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By Matthew Rees

Food and Health Fact #177:

Reflections on the past two years

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The first issue of the Food and Health Facts newsletter was published two years ago this week. Much of the world was in lockdown and data was showing that obese individuals with Covid had significantly higher rates of hospitalization, ICU admission, and mortality than people who were not overweight.

This finding dovetailed with my growing interest in issues around food and health, particularly the way in which America’s toxic food culture was leading to astronomical rates of disease, disability, and death. I decided to launch the newsletter without any particular endgame and not knowing if anyone would be interested in the topics covered.

I’ve learned a lot from digging into these topics over the past two years – much of it centered on the many ways in which the United States is biased against healthy eating and, more broadly, against human health. It’s still shocking to me that life expectancy in the United States is far and away the lowest of any developed nation in the world – and lower than in many developing countries as well.

That’s been one of the big takeaways of the past two years. Here are a few others that are interesting, infuriating, or downright jarring:

A big fat problem in the United States . . . The United States has the highest obesity rate in the world (not counting Kuwait and a few tiny Pacific Island nations) and this rate has sharply increased since 1975. I’d like to think that if every American knew this, it could serve as a dietary equivalent of a Sputnik moment and spur people to eat healthier. Alas, I realize that’s unlikely, but I’m still struck by how little study has been given to the post-1975 increase.

. . . And around the world. Obesity is rising in just about every country in the world – with sharp increases in the two most populous, China and India. Globally, the prevalence of obesity nearly tripled from 1975-2016.

Obesity as social contagion. If your friends, siblings, or spouse are obese, your likelihood of becoming obese increases quite dramatically.

Washington is MIA. I was vaguely aware that the U.S. government was doing very little to promote health diets and to prevent obesity. But a report by a federal watchdog agency, the Government Accountability Office, showcased how even Washington’s meager efforts lack any coordination – and often conflict with each other.

Dining out is hazardous to your health. Restaurants – whether fast food or the most upscale sit-down establishments – default to menu offerings that are typically high in salt, sugar, or fat and served in very large portions (much larger than in the past). That matters, given that nearly 40 percent of total U.S. spending on food goes toward restaurants and other eating establishments.

Ultra-processed foods are an ultra-big problem. Americans get nearly 58 percent of their calories from ultra-processed foods (most of which would qualify as “junk foods”). These concoctions tend to be high in calories and low in nutritional value. Even worse, they’re deceiving us. “Much of what we now eat is engineered to mislead the brain,” writes Mark Schatzker in The End of Craving. “The information we sense as we eat has become unreliable. We react as any animal reacts to uncertainty – by cranking up motivation. We avoid losses and seek the certainty of calories. It is the most significant change in food since the dawn of agriculture.”

The healthy-invisibility paradox. Think about how many ads you see for food. Now think about how many of those ads are touting a simple fruit or vegetable. The gap speaks volumes about the food system, points out Michael Greger in his book, How Not to Diet. “The reason some of the unhealthiest foods are marketed is one of simple economics: Real food goes bad. Fruits and vegetables are perishable. . . . On top of that, real food doesn’t have brand names. Why would a broccoli grower put an ad on TV when you’d just as likely buy their competitor’s broccoli? The system is simply not set up to reward the sale of health-promoting food.”

Obesity is the neglected threat to humanity. Consider climate change and the breadth of advocacy devoted to it (government and non-government), as well as the corresponding media coverage. Now compare that to obesity. The plight of those who are extremely overweight is the forgotten stepchild amid all the causes championed by activists – despite being the world’s number one health risk, contributing to 10.9 million deaths globally in 2017, according to the Institute of Health Metrics and Evaluation.

What could be done to reduce obesity in the United States . . . The federal food stamp program – SNAP – serves 41 million low-income Americans. With this penetration, it could be a powerful vehicle for healthy diet habits. But the program has virtually no limits on what beneficiaries can buy, and studies show that SNAP sending goes toward foods and beverages that are major contributors to obesity. Restricting such purchases – and incentivizing the purchase of fruits and vegetables through benefit increases – could help sharply reduce obesity.

. . . And why it won’t happen. There are three monumental obstacles to reforming SNAP. One is the food and beverage companies, who realize $74 billion in sales through SNAP. Another obstacle is retailers, for whom these products also represent a major pool of revenue. The third obstacle is claims that such restrictions are patronizing and paternalistic -- claims often made by anti-hunger groups, which are funded by the food and beverage companies. (This fact, documented in Big Hunger by Andrew Fisher, may be the most shocking thing I’ve learned in the past two years.) These companies prosper as long as the stalemate is maintained, while the poor are saddled with high rates of disease and mortality.

Fear of being called out for fat shaming . . . or worse. This comes up often in my discussions with people who share my interest in issues around food and health. A professor at one of the world’s leading research institutions told me recently that the sensitivities around even discussing obesity has diminished the amount of research that gets devoted to the subject. And professors have told me that their students have declared discussions of obesity to be racist and thus off limits. Suffice to say, the fear of becoming the latest cancel culture victim is going to curtail debate and minimize the likelihood of realizing progress in obesity treatment and prevention.

Some traditional guardians of health are MIA. Physicians and health insurance companies should be on the frontlines of helping to prevent obesity. Neither of them are. Doctors have little formal knowledge of nutrition as the subject is given only cursory attention in the medical school curriculums. And health insurance companies invest little in obesity prevention since individuals typically switch insurers every four years.

Ineffective advocacy. Much of the United States is an obesogenic environment, which underscores the challenge of preventing obesity. But it’s also the case that advocacy efforts have been ineffective. In 2007, the Robert Wood Johnson Foundation announced that it was going to be spending $500 million to address childhood obesity in the United States. In 2015, the foundation announced it was going to be spending an additional $500 million. I’d love to see a rigorous, independent analysis of how the foundation spent its $1 billion, given that the U.S. childhood obesity rate has been rising since 2007.

Is there any good news to report? A new drug, Semaglutide, is showing promise in treating obesity, but not preventing it. Those getting the injection typically remain overweight (if not obese) – and it’s just another therapy that people would need to take indefinitely.

The macro outlook in the United States is otherwise gloomy. There’s no indication that the major drivers of obesity are changing. And while the effects of Covid on the obese should have been a wakeup call to the medical establishment, policymakers, philanthropists, and perhaps even food and beverage companies, the evidence so far is that they have slept right through it.

After four decades marked mostly by inertia, inaction, and ineffectiveness, should we expect anything different?