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Politics, as they say, makes strange bedfellows and I cannot get my head around the MAHA hearings last week.

Sen. Ron Johnson, R-Wis., has posted a video of the health and nutrition roundtable he held Monday with Robert F. Kennedy Jr., the former presidential candidate now supporting former President Trump, and others including Vani Hari, the “Food Babe.”  He listed participants in a press release.

Vani Hari posted her own video on Twitter (X): “American food companies are making a fool out of us. They are knowingly poisoning us. It’s time for this to stop. Our movement is growing like I have never seen before. It’s going to be historic! This is a clip from my Senate testimony in Washington DC yesterday, watch the whole thing.”

Another Tweet pointed to testimony by Jillian Michaels: “This is one of the best overviews I’ve ever witnessed on how the whole system has been rigged, in what is essentially a ‘bad health by design’ framework As Jillian Michaels says emphatically – People have been ‘sacrificed at the alter of corporate greed.”

This is amazing!

What I find most remarkable is the lack of mainstream nutrition science in this lineup.  The speakers are mainly influencers and not among the most recognized nutrition scientists.  Nearly all havie some decidedly non-mainstream interpretations of nutrition research and the history of federal nutrition policy.

BUT: They are calling for fixing the food system, doing something to coordinate and address diet-related chronic diseases, stopping corporate power, eliminating conflicts of interest between industry and government, getting toxic chemicals out of the food supply, and doing everything possible to refocus the food environment and dietary advice on health.

Try this: “Ultra-processed foods are the new cigarette for my generation,” said Grace Price, described as an 18-year-old social media influencer.

These are things I’ve been writing about here for years.  It’s hard to argue with any of this and I won’t.

But where are my nutrition scientist colleagues?

As Jerry Mande wrote to me, referring to the PCAST report I talked about yesterday:

How did it come to this? We have the nation’s top nutrition scientists afraid to demand action and Senators turning to nutrition influencers for advice. I must admit the influencers did a better job than the WH science advisors stating the urgency of the problem and demanding action.

In Food Fix, Helena Bottemiller Evich described the experience as “rather disorienting.”

I’ve been covering food policy in Washington for 15 years, and I would have never expected this cast of characters to be together in the Senate – and hosted by Republicans, no less. (It was hosted by Johnson, but Sen. Mike Crapo (R-Idaho) also attended. Both said they’d changed their diets to improve their health.)  As I noted recently, there is a political realignment happening here. Many of the concerns discussed during this roundtable – lack of food chemical regulation, metabolic dysfunction, pesticide exposure, lack of focus on nutrition in medical school, etc. – were previously common policy fare on the left. That’s all been shaken up by Johnson’s office.

Could it be that we are heading for bipartisan support for addressing epidemic obesity and diet-related chronic disease?

If so, it’s about time and I”m all for it.

But the mind boggles.

Healthy People 2030 has released its latest set of tracking data.  This, you will recall, is the latest of the US Public Health Service’s 10-year plans for improving the health of Americans.  The agencies involved set specific, measurable objectives and track progress toward achieving them.

You can browse the full set of objectives here.

The objectives for overweight and obesity are here.  Three have tracking data available.  Of these,

One shows no change: Reduce the proportion of children and adolescents with obesity — NWS‑04

Two are getting worse

• Reduce the proportion of adults with obesity — NWS‑03
• Increase the proportion of women who had a healthy weight before pregnancy — MICH‑13

The objectives for Nutrition and Healthy Eating are here.

Of the objectives with data available, two showi improvement!

Thanks to Hugh Joseph for sending this piece on PepsiCo’s commitment to regenerative agriculture in its supply chains: From regenerative ag to reformulation: A deep-dive into how PepsiCo is ‘reimagining the way food is grown, made and enjoyed’

When PepsiCo launched Pep+ in October 2021, the company said it wanted to ‘fundamentally change’ how it does business for the betterment of people and planet​. From ingredient sourcing and production to supporting consumers make choices that are ‘better for themselves and the planet’, Pep+ outlined an ambitious agenda of business transformation.  The company wants to:

•  Spur transition to regenerative practices across land that is equivalent to its entire agricultural footprint, approximately seven million acres.
• Reduce reliance on chemical inputs (but does not rule out their use).
• Secure the future of farming communities and farmer incomes.
• Support farmers by helping them with high fuel and fertilizer costs.
• Support rural communities – and female farmers in particular.
• Transition towards more than 70% of the company’s global electricity needs in direct operations are met by renewables.
• Reach net zero emissions by 2040.
• Improved operational water-use efficiency by 18% in high water-risk areas.
• Use 100% rPET by the end of this year, contributing to 87% of PepsiCo-owned drinks portfolio in the European Union being made using 100% recycled or renewable plastic.
• Eliminate virgin fossil-based plastic in all crisp and chip bags..

And then there are Pepsi’s nutrition objectives [recall: Pepsi makes snack brands like Walkers and Dorito alongside its line-up of fizzy drinks].

Use more chickpeas, plant-based proteins and wholegrains.

Expand nuts and seeds category.

In Europe, cut added sugars in its soft drinks by 50% .

Improve the nutritional quality of snack products.

My questions:

• Is this real or greenwashing and healthwashing?
• Who is holding Pepsi accountable for achieving these objectives?

The larger question is whether Pepsi’s portfolio of snack foods and sugary drinks can ever be sustainable?

In 2011, I was quoted in a New Yorker article about Pepsi’s health initiatives.

As part of PepsiCo’s commitment to being “the good company,” the corporation wants to play a leading role in public-health issues, and particularly in the battle against obesity. Some people think this is ludicrous. Marion Nestle, the author of “Food Politics” and a professor of food studies at N.Y.U., told me, “The best thing Pepsi could do for worldwide obesity would be to go out of business.”

I probably wouldn’t use the word ludicrous (and I’m not sure I did then), but the effort was certainly unrealistic.

Like all publicly traded corporations, PepsiCo is heavily constrained by shareholder profit objectives.

A decade ago, its shareholders objected to a focus on public health when sales of Pepsi declined.

Has anything changed since then?

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Coming soon!  My memoir, October 4.

For 30% off, go to www.ucpress.edu/9780520384156.  Use code 21W2240 at checkout.

Meredith Li-Vollmer.  Graphic Public Health.  Penn State University Press, 2022.

Probably because of my cartoon book, Eat, Drink, Vote: An Illustrated Guide to Food Politics, I was asked to do a blurb for this book, which I was happy to do.

In her thoroughly up-to-date, informative, and useful book, Li-Vollmer convincingly argues for the effectiveness of comics in conveying health risks and desired behaviors.  She proves this point with splendid and deeply engaging examples, and provides an instructive how-to for creating your own. This book should be in every public health curriculum; it’s not only informative but also wonderful fun to read.

They only used the sentence in bold face (edited to convert wonderful to wonderfully).

But the rest explains why I think the book is worth reading.   Li-Vollmer works for Seattle’s health department and discovered comics as a way of communicating public health messages.  The book includes lots of examples of the work of comic artists explaining issues related to a host of public health issues.  Although none of the examples focus specifically on food issues, some briefly cover food safety, eating watery foods on hot days, and how climate change affects food production.

I think this is a great way to communicate public health issues.  New York City subway rider that I am, I greatly enjoyed the AIDS story that the New York City Health Department told in posters in the early 1990s.  As the New York Times explained,

Our story so far, as seen in 6,000 New York City subway cars, above the windows and between the advertisements for hemorrhoid, hernia, and foot doctors:

Julio and Marisol run into each other while visiting Raul Rodriguez, who is in the hospital with AIDS. They apologize for the big quarrel several episodes back, when Julio refused to use a condom and walked out. Their romance rekindled, they leave Raul’s room to get some coffee and talk things over.

Suddenly, Rosa bursts in. “I’m scared,” she tells Raul. “I’m . . . I’m . . . I’m H.I.V. positive.”

I’ve just had a book review published in the American Journal of Public Health: “Public health nutrition deserves more attention.”

It’s for a textbook on public health nutrition but doing it gave me the opportunity to say some things I want public health professionals to know.  I started the review like this:

Public Health Nutrition deserves more attention

Food and nutrition deserve much more attention from public health professionals.  On the grounds of prevalence alone, diet-related conditions affect enormous numbers of people.  Everybody eats.  Everybody is at risk of eating too little for health or survival, or too much to the point of weight gain and increased prevalence of non-communicable diseases (NCDs).  By the latest count, nearly 700 million people in the world do not get enough to eat on a daily basis, a number that has increased by tens of millions over the past five years and will surely increase by many millions more as a result of the Coronavirus pandemic.[i]   At the same time, about two billion adults are overweight or obese, and few countries are prepared to deal with the resulting onslaught of type 2 diabetes and heart disease.[ii]  Beyond that, food production, distribution, consumption, and disposal—collectively food systems—are responsible for a quarter or more of greenhouse gas emissions; climate change affects the health of everyone on the planet.[iii]

The same social, behavioral, economic, and structural determinants that affect health also affect nutritional health, and it is no accident that food choices are flash points for arguments about culture, identity, social class, inequity, and power, as well as about the role of government, private enterprise, and civil society in food systems.   From a public health standpoint, everyone–regardless of income, class, race, gender, or age—should have the power to choose diets that meet nutritional needs, promote health and longevity, protect the environment, and are affordable, culturally appropriate, and delicious.

Nutrition in 2021

For people in high-income countries, dietary prescriptions for health and sustainability advise eating less meat but more foods from plant sources.[iv]  Optimal diets should minimize consumption of ultra-processed foods, those that are industrially produced, bear little resemblance to the basic foods from which they were derived, cannot be prepared in home kitchens, and are now compellingly associated with NCD risk and mortality.[v]  We now know that ultra-processed foods encourage people to unwittingly take in more calories and gain weight.[vi]

Agenda for 2021

Today, a book for researchers and practitioners of public health nutrition needs to emphasize coordinated—triple-duty—recommendations and interventions to deal with hunger and food insecurity, obesity and its consequences, and the effects of food production and dietary choices on the environment.  Such approaches, as described by a Lancet Commission early in 2019,⁴ should encourage populations of high-income countries to eat less meat but more vegetables, those in lower- and middle-income countries (LMICs) to consume a greater variety of foods, and everyone, everywhere to reduce intake of ultra-processed foods.  As that Commission argued, public health nutritionists must recognize that attempts to improve diets, nutritional status, nutritional inequities, and food systems face daunting barriers from governments captured by corporations, civil society too weak to demand more democratic institutions, and food companies granted far too much power to prioritize profits at the expense of public health.  Nutritionists need knowledge and the tools to resist food company marketing and lobbying, to advocate for regulatory controls of those practices, and to promote civil society actions to demand healthier and more sustainable food systems.[vii]

I then go on to talk about the book itself, which alas, did not have much to say about this agenda.

References to the first part of this review

[i] The World Bank.  Brief: Food Security and COVID-19. December 14, 2020. https://www.worldbank.org/en/topic/agriculture/brief/food-security-and-covid-19#:~:text=In%20November%202020%2C%20the%20U.N.,insecure%20people%20in%20the%20world. Accessed January 2, 2021.

[ii] WHO.  Obesity and overweight: Key facts.  Geneva: WHO.  April 1, 2020. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed January 2, 2021.

[iii] International Panel of Experts on Sustainable Food Systems. COVID-19 and the crisis in food systems: symptoms, causes, and potential solutions. IPES-Food, April 2020. www.ipesfood.org/pages/covid19. Accessed January 2, 2021.

[iv] Swinburn BA, Kraak V, Allender S, et al. The global syndemic of obesity, undernutrition, and climate change: The Lancet Commission report. Lancet. 2019;393:791–846.

[v]  Monteiro CA, Cannon G, Levy RB, et al.  Ultra-processed foods: what they are and how to identify them. Public Health Nutr. 2019;22(5):936–941.

[vi] Hall KD, Ayuketah A, Brychta R, et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake. Cell Metab. 2019;30, 67–77.

[vii]  Jayaraman S, De Master K, eds.  Bite Back: People Taking On Corporate Food and Winning.  Oakland, CA: University of California Press; 2020.

 

 

The report, associated documents, and announcement video are on this Lancet website 

I am a big fan of Howard Bauchner, the editor-in-chief of JAMA, who not only promotes science but also seems to have a lot of integrity.  I think it’s worth reading his new year’s wish list for medicine and science.

What concerns him, and what’s on his list applies just as well to food and nutrition.  He says, for example,

An increasingly important question is whether, in a country in which “profit” dominates, it will be possible to have a fair and equitable health care system. Has profit, self-interest, and greed come to dominate the landscape of US medicine? And as the Great Pandemic of 2020 has demonstrated, health care disparities remain a fundamental problem in the US health care system.

Here are some of the items on his wish list:

• Respect for science, the individuals who pursue scientific discovery, and the federal agencies that support and conduct scientific research.
• A comprehensive, coordinated, and effective national response to the COVID-19 pandemic, driven by science and evidence, and based on solid clinical and public health principles, including prevention and widespread vaccination.
• A true national commitment to health care as a right and not a privilege.
• A national debate about a single-payer (Medicare for All), universal health plan that includes private insurers, a public option, further expansion of Medicaid, and lowering the age of Medicare to 60 years.
• Reducing administrative costs and eliminating barriers to health care access to ensure that millions of individuals can be insured without increasing overall health care costs.
• A national campaign to identify and treat every individual with hypertension in the US.
• That the US returns to a time of civility, healthy debate, and respect for the opinions of others.

Amen.

And to his final comment—“This list is my hope for 2021 and beyond: a respect for science, scientists, and public health officials, healthy and civil debate, and a fundamental commitment that no individual in the US should be without health insurance”—I would add: a food system designed to prevent food insecurity and promote health for people and the environment.