What started all this was this graph of obesity prevalence in the US from the Financial Times:

The most complete account of what happened next comes from Helena Bottemiller Evich in Food Fix (a must-read for anyone interested in following the food scene): “Have we passed peak obesity? New data sparks speculation.”

The Financial Times was the first to pick up on new data from the Centers for Disease Control and Prevention showing that the obesity rate for U.S. adults declined two percentage points between 2020 and 2023. The headline from across the pond was upbeat: “We may have passed peak obesity.” Soon, a couple of other news outlets followed, including Axios: “Americans are getting healthier by some key metrics.” The Washington Post editorial board jumped into the fray this week as well: “The obesity rate might have stopped growing. Here’s what could be working.”

The original data came from the CDC:

Plotted this way, the decline is not nearly so impressive (and severe obesity is increasing slightly).

As for the effect of the drugs, it’s much too early to say, says the epidemiologist Deirdre Tobias posting on Twitter (X).

The downtick occurred before the drugs were widely used.  Following her thread produces lots more data on that point.

We will have to wait a few more years to know how all this will play out.  I can’t wait!

Honey has an industry behind it?  Of course it does.

The National Honey Board (a USDA-sponsored checkoff entity) is working hard to convince dietitians that honey is a health food.  Here are three examples sent to me by members of the Academy of Nutrition and Dietetics, who received these ads via e-mail.

I.  “Harness the power of honey in the Mediterranean diet this summer…Incorporating honey into the MSDP [Mediterranean-style dietary pattern] is a natural fit.”

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II.  Another reader, Katherine Walcott, sent me this one about how honey can boost probiotics.  She points out that the ad links to an article in health.com and then to studies one and two , both supported by the National Honey Board.

III.  Yet another dietitian sent me yet another ad, this one featuring dietitians extolling the benefits of honey as part of nutritious diets.

RD: Honey offers antioxidants, heart health and more

Honey may offers numerous healthful benefits: it is rich in antioxidants like flavonoids and phenolic acids, which help neutralize reactive oxygen species, potentially reducing the risk of conditions like premature aging, Type 2 diabetes and heart disease, writes registered dietitian nutritionist SaVanna Shoemaker. Honey may aid in blood sugar management by increasing adiponectin levels, though it should be consumed in moderation, especially by people with diabetes. Studies suggest honey can improve heart health by lowering blood pressure and improving blood fat levels. It also has antibacterial and anti-inflammatory properties, making it effective for treating burns, wounds and coughs in children over 1 year old, however honey should never be given to children under 1 year of age.

Comment

I need to point out the obvious: honey is a form of sugar.  It is a mix of sucrose, glucose, fructose, and traces of other sugars, minerals, and flavors.  Its main benefits?  It is delicious, but most people are unlikely to eat much of it, and not nearly as much as they might eat of sucrose table sugar.  Can it be part of nutritious diets?  Of course it can.  A health food?  Depends on how much you eat of it.

Also obvious: the purpose of the National Honey Board is to convince you to eat more honey.

III.  Personalized, as opposed to Public Health, Nutrition

Stephanie Rogus, a former doctoral studentt in my NYU department, and Peter Lurie, director of the Center for Science in the Public Interest, have a new paper out: Personalized nutrition: aligning science, regulation, and marketing. Health Affairs Scholar, Volume 2, Issue 9, September 2024, qxae107, https://doi.org/10.1093/haschl/qxae107

Proponents of personalized nutrition assert that population-based approaches to dietary recommendations have had limited impact because they have failed to take interindividual differences into account. Proponents argue that increasing or reducing consumption of particular foods in response to the results of a survey or diagnostic test allows for the development of more personalized and, it is argued, more effective recommendations.

Their paper does not deal with the flaws in individualized approached to nutritional health—“precision” nutrition: the cost, the difficulty, the lack of support, the inability to reach those who most need support, etc.  Instead, it focuses on the commercialization of personalized nutrition:

regulatory gaps have led to market growth of products with unknown efficacy that are making bold, and possibly unsubstantiated, claims. As personalized nutrition products and related treatments continue to enter the market without regulation, unreliable products may cause consumers financial, psychological, and physical harm. Stronger regulation will help engender trust in these products among consumers and ensure their safety and effectiveness.

Hard to argue with that.  Glad they wrote it.

II.  The need for nutrition science leadership in promoting policies to prevent and treat disease

Three-quarters of American adults are overweight or obese and at increased chronic disease risk, yet nobody is screaming much about it (except for the MAHA people).

As the Government Accountability Office put it in 2021,  “federal strategy needed to coordinate diet-related efforts.”

Chronic health conditions (like heart disease, diabetes, cancer, and obesity) are costly and deadly—causing over half of U.S. deaths in 2018. They also exacerbated the pandemic: Americans with such conditions were 12 times more likely to die after contracting COVID, according to the CDC.

Yet chronic conditions are largely preventable with a healthy diet and other behaviors like exercise. The federal government leads 200 different efforts, spread across 21 agencies, to improve Americans’ diets. But agency efforts are fragmented and there are gaps in key scientific research, including for children. A strategy for working together could help.

In its recommendations, the GAO says:

Congress should consider identifying and directing a federal entity to lead development and implementation of a federal strategy for diet-related efforts aimed at reducing Americans’ risk of chronic health conditions.

The GAO comments:

The White House sponsored a conference on Hunger, Nutrition, and Health on September 28, 2022. In advance of that event, the White House released a national strategy aimed at ending hunger in America and increasing healthy eating and physical activity by 2030. [Note: I wrote about these events extensively.  For example, here]

However, we do not believe the White House strategy satisfies our matter because it does not contain the necessary information about outcomes and accountability, resources, and leadership. In particular, without designated leadership, it may be difficult to sustain the strategy over time. Therefore, as of March 2024, the matter remains open.

In October 2024, it still remains open.  I see this as an urgent priority.

Tomorrow: Personalized nutrition

Some comments on three recent developments in the field of nurition.

I.  Nutrition in medical education

I’ve been teaching , researching, and writing about nutrition since 1976 when I was on the faculty at Brandeis and assigned my first class.  I then went to the USCF School of Medicine where I taught nutrition to health professions student for the next ten years.

While there, I wrote my first book, Nutrition in Clinical Practice, in which I briefly summarized what all of us at the time thought medical students needed to know.  The book was published in 1985, and is long out of print.  In 2020, a used copy was available on Amazon for $930 (even more surprising, it is no longer on that site).

Consequently, I was amazed to see: Eisenberg DM, Cole A, Maile EJ, et al. Proposed Nutrition Competencies for Medical Students and Physician Trainees: A Consensus Statement. JAMA Netw Open. 2024;7(9):e2435425. doi:10.1001/jamanetworkopen.2024.35425

As one of the authors , Emily Broad Leib, wrote in a Tweet (X), “This article shares the consensus of 37 medical education leaders on what all physicians-in-training should know about nutrition. With this start, I hope we can achieve a future where all drs. are armed with this knowledge!”

Well, wouldn’t that be nice.  When I arrived at UCSF in 1976, it was already nearly 20 years since the first conference on nutrition in medical education called for more nutrition instruction.  It has now been 70 years since then, with little change.

The structural barriers are insurmountable, apparently.

• The focus on treatment, not prevention
• Lack of qualified instructors
• Time in the curriculum
• Time in office visits (anyone seen a doctor lately for more than 15 minutes)
• The complexity of the field

Still, let’s hear applause for this consensus effort, starting with recommendation #1:

Provides evidence-based, culturally sensitive nutrition and food recommendations to patients for the prevention and treatment of disease.

Tomorrow: The need for leadership on precisely that point.

Our hopelessly dysfunctional Congress did not pass a new Farm Bill in 2023, but granted a one-year extension to the 2018 bill.  It has since been unable to pass a new one.  The old one expired on October 1.

So what?   For explanations, see:

• Market Intel:  Here’s What Happens When the Farm Bill Expires.
• Congressional Research Service: Expiration of the 2018 Farm Bill and Extension for 2024.

The Farm Bill is a collection of a huge number of programs, each with its own funding authority and rules. (and lobbyists).

Its termination affects some programs , others not so much.

Market Intel lists programs shut down on October 1.

• International programs, such as the Market Access and Foreign Market Development Cooperator trade promotion programs and Food for Progress
• The Biobased Markets Program and Bioenergy Program for Advanced Biofuels
• Several  animal health programs
• Programs for socially disadvantaged, veteran, young and beginning farmers
• The Specialty Crops Block Grants program
• The National Organic Certification Cost-Share program

Programs with permanent funding can pretty much continue.  These include:

• Crop insurance
• SNAP
• Some disaster programs
• Some commodity support programs

The big problem is with dairy and a few other commodity support programs.  I know this seems unbelievable, but as of January 1, 2025, they revert back to “permanent law,” which means the 1938 and 1949 farm billls (!).

I have no idea why, but the permanent law makes the government pay a lot more for milk, honey, corn, and wheat than current support prices.

For example, the price for milk per hundredweight.

• July 2024: $22.80
• Parity: $65.90
• Permanent (75% of parity): $49.43

Market Intel says:

Purchasing cheese, butter and nonfat dry milk at multiples of the market price would be severely disruptive to markets, would badly distort pricing under the federal milk marketing order system and would undermine demand at home and abroad in return for very uneven benefits to farmers over a limited time. And the release of USDA stocks when permanent law is suspended again would depress markets for months.

Weird, no?

As I am on record as saying, the farm bill drives me insane.

A reader, Bart Peuchot, writes:

I would be very interested to have your view on this new publication for Nature.

As you taught me, I checked the competing interests and it seems to be a perfect industry-funded publication.

And then ,I ran across this Tweet (X) from @Stuart Gillespie:

New paper concluding “more research needed”
…brought to you by Nutrition Foundation of Italy…
…which in turn is brought to you by
…..@Nestle @McDonalds @CocaCola Ferrero, Barilla, Danone et al…

Well.  What  is this about?

I went right to the paper: Visioli, F., Del Rio, D., Fogliano, V. et al. Ultra-processed foods and health: are we correctly interpreting the available evidence?. Eur J Clin Nutr (2024). https://doi.org/10.1038/s41430-024-01515-8

Aha! Another attack on the concept of ultra-processed foods.  The article concludes

the available evidence on how different UPFs have been associated with health, as well as the results of studies examining specific food additives, call into question the possibility that ultra-processing per se is the real culprit. It is possible that other unaccounted for confounding factors play an important role. Future, urgently needed studies will clarify this issue.

The Italian food industry has been especially active in opposing NutriScore labels and anything else that might discourage sales of foods high in sugar, salt, and saturated fat.

But it is not alone in pushing back against the concept of  ultra-processed foods—an existential threat to junk food manufacturers.

Here, for example, is Hank Cardello,  the Executive Director of Leadership Solutions for Health + Prosperity at Georgetown’s Business School writing in Forbes:: New Report Highlights The Sweet Side Of Ultra-Processed Foods.

With ultra-processed foods (UPFs) replacing “junk food” as the new bogeyman for public health advocates, a new study published by  the Georgetown University Business for Impact Center (full disclosure: I am one of the authors) reveals that all UPFs are not created equal. The report spotlighted that candy in particular was the exception, since that category contributes only 6.4% of added sugars and less than 2% of our calories. The most surprising discovery is that the “healthiest of the healthiest” consumer cohort in the study purchased candy 26% more frequently than the general population.

The report: New Consumer Insights on Ultra-Processed Indulgent Foods: How Confectionery Products Are Different.

Candy behaves differently from other ultraprocessed indulgent products. New NMI and NHANES data re-confirm that candy is different and should not be lumped together with other indulgent products. Consumers do not overconsume  chocolate and candy, so targeting these foods will not impact obesity. An approach that focuses on product categories that consumers with the highest BMIs eat and drink the most will be more effective.

OK, readers: Take a guess at who paid for this.

Funding for this paper was provided by the National Confectioners Association.

As I keep saying, you can’t make this stuff up.

Julian Baggini.  How the World Eats: A Global Food Philosophy. Granta, 2024.  443 pages.

I did a blurb for this one:

How the World Eats is an enormously wide overview of how people throughout the entire world–from hunter-gatherers to NASA astronauts–view, exist within, manage, and try to improve their food systems.  Baggini’s philosophy makes sense.  We need sustainable food systems to feed the world.

When I say “enormously wide,” I’m not kidding.  Baggini has interviewed an amazing number of people, including me.  I do not remember our interview (I don’t keep track of interviews), but he quotes me extensively—and my book Food Politics—especially in the chapter titled “The Big Business of Food.”

The book is long, not least because Baggini lets his interviews speak for themselves, regardless of their opinions on controversial food issues.  He does not use the book to argue with the people he interviewed.  If you want to know what everyone, everywhere thinks about food, from every side of an issue, this is a good starting place.

Eventually, Bagggini comes out in favor of food systems that are, in his words, “holistic, circular, pluralistic, foodcentric, resourceful, compassionate, and equitable.”

If we were to adopt the principles of Holism, Circularity, Pluralism, Foodcentrism, Resourcefulness, Compassion, and Equitability, many of the desiderata we have for the food world would come along for the ride. Everyone is in favour of sustainability, and that is what we would get if we followed these seven principles.  Similarly, a circular, plural and resourceful food system is also an efficient ne.  When the main things people want flow naturally from a set of principles, that is a good sign that those principles are the right ones.  p. 361