The Leading Voices in Food

Today we're talking with Kevin Hoban and Jordie Simkovic, the creators and starring characters of Captain & Cat, a popular YouTube kids show with 200,000 subscribers and over 200 million views. The educational show for preschoolers tells stories using entertaining songs and narratives. They've just launched a new series called Explorasaurus: Healthy Food and You, aimed at teaching kids about healthy food and how it's grown. Their first episode about SugarBee apple growers in Washington State has over 500,000 views on YouTube.

Interview Summary

So, for people who aren't familiar with your show, for those few people out there who may not be, tell us about Captain & Cat, the characters, what they do, and how did you guys get started doing this?

Kevin - Gotcha. Well, Jordan and I have been best friends since college. We went to Northwestern University in Chicago, and we were in a band together. We would perform live on campus, in the streets. And we realized that kids would stop and really enjoyed what we were doing. And I think that was the seed of the whole thing was, "Hey, maybe our act that we have, this two-man show is something for kids." And then we graduated. We both moved out to LA. Jordan came out here to act. I moved out here to produce TV shows, and on the weekends, we started performing for kids.

Jordie - Yeah. Actually, we did a show called The Bubble Show. And we were doing probably six to eight shows a weekend for about 10 years. And then during the pandemic we started putting our stuff online because all live performances stopped. And for about three years it was nothing and crickets, and really just our parents watching. And then we won the award for best kid song of the year in 2023. And then that kinda put us on the radar of YouTube Kids who invited us to be one of the featured channels on their platform. And for a while we were doing jingles and music and educational songs and stuff like that. And then towards the end of last summer, we had connected with SugarBee Apples and that whole kind of growing cooperative out there about doing an apple song. And they actually were like, "You know what would be even cooler than that? Why don't you come out here and meet the farmers and see the harvest in action?" And we're like, "Whoa, this is really cool." And honestly, it was a life-changing experience. We now say that we have aunts, uncles, and cousins out in Central Washington. And honestly, I grew up in Miami, I went to college in Chicago, and then I've lived in Los Angeles ever since. I had never stepped foot on a farm, really, in any significant way. And just to be able to get exposure to this incredible pocket of people that otherwise I would have never had a chance to see and meet was completely eye-opening.

Kevin - I would say I went out there thinking, "This is a huge apple company. They sell them all across the country in every grocery store." I went out there thinking, "Well, this is sort of like a big industrial corporate farm," right? Must be just one giant farm with robots harvesting apples. And what we found was it was a co-op of family-owned farms. Smaller families. We met the families. We met the grandparents, the parents, the kids, the grandkids. And we learned so much about apples and how you grow them. That every apple is picked by hand, first and foremost.

Jordie - We honestly expected there was going to be like a machine just going around and shaking the apples off, you know. Because you have no idea. And there's been so much dialogue around factory farming, which has become kind of like the negative word. And honestly, yeah, as Kevin was saying, we expected just a giant faceless corporation there. And it was the exact opposite.

Can I ask you guys a question? I'd like to dive in a little deeper than this, because you're saying something that resonates with me very personally. When I moved to North Carolina from Connecticut, I was offered the opportunity through the North Carolina Farm Bureau to do a tour of farms. Two-day intensive tour of farms in Eastern North Carolina. And we went to a blueberry farm that harvests millions of pounds of blueberries a year. Soybeans, corn, hog farmers, chicken. I mean, we did everything. And it was incredibly interesting. And there was the technology part of it, or the lack of technology that I was learning about, just as you related. But there was also a very moving human part of this. The people, I thought, were really interesting. And the generational nature of farming and all. So, tell me a little bit more about the people part of it. How much that affected you.

Jordie - We met the farmer who like seven generations back, their family introduced the Granny Smith apple to the United States, you know? It's going back and we literally see it's a whole family working and living very close to where they farm. And so, kind of just, it's Uncle Farmer Peoples now, you know? And so, we were kinda talking to him about chemicals and pesticides and stuff like that off the record because we're like, "All right, so now tell us how much you spraying on these?" He's like, "Why would I ever do anything destructive to this land? This is where my family and I live."

Kevin - Yeah. And I think you also picked up on the pressure that these farmers feel to carry on the farm itself. It's been in their family for generations. They need to keep it running. And all of the pressures and anxieties that come with that just to keep this farm afloat. Because again, it's not some huge corporation, it's a family farm that's part of this co-op of other family farms. And they've all kind of banded together to pool their resources to keep everything going, which is just a wonderful... It's a wonderful lesson, I think. These farms rely on people working together day in and day out for their own collective good.

Jordie - The guy who runs the packaging facility is the brother-in-law of one of the growers. So, we thought that they were pranking us, because literally every car that drove by, they're like, "Oh, that's my brother-in-law. Oh, that's my aunt. That's my niece," in this little town right off Lake Chelan. And you really see the impact. We actually were just there last week again to film a new segment about apple blossoms and pollination and stuff like that. And one of the coolest experiences we had there was we went to an elementary school. One of the families in the co-op had donated shoes to a lot of the kids in the elementary school, and we helped go distribute them there. It's honestly so cool to see that the same way that LA is built around the film industry, there they're literally built around the apple and cherry industry, and pears. Ever since we went there, I off-camera would not, you would not catch me eating anything other than a SugarBee. And that's the truth.

You know, so interesting to hear you talk about this and your experience with the apple production facility and the people being related to one another. It's exactly what I found on a sweet potato farm here. North Carolina's the largest producer of sweet potatoes, and I visited a very large farm owned by a man and his daughter. I mean, they really ran this business. And they were farmers at their heart, but this was $100 million a year business. And they're looking at international trade markets and deciding when to release the sweet potato. I mean highly sophisticated financial decisions they were making. But at the end of the day, they were related to their land, and that's what this was all about. I mean, to say it was a spiritual relationship doesn't... I don't know what word captures it. But it was something very special in that sometimes you think about farmers exploiting the land, and that happens with the big factory farms. But in these cases, you find farmers want to be at peace with their land. And I heard it many times, that they wanted to turn the land over in better condition to their children than it was turned over to them. It's obvious from affectively and emotionally the way you're talking about it and the way I'm talking about it, something very special is occurring here. How do you communicate that in a video, especially to children?

Kevin - Well, I think for us, we always lead with the enthusiasm that we have, but then also trying to tease out the enthusiasm that the farmers have themselves. Because some of them are not used to being on camera, and certainly not on a YouTube Kids show. But once we ask the right questions and probe a little bit of, for an example, we just shot with them last week. And we asked for students that we work with around the country to submit questions. And one of the questions was, "Does the farmer talk to his apples?" And we asked one of the farmers that, and he lit up, and you just saw all the sudden that passion that he really does have for his apples. And I think the more that we can bring that out of the farmers, show kids and families how passionate and excited they are about the fruit, that hopefully that will get the kids excited as well.

You can imagine the farmer talking to an apple when it's falls from 30 feet on his head.

Jordie - They're pretty sturdy up there, honestly. And I think another way to kinda communicate the care is to show how much work goes into it. Because literally, this was informative for us just because going from the blossoms, they go through and prune by hand. And hand select it because there are so many variables involved. And what we found is the confluence of this incredible intergenerational wisdom and technique and craft that has been passed down and honed. Also, kind of meeting within the packaging facility. The technology there is honestly mind-blowing. And I think it's only getting more and more advanced.

We shot an episode at a dairy farm. And one of the farms we visited recently had AI milkers - AI robotic milkers. And we're like, "Oh, does this make it so that the cows have a different and negative relationship with you since they're used to robots?" And they're like, "Actually, it's the exact opposite. Now, they're much friendlier with us because they know that we're not coming to do anything, you know. We're not coming to milk them." It's incredible to see. And I recommend everybody getting a chance to go visit a farm and see where their food is made, because it changes your relationship with how you eat, I think.

You know, I can see why your offerings to children and their parents would be so popular. Because you guys have this neat sense of wonder. You know, you learn, you're out there, you're meeting interesting people, and these interactions sound like they mean the world to you. And of course, the wonder is something amazing that children have naturally. And if that can keep invigorated for as many years as possible, hooray.

Kevin - Yeah. You asked earlier whether you should refer to us as Captain and Cat or Kevin and Jordan. And I think the truth is they've become one in the same. I mean, when we go out there and we film these episodes. Sure, we're in costumes and we're wearing bright colors. But for the most part it's just us, Kevin and Jordan. They're excited to learn about whatever we're talking about or talking to. And there is a natural curiosity that I think we both have. We're not acting, we're not faking it. To go to these farms and see, down one row of apples they're harvesting hundreds of thousands of apples. And they've got to get it done within a matter of weeks. You don't have to pretend, that's just impressive. Yeah. That is just impressive to us.

Jordie - And the world is cool out there, honestly. I don't put on anything. We actually pride ourselves on not talking to kids in a silly voice. I talk in our episodes exactly the way I'm talking now. We don't dumb down our content, and we love having kind of complex words and complex ideas, which we then take upon ourselves to translate into simile that helps our audience understand. You know? We're processing all this in real time. And Kevin and I come from an educational background. I'm a teacher at heart, and I've always have been. And it's just amazing to be able to receive and absorb this information, and at the same time relate it to an audience that we believe will catch up with us if we use the right words.

Tell me how you remain optimistic. So, let's talk about kids and food. The average child is exposed to tens of thousands of messages over a period of time that are mainly for unhealthy food. They're being given food in schools and elsewhere that is engineered to hijack the brain chemistry to keep them coming back for more. You know, Tony the Tiger is not on plain cornflakes, and the Trix Rabbit is not on an unsugared cereal. And you can go on and on. They're obviously exposed to a very tough environment. Are you optimistic that can get turned around?

Kevin - I'm optimistic just based on what we've seen with what we're doing with healthy foods and produce. I think we are trying to, in some sense, be the Tony Tiger of apples, right? We want to be there going, "Hey, apples are really exciting because they're healthy, and they're good for you, and they're sweet." And if we can get kids excited about it, we feel like we've done our part. And what we've seen by this classroom program, we're working with classrooms around the country where we're sending in our content, but we're also sending apples with the help of SugarBee. And then the kids and the teachers have been filming videos and sending it to us about how excited they are to eat apples. And I think kids are wonderful. I have two of them of my own. And they will get excited about what you get excited about as an adult. If you say, "Apples are the coolest, most fun thing I've seen," they get excited about it, too. And they wanna learn, and they wanna share, and they wanna talk about it.

Jordie - There's also a really cool, I think, trend that's happening within the produce industry which we've noticed. And we've noticed that since we've gotten in, which is that it's not enough to just be on the shelf anymore. You want to have a branding, and you want to have a logo, and you want to have a messaging, and you want to have connotations around your brand. And I think produce companies are starting to catch up and use a lot of the same marketing tactics and strategies that kinda junk food was using for a long time. And you know what I always say? It's this. If you actually take the time to bite into an apple and really enjoy it, there's nothing sweeter and more nuanced, in my opinion, than that. I think the more we can change the relationship with how and when we eat, the more we'll start to appreciate food that's of a different quality. And I think bringing attention to that, we're obviously swinging since probably the 1950s, maybe even earlier than that, in terms of just mindless, quick-to-go eating. But I think you see that we're changing the way that we think about how and when we eat. And I think that will favor the swing back towards it. And that's why, honestly, I think we're just optimistic people no matter what. If we went out there and did a despairing series about healthy foods, then that's not going to work, you know? But we love what we do, and we really believe in it, so that's our cause for hope.

You mentioned interacting with classrooms. So, you could just post your material out there and not get involved with actual children and actual classrooms. Why the decision to do that? And tell us how that works. How do you interact with classrooms, and are teachers responsive? What kind of reaction are you getting?

Kevin - Well, this actually came out of a conversation we had with the people at SugarBee. They said, " We would love to get into classrooms to teach kids about healthy foods. We've been asked before to send our apples to classrooms, but we just don't know what to do or how to do that necessarily." And so, we took it upon ourselves to start reaching out to teachers one by one on email, Instagram, TikTok, and say, "Hey, we have this healthy food episode. And we're going to create a worksheet for kids, so they learn how apples are grown. And SugarBee has generously said that they will send a bag of apples to every classroom that wants to be participate in this." And we didn't know how teachers were going to react, if they had the time for that or interest, and the response was overwhelmingly, "Yes, please, and thank you." I think teachers are looking for new lesson plans, interactive lesson plans, and obviously want to encourage kids to be eating healthy. And the fact that we can facilitate this to hundreds of classrooms around the country, it was a win for all sides really. And then we didn't ever ask anybody to film anything or post anything on social media. That's not part of the program. But they took it upon themselves to film videos of either the teachers or the kids thanking us. Thanking Sugarbee for doing this. It was more rewarding than I think we even realized going into this.

Jordie - There have been people who reached out to us and got back to us, and they're like, "We just want you to know somebody's offering us a scam of free apples using your name." And we're like, "Actually, that's not a scam. That's a real thing." And I think we all see a huge opportunity. And one of our guiding philosophies and what we've realized is this: at home, you're very set in your ways, and you've created your habits around eating. And it's very hard at that point to disrupt it because at home, you're rebelling against your parents, you're set in your ways, you're not willing to try anything. And that becomes a position or in a place where you kinda dig your heels into the ground and say, "This is what I like, and that's it." But in school, we found that everybody is so open to trying new things. I remember growing up, I would just, anything that they'd put out at snack for me, I would eat. And, because it was a nice break from being in school, you know? And we think that hitting them in this environment is actually much more effective even than hitting them at home with this. And if we're looking to create lasting habits and changing the narrative around these healthy foods. The last thing we want to do is make it feel like you should eat this. Because the second someone tells you what you should do, that becomes the last thing in the world you want to do.

Can you give us a peek at what kind of foods you might be wanting to take on next?

Kevin - Ooh, spoilers. Yeah, we got some cool ones. We just released an episode this month about Sunkist mandarins. We went to Mandarin Farms in Central California. Same thing, we filmed with the farmers. It's also a co-op, all family farms. We went to the processing plant where they wash the mandarins and sort them and bag them and ship them. And so those mandarins are going to go out to classrooms in the next couple of weeks, and then we've got some really fun stuff planned. So basically, our goal with this is honestly to create a healthy food/product of the month club that we would send into participating schools. It's going to be very, very seasonal because we kind of want to create that sense of it. And luckily, we've got a lot of different brands signed on already. Our summer is looking pretty busy, which is a blessing for us. And really a blessing for the kids that we hope will be learning about this and receiving new foods.

It's not too hard to get kids to like the idea of eating something sweet like an apple or mandarins. What about things like broccoli and cauliflower and Brussels sprouts and asparagus? Will you turn your attention to those at some point?

Kevin - Absolutely. Yeah.

Jordie - Absolutely.

Kevin - We're up for the challenge. I know from my own experience with my five-year-old, if you dip anything in ranch, they'll like it.

Or, or do a deep fry it. Or deep fry it.

Jordie - Right? But it's a pairing issue, you know what I mean? And it's a context issue. So, it's the way you eat it. So raw broccoli is probably not your gateway broccoli. You know what I mean? Right. But you can always find different ways, whether or not it's incorporating it into a smoothie, incorporating it into a sandwich, or anything like that. It's kind of a gateway thing. And there's also a cool thing we're doing. So, for example, we are talking to a potato company. We don't want teachers to have to go home and make mashed potatoes, right? Because that's a barrier to entry, and that's kind of a pain. But what we found is a little workaround with a few of these is like, oh, there's an opportunity to send potatoes into classrooms and have them grow their own potato and get a sense of how it goes. It's not only about trying the food, because honestly, nothing has given me more appreciation for blackberries than trying to grow blackberries myself. You know? And so being part of the process and realizing, wow, the stuff that we're getting is remarkable. And remarkably effective and really delicious and gigantic, and the quantity of it is mind-blowing. So just there's so many different angles that we're getting kids into the idea of farming. And getting their hands dirty, and that's stuff that I feel like is really, really missing from modern society.

Your messaging is focusing on how delicious these foods can be, how interesting their story is, who grew them, where it came from, and things like that. Is part of the messaging what these foods do for you? That mean that they can make you run faster, jump higher, whatever. I mean, is there a functional part of what you're trying to communicate?

Kevin - Yes, absolutely. We try to say it gives you superpowers. And then with each food that we're working with, we do get into the science and try to present it in a way that's appropriate for young kids. But getting into even what flavonoids are in an apple, we just did a whole segment of that and all the nutritious benefits. We've partnered with nutritionists. We were just filming with one in Washington to try to expose kids to the ideas that there are, inside of an apple, all of these natural vitamins and things that can help them. And we've even been doing fiber. Now, trying to present fiber in a way that ... doesn't say poop.

Jordie - But we've started saying poop on our show, by the way. We're like, "You know what? We can say it as long as it's an academic context," you know?

Kevin - Yeah. Yes, exactly. We find the way to toe the line, and quite honestly, kids will lean in if they hear something that makes them giggle a little bit. But understanding, I mean, even for me as a grown adult, understanding that apples are a good way to clean out your digestive system. That fiber is good for that. It's even a good reminder for me at my age to be like, "Oh, yeah." If I'm feeling a little bit of indigestion, maybe I need some more fiber.

Jordie - And a cool thing we also did on our Sunkist episode, Captain and I actually dressed up as these ridiculous California surfer bro characters named Sonny Sunkist and Manny Mandarin, and the idea was that we were talking about why it's a perfect snack for surfing. But at the same time, we're also giving kind of the sugar pill treatment, which is like we're doing these ridiculous characters, but at the same time we're actually providing information about why they're so healthy for you. We're doing one about whey where Kevin and I are gonna go and hijack a LA Fitness and as these muscle bros and talk about why whey protein is so rich in protein and calcium and stuff like that. We're always evolving, and each episode ends up being different. But the one thing that we've found is like the story that we can tell of these is really infinite.

And will there be any part of your messaging that will talk about foods kids might eat less of? I mean, you're focusing very positively and optimistically, so the answer to this could very well be no, because it just becomes complicated. But you've got lots of kids eating sugared cereals and drinking sugared beverages and things like that. I'm just wondering if that's part of the picture. It needn't be, but I'm wondering if it is.

Kevin - I think up until now our thought has been if we can try to get them equally or more excited about the healthy options. Hopefully that's enough to sway them in that direction. And honestly, as a parent, I think just giving kids the idea of getting excited about produce, that they go home to their parents and then maybe the parents' job is just a little bit easier. Because I'm faced with that every day when my daughter says she wants a snack, and she wants candy, and I'm trying to say, "No, how about this apple over here?" If we can be on Team Apple, you know, if we can be the helper to the parents that's encouraging the kids to eat a little healthier, I think that we've done our job there.

Jordie - I think it's never about us wanting to disparage or discourage or make anybody feel bad about their habits, because I think a lot of the problem around our eating habits in this country is that there's a lot of shame involved in it. And you're not only getting a dose of those unhealthy foods that kind of give a quick release of dopamine or whatever. It tricks your body into thinking it's also you're getting a little dose of that shame. And the last thing we ever want to do is to turn into police, you know, and policing each other. Nobody wants to take advice from the police, you know? And nobody wants to feel disparaged or talked down to. It's interesting. We never really kinda thought about it, and obviously we just want to keep it an entertaining and enticing picture rather than any sort of daunting... because when you get into the facts of some of those unhealthy foods, it can really seem a little bleak.

And it is. Well, and making foods seem like fun and having] interesting characters associated with them is something the food industry has done successfully forever. It makes perfect sense to do that, but attach these things to the healthy choices.

Kevin - Let's use their tricks for good. Lord knows we're steeped in them, you know?

Jordie - Yeah. Let's wield that as a cause and weapon for good. I think that's what

we're trying to do.

Kevin - We've also been learning about the history, a little bit, of produce, of the produce business, and how for so long these companies looked at their products as commodities, right? It wasn't necessarily SugarBee apple, it was, "We're a company that sells apples. We're trying to be in as many grocery stores as you can." Which I understand. That makes sense. But I think what probably was lost in the process was if you're just a commodity and every apple is just a different Red Delicious or Golden Delicious. You're losing that opportunity to put a fun character behind it. And I think you're seeing now a lot more of these even different produce companies coming together. Like avocados from Mexico. I think is a great example that you see a lot more of their branding and their advertising where all of these avocado growers are coming together and saying " let's just market avocados. Let's get people excited about the food itself."

Jordie - I think there's also going to be an interesting trend away from going to physical grocery stores that will only continue in the future. So I think if we're ordering online from let's say a whatever warehouse, Amazon warehouse, right? And they have 20 different apples there, it's really important to have brand loyalty. And that becomes things that they're having to consider now. And we just happened to release this series at a really nice time, which they're all trying to do that. Because probably 10 years ago they would've been like, "We don't listen to apples. They sell themselves." You know? But now you're dealing with so much competition and so much branding and so many name things that It can be overwhelming. And at a certain point you might just disconnect unless you know what you're looking for.

What I found that historically is that the people selling these foods were pretty splintered. There would be a plum association and an apple association and a pear association. And, they're loosely grouped into a broader produce organization and things like that. But those organizations tend to not to be very well-funded or have a lot of clout because they were so splintered. I wonder if that's beginning to change. Do you see any evidence that the industry as a whole is beginning to unite effectively?

Kevin - It's funny. Just on Instagram alone, there are, like, places that it's like, " we just love cranberries so much." And then it's like cranberries from Wisconsin. That has their own little thing, you know? I feel like there hasn't been that coalescence, and I feel like also there's probably some sort of advocacy group. I think it's largely statewide policy as well from what I've gleaned off of this. They're each focusing on their own state policy.

Jordie - And then maybe there's a national organization. And this honestly, we are just scratching the surface on this because this is more complex than we could have ever imagined. And we are learning every single day in our talks. And we love to just go out to lunch with the people who are on the business side and straddling the business and the farming side. And the things that they are grappling with are fascinating because all these companies ship internationally. So, you're subject to international law, like weather, there are so many different variables that we're like, "I've never felt so connected to the weather in my life."

Well, before talking to you guys, I was having a day of my ordinary level of hopefulness, but it's gone way the heck up now.And you make me feel really optimistic about the future. And I love the work you're doing. And boy, you could have no two more perfect people doing this kind of thing. And also, I wanted to say, I've done hundreds of podcasts, and I think this is the first one ever where I haven't asked a single question from the prearranged script. It just flows so naturally with you two.

That's how we do this series, too. Oh, yeah. Farmers will be like, "Can you send us a script of what we got?" And we'll send them just the most generic questions of all time. But the things we end up talking about conversation that grows naturally, in my opinion, is by far the best one. So here we are just talking like old friends, you know?

That's nice. Yeah, and it's much more human that way. And that's what registers with people. So, in any event, thank you for the good work you do. And I just hope this incredible visibility you have just continues to grow, and that more and more kids are exposed to it. Congratulations.

BIOS

Jordie "Cat" Simkovic was born in Miami, FL and has worked in early childhood education for almost 20 years, specializing in children with ADHD and learning disabilities. He is a classical flautist and enjoys studying music, martial arts, and gardening. He majored in political science and international studies at Northwestern University, and was this close to applying to law school, but is glad he didn't, although he still teaches the LSAT. This new series about farming and healthy foods is the culmination of his interest in nutrition, education, and meeting new people all across the country.

"Captain" Kevin Hoban, born in Detroit, Michigan, has spent two decades travelling the world and producing content for networks like National Geographic and the Discovery Channel. As a lifelong camp counselor, he's always had a passion for teaching children in a fun, interactive (and often musical) setting. Captain & Cat's "Explorasaurus" series allows him to share his love of exploring and learning about the world with kids and families! Kevin lives in Los Angeles with his wife, two adorable daughters and his dog, Charlie.

North Carolina is one of the nation's top agricultural producing states. And it is also a state where one in seven residents don't have the resources to provide food on their table every day. Today, I'm talking with Amy Beros, president and CEO of the Food Bank of Central and Eastern North Carolina - the state's largest food bank. Each year, this organization provides 95 million meals distributed through more than 700 partner agencies, food pantries, congregate meal sites, backpack programs. And they do this in 34 counties in the state. In our conversation today, we will explore the policy issues that this food bank and many food banks face.

Interview Transcript

Amy, I want to ask a really simple question about what got you to this place. So how in the world did you get involved in food banking?

Oh, gosh. Well, you know, when I was growing up, I didn't know what food banking was. But I knew that it was our responsibility to make sure that neighbors helped neighbors. So, I grew up volunteering what I know now is a partner agency of the local food bank in my hometown. And as I moved across the country, I found ways to get involved. When I moved here to North Carolina about 16 years ago, I found food banks. I've been working professionally in food banking for a little over 12 years now. But I believe that food is a basic human right, and it has been my life's work to make sure that we're doing everything we can to ensure everyone has what they need.

Thank you for sharing that. And I can imagine over the years, as I've also been involved in food banking but on the board side or as a volunteer, that this is a work that we sometimes think it's just about moving food and providing that. However, there's a whole policy framework that, sort of, surrounds and influences and shapes what food banking and what the work of the partner agencies, the food pantries on the ground, what they do. I wonder if you could help make this a little bit more real for us. Could you tell us a little bit about how policy becomes personal in your work? Can you share a moment when that really came true for you?

Oh, I think the most recent blinding moment was last year during the government shutdown. Well, one, there's a lot of noise on TV right now, right, and in the media, but you hear of these massive numbers, and we know that our elected leaders are looking at these numbers on spreadsheets. And we see the humans behind those numbers and their stories. And these are thousands and thousands of stories like the ones that we hear about each day. Last year, during the shutdown, a father of five reached out to me and said, "I have five children. I work at the federal prison. I'm missing my second paycheck. For the first time in my life, I don't know how I'm going to put food on the table." Or the SNAP delay and disruption that we had. For the first time in our history during that shutdown, a mother reaching out and saying, "I don't know what to do. I've told my children to eat everything they can at school because I don't know what we're going to have when we get home, if we don't have these benefits." And that's just two stories and one crisis. And so many of our neighbors are living a crisis every day. These systemic issues. And we see those humans and hear their stories each day. And I think that's when it becomes personal. These decisions, one stroke of a pen, impacts food for hundreds of thousands of neighbors.

Thank you for sharing that. I teach a class called the Economics of the Public Sector, and we often talk about policies that provide support to individuals. And it can be easy to talk about these policies as if they're just decisions that policymakers make, but there are real people who are dependent on these policies. And when they don't work or when rules change, it has significant implications for how people navigate. And so, I appreciate the work that you all are doing. I want to take a step back and talk about food banking. And while I know a lot of our listeners are familiar with food banking and food pantries, I do know that people kind of mix those two terms up. Amy, would you just tell us, broadly speaking, what's a food bank, and then what are the partner agencies. And how do they relate to one another?

Yes, absolutely. Our food bank serves 34 counties in North Carolina. And as you shared, we work with over 700 partners. We work with growers. We work with over 80 local farmers in North Carolina. We work with manufacturers in North Carolina. We work with all of the retail chains to get food out into the community. And we do that primarily through those partners because they are embedded into the community. And what we're really proud of here, and I think something of how food banking has changed, you know, many people still think of a food bank as a dimly lit church basement pantry. And that maybe was food banking 30 years ago. But today it is part of the modern food system. We are a critical piece of infrastructure within the food system as part of the charitable food system. And one of the things that I'm most proud of is we live in North Carolina, this beautiful agriculture state, and over half of what we distribute each year is produce and protein. And that is what neighbors are asking for, too. Because neighbors want the healthy fresh foods, and it's also the most expensive to buy. And food banking today is not just focused on moving calories and getting pounds of food out to the community. It's focused on meals and nutritious meals and how to provide that nutrition education to make meals healthier. To use the types of foods you would get in a food pantry. For instance, I just learned at one of our nutrition demos this past weekend, you can leave the peel on a sweet potato, blend it up, and make it into a pancake. You never notice that you left it on there, but you get so much more fiber. And we're doing these types of trainings to help people make meals more nutritious, make meals go further, too, that they're getting. It's really a holistic approach. It's about being alongside community partners that are embedded into the community that are providing holistic supports like workforce development, job training, housing support. And we're that food portion as part of those agencies and making sure they have the right food and enough food to get out into the community.

It's really helpful to hear the ways that food banking is adjusting. This idea you're no longer just this big organization that takes in a bunch of food and then distributes it through, you know, food pantries and what used to be called soup kitchens. But rather you're working with other community partners, you're working with farmers to find ways of moving food, but also providing opportunities and thinking about this almost as wraparound services. Are there other things that are being provided than just meals? I know I've been in pantries where there have been nurses, and there have been other support services like ways to sign up to SNAP. This is a sort of a series of overlapping and intersecting opportunities to help families meet their food needs, but more than that, their sort of broader set of needs. And I think this is a really critical way of understanding that food banking looks different than, like you said, grandmothers working in a church basement. I know that the work that food banks can serve as shock absorbers. When things go down, when things are problematic, food banks are there to sort of meet needs in a real way. We've seen a great deal of breakdown in policies over the last several months, and both at the state and at the national level. What does this shock look like to you and your partner agencies on the ground?

It has been a tough year. You know, our budget went from 27% government funding and support to less than 10% in one year just because of decisions that were made in an instant. And there was no feedback structure. And I think that's one thing that I really pride our food bank on is the community feedback. We're constantly trying to engage with neighbors facing hunger, understand nobody knows what people facing hunger need more than the people who are literally experiencing it every single day. We try to ground all of our decisions in what is the community saying they need of us. And I think that is one of the things that's been so frustrating to see the decisions made this past year at the federal level. There's been no feedback. It's just numbers on a paper. And within, you know, a stroke of a pen, North Carolina lost $30 million for food purchased from North Carolina farmers for schools and food banks. And that was just North Carolina. It was one billion across the nation. And we're impacting people facing hunger, we're impacting farmers at the same time, and we have farmers who are saying, "I don't know if I'm gonna keep my family farm open." With SNAP, you know, we have cuts coming this year for SNAP and changes that are going to be detrimental for so many of our neighbors. And the cost shift to the states that are not prepared to take that. There's not a transition plan place. And SNAP is an economic driver. For every one meal a food bank provides, SNAP provides nine. We can't replace SNAP if we lose those meals. There's no possible way for us to charitable food our way out of that. But I don't think people realize the ripple impact of those decisions. So yes, it's going to impact people facing hunger. And eight out of 10 of those people on SNAP are working families, seniors, people with disabilities, our most vulnerable neighbors. And at the same time, we're going to see rural grocery stores close. We're going to see more farms close because for every dollar of SNAP, it means $1.50 to $1.60 back into the local economy. And that's going to be a detrimental effect that we can't turn around quickly. It's going to be long-term health impacts for neighbors because of the loss of this nutritious food and the loss of jobs. And we can't just flip a switch and turn that back on because of how damaging it's going to be to so many pieces of our economy. And when I say we can't charitable food our way out of it, we were meant to be here in times of crisis to stabilize and to be an ongoing support for people in the community during that time. But we were never meant to replace the safety net. At the same time, we're having all of these changes at the federal level. We're the only state in the country without a budget. There was another multimillion-dollar loss for food banks and farmers that was invested by the state to purchase from local farmers to go back to neighbors in need. And because we have not had that budget, we've not received those funds. And so, it's really been hit after hit, and we're seeing each one increasing need at our pantries.

Right now, we know there's over 600,000 people facing hunger in our community, and we're hearing from our pantries 20% to 60% more than they're seeing last year. I think that 600,000 people number is actually very low, and we're going to see that continue to climb, unfortunately, because of all the changes we're experiencing this year.

Amy, this is pretty sobering. And I realize that we're talking about issues that are also highly political. And I know you are leading in spaces where you have people who have differences of opinion about what policy should be. But a lot of these people are coming to the work of the food bank, either on the board or in partner agencies or wherever, donors even, because they care about addressing issues around hunger, right? So, how do you build trust? How do you work across these differences to help achieve the goals that food banking is supposed to achieve?

I've never met a politician that told me they didn't like food banks or they didn't care about food banks. There's a lot on people's minds, and I think we need to be in front of our leaders more because there's so much coming at our elected leaders that it's hard for them to even understand everything that's happening in the community. It's hard for me to keep up with just what's happening in our sector, and I'm living it every day, because it's been so fast. I often say, you know, we can't be apolitical. We're nonpartisan, but food is political, so we can't be apolitical. But we'll always be nonpartisan, and we have incredible support from both political parties and all sides of the aisle. And I think we can go in, and we can argue all day long about what we disagree on, and there's much that people disagree on. It's filled in a time when everything feels like it can be political, and we're going to walk out, and we're both going to be mad, and neither one of us is going to change each other's mind. And so I think we have to walk into every conversation with what do we align on, and where can we do good together? Because there's always going to be things we disagree on, but I also know there's always things we align on. And how can we choose those things that we align on and do the most impact and the most good possible with that? Because nobody wants to see a child go hungry. No one wants a senior choosing between medicine and their food or their rent. And so how can we focus, and how can we be a voice to tell that human story that they might not be seeing or hearing enough of so that they understand those true impacts, and we can figure out a way to work together on those alignment?

Yes. I think those are wise words given just the difficulty we're facing right now to find that common ground. To find ways of working together. I'm grateful for the way you are trying to navigate those differences to achieve the bigger goal. The goals that I think many of us want to see achieved. And so that brings me to this last question I want to raise with you. This is a challenging moment that we're in. I want to know what gives you hope, and where do you see people making real difference, despite the challenges that we face?

This is bigger than me, this is bigger than you, this is bigger than the food bank. This is our community. This is the health of our community. And focusing on the health of our community, seeing what happened last year during the shutdown... the community responded in a way that was inspiring and breathtaking for neighbors, because they saw their neighbors hurting. And we are a community food bank. I might get emotional. I do get emotional often. Every day, and I can see them right outside my window right now, we operate because of thousands of volunteers who come here and choose to give their time to us. Thousands of donors who choose to give their money to make a difference in their community. Thousands of food partners who are choosing to work with us. And these more than 700 agencies, we are a community food bank. Our new strategic plan 2030 is called Rooted in Community. And it is grounded in what neighbors said they needed from the food bank, what we are uniquely qualified and able to provide for neighbors right now. And I think seeing that community aspect and seeing the community come together during times like this absolutely gives me hope. And we saw the impact on that on policy, too. During the shutdown, so many advocates reached out and said, "This is unacceptable." And Governor Stein's office invested $3.5 million in our food bank, $10 million across the state during that moment because he saw the need, but he, like we heard from the constituents. And I think seeing and watching how powerful people's voices are, it can't just be the food bank there. It has to be the community members saying, "This is unacceptable in our community." And when we see people come together and align on that, we see change, and that gives me hope. I also think our youth today gives me hope. I just watched a video on C-SPAN that our food bank participated in that two high school students here in Raleigh won an award about building food security in their community. I just talked with a Duke student last week, she's in a feminism and farm class, which is an incredible class that I want to take, I didn't know that existed. And talking about how we can make a change. And I see so many people coming together and truly aligning on what we agree on, and I think with that there comes a lot of power.

BIO

Amy Beros is President & CEO of the Food Bank of Central & Eastern North Carolina — among the largest anti-hunger organizations in the United States. Amy returned home to the Food Bank following several years of service with Feeding America, where she led nationwide efforts to build food banks' capacity to better serve people facing hunger and poverty. Throughout her career, Amy has maintained a firm commitment to holding the experiences of neighbors at the heart of every decision. She has applied this community-centered approach across critical efforts in food sourcing and access, disaster response, strategic partnerships, and philanthropy — including leadership roles with Inter-faith Food Shuttle, Easter Seals UCP, and Pillars Community Health. During Amy's prior tenure with the Food Bank, she led the multi-year campaign that established the organization's state-of-the-art Raleigh headquarters and ushered in a new era of systemic solutions to hunger in the region. A South Carolina native, Amy holds a Bachelor of Science from Clemson and an MBA from DePaul University. She currently resides near Raleigh, North Carolina with her husband, two children, and rescue dogs. Outside of work you can find Amy lifting weights, spending time with family, or sharing her love for Dolly Parton with anyone who will listen.

For many people, the FDA-approved drug class called GLP-1s has been a game changer for managing type 2 diabetes and weight loss. An estimated one in eight US adults is using this type of drug, which mimics a natural gut hormone to regulate blood sugar, slow stomach emptying, and suppress appetite. Researchers and the public have been scrutinizing the pros and cons of taking these drugs for many years. One critical question that remains is does the use of GLP-1s translate into lower medical expenses for consumers, healthcare providers, insurance companies, and the government? Today, we're speaking with Duke University health economist Jonathan Zhang on the answer to these questions from his multi-year study of veterans who use GLP-1s. The results are surprising.

Interview Summary

Jonathan, first, let's talk broadly. Would you briefly describe the kinds of health benefits people are experiencing with GLP-1s, particularly in terms of changes in behavior and overall health?

Yes. So GLP-1s are medications that manage body weight and improve metabolic health. The primary health benefits are via better blood sugar regulation and weight loss via reducing appetite. But there's larger health benefits that are much broader. So, trials have also shown that they lower blood pressure, reduce strokes and heart attacks, among other cardiovascular benefits. Overall also improves, so things like obstructive sleep apnea, improvements in inflammation-related measures. And recently it was FDA approved to treat MASH, which is a form of fatty liver disease. Finally, people also report feeling less hungry. They get full faster, fewer cravings, and reduction in what is often called food noise, which can potentially help people make a range of better behavior decisions and changes relating to food and perhaps even beyond food. However, the evidence on that seems to be promising, but new and less strong.

Thank you for sharing those. I know a lot of our listeners have heard some of those issues and some of those points about how GLP-1s could change the way we behave, and some of the health outcomes. So, let's dig into your particular study. In your working paper for the National Bureau of Economic Research (NBER) you and your co-authors describe a natural experiment involving patients and doctors in the Department of Veteran Affairs, and their access to and use of GLP-1s. Would you lay out the general parameters of your study for our listeners?

Yes, absolutely. So, like many medications, what we know about GLP-1s primarily comes from randomized controlled trials, which have small sample sizes and often select for quite sick patients. As GLP-1s reach a broader population, the population becomes less pro-comparable to those in trials, so the real-world impacts become less obvious. Moreover, there are some outcomes such as healthcare utilization or spending costs that are incredibly important for policy but not directly studied in trials. We were interested in studying in a very large healthcare system, that is the VA, the Veterans Health Administration, the real-world impacts of GLP-1s using readily collected data from the healthcare system and a quasi-experiment. So that is we try to emulate a real experiment where some patients get GLP-1s from their primary care doctor and others do not. And the reason one patient might get it while the other doesn't is because their doctors differ in their likelihood or propensity to prescribe these drugs. And we focus on the Veterans Health Administration, the VHA, because the veteran population is quite diverse, at least in terms of comorbidities relative to the trials per se and also in age, say, compared to Medicare. And GLP-1s are provided in the VA to eligible patients at a pretty affordable cost. So, sort of a nice policy playground for us to think about what outcomes might look like when GLP-1s become readily available and affordable to all Americans.

Great. Thank you for sharing that because now we have a good sense of the quasi experiment that you all were able to exploit. That there were providers who had a high tendency to prescribe GLP-1s versus those who didn't. And looking at that difference, you were able to see how GLP-1s may have affected the outcomes that you were interested in. So now tell us a bit about the findings, and I think there's some surprising results here.

So, first we replicate many of the findings from the randomized trials for this diverse, veteran population. We see reductions in body weight, we see hemoglobin A1C blood glucose levels improve and blood pressure improvements as well. Even a reduction in heart attacks and strokes for patients with existing cardiovascular conditions, and even a small reduction in moderate drinking risk as well. The trial evidence seems to hold up in this large and diverse population of we have 1.4 million patients that we're studying. Second, despite these improvements though, we do not see a reduction in healthcare spending. This is actually excluding the cost of the medication, the GLP-1. It's not because GLP-1s are expensive. We're taking that out of the equation. Over four years, this is how long we're able to track these patients for, we're able to rule out reductions of more than 7% in healthcare spending. And we see no reductions in whether that's outpatient clinic or in inpatient hospitalization. We also don't see any reductions in emergency department visits more generally, despite seeing a reduction in heart attack and strokes for those patients with existing cardiovascular condition.

Jonathan, that sounds great, but it's a little hard to understand. So why is it that you're seeing no real changes in the consumer healthcare spending? What's going on?

Yes, we were a little surprised as well. We think there could be a myriad of potential reasons. But first, I want to note that there's also at least three other studies that use real-world data to look at a similar question, and all the studies find no statistically significant spending reductions. And in fact, all of us, we all find a slight positive increase. I think the first explanation is that while heart attacks and strokes are very expensive and obviously, very serious events, they are still thankfully quite rare and thus are not very common in our three to five-year period in which these studies are looking at. But perhaps over ten or twenty years, you could start seeing some healthcare spending materialize. I think that's totally possible. Most cost projection models, whether that's from the CBO or other organizations, they project healthcare spending reductions to accumulate over time. But these models also project immediate spending reduction, which is not yet supported by the data.

Another potential explanation is what I would call these behavioral responses. So, you can imagine that a patient sees some improvement in their health, and that changes their expectation of, "Oh, wow, I could actually make some changes to my health." And they actually go and get some more care. This can also be driven by the physician as well. So, sort of, "Look, things are working. This patient's seeing improvements. Maybe we should treat some of your other health problems and issues." This is what I would call sort of a behavioral response. A third explanation could be that some of these patients have conditions that have progressed to be irreversible even with metabolic health gains. So, for example, late-stage kidney disease would be a good example. We find some suggestive evidence that this might be happening in our study. In other words, for these patients where they have some potentially irreversible health conditions, the metabolic health improvements - that's not a primary reason for their healthcare spending.

This is helpful. That explains why we're seeing some of these challenges with healthcare spending. And I appreciate your point of taking a longer view may actually reveal some differences. And also, the responses of doctors and patients to the benefits that they gain and how that might expand opportunities for healthcare. So, thank you for sharing that. I want to shift focus a little bit. And it is taking a step beyond the paper, but I think it's a natural extension of the work. As you know, I'm an agricultural economist, and I've been interested in obviously food policy issues. And the fact that we're seeing weight loss, the fact that we're seeing better management of A1C suggests that there's something probably happening with food consumption and food patterns. I'd be interested to learn from you if you have any ideas about what this work suggests about the impact of GLP-1s on consumer food choices.

Yes, I think there's a fair amount of both trial and real-world grocery purchase evidence that GLP-1s are impacting consumer food choices. In the randomized trials, GLP-1s reduce, calories consumed, reduce the desire to eat sweet, salty, and savory foods and high fat fast foods in their meals. For example, these trials will look at what people eat for lunch. In real world data, there's a study out of Denmark that found that after patients' first GLP-1 prescription, their grocery store purchases went on to have fewer calories, sugars, saturated fats, carbohydrates, and more protein over the one-year period after they initiate GLP-1s. The share of ultra-processed foods also decreased. The effects were actually quite modest, so there was only about a one percent reduction in calories and a four percent reduction in sugar and a five percent increase in protein in the year after versus the year before in this Danish study. In the US, there's a similar study using kind of this transactional level data as well. And they find that households after they start GLP-1s also reduce caloric intake, fast food consumption, caloric dense processed foods. And there it's a little larger in the US by about five to ten percent. Then the question is, you know, are they shifting towards healthier foods or is it sort of a uniform reduction in calories across all different food classes? And there the evidence is a little less strong. There's some evidence that consumers are shifting towards healthier foods, but if that is the case, the shift is quite small. In both the Danish and the US study, it's roughly looking like a level shift for all different categories. And this is also in terms of not food so much anymore, but there's also been studies looking at alcohol consumption, which has been very interesting and promising. There's a phase two study pilot trial with only forty-eight participants, but the randomized control trial found that among patients with existing alcohol use disorder GLP-1s led to a reduction in the average number of drinks per day. No change in the number of days drinking, but conditional on drinking, the average number of drinks per day declines in the treatment group that get GLP-1s. And then for out of the 48 patients that are also smokers, there's also a reduction in smoking as well in that population. So, very promising early evidence there as well.

Jonathan, this is critical information, and I know some colleagues in the Ag econ profession, folks like Brian Roe, Tim Richards and Glenn Townsend have also worked in this space, and some of the work is showing some issues around the quality of protein or overall food spend is going down. And the choices or the responsiveness of people to prices when it comes to proteins. There's some evidence, some causal evidence to suggest GLP-1s are changing the way people are even looking at food markets. And so that raises a really important issue. If consumers are changing when they're exposed to GLP-1s, I have got to imagine that the food industry, grocery stores, food manufacturers, restaurants are making some adjustments. What have you to say on that particular point?

So, we're both economists, right? We both, of course, believe that producers and grocery stores are adjusting to demand. We do know a lot less about how the supply side is adjusting compared to the demand, and that's because there's just less data and fewer studies on patients. There's more data and more studies on patients and consumers than on grocery stores and restaurants. I've seen a lot of anecdotal evidence, often reported in the mainstream media or reports from various market research agencies that GLP-1s are having this large impact on the food industry. I've seen claims like GLP-1s are hurting Walmart sales or why are beer company sales down, like AB InBev, and range into things like why restaurants are reducing their portions or recently I actually also saw over the past couple weekends claims of why Coachella portions are smaller because everyone's on GLP-1s. So, the best estimates from last year are that one in eight Americans are using GLP-1s. And if each of these users are cutting back in consumption by 5% to 10%, as in those studies, it's totally plausible this leads to a large population reduction that the food industry just cannot ignore, right? I think it's important to note a couple things. First is that the long-term adherence of GLP-1s is generally quite low, with more than 50% discontinuing within a year in most of the studies I've seen in the US. And after discontinuation, most of these patients will gain back a large fraction of their weight. And in that US groceries transactional study I told you about, they find that after discontinuation, purchases at fast food, grocery, restaurants, et cetera, they go up beyond baseline, in fact. So, beyond six months prior to when they were on GLP-1s. It's still an open question to whether these 5% to 10% individual consumption reductions will become long-term and manifest in the population level, especially if adherence is not very high. Second is that up until very recently, there's been a very strong demographic and socioeconomic profile of these GLP-1 users, right? So, they tend to skew near elderly and also a little bit more female, and generally fall in the middle- or higher-income brackets because previously Medicaid, for example, did not cover GLP-1s, right? Until earlier this year. And it still does not cover it for many states. So, any food industry changes will likely be concentrated in the restaurants and the food chains that sort of have these consumer demographic and economic base. That's something to keep in mind. Certainly, there are examples like, you know, Smoothie King has introduced a GLP-1 smoothie. But even in these clear-cut cases where the producer is clearly trying to appeal to this demand shock, it's still very difficult to disentangle the producer's stated intent from general industry market trends, right? So, general trends like rising cost of living. There's been more demand for protein. You can see protein in everything now, right? Even water. Rise in sort of small plates or family-style tapas at restaurants. Feels like every restaurant's doing this now. Or for example, a decline in alcohol consumption or interest in alcohol consumption, especially among young people around the world. I think some of this is certainly happening. Producers are listening, but it's hard to disentangle the general trends from a specific GLP-1 impact.

I'm grateful for you taking some of the hype out of this and thinking through carefully what the economic implications are of this change and recognizing that there's some real important context that people don't stay on these drugs for long. Or there are certain types of folks who are more likely to use them, and therefore we can't assume that there's this massive wave of change that's going to happen, but that there are some responses. These are important ways of framing this discussion. I have one final question. Based on what you're seeing now with the use of GLP-1s and considering their use over time, what would you say is the key takeaway for policymakers?

I think there are a few takeaways. Most importantly, I think policy makers should think about the rapid change in profile of patients who are using this drug. Just because it's beneficial for sick patients doesn't necessarily mean it's going to be equally as beneficial for patients who are less sick. One of the findings in our paper is that as the veteran population that starts to initiate GLP-1s in the more recent years, these patients actually are healthier, so their treatment effects are not quite as strong as those who were initiated in the very early period who in our setting were among the sicker veterans. Policy makers shouldn't extrapolate the potential benefits to a broader population since there's so much demand for this drug, right? This also means that some of the downstream improvements like cost savings or even improved labor outcomes like absenteeism or being able to return to work, while these things might seem logical, it's not fair to assume that it's going to be automatic, especially at a population level. Related to that last point, we should encourage additional research on important socioeconomic outcome that might completely change the calculus of the cost benefit of these drugs, right? So, labor force participation, earnings, use of government transfer programs like disability insurance, even some interesting patterns of household formation and fertility. These are all fascinating and important questions. However, it is imperative to note that GLP-1s already have incredible health benefits for many people. While it's possible that these benefits might spill over to broader societal benefits, these benefits should not be presumed. And at the same time, we shouldn't be holding GLP-1s to a higher standard, say, to reduce healthcare spending or increase earnings just because we know that it does a bunch of wonderful things for a range of conditions. So, maybe it does this and this as well, and suddenly we're less excited if there's no evidence of that and that, right? These things have incredible health benefits. Let's appreciate them for that, and we shouldn't be holding them up to a higher standard just because it appears to do so many wonderful things.

BIO

Jonathan Zhang is a health economist at the Sanford School of Public Policy at Duke University and the Margolis Institute for Health Policy. He is a Faculty Research Fellow at the National Bureau of Economic Research and an evaluator at the Department of Veterans Affairs. He researches how policy can improve mental health and substance use outcomes using quasi-experimental methods.

Interview Transcript

Kate - Welcome to the Leading Voices in Food podcast. I'm Kate Stanley, a researcher at the World Food Policy Center at Duke University. I'm joined today by my co-host, Katariina Koivusaari, a researcher at North Carolina State University. Together, we collaborate on policy research for the Bezos Center for Sustainable Proteins at NC State.

Katariina - Great to have you. Greg, you have been involved in food and agriculture policy in Washington, D.C. for several decades and have worked with both Democratic and Republican administrations. Are food policy politics caught up in party differences depending on which political party is running the executive branch?

A very relevant question right now. I guess it would be wrong to say that the political party in office doesn't make a big difference in the policies being carried out by the executive branch. However, in the food and agricultural space, and especially in the areas that I focus on, which is really around these new technologies in food and Ag and how do those get into the marketplace and adopted, that difference hasn't been so big. Let me give you an example or two. I'll take you back first to about 2000, and we had the Clinton administration. We have the regulation at FDA of biotech crops, and they had a voluntary consultation process and there were a number of stakeholders and others who felt that that wasn't sufficient. The Clinton administration interpreted the Food, Drug, and Cosmetic Act to try to turn that into what they called a mandatory consultation, and they proposed a pre-market notification rule. It didn't get finished in, before the end of the administration in January of 2001. Then we had the Bush administration come in, so we went from a Democrat to a Republican. And the Bush administration looked at the same law and looked at that same proposed regulation and said, "We don't have the legal authority to do that." And they withdrew that proposal, and so we still have to this day this voluntary consultation. And I give you that example for two reasons. One, I think what we've seen when it comes to food and policy regulation by different administrations is how they interpret the law. And I can say this in very general, the Democrats have tended to be a little more expansive in how they interpreted the law to try to find more legal authority to do things that they might want to do. And the Republicans have tended to look at that language much more restrictively or look at just exactly what that language said and not try to interpret anything into it. And so, you see that difference here between what happened in the Clinton administration versus what happened in the Bush administration.

I mention this example because as many of your listeners may know, right now in this administration, we have the question about voluntary GRAS and whether that's going to become mandatory or not. And some of us who have followed that know that the current FDA has submitted to OMB, to the White House, a proposed rule to make GRAS mandatory. Well, that is-- the regulatory process for those biotech crops is also a GRAS process. It's interesting now that we have a Republican administration who's finding the authority to do that, and we'll see what actually comes out and what the courts do with it. But I think this shows that sort of difference in policies between Democrats and Republicans. But overall, we haven't seen a lot of difference.

In this new administration, I think one of the questions people had was what would happen with a technology like cell-cultivated meat? Where would the regulation of it go forward? There's many in the MAHA movement, I think, that felt that that wasn't consistent with what they wanted. But we've seen that those approvals continue to happen. Similarly, pesticides have been an issue in many administrations. Sometimes Democrats have argued to be much more restrictive in the use of pesticides and to make the regulations much harder. And Republicans have oftentimes said to make those easier for the agencies. But what we see is pesticides have moved forward under both administrations. People understand the need for pesticides to produce agriculture. We have some differences in policy, but on the whole, in this area, I think, whether it's Democratic or Republican, they have generally supported following the law.

Kate - Greg, you shared some interesting examples of across administrations how we've seen different actions be taken. And I'm curious. Under this administration, for some of these areas you work in, like these novel technologies, what do you see as driving the new federal legislative actions in food policy?

The legislative area has generally always been more partisan than the executive branch to some extent. I mean, the executive branch is interpreting laws from Congress; the Congress is setting those. But I think again, in the area of food policy, we've seen many good laws come out that have been bipartisan. And when I look at how did those laws come to be, I sort of see a couple different scenarios. One, and I don't think this is unique to food policy or ag policy, we tend to see legislation when some crisis has occurred. The example I would give in the food space was the establishment of the Food Safety Modernization Act more than a dozen years ago. And to a large extent, that was reaction to a number of outbreaks: spinach outbreaks, peanut butter outbreaks, egg outbreaks. And people getting sick, and some people even dying from those outbreaks. And so that brought a bipartisan coalition together to say, "We need to give more authority to FDA to address our food supply and ensure it's as safe as it could be." So that's one way we've seen that.

A second way we see policy change is when a policy is old or that is no longer in favor. And the example I give there is most recently, in this Congress passed the whole Milk for Healthy Kids Act, and that is a definite change in policy from the Hunger-Free Kids Act of 2010. This changes what milks, whether they're flavored, and how much fat they can have and be in the school programs. And I think in both cases, those bills were relatively partisan at the time, and yet they do opposite things. So that would be another reason that we see changes in laws.

But the third way, and I wanted to focus a little more on this, is one way the federal government gets involved and Congress gets involved is when states start regulating an area, and we start getting different standards. And then there's a push at the national level to have some sort of uniformity, some sort of have national standard for markets to work properly, for efficiency's sake and so forth. And I can give several different examples. We can go all the way back to the National Organic Law that was passed back in 1990. You had a number of states who had defined organic; they had different organic labels. Congress came together and said, "Hey, let's set up a national organic standard." We had the same thing happen with the National Bioengineered Disclosure Law, that I think happened around 2017 or 2016. In which case you had a number of states proposing legislation. You had Vermont that had passed legislation requiring mandatory labeling of genetically engineered ingredients. And in fact, the law that was passed by Congress was passed, I think, within a week or two of when the Vermont law was about to go into effect. And people felt it was better to come together and have a national standard than have different states doing different things. Because the reality is, consumers and manufacturers don't just purchase things in one state or produce things for one state. They produce it for the nation. We're a nationwide market. And then we see even those kinds of things happening today, and I go back to the pesticide area as another example. We've had different states having pesticide laws or regulations that have been different than the federal situation. We have a Supreme Court case now that the Supreme Court is going to hear in April of this year about whether that's those state regulations are preempted by the federal law. But Congress and the Farm Bill has also put in language that would ensure that the federal standard is the standard that is applied, not having multiple different state standards. So that's been a way that we've seen a lot of things happen in this food and Ag space.

Kate - We've seen a lot of food policy action at the state level in the past few years. Katariina and I were on this podcast not long ago talking about state legislation aiming to restrict how cell-cultivated meat products are labeled or even banning those products altogether. We've seen action in a variety of other areas as well. Are there issues that states have started regulating where you think we could see federal action in the near future?

I do. I think that the MAHA movement in particular has really set up a situation where we see states taking the lead on a number of issues, and we'll see whether the federal government decides to come in, and particularly Congress, to address those at a national level. For example, in the area of synthetic dyes and food additives, I think there's some 30 states that have introduced bills. And a number of which have passed, either restricting those use at all in any foods, restricting their use in school lunches, having different labeling associated with many of those ingredients. And we've seen some of those laws pass, and we've already seen some court cases. A court case in West Virginia which said that those laws are preempted by federal law. One could envision either something at FDA or in Congress that would set some uniform standard for how this moves forward federally.

You mentioned cell-cultivated meat and the three of us were involved in a paper that looked at the state regulation in that area, especially around labeling. And again, if we don't have a lot of those products on the market yet, but as those products get closer and get on the market, I could definitely see a push again to have some uniform labeling. Either again from the federal executive branch or from the legislative branch. And also, in areas like ultra-processed foods is another one. California has passed a law defining how they're going to define ultra-processed foods. We've heard that FDA may issue a definition about ultra-processed foods, but I could also see Congress getting involved eventually and setting a standard.

Katariina - I'm sure that in working with US regulatory agencies for so long, you've seen trends develop and persist over time. What would you highlight right now for our listeners?

Well, as I said, I've worked very much in this space where we talk about new science, new technology, new kinds of products coming into the marketplace and how do we regulate that? What are the policies and regulations to ensure that that's safe for humans and safe for the environment, and that there's information and access that's necessary for those safe products to, to thrive in the marketplace. And when you look at that, I think I have some observations, I guess, about the US regulatory agencies and what they've done in this area. The first one is that the science tends to move faster in the private sector and in the research community, like you're both in, than it does in the federal government. And so generally, the people in the federal government, who I have the utmost respect for, the career people, tend to always be playing catch up on the science. That the science is moving faster and they're not there. An example I would give is cloned animals. When the industry went to FDA and said, "Hey, can we put these cloned animals into the m- into the marketplace?" FDA sort of said, "Well, wait. We need to look and see whether we need to do a risk assessment to see if there's any risks out there." And they spent a couple years doing that, and they asked for a voluntary moratorium while they were figuring that out. In the end, they figured out that for many cloned animals, there was no risk and there didn't need to be regulation, but they had to catch up. They had to catch up on the science. And I think that's the first thing. It's important for industry and public sector scientists like yourselves to make as much information about new technologies and new products available in the public realm so that those experts in the federal government can stay as close as possible to what is happening.

Second is, anytime you have a first-of-a-kind product. You talked about cell-cultured meat, Kate, a little while ago. We can talk about biotech crops. We can talk about a number of genetically engineered salmon. We can talk about a number of different new products of methane-reducing feed additives. The first-of-its-kind is always going to take a little longer to figure out what is that regulatory pathway. It's great to be the first into the marketplace. You get a lot of advantages, but I guess one of the disadvantages is that you probably have a little slower regulatory timeframe. That again bodes for that transparency for that additional information. The third thing I'd mention, and you would think, oh, this is something that is sort of a given and expected, and that is the level of transparency that we have in our federal government. But that's not true. I've traveled around the world, and many governments don't have that. But interestingly, most of our regulations are, you know, they're all publicly available. There's lots of guidance documents out there. We can go online today and see GRAS applications and decisions made at FDA. We can see what information was submitted for cell-cultivated meat crop, meat, meat products, and what decision the agency made on those. We can do that for genetically engineered animals and for genetically engineered plants. And so, we do have a fair amount of transparency, and I impress upon people to use that to their advantage. I think that builds trust for consumers, but also for people in the industry. It helps them learn so they can be as efficient as possible when they go through the regulatory process. And the final thing I might mention is it may look like from the outside the government moves slow all the time. But I think having been inside the government and in the role, I played as the Chief Regulatory Officer at USDA, that slowness, in part, is to make sure that the government speaks as a single voice.

We've been talking a lot about FDA, and we talk about USDA, but there are actually some 18 or 20 different agencies that actually regulate different parts of the food supply, for example. A decision made in one agency may have some indirect impact on a decision or a regulatory process in another agency. And so, it's important before major decisions are made or major regulations are promulgated, that we have an interagency review of those things to make sure that the government is speaking consistently with one voice about how they interpret laws; about how they apply risk assessments; about how they look at safety and so forth within the context of their laws. And that sometimes takes some time. It is a big bureaucracy, a big government, and again, that could be looked at upon negatively. But at the same time you can look at upon that positively as an opportunity to make sure that the decisions that are made in one place are consistent with other decisions and other statutes in another place.

Katariina - Thank you for sharing that. It's really helpful to get more insight into the policy process. Let me ask you one final question. For organizations seeking to navigate through state and federal regulations in order to bring a food product to market, what are the key, what are key takeaways you would highlight?

Well, there are a number of them. First, I would tell companies or public researchers, whoever is bringing a product to market, to be as transparent as possible. Put as much information about your product and your technology in the public record, especially if it's in peer-reviewed journals that are accessible to everybody. That is only going to come to your benefit. That's going to help the regulators. They know that information is out there. They know that other people have that information. They can utilize that to help make decisions about whether there is a food safety or a risk to the environment, and then how maybe to address those risks. So that would be my first response. The second one is, and I think, again, this is something that I thought was going to be universal when it came to interactions between the regulated community and the regulators, but it's not around the world, and that is to consult. All the agencies that I've worked for have open door policies where they say, if you have a question, as you're thinking of bringing a product to market, come in and consult with us. Come in and talk to us. Let us help you figure out what the regulatory pathway is going to be, what the data you are going to need is, why we need that data, and go through all of that. And, in my consulting business, that's one of the things I do. I help facilitate those conversations between one of the agencies and a client. And I think that just the earlier you do that and the more often you do that, the more efficient you will be, the less money you will spend, the quicker your review process will be. And while I have clients who don't always agree with the decisions by the agencies of what information they might need or what regulatory process they have, it's still better to know that upfront and earlier in the process than later in the process. The third thing I'd mention is to be a little creative. The regulators, you know, they're trying to ensure they're representing the public, and they're trying to make sure that a product is safe for human consumption, for animal consumption, for the environment. They don't always have all the answers, and sometimes they are fitting square pegs into round holes because new technologies come along that aren't exactly a perfect fit. But be creative. Try to help them. I think, you know, sometimes working with people like me or others to help think about what a good regulatory pathway would be, what are the potential risks that really need to be addressed here that can be really helpful. The fourth thing is, you know, that the devil is always in the details. The details and the science matter, and that is something that is very important. And so, we want to look for analogies of your product or your technology to other ones that have happened in the past, and that's always good. But also understand the differences. And so, really, I think, sometimes people think, "Oh, they don't need to engage with the regulators as much about exactly what I'm doing," or "They don't need to know all those details." Those details actually do matter, and I do think those are important. And then I would finally say that, you know, it does take time, especially when we're talking about new technologies and new products, to figure out what that regulatory process will be. And we don't have neat situations. Our laws are written a long time ago. We don't want to write a new law for every new kind of product or every new kind of technology. I'm not sure that's the most efficient way to do it. But by not doing that, we're sometimes, as I mentioned earlier, fitting square pegs into round holes. We have a law, for example, the Food, Drug, and Cosmetic Act, dealt with food, but it never envisioned genetically engineered crops. It doesn't talk about biotechnology. We have a meat law that regulates meat at USDA. Didn't think about cell-cultivated meat. And we have to think about how those fit together. And sometimes we can do that without the new laws, and sometimes you need new laws. When I was at USDA, we worked on methane-reducing feed additives. FDA regulates them, but they really don't fit very well. They're not a drug, but they're also not a feed because they don't have a nutritional benefit. And so how do we fit those into the regulatory system? FDA's come up with a temporary regulatory pathway, but there's also a bill in Congress to set up a more definitive regulatory pathway. And we see that for some of these new technologies that we might see some legislation. And then the final point I would just make is to temper everybody's view that a compromise is essential in this area. No one company or no one stakeholder gets everything they want. Governing and the government's job is to, you know, figure out what's the appropriate balance. They want to ensure safety, but they also want to make sure that safe products can get to market and that consumers can get to take advantage of those products, and we can get the benefits from those products. And so all of this is always a balancing. There will always have to be some sort of compromise. And I'm not saying that's a bad thing, just pointing it out as something that people should be conscious of.

BIO

Gregory Jaffe is President of Jaffe Policy Consulting, which provides strategic advice on national and international policies involving agriculture and food, with specific expertise in sustainability, climate, bioeconomy, biotechnology, PFAS, pesticides, food safety, and food loss and waste. He recently worked as the Senior Advisor for Regulatory Affairs in USDA's Office of the Secretary and the USDA's Chief Regulatory Officer. He managed a broad portfolio of policy issues, including bioeconomy, biotechnology, biofuels, pesticides, PFAS, food safety, sustainability, and scientific research and development. Before joining USDA, Greg worked for at the Center for Science in Public Interest (CSPI), a non-profit consumer organization working on food and nutrition issues. While at CSPI worked extensively in Sub-Saharan Africa and Southeast Asia on projects funded by USAID and the Gates Foundation. He worked with government officials and stakeholders helping them develop laws, policies and regulations that allow for the adoption of agricultural technologies, including biotechnology. He advised on agricultural policy, sustainability, and trade issues, conducted capacity building, and worked on international treaty implementation.

Kelly Brownell interviews Jon-Paul Bianchi, Director of Systems Change at the W.K. Kellogg Foundation, about the foundation's systems-change approach linking food, health, early childhood, and family economic security to address inequities affecting children and families. Bianchi describes his path from PhD research to policy work and then to Kellogg, and explains how integrated grantmaking focuses upstream on policies, practices, resource flows, narratives, and long-term investment in people and relationships rather than isolated programs. He highlights Vermont's inclusion of food quality in childcare ratings and the foundation's Farm to Early Childhood efforts connecting procurement, regional food systems, and state policy, with examples from states like North Carolina, Iowa, and Wisconsin, and notes Brazil's national local purchasing policy as a model for success.

Transcript

As I was mentioning before we got started, I've long admired the work of the Kellogg Foundation. Working with the concept of food systems or connecting agriculture with nutrition and thinking about regenerative agricultures. There are a lot of places where your foundation was out front. So, I salute you and your colleagues for that. And it'll be interesting to find out what's happening right now. Tell us a little bit about yourself, and how did you get into the philanthropic work and your work with Kellogg in particular?

I'm Jon-Paul Bianchi. I'm the director of the Systems Change team at the W.K. Kellogg Foundation. And what that essentially means is I'm the director of national programs at the foundation. But we call it systems change because we really do see in the different areas of work that we focus on- health, family economic security, food, and early childhood- that these things are all interconnected by some distinct systems. But also, common systems that overlap across them. And so, that's the approach that we take. And I'll spend some time sort of diving into that today. You know, to answer the question of how I got here... you know, a master stroke of luck. I was set to be an academic researcher. I was working on my PhD at the University of Wisconsin. I was ABD and decided that I didn't want to be a researcher and I wanted to work in policy. And I moved to Colorado to take a job sort of sight unseen, being the policy director of an organization that worked in K-12 and children's health, and food and early childhood education. And did that for a few years and learned to translate research into practice; into policy. And was giving a presentation and got a tap on a shoulder from somebody that worked at the Kellogg Foundation who was interested in what I was saying. And we had one conversation, and six months later, I wound up having a new job and leaving Colorado and moving to Michigan. That was 15 years ago.

Well, you went into this with a great background having done the science as a graduate student and then into the policy world. And you're right, the intersection of those two is really where the magic can occur. You began talking about this, but let's talk about it a little bit more. So, when you say that there are systems that cut across different problems like food and health and economic security, etc., and I know you structured your team to reflect that cross-cutting kind of view of things. But tell us a little bit more about that. And how is this different than what's usually done, and how does it affect the way your work gets carried out?

So, big picture at the Kellogg Foundation, we envision a society where every child can thrive. But we know that there's too many kids and families that still can't access good food or quality childcare, or their parents can't find quality jobs because of inequities that are embedded in the policies and the practices and narratives that shape our systems. And so, having a multi-issue integrated grant making team, it's made us more effective by better understanding the points of intersection and collaboration across those bodies of work. So, our food systems program officers are in the same team, and they work closely with our program officers in early childhood and family economic security and health. And those collaborations strengthen the work in a variety of ways. We have experts in each of those areas, but because they're spending time with each other and working in the same team, they're exposed to, and they learn about each other's work and each other's worlds. And that creates powerful collaborations in the foundation, but more importantly, out in the field. And it helps us to see that we can't fix any of these systems, including food systems, with surface level or patch kinds of solutions. We really have to work together to get upstream and focus on policies, focus on practices, focus on resource flows and narratives that really sustain the inequities that we see. And so, the foundation partners with organizations to dismantle barriers in food systems in the other areas so that children and families can access quality food. But I think we also recognize that's about investing in people. And it's about investing in people over time to drive transformational change in any of these systems, including food.

For people listening to this who aren't in the world of philanthropy or academics or science or policy they might be saying, "Well, this kind of makes common sense. Isn't this the way it's usually done?" And in fact, it's not usually done to have this cross-cutting work accomplished the way you're doing it. It's actually a pretty impressive thing.

Yes, thank you. And I have a lot of respect for our philanthropic partners and peers, and we work very closely with a lot of large and small foundations. And I think the adage in philanthropy is you know one foundation you know one foundation. So, we do it this way and somebody else will do it differently. And I think there's a lot of connection for us back to our founder. You mentioned Will Keith Kellogg at the top of the call. He was ahead of his time in terms of understanding the interconnectedness between food and the land and opportunity and people's education. And a lot of that came out of his tradition as a Seventh Day Adventist. But also, I think just as a person coming up in the Depression and seeing what happened afterwards and really beginning to understand in his own community of how these things were sort of connected to one another. And so, for us, both inside and outside the foundation, systems change really means betting on people long term to reshape those systems from the outside in. But also, from the inside out. And that's really what we're striving for.

You mentioned the history of Dr. Kellogg. The history of that family is so interesting, and what went on in, you know, the sanitarium in Battle Creek, Michigan, and how the concept of breakfast cereals came about. And how the focus on natural foods was so important. It's worth spending a little time even on just Wikipedia to try to find out what that history is, because I find it fascinating. So, let's go back to food and go a little bit deeper and talk about what this systems approach looks like in practice. You're a philanthropic organization. You exist in the context of a capitalist society where businesses are out to do as well as they can. How is the foundation's work different from, say, funding a food pantry, launching a single nutrition program somewhere, which is what typically might be done?

Yes, I think what we intend to do and how I think our systems approach is a little different from, say, you know, funding a single nutrition program, is that we mean to design and redesign practice and policy based on how kids and families actually live their lives. Right? So, where food and health and early childhood and family economic security show up together in a community, right? Families experience these things simultaneously in their everyday lives. They don't experience these things in silos. And so, we try to have our team and our work reflect that. So, instead of treating food as a narrow problem to fix with one program, we try to think about how the entire system around a child and their caregivers works or doesn't work and find those opportunities and levers to move that whole system. I'll give you a concrete example that will bring in our colleague Linda Jo Doctor, who you mentioned at the top of the conversation. Early in my time at the foundation, I was a reviewer for the Race to the Top Early Learning Challenge Grant. This was an Obama era competitive grant process for building early childhood systems in states. And the state of Vermont did something really interesting that I had the good fortune to review as part of that team. They included the quality of food and access to fresh, healthy food in childcare centers as part of their quality rating and improvement system for childcare. They didn't just talk about teacher quality or curriculum or reflective practice. They actually said, "If we care about child development, then what children are eating every day in those childcare centers is part of what quality means." That's a systems approach. They connected food policy and procurement directly into early childhood policy and practice so that nutrition and education and child wellbeing were all being advanced simultaneously. I brought that back to the foundation and brought it back to Linda. And we had a really great conversation about it, and then another, and then another, and then another. And that experience helped shape how I think and how many people think about our work at the foundation. And it led to things like the expansion of our Farm to Early Childhood work, which again, leans heavily on procurement as the strategy to drive systems change, but connects it into early childhood policy.

Tell us about that. You know, the Vermont example you gave is a terrific one. And you talked about Farm to Early Childhood. What does that mean in practice?

In practice for the foundation, it really leaned heavily first on, sort of, understanding the landscape of where there was capacity to connect regional food hubs, farmers and producers and growers to systems of early childhood. At the same time that you have these burgeoning and developing systems of early care and education with regard to financing and sophistication, you have something similar going on in them in the food system movement, depending on the state that you're in. And so, we work diligently in a subset of states to really connect those policy levers, pull them together, and try to create essentially more situations like Vermont, you had partnership at the local community level, at the regional level, and then at the state systems level. So, syncing up the actual practice on the ground, syncing up how the relationships between different organizations are formed and maintained with regards to better food and early childhood. But then also trying to codify that into state policy and practice. And we did that for a number of years and had remarkable success in places like Iowa and Wisconsin and even in North Carolina, and a handful of other states. And we very much saw this as a build off our successful farm-to-school work, but doing it in a system that comparatively in terms of early childhood, was a little more fragile, right? And it wasn't necessarily as easy to do it, but all the more important and helpful because of the age and the vulnerability of the kids and families that we're talking about.

The systems approach is very powerful, and so I'm going to ask a question not to be challenging, but to in some ways give you a softball for proving the systems approach. If at the end of the day, the most important thing in a childcare setting is to get healthy food into the bodies of the children so they can thrive intellectually and medically and everything else. Couldn't you accomplish that by just giving a good shopping list, a Costco shopping list to the daycare directors, and they could go buy good foods? And why does it need to be connected with farmers and, you know, the broader connection into the community at large, why is that important?

Yes. Well, backing up, I wouldn't want to state, as an early childhood person, that the only thing that, you know, makes an early childhood program high quality would be the quality of the food and that that would, you know, lead to optimal child development and school readiness. I think, you know, there's other things in there that actually matter too. But this is definitely a key component. I would say, you know, to your question, that that system that you named already exists. We have the Child and Adult Care Food Program. We have the ability to subsidize the cost of food, and to have that good shopping list in play. But, I think, what the systems approach does is it asks different questions, right? It seeks to say, where does the food come from? How is it grown? Who is benefiting economically, right? How are schools and childcare centers and farmers and communities connected? And how do we strengthen those, connections and relationships so that we can begin to shift policy and practice so that children and families can reliably have access to good food. And they know that it's coming from the community in which they're situated. And the people on the side that are actually producing the food, the farmers and the folks doing procurement and others, that they're actually connected to it too. And they know where the food is going. And so there is this social kind of interstitial benefit to connecting those systems in a way that I think brings value beyond just you get a healthy meal today. I think it begins to shift culture. And if you could shift culture in the institutions that people are participating in, you can actually shift culture in people. So, you could see if a parent that potentially wasn't exposed to that before, or maybe didn't have access, or didn't know how to get access to that kind of food, if their expectations suddenly shifted because in their childcare program they're getting access to quality food, that then becomes an opportunity to engage in a different way. But it also becomes an opportunity for that parent to become empowered and to come together with other parents and other community members and begin to insist that's a reality in everyday life for them. That becomes a norm rather than an exception.

I really like your answer because, you know, in some ways, people in our country have become distant from their food. You know, it used to be you could just go to the store, and there might've been one agent between you and who grew the food. The farmer would deliver it to, and now there are factories and machines that process the food, and 10 steps, and it comes from different countries, and all that kind of thing. And what you're talking about is shrinking that gap again to decrease the distance, so people are more in touch. And you could easily see that if the food is coming from farmers and the daycare providers know that they're going to feel better about the food. They're more likely to tell a story about it to the children. The farmer might come to the daycare center, or the children go to the farm. And you could see there's a lot more going on here than nutrition, and that's the beauty of this systems approach, isn't it?

I mean, the children want to have a garden, right? I mean, how many times have we seen that? It seems like a small thing in early childhood, but just that simple act of having a garden and being able to understand how things are cultivated and grown. Even for a small child, and I have two small kids, we have a small garden in our backyard: it's meaningful. And it also, I think, establishes a norm that the tomato that you pick off the vine or the pole bean that you pick off, that you eat, that you find just unbelievably delicious, then that becomes normative for them. That's a normative experience, and kids are not as frightened by things when they encounter it. And I think we have a real opportunity in the early childhood space to link up those two systems to say, "Yes, we can affect change." And I think that, again, back to this notion of investing in people long term, the investment in those kids long term and what they come to expect will be the norm matters very much to how we think about our work at the Kellogg Foundation.

So you're talking about both practices and policies and a cross-sector approach to these things. And let's talk about policy for a moment. Where does policy typically break down? And what kind of people need to be at the table, and what sort of partnerships need to be established in order to have better food policy?

I think if we take seriously that food policy is cross-sector, I believe that we need to build tables that look like the food system. And that means not just public health experts or nutrition advocates or academics, but farmers and food workers, and those childcare providers and teachers, and leaders in K-12, and tribal leaders, community organizers, local state government officials, right? And the funders, right? The funders who are willing to invest in the long slow work of doing systems change. And, you know, one place I would highlight is in your home state of North Carolina. For years, there was significant investment that helped really build a dense ecosystem. You established regional food hubs and meat processing infrastructure, and anchor institutions into schools and early childhood centers. And a really strong network of organizers and philanthropic partners. And that made it possible to fully integrate farm to early childhood in your state's definition of early childhood.

And as an aside, I would say North Carolina was also one of the leading states back when I was first coming into the field of building out a high-quality system of childcare. North Carolina led that. And so, these two things converging is a very powerful example, but again, we're getting back to local sourcing. We're getting back to bigger things than just doing food education, right? Those things are now built into the system. And they're not just a side project of the system. They actually are the system.

So, you're talking about a foundation doing a lot more than getting proposals, seeing what needs to be funded, and then sending money out the door. You're talking about connecting people in innovative and unique ways. And building bridges that didn't exist before. And getting people to understand the systems change approach. And it just can lead to so many interesting and innovative things that just weren't possible using traditional models. So, really my hat's off to the work you do, and I can see why it's creating such powerful outcomes.

One piece I would be remiss if I didn't say this, right? What makes all those partnerships work or fall apart? Usually, it's not the brilliance of a single policy idea or practice idea. I. Sort of. Sound like a broken record, but I'm going to come back to this. Investing in that people infrastructure that sits underneath it is really important. And the places that we find that make progress in any of the issues we're talking about, family economic security, food, health, Medicaid, early childhood, K-12, right? The places that make progress really do have varied and diverse voices at the table, and they're able to build real trust. And they're able to cultivate champions and also the next generation of champions and the next generation of champions who can move between those sectors, right? And the funders are involved, but they really understand that they're financing relationships and governance and people. They're not financing programs. And I think as a grant maker, that's an interesting distinction to think about. Think we know it implicitly and we know it when we see it. It's a lot harder to stick it in a white paper and define it and disseminate it in Stanford Social Innovation Review, for example.

No, I totally agree. In the work that we've done over the years with, uh, community partners in Durham, it's been my impression that they get this systems thing from the very get-go. That they understand that if poverty is too severe, then nothing else is going to work, and if housing is a problem, then these other things are going to be affected in pretty serious ways. And they understand the importance of these. And in a way you're letting the flowers bloom. You're taking, I think, what some people understand intuitively and would like to accomplish, but they've been forced into silos. And then once a funder comes along and can allow this to prosper, I think it's sort of a natural thing that occurs.

I think so. And I think the tricky thing there is to not be seduced by the programmatic solution. Like, do you remember several years ago when the notion of collective impact was this very popular term that folks talked about? And it's a good thing. I mean, I think the framework and the model is powerful, and it's a useful thought exercise. But what I found in a lot of collective impact work was that it focused very much on aligning the programs. Sufficiently funding the programs and aligning the programs, but not the human side of design and redesign of how do those programs function, right? Who do they serve? Who's at the table when building them or rebuilding them? Do you have the ability to change them midstream if you feel that you need to? And I think a slightly different approach with systems change is you're sort of engaging in a loose hold of the policies and the practices and the issues to give people and the people infrastructure and the relationships time to come together and figure out how they want to move them individually, and how they want to move them collectively. And that's a subtle difference. That's a nuance that I think has really worked in our particular corner of the world.

One thing I bet some people are interested in is how the Kellogg Foundation might be distinct from Kellogg as a company. You've described beautifully the innovative work you're doing. The company is off doing what it does commercially. How do these two things intersect? And what's been the history of the connection between the foundation and the company?

Yes. So, when the foundation was founded in the 1930s, Will Keith Kellogg, as you said, he endowed the foundation and created it separate and apart from the company. So, it's an independent philanthropic organization. And so, while we bear the name of Will Keith Kellogg, the foundation does not have a formal connection or stake in the company any longer. As you may know, the company split into two companies a few years ago, one called Kellanova and one called the W.K. Kellogg Cereal Company. And since then, I believe both companies have been acquired. I think Mars now owns Kellanova, and Ferrero, an Italian company, owns W.K. At present, the W.K. Kellogg Foundation does not have any connection to either of those companies because they've been acquired by other groups. And aside from having some stock with the foundation, that was sold to support our endowment, we don't have any formal connections anymore.

But I think the proximity of the foundation to the company in Battle Creek, and I think the shared history of Battle Creek and the shared history of Mr. Kellogg's vision is actually important to note. And I think it does matter to how the two institutions are connected. I said this a little while ago in the conversation, but in the 1930s, Mr. Kellogg knew that you couldn't separate food from health and education, family economic security, and he knew this while he was making cornflakes, right? And so he helped make sure in the late 1930s that children in Battle Creek had access to fresh milk in schools at the same time that he was doing work in soil conservation and in building healthy land. And he had a sense of knowing that how the food is grown and how kids are nourished, it's part of the same story. And I think that DNA has pulled forward into the foundation, and it makes it a really special place to work because we still carry that memory of him, and we still carry that vision of him into the work that we do.

Thanks. You know, a long time ago, when I first became familiar with the Kellogg Foundation, I wondered about the history and the independence of the foundation from the company. And I pretty quickly came to learn that the foundation, as you said, is quite independent from the company. But you've enriched my knowledge even beyond what I've known over the years, so thank you. That's a fascinating history. So, let's end with one final question. If you fast-forward and kind of look ahead, what do you think is on the way? And what does success look like to you and your colleagues?

Yes, it's a good question. I mean, I think if we got this right, you know, 10- 20 years from now, success would look like children and families living in communities where good food is just a part of everyday life. It's normal and reliable and not something that folks are lucky to find. I talked a little bit about how Mr. Kellogg thought about this in the '30s, but we also see what's possible in other places, right? When that vision can become a reality in terms of policy and practice. So, we had done some work in the country of Brazil. And we see now that national policy in the country of Brazil now requires that at least 50% of school food be purchased from local sources, grown with high-quality standards, right? That one decision reshaped incentives all along the food chain. What farmers grow, what institutions buy, what kids eat. That's a powerful example of institutions using their everyday purchasing power to build healthier and a more just system. So, you know, 10- 20 years from now, if we've done our job, it would mean that the kinds of innovations in places like Brazil or North Carolina or even in Michigan with our 10 Cents a Meal program, that those types of things would have become the norm. That schools and early childhood centers and hospitals and tribal and local governments would be routinely buying good, locally rooted food. And that workers and farmers are earning a fair and stable wage, and they have incomes. And the communities most affected by hunger and inequity are actually at the core of leading and designing new systems. And food policy would no longer be a patch on top of the inequity. It would be one of the main ways that we build healthier and more equitable futures for kids and families.

BIO

Jon-Paul Bianchi is the Director of Systems change at the W.K. Kellogg Foundation (WKKF) in Battle Creek, Michigan. In this role, he leads WKKF's national grantmaking strategy focused on early childhood care and education, health equity, employment equity and food systems. As a longtime philanthropic leader and national expert with a focus on early childhood education, Bianchi provides strategic oversight to the foundation's national programmatic work to support thriving children, families and communities. Bianchi holds a doctorate of Education from Vanderbilt University's Peabody College of Education and Human Development, a master's degree in child development and a bachelor's degree in child and family studies from the University of Wisconsin-Madison. He helped found and currently serves on the board of Valley Settlement in Glenwood Springs, Colorado.

I'm delighted today to be joined by Dr. Joseph Skelton, professor of Pediatrics, founder and director of Brenner Fit, a program at Wake Forest University School of Medicine. FIT stands for Families in Training, which is a family-based pediatric obesity program. He's the author of a new book on children and their weight, a topic we discussed in a separate podcast. But in this podcast, we're talking about something he teaches at Wake Forest, a course in culinary medicine. This is a fascinating, pioneering area of focus, so let's dig in.

Interview Transcript

There's a lot of language about medicine and nutrition now, so people talk about food as medicine. There's a move afoot to get more training and nutrition and medical education, and here you are doing culinary medicine. Tell me how all these things differ from one another.

Our interest in this here at Wake Forest School Medicine started a little organically with our program. A lot of what we do is focus on family meals. There are decades of research showing the benefits of family meals, not only for the nutrition and obesity risk, but the quality of nutrition, time spent together, parent child communication. Kids are less likely to get pregnant or do drugs and alcohol. All these things from just spending that time together over the meal. And I inherited a small teaching kitchen that was at a local organization that someone before me had gotten funding for. And we, sort of, took it over and used this opportunity to teach families how to cook. And a lot of families know how to cook but trying foods in different ways and to get kids involved and things like that. Then a couple years after that, the local YMCA approached us. They had some space and wanted to do this as a partnership. So I became a fundraising machine for a year or two and took a lot of dinners to raise the funds. And we built this gorgeous teaching kitchen, and we were mainly doing it in the efforts of sort childhood obesity treatment or prevention, getting families, teaching them new recipes, which then kind of extended to that whole key thing of getting families just to be comfortable in the kitchen and spending that time together. And we just started seeing these amazing things. We always say we've converted more kids to Brussels sprouts than I think any other effort of just getting them cooking it a different way. You and I were both probably raised with steamed Brussels sprouts, which I think is an abomination. If you really want to highlight the sulfur smell of a food, then you're going to steam it. And so, we really started to do that. And then students started volunteering. Actually, it was a student, Josh Patman, he's an emergency medicine physician now at East Carolina University, and he was a cook in a professional kitchen college. And he said, hey, could I help volunteer with that? And then more student medical students wanted to do it. And then we all found that you, much like I did, I'm a self-taught cook myself, and the more time you spend in that, the more you learn, the more comfortable you are. And the more you start to know, you know, I can teach med students nutrition all day, but that doesn't teach them how to get nutrition on their patients' plates, into their mouth. And so it really grew from there. And then I, kind of, stumbled upon what other people were doing. It started in New York, but the biggest program started was really Tulane School of Medicine that had it as a very focused way about teaching nutrition through cooking. Not just on a blackboard through PowerPoint slides and stuff like that of like hey, let's teach it in a different way. And the old-fashioned analogy, and actually the medical educators hate this, it used to be see one, do one, teach one. That was sort of the old surgical thing. And so, it's really you got to see how to make a recipe and you got to do it yourself. And what we found that when students start then teaching each other, or teaching patients or teaching community members, it really drives home and gives them a much deeper understanding of what nutrition in the real world is.

Let's talk about the need for this. If we go back in time and we think about your parents or my parents, you know, the likelihood is that meals were being prepared from the real foods rather than from a package, let's say, or in a micro. How are things different now for the modern parent that has kept people distanced from their food and where it comes from, and that's led families to be distant because they're not having meals together as much? What does that look like now?

Yeah, pulling from our own history, you know, Home Ec is not really a thing anymore. We did this study in our own med students. You know, most of their cooking, nutrition, the nutrition education they're getting tends to be the popular media. They're learning it from social media. Very few students have a degree in nutrition or took a nutrition class. And as much as we have to cram into medical student's education, there's not much room for it. They mainly learn to cook from their families. And what we know is families are cooking less and less for multiple reasons. They're much busier. Especially parents, actually parents of kids of all ages with that. And again, the marketing of food, you know, it's much easier to get ready made meals. And I'm not badmouthing those, you know. We're in talks right now of actually writing a cookbook for families, and one of the things that we promise is we're going to have a chapter on assembled meals. You know, having a pre-made salad with a rotisserie chicken, that's still going to be a better thing to do if you bring that home, sit at a table or at a bar or around a coffee table and eat that meal together. It's still going to be better for your family in multiple ways on multiple levels than eating out. And what I see, it really with families right now when it comes to actually raising "healthy eaters" or raising good eaters is when we... and again, I love a good restaurant, I'm not trying to badmouth that... but when you're going out to eat a lot of kids have endless choices and there's two issues. One is a paradox of choice. Whatever they get, they're always going to think that other thing might have been better. And it doesn't allow them to spread their palate and try different foods and get exposed to different things. And we always laugh... whenever in this field we want to play a drinking game where every time you say complex or complexity, you take a drink because, but it is such a complex issue with parents. You know, with kids and getting meals on the table. And hopefully finding some time, whether it's a breakfast or it's a dinner, but finding that time to come together around a meal.

You mentioned the paradox of choice. I was reminded at one point I downloaded this cute app called You Choose or something like that. And it would help you make a decision if you were undecided. It would flip a coin, it would roll a dice. It would do, yes, no, it would do rock, paper, scissors, it would do all these things. And I was at a restaurant once. I couldn't decide between two entrees, so I used it. I did rock, paper, scissors, or something, and I then it said, okay you should choose X. So I ordered X and the second I ordered it, I immediately thought I should have ordered Y. Alright, so tell us about culinary medicine. What does this course look like that you teach?

Yeah, the best way to think about it is applied nutrition. Because again, you can understand a ton about nutrition, but if that doesn't change into you getting the foods that you want in front of you, to me it's almost theoretical or scientific. It's applied nutrition. It's this idea of teaching some very basic cooking skills, and then including within that very core elements of nutrition. And for us, we tend to do it by the balanced plate. We think that works really well for families. But having it be very real world. You know, so again, we have recipes... in two weeks, I'm doing one... we're doing a rotisserie chicken and you're breaking it apart and making a chicken salad out of it. We were always teaching using microwavable rice and a couple of the students cornered me and said, this is very offensive to my culture. You need to teach people how to make real rice. But what it looks like for us is about a quarter, almost a third of med students will rotate through these classes. So, it's voluntary. Next year we're actually hopefully going to surpass half of the first-year med school class.

That's unbelievable. That's very impressive.

Well, especially up until last year I was doing this in my free time and paying for it with fundraising money. But yeah, Wake Forest is really behind this now. But about a quarter to a third of med students. They do five classes. And it's set up and again, that sort of theme of that family meal. They come in and we get stuff cooking. We get stuff in the oven; we get stuff on the stove top. We usually take some time out for a very short lecture. Again, tends to be very practical stuff. We include a lot about social determinants of health and food insecurity. Given what I do, we talk about picky eating. Very little do we go into details about Mediterranean diet and Dash diet and some of the really core things with that. We really just try to keep it about getting that balanced plate of a protein, a starch and a fruit or vegetable on the plate in front of you. They come back and usually finish what they're cooking, and then they sit down to eat together. And unlike when I was in med school and you were in grad school, or when you were teaching, a lot of students don't go to class anymore. A lot of students, they record the lectures so they can listen to them at one and a quarter speed and study in the best way for them. I love getting to know my students on a different level of sitting down. And that's what my really own exposure to medical student education anymore is really through this, which to me is just the ultimate. Being able to sit down, teach them some interesting things, eat a meal with them. Given my chemistry background, I love getting into the science of a lot of the stuff. And I think for them being, you know, sort of STEM kids, it makes a lot more sense. One of my favorite things is the science of grilling, you know, the science of garlic, you know, things like that. And it helps them sort of understand and helps them remember that, and also peppering it with the stories. It just tends to stick that much more when they know the science, they know the story, they know the culture behind it. So, it's five classes. It's all set up that way, that there's a short lecture. They're preparing everything they can and they're eating it. Again, we include some very easy stuff. One of the classes we do microwaveable vegetables because that's what a lot of what their patients are doing. The bagged vegetable medleys. And one, the important thing that we teach them is most of these don't have any seasoning. So yeah, you can microwave them, but you have got to teach your patients throw a bit of olive oil on there, throw a pad of butter, do some salt and pepper, add some other spices to it. And they go nuts with one group will do some more Indian spices. One group will do more sort of traditional, one to do more Asian flavorings to it in our teaching kitchen. It's really teaching very practical things like that. The fun part of that, that's really spun onto the other things that I'll tell you about, is about half of those students that do that- we have about 18 per semester- and about half those students end up volunteering with us. They come to the classes that we have that are community focused. Now some of the students are going through lead teacher training. They get Serve Safe Certified. It's awesome for me and my staff because it saves us a lot of time and overtime that they come in, they let themselves in the kitchen, they set up, they run the class, they clean up, and they can't get enough of it. They absolutely love it.

Now you do some celebration of different food cultures in your class. Tell, tell us about that. Including, as I understand, some of the food culture that you grew up with.

Yeah. Yeah. That, that's about, that was a big understatement right there. We just love that and that's a great thing. Wake Forest, being a private medical school, kids are from all over the country, from all different backgrounds. And so, we absolutely sort of herald that. One of the things I love doing is class three is a plant-based proteins class. The first class is a general cooking class. The second class has a focus on animal proteins, and again, we're always also cooking vegetables and fruits and starches. The third class is plant-based proteins, and I do that as Southern cooking. And I just love that sort of theme with that. So, we do pinto beans, you know, And the slow cooker. We tell them how to use instant pots, pressure cookers. We do black eyed peas. A lot of these kids don't know that you're supposed to eat that on New Year's Day. I do a vegetarian collard green recipe, taught to me by a local chef. And I think this is probably my number one post that I do in social media is cornbread night. And teaching them how to make cast iron skillet cornbread, which is the only way to do cornbread in my book. And letting them know, sort of, the background of a lot of the stuff. My wife is from South Carolina, so I teach them great thing about cornbread if you're a poor student, is you have a slice with your beans and your collard greens, and then for dessert you put honey on. Which is what I picked up in South Carolina. So, you know, really celebrating that stuff. We have a whole Spanish speaking program, and we have an article written, we just haven't found the right journal for it. It says, leave my tortilla out of this. Instead of, you know, saying, oh, you have to eat less tortillas, celebrate it. Why is that such an important part of not even that culture, but this family's food history and stuff like that. Because food is personal, it's cultural, its family, and it's to be celebrated.

We do a fourth-year elective, it's the last full elective of their fourth-year class and a very lucky 20 students get to do that class. And we always have one called Family Night where they bring a dish that's important to them and their family. And it could be like me, it was the roasted chicken that one of my classmates in med school cooked. And I just thought that was so exotic. You know, I never had a whole roasted chicken before. You know, we had a student that had spent the first part of her life in Australia, so she did pavlova and told the history about where the pavlova came from. Now that's considered sort of the national dessert of Australia. And I always remember this one student, he was going to emergency medicine, very quiet kid. And he's over there cooking these porridges. That's the only way I could describe it is just these porridges. We said, what are you doing? And he told the most amazing story. I almost tear up when I talk about it. His grandfather fled Saddam Hussein. He was Iraqi Christian and fled Saddam Hussein and his grandfather lived with them. And this was their afterschool snack. Was this Iraqi dish that his grandfather would make. And there was a sweet one and there was a savory one. And so just stuff like that is... it's fantastic. I just, I can't get enough of that. And they remember that. And so, as students leave us, and I just came from Match Day where they found out where they're spending the next three to seven years of their life. And I always say wherever you're going, learn something about that culture and that food. If you're moving to Cincinnati, you have got to learn about Cincinnati Chili and getta. take something from that. I did all my training in Wisconsin and the Wisconsin supper clubs and how you can tell what a fresh cheese curd is, and it's just... food is fantastic. And we can take that with us wherever we go. And it can give you a way to know your patients even better. And when I hear of a family that they're from West Africa, ah, you like Jollof Rice. And their face lights up and like, oh yeah, where'd you have Jollof rice? So, it's a great way to get to know more about people.

So, there's way more to it than cooking technique. I mean, there's, you know, you roast a chicken that this temperature for that long, or here's how long you microwave. It's really a lot more than that, isn't it?

It's just like medicine. It's science and an art. And you know that one of my most popular lectures I give does not have to do with obesity but has to do with barbecue and all the different styles of barbecue. And what is just amazing, despite what we know about the science of taking spareribs, which are an incredibly tough cut of meat, and you have to cook them low and slow to get that temperature up. I think it's 189 degrees or higher where you start to get the collagen that breaks down and they turn tender. So yeah, spareribs to be good tender and edible, you're talking four to six hours. But then you go to Tuscaloosa, Alabama and you go to Dreamland Barbecue. They do spareribs over live coals for an hour and a half. I sat there talking to the person doing it. I'm like, you must bake them ahead of time. Do you soak them? And he's just like, nope. And so again, I know the science of that. So how do these jokers do that for an hour and a half, and it turns out in what my opinion are the greatest bear ribs in the world.

Oh really? Oh, I'll have to try. I'll have to try that place out.

Yeah, there's several. Birmingham has two there. There's several in Southeast and they cook them for an hour and a half. Over live coals. Violating every scientific principle of low and slow. Don't get it. It's fascinating.

That sounds really good.

Yeah.

Well, Joey, thanks very much. One final question. Do you see this... is this a movement in medicine now or more and more people doing this?

Yeah, you know, it was really big for a while. Tulane had so much. You know, they were sharing their curriculum and they were doing some good research. And that's where a lot of what you see now as the food is medicine food is medicine or as medicine where hey, we need to find ways to get medically tailored meals in the patient's hands. There's really good evidence of that with diabetes and stuff like that. I think what you're seeing now is, I think especially with some of our efforts in the government right now, is sort of demanding more nutrition education in medical school. And I'm going to double down on culinary medicine because you know what? My students, myself, I don't need to know more about the biochemistry of carbohydrates. I need to know the biochemistry of cooking and how to do that quickly and safely to teach my patients. And also, with that, we have to forget, there's an entire field that's already doing this, you know? Dietetics and nutrition and there's professionals that probably are way better than us. But I think having this increased understanding, especially dwelling in that food space, is going to help us relate to them that much more. So even though I do a lot of nutritional counseling and talking, I still use my dieticians way more. I think they're going to be way better at that. So I think there is a lot of steam building towards that, but we don't need to turn doctors into junior dieticians. But I think we can give them deeper understanding of how food and nutrition affects their health and the broader aspects of that. It's not about the biochemistry of insulin secretion, it's about where are they accessing food and how can they make use of the food pantry near them. And let them know, hey, it's okay when you open a can of beans it's gonna smell like cat food initially, but you know what? You wash that off and actually it's not going taste like cat food. And you know, just kind of be able to work with them. Hey, canned beans are perfectly fine. Guess what? Canned beans now are coming in no salt added and low salt preparations. And here's an easy way that you could take these canned great northern beans, chop up some herbs with olive oil and a chunk of garlic and you can make some fantastic bean recipe that is incredibly filling and healthy and cheap as dirt.

Oh, that's really nice. Well, this is an exciting advance in the field and you're really at the forefront of it, and your students are lucky that they have this available to them. So, thanks very much for being with us and sharing your experience.

Well and what the big secret about this is, Kelly, is this is fantastic. I love doing it. Our med school really values it, but it's a lot of fun. That's the thing.

You can tell just by the way you're talking about it.

It is so much fun. And again, I just saw all my students that were graduating. And that some of these I hadn't seen in three years and they're like doing Doctors in the Kitchen and then seeing patients, they're cooking and being able to relate to them in those ways. I just have a text from one of my students going to family medicine, and she's like, this changed the trajectory in my career. And I'm not taking credit for that, but just the idea of giving that experience I think especially in my world to medical students, I absolutely love it. In the end it's a hell of a lot of fun.

BIO

Joseph A. "Joey" Skelton, MD, MS, FAAP, FTOS, DABOM is a Professor of Pediatrics, and of Epidemiology and Prevention, at Wake Forest University School of Medicine. He is the Founder and Director of Brenner FIT® (Families In Training), an interdisciplinary pediatric obesity treatment, prevention, research, and educational program. He serves as the Director of the Center for Prevention Science in Child and Family Health, Vice Chair of Research for the Department of Pediatrics, Associate Leader of Community and Stakeholder Engagement at Wake Forest University School of Medicine. He is the Editor-in-Chief of the journal Childhood Obesity. He is board certified in Pediatrics and Obesity Medicine. His research and clinical work has focused on the treatment of children with obesity. He has secured nearly $10 million in funding over the past 15 years, has given over 50 national and international presentations, and has over 130 peer-reviewed publications. He enjoys teaching cooking classes that are both fun and informative to anyone who will listen.

So going back more than 30 years, I was involved in work on childhood obesity. It was a prevalent problem at the time, but little attention was being devoted to children and weight issues. And it was fair to say that the field, as it were, was an academic backwater. Little was known about short and long-term effects of childhood obesity. The social and emotional lives experienced by the children hadn't really been documented or studied much. There was very little known about treatment or strategies for parents, but thankfully, things are different now. Thanks in part to the work of a number of really innovative people in the field, and one of the most innovative is our guest today, Dr. Joseph Skelton. He's a professor of pediatrics and founder and director of Brenner Fit. FIT stands for Families in Training, which is the family-based pediatric obesity program at Wake Forest University School of Medicine. He's also editor of the Journal of Childhood Obesity is involved in clinical care, research, education, and community outreach. Dr. Skelton has just published what I think is a really important book through the American Academy of Pediatrics, entitled Your Child Is Not Their Weight: Parenting in a Size Obsessed World. I was asked to review the book and was delighted to see it before it was published and just was so happy to see that such a book existed at all, but such a good quality book at entering the picture. Really a very important advance in our field.

Interview Transcript

There have been some books about pediatric weight issues in the past. Who is this book for and how is it different than what's been out there?

I feel overall the big audience for this book is any parent, especially of my generation, that were raised during some really toxic diet culture in the '70s, '80s, and '90s. And so, I think the main folks that that's for is that parent: I want my kids to eat healthy, to be active, to lead healthy lives. But I don't want them to become concerned about their weight to feed into our culture's focus on the ideal body image. I don't want to feed into that. But you know I do want to pay attention to the health habits. How can I do this in a healthy way? How can I focus on health habits with my kid that's not a focus on weight and do it in a way that's backed up by science. You know, that's what parents always want to know. Am I doing this right? Am I causing harm? And it is actually who the book is dedicated to, you know, all those parents that were raised in a toxic diet culture and want to do things differently with their children.

So, in modern day America, what is life like for a child whose weight exceeds the standards that we know might be healthy, and for the parents who are raising those children?

From personal experience and 20 years of running a program, as well as what the research shows, it can be kind of rough. Despite a lot of the advances that we've made around weight bias we're still in a place that kids are trying to live up to this idealized body image. And then they have all these toxic messages when it comes to nutrition and body image. I think it's rough. We know that kids in bigger bodies tend to have a lower quality life. They tend to have more symptoms of depression, anxiety; and it's because of this world that we live in.

You mentioned messages that they might be getting from places like the media, but what are interactions like with peers and teachers and doctors and others in their lives that are affecting how they feel?

Yes. So, the adults in their life were raised in that toxic culture. They're my generation and the generation behind me that was raised in that. You know, there's the myth that a smaller body is healthier than a bigger body. And I think we can't break away from that. And I think that still sort of comes through. We still see this as a lifestyle issue, and everyone has an opinion. Everyone has a thought of, you know, well, I did this... and I lowered my cholesterol... I did this and I lost weight, you need to do it too. And I think in the medical profession, because of a lack of understanding, a lack of training - I think that still occurs. I don't do a ton of medical education. I'm getting more and more into it, especially when it comes to areas around nutrition. But that's what I'm trying to avoid in the next generation of healthcare providers and even actually a lot of our community collaborators, teachers, and stuff like that. To get away from that. This is not a simple issue, so don't share advice because sometimes that advice can be damaging or could be wrong. You know, good lord how much I hear about carbs on a weekly basis. And not the carbs I like to talk about, which is around dessert and Carolina Gold rice and all these other food stuff. But it tends to be around sort of demonizing certain foods and just really bad messages that still are floating around out there.

Let's dive in a little deeper about what you refer to as toxic diet culture that was especially pronounced in previous generations. What does that mean? Does it affect standards for what the ideal body looks like? What about messages about how much control you have over that yourself, and how responsible you are for your weight? How your self-image should be influenced by how you look? But tell us more about what you mean by that.

We wanted this to be a book that didn't necessarily dwell on weight so much, but actually one of the first chapters is to say let's cover how complex weight really is. We know that 50% or more of someone's weight is heavily, heavily influenced by their genetics. Where they live, you know. The amount that our lifestyle affects that is much, much smaller. It's the minority of what goes into our body size. And even that, our habits are so influenced by the world around us. But it's, you know, trying to get people to understand that, hey, body sizes are just different. I love this picture from the Olympics and it was a medalist in gymnastics- it was Simone Biles; you know, the huge media personality of Ilona Maher who is a bronze medalist in rugby; and then one of the women's basketball players. You're talking 4'9", 5'10" and pure muscle and six foot seven, all people at the top of their game. And not only different heights, different body types. And, you know, body type is a hard thing to talk about because there's not standard body types. We're all just built differently. And starting that message at a young age that people are just oftentimes built differently. There's very little control that we have over our weight. And even though there are things that we can do about weight, what you can do is you can focus on your habits for health. And that has just gotten lost. We talk about in the book the, we call it veiled weight talk, and it's basically where you're just substituting the word health for the word weight. And kids pick up on that. They know when their parents and others are talking about weight. And so, a really big thing we want to accomplish is like, Hey, you know, eating for health is important. Being active for health is important. In my world, and I did one part of my early research in this, and we always try to have that message as there's so much more to health than weight. In our medical world right now, our primary outcome on these lifestyle changes that people are making is weight.

You mentioned genetics as a contributing factor to who is affected by the problem. Tell me how you look at the food environment out there that people are exposed to now, and things like food marketing and the processing of foods. The availability of all these foods that are contributing to obesity and things. And the reason I ask is, you know, there was a time in our country when the prevalence of childhood obesity was probably close to zero. And there are plenty of countries around the world where that's still the case. But now in many countries there's large amounts of childhood obesity. And it's not as if the genetics have changed. When people move from other countries to the United States, their weight tends to go up. Their genes obviously don't change. There's something pretty toxic about the food environment that's driving this. So, thinking about things that way, does that help parents by shifting some of the blame from them and their children to an environment that they might be able to manage in some way?

Absolutely. Because parents…they blame themselves oftentimes. You know, how did I let this happen? What did I do to sort of cause it happen and it's not. So, we do try to shift that of looking at ourselves as the reason blame. But you can kind of look at the - and I'm just going to focus on nutrition as the focus - the broader food environment and how that impacts. We tend to get a lot of buy-in or understanding when you talk about how they are trying to market to kids. And so, for any parent, all you have to do is bring up the checkout line at a grocery store, you know? And all the things that are at the kids' level that is just made to make your life as a parent hard when you're trying to feed your kids well-balanced regular meals but you're just kind of constantly walking through this landmine. It's the same thing with electronics and social media. There are so many things that they have a lot more money than you do to market to you than you do to protect yourself against it. And it absolutely influences it. And the way I talk about this is really when it comes down to snack foods, and using the parenting language that snacks get you between long periods of time between meals, but that got co-opted by companies marketing snack foods. And when you see food, smell food or hear about food, you kind of want that food. And that's what parents have every day to now the point is. Snacks always have to be crunchy, salty, and sweet, and we're supposed to give kids snacks when they ask for it, because that's what these companies tell us about hunger. You know, hunger hits us every time and you have got to have this bar to sort of get through that. Parenting is hard enough and then trying to parent through this when they're directly marketing kids... you know, in most European countries, they're not allowed to market to kids. In some countries it's age eight. Some countries it's age 12 because they don't quite recognize this is marketing, they're want you to buy this. It makes it a lot harder for parents.

You know, when I was on the faculty at Yale, I got to know a political scientist. A very impressive person named Jacob Hacker. And he'd written a book called The Great Risk Shift. What he talked about was how government and American businesses have systematically shifted the responsibility for overcoming harm from products from themselves onto the consumer. And that's really true in a way here, isn't it? Because the problem is created by corporations who are marketing unhealthy foods in such high levels. It's not the only cause, but it's certainly an important one. But the responsibility for solving the problem then falls to the parents and the children who have it. And one party has way more resources than the other. As you said, it's really not a fair fight and parents have a very tough battle dealing with these things.

Yes. There was a marketing study called The Nag Factor, and I'm an old Simpsons fan, you know. You imagine the people behind the one-way mirror watching things and trying to manipulate. And that's what the nag factor was. How can we get kids to nag their parents more effectively? And what they found is parents that were immune to nagging tended to be the more educated, higher-income parents. And so, they literally had this plan of we need to change how we're getting these kids to nag. We need to give them reasons to nag. And that's when you started seeing vitamin C, high in protein. So, you think the checkout at the grocery store is bad, but then the signage in the commercials each and every day are giving kids reasons they can go to their parents to tell them get me this. Because nagging is not going to be enough for the high-income parents. They have to have some purpose behind it.

You know, when I was growing up, the only way I saw advertisements for food was on Saturday morning cartoon television. And there were three channels showing it. Well, it shows how old I am, but now it's just an avalanche of messages on social media, built into gaming, and it's just everywhere. And it's probably pretty hard for parents to control that. Wouldn't you say?

Well, now that you've said that, that's what my phone's going to start doing. The next time I open up my Facebook, there's going to be an ad for some sort of food camp because it's listening to us. Absolutely. Oh yeah. There's just no comparison. And I think that's also something very hard for parents, regardless of the topic, is what worked for me that my parents used is different than for my kids. And even between your kids. You know, my 24-year-old and my 20-year-old are completely different kids. You wouldn't even know they're related and different personalities. And so, what worked for one, you can't necessarily apply to the other. And whereas we love the idea of multi-generation households and, you know, being involved and being there to give advice. And you should take the advice of your parents, but it doesn't always apply. It's just a different world. I feel like I need to give credit to my East Tennessee farming roots. There are two stories I always remember my dad talking about when they would go to a car hop. Maybe some of your listeners know what a car hop is maybe they don't. It's like a Sonic, you know, it's the old school drive up. Or for you Atlanta folks, like the varsity drive up. My grandparents would make my dad put on his Sunday clothes. You know, that was how rare they went out is they would actually get dressed up driving into town to go try these hamburgers and these French fries. Versus now you can you DoorDash that 24/7. I mean just what a different world and concept. And I still have to share this other story for my grandfather, who my oldest son is named after, he was a tobacco and sustenance his farmer in East Tennessee. And every time I have a med student that's a vegetarian in my cooking class, I always tell the story of he came home one day, and he was talking to my aunt. He says, you know what? The county agent said one day people are going to be eating soybeans. That's so funny. Soybeans were fed to cattle back then. It's really just how drastically we change and now it's changing even faster. I mean, my grandchildren will be light years different than what my children are.

Let's dive back into your book. Tell me about the collaboration with the American Academy of Pediatrics and how did the book come about?

They have had two books in the past that were sort of geared towards parents, you know, how to address weight in your kids if your child has a problem with their weight, what can you do about it? Well-written books. They had done well. But they were looking to try to do something different. It was kind of time to sort of update that. And the last book was great by Natalie Muth. It was a fantastic book. So, a lot of my friends were on the 2023 clinical practice guidelines. And when that came out, there was a huge blowback from the eating disorder community. And, again, it's sort of the polarization of our country right now. And, they had asked me to speak at a conference saying, hey, can you try to do something in the middle? They knew that we included elements of the body positivity movement in what we do. We're big adherents and teachers of authoritative parenting. And they said could you try to give a talk that kind of goes in between what we're trying to do with the treatment of obesity that's affecting children's health as well as the body positivity movement. It's kind of, again, speaking of the Saturday morning cartoons, it was kind of those things that everyone stepped back, and Bugs Bunny was still in the front and got volunteered. It was sort of one of those situations. And so, I gave this presentation and they said, hey, well, what do you think about turning this into a book? Would you be interested in writing a book? And I said, absolutely not. I don't have time. And never in a million years would I do it. But this needed to be out there. So, first of all, the AAP asks, as a pediatrician, you do it. And second of all, I feel like this book needs to be out there. Both for who I talked about earlier, those parents that don't want to hurt the kids' feelings, make them hate their bodies, feel like something's wrong with them, which is what a lot of kids say. But it's also for those parents that are wanting to do something. These are the parents that, you know, they want to put their kid on a diet or make a comment to them of you sure you need to have seconds on that? You know, which we know can do damage. And of course, parents, you know, they don't want to hurt their kids and get in the way. And so, it was kind of geared toward those parents that were starting down an avenue that may not have been safe. You know, they don't have access to a good evidence-based program. And so, it's also for those parents that says, hey, your kids aren't little adults. Don't take these weight loss approaches to kids. It's just a different beast.

We'll come back in a minute and talk about specific parenting strategy, but you alluded to this blowback from the eating disorders fields and the clinical guidelines. Tell us a little bit more about that, because it's one of the key features that would drive the need for a book like yours.

I'm not an eating disorder specialist, but there was a big concern that one of the big recommendations that was new was that you can't have watchful waiting anymore. It used to be, you know, if younger children were starting to gain weight, before you intervene or start into treatment or start to change a lot that maybe just wait to see if, you know kind of the old-fashioned thing, are they going to outgrow it? Are they going to go through a growth spurt? So that was a part of the recommendations. The evidence says that watchful waiting in today's world, you're unlikely to see a kid outgrow it anymore, including bariatric surgery, use of medications and things like that. And so, they felt like this increased focus that this was going to cause pediatricians and parents to focus even more on weight and therefore lead to eating disorders. And then that was coinciding over the previous five years, a lot of studies were coming out and then it got put into a couple of systematic reviews of meta-analyses that showed that kids in bigger bodies, kids with overweight and obesity, had a two to three times higher prevalence of eating disorders. Because typically eating disorders are always thought to occur in underweight or thinner children. But it actually is much higher risk of these in children in bigger bodies. And so, we use that term threading the needle, how do you help families who want to do something about their child's weight for health reasons but not worsening disorders. And so that blowback was really saying, hey, by increasing focus on this, you're going to make things worse with that. And it was kind of surprising. A lot of my good friends were on that practice guidelines and they're kind of taken aback because these are experts in the field. Well-meaning people that for 10, 15, 20 years had dedicated their careers to helping these kids looking for help. And I think any care provider to be accused of causing harm is always, always jarring.

Tell us how you navigate that and what sort of advice do you give parents in this book?

Yeah, so one is that I call weight literacy. It's sort of understanding this is a complex issue. It's not something you did. This is something that happens. We can't always explain it. There are still things, this is where you read too much of this science, it gets you really paranoid about microplastics and things like that. There are some legitimate arguments to me be made there in endocrine disrupting chemicals and stuff like that. We can't always explain why kids are growing bigger than other kids or at a heavier weight. So, the weight literacy, sort of, understanding this is a complex issue, this is not a lifestyle issue. And the second thing is it's worthwhile to focus on healthy eating and physical activity for health. Sometimes that will see improvements in weight, sometimes it won't. But it's still important to do. That's the idea of getting away from that weight being the primary outcome. We feel like this is a great adjunct for someone who might be pursuing bariatric surgery or medications, because it does give us the opportunity to not keep pushing kids harder on nutrition and physical activity, which could lead to that disorder eating. And I think the final thing is sometimes parents and kids are aligned. You know, give me a 15-year-old girl that wants to lose weight. A 15-year-old girl that wants to lose weight, that is unfortunately a child that's very high risk of developing disordered eating. And maybe the parents really wanted to help. But what oftentimes we see a lot is tension brewing between the parent and child. The parent making efforts to help the child with their health and their weight, and the child interpreting those efforts as you think I'm fat, you think I'm ugly, you think something's wrong with me. And it's causing that tension: you know, you can't eat too much of that. Taking Food away. That movie Spanglish with Adam Sandler, several scenes in that sort of reflect that of just small comments that parents can make. You know, actually wanting to help and how that can hurt children. And what we would hope for a lot of parents is to say how can you do this in a way that can be helpful. And one of our chapters is called how to not talk to your children about their weight. You know, the idea that parents don't need to feel that pressure to bring that up. Now, if their child wants to talk about it, absolutely they need to be there, and we give a lot of tips for that. But, you know, your job as the parent, you don't really have control of your child's weight, but there's lots that you can control and lots that you can do to promote the healthy development of your child.

You know there's a heavy dose of compassion in your book. That was one thing that appealed to me about it and impressed me. Because if one thinks about a book for parents on dealing with their overweight children, you sort of default to, oh, this book is probably a diet or an exercise program, or things like that about how the child can change their weight. And you're talking much more here about understanding the psychological world of the child. Being sensitive to possible risks of talking to them in ways that are unhelpful or lead to eating disorders and things like that. It's wonderful that you pay so much attention to those issues. And it's very affirming because you're saying that there are some things parents can do about this in ways that affirm their children, accept them as individuals. It's built into the title of your book that your child is not their weight. And that just means so much, I think.

Oh, thank you. That is what we had hoped. I mean, you know, parents love their children and in endless, endless ways. And the parents are the key to their children and their children's health. And I feel like sometimes we push too hard. Now we're doing it for good reasons. We want this child to be healthy. We want to help make some improvements. And we put a lot on the parents' back. And I think sometimes then that pressure then is extended to the children. And a lot of this is trying to get parents some insights of, we know you love your children. Here's how to make sure that your child is being loved. You know, the old parenting typology, and I kind of go through some of that history in there, really kind of gets at that. But sometimes we do or say things that doesn't make their children feel loved by accident of course. And it sort of highlights that, not to make parents feel bad, just so they're aware. I've been guilty of it. None of us are perfect parents. And you know, making sure that our kids are feeling, loved by us. Family-based treatment is obviously the key. And I always think of one of your, one of your hypertension studies, I think from 1983. I still quote it to this day. You know, the idea that even though we talk about family-based treatment, we're usually dealing with a parent and a child. The dyad. Now they're representative of the family and I've always felt like something was, sort of, missing there. And two things really influenced me. One of that is one of my co-authors, Dara Gardner-Edwards, who is a licensed clinical social worker. And they are all about the family. They know how to do family assessments. And so, recognizing there's more than just those parents and the child in the clinic with you. In addition to that, working the whole field, I didn't know about human development and family studies. Didn't know that was a field and actually came from the University of Minnesota. I was one of the early. Strong program. So, UNC-Greensboro, our neighbor over there. I started working with a professor over there, Cheryl Buehler, and we would go meet over sushi and she essentially taught me a four-hour freshman-focused family studies course. And just this whole other world, social science world of family dynamics and recognizing when you're working with that child and parent. You may or may not be affecting the family dynamics in the household, of that family system. And so being able to extend differently and having some more appreciation of the complexity of families and the relationships with families. Hopefully we're helping people understand making changes in health habits, relationships matter. We have a project going right now, led by one of my medical students. She was always impressed, in shadowing with us, of how many siblings were picky eaters. And I brought this up to my team, like, oh yeah, this is a huge stress. You know, this parent is obviously wants to change the habits of the entire family but is obviously focused on this child we have in clinic. But the struggle of having this other kid that's a picky eater really throws off those dynamics. And being able to account for that and that stress that that puts on families, and what can we do around that?

Oh, that's so interesting. You know, the more aggressive, dramatic treatments that are being used for adults like bariatric surgery and the GLP one drugs, how do they fit into this picture?

Yeah, so we feel like it's a perfect adjunct if someone is pursuing with this with their child, because it still is talking about that parenting approach. And it's not really going to change anything with how you're parenting around these things. You know, bariatric surgery for many years has been done safely and effectively in children. Not that it's always perfect, but again, because of the cost, the idea that it's not reversible and typically you want that done in a center that's very experienced with working with kids. So, access issues tend to be really big with that. It can be very effective for some kids but is not available to everyone. We're in the same situation with the medicines with GLP1s. There's one that has been approved for use down to age 12, and overall, they tend to work very well with kids. But we're in the real world now. We're learning a lot about that. It can be miraculous for some children because it gives them success with their weight. It takes pressure off themselves. We're always trying to prevent that restriction, both in hearing that from another adult or the child doing it themselves, trying to tell themselves to eat less. It's always going to backfire. It's going to increase your hunger and things like that. And having that GLP1 is going to help with that. It's actually going to lower that pressure. And oftentimes they can get in that healthy routine much quicker. In others, it's causing some problems. We are seeing some kids that it is absolutely wiping out their appetite. And we're figuring out now the kids are sort of at risk for that. And you can't do that. The kids gotta eat. But for some kids, they just lose all appetite whatsoever. And they can't not eat. And so, we're still figuring out through the real world. But I think, what we're also finding is the job that we do in these multidisciplinary teams, it's just as important if not more important when you're using medications than when you're not.

Let me ask you a big picture question and let me see how optimistic you might feel about how, where things are going. So, think of a physician who is treating people with lung cancer. So, the lung cancer is caused by this terrible environmental influence: cigarettes. And the physician then is in the position of having to treat the people who have that really unfortunate problem. And thank God there are physicians who do that, and there's research showing how to treat it effectively. But of course, it would be better if the environmental insult that's causing the problem in the first place didn't exist. That would make everybody happier, except for the companies that sell the product. So, do you think you and colleagues who are doing similar work are faced with a similar kind of a problem? There are all these environmental things that are helping push this problem in the first place. Thankfully, there's kindness, compassion and effective care available and your book helps push that forward even further. But are you hopeful at all that the environmental situation, you know, all the bad foods and stuff out there is changing in a positive way so that there might be less of the problem, or it might be easier on the children now who deal with the problem? Some people think it's getting worse. Others think we might see some progress. But what do you think about that?

My brother is an HR guy and he kind of talks about these different typologies with that. And, I forget, I'm called something like the mad scientist, which is you're very pessimistic in complaining, but you have enthusiasm. I don't really know how to take that. But I think, you know, I'm enthusiastic obviously about this topic and what we can do to help parents. But I'm a little pessimistic when it comes to the broader world. I think there's enough, and not saying that every for-profit company's bad, but I think a lot of history is on my side with that. I don't get paid more the more kids I see and the better success I have. I don't get paid more. My job is to be here to help. But, you know, companies, every time I see a for-profit company that comes out and says safety is our number one priority. Or, you know, your satisfaction is number priority, I'm like, no, it's not. Your number priority are your shareholders. And I think that's a very, you know, jaded way to say, I don't quite trust companies right now because of that. Are there some positives that you see, and do you see some changes being made in some menus? Do you see some different products out there that are really trying to get it healthy? But it's hard. I think I have some trust issues and I think that's well founded. Maybe that's my Appalachian background. I tend to be very distrustful of the large mining companies coming in. That, speaking of your lung analogy, that I think I have some healthy distrust that is well founded. So, I think trying to help, and that's obviously a big movement that we have, of trying to help people be more discerning parents, more discerning consumers. But it's hard because they, like you said earlier, they have a whole lot more marketing dollars to convince you to buy their product than we have trying to convince them to make smarter choices about it.

BIO

Joseph A. "Joey" Skelton, MD, MS, FAAP, FTOS, DABOM is a Professor of Pediatrics, and of Epidemiology and Prevention, at Wake Forest University School of Medicine. He is the Founder and Director of Brenner FIT® (Families In Training), an interdisciplinary pediatric obesity treatment, prevention, research, and educational program. He serves as the Director of the Center for Prevention Science in Child and Family Health, Vice Chair of Research for the Department of Pediatrics, Associate Leader of Community and Stakeholder Engagement at Wake Forest University School of Medicine. He is the Editor-in-Chief of the journal Childhood Obesity. He is board certified in Pediatrics and Obesity Medicine. His research and clinical work has focused on the treatment of children with obesity. He has secured nearly $10 million in funding over the past 15 years, has given over 50 national and international presentations, and has over 130 peer-reviewed publications. He enjoys teaching cooking classes that are both fun and informative to anyone who will listen.

It's the story of a guy on a road trip across the country, checking out America's classic greasy spoons. And the adventure is all about finding the restaurant owners and creative cooks serving up the very best of down-home style food. That's the premise of the hit series Diners, Drive-Ins, and Dives starring everyman chef Guy Fieri. Today we're going to talk with the show's creator, two-time Emmy Award winning food journalist and executive producer David Page.

Interview Transcript

David, I can't wait to talk to you about the show. But before we dive in and talk about the specifics, how long did the show run and how many episodes were done? My impression it's still on and it's always been there.

Yes. I created it in 2006, 2007. I did the first 11 seasons and moved on. And funny story, in the first month of the show we had a couple of strong initial outings. And everyone was all excited thinking maybe this will be a hit. A food network executive called me up to tamp down my expectations and said, look, this is all fine and dandy, but this thing isn't gonna go more than a season or two. There's just not that many restaurants. And you know, to quote the great screenwriter William Goldman whose rule of Hollywood is 'no one knows anything.' I did 11 seasons. It's now in season 40 or something, I think.

Holy cow. I could just think of enough restaurants around me to do a couple of seasons worth. So, tell us the origin story. How did Diners, Drive-Ins and Dives come about?

Well, I had left a career in network news and moved to the Twin Cities because I thought I wanted to be in business for a public corporation. And I took a job as the Senior Vice president at a home shopping channel, and I was all excited, and I hated it. It was just horrible. I did not want to sell second rate gold jewelry to shut ins. So, I quit, and I opened a production company and began to starve because I wasn't selling anything. Then I called Al Roker, who has a production company and who had technically worked for me, although stars don't work for executive producers in the real world. When I was the co-producer of the Weekend Editions of the Today Show. Al was on the weekend show at the time. He hadn't yet moved up to the big show. And I said, hey, Al, I'm starving. You got any work you could throw me? And he said, yeah, I'm doing a lot of stuff for the Food Network. I'll subcontract some of it to you. Which was good for both of us. I got to work, and Al got to take a cut without doing anything. So, that hooked me up with the Food Network. I started working for them and Al and I both knew I wasn't gonna get rich doing a pass-through deal, so I started pitching them directly. And I was getting nowhere. There was this very nice development exec who would talk to me on the phone. And everything I proposed she would shoot down. And one day I'm on the phone with her and we're going through a pitch call and I'm proposing this and proposing that, and she's saying, no, no, no. Finally, the Food Network had asked Al to do a documentary on diners and the history of diners and such. And Al had subcontracted it to me. So, this development exec had a frustration and I think pity for me and finally said to me on this call, don't you have another thing on diners? And I immediately, I said, oh, absolutely. I'm developing a show called Diners, Drive-Ins and Dives. And I told her all about it. And this was like late on a Thursday or Friday afternoon. And she said, 'you know, that sounds good. We have a development meeting Tuesday. Get me a writeup on Monday.' And I got off the phone elated because it was the first time she'd expressed interest in anything. But also, I'd kind of put myself in a jam because I was not developing a show called that. I had literally pulled the title out of thin air. Or a body part, depending upon how scatological you want to get. And that gave me the weekend to try to put a pitch together. So, this was in the old days when you didn't email people, you called them. I did as much research as I could, and I started calling restaurants around the country. And on Monday I sent her a pitch for a one-hour special with, I think, it had seven restaurants in it. And, they had their meeting on Tuesday and here here's, you know, you get lucky. Guy Fieri had just won their second Food Network Star competition. Back then they naively believed that that contest was gonna generate them a new star every year. Someone who would be a big deal for it. In fact, Guy is the only one who ever made it and, when I'm drunk and immodest, I take a lot of credit for having taught him how to make it. But he has immense natural talent. Anyway, they wanted to make Guy a star. And they were trying to get a primetime show for him. And big deal, major league production companies had been asked to come up with proposals, which had not come back yet. They figured, what the hell, let's do a special with Guy just to keep on the air so people wouldn't forget about him. So, they picked up this special from me. It was gonna be a one-shot deal. We did it. I think they were kind of stunned by how well it did. And then something really great happened for me. They looked at the proposals from the big boys and didn't like them. And they were kind of stuck. They were desperate to get Guy on the air in prime time. So, they figured, well, you know, let's pick up a very short season of this thing. And they bought, I don't know if it was eight or 10 episodes, but they committed to that. And very quickly, we became a hit and off we went.

It's an amazing story. So many people have seen so many episodes of that show. But nobody would have any idea that's how it got started. It's wonderful to hear about that. Once you got going and got your feet on the ground with this, what were you hoping to accomplish through this show?

Well, look, TV's about storytelling. I've been a storyteller, hell, for 50 some odd years now as a mostly broadcast journalist. You learn, if you're any good, that the best stories come from and are about people. I conceive this not as a food show, but as an opportunity for the viewer to meet really cool, passionate people doing something they cared about. You know, independent restaurant owners make a buck 3.80 at best. They're passionate about making good food. If they're any good. They're often trying to keep family legacies alive. And more than anything else to succeed in the food biz you gotta wanna serve people. You gotta wanna make people happy. So, I went out to document the stories of some of the coolest people in America. Now, it was in the food world, which is a world of shared experience. We all eat. Most of us have favorite foods. Most of our favorite foods are the kinds of foods that I featured on Diners. TV is about one thing: hanging out with someone you want to hang out with. That's why Tom Selleck remains a star; whatever crappy TV show you put him in. That's why for your older audience, Tyne Daly kept getting series after series, or James Garner. There are just people you want to hang out with and that's all television is. Guy is someone people want to hang out with. His personality comes through the screen in a particular way. And you know, I said earlier, frankly or implied, that I taught him a lot about how to make TV. I did, but that's because at heart, he is the most naturally talented performer I've ever worked with in 50 years in the business. And was brilliantly able to soak up anything he learned along the way. I mean, it's like a chef. If you're a good chef, a better chef can make you better. But if you're not a good chef, you'll never be a good chef. To be good on TV, you have to have it. I can't define IT, but to quote the Supreme Court justice about pornography, I know it when I see it. And Guy has IT. So basically, this show put together people you wanted to hang out with and brought them into your living room or your bedroom or whatever room you watch in.

The show is very compelling and you're right, you get to know the chefs, the restaurant owners in these little places, and there's something wonderfully wholesome about it. It's so good that you came up with this idea. You know, I was reminded as you were talking about a conversation you and I had when we first got to know each other by Zoom a few weeks ago. And I was mentioning I was going to do a self-guided drive called the Blues Triangle Tour. Starting in Memphis going down to Tupelo, over to Mussell Shoals, ending up in Nashville. And immediately you started telling me about places I needed to go. You said, oh, there's this wonderful place in Memphis. It's down an alley and down these stairs.

Yeah, the rendezvous.

Yes. They have the best Memphis dry rub ribs. I thought, oh my God, I'm, I can't tell you how grateful I am for that recommendation.

Well, did you go?

I'm going plan my trip around that. And then as I was reading your book, Food Americana, which we've discussed in a separate podcast, you mentioned the hot wings in Nashville. You mentioned former Mayor of Nashville, Bill Purcell, who was an inspiration for the hot wing festival they have there. Well, I happen to know him. And because our professional paths intersected around some health and wellness things, and he's a wonderful guy. So, you inspire me to get back in touch with him. You know, I wrote to him, I said, I'm going to be in Nashville. Let's go out for some hot wings. You know, at the place where they were invented. How wonderful is all this?

Well, the story behind them is phenomenal. Apparently, the guy, Prince I guess was his last name... he was not a real faithful husband or boyfriend. I'm not sure if he was married to the woman. But he came in one night after gallivanting around and told his partner, told apparently, didn't ask, to make him some wings. And she was so teed off at him that she made them hotter than hell and he liked them. And you know, an industry is born. Or so the story goes.

That's so interesting. Tell us some of your most memorable experiences doing the show. And some of the places you were, the people you met. There must be so many that stand out and you did so many. But give us a few examples.

Well, I understand I kind of lost out on part of this after the first season. I, I was back at home base putting the show together. So, okay, my in-person experiences were somewhat limited. Although I made some phenomenal friends in the course of it. Louie Miller's Barbecue in Taylor, Texas. Which, I visited. It's a legacy joint. Opened 80 some odd years at this point in a converted, they always include the word girls, a converted girls basketball gym in this small town in Texas. And when we went to shoot there, Louis Miller had passed away. His son Bobby was running the place. Bobby has now passed away and his son Wayne has the place. But I just fell in love with Bobby, who was, mm-hmm, dry as a bone and hilarious. I mean, Guy says to him, well, what are you gonna cook these over? You know, expecting post oak or mesquite. Bobby looked at 'em and said, wood. I said, oh, so that's how it's gonna go. And, and that's how it went. Now we started at three in the morning. That's when they start the fire. And, you know, we're in the middle of an interview in front of one of the pits, which was at that point, I don't know, maybe 60 years old. And without looking, without checking, Bobby turns around and starts moving briskets from one part of the pit to the other. And either I or Guy said, why are you doing that? How do you know to do that? He said they needed it. It's that kind of innate understanding of his food, his technique, the pit - which had a personality of its own - and he understood it. It was just extraordinary. It's the best barbecue I've ever had. The brisket there is extraordinary. It's unbelievable.

They make their own sausage, out of bull meat. You know, again, food of the poor. Barbecue started as a way to salvage tough cuts and meat that was going bad in Czech and German owned butcher shops in central Texas. It was all about making do and the argument has allegedly been that bull meat has a better chew. BS. Once the old Bull was done siren, you had to do something with 'em. Grinding them up into sausage was efficient. And I, I mean, it's fascinating what you learn along the way. Bulls are kinda lean. So, when you make sausage outta bull meat, you actually add fat. That you've taken from other animals to get the right mix. Their sausage is amazing. It's the finest barbecue I've ever had. There's a place in West Lafayette, Indiana, called the Triple XXX Family Restaurant. They added family restaurant to it 'cause when it was just the Triple XXX Drive-In, they used to get phone calls, yeah, from people asking what time the next show was. And the married couple that owns it, they started going there when they were in high school dating. His father owned it at one point. It's basically a burger joint, but much more than that where they make the burgers out of steak. They name the burgers after star athletes from Purdue University right down the street. And they just, their, their love for the business, their love for the community, it's just something really, really special. And, you know, Wayne Miller's become a friend. They've become friends. It, it, it's a delight to see. there's a barbecue joint in Lexington, Kentucky. And I know Lexington because when my daughter was in high school, she was a competitive equestrian. And, Lexington has a pretty big deal horse show every year. And we would go there, and she actually ribboned there. She was damn good at it. But there was a barbecue joint that I found there. I didn't find it on a trip there. I mean, my research department found it. And their specialty was, as is the case in that part of Kentucky, mutton. And we sent a crew down there and Guy and did a segment with them. Like the next year when we were in Lexington, I took the family there and we had dinner. And it turned out I couldn't go there very often because they wouldn't let me pay. And they would just fill the table with all this food because as it turned out, they told me that being on Diners saved them from going bankrupt and shutting down. And I found out that we actually saved a bunch of restaurants, which was not our intent. But I'm damn glad it happened. And by the way, if you've never had mutton barbecue, you gotta go for it. It's fabulous.

You know, when you were talking about Texas barbecue, I don't think I've ever come across barbecue I don't like. And, you know, North Carolina has its own distinctive barbecue, and Kansas City and Memphis, you know, all that. But by far my favorite, and I shouldn't say this because I live in North Carolina, but it's Texas barbecue, just like you said.

Well, I think we're talking central Texas barbecue because...

Yes.

In Southern Texas, there's a Mexican style of barbecue, in Southeastern Texas there's the kind of barbecue you're used to because there was an African American migration from the Southeast into that area, so they're making pork. But yes, central Texas barbecue is second to caviar and hallava. Probably the third best substance on earth.

Oh my God, I totally agree. I have a good friend in Austin, so I've been down there and I've gone to Lockhart and, you know, Austin and places, and you're right, that Central Texas barbecue is just unbelievable. It, it hijacks every atom in my body.

And, and what's incredible about it is in most cases. There's no sauce.

No, I was just gonna say...

that it's only with salt and pepper.

You don't... the meat is so good. Yeah. You don't want to besmirch it with sauce.

No, no.

At other places you need sauce because the meat's not that good to begin with. Oh, it's just absolute heaven.

And again, it was born of a need to do something with bad meat. And, and by the way, interestingly enough, you know, unlike North Carolina barbecue, which was born of whole animals, this kind of barbecue was impossible until the meat cutting industry was born. And pieces of beef were being shipped that were not whole carcasses or half carcasses. This old form of food is actually also a modern form of food that couldn't exist until the industrial age began treating beef differently.

You know, I'm dying to make a trip down to Austin, use that as a base and do nothing but barbecue for about three or four days. I don't know if the body can tolerate that, but, oh...

Oh sure it can!

But I'm going to find out perhaps.

Well, you know, there's three Michelin star barbecue joints in Austin now. I interviewed the owner of La Barbecue, which has a Michelin star who was actually married to a woman who is a descendant of Louis Miller's family. And she unfortunately passed away. Her widow runs the place alone now. But they're doing some remarkable stuff. And of course, there's Franklin's, which is famous, which I've never been to. But oh, Obama was the only one allowed to cut the line there.

Yeah, I wasn't, I had to stand in line a long time.

How good was it?

Unbelievably good. I mean, you go up and, you know, Aaron Franklin was there at the counter chopping up the brisket and asked which part you'd like. And you just don't... sauce belongs nowhere near it. The meat is just so tender, so beautiful.

But it does raise a definitional issue. He was one of the first to use prime beef. Is that cheating? Barbecue's goal is to make the most out of the least.

I don't know. If it's good. It's good.

Okay.

Cheating or not? It's really good.

Okay. Just checking.

So, let's get back to food television. Social media has come into the picture, since you began doing the Diners show. How has that changed things? And is TV still the predominant place people are learning about food or is it social? How do the two interact? Where does that work?

I think it's mostly social media these days.I mean, look, TV evolved. Food TV evolved into two things. Truly beautiful paeans to food and chefs done generally on streaming channels. And they're fine. They're good. A bit, too dreamy for my taste. They take you out of the real world of your shared experience, but that's okay. I, I like going to museums and looking at pretty pictures. What troubles me is that so much of food TV turned into competition shows and BS reality shows. They glorify, you know, Gordon Ramsey's a great chef. I doubt he runs his real kitchens the way he screams and yells on that show. And given the toxicity in the restaurant kitchen culture, that got a spotlight a few years ago and is still, you know, it hasn't been eradicated. I'm not in love with the glorification of screaming and yelling. But the Bear has the same problem. I mean, this 'yes chef' mentality but it's still the French brigade system and an awful lot of the chefs I enjoy talking to these days will tell you, you don't have to do that.

But I think the impetus in food as an audio-visual medium. Or food presented as an audio-visual medium is very much social media [these days. And you know, on the one hand, that's fine. The more interest there is in food. Hopefully the more people may sample my podcast Culinary Characters Unlocked. Look for it wherever you get your podcasts. But look, I confused the folks at the Food Network by insisting that my show be completely factual. You know, if they would ask me to stretch a point or something, I would say no. I held it to the same standards that I held all the reporting to when I was the senior investigative producer at 2020. I believe you should tell the truth. Well, social media doesn't give a damn. Most food shows, frankly, don't give a damn. But you've got influencers who have their own agendas. Who are wheedling free meals out of restaurants. I mean, why the hell glorify to buy chocolate? It's a goddamn chocolate bar, but it's 20 bucks. That's ridiculous. Food has been turned into a designer, accoutrement. It's, you know, it's a YSL designer bag. That doesn't make me happy. But then again as a society it's harder and harder to get people to be interested in actually learning stuff. They wanna be titillated, they wanna be shocked, they wanna be amazed. And look, teaching people stuff or imparting information doesn't have to be broccoli. I believe, frankly, one of the things I'm proudest of is that Diners, while entirely factual, was entertaining as hell. You can do both. But there's no code of honor or honesty or obligation among anybody picking up a camera and going on social media and saying, look at this.

Where could it go? How could it be better?

Well, don't take money or free meals to go pump places up. Have some expertise in what you're analyzing. I mean, criticism's fine, but if you don't know what you're talking about, the criticism is not valid. And I look to food critics to guide me toward where I want to go and eat and what I should like and help me broaden my palate and my understanding. Is it entertaining? Yeah, fine. It's okay. But again, I'm a grumpy old man telling kids to get off the shed.

So David, you know, I'm really grateful you joined us today because the Diners, Drive-Ins and Dives is such an important part of American food television history. And it's amazing to hear how it got started and where it went and your vision of how things could be better. But boy, it's just fun to talk to you about food in general and places to eat and the people. And it is just this wonderful world of connection, isn't it?

It, it is. And for example, this conversation, Kelly, I didn't know you till we started talking about doing this podcast, and now you're a new buddy. I love talking food with you.

BIO

David Page is the President and Executive of Page Productions. He is a two-time Emmy award winning Executive Producer with a focus on culinary projects and a special expertise in creating entertaining and engaging programming that combines the highest production values with the richest storytelling. Page is best known for creating the Food Network hit Diners, Drive-Ins and Dives and executive producing the program for eleven seasons. He is also an author, having written the book Food Americana about the evolution of American cuisine. And he is now producing and hosting the podcast Culinary Characters Unlocked, featuring entertaining but substantive interviews with important people in the world of food.

If someone asked you about French, Korean, or Thai food, you could probably name some signature flavors and dishes. I certainly can. Well, what about American food? What stands out for you there and what IS it, really? Today we're going to dig into the roots of American cuisine with food journalist David Page, who initially was an investigative journalist but turned his attention to food. And he's author of a book called Food Americana: The Remarkable People and Incredible Stories Behind America's Favorite Dishes. But you might also know David's work from television. He was executive producer on the hit series Diners, Drive-Ins, and Dives for 11 years. He has two Emmy awards and has his own podcast series, which is excellent, called Culinary Characters Unlocked.

Interview Transcript

So, here's the book: Food Americana. It's really a wonderful read and, you know, every case study you go through in the book, like pizza, Chinese food, Mexican food, every one is completely fascinating. I'd love to dive in and hear more about your thoughts about how all this unfolded. So, is there such a thing as American cuisine and how did you come to write this book, Food Americana?

Well, the short answer is yes, there's American Cuisine. I came to write it out of personal experience. I became really deeply interested in food when I was posted overseas for NBC News as a producer and traveling from country to country, pre-Internet. And not ever having expected to leave America. I mean, they called me up one day and said, Hey, you wanna move to England? And from there I moved to Germany and then Budapest, Hungary. I was remarkably unprepared for all of the places I was being sent. And I kind of had a study pretty quickly. And I found that one of the best ways to understand a country or culture was through its food. You know, why do they eat so much wild boar in Tuscany? Well, because it was historically a poor region. And if you wanted to eat, you had to kill something. And what you were most likely to find that you could kill was a wild boar. When you go to Strasburg in France, why are you eating Germanic choucroute, which is, you know, pork on top of sauerkraut. Well, that reveals to you that that area went back and forth in terms of which country owned it forever. And that really awakened in me a deep interest in food.

When I got back to the States, I eventually ended up creating Diners, Drive-Ins and Dives. And that got me deep into American food, if you will. And, more and more over time, I stockpiled stories and interests and decided as all TV producers do eventually, whether they actually act on it or not. Everyone thinks it's easy to write TV and it's hard to write a book. Those of us who are TV producers carry a chip on our shoulder because frankly, it's harder to write for television. You can't just sit down and type out whatever you want to type out. You've got to figure out the words that integrate with the pictures and that can move the pictures forward. But, you know, we all think we have a book in us, and I said, what interests me? And it was this. And I dived in; thoroughly enjoyed the process.

To answer the other half of the question, I came to the conclusion looking at everything that I had put on Diners, looking at every place that I liked eating in various towns, there was a cuisine. It was something we constructed, much like we constructed American democracy out of other countries and cultures. And you know, when you go to a Chinese restaurant in America, all of us have gone with that real bore who looks up and says, this isn't authentic Chinese food. Well, no, it's not authentic Chinese food. It is authentic Chinese American food. Just as, with the exception of something called polpette, which are very small round meatballs, there are no meatballs as we know them in Italy. When the poorest of the poor left Southern Italy to come to the United States in the 1800s, to their shock when they got here, they found out that being poor here was different than being poor there, where even pasta was considered a luxury item and only enjoyed on a Sunday, if ever. Here, poor people could afford meat. And that is what created Italian American cuisine, which is to a great extent based on abbondanza, you know, a whole lot of everything. I live in New Jersey where red sauce cooking means open your belt and, you know, strap in for a few hours of absolute gluttony. And we've done that with bagels from Poland. In Poland, they weren't quite what they are here. But they were similar, and they were sold by Jewish peddlers in the streets on long sticks. Because they had holes in the middle, you could, you could stack 'em on the sticks and young kids would walk around the town square shouting in polish. I don't know the actual words but shouting something that translated as bagels and lemonade. When Jewish immigrants arrived in the United States, packed into the Lower East side into tenements, they did what they knew how to do. And bakers started making bagels which then became far more than a Jewish food. They became a New York food. And then in horribly awful incarnations, they became an American food. I would argue it's still hard to get a decent bagel outside of New York for any number of reasons, but bagels are American cuisine now. They're not the bagels per se that were eaten in Poland. But there's something from another country that we took and made into our own. And by the way, the cuisine continues to evolve. It now includes Vietnamese banh mi. As more and more cuisines are sampled here, they're modified by the lack of availability of original ingredients for the immigrants who are here who have to look for alternatives. And they're modified to suit broader tastes. You know, the original spices of much of Mexican cuisine... and when I say Mexican cuisine, it was basically the food of the Nortenos, Northern Mexico, because as with all countries, Mexico is a combination of cuisines based on regionality. But, when Americans started sampling, quote, Mexican cuisine, unquote, much of it was too hot for us. For the most part, those people who had lived in what was Mexico who were now living in America after the Mexican American war, when America seized half of Mexico. Those who opened restaurants realize that, you know, if you want a broader clientele, you better tone things down. That's the Americanization of another culture's food, and that is American cuisine.

I'm hoping you wouldn't mind taking a little detour and talk about how magical it is to connect with a culture through food and through the people you meet in that context. You and I were talking before we started recording and you mentioned a trip you made to Spain and how wonderful this particular connection was. And I was thinking about some things I've done recently that have connected me with people and their history through their food. And there's something very magical about that. But tell us about your trip to Spain because I thought it was very interesting.

My wife and I went to Spain a few years ago, and I had worked in Spain a fair amount when I was overseas as a journalist. But I'd never really had the opportunity to do much vacation in Spain. And I can't remember if it was Madrid or Valencia, it may have been Valencia. But we signed up for a half day cooking course. And we showed up and it was taught by somebody's grandmother. I made the mistake of trying to be polite and use my leftover high school Spanish, and I was the only one who in the class who did. So, she decided I was fluent, which I'm not. But she and I had a lengthy conversation during the class, which consisted of her saying things I did not understand in me nodding my head and saying, si. But it was just a remarkably wonderful experience to have my hands on and in and be learning about another culture. You know, one of the things I realized when I first started traveling much of the world for NBC and again, I had never expected to be sent overseas, was that there are a million ways to do things. You know, this is going to sound kind of gross, but until you go overseas and you realize there are different shapes to toilets, you know, people look at the same problem and figure it out in slightly different ways. You learn that there are multiple ways to approach things, to address things, to do things. And first of all, the cooking in Spain is extraordinary. And it's an underappreciated cuisine here in the United States. But, you know, we're in cooking class making a Spanish tortilla, which is not a Mexican tortilla. Mexican tortilla obviously is a disc of dough, either corn or wheat, depending upon the region. A tortilla in Spain is an omelet, but more than an omelet, it's kinda like a frittata. It's a very thick, almost spongy, egg-based product with potatoes in it. And making that and learning how to make that and the way that this teacher had clearly been making it, that she had learned from her mother, who had learned from her mother. You know, you turn it upside down to get it out of the dish. It was just a wonderful experience. And look, I've been fortunate enough to have that experience in any number of countries. This one, wasn't terribly culinary, but I was in Moscow in a bar frequented by locals. And this was under the Soviet Union; it was a long time ago. But they had the bars for Westerners where they took dollars and served the good vodka, which Russians could not get by the way. I mean, there was no Stoli for Russians. But we were in this real low rent bar and a guy sat down next to me with Asian features. And through, kind of, hand signals and some assistance from I guess one of the NBC translators or something, we exchanged life stories. It turned out he was visiting from Siberia to do some kind of business. Had never been to the big city. And he had... everything in the Soviet Union was crappy. I mean, it was made of plastic. He had a plastic briefcase. But he was here on business apparently. And as we got drunker and friendlier and you know, arms around each other and hail fellow well met, he opened his briefcase to reveal that it was filled with salted fish. He had brought his own delicacy from home because you never know what you're going to find in the big, bad city. And sitting at that bar, I had me some Siberian salted fish and it was damn fine.

What a neat experience.

Oh, it was fantastic. Just fantastic.

You've reminded me, and I was mentioning this to you as well, but I love barbecue of all kinds from all places. And the North Carolina form of barbecue is typically pulled pork. And the Eastern part of the state is famous for cooking whole hogs, the Western part for cooking just the pork shoulder. But in the Eastern part they say they talk about cooking everything but the squeal. And there's a local restaurant in Raleigh, which is about a half hour for me and where I live in Durham. And there's a well-known barbecue icon in North Carolina named Sam Jones, who's the third generation of his family to run a restaurant in a little town called Aiden, North Carolina, which is frequently considered the best barbecue place in the state. Sam, at his restaurant in Raleigh, was running a half a day intensive workshop for those of us out there in the world who want to learn more about it. I took that workshop and it was a wonderful experience just like you're talking about. Because not only did I learn about the techniques of cooking the food and I was in their smokehouse, and it was just a great experience. But this fellow, Sam himself, was a really interesting character. And to hear about his family history and what the food means to them and how they learned the traditions and stuff was just absolutely fascinating. And I'm reaching for, I got a copy of a book he wrote on whole hog barbecue. There's Sam himself and with...

Daniel Vaughn the writer.

Yes, that's exactly right. What a great experience. I feel as you do that connecting with cultures through their food and meeting the people is just an incredible experience. Let's get back to your book now, Food Americana. So, you gave us the example of bagels, you talked a little bit about Chinese food, but give us some more richness to how these foods might have begun and what kind of forms they took in America. And I know you talked about pizza as one example. I thought the pizza one was especially interesting. Part of it is because I spent many years of my career at Yale University and was surrounded by New Haven Pizza, which was unbelievable.

Which is called what? Apizza?

Apizza. Yes.

Well, that's coal-fired thin crust, right?

Coal-fired. You know, I could go in one of those restaurants and just order crust and be happy. It was that good.

What I found interesting in researching one of the New Haven pizzas that's legendary is clam pizza. And what I learned was that the clams weren't from Connecticut. That they were brought in from someplace else. I just assumed, because, you know, you got the water there that that was a local thing. And apparently it was not, which surprised the hell outta me. I mean, I live on the coast of New Jersey and there's a place down here that does its version of clam pizza and it is local clams.

Oh, that's interesting.

Pizza was the food of the poor in the South of Italy. Pizza was basically dough with a little bit of tomato. And if you had a couple of bucks that day, that week, maybe you put a piece of lard on top. I mean that, that was it. And when the immigrants began arriving in the United States and found that good food was easier to obtain, that's when pizza started to morph into what we know it as today. Now the wheat in Italy was different than the wheat here. The form of a fire being used was different. I'm trying to remember, I guess it was coal in New York at the time, and wood in Italy. So, you ended up with a different kind of crust in terms of airiness and crispness. But what you also ended up with is a perfect example of the development of American cuisine. Which is every place that pizza went, it was different. It evolved based on what was available in a particular region. You've got pizza in, I think it's St. Louis, maybe Kansas City, where they use kind of a processed provel cheese. I guess it's St. Louis. Because that's what they had. That's nothing. It's not mozzarella. It's not Parmesan. It's the local cheese. Or you have pizza in Old Forge, Pennsylvania, that was created for the miners by a bar owner using what is rumored to have been government cheese. These were poor people. So that's how that developed. You've got Detroit Pizza, which is having a renaissance moment now, but it has its square shape because it was initially baked in these blue steel automotive pans. They may have been oil pans that were liberated either from an auto factory or a parts supplier. You know, Chicago Pizza certainly developed in a unique way, although there are two kinds of Chicago pizza. There's the deep dish that, it's really a frigging casserole. And then there's cracker thin pizza that, that's delightful. But you see pizza developing according to what's around it. I mean, it's the perfect example of local, regional, seasonal. And then as pizza became a self-perpetuating thing, it then became a kind of a palette for creative American chefs to go nuts. The iconic decision being Wolfgang Puck at Spago in Beverly Hills. Putting what would be politely called smoked salmon, what else? New York Jews would call lox on a pizza with creme fresh and, you know, reinventing the world. In fact, the real reinvention of pizza in that way occurred at California Pizza Kitchen in California, where barbecue chicken pizza became a big deal. And pizza continues to evolve. I mean, I had a debate the other day with the owner and chef at an Italian restaurant about whether or not pineapple goes on pizza. And I obviously, I think that Hawaiian pizza with pineapple and ham is a war crime. He argues that doing what he does, which is a not canned pineapple but fresh pineapple that is macerated, chopped, and served with, I think, pork cheek as opposed to ham. Some more subtle, substantial use of pork that is in fact a terrific combination of flavors. And I'm not going to argue with him because that actually sounded pretty damn good.

It does sound good.

You know, pizza continues to evolve. What's interesting with pizza is, and I have this complaint with so much of how Americans consume food, is that given the choice between a great local pizzeria and BS factory like Dominoes, so much of America picks Dominoes. I mean, at the time I wrote the book a few years ago, 60% of pizza was sold at chains; 40% was sold at independents. But why, why would you possibly pick this cookie cutter piece of crap when somebody down the street from you is doing it right?

You just remind me of so much, and when you mentioned Old Forge, Pennsylvania, when I read that in your book, I have a good friend who lives in Philadelphia. And I got in touch with him. I said, oh, I need to come up to Philadelphia, and we need to make a road trip to the Martin Guitar Factory in Nazareth, Pennsylvania. And then go down to Old Forge and try this pizza David Page was writing about and stuff. And it's just fun to do this. And I did this recently. I told you earlier, I'd made a road trip and driven part of Route 66 through Oklahoma. And stopped in this little town El Reno and had the famous Oklahoma onion burger at Johnny's and sat at the counter and talked to the cook. And I enjoyed that as much as any four-star, high end, hundreds of dollars meal. It just, it's fun.

Well, but there is a misunderstanding of what good food is. I liked, well, many things about what Pete Wells did when he was a New York Times food critic. But one of the things I really liked was the fact that he evaluated restaurants based on their intent. You could be a three-star taco stand. If the promise you are making to someone is, I'm gonna make you the best goddamn taco you ever had. You have to evaluate that based on that. Not, is it La Verna dining? And frankly, our hangup with and fascination on high end haute cuisine, $350 a plate, little, tiny morsels of shit. I much prefer real food. And, you know, the foodie culture goes nuts for stuff that is fru fru, and they did this, and they did that. Making the perfect hamburger in El Reno, Oklahoma, and you know, I talked about how in Tuscany boar was the food of poverty. Onion burgers, which are considered by some purest to be the finest form of hamburger came out of, I think it was the Depression. It was certainly a time of poverty. Where you stretched a burger by adding onions to the meat. And that's a wonderful, wonderful thing. Now, I don't think it was... is El Reno outside Oklahoma City?

Yes. It's within an hour drive.

Yeah. It's near Tinker Airbase. El Reno is where, I included this in the book, there is a fabulous sushi restaurant in a gas station. Now the local clientele heavily Air Force people who have been in Asia, but apparently, it's phenomenal sushi. And interestingly enough, I just interviewed the chef owner of three restaurants in Oklahoma. He has a restaurant called Gray Sweater, which is highly upscale, and he has a couple of others. He was telling me that the food scene in Oklahoma has been really, really booming under the radar. And I went to school in Oklahoma. I was thrown out of both major state universities. And you know, back when I went, it was great chicken fried steak. There was some barbecue that was basically Texas barbecue that had migrated North. But I didn't see Oklahoma as culinary heaven. And apparently, it's quite the place to eat these days.

I would agree with that. I went to some really fine restaurants when I was there. Plus the people are just lovely.

Oh, yeah. And by the way, you talk about American cuisine. And I'm not sure if there was a direct evolution, but clearly it's an Americanized form of schnitzel. It's hard to, if you live in the East coast and you haven't had a chicken fried steak...you have no idea what you're missing. But again, food of poverty. You take a bad cut of meat, you tenderize it by beating the hell out of it with a mallet, then you dip it in egg and flour and you deep fry it. I mean that's...

Oh, and the right gravy on that.

Oh yeah. The cream gravy.

Yeah.

And, you know, don't mention it to your cardiologist, but I fell in love with that and as a college student with pure grain alcohol when I was in Oklahoma. So, it did have a couple of things I liked.

I might have recorded 300 podcasts or something like that, but none has made me as hungry.

This is good, right?

Oh, it's great. So, let me end with a final question. And I think I can guess how you're going to answer this, but if you look at American cuisine compared to the things that it descended from, like foods from Italy and Mexico, and China and things. Is it just different? Is it authentic in its own right? Is it better worse? How do you think about that?

It is wonderfully different. It has an antecedent. It's like looking at a German Shepherd and also being aware it was once a wolf. They're two completely different species. And some of the traits of one are reflected in the other, but they're different cuisines. I mean, I've spent a lot of time in Italy, thank God. And second to Spanish food, it's probably my number two all-time favorite. But, when you look at American cuisine, red sauce Italian is among my favorites. They're totally different cuisines. Chinese food, the same. You know, there's a great book and documentary In Search Of General Tso, in which the writer, Jennifer A. Lee. went looking for the guy who invented General Tso's chicken in Taiwan. And she found him and showed him what his invention had become in America. They bear no resemblance to each other. He was shocked. But I love general. Now, I can't eat it much because had a diabetes scare and had to lose a bunch of weight. But it's a wonderful dish. It is about as Chinese as Matzo. You know, it's an American invention, but remember, American Chinese food began in California after the Gold Rush when a whole bunch of Cantonese people came over to search for gold and they set up restaurants. Some came to set up restaurants for them, and they realized that Americans didn't eat offal, and much of Chinese cuisine is, you know, a nose to tail. So, they either invented or reinvented chopped suey with Americanized proteins and that's what kicked off the Chinese food boom. And there's this mall in Flushing New York that serves the food the way it's served in China. This stuff, it'll blow your mind. It's extraordinary. But that doesn't make the food that you get at a good Chinese American restaurant invalid. It's just wonderfully different.

BIO

David Page is the President and Executive of Page Productions. He is a two-time Emmy award winning Executive Producer with a focus on culinary projects and a special expertise in creating entertaining and engaging programming that combines the highest production values with the richest storytelling. Page is best known for creating the Food Network hit Diners, Drive-Ins and Dives and executive producing the program for eleven seasons. He is also an author, having written the book Food Americana about the evolution of American cuisine. And he is now producing and hosting the podcast Culinary Characters Unlocked, featuring entertaining but substantive interviews with important people in the world of food.

Transcript

Paper: Gearhardt AN, Brownell KD, Brandt AM. From Tobacco to Ultraprocessed Food: How Industry Engineering Fuels the Epidemic of Preventable Disease. Milbank Q. 2026;104(1):0202.https://doi.org/10.1111/1468-0009.70066

https://www.milbank.org/quarterly/articles/from-tobacco-to-ultraprocessed-food-how-industry-engineering-fuels-the-epidemic-of-preventable-disease/

Ashley, let's talk a little bit about, just set the stage for what this paper was all about, and since it was your brainchild, you approached Allan and me about being involved. Tell us what you set out to do and why you thought these issues were worth digging into.

Ashley - You know, I've just been so struck that when we think of cigarettes, they were something that's so common, so normal that we kind of think, oh, they've always just sort of been there. But truly, they're just taking a natural plant from the ground and through advancements and corporate engineering and technology and knowhow, they took a poisonous plant and made it into the most deadly and addictive drug in human history. And yet that was, you know, just accompanied by tons of debate. It didn't look like other addictive substances. And I just really felt like, man, we're reliving this history right now when it comes to how we've altered our food supply. I wanted to really bring you all together and see if we could really lay that story out of the, the parallels of these two public health crises.

We'll get in a minute into the issue of what you discovered, but tell us what you covered, what the paper was meant to do.

Ashley - The paper really goes back from how you take the tobacco plant in the field, or the corn in the field, and walks essentially through all the kind of levers that are being pulled to transform it in very specific ways. And through specific technologies and corporate practices that are being shared by modern cigarettes and ultra processed foods. These products maybe look harmless on their face initially, or don't look like they're just maybe pleasurable or craveable. But truly, I would argue that they've crossed thresholds into things that are addictive and clearly damaging many people's lives.

Okay, so several decades ago, I don't know who came up with a term, but there was a lot of discussion about similarities between tobacco industry behavior and food industry behavior. And the press started publishing cover pieces that would say food is the next tobacco. And it was a term that the food industry really didn't like, and they don't want that comparison at all. It'll be interesting to see whether they deserve it. You clearly made that connection in this paper.

Allan, let's turn to you. Oh my God. I mean, we could do a 15-hour podcast and not cover the history of the tobacco industry. There's so much to say, enough that you wrote a massive book about it. But give an overall sense, if you will, of the kind of tactics and morality of that industry.

Allan - Well, as Ashley already mentioned, early in the 20th Century we wouldn't really be thinking much of cigarettes, and they were just a very peripheral sales consumer item. And over the course of the 20th Century, we came to a point in the middle of the century of the 1970s, and '80s where about half of all American adults were smoking cigarettes regularly. I wanted to understand that. How do you take something that's at the very margin of the economy and culture and make it a dominant consumer force? And I think in that way, we have certain parallels to ultra processed foods. But then there were the questions, how do you make it so popular? Is it dangerous to use? Is it addictive? Does it cause disease? And how do you resist regulation and other public health approaches to try to keep people smoking? And I found a lot of evidence in each of those areas, both of how the industry acted. And when you say, you know, it's ultra processed food like cigarettes, we're learning a lot about ultra processed foods. But we know a ton about what the industry did to make the 20th Century what I call the Cigarette Century. And we have seen really important declines in smoking in the last 30-40 years. It's a remarkable public health effort. But at the same time, the industry worked incredibly hard and, in some ways brilliantly, to maintain the popularity of their product. And underlying all this is the idea that nicotine is highly addictive. And the industry came to understand that certainly before consumers did. And as a result, they could engineer, manage, manipulate the addictive character of a product that kills. I think looking for parallels, both in terms of how the industry did it and how perhaps public health law regulation can undo it, is the critical aspect of what we've been working on together.

Okay. So, the tobacco industry did more than just take a plant, dry it out, chop it up, and roll it up in some paper. Then people might be driving whatever natural pleasure there would be from that product. But they did more, didn't they?

Allan - Yes.

And you talked about nicotine in particular. So how manipulated was this industrial process and was it designed to create such high levels of addiction?

Allan - Well, for a long time we couldn't be sure about that. And we have learned that the industry had learned sophisticated techniques of industrial production of cigarettes. So, it wasn't like just chopping up tobacco and putting it in paper. You know, they added many additives. They added liquids. They dried it out, they put it in long strips of tobacco for cutting and packaging. And they had innovated the technologies, instead of human beings rolling cigarettes, they were able through machinery and technology to produce hundreds of thousands of cigarettes a day. And then they had to figure out how do we sell this tremendous volume of cigarettes in order to make our industry truly lucrative. So, there were those aspects. And certainly by the middle of the 20th Century, many people realize that - I smoke regularly and I crave my next cigarette and I'm smoking a pack a day, sometimes two packs a day. And people would ask, well, is it a habit? Is it habituating? Is it addictive? And as the science of addiction really grew in the middle of the 20th Century, we began to realize it had all the characteristics of addiction. But we really didn't know exactly what the companies were doing. And what we did learn in the '80s and '90s is that the companies had a precise ability to manage the nicotine in their product. And they did, so that even as they put filters on and they claimed they had safer cigarettes, they were also producing increasingly addictive cigarettes where we have craving, we have withdrawal, we have tolerance. The basic categories, that structure, how we understand addiction.

Okay. We'll dive into some of those in a little more detail, but thanks for that background. Ashley, people kind of get it that drugs can be addictive and they know that alcohol can be addictive. They know that cigarettes can. But what about food?

Ashley - Yes, so I think one of the things that when I take a step back, is that the reward and motivation system that alcoholic beverages, cigarettes can start to hijack and drive towards compulsive problematic use, that was laid down in the brain to make sure we were getting enough food. It's really sensitive to food reward, energy density. But the thing is you actually consume nicotine probably most days. Nicotine is actually in a lot of plants like tomato and eggplant, but nobody's getting addicted to the chemical in that delivery vehicle. I would argue the same thing's happening. When we look at our research nobody's getting addicted to minimally processed foods like bananas and broccoli, and salmon filets. It's when you're able to process and titrate and hedonically engineer food reward in a way that mimics the intensity and the sensory appeal and the spikes and crashes and the craveability of something like cigarettes, that you start to see people losing control. And when I read Allan's book, my husband was watching over my shoulder. And he's like, you know, if you highlight every single sentence, it's not gonna help you because you've highlighted the whole book. And reading what Allan laid out about how each wave of cigarette addiction, it wasn't because we suddenly discovered what nicotine was, it's because the industry got better at manipulating engineering, designing, flooding the market with it. And then health washing it, so people didn't really understand what they were getting into. And to me, that is what we've done to our food supply. And the result of that has been the astronomical increases in diet related disease and health concerns.

Tell us about the concept of ultra processed food and how that fits in.

Ashley - Yes. Yeah, that's a great question. So, ultra processed food is a concept that actually came out at about the same time as the Yale Food Addiction Scale, that Kelly and I published together, about how to operationalize who might be showing signs of addiction and certain foods. Carlos Monteiro from Brazil was noticing that his grocery store was starting to be flooded by foods that you could not make in your home kitchen. I have exactly no idea how to make a double stuffed Oreo or a flaming hot Cheeto, or a Cherry Coca-Cola. And as these products that were industrially created with additives and flavor enhancers that are kind of biologically novel, that's when the disease risk started to go up. And so, these foods are so fundamentally changed in they're kind of most archetypal forms of things, like sodas and, you know, your sweet, savory sort of snacks, that a whole new category had to be created for them. To really distinguish them from, you know, grandma's homemade cookies or, you know, an apple or an orange.

Ashley, you're brilliant at framing things. And one of the things that I learned from you a long time ago, and I've used a thousand times in discussions with people, is thinking about food, like turning the coca plant into cocaine and into crack cocaine. That if you take the coca plant into its natural form, people can live in harmony with it. You don't really have addiction. But when you process it and it becomes cocaine, then things change dramatically. And when you hyper process it, like the hyper palatable foods and the ultra processed foods, then the crack cocaine becomes incredibly addictive. So that same sort of phenomenon I think applies here. And it's a very compelling way to think about this.

Allan, let's get back to the addiction thing and tobacco. One of the most stunning things I remember about the tobacco history. Is the videotape of the seven tobacco company executives testifying before Congress that nicotine wasn't addictive. Swearing, you know, sworn statements about nicotine. Tell us about that and what that kind of meant in history.

Allan - It's a great story and it has a kind of visual linkage to many of us who actually saw those congressional hearings. And it was a brilliant sort of performative politics, if you will. And there had been more and more knowledge that the industry was manipulating nicotine to make cigarettes that they were claiming were safer and not addictive, even more highly addictive. And David Kessler, the head of the FDA under Clinton, had really been a major player in this. And one thing I should say is we were learning more and more about the industry because people were suing them. And they would typically lose the suits, but they would get hundreds, hundreds of thousands of documents. And the industry also had whistleblowers who were coming forward and saying, of course we know it's addictive. So, Henry Waxman, a really fantastic congressman who represented consumers invited all seven of the major tobacco CEOs to a hearing on nicotine. And he went one by one - do you believe nicotine is addictive? And they would say, Congressman, I do not believe that nicotine is addictive. And it's like any great prosecutor, he had figured out how to get them essentially to perjure themselves in front of a congressional, and video news audience. And in fact, the Department of Justice considered for some time whether they should be put on trial and indicted for perjury before Congress. But it was so in congress, with what we had come to know, especially experts, but even, you know, parents and the public and citizens had come to know that it was incredibly difficult to get off of nicotine. It just didn't comport with our existing knowledge. And we're not quite to that point with ultra processed foods yet, but I think we have a good chance to get there because as we understand what they're doing better and we have a sophisticated understanding of the characteristics of addiction, that same question will be put ultimately to CEOs of the food industry. Especially those who are producing these highly addictive products. And there are many people who are involved in this. So, they will tell a story of how we understood we could make our product sell better and be used at a much higher level if we could make it addictive. And regrettably, as we learn more about addictive addiction, we not only learn perhaps how to help people who are addicted. But we often learn how to make certain products even more highly addictive.

Ashley, let's take what Allan said and apply it into the food arena. So, if you think about the criteria for addiction, like Allan had mentioned: cravings, withdrawal, and tolerance, and, tolerance being the need to have more of the substance over time in, in order to produce the same pharmacologic effect. How do those things apply to foods?

Ashley - Yes. There there's very strong parallels there. And I actually have a paper I wrote with Dr. Alex DiFeliceantonio, where we took the 1988 Surgeon General's report on the addictiveness of tobacco and nicotine in particular. And we took what they identified as the necessary and sufficient criteria to prove that it was addictive. It was a watershed moment for tobacco. And the major one is that people consume it compulsively. Meaning, you know, they want to cut down and they can't. They know it's harming them and they can't. Clearly we see that with ultra processed food. That it shifts mood. It increases pleasure. It reduces negative affect through its mechanism on the brain. And I think if you look at any marketing, you know, they're always saying you're craving meet your maker, get your bliss point. You're not you unless you're eating a Snickers. They show that it was highly reinforced. And that is, you know, animals and humans will work really hard to get access to it. With nicotine one of the major points of that is that animals, about 20% of the time, would work to get nicotine over cocaine. And that was quite striking because cocaine is so powerfully addictive. Well in those same models, animals will work for processed sweet taste and choose it 80% of the time over cocaine. It just shows that when we start altering, processing food reward into these unnaturally intensely stimulating packages, our brains were not evolved to protect itself against that. And then the final pieces that's been kind of added over time has been the cravings. I mean, if you think about what is the core of addiction, it's the craveability of it. That they maximize that. So, you can't stop thinking about anything else. And when I read, and we even quote in our paper, spots where, you know, industries, the big food is having webinars and how to turn cravings into corporate wins. And how to take snackers who are consuming, because their cravings feel unmanageable, but here's how you can keep them snacking even though they want to quit. And so, the craving really seems to me, based on my read of what I've seen from the industry, is the core engine of driving and selling ultra processed food.

So, these foods, and I've heard you say this, Ashley, you know, they have less to do with the farm and, you know, these sort of romantic ideas of the farmer growing crops and the crops being harvested and coming to a farmer's market. These are really industrial lab-based, you know, heavy duty factory related products. And there's a real question, isn't there, about what you even should call them food.

Ashley - Yes, absolutely. I actually grew up on a farm and I never ate anything that we grew on the farm because it was all due to Ag policy. Just, corn to go into high fructose corn syrup, soy to go into soybean oil. And I was surrounded by what looked like lots of food, but in reality, it was not. And some of the things that I learned in writing this paper with you all is just to what degree ultra processing allows them to even control the molecular structure and size of the different starch chemicals. That carby kind of access point in food. Allan talks in his book about how you can treat tobacco. So, you break it down and make it molecularly more bioavailable so nicotine gets more rapidly into the body. That's a huge driver of addictive potential. I found in ours that they were actually using enzymes that mimic what's in the saliva in your mouth. And hitting starches with it. Essentially you were predigesting, pre salivating, essentially the starch creating what's called a starch slurry. And that's a base of so many common ultra processed foods like cereals and savory snacks. Many of these products really have far more in common with that cigarette and have almost nothing in common, you know, with the apple or the can of beans anymore.

You know, that image that you said about pre salivating food. I mean, it's in some ways as if the industry is spitting in your food to bypass your own biological mechanisms that occur when the food gets in the mouth and. People get a kind of a yuck response to that, but it deserves that kind of a response. Let's dive into the paper and talk about what you reported, Ashley. You talk a lot about the kind of processes. You just mentioned one of them, but there are a lot more. What are some of the specific techniques to food processing that surprised you when you started digging in. How did you get this information?

Ashley - Yes, so one of the functions that actually didn't surprise me, but it made me look at it in new light, is the work on how we really changed the way we saw cigarettes when we realized they weren't just taking a plant and drying it and rolling it up. But that they were actually curating and titrating these just right doses of nicotine. So, you get stimulated, but not too satisfied and you don't feel overwhelmed by the amount of nicotine. When we realized that was very intentional and designed and titrated, that really changed this from a natural kind of product, it's just a plant to, oh, this is an in industry engineered product. They're controlling so much of this. We all know that they are altering the amount of sweetened refined carbohydrates and fats in our food. I mean, that's just plain knowledge. And at levels that go way beyond what exists in nature. But I think I've become very obsessed with extrusion technology. Extrusion is something where they take really high pressure, high shear mechanical impact, high pH, high temperature. And they can break the corn or the potatoes and things into this slurry that is broken down again into this kind of predigested molecular base that on its own is nasty. No one is like, oh, starch, slurry, yes! They need all the sensory and flavor additives to blitz that and texturize it so it can trick your brain into thinking it's appealing. I realized that actually has such a strong parallel to modern cigarette where, as Allan talks about in his book, one of the major technological advances was creating reconstituted tobacco where they take the tobacco scraps and they do the same sort of process to create what they call a tobacco slurry. That was then very easy to manipulate by putting flavor and preservative additives in it, and that's what makes up a large component of modern cigarette. And so, when we look at these processes and those sensory additives, the flavors, that are put in it, cigarettes have more sugar and flavor additives in them by weight than they do nicotine. And so many of those flavor additives are actually in our ultra processed food supply. Why? Because the flavor and sensory profiles are what you start to become really emotionally attached to. And that starts to drive brand loyalty from a very young age. I could go on and on and on. Oh man, we could be here for a day, so I'm really inhibiting myself. I'll be exhausted. I'll have to go get an ultra processed food from this. But it was stunning to me to see how the goals of the engineering were so shared. And I guess it shouldn't surprise us because, you know, we know that the tobacco companies like Philip Morris and RJ Reynolds actually created, manufactured and sold many of our favorite ultra processed foods that are now in our modern food supply, like Fig Newton's and you know, Hawaiian Punch and things. It really came from the same industrial practices.

So Allan, I want to bring this back to the tobacco industry in a minute, but Ashley, I wanted to ask you first. I'm going to make a characterization. Tell me if I'm off on this. The industry is kind of manipulating every possible characteristic of a product. Its fragrance, its color, its texture, everything in the ways you mentioned. It becomes this industrialized product much more than a food. People consume it. They get immense reward from it because it's delivering a drug, basically, to the brain very quickly in a very efficient way. People then, of course, want more of that sensation. If tolerance exists, then it means they need more of the food over time in order to get the same reward. And then you've got a public health nightmare on your hand because people aren't just eating a little bit of these foods, they're eating a lot of these foods. And they're designed in order to produce that very impact. Does that seem fair?

Ashley - Absolutely. That sums it up quite nicely.

Okay, Allan, back to the tobacco experience. This kind of information that Ashley is talking about in the context of food, and you talked about in the context of tobacco. Manipulation of the product. As this kind of damning information became public knowledge, how did that happen in the tobacco arena? And then what was the consequence? Was it, you mentioned whistleblowers; was it investigative journalism? The hearings you mentioned were important. Scientific research, discovery. It sounds like a whole lot of things happened that made this information available to the public, which in turn changed public opinion against the industry.

Allan - Yes, I think that's exactly right. It changed public opinion and it changed public policy and it took a long time. So, these are aspects that I think we have to, you know, acknowledge in thinking about public health and especially these powerful commercial interests that spend a lot of money on lobbying. They spend a lot of money on advertising. They know how to get to kids. These are very challenging. I do think, you know, early in the anti-tobacco campaigns, there were a few lawyers who said, well, we're going to sue them because they have misled, deceived, and in some instances probably acted criminally to build their addictive and extremely harmful life-threatening product. And people said, well, you know, it's everybody's decision whether they want to smoke and people quit all the time, so you're not going to do very well. And I think as a young academic type, I was very skeptical of the suits against the companies. But one thing that happened that I think was unanticipated, the lawyers asked for the company's records and their research reports and what people were doing. And they took depositions and the lawyers often lost the case, but they won an incredible archive that was incredibly self-incriminating of what the industry knew. When they knew it and how they continued to act to sell a harmful product. And I think that began to change things. So once you have documents, you know you're going to be more successful in court. Once you have some documents, you can call the CEOs in and say is it addictive? When they say no, you have documentation to challenge them about their own industry. Obviously, education is important. Investigative journalism. A lot of the documents not only came from the court suits, but from whistleblowers who snuck them out of law firms. Some of the whistleblowers came directly from the industry where they said, here's what my bosses told me. They need to know can you make this cigarette even more addictive? And they knew, for example, that taking nicotine out of cigarettes, which is not that difficult to do given the extent of manipulation, had to be something that was resisted. We could end the tobacco pandemic by just removing nicotine. Even if we did, you know, 10% a year. Many people would be able to stop smoking who cannot. But we had to array a kind of knowledge and practice and advocacy that really hadn't existed till the second half of the 20th Century.

Ashley, when Allan mentioned these archives that exist on tobacco industry behavior, there's some food things in there, aren't there? Tell us about that connection between tobacco and food companies.

Ashley - Yes, so you know, actually, Dr. Laura Schmidt at University of California - San Francisco, has done this just stunning work by using those same tobacco archives. Because they owned alcoholic beverage and ultra processed food and beverage companies she's been able to show really how much these industries kind of spoke back and forth. The different sectors of Philip Morris and RJ Reynolds, you know, they're big conglomerates. They were pulling scientists working on the cigarettes, or the marketers working on marketing cigarettes to kids, and putting them on and intentionally using that playbook to sell their ultra processed foods and beverages. That's very clear and very intentional. They might not say as blatantly. I feel like they learned their lesson a little bit. Oh, we're going to make this more addictive. They use synonyms even out in the public. Some of it that we report in this paper is not hidden. It's industry trade newsletters. It's interviews on 60 minutes with labor scientists where they're saying, yeah, we design these products, so you get a big flavor burst. And then it fades really rapidly because that makes you want to keep coming back for more and more and more. And yeah, addictive is a good word for that. And so there is this moment where it just becomes so implausible that they don't know that they have crossed the Rubicon into something that is hooking people. That plausible deniability that we're just, you know, giving consumers what they want, not actually engineering their desires to override what they know they should have to nourish themselves. It just feels beyond the pale to me to believe that's the case.

Allan, look, you mentioned delay. And I'd like to talk about that a little bit more. There's a point in time when the science on something becomes robust. And you're very certain say that tobacco is causing lung cancer and heart disease. And then you can't change things the next day or the next week. So, a little bit of delay is probably acceptable and to be understood. But the delay in this case between that knowledge and significant public health action policy action wasn't measured in days, weeks, months, or even years. It was decades. And you can count the number of attributable deaths to that delay in the millions. What did the industry do to make that delay as long as possible in terms of planting doubt, conflicts of interest with science and things like that?

Allan - This is highly relevant to our moment because I make a few claims in the book. One is that the industry invented disinformation and misinformation. And there's always this way that says, well, I know that study appeared, but we need more information. And this was very clever on the part of the tobacco companies because they said, well, you know, that science shows this, but that science is unreliable. And we need to use different methods. And lung cancer is not a result of cigarette smoking, it's actually genetic. And maybe there are a few people that shouldn't be smoking cigarettes. We should be able to identify what's different about them. They kept finding strategies of delay, manipulation, building uncertainty. There's one of the tobacco documents in this phase that says, from now on, our product is doubt. And what they really needed to do to sell the product was to create doubt about a science that was highly robust and really important to consumers. On the other hand, I think consumers are sensitive to being manipulated. They don't like that. They don't like being tricked. They know these industries, especially tobacco industry, you know, is disreputable. And as that became the case, what did they know and what are they selling. We began to see some slow shifts in public awareness. And, you know, it's so interesting presenting the cigarette problem to a jury in 1970 became radically different than presenting the case against the tobacco companies in the 1990s. And a lot had changed, A lot had been documented and, you know, we never even thought of the idea that a company would scientifically mislead us probably until in any consequential way till the middle of the 20th Century. And now we're incredibly skeptical and I think taking advantage of the public skepticism, both politically and culturally is going to be one of the important issues of pushing back against what I've called rogue industries. They're operating unethically; in many cases, unlawfully. They're misrepresenting what they produce. And they have the idea that having addicted customers is the best customer. And Warren Buffet once said, you know the tobacco industry, that's crazy. It cost a dime to make it. You sell it for a dollar and its addictive. He said, what industry could be more, you know, lucrative than tobacco?

Ashley, how do those things apply into the food area now?

Ashley - Oh, my brain is just exploding with all the things I want to say. But I think I have an answer to Warren Buffett, which is if you've pulled all those same levers and pretend to people that it's food, and it's because we all have to eat, you know? And I walk around a grocery store and I, in my head, I'm like, if I waved a magic wand, and all the products in here that are masquerading as food but are actually ultra processed, chemically adulterated starch, slurries essentially disappeared. There is so little food in my grocery store. Real food. And it's also expensive. We would be rioting in the streets if we really saw the degree that we're not being adequately nourished or supported in our current environment. And it's the mirage of abundance that is totally hooking us. You know, taking us hook, line, and sinker. And so, you know, I'll have people often say to me, you know, it's food. Like can't really be addictive. We all need to eat. And to me that is absolutely true. Just like we all need pain management. And there used to be a belief, a myth, that if you were in pain, you couldn't get addicted to painkillers like opiates which we now know is incredibly wrong. That just because we need calories to survive doesn't mean that if you manipulate and hedonically engineer those products, that it won't impact the brain in a way that can drive it in compulsive problematic ways. It's so essential for us to carve out, yes, you need real nourishing food. This is real nourishing food and these other things. I'd love it if the grocery store, it's like you're walking around this spot, you know you're getting real food. Sure, you want to go get those Cheetos, go for it. But it's in a very clear designated area that you're not being tricked into thinking that you're eating something that's nourishing you when it's really addicting you.

So, people have very strong affective attachments to foods. Particular foods that they like. Some of it is kind of what you grew up with, what your parents gave you, but a lot of it's marketing as well. And you mentioned a Cheeto or Coca-Cola, or a Dorito or a Twinkie or whatever it is. People don't want that taken away from them. Tell me if this is correct, the problem isn't so much that people eat Cheetos. It's that they overeat Cheetos, and then you add to that all the other thing, not just that food. But then you've got a real problem. Could it be a matter of just removing some of the especially troublesome ingredients from that. If you look at the list of ingredients on these foods, there could be 25 or 30 different ingredients. Well, what if, what if 12 of them got taken out or 13 or 15 of them got taken out? You'd still have the food; it would still have its taste. People could enjoy it, but it's not hijacking your biology.

Ashley - Yes, I'm very skeptical of that as the response, because as Allan lays out in his book, we were like, okay, if we just get the tar out of the cigarette. You know, it's all fine, Vapes, right? Oh, you're vaping. It's fine. It will be harmless because our reward system is so porous to different levers that signal food reward. We see it with the non-sugar sweeteners. Look, we took all the sugar out, we gave you Diet Coke, we gave you non-sugar sweeteners. It's a get out of jail free card. And now we're realizing how much that messes up our gut microbiome, could potentially lead to earlier brain aging and so, you know, abstinence, clearly making this stuff illegal, that's never the goal. But I think that sense of saying, oh, we can just engineer our way out of this is unlikely. And we have the alternative. You know, for what should be the majority of what we're eating. I love a Reese's Cup, right? I will have an ultra processed food, but it shouldn't be 60% of the food supply, or 70% of what my kids are getting for their calories. And so again, that clear understanding that this is something that's fundamentally different from the food that nourishes us. We have the answer which is real food. If we poured even a tiny amount of the investment, even closing the tax loopholes on things like ultra processed food marketing to kids that they get tax breaks on and invested that into technology to make real food in its original food matrix affordable, accessible, convenient. That stuff is tasty. Have a fresh apple. It's just everything's been wired for that to be the minority of our food supply. That's often unaffordable and we all feel really time poor. These are solvable problems. We've just been shoving all our money towards how we make new flavor additives to sell high fructose corn syrup, starch, slurries. So, we just need to have the right in incentives in mind.

Your point is very well taken that government trying to say, okay, let take out this ingredient or that ingredient is stepping into a trap. It makes all the sense to me in the world that that is a trap because. Using that philosophy requires a trust in the industry that if you ask them to take out these 12 things, they're not going to put in 12 new things that might even make things worse. And both of these industries, tobacco and the food industry have done everything but earn our trust so that's a very good cautionary note that you raised.

I would say in the tobacco area, the idea of that we think that, you know, vaping will be harm reduction. And there's been a strong political notion that we should be, you know, doing harm reduction. And of course, in many instances, harm reduction can be helpful. But I found in tobacco, that I can't trust the industry to make a harm reduction product that's not going to get kids addicted. That's going to, you know, make sure that we're not using both tobacco and nicotine in the form of vape or other products. And so while many people who I admire in the public health world have said, yes, harm reduction is the way to go. I don't think that's true with tobacco. We have a lot of children and adolescents today who are profoundly addicted to nicotine.

So, this discussion has led to lots of, oh my God, kind of observations from both of you. Paints a pretty scary picture of the food supply. How much manipulation there is. And how much harm gets caused by it. I'm hoping we might end on a bit of a positive note if there is one here. I'd like to ask each of you, is there a reason to be hopeful about the future? Allan, let me start with you. You're looking in on this with a unique perspective because of your years and years of working on tobacco. As you look in on the food space and see what's happening, what do you think?

Allan - Well, I tend to be an optimist. I believe public policies can make a difference. I believe the courts can be used to serve consumers who have been harmed in the market. So, I have seen those things work to a really significant degree around the cigarette. Especially in countries where we have resources for education, where we can make policies that sometimes work or mostly work. I don't think I ever would've thought when I started this work in like the 1980s that we would've gotten so far. I once said to my son when he was seven, he was taking a flight with me. And I said, you know, people used to smoke on airplanes. And he said, no, that's impossible. And he just couldn't believe the idea that we had let people smoke on airplanes. And I've been collecting cigarette packages that were given out by the big airlines. Of course, you and I, Kelly, remember probably, when they start to put smokers in the back of the plane. But the smoke was wafting throughout it. And a lot of things that seem almost impossible now, were actually reduced through regulation and politics and public health. I'm very hopeful that we can use what we've learned about how to get smoking from 50% of the population down to 15 or 12, as bad as that is. And apply it to other gigantic risks like ultra processed foods.

All right, thanks for that positive note. Ashley, what do you think are there grounds for being positive?

Ashley - Yes, I'm also a huge optimist. I feel wildly optimistic. I just, from listening to consumer sentiment right now, the degree to which corporations are able to hack our limbic systems, I mean, you see it right now with social media and sports betting. I think in our bones as a society, we're starting to just get fed up. And to me there is nothing that is more clear cut of how industries can manipulate us than taking food, the thing we most evolved to care about and to find rewarding and nourishing, and somehow jacking it up into an addictive, harmful substance. And I have two little kids. I have a five and 7-year-old and I am just as a mom full of rage every time I go grocery shopping because they've just shoved protein in a Pop-Tart, now they're trying to tell me it's a health food. I think we're catching onto them, and I think that there is no way to go but up. And again, we already have the solution. In opiates, we are still struggling to find non-addictive pain management. We have non-addictive food and it's called, you know, minimally processed real foods. So, it's just about putting the incentives in the right place.

BIOS

Ashley Gearhardt, Ph.D., is a Professor of Psychology in the Clinical Science area at the University of Michigan. She also earned her B.A. in psychology from The University of Michigan as an undergraduate. While working on her doctorate in clinical psychology at Yale University, Dr. Gearhardt became interested in the possibility that certain foods may be capable of triggering an addictive process. To explore this further, she developed the Yale Food Addiction Scale (YFAS) to operationalize addictive eating behaviors, which has been linked with more frequent binge eating episodes, an increased prevalence of obesity and patterns of neural activation implicated in other addictive behaviors. It has been cited over 800 times and translated into over ten foreign languages. Her areas of research also include investigating how food advertising activates reward systems to drive eating behavior and the development of food preferences and eating patterns in infants. She has published over 100 academic publications and her research has been featured on media outlets, such as ABC News, Good Morning America, the Today Show, the Wall Street Journal, and NPR.

Allan M. Brandt is the Amalie Moses Kass Professor of the History of Medicine and Professor of the History of Science at Harvard University, where he holds a joint appointment between the Faculty of Arts and Sciences and Harvard Medical School. Brandt served as Dean of the Graduate School of Arts and Sciences from 2008 to 2012. He earned his undergraduate degree at Brandeis University and a Ph.D. in American History from Columbia University. His work focuses on social and ethical aspects of health, disease, medical practices, and global health in the twentieth century. Brandt is the author of No Magic Bullet: A Social History of Venereal Disease in the United States since 1880 (paperback, 1987; 35th Anniversary Edition, 2020); and co-editor of Morality and Health (1997). He has written on the social history of epidemic disease, the history of public health and health policy, and the history of human experimentation, among other topics. His book on the social and cultural history of cigarette smoking in the U.S., The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product that Defined America, was published by Basic Books in 2007 (paperback, 2009). It received the Bancroft Prize from Columbia University in 2008 and the Welch Medal from the American Association for the History of Medicine in 2011, among other awards. Brandt has been elected to the National Academy of Medicine and the American Academy of Arts and Sciences. In 2015, he was awarded the Everett Mendelsohn Excellence in Mentoring Award by the Harvard Graduate School of Arts and Sciences. In 2019-20, Brandt was a recipient of fellowships from the American Council of Learned Societies and the Radcliffe Institute for Advanced Study. He recently served as the interim chair of the Department of Global Health and Social Medicine at Harvard Medical School. Brandt is currently writing about the history and ethics of stigma and its impact on patients and health outcomes.