More Action Needed to Improve Nutrition in the U.S., Experts and Lawmakers Agree – MedPage Today
by Joyce Frieden, Washington Editor, MedPage Today November 2, 2021
WASHINGTON — With nearly one-third of federal spending now going to healthcare, what is most of the money — 80% — spent on? Treatment of preventable diseases, many of which are caused by poor diets, Sen. Cory Booker (D-N.J.), chairman of the Senate Agriculture, Nutrition, & Forestry Subcommittee on Food and Nutrition, Specialty Crops, Organics, and Research, said Tuesday.
“Currently in the United States, half of the U.S. population is pre-diabetic, or has type 2 diabetes,” Booker continued. “In 1960, approximately 3% of the U.S. population was obese. Today, more than 40% of Americans are obese and more than 70% of Americans are either obese or overweight.”
Booker’s remarks kicked off a hearing on the state of nutrition in the U.S. He noted that while the country has made some strides in addressing the problem of hunger, “now we face that second food crisis — one of nutrition insecurity where too many Americans are overfed but undernourished and are seeing these staggering rates of disease and early death.” Although the U.S. is the world’s wealthiest nation, “we have created a food system that relentlessly encourages the overeating of empty calories, literally making us sick and causing us to spend an ever-increasing amount of our taxpayer dollars … on healthcare costs to treat diet-related diseases such as type 2 diabetes, heart disease, stroke, certain types of cancer, and chronic kidney disease.”
One potential solution to this problem is more and better nutrition education for doctors, according to Dariush Mozaffarian, MD, cardiologist and dean of the Friedman School of Nutrition Science & Policy at Tufts University in Boston. “The vast majority of doctors say in polls that they recognize nutrition is so crucial for their patients, they want to learn more and they’re not learning enough in their training,” he said at the hearing. “The simple way to fix this is to change the tests. We have to change the U.S. medical licensing exam, the specialty boards’ tests, and the continuing medical education tests that every physician takes, for the top cause of poor health in our country. Shouldn’t all of the tests have 5% or 8% of questions on nutrition? We change the test, we’ll change medical education overnight.”
Mozaffarian listed three other ways to make nutrition a priority:
Sen. Mike Braun (R-Ind.) the committee’s ranking member, asked how important it is to get the American Medical Association (AMA) to take the lead on this issue, “as opposed to trying to force solutions through government — that always is a little trickier … How important is it that the AMA get on board with this?”
Patrick Stover, PhD, dean and vice chancellor for Agriculture and Life Sciences at Texas A&M University in College Station, did not answer directly, noting that when he was president of the American Society for Nutrition, “we spent a lot of time trying to focus on getting more nutrition into medical education. That’s a tremendous challenge because every professional society wants more of their type of education in the medical degree. At Texas A&M, we are encouraging combined programs of nursing and dietetics. It’s nurses who are the frontline healthcare workers who see every patient, especially in our disadvantaged communities. We need to have those frontline workers have that nutrition education, because there simply aren’t enough dietitians in these healthcare facilities to educate about nutrition.”
Food marketing and advertising is another piece of the puzzle, Booker said. “The majority of our food system is being now controlled by just a handful of big multinational corporations. These food companies carefully format, formulate, and market nutrient-poor, addictive, ultra-processed foods, which now comprise two-thirds of the calories in children and teens’ diets in the United States. And these companies want us to believe that the resulting diet-related diseases such as obesity and diabetes are somehow a moral failing, that they represent a lack of willpower or failure to get enough exercise. That is just a lie.”
Instead, Booker said, “it is our collective policy failure because the federal government is currently subsidizing easy access to the foods that are high in calories but have minimal nutritional value, while at the same time, too many communities — rural and urban alike — lack access to the healthy foods they need to thrive.” In addition, although federal guidelines suggest that Americans’ diets should consist largely of fruits and vegetables, “currently less than 2% of our federal agricultural subsidies in the United States go to these healthy foods.”
Much of the marketing of unhealthy foods is directed toward communities of color, said Angela Odoms-Young, PhD, director of the Food and Nutrition Education in Communities Program and an associate professor of nutritional sciences at Cornell University in Ithaca, New York. A 2019 report from the University of Connecticut Rudd Center for Food Policy & Obesity found that “23 restaurants spent $99 million to advertise on television that targets predominantly African Americans,” she said. “As compared to white preschoolers, Black preschoolers saw about 72% more fast food ads. If you look at teens, they saw about 77% more fast food ads.”
“This has serious implications when you look at dietary preferences in eating behaviors,” Odoms-Young continued. “Several studies have shown that immediately after you see these ads, they have a desire for unhealthy foods, junk food, and fast food. And if you look at Black, Indigenous, and Latinx communities, where you have more of that food available, you can actually act on that marketing.”
Booker said that he and Braun introduced legislation last week to convene a White House conference on food, nutrition, hunger and health, similar to one that was convened just over 50 years ago. One witness who liked that idea was Donald Warne, MD, MPH, director of the Indians into Medicine program at the University of North Dakota in Grand Forks. “According to the CDC, 48% of the American Indian and Alaskan Native population over age 18 is obese, compared to 30% of the non-Hispanic White population,” Warne said, adding that he is from the Pine Ridge Indian Reservation in South Dakota, where the nearest supermarket is 90 miles away in Rapid City. “As a result, many of my family members contend with significant barriers to accessing healthy foods, and many of them are suffering from diabetes and heart disease.”
In addition to the White House conference, “we also need a comprehensive policy approach that’s well coordinated and we need to understand the nuances of engaging tribes in these areas,” said Warne. “Ideally, we will include stakeholders with lived experience as part of these important discussions.”
Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. Follow
The material on this site is for informational purposes only, and is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.
© 2021 MedPage Today, LLC. All rights reserved.
Medpage Today is among the federally registered trademarks of MedPage Today, LLC and may not be used by third parties without explicit permission.
