflect the percentages of daily value for today. So this -- FDA officials have signaled that they are looking at that and revising the nutrition facts label.

MOSCOVITCHBut FDA also has a lot on their plate right now. As I mentioned, they're trying to tackle the front of package labeling. They've mentioned that they're trying to tackle sodium. A big buzz word for the Obama administration FDA is enforcement, which resources are going there. And FDA's budget -- FDA officials and stake holders across the industry, including food groups and consumer groups, have said the FDA is underfunded to do all of these different goals.

MOSCOVITCHSo it's unclear when FDA is going to get to the nutrition facts label and actually prioritize that.

NNAMDIOne of the things that the original act did was to restrict the nutrition claims on the front of the packages, things like reduces cholesterol and that kind of thing. That's come up recently.

MOSCOVITCHYeah. It's come up recently. Also, things such as natural and also a lot of claims that are disease claims where the product is said to have an impact on a certain disease, either treat it or mitigate it. And FDA considers many of those claims to be drug claims. And in order to make a drug claim, FDA tells companies in warning letters that they need to submit data to FDA and conduct clinical trials if they're going to make a drug claim.

NNAMDILisa, the FDA right now is looking at what kinds of front of the package nutrition labels are effective. What's going on?

KATICWell, I mean, we -- this was started several years ago. And interestingly, the industry asked the FDA to do this several years ago because we started to see a lot of different symbols and claims and what we call, like, guideline daily amount type schemes. And it -- I think the industry felt that it really was getting to be a little bit confusing in the marketplace. So we needed something consistent.

KATICThey came together, tried to work on a program through a group called Keystone and came up with their own symbol and program that was heavily supported by a broad-base of the industry. And it just -- it was not successful, unfortunately. I think, you know, some people touted that it wasn't credible because the industry did it.

KATICSo now, we're kind of back to the square one with now FDA understanding they need to step in and, you know, put some regulation behind this. And the industry is, in fact, paying very much attention and, obviously, in discussions with FDA, as we speak.

NNAMDIWe got an e-mail from Myles in Baltimore, who said, "If water is sold within the state that it is produced, it is not regulated by the FDA. That's why every state has its own brands of bottled water, even though their parent company might be national." And then, we got this comment posted on our Facebook page that simply says, "Definitely Vitamin Water, but even less conspicuous fruit drinks. Many have lost their nutrients through processing, as even a minimal amount of processing can take out many natural nutrients.

NNAMDIMany also tend to be overloaded with more sugar than is likely necessary, especially when the fruits themselves tend to provide enough." Scott Kahan, would you recommend a specialized bottled water for vitamins?

KAHANNo. I think that we should drink water. And I think that we can drink some other drinks as well, but I certainly don't see any need for putting vitamins into water. We get plenty from just eating a normal, healthy diet.

NNAMDILisa, why would someone drink these instead of mineral water, just choice?

KATICI mean, to me, I don't know what the difference is if you drink a glass of water and take a vitamin supplement at the same time versus putting it in the water. I mean, it really is, again, just comes down to a choice. I think people need to educate themselves. That's why we have labels. That's why we have information available. And, you know, I -- if I'm not near a vitamin pill one day and there's a Vitamin Water available, I might use that as a substitute. So again, I think it's educating people and helping them understand how it all fits.

NNAMDIBack to the telephones. Here is Lee in Washington D.C. Lee, you're on the air. Go ahead, please.

LEEHi. I enjoy your program every day.

NNAMDIThank you.

LEEAre there significant gender and/or racial differences in the absorption of the sugars? Because that might be an initially effective way of inducing people by those categories to have less sugar, just as the manufactures do to induce to buy them.

NNAMDICare to answer that, Scott?

KAHANI haven't seen any data on that.

KATICNo.

NNAMDIAnyone else seen data?

KATICNo.

NNAMDINo. No. No. Ben, I forgot to ask you to weigh-in on the e-mail I just read about the FDA and how it regulates water. Can you talk about that?

MOSCOVITCHWell, I think...

NNAMDIHow Myles in Baltimore said if water is sold within the state that it is produced in, it is not regulated by the FDA.

MOSCOVITCHI cover the federal FDA, not state FDAs, but I know this issue ties into federal preemption and when the federal regulations take precedence over state regulations. And in FDA law, it's very complicated and very specific in different situations, even between medical drugs and medical devices, there's different preemption language.

NNAMDIOkay. Here's Lisa in Washington D.C. Lisa, you're on the air. Go ahead, please.

LISAHi Kojo. Thanks a lot for taking my call. I get really nervous because whenever you have some really smart people and everything, I tend to have trouble focusing, but I know you'll help me do that. Thanks for taking my call again. And I just wanted to kind of say something that I hope will resonate with all three of the panel members now.

LISABut I felt like I could really hear Lisa's challenge in her voice and even just the -- what's she up against in terms of educating. Because I know, Scott, you probably deal mostly with people who are trying to lose weight, but there's also a whole faction of people out here, for one reason or another, whether it's a disease or -- a physical disease or a different kind of disease, that need to gain weight.

LISAAnd I know that's a category that a lot of people say, oh, don't I wish, or I'd love to be able to have to gain weight.

NNAMDICounter-intuitive, yes. Go ahead.

LISAYeah. And -- what was that?

NNAMDII said it's kind of counter-intuitive. We think everybody's trying to lose weight.

LISARight. And -- but believe me, no, you wouldn't. Because there's at least as many -- some of the kind of parallel challenges as there are to having to lose weight. And I just wanted to make the point that when Lisa was so trying to keep feeling like no matter how much she says it, people won't get that it all boils down to your calorie deficit and calories in, calories out. And for somebody's who's challenged with gaining weight, you got to stay rational.

LISAAnd no matter what you do and how you get them, it does boil down to if you -- the number of calories that you take in, if you need to gain weight, has to be greater than the number that you put out and vice versa.

NNAMDIWhat a lot of us don't know, however, Lisa, is how much -- how many calories we are putting out, Scott Kahan. If we read labels carefully, we can know how many we're taking in.

KAHANYeah. There are no labels for physical activity, and certainly we are sitting around quite a bit and we're in front of our TVs and computers and such, and we need to exercise more. One of the issues here is that there's so much density of calories in food that it's hard to make up for it in terms of physical activity. So for example, if you just have one of these vitamin waters that ultimately is just about 200 calories, that takes about two hours of moderate walking to burn off those calories.

KAHANSo physical activity very important, certainly. Not just for weight, but for health in general. But the calories in our food really are quite dense, and it's hard to make up for that.

NNAMDIThank you.

KATICAnd I think we've always had dense calories in food. I think we have to remember we used to eat full fatty meats and full -- whole milk and lard and butter and everything was slathered in, you know, fats. And so I think we have to keep this in perspective that we've always had caloric foods available to us. I think we have more choices now in the marketplace than we ever had for low calorie.

NNAMDIBen, that report by the Institute of Medicine that came out last week on front of package food labeling recommended, it's my understanding, that on the front of the packages there should just be three items, fat, sugar, salt?

MOSCOVITCHMm-hmm.

NNAMDIAnd it advises against positive nutrition info on the front like fiber, we talked about that. Does the FDA have to take this report into account when it revises its front of package labeling rules?

MOSCOVITCHFDA doesn't have to, but it likely will. FDA often requests reports from the Institute of Medicine and then they're funded by Congress. So the Institute of Medicine, its report then supports any FDA activity and FDA studies which it is doing with front of package labels, and helps FDA craft a policy, whether it's voluntary or mandatory. And also, the Institute of Medicine, its reports often inform Congress and help Congress decide what legislation they should push and the impact of their legislation with them.

NNAMDIThe UK has an interesting system. Tell us about that.

MOSCOVITCHSure. The UK system -- it's been actually discussed quite a bit within FDA and by commissioner Dr. Margaret Hamburg where it looks like a traffic light system where red says -- a red circle would say, this product has a high -- nutrients that are not good for you. Yellow would be has moderate amounts of that, and green would be, this is all -- this system is okay -- this nutrient is okay for you.

NNAMDILisa, how would that go over with the food and beverage industry here you think?

KATICWell, I mean, they're actually evaluating it right now. I believe the major trade association that represents all food companies are -- they have commissioned some consumer research, I think -- Ben, correct me if I'm wrong, in tandem with FDA to evaluate what, you know -- I mean, they want what consumers understand and can, you know, can read and use and -- make sure that it's useful for consumers.

NNAMDIScott, what do you think about this kind of stoplight analogy image that the UK is using?

KAHANI think it's something that certainly simplifies having to look at the entire label so it's helpful in that way potentially. And its being on the front of the package...

NNAMDIAnd you don't have to be literate to pick it up.

KAHANThere you go.

NNAMDIHere now is Alexander in Arlington, Va. Alexander, you're on the air. Go ahead, please.

ALEXANDERHi, Kojo. Thanks for taking my call. I'm a big, big fan of your show. I have a comment couched with a question or a question couched with a comment, I'm not sure. I'll let you decide. Here goes. My line of work takes me all over the world and I've lived and worked in many places. And one of these places is Italy -- Rome, Italy.

ALEXANDERAnd it's apparent if you live in Italy, that the population -- at least the adult population has no huge problems with obesity. So they seem to be doing something right with the food intake. And I remember going to markets or buying foods with Italian friends and engaging in vigorous discussions about calorie intake counts and reading labels. And while to say it's not statistically proven, I don't have data, but (unintelligible) to. None of them bother with labels, with calorie intakes.

ALEXANDERIt seemed the entire discussion about what calories are there in this food or in that food is irrelevant.

NNAMDII'll put you in...

ALEXANDERAnd it seems to me...

NNAMDIYes.

ALEXANDER...it seems to me like if a discussion about calorie intake counts, it takes us on the wrong path. It takes us on the path of processed foods, which do need the calorie intake counts, as opposed to on the path of unprocessed meats, fish, tomatoes, raw vegetables, which don't have these labels. And maybe, before we get so much involved in a discussion of a symptom, we should talk about the broader issue.

NNAMDIWell, it seems...

ALEXANDERDo we need education by FDA regarding other non-processed foods which don't necessarily have the kind of intake...

NNAMDIAllow me to get a response from Lisa Katic on that. That horse has left that barn.

KATICYeah. Thanks, Alexander. I appreciate it. I have an Italian background as well, and I can tell you it's not just in the Italian culture where some of the older folks in that culture don't have problems with obesity. And I can go back to my age-old statement is, I suspect that those people were very active in their daily life. I mean, that's what I said about taking manual labor out of our culture.

KATICThey worked the land. They had to farm for their food. Look at how women cooked. Even my mother and grandmother, you know, in this country, they had to use everything that was manual. And when I do that myself in my kitchen, I'm at the tired at the end of just, you know, cooking for an hour or two. So it's astounding...

NNAMDIAnd I'm afraid that's all the time we have. Lisa Katic is a registered dietician and the principal of K Consulting. She's a nutrition advisor to the food and beverage industry. Scott Kahan is the co-director of George Washington University's weight management program and is on the faculty at Johns Hopkins School of Public Health. And Ben Moscovitch is an associate editor with Inside Health Policy. Thank you all for joining us and thank you all for listening. I'm Kojo Nnamdi.