What motivated you to launch Food and Health Facts?

The compromised health of so many Americans has been brought into sharp focus by Covid-19. Those who have tested positive for the virus and who live with comorbidities face risks that greatly exceed those who are in good health.

The dean of the Tufts Friedman School of Nutrition Science, Dariush Mozaffarian, has aptly described the current situation: “So very few of us are actually healthy, and Covid-19 is basically like pouring gasoline on a smoldering fire.”

One indicator of Americans’ poor health is the incidence of chronic diseases, which afflict 60 percent of the adult population. Three chronic conditions – heart disease, stroke, and type 2 diabetes – were responsible for more than 700,000 deaths in the United States in 2012. Dietary factors were associated 45 percent of those deaths.

A powerful (and cost-effective) approach to reversing these conditions – and preventing them – is the consumption of healthy foods. “Diet is the most important medicine we all possess,” writes British epidemiologist Tim Spector. “We urgently need to learn how best to use it.”

This is not a new idea, of course. (It was Hippocrates, after all, who wrote, “Let food be thy medicine, and medicine be thy food.”) But the intersection of food and health is a fraught topic, filled with misinformation. That is one reason (among many) why the obesity rate in the United States has been steadily rising for the past 40 years – and is now the second highest in the world, after Kuwait (if a few small Pacific island nations are excluded).

Throughout this period, obesity has been largely absent from the U.S. public policy agenda. Having observed this inaction for several years, and with the consequences magnified by Covid-19, I decided to do something. The Food and Health Facts newsletter is the “something.”

What sources of information will be drawn on for the Food and Health Facts newsletter?

There will an array of sources, including medical journals, books, newspapers, magazines, and websites. The information will include citations and, as much as possible, will be drawn from evidence-based research. 

Is there a pithy way of summarizing how you think about assessing evidence?

The plural of anecdote is not data.

Are you an M.D. or Ph.D.?

No.

How can doctors help reduce the obesity rate?

There is a high level of trust in doctors when it comes to nutrition, and they would seem like obvious candidates to be at the forefront of anti-obesity efforts. Regrettably, that is not happening. Here is a concise explanation, from the Dean of Stanford University’s School of Medicine, Lloyd Minor:

Until nutrition becomes a consistent part of patient-doctor conversations, we will continue missing a major opportunity to help people live longer, healthier lives. And a good place to start is with medical education. Doctors have historically received almost no nutritional training, which limits their ability to effectively talk to patients about it. During four years of medical school, most students spend fewer than 20 hours on nutrition. That’s completely disproportionate to its health benefits for patients.

The 20 hours represents about one percent of the time spent in medical training. As a result, doctors’ knowledge about nutrition is likely to be a product of their own efforts to educate themselves on the topic. Alas, one study, published in the American Journal of Clinical Nutrition, found that physicians had less knowledge of nutrition than their non-physicians.

How likely is progress in improving the American diet and reducing obesity?

On the positive side, we know that behaviors can change for the better. Consider smoking. In 1964, 42 percent of U.S. adults were smokers. By 2018, that figure had fallen to less than 14 percent. Today, there are also several digital tools that make it easier for people to track their eating habits and their health.

But the magnitude of the challenge associated with reversing unhealthy dietary habits was highlighted in a 2013 speech by the then-head of the World Health Organization, Margaret Chan: “Not one single country has managed to turn around its obesity epidemic in all age groups.”

The reasons for this vary from country to country, and even regions within countries. But one simple factor in the United States is that preventing disease is not a fundamental element of the U.S. health care system. Until that changes, meaningful improvement will be difficult to achieve.

What’s an example of an interesting fact about obesity?

It appears to be contagious. A 2007 study, published in the New England Journal of Medicine, found that obesity was 40 percent more likely if one’s sibling had already become obese, 57 percent more likely if someone’s friend had become obese, and 171 percent more likely among close mutual friends. One of the study’s coauthors, Nicholas Christakis, pointed out that, “a person becoming obese most likely causes a change of norms about what counts as an appropriate body size. People come to think that it is okay to be bigger since those around them are bigger, and this sensibility spreads.”

What’s an interesting fact about mortality in the United States?  

The number of people who die prematurely each year and the causes of those deaths. The authors of a 2013 report sponsored by the National Institutes of Health wrote that, “Americans are dying and suffering from illness and injury at rates that are demonstrably unnecessary.” The causes of those deaths were spelled out in another comprehensive study, which was published in the Journal of the American Medical Association. The researchers found that the primary causes of U.S. morbidity and mortality were poor diet, obesity, smoking, and high blood pressure.

Is there a food you’ve discovered recently that you would recommend to others?

Korean sweet potatoes (also known as Japanese sweet potatoes). They can be cooked in a microwave, but they’re much better baked. And nothing needs to be added to them.