In this episode of the Leading Voices in Food podcast, Norbert Wilson of Duke University's Sanford School of Public Policy speaks with researchers Jean Adams from the University of Cambridge and Mike Essman from Duke's World Food Policy Center. They discuss the mandatory calorie labeling policy introduced in England in April 2022 for large food-away-from-home outlets. The conversation covers the study recently published in the British Medical Journal, exploring its results, strengths, limitations, and implications within the broader context of food labeling and public health policies. Key findings include a slight overall reduction in calorie content offered by food outlets, driven by the removal of higher-calorie items rather than reformulation. The discussion also touches on the potential impacts on different consumer groups, the challenges of policy enforcement, and how such policies could be improved to more effectively support public health goals.

Interview Summary

Now everyone knows eating out is just part of life. For many, it's a place to make connections, can be a guilty pleasure, and sometimes it's just an outright necessity for busy folks. But it is also linked to poor dietary quality, weight gain, and even obesity. For policymakers, the challenge is identifying what policy changes can help improve population health. Jean, let's begin with you. Can you tell our listeners about the UK's menu labeling intervention and what change did you hope to see?

Jean - Yes, so this was a policy that was actually a really long time in coming and came in and out of favor with a number of different governments. So maybe over the last 10 years we've had various different suggestions to have voluntary and/or mandatory calorie labeling in the out-of-home sector. Eventually in April, 2022, we did have new mandatory regulations that came into a force that required large businesses just in England - so not across the whole of the UK, just in England - if they sold food and non-alcoholic drinks and they had to display the calories per portion of every item that they were selling. And then have alongside that somewhere on their menu, a statement that said that adults need around 2000 calories per day. The policy applied just to large businesses, and the definition of that was that those businesses have 250 or more employees, but the employees didn't all have to be involved in serving food and drinks. This might apply also to a large hotel chain who just have some bars or something in their hotels. And the food and drinks covered were things that were available for immediate consumption. Not prepackaged. And then there was also this proviso to allow high-end restaurants to be changing their menus regularly. So, it was only for things that were on the menu for at least 30 days.

You mentioned that this policy or a menu labeling might have at least two potential modes of impacts. There's first this idea that providing calories or any sort of labeling on food can somehow provide information for consumers to make what we might hope would be better choices. Might help them choose lower calorie options or healthier options. And then the second potential impact is that businesses might also use the information to change what sort of foods they're serving. It might be that they didn't realize how many calories were in the foods and they're suddenly embarrassed about it. Or as soon as their customers realize, they start to put a little bit of pressure on, you know, we want something a little bit lower calorie. So, there's this potential mechanism that operates at the demand side of how consumers might make choices. And another one at the supply side of what might be available to consumers. And we knew from previous evaluations of these sorts of interventions that there was some evidence that both could occur. Generally, it seems to be that findings from other places and countries are maybe null to small. So, we were thinking that maybe we might see something similar in England.

Thank you for sharing that background. I do have a question about the length of time it took to get this menu labeling law in place. Before we get into the results, do you have a sense of why did it take so long? Was it industry pushback? Was it just change of governments? Do you have a sense of that?

Jean - Yes, so I think it's probably a bit of both. To begin with, it was first proposed as a voluntary measure actually by industry. So, we had this kind of big public-private partnership. What can industry do to support health? And that was one of the things they proposed. And then they didn't really do it very well. So, there was this idea that everybody would do it. And in fact, we found maybe only about 20% of outlets did it. And then definitely we have had government churn in the UK over the last five years or so. So, every new prime minister really came in and wanted to have their own obesity policy threw out the last one started over. And every policy needs consulted on with the public and then with industry. And that whole process just kind of got derailed over and over again.

Thank you. That is really helpful to understand that development of the policy and why it took time. Industry regulated policy can be a tricky one to actually see the results that we would hope. You've already given us a sort of insight into what you thought the results may be from previous studies - null to relatively small. So, Mike, I want to turn to you. Can you tell us what came out of the data?

Mike - Thank you, yes. So, we found a small overall drop in average calories offered per item. That amounts to a total of nine calories per item reduction in our post policy period relative to pre policy. And this is about a 2% reduction. It was statistically significant and we do in public health talk about how small effects can still have big impacts. So, I do want to sort of put that out there, but also recognize that it was a small overall drop in calories. And then what we did is we looked at how different food groups changed, and also how calories changed at different types of restaurants, whether it was fast food, restaurants, sit downs that we call pubs, bars, and inns. And then also other different types of takeaways like cafes and things like that where you might get a coffee or a cappuccino or something like that.

What we found was driving the overall reduction in calories was a reduction in higher calorie items. So, as Jean mentioned at the outset, one of the things we were trying to identify in this analysis was whether we saw any evidence of reformulation. And we defined reformulation as whether specific products were reduced in their calories so that the same products were lower calories in the post period. We define that as reformulation. And that would be different from, say, a change in menu offering where you might identify a high calorie item and take it off the menu so that then the overall calories offered goes down on average. We found more evidence for the latter. Higher calorie items were removed. We separated into categories of removed items, items that were present in both periods, and new items added in the post period. There were higher calorie items in the removed group. The items that were present in both periods did not change. The new items were lower calorie items. What this says overall is this average reduction is driven by taking off high calorie items, adding some slightly lower calorie items. But we did not find evidence for reformulation, which is a crucial finding as well.

We saw that the largest reductions occurred in burgers, beverages and a rather large mixed group called Mains. So, burgers reduced by 103 calories per item. That's pretty substantial. One of the reasons that's so large is that burgers, particularly if they're offered at a pub and might even come with fries or chips, as they say in the UK. And because they have such a high baseline calorie level, there's more opportunity to reduce. So, whether it's making it slightly smaller patty or reducing the cheese or something like that, that's where we saw larger reductions among the burgers. With beverages, typically, this involved the addition of lower calorie options, which is important if it gives an opportunity for lower calorie selections. And that was the main driver of reduction there. And then also we saw in Mains a reduction of 30 calories per item.

A couple of the other things we wanted to identify is whether there was a change in the number of items that were considered over England's recommended calories per meal. The recommended calories per meal is 600 calories or less for lunch and dinner. And we saw no statistical change in that group.

So overall, we do see a slight reduction in average calories. But this study did not examine changes in consumer behavior. I do want to just briefly touch on that because this was part of a larger evaluation. Another study that was published using customer surveys that was published in Nature Human Behavior found no change in the average calories purchased or consumed after the policy. This evaluation was looking at both the supply and the demand side changes as a result of this policy.

Thanks, Mike and I've got lots of questions to follow up, but I'll try to control myself. The first one I'm interested to understand is you talk about the importance of the really calorie-heavy items being removed and the introduction of newer, lower calorie items. And you said that this is not a study of the demand, but I'm interested to know, do you have a sense that the higher calorie items may not have been high or top sellers. It could be easy for a restaurant to get rid of those. Do you have any sense of, you know, the types of items that were removed and of the consumer demand for those items?

Mike - Yes. So, as I mentioned, given that the largest changes were occurring among burgers, we're sort of doing this triangulation attempt to examine all of the different potential impacts we can with the study tools we have. We did not see those changes reflected in consumer purchases. So, I think sticking with the evidence, the best thing we could say is that the most frequently purchased items were not the ones that were being pulled off of menus. I think that would be the closest to the evidence. Now, no study is perfect and we did in that customer survey examine the purchases and consumption of about 3000 individuals before and after the policy. It's relatively large, but certainly not fully comprehensive. But based on what we were able to find, it would seem that those reductions in large calorie items, it's probably fair to say, were sort of marginal choices. So, we see some reduction in calories at the margins. That's why the overall is down, but we don't see at the most commonly sold. I should also mention in response to that, a lot of times when we think about eating out of home, we often think about fast food. We did not see reductions in fast food chains at all, essentially. And so really the largest reductions we found were in what would be considered more sit-down dining establishment. For example, sit-down restaurants or even pubs, bars and ends was one of our other categories. We did see average reductions in those chains. The areas you kind of think about for people grabbing food quickly on the go, we did not see reductions there. And we think some of this is a function of the data itself, which is pubs, bars and inns, because they offer larger plates, there's a little bit more space for them to reduce. And so those are where we saw the reductions. But in what we might typically think is sort of the grab and go type of food, we did not see reductions in those items. And so when we did our customer surveys, we saw that those did not lead to reductions in calories consumed.

Ahh, I see this and thank you for this. It sounds like the portfolio adjusted: getting rid of those heavy calorie items, adding more of the lower calorie items that may not have actually changed what consumers actually eat. Because the ones that they typically eat didn't change at all. And I would imagine from what you've said that large global brands may not have made many changes, but more local brands have more flexibility is my assumption of that. So that, that's really helpful to see.

As you all looked at the literature, you had the knowledge that previous studies have found relatively small changes. Could you tell us about what this work looks like globally? There are other countries that have tried policy similar to this. What did you learn from those other countries about menu labeling?

Jean - Well, I mean, I'm tempted to say that we maybe should have learned that this wasn't the sort of policy that we could expect to make a big change. To me one of the really attractive features of a labeling policy is it kind of reflects back those two mechanisms we've talked about - information and reformulation or changing menus. Because we can talk about it in those two different ways of changing the environment and also helping consumers make better choices, then it can be very attractive across the political landscape. And I suspect that that is one of the things that the UK or England learned. And that's reflected in the fact that it took a little while to get it over the line, but that lots of different governments came back to it. That it's attractive to people thinking about food and thinking about how we can support people to eat better in kind of a range of different ways. I think what we learned, like putting the literature all together, is this sort of policy might have some small effects. It's not going to be the thing that kind of changes the dial on diet related diseases. But that it might well be part of an integrated strategy of many different tools together. I think we can also learn from the literature on labeling in the grocery sector where there's been much more exploration of different types of labeling. Whether colors work, whether black stop signs are more effective. And that leads us to conclusions that these more interpretive labels can lead to bigger impacts and consumer choices than just a number, right? A number is quite difficult to make some sense of. And I think that there are some ways that we could think about optimizing the policy in England before kind of writing it off as not effective.

Thank you. I think what you're saying is it worked, but it works maybe in the context of other policies, is that a fair assessment?

Jean - Well, I mean, the summary of our findings, Mike's touched on quite a lot of it. We found that there was an increase in outlets adhering to the policy. That went from about 20% offered any labeling to about 80%. So, there were still some places that were not doing what they were expected to do. But there was big changes in actual labeling practice. People also told us that they noticed the labels more and they said that they used them much more than they were previously. Like there was some labeling before. We had some big increases in noticing and using. But it's... we found this no change in calories purchased or calories consumed. Which leads to kind of interesting questions. Okay, so what were they doing with it when they were using it? And maybe some people were using it to help them make lower calorie choices, but other people were trying to optimize calories for money spent? We saw these very small changes in the mean calorie of items available that Mike's described in lots of detail. And then we also did some work kind of exploring with restaurants, people who worked in the restaurant chains and also people responsible for enforcement, kind of exploring their experiences with the policy. And one of the big conclusions from that was that local government were tasked with enforcement, but they weren't provided with any additional resources to make that happen. And for various reasons, it essentially didn't happen. And we've seen that with a number of different policies in the food space in the UK. That there's this kind of presumption of compliance. Most people are doing it all right. We're not doing it a hundred percent and that's probably because it's not being checked and there's no sanction for not following the letter of the law. One of the reasons that local authorities are not doing enforcement, apart from that they don't have resources or additional resources for it, is that they have lots of other things to do in the food space, and they see those things as like higher risk. And so more important to do. One of those things is inspecting for hygiene, making sure that the going out is not poisonous or adulterated or anything like that. And you can absolutely understand that. These things that might cause acute sickness, or even death in the case of allergies, are much more important for them to be keeping an eye on than labeling.

One of the other things that emerged through the process of implementation, and during our evaluation, was a big concern from communities with experience of eating disorders around kind of a greater focus on calorie counting. And lots of people recounting their experience that they just find that very difficult to be facing in a space where they're maybe not trying to think about their eating disorder or health. And then they're suddenly confronted with it. And when we've gone back and looked at the literature, there's just not very much literature on the impact of calorie labeling on people with eating disorders. And so we're a little bit uncertain still about whether that is a problem, but it's certainly perceived to be a problem. And lots of people find the policy difficult for that reason because they know someone in their family or one of their friends with an eating disorder. And they're very alert to that potential harm.

I think this is a really important point to raise that the law, the menu labeling, could have differential effects on different consumers. I'm not versed in this literature on the triggering effects of seeing menu labeling for people with disordered eating. But then I'm also thinking about a different group of consumers. Consumers who are already struggling with obesity, and whether or not this policy is more effective for those individuals versus folks who are not. In the work that you all did, did you have any sense of are there heterogeneous effects of the labeling? Did different consumers respond differentially to seeing the menu label? Not just, for example, individuals maybe with disordered eating?

Mike - In this work, we mostly focused on compliance, customer responses in terms of consumption and purchases, changes in menus, and customers reporting whether or not they increase noticing and using. When we looked at the heterogeneous effects, some of these questions are what led us to propose a new project where we interviewed people and tried to understand their responses to calorie labeling. And there we get a lot of heterogenous groups. In those studies, and this work has not actually been published, but should be in the new year, we found that there's a wide range of different types of responses to the policy. For example, there may be some people who recently started going to the gym and maybe they're trying to actually bulk up. And so, they'll actually choose higher calorie items. Conversely, there may be people who have a fitness routine or a dieting lifestyle that involves calorie tracking. And they might be using an app in order to enter the calories into that. And those people who are interested in calorie counting, they really loved the policy. They really wanted the policy. And it gave them a sense of control over their diet. And they felt comfortable and were really worried that if there was evidence that it wouldn't work, that would be taken away. Then you have a whole different group of people who are living with eating disorders who don't want to interact with those numbers when they are eating out of home. They would rather eat socially and not have to think about those challenges. There's really vast diversity in terms of the responses to the policy. And that does present a challenge.

And I think what it also does is cause us just to question what is the intended mechanism of action of this policy? Because when the policy was implemented, there's an idea of a relatively narrow set of effects. If customers don't understand the number of calories that are in their items, you just provide them with the calories that are in those items, they will then make better choices as rational actors. But we know that eating out of home is far more complex. It's social. There are issues related to value for money. So maybe people want to make sure they're purchasing food that hasn't been so reduced in portions that now they don't get the value for money when they eat out. There are all sorts of body image related challenges when people may eat out. We didn't find a lot of evidence of this in our particular sample, but also in some of our consultation with the public in developing the interview, there's concern about judgment from peers when eating out. So, it's a very sensitive topic. Some of the implications of that are we do probably need more communication strategies that can come alongside these policies and sort of explain the intended mechanism impact to the public. We can't expect to simply add numbers to items and then expect that people are going to make the exact choices that are sort of in the best interest of public health. And that sort of brings us on to some potential alternative mechanisms of impact and other modes of labeling, and those sorts of things.

Mike, this has been really helpful because you've also hinted at some of the ways that this policy as implemented, could have been improved. And I wonder, do you have any other thoughts to add to how to make a policy like this have a bigger impact.

Mike - Absolutely. One of the things that was really helpful when Jean laid out her framing of the policy was there's multiple potential mechanisms of action. One of those is the potential reformulation in menu change. We talked about those results. Another intended mechanism of action is through consumer choice. So, if items have fewer calories on average, then that could reduce ultimately calories consumed. Or if people make choices of lower calorie items, that could also be a way to reduce the overall calories consumed. And I would say this calorie labeling policy, it is a step because the calories were not previously available. People did not know what they were eating. And if you provide that, that fulfills the duty of transparency by businesses. When we spoke to people who worked in enforcement, they did support the policy simply on the basis of transparency because it's important for people to understand what they're consuming. And so that's sort of a generally acceptable principle. However, if we want to actually have stronger population health impact, then we do need to have stronger mechanisms of action.

One of the ways that can reduce calories consumed by the consumers, so the sort of demand side, would be some of the interpretive labels. Jean mentioned them earlier. There's now a growing body of evidence of across, particularly in Latin America. I would say some of the strongest evidence began in Chile, but also in Mexico and in other Latin American countries where they've put warning labels on items in order to reduce their consumption. These are typically related to packaged foods is where most of the work has been done. But in order to reduce consumer demand, what it does is rather than expecting people to be sort of doing math problems on the fly, as they go around and make their choices, you're actually just letting them know, well, by the way, this is an item that's very high in calories or saturated fat, or sodium or sugars. Or some combination of those. What that does is you've already helped make that decision for the consumers. You've at least let them know this item has a high level of nutrients of concern. And you can take that away. Conversely, if you have an item that's 487 calories, do you really know what you're going to do with that information? So that's one way to have stronger impact.

The other way that that type of policy can have stronger impact is it sets clear thresholds for those warnings. And so, when you have clear thresholds for warnings, you can have a stronger mechanism for reformulation. And what companies may want to do is they may not want to display those warning labels, maybe because it's embarrassing. It makes their candy or whatever the unhealthy food look bad. Sort of an eyesore, which is the point. And what they'll do is they can reformulate those nutrients to lower levels so that they no longer qualify for that regulation. And so there are ways to essentially strengthen both of those mechanisms of action. Whereas when it's simply on the basis of transparency, then what that does is leave all of the decision making and work on the consumer.

Mike, this is great because I've worked with colleagues like Gabby Fretes and Sean Cash and others on some menu labeling out of Chile. And we're currently doing some work within the center on food nutrition labels to see how different consumers are responding. There's a lot more work to be done in this space. And, of course, our colleagues at UNC (University of North Carolina-Chapel Hill) have also been doing this work. So, this work is really important because it tells us how it can help consumers make different choices, and how it can affect how companies behave. My final question to the two of you is simply, what would you like policymakers to learn from this study? Or maybe not just this study alone, but this body of work. What should they take away?

Jean - Well, I think there's lots of information out there on how to do food labeling well, and we can certainly learn from that. And Mike talks about the work from South America particularly where they're helping people identify the least healthy products. And they're also providing messaging around what you should do with that - like choose a product with fewer of these black symbols. But I think even if labeling is optimized, it's not really going to solve our problem of dietary related diseases. And I think I always want policymakers to know, and I think many of them do understand this, that there is no one magic solution and we need to be thinking about labeling as part of a strategy that addresses marketing in its entirety, right? Companies are using all sorts of strategies to encourage us to buy products. We need to be thinking of all sorts of strategies to support people to buy different products and to eat better. And I think that focuses on things like rebalancing price, supporting people to afford healthier food, focusing advertising and price promotions on healthier products. And I also think we need to be looking even further upstream though, right? That we need to be thinking about the incentives that are driving companies to make and sell less healthy products. Because I don't think that they particularly want to be selling less healthy products or causing lots of illness. It's those products are helping them achieve their aims of creating profit and growth for their shareholders. And I think we need to find creative ways to support companies to experiment with healthier products that either help them simultaneously achieve those demands of profit or growth. Or somehow allow them to step away from those demands either for a short period or for a longer period. I think that that requires us to kind of relook at how we do business in economics in our countries.

Mike?

Yes, I think that was a really thorough answer by Jean. So, I'll just add a couple points. I think most fundamentally what we need to think about when we're doing policy making to improve diet is we need to always think about are we helping to make the healthier choice the easier choice? And what that means is we're not implementing policies that merely provide information that then require individuals to do the rest of the work. We need to have a food environment that includes healthier options that are easily accessible, but also affordable. That's one thing that's come through in quite a lot of the work we've done. There are a lot of concerns about the high cost of food. If people feel like the healthier choices are also affordable choices, that's one of many ways to support the easier choice. And I really just want to reiterate what Jean said in terms of the economics of unhealthy food. In many ways, these large multinational corporations are from their perspective, doing right by their shareholders by producing a profitable product.

Now there are debates on whether or not that's a good thing, of course. There's quite a lot of evidence for the negative health impacts of ultra-processed (UPF) products, and those are getting a lot more attention these days and that's a good thing. What we do need to think about is why is it that UPFs are so widely consumed. In many ways they are optimized to be over consumed. They're optimized to be highly profitable. Because the ingredients that are involved in their production means that they can add a lot of salt, sugar, and fat. And what that does is lead to overconsumption. We need to think about that there's something fundamentally broken about this incentive structure. That is incentivizing businesses to sell unhealthy food products with these food additives that lead to over consumption, obesity, and the associated comorbidities. And if we can start to make a little progress and think creatively about how could we incentivize a different incentive structure. One where actually it would be in a food business's best interest to be much more innovative and bolder and produce healthier products for everyone. That's something that I think we will have to contend with because if we are thinking that we are only going to be able to restrict our way out of this, then that's very difficult. Because people still need to have healthy alternatives, and so we can't merely think about restricting. We also have to think about how do we promote access to healthier foods.

This is great insight. I appreciate the phrasing of making the healthy choice the easy choice, and I also heard a version of this making the healthy choice the affordable choice. But it also seems like we need to find ways to make the healthy choice the profitable choice as well.

Bios:

Jean Adams is a Professor of Dietary Public Health and leads the Population Health Interventions Programme at the University of Cambridge MRC Epidemiology Unit. Adams trained in medicine before completing a PhD on socio-economic inequalities in health. This was followed by an MRC Health of the Population fellowship and an NIHR Career Development Fellowship both exploring influences on health behaviours and socio-economic inequalities in these. During these fellowships Jean was appointed Lecturer, then Senior Lecturer, in Public Health at Newcastle University. Jean moved to Cambridge University to join the MRC Epidemiology Unit and CEDAR in 2014 where she helped establish the Dietary Public Health group. She became Programme Leader in the newly formed Population Health Interventions programme in 2020, and was appointed Professor of Dietary Public Health in 2022.

Mike Essman is a Research Scientist at Duke University's World Food Policy Center. His background is in evaluating nutrition and food policies aimed at improving diets and preventing cardiometabolic diseases. His work employs both quantitative and qualitative methods to explore drivers of dietary behavior, particularly ultra-processed food consumption, across diverse environments and countries. Mike earned his PhD in Nutrition Epidemiology from the University of North Carolina at Chapel Hill, where his research focused on evaluating the impacts of a sugary beverage tax in South Africa. He completed MSc degrees in Medical Anthropology and Global Health Science at the University of Oxford through a fellowship. Prior to joining Duke, he conducted research at the MRC Epidemiology Unit at the University of Cambridge, where he evaluated the impacts of calorie labeling policies in England and led a study examining public perceptions of ultra-processed foods.

In this episode, Kelly Brownell speaks with Jerold Mande, CEO of Nourish Science, adjunct professor at the Harvard School of Public Health, and former Deputy Undersecretary for Food Safety at the USDA. They discuss the alarming state of children's health in America, the challenges of combating poor nutrition, and the influence of the food industry on public policy. The conversation explores the parallels between the tobacco and food industries and proposes new strategies for ensuring children reach adulthood in good health. Mande emphasizes the need for radical changes in food policy and the role of public health in making these changes.

Transcript

So, you co-founded this organization along with Jerome Adams, Bill Frist and Thomas Grumbly, as we said, to ensure every child breaches age 18 at a healthy weight and in good metabolic health. That's a pretty tall order given the state of the health of youth today in America. But let's start by you telling us what inspired this mission and what does it look like to achieve this in today's food environment?

I was trained in public health and also in nutrition and in my career, which has been largely in service of the public and government, I've been trying to advance those issues. And unfortunately over the arc of my career from when I started to now, particularly in nutrition and public health, it's just gotten so much worse. Indeed today Americans have the shortest lifespans by far. We're not just last among the wealthy countries, but we're a standard deviation last. But probably most alarming of all is how sick our children are. Children should not have a chronic disease. Yet in America maybe a third do.

I did some work on tobacco at one point, at FDA. That was an enormous success. It was the leading cause of death. Children smoked at a higher rate, much like child chronic disease today. About a third of kids smoked. And we took that issue on, and today it's less than 2%. And so that shows that government can solve these problems. And since we did our tobacco work in the early '90s, I've changed my focus to nutrition and public health and trying to fix that. But we've still made so little progress.

Give us a sense of how far from that goal we are. So, if the goal is to make every child reaching 18 at a healthy weight and in good metabolic health, what percentage of children reaching age 18 today might look like that?

It's probably around a half or more, but we're not quite sure. We don't have good statistics. One of the challenges we face in nutrition is, unfortunately, the food industry or other industries lobby against funding research and data collection. And so, we're handicapped in that way. But we do know from the studies that CDC and others have done that about 20% of our children have obesity about a similar number have Type 2 diabetes or the precursors, pre-diabetes. You and I started off calling it adult-onset diabetes and they had to change that name to a Type 2 because it's becoming so common in kids. And then another disease, fatty liver disease, really unthinkable in kids. Something that the typical pediatrician would just never see. And yet in the last decade, children are the fastest growing group. I think we don't know an exact number, but today, at least a third, maybe as many as half of our children have a chronic disease. Particularly a food cause chronic disease, or the precursors that show they're on the way.

I remember probably going back about 20 years, people started saying that we were seeing the first generation of American children that would lead shorter lives than our parents did. And what a terrible legacy to leave our children.

Absolutely. And that's why we set that overarching goal of ensuring every child reaches age 18 in good metabolic health. And the reason we set that is in my experience in government, there's a phrase we all use - what gets measured gets done. And when I worked at FDA, when I worked at USDA, what caught my attention is that there is a mission statement. There's a goal of what we're trying to achieve. And it's ensuring access to healthy options and information, like a food label. Now the problem with that, first of all, it's failed. But the problem with that is the bureaucrats that I oversaw would go into a supermarket, see a produce section, a protein section, the food labels, which I worked on, and say we've done our job. They would check those boxes and say, we've done it. And yet we haven't. And if we ensured that every child reaches age 18 at a healthy weight and good metabolic health, if the bureaucrats say how are we doing on that? They would have to conclude we're failing, and they'd have to try something else. And that's what we need to do. We need to try radically different, new strategies because what we've been doing for decades has failed.

You mentioned the food industry a moment ago. Let's talk about that in a little more detail. You made the argument that food companies have substituted profits for health in how they design their products. Explain that a little bit more, if you will. And tell us how the shift has occurred and what do you think the public health cost has been?

Yes, so the way I like to think of it, and your listeners should think of it, is there's a North star for food design. And from a consumer standpoint, I think there are four points on the star: taste, cost, convenience, and health. That's what they expect and want from their food. Now the challenge is the marketplace. Because that consumer, you and I, when we go to the grocery store and get home on taste, cost, and convenience, if we want within an hour, we can know whether the food we purchased met our standard there. Or what our expectations were. Not always for health. There's just no way to know in a day, a week, a month, even in a year or more. We don't know if the food we're eating is improving and maintaining our health, right? There should be a definition of food. Food should be what we eat to thrive. That really should be the goal. I borrowed that from NASA, the space agency. When I would meet with them, they said, ' Jerry, it's important. Right? It's not enough that people just survive on the food they eat in space. They really need to thrive.' And that's what WE need to do. And that's really what food does, right? And yet we have food, not only don't we thrive, but we get sick. And the reason for that is, as I was saying, the marketplace works on taste, cost and convenience. So, companies make sure their products meet consumer expectation for those three. But the problem is on the fourth point on the star: on health. Because we can't tell in even years whether it's meeting our expectation. That sort of cries out. You're at a policy school. Those are the places where government needs to step in and act and make sure that the marketplace is providing. That feedback through government. But the industry is politically strong and has prevented that. And so that has left the fourth point of the star open for their interpretation. And my belief is that they've put in place a prop. So, they're making decisions in the design of the product. They're taste, they gotta get taste right. They gotta get cost and convenience right. But rather than worrying what does it do to your health? They just, say let's do a profit. And that's resulted in this whole category of food called ultra-processed food (UPF). I actually believe in the future, whether it's a hundred years or a thousand years. If humanity's gonna thrive we need manmade food we can thrive on. But we don't have that. And we don't invest in the science. We need to. But today, ultra-processed food is manmade food designed on taste, cost, convenience, and then how do we make the most money possible.

Now, let me give you one other analogy, if I could. If we were CEOs of an automobile company, the mission is to provide vehicles where people can get safely from A to point B. It's the same as food we can thrive on. That is the mission. The problem is that when the food companies design food today, they've presented to the CEO, and everyone gets excited. They're seeing the numbers, the charts, the data that shows that this food is going to meet, taste, cost, convenience. It's going to make us all this money. But the CEO should be asking this following question: if people eat this as we intend, will they thrive? At the very least they won't get sick, right? Because the law requires they can't get sick. And if the Midmanagers were honest, they'd say here's the good news boss. We have such political power we've been able to influence the Congress and the regulatory agencies. That they're not going to do anything about it. Taste, cost, convenience, and profits will work just fine.

Couldn't you make the argument that for a CEO to embrace that kind of attitude you talked about would be corporate malpractice almost? That, if they want to maximize profits then they want people to like the food as much as possible. That means engineering it in ways that make people overeat it, hijacking the reward pathways in the brain, and all that kind of thing. Why in the world would a CEO care about whether people thrive?

Because it's the law. The law requires we have these safety features in cars and the companies have to design it that way. And there's more immediate feedback with the car too, in terms of if you crashed right away. Because it didn't work, you'd see that. But here's the thing. Harvey Wiley.He's the founder of the food safety programs that I led at FDA and USDA. He was a chemist from academia. Came to USDA in the late 1800s. It was a time of great change in food in America. At that point, almost all of families grew their own food on a farm. And someone had to decide who's going to grow our food. It's a family conversation that needed to take place. Increasingly, Americans were moving into the cities at that time, and a brand-new industry had sprung up to feed people in cities. It was a processed food industry. And in order to provide shelf stable foods that can offer taste, cost, convenience, this new processed food industry turned to another new industry, a chemical industry. Now, it's hard to believe this, but there was a point in time that just wasn't an industry. So these two big new industries had sprung up- processed food and chemicals. And Harvey Wiley had a hypothesis that the chemicals they were using to make these processed foods were making us sick. Indeed, food poisoning back then was one of the 10 leading causes of death. And so, Harvey Wiley went to Teddy Roosevelt. He'd been trying for years within the bureaucracy and not making progress. But when Teddy Roosevelt came in, he finally had the person who listened to him. Back then, USDA was right across from the Washington Monument to the White House. He'd walk right over there into the White House and met with Teddy Roosevelt and said, ' this food industry is making us sick. We should do something about it.' And Teddy Roosevelt agreed. And they wrote the laws. And so I think what your listeners need to understand is that when you look at the job that FDA and USDA is doing, their food safety programs were created to make sure our food doesn't make us sick.

Acutely sick. Not heart disease or cancer, 30, 40 years down the road, but acutely sick.

No. I think that's absolutely the point. That's what Wiley was most concerned about at the time. But that's not the law they wrote. The law doesn't say acutely ill. And I'll give you this example. Your listeners may be familiar with something called GRAS - Generally Recognized as Safe. It's a big problem today. Industry co-opted the system and no longer gets approval for their food additives. And so, you have this Generally Recognized as Safe system, and you have these chemicals and people are worried about them. In the history of GRAS. Only one chemical has FDA decided we need to get that off the market because it's unsafe. That's partially hydrogenated oils or trans-fat. Does trans-fat cause acute illness? It doesn't. It causes a chronic disease. And the evidence is clear. The agency has known that it has the responsibility for both acute and chronic illness. But you're right, the industry has taken advantage of this sort of chronic illness space to say that that really isn't what you should be doing. But having worked at those agencies, I don't think they see it that way. They just feel like here's the bottom line on it. The industry uses its political power in Congress. And it shapes the agency's budget. So, let's take FDA. FDA has a billion dollars with a 'b' for food safety. For the acute food safety, you're talking about. It has less than 25 million for the chronic disease. There are about 1400 deaths a year in America due to the acute illnesses caused by our food that FDA and USDA are trying to prevent. The chronic illnesses that we know are caused by our food cause 1600 maybe a day. More than that of the acute every day. Now the agency should be spending at least half its time, if not more, worrying about those chronic illness. Why doesn't it? Because the industry used their political power in Congress to put the billion dollars for the acute illness. That's because if you get acutely ill, that's a liability concern for them.

Jerry let's talk about the political influence in just a little more detail, because you're in a unique position to tell us about this because you've seen it from the inside. One mechanism through which industry might influence the political process is lobbyists. They hire lobbyists. Lobbyists get to the Congress. People make decisions based on contributions and things like that. Are there other ways the food industry affects the political process in addition to that. For example, what about the revolving door issue people talk about where industry people come into the administrative branch of government, not legislative branch, and then return to industry. And are there other ways that the political influence of the industry has made itself felt?

I think first and foremost it is the lobbyists, those who work with Congress, in effect. Particularly the funding levels, and the authority that the agencies have to do that job. I think it's overwhelmingly that. I think second, is the influence the industry has. So let me back up to that a sec. As a result of that, we spend very little on nutrition research, for example. It's 4% of the NIH budget even though we have these large institutes, cancer, heart, diabetes, everyone knows about. They're trying to come up with the cures who spend the other almost 50 billion at NIH. And so, what happens? You and I have both been at universities where there are nutrition programs and what we see is it's very hard to not accept any industry money to do the research because there isn't the federal money. Now, the key thing, it's not an accident. It's part of the plan. And so, I think that the research that we rely on to do regulation is heavily influenced by industry. And it's broad. I've served, you have, others, on the national academies and the programs. When I've been on the inside of those committees, there are always industry retired scientists on those committees. And they have undue influence. I've seen it. Their political power is so vast.

The revolving door, that is a little of both ways. I think the government learns from the revolving door as well. But you're right, some people leave government and try to undo that. Now, I've chosen to work in academia when I'm not in government. But I think that does play a role, but I don't think it plays the largest role. I think the thing that people should be worried about is how much influence it has in Congress and how that affects the agency's budgets. And that way I feel that agencies are corrupted it, but it's not because they're corrupted directly by the industry. I think it's indirectly through congress.

I'd like to get your opinion on something that's always relevant but is time sensitive now. And it's dietary guidelines for America. And the reason I'm saying it's time sensitive is because the current administration will be releasing dietary guidelines for America pretty soon. And there's lots of discussion about what those might look like. How can they help guide food policy and industry practices to support healthier children and families?

It's one of the bigger levers the government has. The biggest is a program SNAP or food stamps. But beyond that, the dietary guidelines set the rules for government spending and food. So, I think often the way the dietary guidelines are portrayed isn't quite accurate. People think of it in terms of the once (food) Pyramid now the My Plate that's there. That's the public facing icon for the dietary guidelines. But really a very small part. The dietary guidelines are meant to help shape federal policy, not so much public perception. It's there. It's used in education in our schools - the (My) Plate, previously the (Food) Pyramid. But the main thing is it should shape what's served in government feeding programs. So principally that should be SNAP. It's not. But it does affect the WIC program- Women, Infants and Children, the school meals program, all of the military spending on food. Indeed, all spending by the government on food are set, governed by, or directed by the dietary guidelines. Now some of them are self-executing. Once the dietary guidelines change the government changes its behavior. But the biggest ones are not. They require rulemaking and in particular, today, one of the most impactful is our kids' meals in schools. So, whatever it says in these dietary guidelines, and there's reason to be alarmed in some of the press reports, it doesn't automatically change what's in school meals. The Department of Agriculture would have to write a rule and say that the dietary guidelines have changed and now we want to update. That usually takes an administration later. It's very rare one administration could both change the dietary guidelines and get through the rulemaking process. So, people can feel a little reassured by that.

So, how do you feel about the way things seem to be taking shape right now?

This whole MAHA movement Make America Healthy Again. What is it? To me what it is we've reached this tipping point we talked about earlier. The how sick we are, and people are saying, 'enough. Our food shouldn't make us sick at middle age. I shouldn't have to be spending so much time with my doctor. But particularly, it shouldn't be hard to raise my kids to 18 without getting sick. We really need to fix that and try to deal with that.' But I think that the MAHA movement is mostly that. But RFK and some of the people around them have increasingly claimed that it means some very specific things that are anti-science. That's been led by the policies around vaccine that are clearly anti-science. Nutrition is more and more interesting. Initially they started out in the exact right place. I think you and I could agree the things they were saying they need to focus on: kids, the need to get ultra-processed food out of our diets, were all the right things. In fact, you look at the first report that RFK and his team put out back in May this year after the President put out an Executive Order. Mostly the right things on this. They again, focus on kids, ultra-processed food was mentioned 40 times in the report as the root cause for the very first time. And this can't be undone. You had the White House saying that the root cause of our food-caused chronic disease crisis is the food industry. That's in a report that won't change. But a lot has changed since then. They came out with a second report where the word ultra-processed food showed up only once.

What do you think happened?

I know what happened because I've worked in that setting. The industry quietly went to the White House, the top political staff in the White House, and they said, you need to change the report when you come out with the recommendations. And so, the first report, I think, was written by MAHA, RFK Jr. and his lieutenants. The second report was written by the White House staff with the lobbyists of the food industry. That's what happened. What you end up with is their version of it. So, what does the industry want? We have a good picture from the first Trump administration. They did the last dietary guidelines and the Secretary of Agriculture, then Sonny Perdue, his mantra to his staff, people reported to me, was the industries- you know, keep the status quo. That is what the industry wants is they really don't want the dietary guidelines to change because then they have to reformulate their products. And they're used to living with what we have and they're just comfortable with that. For a big company to reformulate a product is a multi-year effort and cost billions of dollars and it's just not what they want to have to do. Particularly if it's going to change from administration to administration. And that is not a world they want to live in. From the first and second MAHA report where they wanted to go back to the status quo away from all the radical ideas. It'll be interesting to see what happens with dietary guidelines because we've seen reports that RFK Jr. and his people want to make shifts in policies. Saying that they want to go back to the Pyramid somehow.

There's a cartoon on TV, South Park, I thought it was produced to be funny. But they talked about what we need to do is we need to flip the Pyramid upside down and we need to go back to the old Pyramid and make saturated fat the sort of the core of the diet. I thought it meant to be a joke but apparently that's become a belief of some people in the MAHA movement. RFK. And so, they want to add saturated fat back to our diets. They want to get rid of plant oils from our diets. There is a lot of areas of nutrition where the science isn't settled. But that's one where it is, indeed. Again, you go back only 1950s, 1960s, you look today, heart disease, heart attacks, they're down 90%. Most of that had to do with the drugs and getting rid of smoking. But a substantial contribution was made by nutrition. Lowering saturated fat in our diets and replacing it with plant oils that they're now called seed oils. If they take that step and the dietary guidelines come out next month and say that saturated fat is now good for us it is going to be just enormously disruptive. I don't think companies are going to change that much. They'll wait it out because they'll ask themselves the question, what's it going to be in two years? Because that's how long it takes them to get a product to market.

Jerry, let me ask you this. You painted this picture where every once in a while, there'll be a glimmer of hope. Along comes MAHA. They're critical of the food industry and say that the diet's making us sick and therefore we should focus on different things like ultra-processed foods. In report number one, it's mentioned 40 times. Report number two comes out and it's mentioned only once for the political reasons you said. Are there any signs that lead you to be hopeful that this sort of history doesn't just keep repeating itself? Where people have good ideas, there's science that suggests you go down one road, but the food industry says, no, we're going to go down another and government obeys. Are there any signs out there that lead you to be more hopeful for the future?

There are signs to be hopeful for the future. And number one, we talked earlier, is the success we had regulating tobacco. And I know you've done an outstanding job over the years drawing the parallels between what happened in tobacco and food. And there are good reasons to do that. Not the least of which is that in the 1980s, the tobacco companies bought all the big food companies and imparted on them a lot of their lessons, expertise, and playbook about how to do these things. And so that there is a tight link there. And we did succeed. We took youth smoking, which was around a 30 percent, a third, when we began work on this in the early 1990s when I was at FDA. And today it's less than 2%. It's one area with the United States leads the world in terms of what we've achieved in public health. And there's a great benefit that's going to come to that over the next generation as all of those deaths are prevented that we're not quite seeing yet. But we will. And that's regardless of what happens with vaping, which is a whole different story about nicotine. But this idea success and tobacco. The food industry has a tobacco playbook about how to addict so many people and make so much money and use their political power. We have a playbook of how to win the public health fight.

So, tell us about that. What you're saying is music to my ears and I'm a big believer in exactly what you're saying. So, what is it? What does that playbook look like and what did we learn from the tobacco experience that you think could apply into the food area?

There are a couple of areas. One is going to be leadership and we'll have to come back to that. Because the reason we succeeded in tobacco was the good fortune of having a David Kessler at FDA and Al Gore as Vice President. Nothing was, became more important to them than winning this fight against a big tobacco. Al Gore because his sister died at a young age of smoking. And David Kessler became convinced that this was the most important thing for public health that he could do. And keep in mind, when he came to FDA, it was the furthest thing from his mind. So, one of it is getting these kinds of leaders. Did does RFK Jr. and Marty McCarey match up to Al Gore? And we'll see. But the early signs aren't that great. But we'll see. There's still plenty of time for them to do this and get it right.

The other thing is having a good strategy and policy about how to do it. And here, with tobacco, it was a complete stretch, right? There was no where did the FDA get authority over tobacco? And indeed, we eventually needed the Congress to reaffirm that authority to have the success we did. As we talked earlier, there's no question FDA was created to make sure processed food and the additives and processed food don't make us sick. So, it is the core reason the agency exists is to make sure that if there's a thing called ultra-processed food, man-made food, that is fine, but we have to thrive when we eat it. We certainly can't be made sick when we eat it. Now, David Kessler, I mentioned, he's put forward a petition, a citizens' petition to FDA. Careful work by him, he put months of effort into this, and he wrote basically a detailed roadmap for RFK and his team to use if they want to regulate ultra-processed stuff food. And I think we've gotten some, initially good feedback from the MAHA RFK people that they're interested in this petition and may take action on it.

So, the basic thrust of the Kessler petition from my understanding is that we need to reconsider what's considered Generally Recognized as Safe. And that these ultra-processed foods may not be considered safe any longer because they produce all this disease down the road. And if MAHA responds positively initially to the concept, that's great. And maybe that'll have legs, and something will actually happen. But is there any reason to believe the industry won't just come in and quash this like they have other things?

This idea of starting with a petition in the agency, beginning an investigation and using its authority is the blueprint we used with tobacco. There was a petition we responded, we said, gee, you raised some good points. There are other things we put forward. And so, what we hope to see here with the Kessler petition is that the FDA would put out what's called an advanced notice of a proposed rulemaking with the petition. This moves it from just being a petition to something the agency is saying, we're taking this seriously. We're putting it on the record ourselves and we want industry and others now to start weighing in. Now here's the thing, you have this category of ultra-processed food that because of the North Star I talked about before, because the industry, the marketplace has failed and gives them no incentive to make sure that we thrive, that keeps us from getting sick. They've just forgotten about that and put in place profits instead. The question is how do you get at ultra-processed food? What's the way to do it? How do you start holding the industry accountable?

Now what RFK and the MAHA people started with was synthetic color additives. That wasn't what I would pick but, it wasn't a terrible choice. Because if you talk to Carlos Monteiro who coined the phrase ultra-processed food, and you ask him, what is an ultra-processed food, many people say it's this industrial creation. You can't find the ingredients in your kitchen. He agrees with all that, but he thinks the thing that really sets ultra-processed food, the harmful food, is the cosmetics that make them edible when they otherwise won't I've seen inside the plants where they make the old fashioned minimally processed food versus today's ultra-processed. In the minimally processed plants, I recognize the ingredients as food. In today's plants, you don't recognize anything. There are powders, there's sludges, there's nothing that you would really recognize as food going into it. And to make that edible, they use the cosmetics and colors as a key piece of that. But here's the problem. It doesn't matter if the color is synthetic or natural. And a fruit loop made with natural colors is just as bad for you as one made with synthetics. And indeed, it's been alarming that the agency has fast tracked these natural colors and as replacements because, cyanide is natural. We don't want to use that. And the whole approach has been off and it like how is this going to get us there? How is this focus on color additives going to get us there. And it won't.

Yeah, I agree. I agree with your interpretation of that.

But the thing with Kessler you got part of it right but the main thing he did is say you don't have to really define ultra-processed food, which is another industry ploy to delay action. Let's focus on the thing that's making us sick today. And that's the refined carbohydrates. The refined grains in food. That's what's most closely linked to the obesity, the diabetes we're seeing today. Now in the 1980s, the FDA granted, let's set aside sugar and white flour, for example, but they approved a whole slew of additives that the companies came forward with to see what we can add to the white flour and sugar to make it shelf stable, to meet all the taste, cost, and convenience considerations we have. And profit-making considerations we have. Back then, heart disease was the driving health problem. And so, it was easy to overlook why you didn't think that the these additives were really harmful. That then you could conclude whether Generally Recognized as Safe, which is what the agency did back then.

What Kessler is saying is that what he's laid out in his petition is self-executing. It's not something that the agency grants that this is GRAS or not GRAS. They were just saying things that have historical safe use that scientists generally recognize it as safe. It's not something the agency decides. It's the universe of all of us scientists generally accept. And it's true in the '80s when we didn't face the obesity and diabetes epidemic, people didn't really focus on the refined carbohydrates. But if you look at today's food environment. And I hope you agree with this, that what is the leading driver in the food environment about what is it about ultra-processed food that's making us so sick? It's these refined grains and the way they're used in our food. And so, if the agency takes up the Kessler petition and starts acting on it, they don't have to change the designation. Maybe at some point they have to say some of these additives are no longer GRAS. But what Kessler's saying is by default, they're no longer GRAS because if you ask the scientists today, can we have this level of refined grains? And they'd say, no, that's just not Generally Recognized as Safe. So, he's pointing out that status, they no longer hold that status. And if the agency would recognize that publicly and the burden shifts where Wiley really always meant it to be, on the industry to prove that there are foods or things that we would thrive on, but that wouldn't make us sick.

And so that's the key point that you go back to when you said, and you're exactly right that if you let the industry use their political power to just ignore health altogether and substitute profits, then you're right. Their sort of fiduciary responsibility is just to maximize profits and they can ignore health. If you say you can maximize profits, of course you're a capitalist business, but one of the tests you have to clear is you have to prove to us that people can thrive when they eat that. Thrive as the standard, might require some congressional amplification because it's not in the statute. But what is in the statute is the food can't make you sick. If scientists would generally recognize, would say, if you eat this diet as they intend, if you eat this snack food, there's these ready to heat meals as they intend, you're going to get diabetes and obesity. If scientists generally believe that, then you can't sell that. That's just against the law and the agency needs them to enforce the law.

Bio:

Jerold Mande is CEO of Nourish Science; Adjunct Professor of Nutrition, Harvard T.H. Chan School of Public Health; and a Non-Resident Senior Fellow, Tisch College of Civic Life, Tufts University. Professor Mande has a wealth of expertise and experience in national public health and food policy. He served in senior policymaking positions for three presidents at USDA, FDA, and OSHA helping lead landmark public health initiatives. In 2009, he was appointed by President Obama as USDA Deputy Under Secretary for Food Safety. In 2011, he moved to USDA's Food, Nutrition, and Consumer Services, where he spent six years working to improve the health outcomes of the nation's $100 billion investment in 15 nutrition programs. During President Clinton's administration, Mr. Mande was Senior Advisor to the FDA commissioner where he helped shape national policy on nutrition, food safety, and tobacco. He also served on the White House staff as a health policy advisor and was Deputy Assistant Secretary for Occupational Health at the Department of Labor. During the George H.W. Bush administration he led the graphic design of the iconic Nutrition Facts label at FDA, for which he received the Presidential Design Award. Mr. Mande began his career as a legislative assistant for Al Gore in the U.S. House and Senate, managing Gore's health and environment agenda, and helping Gore write the nation's organ donation and transplantation laws. Mande earned a Master of Public Health from the University of North Carolina at Chapel Hill and a Bachelor of Science in nutritional science from the University of Connecticut. Prior to his current academic appointments, he served on the faculty at the Tufts, Friedman School of Nutrition Science and Policy, and Yale School of Medicine.

In this episode of the Leading Voices in Food podcast, host Norbert Wilson is joined by food and nutrition policy economists Will Masters and Parke Wilde from Tufts University's Friedman School of Nutrition, Science and Policy. The discussion centers around the concept of the least cost diet, a tool used to determine the minimum cost required to maintain a nutritionally adequate diet. The conversation delves into the global computational methods and policies related to least cost diets, the challenges of making these diets culturally relevant, and the implications for food policy in both the US and internationally. You will also hear about the lived experiences of people affected by these diets and the need for more comprehensive research to better reflect reality.

Interview Summary

I know you both have been working in this space around least cost diets for a while. So, let's really start off by just asking a question about what brought you into this work as researchers. Why study least cost diets? Will, let's start with you.

I'm a very curious person and this was a puzzle. So, you know, people want health. They want healthy food. Of course, we spend a lot on healthcare and health services, but do seek health in our food. As a child growing up, you know, companies were marketing food as a source of health. And people who had more money would spend more for premium items that were seen as healthy. And in the 2010s for the first time, we had these quantified definitions of what a healthy diet was as we went from 'nutrients' to 'food groups,' from the original dietary guidelines pyramid to the MyPlate. And then internationally, the very first quantified definitions of healthful diets that would work anywhere in the world. And I was like, oh, wow. Is it actually expensive to eat a healthy diet? And how much does it cost? How does it differ by place location? How does it differ over time, seasons, and years? And I just thought it was a fascinating question.

Great, thank you for that. Parke?

There's a lot of policy importance on this, but part of the fun also of this particular topic is more than almost any that we work on, it's connected to things that we have to think about in our daily lives. So, as you're preparing and purchasing food for your family and you want it to be a healthy. And you want it to still be, you know, tasty enough to satisfy the kids. And it can't take too long because it has to fit into a busy life. So, this one does feel like it's got a personal connection.

Thank you both for that. One of the things I heard is there was an availability of data. There was an opportunity that seems like it didn't exist before. Can you speak a little bit about that? Especially Will because you mentioned that point.

Will: Yes. So, we have had food composition data identifying for typical items. A can of beans, or even a pizza. You know, what is the expected, on average quantity of each nutrient. But only recently have we had those on a very large scale for global items. Hundreds and hundreds of thousands of distinct items. And we had nutrient requirements, but only nutrient by nutrient, and the definition of a food group where you would want not only the nutrients, but also the phytochemicals, the attributes of food from its food matrix that make a vegetable different from just in a vitamin pill. And those came about in, as I mentioned, in the 2010s. And then there's the computational tools and the price observations that get captured. They've been written down on pads of paper, literally, and brought to a headquarters to compute inflation since the 1930s. But access to those in digitized form, only really in the 2000s and only really in the 2010s were we able to have program routines that would download millions and millions of price observations, match them to food composition data, match that food composition information to a healthy diet criterion, and then compute these least cost diets. Now we've computed millions and millions of these thanks to modern computing and all of that data.

Great, Will. And you've already started on this, so let's continue on this point. You were talking about some of the computational methods and data that were available globally. Can you give us a good sense of what does a lease cost diet look like from this global perspective because we're going to talk to Parke about whether it is in the US. But let's talk about it in the broad sense globally.

In my case the funding opportunity to pay for the graduate students and collaborators internationally came from the Gates Foundation and the UK International Development Agency, initially for a pilot study in Ghana and Tanzania. And then we were able to get more money to scale that up to Africa and South Asia, and then globally through a project called Food Prices for Nutrition. And what we found, first of all, is that to get agreement on what a healthy diet means, we needed to go to something like the least common denominator. The most basic, basic definition from the commonalities among national governments' dietary guidelines. So, in the US, that's MyPlate, or in the UK it's the Eat Well Guide. And each country's dietary guidelines look a little different, but they have these commonalities. So, we distilled that down to six food groups. There's fruits and vegetables, separately. And then there's animal source foods altogether. And in some countries they would separate out milk, like the United States does. And then all starchy staples together. And in some countries, you would separate out whole grains like the US does. And then all edible oils. And those six food groups, in the quantities needed to provide all the nutrients you would need, plus these attributes of food groups beyond just what's in a vitamin pill, turns out to cost about $4 a day. And if you adjust for inflation and differences in the cost of living, the price of housing and so forth around the world, it's very similar. And if you think about seasonal variation in a very remote area, it might rise by 50% in a really bad situation. And if you think about a very remote location where it's difficult to get food to, it might go up to $5.50, but it stays in that range between roughly speaking $2.50 and $5.00.

Meanwhile, incomes are varying from around $1.00 a day, and people who cannot possibly afford those more expensive food groups, to $200 a day in which these least expensive items are trivially small in cost compared to the issues that Parke mentioned. We can also talk about what we actually find as the items, and those vary a lot from place to place for some food groups and are very similar to each other in other food groups. So, for example, the least expensive item in an animal source food category is very often dairy in a rich country. But in a really dry, poor country it's dried fish because refrigeration and transport are very expensive. And then to see where there's commonalities in the vegetable category, boy. Onions, tomatoes, carrots are so inexpensive around the world. We've just gotten those supply chains to make the basic ingredients for a vegetable stew really low cost. But then there's all these other different vegetables that are usually more expensive. So, it's very interesting to look at which are the items that would deliver the healthfulness you need and how much they cost. It's surprisingly little from a rich country perspective, and yet still out of reach for so many in low-income countries.

Will, thank you for that. And I want to turn now to looking in the US case because I think there's some important commonalities. Parke, can you describe the least cost diet, how it's used here in the US, and its implications for policy?

Absolutely. And full disclosure to your audience, this is work on which we've benefited from Norbert's input and wisdom in a way that's been very valuable as a co-author and as an advisor for the quantitative part of what we were doing. For an article in the journal Food Policy, we use the same type of mathematical model that USDA uses when it sets the Thrifty Food Plan, the TFP. A hypothetical diet that's used as the benchmark for the maximum benefit in the Supplemental Nutrition Assistance Program, which is the nation's most important anti-hunger program. And what USDA does with this model diet is it tries to find a hypothetical bundle of foods and beverages that's not too different from what people ordinarily consume. The idea is it should be a familiar diet, it should be one that's reasonably tasty, that people clearly already accept enough. But it can't be exactly that diet. It has to be different enough at least to meet a cost target and to meet a whole long list of nutrition criteria. Including getting enough of the particular nutrients, things like enough calcium or enough protein, and also, matching food group goals reasonably well. Things like having enough fruits, enough vegetables, enough dairy. When, USDA does that, it finds that it's fairly difficult. It's fairly difficult to meet all those goals at once, at a cost and a cost goal all at the same time. And so, it ends up choosing this hypothetical diet that's almost maybe more different than would feel most comfortable from people's typical average consumption.

Thank you, Parke. I'm interested to understand the policy implications of this least cost diet. You suggested something about the Thrifty Food Plan and the maximum benefit levels. Can you tell us a little bit more about the policies that are relevant?

Yes, so the Thrifty Food Plan update that USDA does every five years has a much bigger policy importance now than it did a few years ago. I used to tell my students that you shouldn't overstate how much policy importance this update has. It might matter a little bit less than you would think. And the reason was because every time they update the Thrifty Food Plan, they use the cost target that is the inflation adjusted or the real cost of the previous edition. It's a little bit as if nobody wanted to open up the whole can of worms about what should the SNAP benefit be in the first place.

But everything changed with the update in 2021. In 2021, researchers at the US Department of Agriculture found that it was not possible at the old cost target to find a diet that met all of the nutrition criteria - at all. Even if you were willing to have a diet that was quite different from people's typical consumption. And so, they ended up increasing the cost of the Thrifty Food Plan in small increments until they found a solution to this mathematical model using data on real world prices and on the nutrition characteristics of these foods. And this led to a 21% increase in the permanent value of the maximum SNAP benefit. Many people didn't notice that increase all that much because the increase came into effect at just about the same time that a temporary boost during the COVID era to SNAP benefits was being taken away. So there had been a temporary boost to how much benefits people got as that was taken away at the end of the start of the COVID pandemic then this permanent increase came in and it kind of softened the blow from that change in benefits at that time. But it now ends up meaning that the SNAP benefit is substantially higher than it would've been without this 2021 increase. And there's a lot of policy attention on this in the current Congress and in the current administration. There's perhaps a skeptical eye on whether this increase was good policy. And so, there are proposals to essentially take away the ability to update the Thrifty Food Plan change the maximum SNAP benefit automatically, as it used to. As you know, Norbert, this is part of all sorts of things going on currently. Like we heard in the news, just last week, about plans to end collecting household food security measurement using a major national survey. And so there will be sort of possibly less information about how these programs are doing and whether a certain SNAP benefit is needed in order to protect people from food insecurity and hunger.

Parke, this is really important and I'm grateful that we're able to talk about this today in that SNAP benefit levels are still determined by this mathematical program that's supposed to represent a nutritionally adequate diet that also reflects food preferences. And I don't know how many people really understand or appreciate that. I can say I didn't understand or appreciate it until working more in this project. I think it's critical for our listeners to understand just how important this particular mathematical model is, and what it says about what a nutritionally adequate diet looks like in this country. I know the US is one of the countries that uses a model diet like this to help set policy. Will, I'd like to turn to you to see what ways other nations are using this sort of model diet. How have you seen policy receive information from these model diets?

It's been a remarkable thing where those initial computational papers that we were able to publish in first in 2018, '19, '20, and governments asking how could we use this in practice. Parke has laid out how it's used in the US with regard to the benefit level of SNAP. The US Thrifty Food Plan has many constraints in addition to the basic ones for the Healthy Diet Basket that I described. Because clearly that Healthy Diet Basket minimum is not something anyone in America would think is acceptable. Just to have milk and frozen vegetables and low-cost bread, that jar peanut butter and that's it. Like that would be clearly not okay. So, internationally what's happened is that first starting in 2020, and then using the current formula in 2022, the United Nations agencies together with the World Bank have done global monitoring of food and nutrition security using this method. So, the least cost items to meet the Healthy Diet Basket in each country provide this global estimate that about a third of the global population have income available for food after taking account of their non-food needs. That is insufficient to buy this healthy diet. What they're actually eating is just starchy staples, oil, some calories from low-cost sugar and that's it. And very small quantities of the fruits and vegetables. And animal source foods are the expensive ones. So, countries have the opportunity to begin calculating this themselves alongside their normal monitoring of inflation with a consumer price index. The first country to do that was Nigeria. And Nigeria began publishing this in January 2024. And it so happened that the country's national minimum wage for civil servants was up for debate at that time. And this was a newly published statistic that turned out to be enormously important for the civil society advocates and the labor unions who were trying to explain why a higher civil service minimum wage was needed. This is for the people who are serving tea or the drivers and the low wage people in these government service agencies. And able to measure how many household members could you feed a healthy diet with a day's worth of the monthly wage. So social protection in the sense of minimum wage and then used in other countries regarding something like our US SNAP program or something like our US WIC program. And trying to define how big should those benefit levels be. That's been the first use.

A second use that's emerging is targeting the supply chains for the low-cost vegetables and animal source foods and asking what from experience elsewhere could be an inexpensive animal source food. What could be the most inexpensive fruits. What could be the most inexpensive vegetables? And that is the type of work that we're doing now with governments with continued funding from the Gates Foundation and the UK International Development Agency.

Will, it's fascinating to hear this example from Nigeria where all of the work that you all have been doing sort of shows up in this kind of debate. And it really speaks to the power of the research that we all are trying to do as we try to inform policy. Now, as we discussed the least cost diet, there was something that I heard from both of you. Are these diets that people really want? I'm interested to understand a little bit more about that because this is a really critical space.Will, what do we know about the lived experiences of those affected by least cost diet policy implementation. How are real people affected?

It's such an important and interesting question, just out of curiosity, but also for just our human understanding of what life is like for people. And then of course the policy actions that could improve. So, to be clear, we've only had these millions of least cost diets, these benchmark 'access to' at a market near you. These are open markets that might be happening twice a week or sometimes all seven days of the week in a small town, in an African country or a urban bodega type market or a supermarket across Asia, Africa. We've only begun to have these benchmarks against which to compare actual food choice, as I mentioned, since 2022. And then really only since 2024 have been able to investigate this question. We're only beginning to match up these benchmark diets to what people actually choose. But the pattern we're seeing is that in low and lower middle-income countries, people definitely spend their money to go towards that healthy diet basket goal. They don't spend all of their additional money on that. But if you improve affordability throughout the range of country incomes - from the lowest income countries in Africa, Mali, Senegal, Burkina Faso, to middle income countries in Africa, like Ghana, Indonesia, an upper middle-income country - people do spend their money to get more animal source foods, more fruits and vegetables, and to reduce the amount of the low cost starchy staples. They do increase the amount of discretionary, sugary meals. And a lot of what they're eating exits the healthy diet basket because there's too much added sodium, too much added sugar. And so, things that would've been healthy become unhealthy because of processing or in a restaurant setting. So, people do spend their money on that. But they are moving towards a healthy diet. That breaks down somewhere in the upper income and high-income countries where additional spending becomes very little correlated with the Healthy Diet Basket. What happens is people way overshoot the Healthy Diet Basket targets for animal source foods and for edible oils because I don't know if you've ever tried it, but one really delicious thing is fried meat. People love it. And even low middle income people overshoot on that. And that displaces the other elements of a healthy diet. And then there's a lot of upgrading, if you will, within the food group. So, people are spending additional money on nicer vegetables. Nicer fruits. Nicer animal source foods without increasing the total amount of them in addition to having overshot the healthy diet levels of many of those food groups. Which of course takes away from the food you would need from the fruits, the vegetables, and the pulses, nuts and seeds, that almost no one gets as much as is considered healthy, of that pulses, nuts and seeds category.

Thank you. And I want to shift this to the US example. So, Parke, can you tell us a bit more about the lived experience of those affected by least cost diet policy? How are real people affected?

One of the things I've enjoyed about this project that you and I got to work on, Norbert, in cooperation with other colleagues, is that it had both a quantitative and a qualitative part to it. Now, our colleague Sarah Folta led some of the qualitative interviews, sort of real interviews with people in food pantries in four states around the country. And this was published recently in the Journal of Health Education and Behavior. And we asked people about their goals and about what are the different difficulties or constraints that keep them from achieving those goals. And what came out of that was that people often talk about whether their budget constraints and whether their financial difficulties take away their autonomy to sort of be in charge of their own food choices. And this was something that Sarah emphasized as she sort of helped lead us through a process of digesting what was the key findings from these interviews with people. One of the things I liked about doing this study is that because the quantitative and the qualitative part, each had this characteristic of being about what do people want to achieve. This showed up mathematically in the constrained optimization model, but it also showed up in the conversations with people in the food pantry. And what are the constraints that keep people from achieving it. You know, the mathematical model, these are things like all the nutrition constraints and the cost constraints. And then in the real conversations, it's something that people raise in very plain language about what are all the difficulties they have. Either in satisfying their own nutrition aspirations or satisfying some of the requirements for one person or another in the family. Like if people have special diets that are needed or if they have to be gluten free or any number of things. Having the diets be culturally appropriate. And so, I feel like this is one of those classic things where different disciplines have wisdom to bring to bear on what's really very much a shared topic.

What I hear from both of you is that these diets, while they are computationally interesting and they reveal some critical realities of how people eat, they can't cover everything. People want to eat certain types of foods. Certain types of foods are more culturally relevant. And that's really clear talking to you, Will, about just sort of the range of foods that end up showing up in these least cost diets and how you were having to make some adjustments there. Parke, as you talked about the work with Sarah Folta thinking through autonomy and sort of a sense of self. This kind of leads us to a question that I want to open up to both of you. What's missing when we talk about these least cost diet modeling exercises and what are the policy implications of that? What are the gaps in our understanding of these model diets and what needs to happen to make them reflect reality better? Parke?

Well, you know, there's many things that people in our research community are working on. And it goes quite, quite far afield. But I'm just thinking of two related to our quantitative research using the Thrifty Food Plan type models. We've been working with Yiwen Zhao and Linlin Fan at Penn State University on how these models would work if you relaxed some of the constraints. If people's back in a financial sense weren't back up against the wall, but instead they had just a little more space. We were considering what if they had incentives that gave them a discount on fruits and vegetables, for example, through the SNAP program? Or what if they had a healthy bundle of foods provided through the emergency food system, through food banks or food pantries. What is the effect directly in terms of those foods? But also, what is the effect in terms of just relaxing their budget constraints. They get to have a little more of the foods that they find more preferred or that they had been going without. But then also, in terms of sort of your question about the more personal. You know, what is people's personal relationships with food? How does this play out on the ground? We're working with the graduate student Angelica Valdez Valderrama here at the Friedman School, thinking about what some of the cultural assumptions and of the food group constraints in some of these models are. If you sort of came from a different immigrant tradition or if you came from another community, what things would be different in, for example, decisions about what's called the Mediterranean diet or what's called the healthy US style dietary pattern. How much difference do this sort of breadth, cultural breadth of dietary patterns you could consider, how much difference does that make in terms of what's the outcome of this type of hypothetical diet?

Will: And I think, you know, from the global perspective, one really interesting thing is when we do combine data sets and look across these very different cultural settings, dry land, Sahelian Africa versus countries that are coastal versus sort of forest inland countries versus all across Asia, south Asia to East Asia, all across Latin America. We do see the role of these cultural factors. And we see them playing out in very systematic ways that people come to their cultural norms for very good reasons. And then pivot and switch away to new cultural norms. You know, American fast food, for example, switching from beef primarily to chicken primarily. That sort of thing becomes very visible in a matter of years. So, in terms of things that are frontiers for us, remember this is early days. Getting many more nutritionists, people in other fields, looking at first of all, it's just what is really needed for health. Getting those health requirements improved and understood better is a key priority. Our Healthy Diet Basket comes from the work of a nutritionist named Anna Herforth, who has gone around the world studying these dietary guidelines internationally. We're about to get the Eat Lancet dietary recommendations announced, and it'll be very interesting to see how those evolve.

Second thing is much better data on prices and computing these diets for more different settings at different times, different locations. Settings that are inner city United States versus very rural. And then this question of comparing to actual diets. And just trying to understand what people are seeking when they choose foods that are clearly not these benchmark least cost items. The purpose is to ask how far away and why and how are they far away? And particularly to understand to what degree are these attributes of the foods themselves: the convenience of the packaging, the preparation of the item, the taste, the flavor, the cultural significance of it. To what degree are we looking at the result of aspirations that are really shaped by marketing. Are really shaped by the fire hose of persuasion that companies are investing in every day. And very strategically and constantly iterating to the best possible spokesperson, the best possible ad campaign. Combining billboards and radio and television such that you're surrounded by this. And when you drive down the street and when you walk into the supermarket, there is no greater effort on the planet than the effort to sell us a particular brand of food. Food companies are basically marketing companies attached to a manufacturing facility, and they are spending much more than the entire combined budget of the NIH and CDC, et cetera, to persuade us to eat what we ultimately choose. And we really don't know to what degree it's the actual factors in the food itself versus the marketing campaigns and the way they've evolved. You know, if you had a choice between taking the food system and regulating it the way we regulate, say housing or vehicles. If we were to say your supermarket should be like an auto dealership, right? So, anything in the auto dealership is very heavily regulated. Everything from the paint to where the gear shift is to how the windows work. Everything is heavily regulated because the auto industry has worked with National Transportation Safety Board and every single crash investigation, et cetera, has led to the standards that we have now. We didn't get taxes on cars without airbags to make us choose cars with airbags. They're just required. And same is true for housing, right? You can't just build, you know, an extension deck behind your house any way you want. A city inspector will force you to tear it out if you haven't built it to code. So, you know, we could regulate the grocery store like we do that. It's not going to happen politically but compare that option to treating groceries the way we used to treat the legal services or pharmaceuticals. Which is you couldn't advertise them. You could sell them, and people would choose based on the actual merit of the lawyer or the pharmaceutical, right? Which would have the bigger impact. Right? If there was zero food advertising, you just walked into the grocery store and chose what you liked. Or you regulate the grocery store the same way we regulate automotive or building trades. Obviously, they both matter. There's, you know, this problem that you can't see, taste or smell the healthiness of food. You're always acting on belief and not a fact when you choose something that you're seeking health. We don't know to what extent choice is distorted away from a low-cost healthy diet by things people genuinely want and need. Such as taste, convenience, culture, and so forth. Versus things that they've been persuaded to want. And there's obviously some of both. All of these things matter. But I'm hopeful that through these least cost diets, we can identify that low-cost options are there. And you could feed your family a very healthy diet at the Thrifty Food Plan level in the United States, or even lower. It would take time, it would take attention, it would be hard. You can take some shortcuts to make that within your time budget, right? And the planning budget. And we can identify what those look like thanks to these model diets.

It's a very exciting area of work, but we still have a lot to do to define carefully what are the constraints. What are the real objectives here. And how to go about helping people, acquire these foods that we now know are there within a short commuting distance. You may need to take the bus, you may need carpool. But that's what people actually do to go grocery shopping. And when they get there, we can help people to choose items that would genuinely meet their needs at lower cost.

Bios

Will Masters is a Professor in the Friedman School of Nutrition, with a secondary appointment in Tufts University's Department of Economics. He is coauthor of the new textbook on Food Economics: Agriculture, Nutrition and Health (Palgrave Macmillan, 2024). Before coming to Tufts in 2010 he was a faculty member in Agricultural Economics at Purdue University (1991-2010), and also at the University of Zimbabwe (1989-90), Harvard's Kennedy School of Government (2000) and Columbia University (2003-04). He is former editor-in-chief of the journal Agricultural Economics (2006-2011), and an elected Fellow of the American Society for Nutrition (FASN) as well as a Fellow of the Agricultural and Applied Economics Association (AAEA). At Tufts his courses on economics of agriculture, food and nutrition were recognized with student-nominated, University-wide teaching awards in 2019 and 2022, and he leads over a million dollars annually in externally funded research including work on the Agriculture, Nutrition and Health Academy (https://www.anh-academy.org), as well as projects supporting government efforts to calculate the cost and affordability of healthy diets worldwide and work with private enterprises on data analytics for food markets in Africa.

Parke Wilde (PhD, Cornell) is a food economist and professor at the Friedman School of Nutrition Science and Policy at Tufts University. Previously, he worked for USDA's Economic Research Service. At Tufts, Parke teaches graduate-level courses in statistics, U.S. food policy, and climate change. His research addresses the economics of U.S. food and nutrition policy, including federal nutrition assistance programs. He was Director of Design for the SNAP Healthy Incentives Pilot (HIP) evaluation. He has been a member of the National Academy of Medicine's Food Forum and is on the scientific and technical advisory committee for Menus of Change, an initiative to advance the health and sustainability of the restaurant industry. He directs the USDA-funded Research Innovation and Development Grants in Economics (RIDGE) Partnership. He received the AAEA Distinguished Quality of Communication Award for his textbook, Food Policy in the United States: An Introduction (Routledge/Earthscan), whose third edition was released in April 2025.

The gut is in the news. It's really in the news. Catapulted there from exciting developments coming from laboratories all around the world. Links of gut health with overall health are now quite clear and surprising connections are being discovered between gut health and things like dementia and Alzheimer's. But how does the gut communicate with other parts of the body in ways that make it this important, and where does the brain figure into all this? Well, there's some interesting science going on in this topic, and a leading person in this area is Dr. Diego Bohorquez. Dr. Bohorquez is the associate professor of medicine, of molecular genetics and microbiology and of cell biology at the Duke University School of Medicine.

Interview Transcript

Diego, your bio shows that you blend work in nutritional biochemistry, gastrointestinal physiology, and sensory neurobiology. It took me a little time to figure out just what these things are, but what this represents, to be a little more serious, is a unique ability to understand that the different parts of the body, the gut and the brain in particular, interact a lot. And you're in a very good position to understand how that happens. Let's dive in with the kind of a basic question. What got you interested in this interaction of the gut with the brain and why care about it?

Yes. Kelly, I think that that's all technicalese for saying that we are at the interface of food, the gut, and the brain. Apart from the fact that we are what we eat and if we truly believe that then food will be shaping us. Not only our body, but also like our belief systems, our societal systems, and so on and so forth. I don't think that that is anything new. However, what is new is the ability of the gut to guide our decision making. And it was interesting to hear in your introduction that now the gut is all in the news. In 2005 when I came to the United States, and I was at North Carolina State University, and I joined a graduate school. I remember taking a graduate course in physiology in 2007. And when the professor opened the session on gastrointestinal physiology, he said the gut is one of the most misunderstood and mysterious organs. It has almost as many neurons as the spinal cord, or more. But honestly, we don't give a lot of respect to the gut. We only think that it does some digestion and absorption, and we judge it more for the value of its products of digestion than what it does for the entire body.

And fast forward almost 20 years later now, partly my laboratory and other laboratories that have entered this field since some of our discoveries started to emerge, it's very clearly showing that the gut not only has its own sensory system that is behind what we call gut feelings. The gut feelings are actually real. But it actually can influence our decision making. Like specifically, we have shown that our ability to choose sugars and consume sugars and feel sugars and choose them over sweeteners, it can be pinpointed to a specific set of cells in the intestine called neuropod cells and specific receptors in those cells. And the intestine is right after the stomach. And this is where these cells are exposed to the surface of the gut and detect the chemical composition of food to guide our decision making.

Let's talk about that a little bit more. So, you've got this axis, or this means of communication between the gut and the brain going on. And let's talk about how it affects what we eat. You just alluded to the fact that it's pretty important. What does it tell us? What to eat, how much to eat? What we like to eat? When we're hungry, when we've had enough? How does this affect our eating?

We are beginning to understand how much it affects this eating. And obviously we are departing from understanding, right? And an understanding is cognitive. In the 1500s is when the idea of 'we think therefore we are,' came online. And we needed to think things before we actually will understand them. But well before thinking them, we actually feel them. And you probably have noticed that. If anybody offers you maybe a cup of water at 5:00 AM, 6:00 AM, it will be very welcome. Especially with it's a little bit warm. If they offer you a steak at 5:00 AM you will run away from that. But in fact, you'll create distress I think unless you are like severely jet lagged. And a lot of those feelings not only come from the experience, but even if you blind are blindfolded, your gut will be able to evaluate what you just ingested.

And it is because the intestine, it is the point where those molecules in the meal or in the drink, will be either absorbed to become part of who we are, or will be excreting and expelled. And that absorption of who we are is dependent on the context. Like for instance, the part of the month, morning versus afternoon, health status, age, will influence specifically like at the molecular level, what it is that we need to continue to thrive.

It sounds like there's lots of potential for the gut and its interaction with the brain working in concert with the rest of the body. Things are in balance and working like they should be. But there are lots of things going on out there that disrupt that. Tell us more about that and how it affects eating. For example, the levels of obesity have risen so much in the past decades. How does the gut figure into that, for example. Could there be environmental things like the microplastics or exposure to toxins like pesticides and things that might be affecting the gut that throws the system off?

I think that that is a very timely question for the days. Over the last 10 years, we have documented that the gut has its own sensory system. And in fact, it's one of the most ancient sensory systems. At the very beginning, 600 million years ago, when cells started to coalesce into animals, multicellular organisms, they needed to eat. And they needed to not only find the food but create a sensory representation of the food. What do I mean by that? Eating algae is very different than eating bacteria, for instance. And the gut needed to have these sensors to be able to rapidly create first a representation, this is bacteria. And then put out the molecules to digest that bacterium or those bacteria. And then ultimately absorb them, turn them into metabolites and continue to thrive, right? Perhaps reproduce, coalesce and so on and so forth. This is a very important concept because our reality, the reality that you and I are having right now, it is guided by our senses. And we have multiple senses. Like for instance, we are able to communicate partly because of the sound that is going through our ears. And then there are inner hair cells that are picking up those waves. Passing that information to the brain, decoding it, and then the brain coalesces with everything else and saying like, 'okay, Diego, you're in a podcast. Make sure that you say something hopefully reasonable, right?' What the gut is doing, as a true sensory system, is also detecting the food that we have ingested, creating a rapid representation. It's not the reality itself. It is a representation of the reality. Because when we eat an apple, ultimately the gut, what it's doing is creating a representation that was an apple and not an orange. And then telling the brain, look, you're going to get some glucose, some fiber, a little bit of a skin. And you may need to adjust it with water, right? And then that will trigger the desire to, 'oh, maybe I should have also a cup of water.' Why does that have to do with, the societal issues that we are facing? Since the 1970s, we learned to disentangle the sensory experience of food, not only as humans or scientists, but also that was extrapolated to the society. So, if you go and look, and it is not a secret, it has been very well documented. For instance, the ability to put artificial sweeteners out there. It has really changed the health landscape. And it was just a normal progression of how it is that we humans think. We thought well, people consume sugars because they're sweet. If we take out the calorie and we just leave the sweetness, it will be totally fine because it's benign. You're not consuming anything else. However, the gut, you have promised the gut something sweet. That it has always, or almost always, invariably, been associated with a nutritional value. Then the gut is fed this information that is skewed. Then it has to go and adjust. And we actually have demonstrated that in the laboratory that when the neuro pods detect a non-caloric sweetener, they actually release a different neurotransmitter that communicates to the brain that artificial sweeteners have arrived at the gut, as opposed to glucose, which triggers the release of glutamate. And that glutamate is essential for the organism to know that we have consumed sugar.

Is it safe to say then that the body has evolved to be able to have effective signaling and feedback systems with things that are found out there in nature, like sugar or an apple or an orange. But when you start introducing things that don't exist in nature, like the artificial sweeteners, then bad things can happen.

Yes. Because imagine right now your brain will swap the reality and you will transport yourself or the beach. You may not even have the clothing ready to confront the breeze of the beach, right? Or the salt. You would have not been prepared, right? We evolved around nature because nature was there before us. Therefore, we had gradually adjusted to what nature had to offer. Eventually we introduced fire, and we were able to transform simple or complex carbohydrates into something digestible. And then the body had the ability to adjust to it. And not only the body, but also the microbiota in the gut. Now we are talking about like the transformation of foods. And especially I think in the last 30 years we have been able to transform those foods. Beverages have sweeteners now. We have energy drinks that have a composition of vitamins and other things. And while those things individually perhaps are not innocuous, we haven't explored what is the conglomerate effect on long-term health.

When we talk about these things being added to foods, I mean, there are whole classes of things like colorings and dyes and artificial sweeteners and things. And then there are processing things that go on, like extrusion and different things that take something like wheat or corn and turn it into something that the body is not accustomed to dealing with. Is the body incapable of perceiving what these things are? Does it get send out wrong signals? Why should we be worried about these things?

I don't think that we should be worried necessarily because that's alarming, right? But we should be aware, certainly, that the body keeps tabs on it. Something very simple. If you rub water on your skin versus if you rub oil on your skin, your brain already starts to perceive that substance as different. Now, imagine the gut is going to know exactly the same thing. It knows what water is. It knows what oil is. It knows what carbs are. It knows what protein is. And depending on what it has been fed for, thousands of years, it will be able to create that representation as I alluded to. And therefore, if there is a foreign composition, it's going to have to adjust to the situation. And that is how you can end up altering the composition of a regular body. Because like, for instance, in nature if you go and look at native populations that live very close to nature, you know, the body composition is in a certain form. But in cities where you're exposed to foods that have been transformed, the body composition is very different. And I'm not talking only about body weight, but also height, shape, you know.

That certainly makes sense. You know, something that's been in the news a lot lately are the GLP1 drugs like Ozempic and Zepbound and they have very powerful effects on appetite, satiety, and weight regulation. How is the gut brain axis involved in this?

I would like to make a couple of points in there.The first one is that glucagon-like peptide is obviously is very similar to glucagon. Glucagon is produced in the pancreas. Glucagon-like peptide is actually produced in the gut. And it is produced by these neuro pod cells that also produce some neurotransmitters. And it is produced in response to specific nutrients like glucose. And it is a signal glucagon like peptide 1. It is a signal for not only adjusting insulin release, but it is also a signal for coordinating what has arrived in the gut. It does affect motility. Eventually it is thought that goes into the bloodstream and affects the nervous system. However, and I said it is thought because the brain also produces glucagon-like peptide. There are cells in the skin. There are cells in the urethra. There are cells in the bladder. There are cell cells in the spinal cord in the choroid plexus that is exposed to the cerebral spinal fluid that also produces some of these peptides as signaling molecules. And I have to make that clarification because traditionally it has been thought to be a signal from the gut, per se. But these are just signaling molecules. The second part is that the arrival of Ozempic, I thought that it was obviously a very important step not only scientifically, but also societally. Why? Because up until 1980s and I have thought with many colleagues especially in medicine. And they will say like, when an obese patient will arrive in the office, first of all, there was not a lot of options. One of the recommendations is - are you doing enough dieting or exercise? And if the patient was like, you know, I'm not eating even a lot, but I'm gaining weight. Or it was perhaps psychosomatic because we didn't have the molecular language to be able to explain what was going on. I think that Ozempic clearly has shown that when we are affecting a set of receptors in the body, perhaps in the gut, it's changing many different things. Not only like food intake, but also alcohol intake and how people feel. I think that is definitely a breakthrough. Where are we going from here? I think that this is the beginning of a long conversation in which we are going to be looking for options not only to reduce the amount of food, but actually to steer food choices from the gut. Because the gut is still as an external surface. And that's what I've mentioned that the discovery that these neuro pot cells can guide our food choices, I think that is very attractive for future options on how we are going to steer decision making.

So, let me ask a final question. You partly just answered it, but where do you see this field going? What are you excited about and what do you think the next frontiers will be?

I think that I'm a little bit more close to nature. I think that on moving forward, there's all obviously a lot of technologies and molecules that are going to be developed to perhaps treat some disorders. Not only related to the body, but also to the mind. Chronic depression and so on and so forth. But I think a lot of these elements have already been explored in nature. And if we look back anthropologically, people were solving the issue of medicine with their environment. In fact, what we call metropolitan medicine evolved largely from natural medicine. And in fact, today, 80% of the world, they still rely directly on plants and other compounds that are directly from plants for healthcare. I think that there is a lot to learn in there and a lot to merge, especially with the new technologies on diagnostics. And I think that that's a very exciting area to keep nature in mind. And when I said nature is like our relationship with environment, right?

Bio

Diego V. Bohorquez is an associate professor of medicine, associate professor in molecular genetics and microbiology, associate professor of cell biology, associate research professor in neurobiology, and an associate professor in pathology at Duke University's Department of Medicine. Bohorquez is a gut-brain neuroscientist and holds a Ph.D. from North Carolina State University. His research focus is to unveil how the brain perceives what the gut feels, how food in the intestine is sensed by our body, and how a sensory signal from a nutrient is transformed into an electrical signal that alters behavior.

An avalanche of information besets us on what to eat. It comes from the news, from influencers of every ilk, from scientists, from government, and of course from the food companies. Super foods? Ultra-processed foods? How does one find a source of trust and make intelligent choices for both us as individuals and for the society as a whole. A new book helps in this quest, a book entitled Food Intelligence: the Science of How Food Both Nourishes and Harms Us. It is written by two highly credible and thoughtful people who join us today.Julia Belluz is a journalist and a contributing opinion writer for the New York Times. She reports on medicine, nutrition, and public health. She's been a Knight Science Journalism Fellow at MIT and holds a master's in science degree from the London School of Economics and Political Science. Dr. Kevin Hall trained as a physicist as best known for pioneering work on nutrition, including research he did as senior investigator and section chief at the National Institutes of Health. His work is highly regarded. He's won awards from the NIH, from the American Society of Nutrition, the Obesity Society and the American Physiological Society.

Interview Transcript

Thank you both very much for being with us. And not only for being with us, but writing such an interesting book. I was really eager to read it and there's a lot in there that people don't usually come across in their normal journeys through the nutrition world. So, Julia, start off if you wouldn't mind telling us what the impetus was for you and Kevin to do this book with everything else that's out there.

Yes, so there's just, I think, an absolute avalanche of information as you say about nutrition and people making claims about how to optimize diet and how best to lose or manage weight. And I think what we both felt was missing from that conversation was a real examination of how do we know what we know and kind of foundational ideas in this space. You hear a lot about how to boost or speed up your metabolism, but people don't know what metabolism is anyway. You hear a lot about how you need to maximize your protein, but what is protein doing in the body and where did that idea come from? And so, we were trying to really pair back. And I think this is where Kevin's physics training was so wonderful. We were trying to look at like what are these fundamental laws and truths. Things that we know about food and nutrition and how it works in us, and what can we tell people about them. And as we kind of went through that journey it very quickly ended up in an argument about the food environment, which I know we're going to get to.

We will. It's really interesting. This idea of how do we know what we know is really fascinating because when you go out there, people kind of tell us what we know. Or at least what they think what we know. But very few people go through that journey of how did we get there. And so people can decide on their own is this a credible form of knowledge that I'm being told to pursue. So Kevin, what do you mean by food intelligence?

Coming from a completely different background in physics where even as we learn about the fundamental laws of physics, it's always in this historical context about how we know what we know and what were the kind of key experiments along the way. And even with that sort of background, I had almost no idea about what happened to food once we ate it inside our bodies. I only got into this field by a happenstance series of events, which is probably too long to talk about this podcast. But to get people to have an appreciation from the basic science about what is going on inside our bodies when we eat. What is food made out of? As best as we can understand at this current time, how does our body deal with. Our food and with that sort of basic knowledge about how we know what we know. How to not be fooled by these various sound bites that we'll hear from social media influencers telling you that everything that you knew about nutrition is wrong. And they've been hiding this one secret from you that's been keeping you sick for so long to basically be able to see through those kinds of claims and have a bedrock of knowledge upon which to kind of evaluate those things. That's what we mean by food intelligence.

It makes sense. Now, I'm assuming that food intelligence is sort of psychological and biological at the same time, isn't it? Because that there's what you're being told and how do you process that information and make wise choices. But there's also an intelligence the body has and how to deal with the food that it's receiving. And that can get fooled too by different things that are coming at it from different types of foods and stuff. We'll get to that in a minute, but it's a very interesting concept you have, and wouldn't it be great if we could all make intelligent choices? Julia, you mentioned the food environment. How would you describe the modern food environment and how does it shape the choices we make?

It's almost embarrassing to have this question coming from you because so much of our understanding and thinking about this idea came from you. So, thank you for your work. I feel like you should be answering this question. But I think one of the big aha moments I had in the book research was talking to a neuroscientist, who said the problem in and of itself isn't like the brownies and the pizza and the chips. It's the ubiquity of them. It's that they're most of what's available, along with other less nutritious ultra-processed foods. They're the most accessible. They're the cheapest. They're kind of heavily marketed. They're in our face and the stuff that we really ought to be eating more of, we all know we ought to be eating more of, the fruits and vegetables, fresh or frozen. The legumes, whole grains. They're the least available. They're the hardest to come by. They're the least accessible. They're the most expensive. And so that I think kind of sums up what it means to live in the modern food environment. The deck is stacked against most of us. The least healthy options are the ones that we're inundated by. And to kind of navigate that, you need a lot of resources, wherewithal, a lot of thought, a lot of time. And I think that's kind of where we came out thinking about it. But if anyone is interested in knowing more, they need to read your book Food Fight, because I think that's a great encapsulation of where we still are basically.

Well, Julie, it's nice of you to say that. You know what you reminded me one time I was on a panel and a speaker asks the audience, how many minutes do you live from a Dunkin Donuts? And people sort of thought about it and nobody was more than about five minutes from a Dunkin Donuts. And if I think about where I live in North Carolina, a typical place to live, I'm assuming in America. And boy, within about five minutes, 10 minutes from my house, there's so many fast-food places. And then if you add to that the gas stations that have foods and the drug store that has foods. Not to mention the supermarkets. It's just a remarkable environment out there. And boy, you have to have kind of iron willpower to not stop and want that food. And then once it hits your body, then all heck breaks loose. It's a crazy, crazy environment, isn't it? Kevin, talk to us, if you will, about when this food environment collides with human biology. And what happens to normal biological processes that tell us how much we should eat, when we should stop, what we should eat, and things like that.

I think that that is one of the newer pieces that we're really just getting a handle on some of the science. It's been observed for long periods of time that if you change a rat's food environment like Tony Sclafani did many, many years ago. That rats aren't trying to maintain their weight. They're not trying to do anything other than eat whatever they feel like. And, he was having a hard time getting rats to fatten up on a high fat diet. And he gave them this so-called supermarket diet or cafeteria diet composed of mainly human foods. And they gained a ton of weight. And I think that pointed to the fact that it's not that these rats lacked willpower or something like that. That they weren't making these conscious choices in the same way that we often think humans are entirely under their conscious control about what we're doing when we make our food choices. And therefore, we criticize people as having weak willpower when they're not able to choose a healthier diet in the face of the food environment. I think the newer piece that we're sort of only beginning to understand is how is it that that food environment and the foods that we eat might be changing this internal symphony of signals that's coming from our guts, from the hormones in our blood, to our brains and the understanding that of food intake. While you might have control over an individual meal and how much you eat in that individual meal is under biological control. And what are the neural systems and how do they work inside our brains in communicating with our bodies and our environment as a whole to shift the sort of balance point where body weight is being regulated. To try to better understand this really intricate interconnection or interaction between our genes, which are very different between people. And thousands of different genes contributing to determining heritability of body size in a given environment and how those genes are making us more or less susceptible to these differences in the food environment. And what's the underlying biology? I'd be lying to say if that we have that worked out. I think we're really beginning to understand that, but I hope what the book can give people is an appreciation for the complexity of those internal signals and that they exist. And that food intake isn't entirely under our control. And that we're beginning to unpack the science of how those interactions work.

It's incredibly interesting. I agree with you on that. I have a slide that I bet I've shown a thousand times in talks that I think Tony Sclafani gave me decades ago that shows laboratory rats standing in front of a pile of these supermarket foods. And people would say, well, of course you're going to get overweight if that's all you eat. But animals would eat a healthy diet if access to it. But what they did was they had the pellets of the healthy rat chow sitting right in that pile.

Exactly.

And the animals ignore that and overeat the unhealthy food. And then you have this metabolic havoc occur. So, it seems like the biology we've all inherited works pretty well if you have foods that we've inherited from the natural environment. But when things become pretty unnatural and we have all these concoctions and chemicals that comprise the modern food environment the system really breaks down, doesn't it?

Yeah. And I think that a lot of people are often swayed by the idea as well. Those foods just taste better and that might be part of it. But I think that what we've come to realize, even in our human experiments where we change people's food environments... not to the same extent that Tony Sclafani did with his rats, but for a month at a time where we ask people to not be trying to gain or lose weight. And we match certain food environments for various nutrients of concern. You know, they overeat diets that are higher in these so-called ultra-processed foods and they'd spontaneously lose weight when we remove those from the diet. And they're not saying that the foods are any more or less pleasant to eat. There's this underlying sort of the liking of foods is somewhat separate from the wanting of foods as neuroscientists are beginning to understand the different neural pathways that are involved in motivation and reward as opposed to the sort of just the hedonic liking of foods. Even the simple explanation of 'oh yeah, the rats just like the food more' that doesn't seem to be fully explaining why we have these behaviors. Why it's more complicated than a lot of people make out.

Let's talk about ultra-processed foods and boy, I've got two wonderful people to talk to about that topic. Julia, let's start with your opinion on this. So tell us about ultra-processed foods and how much of the modern diet do they occupy?

So ultra-processed foods. Obviously there's an academic definition and there's a lot of debate about defining this category of foods, including in the US by the Health and Human Services. But the way I think about it is like, these are foods that contain ingredients that you don't use in your home kitchen. They're typically cooked. Concocted in factories. And they now make up, I think it's like 60% of the calories that are consumed in America and in other similar high-income countries. And a lot of these foods are what researchers would also call hyper palatable. They're crossing these pairs of nutrient thresholds like carbohydrate, salt, sugar, fat. These pairs that don't typically exist in nature. So, for the reasons you were just discussing they seem to be particularly alluring to people. They're again just like absolutely ubiquitous and in these more developed contexts, like in the US and in the UK in particular. They've displaced a lot of what we would think of as more traditional food ways or ways that people were eating. So that's sort of how I think about them.

You know, if you go to a supermarket these days, it's pretty hard to find a part of the supermarket that doesn't have these foods. You know, whole entire aisles of processed cereals and candies and chips and soft drinks and yogurts, frozen foods, yogurts. I mean, it's just, it's all over the place. And you know, given that if the average is 60% of calories, and there are plenty of people out there who aren't eating any of that stuff at all. For the other people who are, the number is way higher. And that, of course, is of great concern. So there have been hundreds of studies now on ultra-processed foods. It was a concept born not that long ago. And there's been an explosion of science and that's all for the good, I think, on these ultra-processed foods. And perhaps of all those studies, the one discussed most is one that you did, Kevin. And because it was exquisitely controlled and it also produced pretty striking findings. Would you describe that original study you did and what you found?

Sure. So, the basic idea was one of the challenges that we have in nutrition science is accurately measuring how many calories people eat. And the best way to do that is to basically bring people into a laboratory and measure. Give them a test meal and measure how many calories they eat. Most studies of that sort last for maybe a day or two. But I always suspected that people could game the system if for a day or two, it's probably not that hard to behave the way that the researcher wants, or the subject wants to deceive the researcher. We decided that what we wanted to do was bring people into the NIH Clinical Center. Live with us for a month. And in two two-week blocks, we decided that we would present them with two different food environments essentially that both provided double the number of calories that they would require to maintain their body weight. Give them very simple instructions. Eat as much or as little as you'd like. Don't be trying to change your weight. We're not going to tell you necessarily what the study's about. We're going to measure lots of different things. And they're blinded to their weight measurements and they're wearing loose fitting scrubs and things like that, so they can't tell if their clothes are getting tighter or looser. And so, what we did is in for one two-week block, we presented people with the same number of calories, the same amount of sugar and fat and carbs and fiber. And we gave them a diet that was composed of 80% of calories coming from these ultra-processed foods. And the other case, we gave them a diet that was composed of 0% of calories from ultra-processed food and 80% of the so-called minimally processed food group. And what we then did was just measured people's leftovers essentially. And I say we, it was really the chefs and the dieticians at the clinical center who are doing all the legwork on this. But what we found was pretty striking, which was that when people were exposed to this highly ultra-processed food environment, despite being matched for these various nutrients of concern, they overate calories. Eating about 500 calories per day on average, more than the same people in the minimally processed diet condition. And they gained weight and gained body fat. And, when they were in the minimally processed diet condition, they spontaneously lost weight and lost body fat without trying in either case, right? They're just eating to the same level of hunger and fullness and overall appetite. And not reporting liking the meals any more or less in one diet versus the other. Something kind of more fundamental seemed to have been going on that we didn't fully understand at the time. What was it about these ultra-processed foods? And we were clearly getting rid of many of the things that promote their intake in the real world, which is that they're convenient, they're cheap, they're easy to obtain, they're heavily marketed. None of that was at work here. It was something really about the meals themselves that we were providing to people. And our subsequent research has been trying to figure out, okay, well what were the properties of those meals that we were giving to these folks that were composed primarily of ultra-processed foods that were driving people to consume excess calories?

You know, I've presented your study a lot when I give talks. It's nice hearing it coming from you rather than me. But a couple of things that interest me here. You use people as their own controls. Each person had two weeks of one diet and two weeks of another. That's a pretty powerful way of providing experimental control. Could you say just a little bit more about that?

Yeah, sure. So, when you design a study, you're trying to maximize the efficiency of the study to get the answers that you want with the least number of participants while still having good control and being able to design the study that's robust enough to detect a meaningful effect if it exists. One of the things that you do when you analyze studies like that or design studies like that, you could just randomize people to two different groups. But given how noisy and how different between people the measurement of food intake is we would've required hundreds of people in each group to detect an effect like the one that we discovered using the same person acting as their own control. We would still be doing the study 10 years later as opposed to what we were able to do in this particular case, which is completed in a year or so for that first study. And so, yeah, when you kind of design a study that way it's not always the case that you get that kind of improvement in statistical power. But for a measurement like food intake, it really is necessary to kind of do these sorts of crossover type studies where each person acts as their own control.

So put the 500 calorie increment in context. Using the old fashioned numbers, 3,500 calories equals a pound. That'd be about a pound a week or a lot of pounds over a year. But of course, you don't know what would happen if people were followed chronically and all that. But still 500 calories is a whopping increase, it seems to me.

It sure is. And there's no way that we would expect it to stay at that constant level for many, many weeks on end. And I think that's one of the key questions going forward is how persistent is that change. And how does something that we've known about and we discuss in our books the basic physiology of how both energy expenditure changes as people gain and lose weight, as well as how does appetite change in a given environment when they gain and lose weight? And how do those two processes eventually equate at a new sort of stable body weight in this case. Either higher or lower than when people started the program of this diet manipulation. And so, it's really hard to make those kinds of extrapolations. And that's of course, the need for further research where you have longer periods of time and you, probably have an even better control over their food environment as a result.

I was surprised when I first read your study that you were able to detect a difference in percent body fat in such a short study. Did that surprise you as well?

Certainly the study was not powered to detect body fat changes. In other words, we didn't know even if there were real body fat changes whether or not we would have the statistical capabilities to do that. We did use a method, DXA, which is probably one of the most precise and therefore, if we had a chance to measure it, we had the ability to detect it as opposed to other methods. There are other methods that are even more precise, but much more expensive. So, we thought that we had a chance to detect differences there. Other things that we use that we also didn't think that we necessarily would have a chance to detect were things like liver fat or something like that. Those have a much less of an ability. It's something that we're exploring now with our current study. But, again, it's all exploratory at that point.

So what can you tell us about your current study?

We just wrapped it up, thankfully. What we were doing was basically re-engineering two new ultra-processed diets along parameters that we think are most likely the mechanisms by which ultra-processed meals drove increased energy intake in that study. One was the non-beverage energy density. In other words, how many calories per gram of food on the plate, not counting the beverages. Something that we noticed in the first study was that ultra-processed foods, because they're essentially dried out in the processing for reasons of food safety to prevent bacterial growth and increased shelf life, they end up concentrating the foods. They're disrupting the natural food matrix. They last a lot longer, but as a result, they're a more concentrated form of calories. Despite being, by design, we chose the overall macronutrients to be the same. They weren't necessarily higher fat as we often think of as higher energy density. What we did was we designed an ultra-processed diet that was low in energy density to kind of match the minimally processed diet. And then we also varied the number of individual foods that were deemed hyper palatable according to kind of what Julia said that crossed these pairs of thresholds for fat and sugar or fat and salt or carbs and salt. What we noticed in the first study was that we presented people with more individual foods on the plate that had these hyper palatable combinations. And I wrestle with the term terminology a little bit because I don't necessarily think that they're working through the normal palatability that they necessarily like these foods anymore because again, we asked people to rate the meals and they didn't report differences. But something about those combinations, regardless of what you call them, seemed to be driving that in our exploratory analysis of the first study. We designed a diet that was high in energy density, but low in hyper palatable foods, similar to the minimally processed. And then their fourth diet is with basically low in energy density and hyper palatable foods. And so, we presented some preliminary results last year and what we were able to show is that when we reduced both energy density and the number of hyper palatable foods, but still had 80% of calories from ultra-processed foods, that people more or less ate the same number of calories now as they did when they were the same people were exposed to the minimally processed diet. In fact they lost weight, to a similar extent as the minimally processed diet. And that suggests to me that we can really understand mechanisms at least when it comes to calorie intake in these foods. And that might give regulators, policy makers, the sort of information that they need in order to target which ultra-processed foods and what context are they really problematic. It might give manufacturers if they have the desire to kind of reformulate these foods to understand which ones are more or less likely to cause over consumption. So, who knows? We'll see how people respond to that and we'll see what the final results are with the entire study group that, like I said, just finished, weeks ago.

I respond very positively to the idea of the study. The fact that if people assume ultra-processed foods are bad actors, then trying to find out what it is about them that's making the bad actors becomes really important. And you're exactly right, there's a lot of pressure on the food companies now. Some coming from public opinion, some coming from parts of the political world. Some from the scientific world. And my guess is that litigation is going to become a real actor here too. And the question is, what do you want the food industry to do differently? And your study can really help inform that question. So incredibly valuable research. I can't wait to see the final study, and I'm really delighted that you did that. Let's turn our attention for a minute to food marketing. Julia, where does food marketing fit in all this?

Julia - What I was very surprised to find while we were researching the book was this deep, long history of calls against marketing junk food in particular to kids. I think from like the 1950s, you have pediatrician groups and other public health professionals saying, stop this. And anyone who has spent any time around small children knows that it works. We covered just like a little, it was from an advocacy group in the UK that exposed aid adolescents to something called Triple Dip Chicken. And then asked them later, pick off of this menu, I think it was like 50 items, which food you want to order. And they all chose Triple Dip chicken, which is, as the name suggests, wasn't the healthiest thing to choose on the menu. I think we know obviously that it works. Companies invest a huge amount of money in marketing. It works even in ways like these subliminal ways that you can't fully appreciate to guide our food choices. Kevin raised something really interesting was that in his studies it was the foods. So, it's a tricky one because it's the food environment, but it's also the properties of the foods themselves beyond just the marketing. Kevin, how do you think about that piece? I'm curious like.

Kevin - I think that even if our first study and our second study had turned out there's no real difference between these artificial environments that we've put together where highly ultra-processed diets lead to excess calorie intake. If that doesn't happen, if it was just the same, it wouldn't rule out the fact that because these foods are so heavily marketed, because they're so ubiquitous. They're cheap and convenient. And you know, they're engineered for many people to incorporate into their day-to-day life that could still promote over consumption of calories. We just remove those aspects in our very artificial food environment. But of course, the real food environment, we're bombarded by these advertisements and the ubiquity of the food in every place that you sort of turn. And how they've displaced healthy alternatives, which is another mechanism by which they could cause harm, right? It doesn't even have to be the foods themselves that are harmful. What do they displace? Right? We only have a certain amount the marketers called stomach share, right? And so, your harm might not be necessarily the foods that you're eating, but the foods that they displaced. So even if our experimental studies about the ultra-processed meals themselves didn't show excess calorie intake, which they clearly did, there's still all these other mechanisms to explore about how they might play a part in the real world.

You know, the food industry will say that they're agnostic about what foods they sell. They just respond to demand. That seems utter nonsense to me because people don't overconsume healthy foods, but they do overconsume the unhealthy ones. And you've shown that to be the case. So, it seems to me that idea that they can just switch from this portfolio of highly processed foods to more healthy foods just doesn't work out for them financially. Do you think that's right?

I honestly don't have that same sort of knee jerk reaction. Or at least I perceive it as a knee jerk reaction, kind of attributing malice in some sense to the food industry. I think that they'd be equally happy if they could get you to buy a lot and have the same sort of profit margins, a lot of a group of foods that was just as just as cheap to produce and they could market. I think that you could kind of turn the levers in a way that that would be beneficial. I mean, setting aside for example, that diet soda beverages are probably from every randomized control trial that we've seen, they don't lead to the same amount of weight gain as the sugar sweetened alternatives. They're just as profitable to the beverage manufacturers. They sell just as many of them. Now they might have other deleterious consequences, but I don't think that it's necessarily the case that food manufacturers have to have these deleterious or unhealthy foods as their sole means of attaining profit.

Thanks for that. So, Julia, back to you. You and Kevin point out in your book some of the biggest myths about nutrition. What would you say some of them are?

I think one big, fundamental, overarching myth is this idea that the problem is in us. That this rise of diet related diseases, this explosion that we've seen is either because of a lack of willpower. Which you have some very elegant research on this that we cite in the book showing willpower did not collapse in the last 30, 40 years of this epidemic of diet related disease. But it's even broader than that. It's a slow metabolism. It's our genes. Like we put the problem on ourselves, and we don't look at the way that the environment has changed enough. And I think as individuals we don't do that. And so much of the messaging is about what you Kevin, or you Kelly, or you Julia, could be doing better. you know, do resistance training. Like that's the big thing, like if you open any social media feed, it's like, do more resistance training, eat more protein, cut out the ultra-processed foods. What about the food environment? What about the leaders that should be held accountable for helping to perpetuate these toxic food environments? I think that that's this kind of overarching, this pegging it and also the rise of personalized nutrition. This like pegging it to individual biology instead of for whatever the claim is, instead of thinking about how did environments and don't want to have as part of our lives. So that's kind of a big overarching thing that I think about.

It makes sense. So, let's end on a positive note. There's a lot of reason to be concerned about the modern food environment. Do you see a helpful way forward and what might be done about this? Julia, let's stay with you. What do you think?

I think so. We spent a lot of time researching history for this book. And a lot of things that seem impossible are suddenly possible when you have enough public demand and enough political will and pressure. There are so many instances and even in the history of food. We spend time with this character Harvey Wiley, who around the turn of the century, his research was one of the reasons we have something like the FDA protecting the food supply. That gives me a lot of hope. And we are in this moment where a lot of awareness is being raised about the toxic food environment and all these negative attributes of food that people are surrounded by. I think with enough organization and enough pressure, we can see change. And we can see this kind of flip in the food environment that I think we all want to see where healthier foods become more accessible, available, affordable, and the rest of it.

Sounds good. Kevin, what are your thoughts?

Yes, I just extend that to saying that for the first time in history, we sort of know what the population of the planet is going to be that we have to feed in the future. We're not under this sort of Malthusian threat of not being able to know where the population growth is going to go. We know it's going to be roughly 10 billion people within the next century. And we know we've got to change the way that we produce and grow food for the planet as well as for the health of people. We know we've got to make changes anyway. And we're starting from a position where per capita, we're producing more protein and calories than any other time in human history, and we're wasting more food. We actually know we're in a position of strength. We don't have to worry so acutely that we won't be able to provide enough food for everybody. It's what kind of food are we going to produce? How are we going to produce it in the way that's sustainable for both people and the planet? We have to tackle that anyway. And for the folks who had experienced the obesity epidemic or finally have drugs to help them and other kinds of interventions to help them. That absolve them from this idea that it's just a matter of weak willpower if we finally have some pharmaceutical interventions that are useful. So, I do see a path forward. Whether or not we take that is another question.

Bios

Dr. Kevin Hall is the section chief of Integrative Physiology Section in the Laboratory of Biological Modeling at the NIH National Institute of Diabetes and Digestive and Kidney Diseases. Kevin's laboratory investigates the integrative physiology of macronutrient metabolism, body composition, energy expenditure, and control of food intake. His main goal is to better understand how the food environment affects what we eat and how what we eat affects our physiology. He performs clinical research studies as well as developing mathematical models and computer simulations to better understand physiology, integrate data, and make predictions. In recent years, he has conducted randomized clinical trials to study how diets high in ultra-processed food may cause obesity and other chronic diseases. He holds a Ph.D. from McGill University.

Julia Belluz is a Paris-based journalist and a contributing opinion writer to the New York Times, she has reported extensively on medicine, nutrition, and global public health from Canada, the US, and Europe. Previously, Julia was Vox's senior health correspondent in Washington, DC, a Knight Science Journalism fellow at the Massachusetts Institute of Technology in Cambridge, and she worked as a reporter in Toronto and London. Her writing has appeared in a range of international publications, including the BMJ, the Chicago Tribune, the Economist, the Globe and Mail, Maclean's, the New York Times, ProPublica, and the Times of London. Her work has also had an impact, helping improve policies on maternal health and mental healthcare for first responders at the hospital- and state-level, as well as inspiring everything from scientific studies to an opera. Julia has been honored with numerous journalism awards, including the 2016 Balles Prize in Critical Thinking, the 2017 American Society of Nutrition Journalism Award, and three Canadian National Magazine Awards (in 2007 and 2013). In 2019, she was a National Academies of Sciences, Engineering, and Medicine Communications Award finalist. She contributed chapters on public health journalism in the Tactical Guide to Science Journalism, To Save Humanity: What Matters Most for a Healthy Future, and was a commissioner for the Global Commission on Evidence to Address Societal Challenges.

Interview Summary

You know I really like the innovative nature of Food On The Move, and I'm eager for you to tell us more about what it involves. But before we do that, how does a young, highly successful musician turn to battling food insecurity? What led you to create Food On The Move?

It took me years to say I even created it. I didn't even use the term founder because I really had this sense of partnership that was a part of how it came to be. But I did found or 'start' Food On The Move because I have just a deep sense of gratitude in my life experience and also maybe a calling? I call it the tap on the shoulder that said there's more for you to do. There's more for me to do. And I didn't really know what that meant. I wanted to invest in Oklahoma and where we're from because as a musician, first you travel, you leave, you go out, you connect with people all over the world. But there's something about building and doing well for your community from the town you're from. And I was inspired by a former US ambassador. A man named Edward Perkins, who was an incredible representative of our country. He worked in some of the most difficult parts of the world representing the US and working with other nations. And his story struck me so deeply because he found ways to partner and transform communities as an ambassador. And I got to know him after his time as an ambassador because he was teaching as a professor at OU (Oklahoma University), in Oklahoma. And I asked him, I said - I want to honor your life. I want to learn from you. If I was to begin to really impact my community, Oklahoma where I'm from and maybe beyond, where would you begin? And he said, I would start with food.

That's so interesting. You know, your concept of partnership is so interesting. I'd like to dive into that a little bit deeper in a little bit. But first, tell us about your organization and what it does, how it works, what it tries to accomplish.

Yes. So, inspired by Ambassador Perkins' example, we set out to ask the right questions more than have the answers. And in 2014, I just basically cold called everyone in the community that worked in food - from the food bank to the food pantries and said 'help me understand the gaps.' Help me understand where it's hard to accomplish change. And the term food desert began coming up more and more. And food deserts are communities without grocery stores. So, think of it as the canary in the mine. Sort of when a grocery store goes, the neighborhood is declining. Because they're small margin organizations they have a hard time staying afloat and when they go it's hard to bring them back because you need either a company like a big chain or a small business that doesn't have a lot of resources. And oftentimes that decline continues, and it impacts the community. So, with Food On The Move I basically brought together partners to create an access point in food deserts where it's was all in kind. From food trucks that could bring great, tasty food and give people dignity and excitement and energy, to partners that are doing food safety training and teaching people to cook. And places like Oklahoma State University extension where they train people about how to prepare food because they may not know. And so, all these partners came together, and we basically spent five years just learning and serving people in those communities. And focusing on an environment that was not about raising a bunch of money; it was really about who is already in this space that we can garner relationships with and get to know the communities. And now those events continue to be flagships. We call them food and resource festivals. They are a pay-as-you-can. You show up, you get access to fresh produce, you have food trucks, you have wraparound services. You have people that are in the community, in different nonprofits, for-profits, and government organizations that we all collaborate with. And we reach people where they are while serving and getting to know them and learning from them. And through those relationships, through those events - which we still do - what it's brought us to is the innovation and education side, and ultimately transformation. We realized in order to change food deserts, end food deserts, bring grocery stores back, that we had to get to the heart of the food system. Which is we had to be teaching people to grow things again, rebuild the local foundation of farmers being trained, use new, innovative systems like indoor growing and aquaponics, hydroponics. And basically, we had to kind of build the foundation back that's been lost since post World War II in our community, like many places. And that means a food hub to bridge farmers to distributors. That means training those farmers for the future. And it ultimately means building a new model for a grocery store. So, we are at the heart of that now with a project we call Food Home, where we are building a campus that is like a microcosm of the food system. Hopefully could be the end of this year, we'll see. Construction is always tricky. But, for sure by the start of first quarter next year, we'll be opening a 10,000 square foot urban farm, which is a training facility, and producing hundreds of thousands of pounds of food every year, and this is really the launchpad for future farmers.

My God, I mean, and one of those things you mentioned would be wonderful to dive into and talk about a lot. Because I mean, each is impressive in its own right. But you bring them together, you're probably doing some of the most extensive, impressive things I know of around the country. Let me ask how you address the fundamental issue that we've actually faced ourselves. So communities often feel set upon by outsiders coming in to help. You know, it could be a philanthropy, it could be universities, it could be somebody, you know, who's just coming in well-meaning, wanting to help. But nonetheless may not know the communities or understand the realities of day-to-day life and things like that. And people from communities have often told us that 'we're in the best position to come up with solutions that will work for the members of our own community.' How did you work through those things?

Well, this is always why my story elevator pitch tends to be too long. Because I want to actually talk about that element. It's not super elevator pitchy because what it involves is building relationships and trust and what I first learned from Ambassador Perkins. I'll tell you a small story of his example and it really rocked me. I asked him where would you start if you wanted to change community? Because I'd learned from his story that he had actually done it. He was sent to South Africa at the heart of the Apartheid Movement to with a mission from at the time President Ronald Reagan, to free Nelson Mandela from prison and help dismantle the Apartheid system. This is about as high a mark as anybody could have. And he had no policy. They said you're going to make policy. And what he did was so extraordinary, and I think is the mark of his success. And that's, to answer your question, he said, I recognized that every ambassador had held court. You are one step away from the president of the United States, which means you're always the most powerful person in the room. And other ambassadors, he'd ask them to come to him. But you had this deep divide between Black and white, deep divide between economics. And so, what he did was he told his team when he went to South Africa, he said, put the American flags on the front of the car, roll the windows down and take me to the townships. Take me to the neighborhoods. They need to know I'm here. And he took the time to build real relationships and build trust with communities. Black, white, rich, and poor, you know, old and young. He really did the time. And so that model, though obviously South Africa is a deeply entrenched community that, you know, especially that time.

And this is kind of world politics, but I listened to that. And I thought, wow, we have a divide in our own community. And it's true of so many American cities. And where people, they see an area and they say that's not my community. They're going to come to me. And so, Food On The Move is built on we will build a partnership-based foundation which is like a block party where you walk up, and I'm a musician, I'm a DJ. So, we have a DJ playing music, we have food trucks. It smells great. You have smiling faces. You have a feeling that when you go there, you're not there, like, I need help and I'm in a soup kitchen. It's like there's a community party and you get invited and everyone's available to go there because if you want to give, you can go. If you don't have a dollar in your pocket, you go. And everybody leaves with the same treatment. And that foundation, the way we go about building those relationships, that is the heart and soul of how we are getting to the question and then trying to answer: we need more grocery stores, and we need more farmers. Because we heard it from the neighborhood. And I'll wrap up the answer a little bit which is to say we have multiple community farms as well as our own training farms. And we've worked in middle schools to teach young people to grow things with high-end aquaponics. You know, statistically the worse school in the city. But we've seen it just rocket people to engagement and better education and being fired up to come to school. But the community grow beds are the real test because you can't just drop a community grow bed and say, 'Hey, isn't this awesome? Here's your grow bed.' You have to stay engaged with community, but you also have to invite them to be participants. And so, we work with our neighbors. We treat one another as neighbors, and you are right, it is wrought with pick your cliche. You know, the complex of the outsider coming in with money. The contrast between racial issues and economic issues. It's so wrought with problems potentially. But I believe that real solutions are possible when you build relationships.

It sounds like one of the, you didn't say this directly, but one of the most important things you did was listen. Tell me about that a little more.

Well, yes. I mean, I said it. I kind of coined this phrase now because I realize it's so true. We really started with I think good questions, not good answers. And so, the listening... first of all, the listening started with people that were doing work. So, if you went to the food bank, the question wasn't, 'hey, we're here to help.' This is what we want to do. It was what's going on? You're the food bank, you guys have been here since the '80s. And hey, you're the health department. Hey, you're a food truck, like, what do you see? And I determined early that we needed to always have three pillars. We need to always have representation of for-profit, non-profit, and government agencies at some level. And so, a food truck is a business, right? They understand how hard it is to get people to show up and make a living, right? And you know, a nonprofit or an agency they know about service, they know about the stats. And frankly, however you are on the political spectrum, the government agencies, whatever they happen to be, they have a role to play. They have, whether big or small. Again, people of different walks of life have different views on that. But they should be a part of the conversation no matter what. And so, that was the first step. And then I like to say, an example Kelly, of kind of the dynamic shift is - if you walk up to somebody you barely know, you're not going to tell them like, 'hey man, I'm not sure about that shirt. Or you got something in your tooth,' you know? Or, 'have you really considered redecorating your house? Like, it's kind of dated.' Those are things you get to say to friends. You know, you tell a friend, 'hey man, you know, suck it in. You're taking a picture.' You know? And so at the foundation, the questions we were asking were also why do you think this has happened? Why is a neighborhood that was a thriving new neighborhood in 1965 now dangerous and in decline. And talking with elders. And they became and have become some of our greatest advocates. And you know what? It's not flashy. You show up and you just keep showing up. And you show up when it's rainy and you show up when it's cold. And at some point people go. Wow. Like they're actually going to do this. So, you know, we're still doing it. We're not there. There's no finish line on this.

So consistent with what we found in our own work about the importance of showing up. I'm happy that you raised that particular term. Speaking of terms, when I introduced you there, I used this term that I pulled right from your website about the legacy issues created by food insecurity. What do you mean by that?

Yes. So legacy issues. You know, people develop heart disease, diabetes, frankly anxiety, ADHD/ADD things. A lot of stuff that's diet and a lot of things that's habit. So, if you grow up in a house that nobody ever cooked really. Because the neighborhood lost its store. Mom and dad were busy. Maybe a single parent home. You know, look, my wife and I have blessed, we have seven children. Wow. And we have a full house. And even with, you know, plenty of resources and plenty of support, it's still hard to do right. It's still hard to eat well. You know, you're running and you're gunning. And so legacy issues are habits. Eating habits. Consumption habits. By the way, poverty does not discriminate on race. Poverty hits whoever it hits, right? And so, Black and white, different backgrounds you'd be speaking with somebody that, 'like I've never seen a red bell pepper. I didn't know that existed. I've never seen What is That's a kiwi. What's a kiwi? I don't want to eat that.' You know? And so, the legacy issues are health, habits, education. Also, if you've never had access to resources, if you've never had an uncle that became an attorney or somebody that knew how to manage money because your neighborhood was a history of decline. You just don't know anybody. Or even worse, you have communities because of poverty that everybody in your family knows somebody that was in jail or was headed to jail because of their climate, their environment. And things that occur because of limited, you know, resources. And things that happen among, you know, communities with less available to them. And you have to take judgment and just throw it across the room. Just completely eject any sense of judgment. And recognize that somebody that's grown up with those different parameters, they're carrying those around. So, you're trying to restart. You're trying to begin again. And say, you know, let's get us back to having as little baggage behind us. Let's get diabetes out of the way. Let's get heart disease (out of the way) and we're going to do it by eating good food. Or getting educated. And it's not going to happen quick. It's going to happen through probably an entire generation if we're lucky.

Now, let me ask a related question about dignity because this comes up in the way you've spoken about this. And in the way our country has addressed hunger. I mean, going back to when the War on Hunger began really in the 1960s, it was a nation's compassionate response to a very real issue that so many people faced. But the solution wasn't to try to give people more financial means so they could buy their own food and not have to face this. It was to give them food. But to do so in ways that really did destroy dignity in many ways. How are you addressing that and how does that term figure into the work you're doing?

Well, I love the way you couch that. And unfortunately, among these discussions, people glom onto certain aspects if they have their own sort of paradigm that's ingrained. And one, you have to throw out ideology and focus on, I think, common sense. And the short answer is we believe in teach a man to fish as the philosophy. There is no way to ultimately change things if your goal is not aligned with creating opportunity, creating, transitioning folks that have not been able to support their families, to finding ways to transform that. And that comes by getting to know one another. That comes with creating education. And that comes with looking at the whole system. And so, when I brought sort of to my team this answer or this proposal of why we need to build Food Home. The Food Home campus. It wasn't just that I had some epiphany that I walked into the desert and came back with an idea. It was built around the work we were doing. And we already had somebody that wanted to build a grocery store. We already had somebody that was farm focused, thinking about food hub to bridge the gap with farmers. We had a study that was done by a local foundation that said we don't have enough farmers right now to get all the local food. And we need local because it's more affordable. We shouldn't be paying for our lettuce to travel from California to Oklahoma. We don't need to do that. And so, dignity and building the transition, the future, is about looking at the whole and being willing to do, I think, the hard work. Which is to realize our food, our food economy has to change. And recognizing that opportunity is not a bad word, you know? Economic investment in communities. These are good things. And at the same time, you meet people where they are. You meet them right where they are.

And when COVID happened, our pitch about building Food Home and building the food systems and training people to grow things, it pivoted a little bit. Because people saw for the first time in a generation what it's like when the food's not there. Like you're in Oklahoma and we were the distribution partner for the USDA doing Farm to Family boxes. Food On The Move was. We had trucks that were designated for us from farmers that had been supported by government purchasing to bring food to food banks, and to resources, to communities. And we had a truck that was a state away and we were supposed to go get that truck and give it to people that needed it in our neighborhood in Oklahoma. And we were going guys, if we had a food home, a food hub, a bridge between local farmers, every community would know where their food is coming from. And so there is a food security side of this discussion as well which is that we need to have sovereignty. We need to have structure that gives us access and that builds long-term economic sustainability. And Oklahoma is a great example of this. We used to have a very thriving local farm community system. All my grandparents, my parents, they went to farmer's markets. They bought great food. And many of those folks working in that land because there's not a food hub that bridges this medium farmer to the distributors - they've lost economic ability to scale. And they do better to sell their land to a developer and grow sod or put a bunch of houses on it. And that has got to change.

You know, you reinforce the idea that there's a lot of ingenuity in communities. And lots of good ideas about how to solve the problems. And many times, the people that are wanting to help communities can be helped best by just supporting the ideas that are already there. Because, as I said, we've encountered so much ingenuity from people in the communities who've been thinking about these issues for a long time. Let me ask something. You kind of began this by talking about food deserts and grocery stores leaving areas. And you've come up with a lot of creative ways of compensating for the loss of grocery stores. But what about correcting that problem. What about getting more grocery stores back into these areas? Is that something that you guys deal with?

That's ultimately our mission. I mean, I say the mission is the solution so that I don't want to put it into one square box called a store. But the store departing is at the heart of the key question we're asking. Why? And so, the Food Home campus is a four phased vision. And the first two phases are underway, or about to be open with the food hub and the urban farm. The second two are a community hub, which is teaching and training people to prepare and cook food better, getting urban and rural together. And the last phase, which started as the first, by the way. It began as the first thinking we're just going to get a store. We realized you had to get the food chain right before you could build a better store. And so the model for a store, we believe, is going to be probably a hybrid between a fresh delivery and a physical place that is there living right at the heart of a neighborhood. Let's do an update on this here as we get to opening that door, because I believe what we've seen is the umbrella that allows the small store is still needed. That's, kind of, we're stepping in with a food hub. We're stepping in with a bigger footprint, buying power, larger volume, purchasing local. But really entrepreneurs where single operators are invested in owning and operating that store. They're also committed more to that store. It's not just a corporate line item. I'm interested in studying, frankly, some of the really smart food franchisees that have understood the power of creating economic models that are sustainable. But you have to connect them to a bigger umbrella to help support that medium grocer. It's going to be a combination of those things. But yeah, we have to get stores where you can actually buy your food and it is affordable and it is quality.

Quality becomes an interesting issue here. And I haven't looked at the research literature on this for a little while. When I did, there was some research looking at what happened to the quality of nutrition in neighborhoods where grocery stores had left or had come back in. And it didn't seem to make a lot of difference in terms of overall nutrition profile of the people there. It provided some real benefits. Access. People didn't have to go a long way to get their groceries. Costs tended to come down, so there were some real benefits aside from nutrition. But just focusing on nutrition, of course a big supermarket brings more fresh fruits and vegetables. But it also brings aisle after aisle of highly processed, highly calorie dense foods that aren't necessarily helpful. So, the fact that you're working on the healthy food part of the equation and finding ways to get foods from farms to people, not necessarily from a big food processing plant. From farms to people, is really an important part of the overall picture, isn't it?

Fresh produce is the sort of heart and soul of the food dilemma. And so yes, it is very, very tricky. You know, a little bit like how do you raise a child to have good habits? We're all trying to have good habits and we still eat hamburgers and fries because they're delicious. So, going back to dignity, I do not believe, and this is my perspective mixed with the data and the experience. I don't believe, the opinion side, in deciding whether or not people deserve certain things. And early on when we started the food pop-up events, I suggested, 'hey, call the food trucks. Have the pizza truck come have because they're awesome and they're mobile and they can show up.' And we had some folks that were partners that kind of went well, but that's greasy food and that's, you know, it's X, Y, and Z. And this is what I said to that: it's like, look, our job is first to meet people and treat them like we would want to be treated. And then we work on the produce. And so, with a grocery store, you're absolutely right. You can't just drop good food somewhere and think everybody's going to get healthy. Most people are going to eat what they like. But mostly the barrier to entry on healthy food is economics. People do not have the dollars to buy the kale or to buy the fresh tomatoes. Most people actually do, find that they will, you know, consume that food. But you have to get the generational conversation happening where families have grown up seeing fresh produce. Cooking with fresh produce. And they can actually buy it. And that's not going to happen unless we get food closer. Because the closer food allows us to cut down the margin that's going to transportation and make quality food more affordable.

Makes good sense. So you've been at this a while. What have you learned? How do you look at things differently now than when you started?

I learned that creating change is not for the faint of heart. First of all, you better really sort of revel in a challenge. And also, we've touched on several of the elements of what I've learned. You have to build trust. You can't expect people to just change just because you say so. You also have to be really interested in learning. Like, not just learning because you have to, but you have to be interested in understanding. And I think that's at the heart of getting to solutions. It's not even just asking the right question. It's actually being interested in the answer to that question. Like it's wanting to genuinely know. And so, these are all things I put in and I'll say the last, which is not the sexy one. It's difficult to build a good organization that's sustainable. And we've spent the second half of the Food On The Move journey building a strong team, hiring the right CEO, building a great board, having governance, having sustainability in your culture. I mean, these are business things and you know, I'm the founder. I'm a board member. I'm at the heart of who we are, but we've had to build a team. And so, anybody that wants to make things sustainable or create sustainable change, and this would be my last takeaway to your question, is you have to grow past yourself. You have to be anticipating giving that away. Growing much, much further than the bottleneck of the big idea person. But you also have to stay in stewardship mode. So, that's kind of where I am now is how do we make this continue to grow towards the solutions we're hoping for? And how do I stay engaged, fired up, focused, inspired to get the team involved, but also trust people on the team to do what they have been asked to do.

I'd like to pick up on something that you mentioned along the way, which is work that you're doing on urban farming, and you mentioned things like hydroponics and aquaponics. Tell us a little bit more about that.

Wo we came across hydroponics and aquaponics because when you look at growing methodologies, one of the challenges we have is our eating habits have changed. People don't just eat seasonally. We've become accustomed to getting strawberries year-round and getting all these different flavors. And you can't expect that that's just going to happen. We're not just going to change that and make everybody eat the harvest of Ohio or the harvest of Tulsa. Like we all expect good food when we do go to the store. The economics of food means people are ready to buy certain things. And for a sustainable grocery store, you need to have the things that people will buy. So, aquaponics and hydroponics are new technologies that were pioneered to create high production and high volume in areas that might have different climates. You can grow year round. The things that grow best are leafy greens, but you can grow all kinds of things. Tomatoes, you know, vining plants. Cucumbers. You can grow incredible amounts of food. A large portion of your food can be grown through these indoor systems, and they cost more to start than a traditional dirt farm. But once established they produce year round, they are more resilient with obviously pests and weather and things like that. With aquaponics and hydroponics you have systems that naturally are organic. They need to be organic because that's how they function, you know? Fish tanks, you know, that are naturally fertilizing. The fish are giving the plants what they need. This is cool stuff. So, we were led to those systems because sustainability and better food and more of it for small communities in a place like Oklahoma where you have hot and cold, and if you can grow year round, then you could have a cash crop that somebody could build a business with and provide better for that store. And not be buying it from Mexico or California. I mean, God bless Mexico and California, but we're putting too much food on a truck. And it's older than it should be, and it's sprayed with stuff because it needs to look good when it shows up, and that's hurting everybody. So, we need new methodologies.

Well, and not only are you producing food, but it's a community driven solution because it's right there. People in the community can own it, can run it, can work at it, and things like that. And just it's mere presence probably signals something very positive that is good economically good nutritionally, but also good psychologically, I think. So, let me ask one parting question. Hunger has been an issue in the United States for a long, long time. And it continues to be. And now there have been even more cutbacks than before and the SNAP program and things like that. Are you optimistic that we can address this problem and do you think a local very creative and innovative local solution that you're talking about in Oklahoma, can that be exported and replicated and are you optimistic? Let me just ask you that.

Are you optimistic is an interesting question because I don't think we can afford not to be optimistic. If you ask a parent, are you optimistic your child will eat, there's no choice there. Your child will eat. Or you will die trying to feed them. And I've spoken to, you know, leadership groups and rotary clubs and nonprofits about different aspects of my journey. And I think the heart of this issue is to not make it an option that we don't solve this. We cannot talk about feeding our community. And by the way, I don't mean feeding them just like I said, through nonprofit, but changing the culture and eliminating hunger in this country. And really, it's facing hunger. We can't make it an option that we don't. My perspective is, I think it's going to take, solutions like what Food On the Move is doing, which is at the heart of understanding our food systems. And we are definitely building. Everything we're doing is to try and have a model hoping that what we're doing in Oklahoma, which has a lot of parallels to, you know, whether you're talking about North Carolina or Ohio or Missouri, or Houston. All these communities have a lot of similarities. We believe that if we can show that you build trust, you then develop models, you then train future farmers. You build an infrastructure to launch and bridge the gap between small and medium farmers. And then here's a model for a better store that's sustainable. We believe that we're going to be able to show that that is a long road, but the road that is maybe less traveled but needed. And that could be the difference that's needed. So, it's fingers are crossed.

BIO

Tulsa native Taylor Hanson grew up in a home where artistic expression was encouraged and celebrated. At the age of nine he, along with brothers Isaac and Zac, formed the band HANSON. Just five years later their debut album was released and the lead single, "MMMBop", hit number one in 27 countries, and earned the group 3 GRAMMY nominations. At the age of 20, he co-founded 3CG Records, allowing the band to produce music on their own terms, and is recognized as a longtime advocate for independent music globally. The group continues to produce meaningful music for its ever-growing fanbase. Hanson possesses a deep commitment to social change. In 2007 he inspired others to make an impact through simple actions, co-founding non-profit Take The Walk, combating extreme poverty in Sub-Saharan Africa. In 2014, he founded Food On The Move, which provides access, education, and innovative solutions, to transform food deserts and the legacy issues created by food insecurity. Since its founding, Food On The Move has distributed millions of pounds of fresh produce to members of the Oklahoma community, and is a leader in the movement to reshape sustainable local food systems. He has been instrumental in a number of community-oriented music initiatives, including contributing to "The Sounds of Black Wall Street", to commemorate the centennial of the Tulsa Race Massacre, spearheading "For Women Life Freedom" highlighting the human-rights atrocities taking place in Iran, and currently serves as is a National Trustee of the Recording Academy. Hanson, his wife Natalie, and their seven children, make their home in Tulsa, where he was recently named Tulsan of the Year.

In today's episode, we're discussing the complex and urgent topic of global food demand. The United Nations Sustainable Development Goals, or SDGs, ask countries to make measurable progress in reducing poverty, achieving zero hunger, and supporting every individual in realizing good health. While also mitigating climate change, sustaining the environment and responsible consumption and production habits. Researchers have recommended sustainable diets - planetary health diets. For example, the Eat Lancet Planetary Health Diet. However, others have criticized some of these diets for not addressing the economic and social impacts of transitioning to such diets. Is it possible to balance changing diets, rising incomes, and economic growth with economic feasibility, environmental impact, and long-term sustainability? Well, that's what our goals are today. Our guests today are Andrew Muhammad of the University of Tennessee Institute of Agriculture, and Emiliano Lopez Barrera from Texas A&M. They are my co-authors on a new paper in the Annual Review of Resource Economics entitled Global Food Demand: overcoming Challenges to Healthy and Sustainable Diets.

Interview Summary

Andrew let's begin with you. Why is it important to study the economics of dietary habits and food choices in a global context?

Well, it's important for several reasons, right? When we think both about food security as well as environmental outcomes and maintaining biodiversity, in keeping both human beings and the planet healthy, we really do need to think about this in a global context. One could see agriculture as a global ecosystem where decisions in one country clearly have impacts on outcomes in others. While at the same time, we need to see food as a means by which we satisfy the demands of a global community. Whether it be through our own domestic production or international trade. And then the last thing I'll say, which is really most important are all the actual things we want to tackle and mitigate and correct, fix or improve. Whether it be the environmental issues, global food security outcomes, individual diets, mitigating obesity issues globally, right? It's pretty clear that most of the things affecting human beings in the environment as it relates to agriculture are global in nature, and there's an economic component that we need to consider when addressing these issues in a global context.

Thank you for sharing that. And I am interested to understand what the role of economics in dietary habits is as we explored it in this review paper.

In economics, this is a pretty long history, one could say going back centuries, right? This idea of how income growth impacts food spending on a household or individuals, as well as what economic affluence in development does to sort of how diets transition. And so, for example, it's been long established, right, as individuals get richer, a smaller and smaller share of their income is spent on food. So therefore, food dynamics become less important in [a developed, rich country versus a developing country where a large percentage of income is still spent on food. And what does that mean? That means that while I may find price shocks annoying, and while I may find higher grocery prices annoying, in a developing world that clearly has some implications on the nutritional needs and food decisions far more than it would have on me, for example. But the other thing which is something that has been highlighted for quite some time, and that is this transition from basic staples - from rice, grain, corn, cassava, potatoes, etc. - to more complex food products like high protein dense meat products, fish, milk, dairy, and even highly processed products that are deemed unhealthy. But the point is, as we look at the full spectrum of countries from least developed to most developed, you see this transition from basic staples to these protein dense products as well as complex processed products.

This is a really important point about what are the trends across countries and over time as incomes change and as global prices affect choices. And I do appreciate what you're saying about those of us in, say a country like the United States, where we may be able to absorb some of the shocks that may happen with food prices, we also recognize that there are folks from lower income households where those kinds of price shocks can be really challenging.

That's true.

But this is a different story when we're then talking about developing countries and some of the challenges that they face. Thank you for sharing that. I'm also interested in understanding what do economists mean by a nutritious and sustainable food demand, especially in the context of global or cross-country comparisons. What are some of the things that you uncovered in this review?

Yes, and I think the main thing, which is particularly interesting, is how early diets transition. How quick countries go from being staple dependent to sort of relying more on protein in consumption and demand. And that happens pretty early and so long before you get to say, countries like the United States with a per capita income of around $50,000 per person, you start seeing transitions quite early, right? Whereas income goes from say less than a $1,000 per person to maybe $5,000 and $10,000, you see these transitions right away. And in fact, you begin to see things level off. And what that means is when we think about, for example, animal protein production, which is in the context of dairy and beef, which is considered relatively more harmful to the environment than say poultry production. What you do find is that in these developing countries, they really do transition right away to meat with just minimal income growth. Whereas at the same time, when you start seeing income growth at the higher end of the spectrum, you don't see that much of a change. Now, something that's also unfortunate, what you find is that with income growth, you do see decrease in consumption of vegetables. A part of that is that some staples are counted as vegetables, but another part of that is that wealth and influence doesn't necessarily lead to improved diets. And that's something that's unfortunate. And what it says is that interventions are possibly needed for these improved diets. But to really get back to your question, this idea when we say sort of a nutritious diet, obviously we're thinking about diets that satisfy the nutritional needs of individuals. While at the same time mitigating unhealthy outcomes. Mitigating obesity, cardiovascular disease, etc. But then coupled with that is this whole notion of sustainable agricultural production. And I think one of the difficult things about both nutritious and abundant food as well as environmental outcomes, is we really are thinking about sort of trade-offs and complementarities. Then I think economics gives us a real keen insight into how these things play out.

Andrew, you make me worry that we're locked in. That is as soon as income start to rise, people move to more animal protein-based products. They move away from some fruits and vegetables. And knowing that the environmental consequences of those choices and even the health consequences, my question to you is what kinds of interventions or how do you think about interventions as a way to shape that demand? Is that an appropriate way to think about this?

Alright, so there's a few things. One is just sort of provide nutrition education globally. Having countries and their governments sort of understand these outcomes and then making a concerted effort to educate the public. The other thing is what you often do see is incentivized, for example, fish consumption. Incentivizing poultry production. And you do actually see a lot of incentives for poultry and egg consumption. And I think of like the Gates Foundation in that One Egg a Day initiative to help with child stunting and child growth in the developing world. And so, they're clearly protein alternatives to bovine type products. And I have to be clear here. Like I'm only speaking about this in the context of what's being said, in terms of the environment and animal production. But the other thing I think, it's probably even more important, right? Is this idea that we really do need to rethink how we, both in the developing world as well as in the developed world, rethink how we think about nutrition and eating. And that's just not for developing countries. That's for all countries. And obviously there's one last thing I'll highlight. You do have to be sort of concerned about, say something like taxes. Which would be clearly regressive in the developing world, and probably much more harmful to overall consumer welfare. The point is that taxes and subsidies seem to be the policy instruments of choice.

Great. Thank you for that. Andrew has just shared with us some of the issues of what happens as incomes rise and the changing patterns of behavior. And that there are some implications for sustainable diets. Emiliano, how can we use the type of data that, Andrew talked about to model food systems in terms of health and nutrition. What can we learn from these models and, what should we do with them?

Emiliano – Yes, thank you. Andrew really pointed to like many very important issues, aspects. We see some worrisome trends in the sense that current diets are going in the direction of showing less nutritious. Also, we are looking at a lot of issues in the environmental externalities, embedded resources. A lot of that within the current diet trajectory. Economic models, they have this advantage that they can connect these things together, right? Each time that we decide what we are purchasing for eating each day we are deciding in a combination of these resources embedded in the food that also some potential nutritional outcomes or health outcomes related to that diet. And the models help to connect these things very well. We can trace this back from more, sort of naive approach where we do have lifecycle assessments where you just track the account numbers through the different stages of the food. And you can just basically trace the footprint or head print of the foods. But you can come up with more advanced models. We have seen a huge advance on that area in the last 10-15 years where models can really connect the things in a more holistic approach. Where you can connect the demand systems and the supply system both together. And then from and calibrate the models. And then also they're very useful to project to the future, different states of the world in the future. By doing that sort of exercises, we can learn a lot of how these things are connected, and how potential different pathways towards the future will also have potential different outcomes in terms of nutrition. But also, in terms of environmental pressure. We can model things, for instance, we were talking a little bit on how to shape these different sorts of diets. That's a thing that is advancing more and more in the modeling literature. We can see that people are going from these earlier approaches where we just get a particular diet that we have as a goal, and then we use that as a sort of counterfactual compared to the baseline sort of trajectory. Now we are looking more and more people doing exercises like how we can actually get there with this, for example, differential value added taxes where you kind of harm some type of food and then you kind of incentivize the consumption of others, as Andrew was saying. And we are looking at a lot of those sort of exercises at the global level, localized, and we are learning a lot of these intricate relations from the models. I think that's bottom line. And in that sense is models are really well equipped to this problem in the sense that show this holistic picture of the issue.

Thank you for that. And what we've been learning from these models is this holistic picture, but can you tell us anything about how these models help show these relationships between diet and health outcomes and environmental sustainability? I mean, what's happening? Are we seeing models help predict the greenhouse gas emissions or changes in cardiovascular outcomes? What are you seeing?

Well, typically when we do baseline projections, we use a lot of end use information where we have been studying things backwards, and in these integrated relationships. And when we look into the future, these relationships get stronger. Like some low income, middle countries tend to sort of repeat similar patterns of things that we have seen already in more industrialized countries. We have all this nutrition transition that comes strong. Pretty fast and pretty strong within the models. And when we look forward, the problems are not only going to be like the ones we see now, but probably somewhat worse. Especially in the pressure on the use of natural resources. So that's one thing that we have seen. Another thing that we have seen is that there can be a lot of potential multiple dividends of alternative pathways, right? We have this sort of baseline situation where diets kind of go that way and they become less sustainable, less healthy. We have dual burdens, multiple burdens of malnutrition rising in many countries at the same time. But then when we kind of model this counterfactual situation where what if we get a different diet that can follow certain guidelines or a flexitarian diet or even a vegan diet, whatever. All of those things can bring together some multiple dividends in the sense that you can certainly reduce the pressure on the use of natural resources in many degrees. And then also at the same time, you can reduce the burden of the health outcomes. That's a thing that we have been learning. Another thing that is interesting and is really strong in the model is that you can actually see a lot of synergistic things, synergistic goals that we can learn, but also a lot of potential tradeoffs, right? When we shift towards these sorts of alternative diets in an ideal world, well then, a lot of sub populations in certain parts of the world may suffer that thing too. There are multiple benefits, but also there are a lot of tensions. And we are learning more and more about those as well. And models actually showing those synergistics, but also some of these potential trade-offs in a very, very interesting way.

Thank you for sharing that because one of the topics I was interested in understanding is can folks actually afford these diets? I mean, there was a lot of controversy around, or concern around an Eat Lancet diet in saying can people afford this. And we actually review that in the paper. What you're telling me is that there is a possibility of understanding distributional effects within societies of if we move our diets in this certain way who's able to afford it. Whether the implications for lower income folks in that society as compared to other model diets. Is that a fair assessment of some of the work that you've seen?

Yes, absolutely. If, for instance, when we're doing the models, I'm going to put an example, we do this sort of incentivizing certain kind of foods and we put high taxes on other kinds of foods. Well one thing that is interesting is that all of these potential benefits or spillovers or global spillovers are really interconnected with also trade policies. And global models can tell us a really compelling story about that. In a more connected sort of world, when you do something in certain region that can have some benefits, then that creates spillovers to others. Let's say you reduce the demand of food in certain regions, certain countries, you can shape that. Then that globally through global markets can affect the accessibility or affordability of food in other regions. In that sense, those two things are connected and bring some benefit. But when you look at deeper in that particular region where you're trying to intervene with certain taxes for certain kind of foods, it is obviously going to bring some challenges. Some equity challenges because those particular areas that are devoted to produce that kind of food are also related to a lot of workers, a lot of producers, farmers, etc. And a lot of those are going to get the negative effects of this sort of policies. So that's one side. Then the other side is, yeah, when you affect prices, prices affect obviously the consumers as well. And again, in those certain regions when you have some population that is already are having some challenges to afford certain kind of food, if you impose a tax, then that again will handle those population. There is a lot of work to do to look at the details. And sometimes global models or two aggregated models can fail short in that direction. But we see that in an aggregated world, let's say.

Yes, I appreciate and want to pick up on both something you and Andrew have been really pushing. Is this interconnectedness. Once we intervene in one part of the market or in even one part of the world, there are reverberations throughout. And these models sound really rich, and you started to hit on something that I want to learn a little bit more. And it's this idea that the models aren't perfect. Can you tell us a little bit more about some of the limitations of these models, especially as it relates to policy design or policy discussion?

Yes. Well one thing that is, and the more you look at these things, is some of these models or mostly global models, they do have again this benefit that you can see many things interconnected at the same time. But that then you have to neglect something. There is a trade off in that decision. And typically, you are looking at things at a slightly aggregated sort of level. So typically, you have a average representative consumer or an average representative producer in a different region or a different country. With that, you then could miss a lot of the heterogeneous effects that a policy or a counterfactual state of the world will have on a certain population. In many cases we will fall short on that. And one thing that we have seen, and it's really cool, and I think it's a really good advancement in recent years more, people is doing, is that sort of multi-scale kind of approach where you do have a sort of global model to solve certain situation and then with that you calibrate in a more granular type of level of model. That sort of multi-scale approach it's working pretty well to see more of these multi-level effects. But sometimes global models can fail short on getting a heterogeneous result, I guess.

Thank you for sharing that. And it's important to understand that models are not perfect, and that we're regularly as a discipline, as a field, we're always working on improving the models, making them more realistic, and more responsive to policy shifts. And so that begs this question, and then I'm going to open this up first to Andrew and then back to you, Emiliano. In this review paper, we were looking at the state of the world, the state of the art of research in this space. And my question to you both is what are some places where you see a need for new research or new research questions that we haven't really dealt with? What are you seeing as important places to go here?

Here's the thing. I wouldn't necessarily refer to it as sort of new research, but certainly where we definitely need more research. And so, for those studies that continue to link greenhouse gas emissions with animal protein production, and really trying to think about what that would necessarily mean if we in some way mitigate animal protein production. Particularly let's say cattle and dairy. What does that necessarily mean for countries at the lower end of the spectrum where that initial demand for protein is needed. While at the same time we're not seeing changes in the developing world. The point is, where do we get the most bang for our buck? Do we get the most bang for our buck environmentally by trying to mitigate consumption globally? Or in some way trying to mitigate consumption, say in the United States and Europe, while at the same time letting Botswana and other countries carry through on that dietary transition that would otherwise occur. And I do think I've seen studies like that. But I do think this whole issue of where best to mitigate meat production and where best to sort of let it go.

The other thing, and we're going to continue with this going forward. And that is particularly in the developing world this idea of how one manages both rising obesity and rise in malnutrition all at the same time. Like that is a very sort of precarious position for governments to find themselves in. One, having to both feed people more than what's available, while at the same time having a subset of the population eating too much. Whereas unlike the United States where we could pretty much have a blanketed dietary strategy to try to reduce size, girth, and just sort of eating habits. In the developing world, you really do have to manage the dual negative outcomes of both obesity as well as malnutrition.

Great. Thank you. And I really appreciate this idea of where do we target interventions? Where do we, as you said, where do we get the biggest bang for our buck? And then this really complicated tension of some folks is experiencing food security challenges, others are facing issues around obesity. And we actually see in some places where those two things come together really complex ways. What's the right set of policies to actually solve both of those problems? And how do you do that well? Emiliano, what are you thinking about in terms of new directions or areas to go?

So, in terms of approaches like more in a technical way, but I'm going to be brief from this I promise, I feel that there is a lot of work to do in multilayer modeling. I think that's a really exciting avenue that people are trying. And there are different ways to go from top bottom sort of approaches in the demand spectrum, but also in the resource embedded spectrum. So that's pretty exciting. But then topically, I think Andrew covered pretty well. I will say also that we do have the multiple burdens of malnutrition. On top of that thing that I would mention is the food waste. A thing that I have learned in the past that food waste is a big portion of the overall purchasing basket. And it's coming pretty clear still is way sort of underdeveloped kind of area because it's a very difficult thing to measure. There are not a lot of papers that can address this globally or look at long run trends and things like that. But it's typically mirroring the dietary transition as well. But we really need to learn how that looks. Is this a thing that we used to think 5-10 years ago? It was more like a sort of static problem in rich countries that they tend to waste food. But now we're looking more and more that this is an increasing problem in more developing countries, emerging economies. And as soon as we get certain threshold of income, people start purchasing more than what they need. And then we see more and more food waste. And that area I think is somewhat overlooked or still a good challenge to be addressed. And then from there, when you look at that, we should look at how that again enters the big picture, right? I mean, there are a couple of papers that have combined these changes in diets, reducing food waste as a part of it, and so like that. But still there is a lot of work to do on that. We tend to think also, and again, similarly to with the other things, that food waste is not a great thing. It's a clear sign of inefficiency in the global food system. Food waste itself also has a lot of embedded resources, right? One of them is labor. So, we just try or do a huge amount of effort to just reduce or eliminate food waste or reduce in a big portion of food waste. Then what's going to happen with a lot of employment that it was devoted to that. I think that particular fact is somewhat overlooked too. But again, those are the sort of areas I would be excited to look in the near future.

I really appreciate this point about food waste. That's an area that I've been working on mostly in the US. And I agree, I think there's some critical places for us to consider. And also thinking about what that means for modeling. I know with the Thrifty Food Plan here in the United States, there's an assumption of a 5% food waste and that's a big assumption. When you can imagine just how different households may respond to incentives or how prices may influence their choice or maybe even lack of choice as food waste does occur. So, I think you are touching on some really important points, and I really like how, Andrew, you're talking about the importance of targeting.

Bios

Andrew Muhammad is a professor of Agricultural and Resource Economics at the University of Tennessee Knoxville. He is an expert in international trade and agricultural policy. He assists state and national agricultural decision-makers in evaluating policies and programs dealing with agricultural commodities, food and nutrition, natural resources, and international trade.

Emiliano Lopez Barrera is a visiting assistant professor in the Department of Agricultural Economics at the University of Texas A&M University. His current research focuses on understanding how future patterns of global food consumption will affect human health, and how the agricultural changes needed to support the ongoing global nutrition transition will affect the environment. He combines econometric tools with economic and nutrition modeling to explore the trade-offs and linkages among diets, human health, and environmental sustainability. Prior to his grad studies, he worked as a consultant for the Inter-American Development Bank at the Central Bank of Uruguay.

Lots of talk these days about ultra-processed foods (UPFs). Along with confusion about what in the heck they are or what they're not, how bad they are for us, and what ought to be done about them. A landmark in the discussion of ultra-processed foods has been the publication of a book entitled Ultra-processed People, Why We Can't Stop Eating Food That Isn't Food. The author of that book, Dr. Chris van Tulleken, joins us today. Dr. van Tulleken is a physician and is professor of Infection and Global Health at University College London. He also has a PhD in molecular virology and is an award-winning broadcaster on the BBC. His book on Ultra-processed People is a bestseller.

Interview Summary

Chris, sometimes somebody comes along that takes a complicated topic and makes it accessible and understandable and brings it to lots of people. You're a very fine scientist and scholar and academic, but you also have that ability to communicate effectively with lots of people, which I very much admire. So, thanks for doing that, and thank you for joining us.

Oh, Kelly, it's such a pleasure. You know, I begin some of my talks now with a clipping from the New York Times. And it's a picture of you and an interview you gave in 1995. So exactly three decades ago. And in this article, you just beautifully communicate everything that 30 years later I'm still saying. So, yeah. I wonder if communication, it's necessary, but insufficient. I think we are needing to think of other means to bring about change.

I totally agree. Well, thank you by the way. And I hope I've learned something over those 30 years. Tell us, please, what are ultra-processed foods? People hear the term a lot, but I don't think a lot of people know exactly what it means.

The most important thing to know, I think, is that it's not a casual term. It's not like 'junk food' or 'fast food.' It is a formal scientific definition. It's been used in hundreds of research studies. The definition is very long. It's 11 paragraphs long. And I would urge anyone who's really interested in this topic, go to the United Nations Food and Agricultural Organization website. You can type in NFAO Ultra and you'll get the full 11 paragraph definition. It's an incredibly sophisticated piece of science. But it boils down to if you as a consumer, someone listening to this podcast, want to know if the thing you are eating right now is ultra-processed, look at the ingredients list. If there are ingredients on that list that you do not normally find in a domestic kitchen like an emulsifier, a coloring, a flavoring, a non-nutritive sweetener, then that product will be ultra-processed. And it's a way of describing this huge range of foods that kind of has taken over the American and the British and in fact diets all over the world.

How come the food companies put this stuff in the foods? And the reason I ask is in talks I give I'll show an ingredient list from a food that most people would recognize. And ask people if they can guess what the food is from the ingredient list. And almost nobody can. There are 35 things on the ingredient list. Sugar is in there, four different forms. And then there are all kinds of things that are hard to pronounce. There are lots of strange things in there. They get in there through loopholes and government regulation. Why are they there in the first place?

So, when I started looking at this I also noticed this long list of fancy sounding ingredients. And even things like peanut butter will have palm oil and emulsifiers. Cream cheese will have xanthum gum and emulsifiers. And you think, well, wouldn't it just be cheaper to make your peanut butter out of peanuts. In fact, every ingredient is in there to make money in one of two ways. Either it drives down the cost of production or storage. If you imagine using a real strawberry in your strawberry ice cream. Strawberries are expensive. They're not always in season. They rot. You've got to have a whole supply chain. Why would you use a strawberry if you could use ethyl methylphenylglycidate and pink dye and it'll taste the same. It'll look great. You could then put in a little chunky bit of modified corn starch that'll be chewy if you get it in the right gel mix. And there you go. You've got strawberries and you haven't had to deal with strawberry farmers or any supply chain. It's just you just buy bags and bottles of white powder and liquids. The other way is to extend the shelf life. Strawberries as I say, or fresh food, real food - food we might call it rots on shelves. It decays very quickly. If you can store something at room temperature in a warehouse for months and months, that saves enormous amounts of money.

So, one thing is production, but the other thing is the additives allow us to consume to excess or encourage us to consume ultra-processed food to excess. So, I interviewed a scientist who was a food industry development scientist. And they said, you know, most ultra-processed food would be gray if it wasn't dyed, for example. So, if you want to make cheap food using these pastes and powders, unless you dye it and you flavor it, it will be inedible. But if you dye it and flavor it and add just the right amount of salt, sugar, flavor enhancers, then you can make these very addictive products. So that's the logic of UPF. Its purpose is to make money. And that's part of the definition.

Right. So, a consumer might decide that there's, you know, beneficial trade-off for them at the end of the day. That they get things that have long shelf life. The price goes down because of the companies don't have to deal with the strawberry farmers and things like that. But if there's harm coming in waves from these things, then it changes the equation. And you found out some of that on your own. So as an experiment you did with a single person - you, you ate ultra-processed foods for a month. What did you eat and how did it affect your body, your mood, your sleep? What happened when you did this?

So, what's really exciting, actually Kelly, is while it was an n=1, you know, one participant experiment, I was actually the pilot participant in a much larger study that we have published in Nature Medicine. One of the most reputable and high impact scientific journals there is. So, I was the first participant in a randomized control trial. I allowed us to gather the data about what we would then measure in a much larger number.

Now we'll come back and talk about that study, which I think was really important. It was great to see it published.

So, I was a bit skeptical. Partly it was with my research team at UCL, but we were also filming it for a BBC documentary. And I went into this going I'm going to eat a diet of 80% of my calories will come from ultra-processed food for four weeks. And this is a normal diet. A lifelong diet for a British teenager. We know around 20% of people in the UK and the US eat this as their normal food. They get 80% of their calories from ultra-processed products. I thought, well, nothing is going to happen to me, a middle-aged man, doing this for four weeks. But anyway, we did it kind of as a bit of fun. And we thought, well, if nothing happens, we don't have to do a bigger study. We can just publish this as a case report, and we'll leave it out of the documentary. Three big things happened. I gained a massive amount of weight, so six kilos. And I wasn't force feeding myself. I was just eating when I wanted.

In American terms, that's about 15 pounds in four weeks.

And that's very consistent with the other published trials that have been done on ultra-processed food. There have been two other RCTs (randomized control trials); ours is the third. There is one in Japan, one done at the NIH. So, people gain a lot of weight. I ate massively more calories. So much so that if I'd continued on the diet, I would've almost doubled my body weight in a year. And that may sound absurd, but I have an identical twin brother who did this natural experiment. He went to Harvard for a year. He did his masters there. During his year at Harvard he gained, let's see, 26 kilos, so almost 60 pounds just living in Cambridge, Massachusetts.

But how did you decide how much of it to eat? Did you eat until you just kind of felt naturally full?

I did what most people do most of the time, which is I just ate what I wanted when I felt like it. Which actually for me as a physician, I probably took the breaks off a bit because I don't normally have cocoa pops for breakfast. But I ate cocoa pops and if I felt like two bowls, I'd have two bowls. It turned out what I felt like a lot of mornings was four bowls and that was fine. I was barely full. So, I wasn't force feeding myself. It wasn't 'supersize' me. I was eating to appetite, which is how these experiments run. And then what we've done in the trials.

So, I gained weight, then we measured my hormone response to a meal. When you eat, I mean, it's absurd to explain this to YOU. But when you eat, you have fullness hormones that go up and hunger hormones that go down, so you feel full and less hungry. And we measured my response to a standard meal at the beginning and at the end of this four-week diet. What we found is that I had a normal response to eating a big meal at the beginning of the diet. At the end of eating ultra-processed foods, the same meal caused a very blunted rise in the satiety hormones. In the 'fullness' hormones. So, I didn't feel as full. And my hunger hormones remained high. And so, the food is altering our response to all meals, not merely within the meal that we're eating.

Then we did some MRI scans and again, I thought this would be a huge waste of time. But we saw at four weeks, and then again eight weeks later, very robust changes in the communication between the habit-forming bits at the back of the brain. So, the automatic behavior bits, the cerebellum. Very conscious I'm talking to YOU about this, Kelly. And the kind of addiction reward bits in the middle. Now these changes were physiological, not structural. They're about the two bits of the brain talking to each other. There's not really a new wire going between them. But we think if this kind of communication is happening a lot, that maybe a new pathway would form. And I think no one, I mean we did this with very expert neuroscientists at our National Center for Neuroscience and Neurosurgery, no one really knows what it means. But the general feeling was these are the kind of changes we might expect if we'd given someone, or a person or an animal, an addictive substance for four weeks. They're consistent with, you know, habit formation and addiction. And the fact that they happened so quickly, and they were so robust - they remained the same eight weeks after I stopped the diet, I think is really worrying from a kid's perspective.

So, in a period of four weeks, it re-altered the way your brain works. It affected the way your hunger and satiety were working. And then you ended up with this massive weight. And heaven knows what sort of cardiovascular effects or other things like that might have been going on or had the early signs of that over time could have been really pretty severe, I imagine.

I think one of the main effects was that I became very empathetic with my patients. Because we did actually a lot of, sort of, psychological testing as well. And there's an experience where, obviously in clinic, I mainly treat patients with infections. But many of my patients are living with other, sort of, disorders of modern life. They live with excess weight and cardiovascular disease and type two diabetes and metabolic problems and so on. And I felt in four weeks like I'd gone from being in my early 30, early 40s at the time, I felt like I'd just gone to my early 50s or 60s. I ached. I felt terrible. My sleep was bad. And it was like, oh! So many of the problems of modern life: waking up to pee in the middle of the night is because you've eaten so much sodium with your dinner. You've drunk all this water, and then you're trying to get rid of it all night. Then you're constipated. It's a low fiber diet, so you develop piles. Pain in your bum. The sleep deprivation then makes you eat more. And so, you get in this vicious cycle where the problem didn't feel like the food until I stopped and I went cold turkey. I virtually have not touched it since. It cured me of wanting UPF. That was the other amazing bit of the experience that I write about in the book is it eating it and understanding it made me not want it. It was like being told to smoke. You know, you get caught smoking as a kid and your parents are like, hey, now you finish the pack. It was that. It was an aversion experience. So, it gave me a lot of empathy with my patients that many of those kinds of things we regard as being normal aging, those symptoms are often to do with the way we are living our lives.

Chris, I've talked to a lot of people about ultra-processed foods. You're the first one who's mentioned pain in the bum as one of the problems, so thank you.

When I first became a physician, I trained as a surgeon, and I did a year doing colorectal surgery. So, I have a wealth of experience of where a low fiber diet leaves you. And many people listening to this podcast, I mean, look, we're all going to get piles. Everyone gets these, you know, anal fishes and so on. And bum pain it's funny to talk about it.

No, not the...

it destroys people's lives, so, you know, anyway.

Right. I didn't want to make light of it.

No, no.

Okay. So, your own experiment would suggest that these foods are really bad actors and having this broad range of highly negative effects. But what does research say about these things beyond your own personal experience, including your own research?

So, the food industry has been very skillful at portraying this as a kind of fad issue. As ultra-processed food is this sort of niche thing. Or it's a snobby thing. It's not a real classification. I want to be absolutely clear. UPF, the definition is used by the World Health Organization and the United Nations Food and Agricultural Organization to monitor global diet quality, okay? It's a legitimate way of thinking about food. The last time I looked, there are more than 30 meta-analyses - that is reviews of big studies. And the kind of high-quality studies that we use to say cigarettes cause lung cancer. So, we've got this what we call epidemiological evidence, population data. We now have probably more than a hundred of these prospective cohort studies. And they're really powerful tools. They need to be used in conjunction with other evidence, but they now link ultra-processed food to this very wide range of what we euphemistically call negative health outcomes. You know, problems that cause human suffering, mental health problems, anxiety, depression, multiple forms of cancer, inflammatory diseases like Crohn's disease and ulcerative colitis, metabolic disease, cardiovascular disease, Alzheimer's and dementia. Of course, weight gain and obesity. And all cause mortality so you die earlier of all causes. And there are others too. So, the epidemiological evidence is strong and that's very plausible. So, we take that epidemiological evidence, as you well know, and we go, well look, association and causation are different things. You know, do matches cause cancer or does cigarettes cause cancer? Because people who buy lots of matches are also getting the lung cancer. And obviously epidemiologists are very sophisticated at teasing all this out. But we look at it in the context then of other evidence. My group published the third randomized control trial where we put a group of people, in a very controlled way, on a diet of either minimally processed food or ultra-processed food and looked at health outcomes. And we found what the other two trials did. We looked at weight gain as a primary outcome. It was a short trial, eight weeks. And we saw people just eat more calories on the ultra-processed food. This is food that is engineered to be consumed to excess. That's its purpose.

So maybe to really understand the effect of it, you have to imagine if you are a food development engineer working in product design at a big food company - if you develop a food that's cheap to make and people will just eat loads of it and enjoy it, and then come back for it again and again and again, and eat it every day and almost become addicted to it, you are going to get promoted. That product is going to do well on the shelves. If you invent a food that's not addictive, it's very healthy, it's very satisfying, people eat it and then they're done for the day. And they don't consume it to excess. You are not going to keep your job. So that's a really important way of understanding the development process of the foods.

So let me ask a question about industry and intent. Because one could say that the industry engineers these things to have long shelf life and nice physical properties and the right colors and things like this. And these effects on metabolism and appetite and stuff are unpleasant and difficult side effects, but the foods weren't made to produce those things. They weren't made to produce over consumption and then in turn produce those negative consequences. You're saying something different. That you think that they're intentionally designed to promote over consumption. And in some ways, how could the industry do otherwise? I mean, every industry in the world wants people to over consume or consume as much of their product as they can. The food industry is no different.

That is exactly right. The food industry behaves like every other corporation. In my view, they commit evil acts sometimes, but they're not institutionally evil. And I have dear friends who work in big food, who work in big pharma. I have friends who work in tobacco. These are not evil people. They're constrained by commercial incentives, right? So, when I say I think the food is engineered, I don't think it. I know it because I've gone and interviewed loads of people in product development at big food companies. I put some of these interviewees in a BBC documentary called Irresistible. So rather than me in the documentary going, oh, ultra-processed food is bad. And everyone going, well, you are, you're a public health bore. I just got industry insiders to say, yes, this is how we make the food. And going back to Howard Moskovitz, in the 1970s, I think he was working for the Campbell Soup Company. And Howard, who was a psychologist by training, outlined the development process. And what he said was then underlined by many other people I've spoken to. You develop two different products. This one's a little bit saltier than the next, and you test them on a bunch of people. People like the saltier ones. So now you keep the saltier one and you develop a third product and this one's got a bit more sugar in it. And if this one does better, well you keep this one and you keep AB testing until you get people buying and eating lots. And one of the crucial things that food companies measure in product development is how fast do people eat and how quickly do they eat. And these kind of development tools were pioneered by the tobacco industry. I mean, Laura Schmidt has done a huge amount of the work on this. She's at University of California, San Francisco (UCSF), in California. And we know the tobacco industry bought the food industry and for a while in the '80s and '90s, the biggest food companies in the world were also the biggest tobacco companies in the world. And they used their flavor molecules and their marketing techniques and their distribution systems. You know, they've got a set of convenience tools selling cigarettes all over the country. Well, why don't we sell long shelf-life food marketed in the same way?

And one thing that the tobacco industry was extremely good at was figuring out how to get the most rapid delivery of the drug possible into the human body when people smoke. Do you think that some of that same thing is true for food, rapid delivery of sugar, let's say? How close does the drug parallel fit, do you think?

So, that's part of the reason the speed of consumption is important. Now, I think Ashley Gearhardt has done some of the most incredible work on this. And what Ashley says is we think of addictive drugs as like it's the molecule that's addictive. It's nicotine, it's caffeine, cocaine, diamorphine, heroin, the amphetamines. What we get addicted to is the molecule. And that Ashley says no. The processing of that molecule is crucially important. If you have slow-release nicotine in a chewing gum, that can actually treat your nicotine addiction. It's not very addictive. Slow-release amphetamine we use to treat children with attention and behavioral problems. Slow-release cocaine is an anesthetic. You use it for dentistry. No one ever gets addicted to dental anesthetics. And the food is the same. The rewarding molecules in the food we think are mainly the fat and the sugar. And food that requires a lot of chewing and is slow eaten slowly, you don't deliver the reward as quickly. And it tends not to be very addictive. Very soft foods or liquid foods with particular fat sugar ratios, if you deliver the nutrients into the gut fast, that seems to be really important for driving excessive consumption. And I think the growing evidence around addiction is very persuasive. I mean, my patients report feeling addicted to the food. And I don't feel it's legitimate to question their experience.

Chris, a little interesting story about that concept of food and addiction. So going back several decades I was a professor at Yale, and I was teaching a graduate course. Ashley Gerhardt was a student in that course. And, she was there to study addiction, not in the context of food, but I brought up the issue of, you know, could food be addictive? There's some interesting research on this. It's consistent with what we're hearing from people, and that seems a really interesting topic. And Ashley, I give her credit, took this on as her life's work and now she's like the leading expert in the world on this very important topic. And what's nice for me to recall that story is that how fast the science on this is developed. And now something's coming out on this almost every day. It's some new research on the neuroscience of food and addiction and how the food is hijacking in the brain. And that whole concept of addiction seems really important in this context. And I know you've talked a lot about that yourself.

She has reframed, I think, this idea about the way that addictive substances and behaviors really work. I mean it turns everything on its head to go the processing is important. The thing the food companies have always been able to say is, look, you can't say food is addictive. It doesn't contain any addictive molecules. And with Ashley's work you go, no, but the thing is it contains rewarding molecules and actually the spectrum of molecules that we can find rewarding and we can deliver fast is much, much broader than the traditionally addictive substances.

For policy, it's vital because part of regulating the tobacco industry was about showing they know they are making addictive products. And I think this is where Ashley's work and Laura Schmidt's work are coming together. With Laura's digging in the tobacco archive, Ashley's doing the science on addiction, and I think these two things are going to come together. And I think it's just going to be a really exciting space to watch.

I completely agree. You know when most people think about the word addiction, they basically kind of default to thinking about how much you want something. How much, you know, you desire something. But there are other parts of it that are really relevant here too. I mean one is how do you feel if you don't have it and sort of classic withdrawal. And people talk about, for example, being on high sugar drinks and stopping them and having withdrawal symptoms and things like that. And the other part of it that I think is really interesting here is tolerance. You know whether you need more of the substance over time in order to get the same reward benefit. And that hasn't been studied as much as the other part of addiction. But there's a lot to the picture other than just kind of craving things.

And I would say that the thing I like about this is it chimes with my. Personal experience, which is, I have tried alcohol and cigarettes and I should probably end that list there. But I've never had any real desire for more of them. They aren't the things that tickle my brain. Whereas the food is a thing that I continue to struggle with. I would say in some senses, although I no longer like ultra-processed food at some level, I still want it. And I think of myself to some degree, without trivializing anyone's experience, to some degree I think I'm in sort of recovery from it. And it remains that tussle. I mean I don't know what you think about the difference between the kind of wanting and liking of different substances. Some scientists think those two things are quite, quite different. That you can like things you don't want, and you can want things you don't like.

Well, that's exactly right. In the context of food and traditional substances of abuse, for many of them, people start consuming because they produce some sort of desired effect. But that pretty quickly goes away, and people then need the substance because if they don't have it, they feel terrible. So, you know, morphine or heroin or something like that always produces positive effects. But that initial part of the equation where you just take it because you like it turns into this needing it and having to have it. And whether that same thing exists with food is an interesting topic.

I think the other really important part of the addiction argument in policy terms is that one counterargument by industrial scientists and advocates is by raising awareness around ultra-processed food we are at risk of driving, eating disorders. You know? The phenomenon of orthorexia, food avoidance, anorexia. Because all food is good food. There should be no moral value attached to food and we mustn't drive any food anxiety. And I think there are some really strong voices in the United Kingdom Eating Disorder scientists. People like Agnes Ayton, who are starting to say, look, when food is engineered, using brain scanners and using scientific development techniques to be consumed to excess, is it any wonder that people develop a disordered relationship with the food? And there may be a way of thinking about the rise of eating disorders, which is parallel to the rise of our consumption of ultra-processed food, that eating disorders are a reasonable response to a disordered food environment. And I think that's where I say all that somewhat tentatively. I feel like this is a safe space where you will correct me if I go off piste. But I think it's important to at least explore that question and go, you know, this is food with which it is very hard, I would say, to have a healthy relationship. That's my experience. And I think the early research is bearing that out.

Tell us how these foods affect your hunger, how full you feel, your microbiome. That whole sort of interactive set of signals that might put people in harmony with food in a normal environment but gets thrown off when the foods get processed like this.

Oh, I love that question. At some level as I'm understanding that question, one way of trying to answer that question is to go, well, what is the normal physiological response to food? Or maybe how do wild animals find, consume, and then interpret metabolically the food that they eat. And it is staggering how little we know about how we learn what food is safe and what food nourishes us. What's very clear is that wild mammals, and in fact all wild animals, are able to maintain near perfect energy balance. Obesity is basically unheard of in the wild. And, perfect nutritional intake, I mean, obviously there are famines in wild animals, but broadly, animals can do this without being literate, without being given packaging, without any nutritional advice at all. So, if you imagine an ungulate, an herbivore on the plains of the Serengeti, it has a huge difficulty. The carnivore turning herbivore into carnivore is fairly easy. They're made of the same stuff. Turning plant material into mammal is really complicated. And somehow the herbivore can do this without gaining weight, whilst maintaining total precision over its selenium intake, its manganese, its cobalt, its iron, all of which are terrible if you have too little and also terrible if you have too much. We understand there's some work done in a few wild animals, goats, and rats about how this works. Clearly, we have an ability to sense the nutrition we want. What we understand much more about is the sort of quantities needed. And so, we've ended up with a system of nutritional advice that says, well, just eat these numbers. And if you can stick to the numbers, 2,500 calories a day, 2300 milligrams of sodium, no more than 5% of your calories from free sugar or 10%, whatever it is, you know, you stick to these numbers, you'll be okay. And also, these many milligrams of cobalt, manganese, selenium, iron, zinc, all the rest of it. And obviously people can't really do that even with the packaging.

This is a very long-winded answer. So, there's this system that is exquisitely sensitive at regulating micronutrient and energy intake. And what we understand, what the Academy understands about how ultra-processed food subverts this is, I would say there are sort of three or four big things that ultra-processed does that real food doesn't. It's generally very soft. And it's generally very energy dense. And that is true of even the foods that we think of as being healthy. That's like your supermarket whole grain bread. It's incredibly energy dense. It's incredibly soft. You eat calories very fast, and this research was done in the '90s, you know we've known that that kind of food promotes excessive intake. I guess in simple terms, and you would finesse this, you consume calories before your body has time to go, well, you've eaten enough. You can consume an excess. Then there's the ratios of fat, salt, and sugar and the way you can balance them, and any good cook knows if you can get the acid, fat, salt, sugar ratios right, you can make incredibly delicious food. That's kind of what I would call hyper palatability. And a lot of that work's being done in the states (US) by some incredible people. Then the food may be that because it's low in fiber and low in protein, quite often it's not satiating. And there may be, because it's also low in micronutrients and general nutrition, it may be that, and this is a little bit theoretical, but there's some evidence for this. Part of what drives the excess consumption is you're kind of searching for the nutrients. The nutrients are so dilute that you have to eat loads of it in order to get enough. Do you think, does that, is that how you understand it?

It does, it makes perfect sense. In fact, I'm glad you brought up one particular issue because part of the ultra-processing that makes foods difficult for the body to deal with involves what gets put in, but also what gets taken out. And there was a study that got published recently that I think you and I might have discussed earlier on American breakfast cereals. And this study looked at how the formulation of them had changed over a period of about 20 years. And what they found is that the industry had systematically removed the protein and the fiber and then put in more things like sugar. So there, there's both what goes in and what gets taken out of foods that affects the body in this way. You know, what I hear you saying, and what I, you know, believe myself from the science, is the body's pretty capable of handling the food environment if food comes from the natural environment. You know, if you sit down to a meal of baked chicken and some beans and some leafy greens and maybe a little fruit or something, you're not going to overdo it. Over time you'd end up with the right mix of nutrients and things like that and you'd be pretty healthy. But all bets are off when these foods get processed and engineered, so you over consume them. You found that out in the experiment that you did on yourself. And then that's what science shows too. So, it's not like these things are sort of benign. People overeat them and they ought to just push away from the table. There's a lot more going on here in terms of hijacking the brain chemistry. Overriding the body signals. Really thwarting normal biology.

Do you think it's important to add that we think of obesity as being the kind of dominant public health problem? That's the thing we all worry about. But the obesity is going hand in hand with stunting, for example. So, height as you reach adulthood in the US, at 19 US adults are something like eight or nine centimeters shorter than their counterparts in Northern Europe, Scandinavia, where people still eat more whole food. And we should come back to that evidence around harms, because I think the really important thing to say around the evidence is it has now reached the threshold for causality. So, we can say a dietary pattern high in ultra-processed food causes all of these negative health outcomes. That doesn't mean that any one product is going to kill you. It just means if this is the way you get your food, it's going to be harmful. And if all the evidence says, I mean, we've known this for decades. If you can cook the kind of meal, you just described at home, which is more or less the way that high income people eat, you are likely to have way better health outcomes across the board.

Let me ask you about the title of your book. So, the subtitle of your book is Why We Can't Stop Eating Food That Isn't Food. So, what is it?

The ultra-processed definition is something I want to pay credit for. It's really important to pay a bit of credit here. Carlos Montero was the scientist in Brazil who led a team who together came up with this definition. And, I was speaking to Fernanda Rauber who was on that team, and we were trying to discuss some research we were doing. And every time I said food, she'd correct me and go, it is not, it's not food, Chris. It's an industrially produced edible substance. And that was a really helpful thing for me personally, it's something it went into my brain, and I sat down that night. I was actually on the UPF diet, and I sat down to eat some fried chicken wings from a popular chain that many people will know. And was unable to finish them. I think our shared understanding of the purpose of food is surely that its purpose is to nourish us. Whether it's, you know, sold by someone for this purpose, or whether it's made by someone at home. You know it should nourish us spiritually, socially, culturally, and of course physically and mentally. And ultra-processed food nourishes us in no dimension whatsoever. It destroys traditional knowledge, traditional land, food culture. You don't sit down with your family and break, you know, ultra-processed, you know, crisps together. You know, you break bread. To me that's a kind of very obvious distortion of what it's become. So, I don't think it is food.

You know, I think it's not too hard of a stretch to see a time when people might consider these things non-food. Because if you think of food, what's edible and whether it's food or not is completely socially constructed. I mean, some parts of the world, people eat cockroaches or ants or other insects. And in other parts of the world that's considered non-food. So just because something's edible doesn't mean that it's food. And I wonder if at some point we might start to think of these things as, oh my God, these are awful. They're really bad for us. The companies are preying on us, and it's just not food. And yeah, totally your book helps push us in that direction.

I love your optimism. The consumer facing marketing budget of a big food company is often in excess of $10 billion a year. And depends how you calculate it.

I'll give you a quick quiz on this. So, for a while, the Robert Wood Johnson Foundation was by far the biggest funder of research in the world on childhood obesity. And they were spending $500 million a year to address this problem. Just by which day of the year the food industry has already spent $500 million just advertising just junk food just to children.

Okay, so the Robert V. Wood Foundation is spending it and they were spending that annually.

Annually, right. So, what's, by what day of the year is the food industry already spent that amount? Just junk food advertising just to kids.

I'm going to say by somewhere in early spring.

No. January 4th.

I mean, it's hysterical, but it's also horrifying. So, this is the genius of ultra-processed food, of the definition and the science, is that it creates this category which is discretionary. And so at least in theory, of course, for many people in the US it's not discretionary at all. It's the only stuff they can afford. But this is why the food industry hate it so much is because it offers the possibility of going, we can redefine food. And there is all this real food over there. And there is this UPF stuff that isn't food over here. But industry's very sophisticated, you know. I mean, they push back very hard against me in many different ways and forms. And they're very good at going, well, you're a snob. How dare you say that families with low incomes, that they're not eating food. Are you calling them dupes? Are you calling them stupid? You know, they're very, very sophisticated at positioning.

Isn't it nice how concerned they are about the wellbeing of people without means?

I mean they have created a pricing structure and a food subsidy environment and a tax environment where essentially people with low incomes in your country, in my country, are forced to eat food that harms them. So, one of the tells I think is if you're hearing someone criticize ultra-processed food, and you'll read them in the New York Times. And often their conflicts of interest won't be reported. They may be quite hidden. The clue is, are they demanding to seriously improve the food environment in a very clear way, or are they only criticizing the evidence around ultra-processed food? And if they're only criticizing that evidence? I'll bet you a pound to a pinch of salt they'll be food-industry funded.

Let's talk about that. Let's talk about that a little more. So, there's a clear pattern of scientists who take money from industry finding things that favor industry. Otherwise, industry wouldn't pay that money. They're not stupid in the way they invest. And, you and I have talked about this before, but we did a study some years ago where we looked at industry and non-industry funded study on the health effects of consuming sugar sweetened beverages. And it's like the ocean parted.

It's one of my favorites. And it was something like 98 or 99% of the independently funded studies found that sugar sweetened beverages do cause harm. And 98 or 99% of the industry funded studies funded by Snapple and Coke and a whole bunch of other companies found that they did not cause harm. It was that stark, was it?

It was. And so you and I pay attention to the little print in these scientific studies about who's funded them and who might have conflicts of interest. And maybe you and I and other people who follow science closely might be able to dismiss those conflicted studies. But they have a big impact out there in the world, don't they?

I had a meeting in London with someone recently, that they themselves were conflicted and they said, look, if a health study's funded by a big sugary drink company, if it's good science, that's fine. We should publish it and we should take it at face value. And in the discussion with them, I kind of accepted that, we were talking about other things. And afterwards I was like, no. If a study on human health is funded by a sugary drink corporation, in my opinion, we could just tear that up. None of that should be published. No journals should publish those studies and scientists should not really call themselves scientists who are doing it. It is better thought of as marketing and food industry-funded scientists who study human health, in my opinion, are better thought of as really an extension of the marketing division of the companies.

You know, it's interesting when you talk to scientists, and you ask them do people who take money from industry is their work influenced by that money? They'll say yes. Yeah, but if you say, but if you take money from industry, will your work be influenced? They'll always say no.

Oh yeah.

There's this tremendous arrogance, blind spot, whatever it is that. I can remain untarnished. I can remain objective, and I can help change the industry from within. In the meantime, I'm having enough money to buy a house in the mountains, you know, from what they're paying me, and it's really pretty striking.

Well, the money is a huge issue. You know, science, modern science it's not a very lucrative career compared to if someone like you went and worked in industry, you would add a zero to the end of your salary, possibly more. And the same is true of me. I think one of the things that adds real heft to the independent science is that the scientists are taking a pay cut to do it.

So how do children figure in? Do you think children are being groomed by the industry to eat these foods?

A senator, I think in Chile, got in hot water for comparing big food companies to kind of sex offenders. He made, in my view, a fairly legitimate comparison. I mean, the companies are knowingly selling harmful products that have addictive properties using the language of addiction to children who even if they could read warning labels, the warning labels aren't on the packs. So, I mean, we have breakfast cereals called Crave. We have slogans like, once you stop, once you pop, you can't stop. Bet you can't just eat one. Yeah, I think it is predatory and children are the most vulnerable group in our society. And you can't just blame the parents. Once kids get to 10, they have a little bit of money. They get their pocket money, they're walking to school, they walk past stores. You know, you have to rely on them making decisions. And at the moment, they're in a very poor environment to make good decisions.

Perhaps the most important question of all what can be done.

So, I'm speaking to you at a kind of funny moment because I've been feeling that a lot of my research and advocacy, broadcasting... you know, I've made documentaries, podcasts, I've written a book, I've published these papers. I've been in most of the major newspapers and during the time I've been doing this, you know, a little under 10 years I've been really focused on food. Much less time than you. Everything has got worse. Everything I've done has really failed totally. And I think this is a discussion about power, about unregulated corporate power. And the one glimmer of hope is this complaint that's been filed in Pennsylvania by a big US law firm. It's a very detailed complaint and some lawyers on behalf of a young person called Bryce Martinez are suing the food industry for causing kidney problems and type two diabetes. And I think that in the end is what's going to be needed. Strategic litigation. That's the only thing that worked with tobacco. All of the science, it eventually was useful, but the science on its own and the advocacy and the campaigning and all of it did no good until the lawyers said we would like billions and billions of dollars in compensation please. You know, this is an exciting moment, but there were a great many failed lawsuits for tobacco before the master settlement agreement in the '90s really sort of changed the game.

You know, I agree with you.

Are you, are you optimistic? I mean, what do you think?

I am, and for exactly the same reason you are. You know, the poor people that worked on public health and tobacco labored for decades without anything happening long, long after the health consequences of cigarette smoking were well known. And we've done the same thing. I mean, those us who have been working in the field for all these years have seen precious little in the ways of policy advances. Now tobacco has undergone a complete transformation with high taxes on cigarettes, and marketing restrictions, and non-smoking in public places, laws, and things like that, that really have completely driven down the consumption of cigarettes, which has been a great public health victory. But what made those policies possible was the litigation that occurred by the state attorneys general, less so the private litigating attorneys. But the state attorneys general in the US that had discovery documents released. People began to understand more fully the duplicity of the tobacco companies. That gave cover for the politicians to start passing the policies that ultimately made the big difference. I think that same history is playing out here. The state attorneys general, as we both know, are starting to get interested in this. I say hurray to that. There is the private lawsuit that you mentioned, and there's some others in the mix as well. I think those things will bring a lot of propel the release of internal documents that will show people what the industry has been doing and how much of this they've known all along. And then all of a sudden some of these policy things like taxes, for example, on sugared beverages, might come in and really make a difference. That's my hope. But it makes me optimistic.

Well, I'm really pleased to hear that because I think in your position it would be possible. You know, I'm still, two decades behind where I might be in my pessimism. One of the kind of engines of this problem to me is these conflicts of interest where people who say, I'm a physician, I'm a scientist, I believe all this. And they're quietly paid by the food industry. This was the major way the tobacco industry had a kind of social license. They were respectable. And I do hope the lawsuits, one of their functions is it becomes a little bit embarrassing to say my research institute is funded [by a company that keeps making headlines every day because more documents are coming out in court, and they're being sued by more and more people. So, I hope that this will diminish the conflict, particularly between scientists and physicians in the food industry. Because that to me, those are my biggest opponents. The food industry is really nice. They throw money at me. But it's the conflicted scientists that are really hard to argue with because they appear so respectable.

Bio

Dr. Chris van Tulleken is a physician and a professor of Infection and Global Health at University College London. He trained at Oxford and earned his PhD in molecular virology from University College London. His research focuses on how corporations affect human health especially in the context of child nutrition and he works with UNICEF and The World Health Organization on this area. He is the author of a book entitled Ultraprocessed People: Why We Can't Stop Eating Food That Isn't Food. As one of the BBC's leading broadcasters for children and adults his work has won two BAFTAs. He lives in London with his wife and two children.

The Food and Drug Administration or FDA regulates roughly 78% of the US food supply. This includes packaged products, food additives, infant formula, ultra-processed foods, and lots more. However, an analysis by the Environmental Working Group found that 99% of new food ingredients enter our food supply through a legal loophole that skirts FDA oversight and seems, to me at least, to be incredibly risky. Today we're speaking with two authors of a recent legal and policy analysis published in the Journal Health Affairs. They explain what this loophole is and its risks and suggest a new user fee program to both strengthen the FDA's ability to regulate food ingredients and address growing concerns about food safety. Our guests are Jennifer Pomeranz Associate Professor of Public Health Policy and Management at New York University School of Global Public Health and Emily Broad, director of Harvard Law School Center for Health Law and Policy Innovation.

Interview Summary

So Jennifer, let's start with you, help our listeners understand the current situation with food ingredient oversight. And what is this legal loophole that allows food companies to add new ingredients without safety reviews.

Sure. So, Congress passed the Food Additives Amendment in 1958, and the idea was to divide food additives and generally recognized as safe ingredients into two different categories.

That's where the GRAS term comes from generally recognized as safe?

'Generally Recognized As Safe' is GRAS. But it circularly defines food additives as something that's not GRAS. So, there's not actually a definition of these two different types of substances. But the idea was that the food industry would be required to submit a pre-market, that means before it puts the ingredient into the marketplace, a pre-market petition to the FDA to review the safety. And then the FDA promulgates a regulation for safe use of a food additive.

GRAS ingredients on the other hand, initially thought of as salt, pepper, vinegar, are things like that would just be allowed to enter the food supply without that pre-market petition. The problem is the food industry is the entity that decides which category to place each ingredient. There's no FDA guidance on which category they're supposed to ascribe to these ingredients. What has happened is that the food industry has now entered into the food supply an enormous amount of ingredients under what we call the GRAS loophole, which is allowing it to just bring it to the market without any FDA oversight or even knowledge of the ingredient. So, in essence, what we're having now is that the food industry polices itself on whether to submit this pre-market petition for a food additive or just include it in its products without any FDA knowledge.

When you said 'enormous number of such things,' are we talking dozens, hundreds, thousands?

Nobody knows, but the environmental working group did find that 99% of new ingredients are added through this loophole. And that's the concerning part.

Well, you can look at some ultra-processed foods and they can have 30 or 40 ingredients on them. That's just one food. You can imagine that at across the food supply, how many things there are. And there are these chemicals that nobody can pronounce. You don't know what's going on, what they are, what they're all about. So, what you're saying is that the food industry decides to put these things in foods. There's some processing reason for putting them in. It's important that the public be protected against harmful ingredients. But the food industry decides what's okay to put in and what's not. Are they required to do any testing? Are there criteria for that kind of testing? Is there any sense that letting the industry police itself amounts to anything that protects the public good?

Well, the criteria are supposed to be the same for GRAS or food additives. They're supposed to be meeting certain scientific criteria. But the problem with this is that for GRAS ingredients, they don't have to use published data and they can hold that scientific data to themselves. And you mentioned food labels, the ingredient list, right? That doesn't necessarily capture these ingredients. They use generic terms, corn oil, color additive, food additive whatever. And so, the actual ingredient itself is not necessarily listed on the ingredient list. There is no way to identify them and it's unknown whether they're actually doing the studies. They can engage in these, what are called GRAS panels, which are supposed to be experts that evaluate the science. But the problem is other studies have found that 100% of the people on these GRAS panels have financial conflicts of interest.

Okay, so let me see if I have this right. I'm a food company. I develop a new additive to provide color or flavor or fragrance, or it's an emulsifier or something like that. I develop a chemical concoction that hasn't really been tested for human safety. I declare it safe. And the criteria I use for declaring it set safe is putting together a panel of people that I pay, who then in a hundred percent of cases say things are. That's how it works?

I can't say that in a hundred percent of cases they say it's safe, but a hundred percent of the people have financial conflicts of interest. That's one of the major concerns there.

Well, one can't imagine they would continue to be paid...

Exactly.

This sounds like a pretty shaky system to be sure.

Emily: I wanted to add a couple other really quick things on the last discussion. You were saying, Kelly, like they're using a panel of experts, which indeed are paid by them. That would be best case in some cases. They're just having their own staff say, we think this is generally recognized as safe. And I think there's some examples we can give where there isn't even evidence that they went to even any outside people, even within industry. I think that the takeaway from all of that is that there's really the ability for companies to call all the shots. Make all the rules. Not tell FDA what they're doing. And then as we talked about, not even have anything on the label because it's not a required ingredient if it's, used as part of a processing agent that's not a substance on there.

So I was feeling pretty bad when Jennifer is talking about these panels and the heavy conflict...

Even worse.

Of interest, now I feel worse because that's the best case.

Totally. And one other thing too is just you kind of warmed this up by talking about this loophole. When we put an earlier article out that we wrote that was about just this generally recognized as safe, the feedback we got from FDA was this isn't a loophole. Why are you calling this a loophole? And it's pretty clear that it's a loophole, you know?

It's big enough to drive thousands of ingredients through.

Yes, totally.

Emily, you've written about things like partially hydrogenated vegetable oils, trans fats, and red dye number three in particular. Both of which FDA has now prohibited in food. Can you walk us through those cases?

You asked about partially hydrogenated oils or trans-fat, and then red dye three, which are two examples that we talk about a little bit in our piece. Actually, one of those, the partially hydrogenated oils was allowed in food through the generally recognized as safe definition. And the other was not. But they are both really good examples of another real issue that FDA has, which is that not only are they not doing a good job of policing substances going into food on the front end, but they do an even worse job of getting things out of food on the backend, post-market once they know that those substances are really raising red flags. And you raised two of the prime examples we've been talking about.

With partially hydrogenated oils these are now banned in foods, but it took an extremely long time. Like the first evidence of harm was in the mid-nineties. By 2005, the Institute of Medicine, which is now the National Academies, said that intake of trans fat, of partially hydrogenated oils, should be as low as possible. And there was data from right around that time that found that 72,000 to 228,000 heart attacks in the US each year were caused by these partially hydrogenated oils. And on FDA's end, they started in early 2000s to require labeling. But it wasn't until 2015 that they passed a final rule saying that these substances were not generally recognized as safe. And then they kept delaying implementation until 2023. It was basically more than 20 years from when there was really clear evidence of harm including from respected national agencies to when FDA actually fully removed them from food. And red dye number three is another good example where there were studies from the 1980s that raised concerns about this red dye. And it was banned from cosmetics in 1990. But they still allowed it to be added to food. And didn't ban it from food until early this year. So early 2025. In large part because one of the other things happening is states are now taking action on some of these substances where they feel like we really need to protect consumers in our states. And FDA has been doing a really poor job. California banned red dye about 18 months before that and really spurred FDA to action.

So that 20-year delay with between 72,000 and 228,000 heart attack deaths attributable to the trans fats is the cost of delay and inaction and I don't know, conflicts of interest, and all kinds of other stuff that happened in FDA. So we're not talking about something trivial by any means. These are life and death things are occurring.

Yes.

Give us another example, if you would, about something that entered the food supply and caused harm but made it through that GRAS loophole.

The example that I've talked about both in some of the work we've done together and also in a perspective piece in the New England Journal of Medicine that really focused on why this is an issue. There was this substance added to food called tara flour. It came on the scene in 2022. It was in food prepared by Daily Harvest as like a protein alternative. And they were using it from a manufacturer in South America who said we have deemed this generally recognized as safe. Everything about that is completely legal. They deemed it generally recognized as safe. A company put it into food, and they sold that. Up until that point, that's all legal. What happened was very quickly people started getting really sick from this. And so there were, I think, about 400 people across 39 states got sick. Nearly 200 people ended up in the hospital, some of them with liver failure because of this toxicity of tara flour. And so FDA followed the thread they did help work with the company to do a voluntary recall, but it then took them two years, until May, 2024, to declare tara flour not generally recognized as safe. So I think, in some ways, this is a great example because it shows how it's so immediate, the impact of this substance that, again, was legally added to food with no oversight. In some ways it's a misleading example because I think so many of the substances in food, it's not going to be so clear and so immediate. It's going to be year over year, decade over decade as part of a full diet that these are causing cardiovascular risk, thyroid disease, cancer risk, those kinds of things.

I'd love to hear from either of you about this. Why is FDA falling down on the job so badly? Is it that they don't have the money to do the necessary testing? Do they not have the authority? Is there not the political will to do this? Is there complete caving into the food industry? Just let them do what they want and we're going let it go?

Jennifer: All of the above? Everything you just said? It's all of the above.

Emily: Jen, do you wanna talk about the money side? Because that sort of gets to the genesis of the article we worked on, which was like maybe there's a creative solution to that piece.

Yes, I'd love to hear about that because I thought that was a very creative thing that you guys wrote about in your paper. That there would be an industry user fee to help produce this oversight. Tell us what you had in mind with that. And then then convince me that FDA would appropriately use this oversight and do its job.

So, the idea in the paper was proposing a comprehensive user fee program for the food branch of the FDA. The FDA currently collects user fees for all of human drugs, animal drugs, medical devices, etc. With Tobacco, it's a hundred percent funded by user fees. But food, it only gets 1% of its funding through user fees. And it's important to note user fees fund processes. They don't fund outcomes. It's not like a bribe. And the idea behind user fees and why industry sometimes supports them is actually to bring predictability to the regulatory state. It brings efficiency to reviews. And then this all allows the industry to anticipate timelines so they can bring products to market and know when they're going be able to do it. In the food context, for example, the FDA is required to respond to those food additives petitions that we talked about within 180 days. But they can't respond in time. And they have a lot of timelines that are required of them in the food context that they can't meet. They can't meet their timelines because they're so underfunded. So, we proposed a comprehensive user fee. But one of the main reasons that we think a user fee is important is to address the pre-market issues that I talked about and the post-market issues that Emily talked about.

In order to close that GRAS loophole, first of all, FDA needs to either reevaluate its authorities or Congress needs to change its authorities. But it would need resources to be able to do something pre-market. Some of the ideas we had was that the user fee would fund some type of either pre-market review, pre-market notification, or even just a pre-market system where the FDA determines whether a proposed ingredient should go through the GRAS avenue, or through food additive petition. So at least that there will be some type of pre-market oversight over all the ingredients in the food supply. And then also the FDA is so severely lacking in any type of comprehensive post-market into play, they would have the resources to engage in a more comprehensive post-market review for all the ingredients.

Could you see a time, and I bring this up because of lawsuits against the food industry for some of these additives that are going on now. The state attorney's generals are starting to get involved, and as you said, Emily, the some states are taking legislative action to ban certain things in the food supply. Do you think there could come a time when the industry will come to government pleading to have a user fee like this? To provide some standardization across jurisdictions, let's say?

So, there's two things. The first is Congress has to pass the user fee, and historically, actually, industry has done exactly what you said. They have gone to Congress and said, you know what? We want user fees because we want a streamlined system, and we want to be able to know when we're bringing products to market. The problem in the context of food for the issues we're talking about is that right now they can use the GRAS loophole. So, they have very little incentive to ask for user fees if they can bring all their ingredients into the market through the GRAS loophole. There are other areas where a user fee is very relevant, such as the infant formula 90 day pre-market notification, or for different claims like health claims. They might want user fees to speed those things up, but in terms of the ingredients, unless we close the GRAS loophole, they'd have little incentive to actually come to the table.

But wouldn't legal liability change that? Let's say that some of these lawsuits are successful and they start having to pay large settlements or have the State Attorneys General, for example, come down on them for these kinds of things. If they're legally liable for harm, they're causing, they need cover. And wouldn't this be worth the user fee to provide them cover for what they put in the food supply? Yes, it's great to have the flexibility to have all these things get through the loophole, but it'd be great as well to have some cover so you wouldn't have so much legal exposure. But you guys are the lawyers, so I'm not sure it makes sense.

I think you're right that there are forces combining out in the world that are pushing for change here. And I think it's hard to disentangle how much is it that industry's pushing for user fees versus right now I think more willing to consider federal regulatory changes by either FDA or by Congress. At the state level this is huge. There's now becoming a patchwork across states, and I think that is really difficult for industry. We were tracking this year 93 bills in 35 states that either banned an additive in the general public, banned it in schools. Banned ultra-processed foods, which most of the states, interestingly, have all defined differently. But where they have had a definition, it's been tied to various different combinations of additives. So that's going on. And then I think you're right, that the legal cases moving along will push industry to really want clear and better standards. I think there's a good question right now around like how successful will some of these efforts be? But what we are seeing is real movement, both in FDA and in Congress, in taking action on this. So interestingly, the Health Affairs piece that we worked on was out this spring. But we had this other piece that came out last fall and felt like we were screaming into the void about this is a problem generally recognized as safe as a really big issue. And suddenly that has really changed. And so, you know, in March FDA said they were directed by RFK (Robert F. Kennedy), by HHS (Health and Human Services) to really look into changing their rule on generally recognized as safe. So, I know that's underway. And then in Congress, multiple bills have been introduced. And I know there are several in the works that would address additives and specifically, generally recognized as safe. There's this one piece going on, which is there's forces coalescing around some better method of regulation. I think the question's really going to also be like, will Congress give adequate resources? Because there is also another scenario that I'm worried about that even if FDA said we're going now require at least notification for every substance that's generally recognized as safe. It's a flood of substances. And they just, without more resources, without more staff devoted to this, there's no way that they're going to be able to wade through that. So, I think that either the resources need to come from user fees, or at least partially from user fees, from more appropriations and I think, In my opinion, they are able to do that on their own. Even given where current administrative law stands. Because I think it's very clear that the gist of the statute is that FDA should be overseeing additives. And I think a court would say this is allowing everything to instead go through this alternative pathway. But I really think FDA's going to need resources to manage this. And perhaps more of a push from Congress to make sure that they really do it to the best of their ability.

I was going to say there's also an alternative world where we don't end up spending any of these resources, and they require the industry just to disclose all the ingredients they've added to food and put it on a database. This is like low hanging fruit, not very expensive, doesn't require funding. And then the NGOs, I hope, would go to work and say, look at this. There is no safety data for these ingredients. You know, because right now we just can't rely on FDA to do anything unless they get more funding to do something. So, if FDA doesn't get funding, then maybe this database where houses every ingredient that's in the food supply as a requirement could be a low resource solution.

Jennifer, I'll come back to you in a minute because I'd like to ask how worried should we be about all this stuff that's going into food. But Emily, let me ask you first, does FDA have the authority to do what it needs to do? Let's say all of a sudden that your wish was granted and there were user fees would it then be able to do what needs to be done?

I think certainly to be able to charge these user fees in almost all areas, it right now doesn't have that authority, and Congress would need to act. There's one small area which is within the Food Safety Modernization Act for certain types of like repeat inspections or recalls or there's a couple other. FDA isn't charging fees right now because they haven't taken this one step that they need to take. But they do have the authority if they just take those steps. But for everything else, Congress has to act. I think the real question to me is because we now know so many of these substances are going through this GRAS pathway, the question is really can they do everything they need to do on their own to close that loophole? And again, my opinion is Congress could make it clear and if Congress were to act, it would be better. Like they could redefine it in a way that was much more clear that we are drawing a real line. And most things actually should be on the additive side of the line rather than the generally recognized as safe side of the line. But even with their current authority, with the current definition, I think FDA could at least require notification because they're still drawing a line between what's required for additives, which is a very lengthy pre-market process with, you know, a notice and comment procedure and all of these things. My take is FDA do what you can do now. Let's get the show on the road. Let's take steps here to close up the loophole. And then Congress takes time. But they definitely can even strengthen this and give a little more, I think, directives to FDA as to how to make sure that this loophole doesn't recur down the line.

In talks that I've given recently, I've shown an ingredient list from a food that people will recognize. And I ask people to try to guess what that food is from its ingredient list. This particular food has 35 ingredients. You know, a bunch of them that are very hard to pronounce. Very few people would even have any idea at all what those ingredients do. There's no sense at all about how ingredient number 17 would interact with ingredient 31, etc. And it just seems like it's complete chaos. And I don't want to take you guys outside your comfort zone because your backgrounds are law. But Jennifer, let me ask you this. You have a background in public health as well. There are all kinds of reasons to be worried about this, aren't there? There are the concerns about the safety of these things, but then there's a concern about what these ultra-processed ingredients do to your metabolism, your ability to control your weight, to regulate your hunger and things like that. It sounds this is a really important thing. And it's affecting almost everybody in the country. The percentage of calories that are now coming from ultra-processed foods is over 50% in both children and adults. So it sounds like there's really reason to worry. Would you agree?

Yes. And also, the FDA is supposed to be overseeing the cumulative effects of the ingredients and it doesn't actually enforce that regulation. Its own regulation that it's supposed to evaluate the cumulative effects. It doesn't actually enforce this.

So by cumulative effects do you mean the chronic effects of long term use?

And, having these ingredients across multiple products within one person's consumption. Also, the FDA doesn't look at things like the effect on the gut microbiome, neurotoxicity, even cancer risk, even though they're supposed to, they say that if something is GRAS, they don't need to look at it because cancer risk is relegated only to food additives. So here we're at a real issue, right? Because if everything's entering through the GRAS loophole, then they're not looking at carcinogen effects. So, I think there is a big risk and as Emily had said earlier, that these are sometimes long-term risks versus that acute example of tara flour that we don't know. And we do know from the science, both older and emerging science, that ultra-processed food has definite impact on not only consumption, increased consumption, but also on diet related diseases and other health effects. And by definition what we're talking about here are ultra-processed foods. These ingredients are only found in ultra-processed foods. So, we do know that there is cause for concern.

It's interesting that you mentioned the microbiome because we've recorded a cluster of podcasts on the microbiome and another cluster of podcasts on artificial sweeteners. Those two universes overlap a good bit because the impact of the artificial sweeteners on some of them, at least on the microbiome, is really pretty negative. And that's just one thing that goes into these foods. It really is pretty important. By the way, that food with 35 ingredients that I mentioned is a strawberry poptart.

Jennifer: I know that answer!

Emily: How do you know that?

Jennifer: Because I've seen Kelly give a million talks.

Yes, she has.

Emily: I was wondering, I was like, are we never going to find out?

So the suspense is lifted. Let me end with this. This has been highly instructive, and I really appreciate you both weighing in on this. So let me ask each of you, is there reason to be optimistic that things could improve. Emily, I'll start with you.

So, I've been giving this talk the past few months that's called basically like Chronic Disease, Food Additives and MAHA, like What Could Go Right and What Could Go Wrong. And so, I'm going give you a very lawyerly answer, which is, I feel optimistic because there's attention on the issue. I think states are taking action and there's more attention to this across the political spectrum, which both means things are happening and means that the narrative changing, like people are getting more aware and calling for change in a way that we weren't seeing.

On the flip side, I think there's a lot that could go wrong. You know, I think some of the state bills are great and some of them are maybe not so great. And then I think this administration, you have an HHS and FDA saying, they're going to take action on this in the midst of an administration that's otherwise very deregulatory. In particular, they're not supposed to put out new regulations if they can get rid of 10 existing ones. There are some things you can do through guidance and signaling, but I don't think you can really fix these issues without like real durable legislative change. So, I'm sorry to be one of the lawyers here. I think the signals are going in the right direction, but jury is out a little bit on how well we'll actually do. And I hope we can do well given the momentum.

What do you think, Jennifer?

I agree that the national attention is very promising to these issues. The states are passing laws that are shocking to me. That Texas passing a warning label law, I would never have thought in the history of the world, that Texas would be the one to pass a warning label law. They're doing great things and I actually have hope that something can come of this. But I am concerned at the federal level of the focus on deregulation may make it impossible. User fees is an example of where they won't have to regulate, but they could provide funding to the FDA to actually act in areas that it has the authority to act. That is one solution that could actually work under this administration if they were amenable to it. But I also think in some ways the states could save us. I worry, you know, Emily brought up the patchwork, which is the key term the industry uses to try to get preemption. I do worry about federal preemption of state actions. But the states right now are the ones saving us. California is the first to save the whole nation. The food industry isn't going to create new food supply for California and then the rest of the country. And then it's the same with other states. So, the states might be the ones that actually can make some real meaningful changes and get some of the most unsafe ingredients out of the food supply, which some of the states have now successfully done.

Bios

Emily Broad Leib is a Clinical Professor of Law, Director of Harvard Law School Center for Health Law and Policy Innovation, and Founding Director of the Harvard Law School Food Law and Policy Clinic, the nation's first law school clinic devoted to providing legal and policy solutions to the health, economic, and environmental challenges facing our food system. Working directly with clients and communities, Broad Leib champions community-led food system change, reduction in food waste, food access and food is medicine interventions, and equity and sustainability in food production. Her scholarly work has been published in the California Law Review, Wisconsin Law Review, Harvard Law & Policy Review, Food & Drug Law Journal, and Journal of Food Law & Policy, among others.

Professor Jennifer Pomeranz is a public health lawyer who researches policy and legal options to address the food environment, obesity, products that cause public harm, and social injustice that lead to health disparities. Prior to joining the NYU faculty, Professor Pomeranz was an Assistant Professor at the School of Public Health at Temple University and in the Center for Obesity Research and Education at Temple. She was previously the Director of Legal Initiatives at the Rudd Center for Food Policy and Obesity at Yale University. She has also authored numerous peer-reviewed and law review journal articles and a book, Food Law for Public Health, published by Oxford University Press in 2016. Professor Pomeranz leads the Public Health Policy Research Lab and regularly teaches Public Health Law and Food Policy for Public Health.

Every day, with few exceptions, I eat a handful of nuts. Usually a combination of almonds, walnuts, pecans, cashews, and pistachios. And they taste good for sure. But I'm responding mainly to research showing that consumption of nuts is related to less chronic disease. In particular, eating nuts lowers levels of inflammation related to heart disease and diabetes, and may improve cholesterol levels among other benefits. So, I saw it as welcome news that someone has just published a book about nuts, all aspects of nuts, actually. Today we're joined by NPR, food Writer Elspeth Hay author of a new book called Feed Us with Trees- nuts, and The Future of Food. And I had no idea. Nuts were so interesting until I dove in a little bit. Elspeth has gathered stories from dozens of nut growers, scientists, indigenous knowledge keepers, researchers and food professionals. She writes that humans once grew their staple crops in forest gardens of perennial nuts, such as oaks, chestnuts, and hazelnuts in these species. Particularly important to the environment as well as to human wellbeing.

Interview Summary

Elspeth, thanks so much for joining us and for writing such an amazing book.

Thank you so much for having me. And it sounds like you have the same habit as my dad. He makes sure to eat a little bit of mixed nuts every night, ever since I can remember for his health.

Let's start by having you describe your book. Tell us about Feed us with Trees. Why did you write it and what's it about?

I wrote it because I've been reporting on food in the environment for a long time, a little more than 15 years. And I had never heard anyone mention anything about eating acorns until a few years ago. And someone sent me a TEDx talk by a woman in Greece named Marcie Mayer, and she said, you can eat acorns. And not only that, but they're a super food nutritionally, and one of humanity's oldest foods. And I live in this giant oak forest that's protected on Cape Cod as part of the Cape Cod National Seashore. And I had always seen this forest as a sort of impediment to local food production, right? There's all this land that can't be farmed. And all that time, it turns out there was food literally raining down on my roof, underfoot in my driveway, and I just wasn't equipped to see it. The stories that I had grown up with hadn't mentioned that. And so that was a real eyeopener for me and I just couldn't stop thinking about it and I kept researching.

So, have you started consuming acorns?

I have, yes. I've collected them the past probably five falls and, you know, oaks do something called masting. Some years they have a really big production and some years smaller production. Some years I've gotten more than others. But I have started processing them at home and experimenting with different ways of using the flour. And I've also ordered online acorn oil. There are actually three food products that you can make from acorns. You can make starch, which works just like corn starch or potato starch. Thickens things. You can make flour and with some species you can make oil. It's actually a pretty diverse crop.

That's so interesting. You know, I have a series of oak trees right outside my window and I never thought that they might be producing food I could consume. It's so interesting to hear your history with that.

Yes, I mean I had no idea. And it turns out that actually acorns are very similar to olives in the way that they need to be processed. They're very high in these compounds that are very bitter, called tannins, just like an olive. I had the experience once of going to Italy with my husband, and we saw this olive grove and we thought, oh cool. Olives growing right here. And we picked one off the tree and he put his in his mouth and immediately spat it out and said, oh, that's awful. Tannins are not something that we want to eat. They don't taste good, but obviously they haven't hampered the olives rise to glory in terms of a human food source. And Acorns need the same kind of processing. So, tannins are water soluble. You pull them out with water. You know, you always get olives in brine, right? And so Yes, just started learning more about how to work with them and then also more about our relationship with oak trees. And I started seeing them differently in that light too. Going from sort of the species that I'd always seen as natural and wild and better off without humans, to actually understanding that we have a really long history with oak trees and in some places, they actually really depend on us. So that was total game changer for me.

There's more to the story than oaks and acorns. Tell us what you learned about the history of humans eating nuts like acorns, but also things like chestnuts and hazelnut.

Yes, I was really surprised. At first, I thought, okay, this is going to be an isolated thing where some people in really hilly areas or areas that aren't good for row crops are eating these nuts as staple foods. But when I looked back, actually all over the Northern Hemisphere in a huge variety of cultures, people have been in relationship with these nut trees as a staple food for a lot of the past 12,000 years. So, there's records in Japan of this ancient society that was sort of the first known chestnut cultivators in Japan. The burr size increased a lot. The nut size increased a lot during that early era of cultivation. There's a really interesting history of chestnut cultivation throughout Europe during what we call the quote unquote dark ages, although I'm starting to think maybe it was lighter than we thought during that time. There was a lot of cool stuff happening with Agroforestry. And in some areas of Europe, people ate an average of 330 pounds of chestnuts per person, per year. To put that in perspective, today, the average American eats about 150 pounds of grains per person per year. So that is a pretty serious level of chestnut consumption. You know, it's called in some places the bread tree. And I just started finding all these examples. There was a time in the British Isles known as the Nut Age, between about 7,000 and 5,000 years ago. There were just all these examples of different people at different times tending to these trees and harvesting a huge amount of food from them.

You've written that trees like oaks and chestnut and hazels and also humans are what ecologists call keystone species.

Yes.

Tell us what you mean by that and how such species play an outsized role in local ecosystems.

So, a keystone species, the first time I ever heard of them I think I was in Jamaica, and someone was talking about the sea urchins on the reef and the beach there. And it turned out that when they disappeared, for a variety of reasons, this whole ecosystem fell apart. And there's different types of keystone species, but a keystone species is as important to its ecosystem as the keystone in a Roman arch, right? So, if you pull that keystone out, you have this cascade of effects where everything kind of falls apart. And oaks are a huge life support tree. I don't know if listeners have heard of the work of entomologist, Doug Tallamy. He's done some really interesting studies on different families of plants and how much life they support by looking at insects. And in most counties where they occur, oaks are the top life support plant in North America. They're this incredibly important basis of the food chain. They provide food for a ton of insects. Those insects in turn feed birds and mammals and other creatures. And you know, at first as I am learning all this, I thought, okay, great oaks are important. Well, you know, I kind of already knew that, but that's exciting that we can eat from them. But then I started getting to know some fire practitioners. Especially an indigenous man in present day Northern California named Ron Reed. And he's a member of the Karuk Tribe there. And he started telling me about the relationship between cultural fire, prescribed fire, and oak trees. And what I learned is that oaks and human fire have actually been in relationship for millennia. And there's this whole, on the east coast, this hypothesis called the Oak Fire Hypothesis. And most ecologists that I've spoken with ascribe to it and believe that the reason that white oak and hickory have been this sort of dominant forest type through a lot of Eastern North America for the past 9,000 years, despite some really dramatic climate changes, is because humans have burned to keep them dominant on the landscape. And that in doing that we actually play a role as a keystone species too, right? So, if our fire is supporting this incredibly important keystone species, oaks, and other nut trees, we're in the category that they call ecosystem engineers.

Mm-hmm.

So, a beaver is an example of an ecosystem engineer, right? You take the beaver out of the wetland and the whole thing falls apart. And a lot of fire historians and ecologists see us as the fire animal. And historically, in a lot of different ecosystems, that has been our largest and most important role is creating ecosystems for other wildlife habitat, for other wildlife, with fire.

So, it sounds like there was a time in human history when humans would selectively burn other things in order to protect these trees.

Yes, and truly not just these trees. If you look at other places, other continents, there's human burning in Australia, there's human burning in the Amazon, there's tons of examples. But around here where I live, at least in New England and in the East, fire has been used intentionally to keep these nut trees dominant. Because what happens is. oaks are a mid-succession species. If folks don't know a lot about succession, early is like bare dirt, right? When we have an open field that's been plowed up, that's the beginning of succession. And then it proceeds all the way to an old growth forest. And oaks, if they get shaded out, they're not a particularly shade tolerant species. So, a lot of these nut trees like that kind of middle, sweet spot of succession. Where it's still a little open, there's still plenty of sun for regeneration. And so that can be intentionally preserved with fire or with other methods. But that's been a major one historically.

Well, that's so interesting. In your book, you draw a comparison between the yield from these trees to more modern agriculture or industrial farming of things like corn and soybeans. That tell us about that. That's a very interesting point to make.

Yes. I spent a lot of time on what I started calling the yield thing because it seemed really important, right? If these trees are actually a viable alternative to the industrial monocultures that we're struggling to maintain, well then, they need to really feed us, right? There needs to be enough food. And there are a number of different ways to look at it. I think, you know, one thing that we don't talk about a lot is when we talk about a monoculture of corn, for instance, I think the record, I'm not going to remember the exact statistics. But the average is maybe12,000 tons per acre or something. But there have been these huge records, and what we don't talk about is that yield is a ratio, right? If land is the limiting factor for us to produce food. And we're just talking about what's coming off this one acre, but we're not talking about the land it took to produce the fertilizer. We're not talking about the land it took to produce the tractor or the fuel or all these other inputs. And when you factor those in, those high yields completely disappear. When we actually look at how much land we need to produce food, an ecosystem based on these keystone trees will always produce the most because they produce the most life, right? And, you know, we tend to get caught up in other measures, but ultimately life comes from photosynthesis and these relationships between different species. And when you have a piece of land that is producing an abundance of life, you also have an abundance of food. And I broke the yield question down in a lot of different ways, but there have been some direct comparisons between oak savannah versus cornfield ecosystems and the amount of photosynthesis and food production that's happening. And the oak ecosystems, I mean, if you just think about the size of an oak tree and its photosynthetic capacity versus the sort of short grass, it can do a lot more.

Well, if you happen to park your car under an oak tree, you get a good sense of exactly how many acorns one can produce.

Yes, it's quite a bit. And actually, another cool thing about acorns, is that because of the tannins, which are kind of a pain, right, for processing. People often wish they didn't have these tannins. But tannins are an incredible preservative. So, from a food security standpoint, if you gather some acorns and you dry them out a little, just by letting them sit in an airy, dry spot, they can store for decades. So, even if the acorn production isn't consistent year to year, like say a hazelnut or a chestnut or a field of corn might be. Those fluctuations are not as big of a deal because of that food security potential. There's a lot of different ways to break it down. But I was a skeptic, a yield skeptic. And by the end of the research, I felt quite confident in saying that these trees produce plenty and it's definitely not a yield issue why we moved away from them.

Well, I'm glad you decided to dive into the yield thing because it's actually very interesting once you get into it. Let's talk about something else that you wrote about. A little-known part of US history. You wrote that in the not-so-distant past, the US government considered keystone nut trees as a solution to some of our biggest environmental and economic challenges. I had no idea about that. Tell us about it and what happened.

I had no idea either. When I first started researching the book, I went on this trip through Appalachia talking to different people who had some knowledge of this stand of trees that was planted in between the late 1920s and the 1960s by a guy named John Hershey. And I just thought, oh, cool, I'll go see these old nut trees. This sounds really interesting. But what I learned when I got there and started talking to the folks who had found where the trees were and were sort of caretaking them, was that Hershey was part of, Roosevelt's depression recovery plan. And he had this experimental fruit and nut tree nursery where he had ads in the newspaper and people all over the eastern seaboard were sending in entries of their best nut seeds, best trees. He got these genetics that probably represented, you know, hundreds if not thousands of years of human breeding in the east. And he started planting these experimental nurseries. And as part of Roosevelt's tree army, not only were they planting trees to try to prevent erosion and reforest areas that have been cut over. They were also planting these nut trees and seeing them as a really viable solution to hunger, to environmental crises, and to reviving rural economies. And unfortunately, Hershey ended up getting cancer. His other buddy who was doing the program with him got in a fight with one of the Roosevelt administrators, and the program fell apart. Also, World War II began. So that was another reason that things kind of fell apart. But for a moment there it was at the highest levels of government. The officials saw, wow, this could actually solve a lot of problems at once. And I think it's a bummer that it didn't catch on then. But it's not too late now. We still have a lot of problems as we unfortunately all know. And these trees still offer a lot of solutions.

So given the long human history of this, the story of indigenous cultures becomes really fascinating. And you've talked about how the indigenous cultures tended oak trees and other trees with what you called forest farming. And I'm interested in that concept and if you would tell us what that means and also, why haven't these things caught on? And why don't most Americans eat acorns or even know that one can eat them?

So, the history of forest farming in the US is pretty long and violent. Our government has pursued a policy of trying to eradicate a lot of these indigenous food production systems because people are easier to control when they're hungry and when they don't have access to the resources that they need. We often talk about our industrial style of farming that we have today as inevitable, right? Oh, well, these older methods didn't produce enough food and so we had to transition from quote unquote hunting and gathering to farming. And what I found as I looked through the history is that is a completely made-up story. Instead, what was happening is that as Euro-American colonists kept trying to expand our land base, you know, kept trying to move West, force into new areas, is that it was very hard to gain access to more land without also using violence and a tactic that, some historians have called a feed fight. Targeting indigenous food production and then forcing survivors to assimilate into grain crop culture. And that, we've been told was because it was a way of producing more food. But in fact, often it yielded less food and was actually a war tactic. And there's a lot of talk right now about regenerative farming and there's also a lot of talk about racial healing and having real conversations about racial history in the US and trying to move forward. And I think that this food aspect is really key to that conversation. And if we want to build a better future, it's something that we really have to reckon with and talk about, you know? We can't change what happened, but we also can't move forward without knowing what happened and really understanding it.

So interesting how the history of this particular food was so shaped by politics, colonialism, things like that. And also by things like Mr. Hershey getting cancer and, you know, his, his colleague having a fight. I mean, it's just an incredibly interesting history and it's too bad that it played out like it did for a million tragic reasons. But whoa, that's interesting.

I found some of the historic literature just totally confounding and fascinating because there would be, you know, sometimes the same people would be commenting on how they'd gotten to present day California. You know, these Euro-American soldier, settlers, they got there. They couldn't believe how much food there was. You know, wild geese, as far as you can see, wild oats as far as you can see, salmon filling up the rivers. And then in the same letter sometimes saying these indigenous people don't know how to produce food. They have nothing to eat. It was a really important reminder to me of the importance of stories and the stories that we internalize. Because I can now think of examples in my own life of, you know, I live in this national park and on the website of the National Park, there's one page about the importance of human fire in the ecosystem of this place over the past 10,000 years. And on another page of the same website, there's a description of this natural, pristine wilderness, that is supposedly also here. Of course, those two things can't really both be true. But until I started learning all this about oaks and these other trees, that didn't set off any alarm bells in my head. And we all have internalized narratives that we forget to question. For me, for whatever reason, these acorns have been this huge opener of like, okay, what else am I missing? What else do I need to reexamine about the stories around food that I've grown up with and the stories around our relationship with the living world around us. Because there's a lot of layers there to unpack.

Well, there sure are. One other thing I wanted to ask you about, because you brought up this issue earlier of forest succession. And in that context, tree pruning is an interesting topic. And you write that tree pruning, this could happen by fire, or it could also happen with other things like pollarding. I didn't know what pollarding was. But those could hold some surprising opportunities when it comes to food production and climate change. And you write that regularly pruned and burned landscapes aren't like the typical old growth forest that we often associate with climate solutions. So why is this?

So, we often think of old growth forests as simply a forest that looks really old, right? The trees are tall and they're broad. And there are forests that can be really old but can be in an earlier stage of succession. So, what happens with a lot of these interactions over time where people are either burning or coppicing or pollarding, which I'll define for your listeners. Because I also had no idea what those words meant when I first started researching. But coppicing is where you cut a woody plant back to the ground year after year. It could be every year. It could be in a rotation of every eight or 15 or 20 years to produce new stems. Like it's a plant that will resprout. And pollarding is the same idea but was often done in systems where livestock were also involved. You're cutting much higher off the ground, typically above animal head height, so that they can't graze those tasty young shoots. And there are a lot of traditionally managed forests in Europe that have been managed with coppice and pollard. What's happening is when we produce food in a farm field, right? We're taking succession back to zero every year. We're re plowing the field. Every time we do that the carbon that the plants had stored in their roots and had sent down to the soil gets burped back out into the atmosphere. I talked to a great soil scientist about this, and he was just like, oh, it's carbon dioxide burps everywhere. It's awful. But when we work with these woody plants where you're not taking out the roots, you're not taking out the trunk necessarily, if you're pollarding, right? You're leaving these trees. And these trees can get really old and really big around the trunk, and then they're getting pruned up top and sending out these new shoots. It is more like giving the plant a haircut. You're not killing it back. You're not losing all that carbon that's stored in the soil. And you're kind of renewing its youth and vigor. There are some studies indicating that trees that are coppiced and pollarded can actually live longer than trees with no human interaction. And so, there's this really fine line between, you know, too much interference where we're messing up the succession cycle of the forest and taking it back to zero. And maybe some interference, but not going all the way back to zero. And that has huge climate implications.

Bio

Elspeth Hay is the author and creator of Feed Us with Trees and the Local Food Report on NPR, and proponent of place-based living. Deeply immersed in her own local-food system, Elspeth's work focuses on food, the environment, and the people, places, and ideas that feed us. She spent the past 15+ years interviewing local food producers, harvesters, processors, cooks, policymakers and visionaries about what it means to be human and live thoughtfully in place. In the process, she's come to understand that we humans are, in fact, perfectly adapted to a wide range of places—and to believe that reconnecting with our home ecosystems is both the great challenge and great joy of our times. In addition to her work as a writer and public radio host, Elspeth is deeply immersed in the local food system of her own home community of Wellfleet, MA on the Outer Cape. She is part of the team behind the Wicked Oyster restaurant in Wellfleet, a co-founder of the Wellfleet Farmers Market, co-founder of the newly launched Commons Keepers, and a passionate student and teacher of place-based living.