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By Matthew Rees

Food and Health Fact #178:

An interview with Marion Nestle

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The inaugural Food and Health Facts Q&A interview appears below, and it’s with Marion Nestle – an icon in the world of nutrition studies and food politics. Her pioneering research has focused on the scientific and socioeconomic influences on food choice, obesity, and food safety – and emphasizing the role of food industry influence. (And lest there be any confusion, Nestle – it rhymes with “wrestle” – has no relation to Nestlé, the multinational food and drink conglomerate.)

She is the author of 12 books, including the landmark Food Politics: How the Food Industry Influences Nutrition and Health. Her latest is Slow Cooked: An Unexpected Life in Food Politics, which is a fascinating account of her life, spanning from childhood to the present. (Descriptions of all her books can be found here.) Her blog, Food Politics, is also full of information that will be of interest to Food and Health Facts readers.

From 1988-2017, Nestle was a professor at New York University, where she remains professor emerita, and she is Visiting Professor of Nutritional Sciences at Cornell. (Previously, she held faculty positions at UC San Francisco and Brandeis.)

Looking Back 

You’ve been immersed in the world of food, nutrition, and food policy since you started teaching a course on nutrition science at Brandeis in 1975. How has your thinking evolved during this period?  

The main trajectory was nutrients, to food, to food systems. I started out focused on nutrients—what they were, what they did in the body, which foods had them, what happened when you didn’t get enough or too much. But people eat food, not nutrients. Then I thought we should really be talking about foods and dietary patterns.

Later, I caught on to the importance of agriculture in determining what people eat. Now I’m talking about food systems—the entire cycle of everything that happens to a food from the time it is produced, transported, sold, consumed, and wasted. You can’t really understand why people eat the way we do without looking at the whole picture.

You write that preparing for this first course on nutrition science “was like falling in love, and I’ve never looked back.” Can you explain what you loved then and what you still love today?  

Food is connected to everything. And everyone eats. Everyone has a vested interest in food, nutrition, and health, and gets why food matters. I can hardly think of a major problem in modern society that is not related to food: poverty, inequity, racial injustice, poor health, poor education, climate change, immigration, culture, religion, history, science, and politics. You can use food to illustrate how to analyze anything. 

Looking back on the past 47 years, are there topics that you regret not giving more attention?

I tend to focus on contemporary food politics and policy. There are some aspects I will never understand: milk marketing orders, for example, and certain aspects of food trade.

What do you see as having been the biggest contributions to the rise in obesity over the past 40 years? In sum, what’s changed?  

I tend to take a thermodynamic view: people are eating more calories than they did 40 years ago, a lot more (much evidence supports this statement). The question is why. I think the answer has a lot to do with the effects of food overproduction in conjunction with the shareholder value movement on food companies. Calories in the food supply increased from 3200 to 4000 a day from 1980 to 2000.

Those calories had to be sold. Starting in the early 1980s, food companies had to make higher immediate returns on investment their sole focus. To do that, they made food available everywhere (bookstores, libraries, clothing stores), increased portions sizes, and ratcheted up marketing. The result was today’s cheap calories-in-your-face food environment.

Looking back 30-40 years, did you -- or anyone – foresee that there would be such a sharp rise in the U.S. obesity rate? 

Obesity prevalence had been increasing gradually but the rise between 1980 and 2000 was unprecedented. I’m not aware that anyone could have predicted so much weight gain as a result of the shareholder value movement.

In thinking about food, nutrition, and food policy, what do you see as the most important steps forward, and backward, of the past 47 years? 

Healthy food is much more widely available now than it was back then, and we have more and better farmers markets, more organic food, and more people interested in food issues. The policies are stuck though. There still isn’t enough money in school food, food assistance programs, or food safety oversight. And we still do not link agriculture to health policy.

Instead, we support an industrial agricultural system that produces feed for animals and fuel for cars, and puts only tokens into supporting food for people.

What have you found most rewarding about your work over the past 47 years? 

Have I mentioned that I love it? I’ve never stopped being fascinated by how and why people eat the way they do. What’s most gratifying about teaching is watching students learn and go on to use that learning to forge their own careers.

Food and Beverage Companies – and Restaurants 

Are the major food and beverage companies doing anything meaningful to help promote healthier eating habits? And what would you like to see them do?  

Some are, but their main goal has to be to stay in business. If healthy items don’t sell, they can’t produce them. As I keep saying, food companies are not public health or social service agencies; they are businesses with stockholders to please.

What about restaurants? 

Same thing.

Government 

You spent two years in the federal government, 1986-88, at the Department of Health and Human Services, as a senior nutrition policy adviser. In thinking about your experience, and what you’ve learned since then, what do you see as the likelihood of the executive branch and the legislative branch coming together on policy measures that would trigger major changes in America’s food environment and improve human health? 

This is a matter of political will. It could be done in a heartbeat if anyone wanted to.

A report by the Government Accountability Office last year documented the federal government’s uncoordinated efforts related to promoting healthier dietary habits. But the related issue is whether there’s any real momentum behind making this a priority, particularly in Congress, given that Republicans tend to be opposed to taxation and regulation and Democrats fear being accused of targeting people who are overweight. Can you talk about the factors you see conspiring to produce a stalemate?  

We have a deeply polarized population with respect to science as well as politics. Until people are willing to give benefits to society as a whole at least the same priority as benefits to themselves, I think we are stuck.

You attended the recent White House conference on hunger, nutrition, and health. We’ll have to wait and see whether the conference leads to meaningful policies and initiatives, but what are your thoughts about what was emphasized and what was not?  

As I described in my report on that meeting, the conference focused on hunger (not enough food) and had little to say about diet-related chronic disease (too much of the wrong kinds of foods). Nobody wants to talk about calories and nobody wants to take on the food industry.

In thinking about how to reduce the obesity rate, do you see any public policy lessons from the reduction in smoking? Or from other issues that involve behavior change? 

We know that education alone is not enough to change behavior, and we know that voluntary attempts by food companies to do anything against their own economic interests are doomed to fail. We need policies to regulate food industry marketing (especially to children), portion sizes, sales of ultra-processed foods, and other such methods. We also need policies for keeping companies from funding research in their own interest, supporting (and thereby coopting) food and nutrition societies, and being involved in setting policy.

What do you think should be done to promote healthier eating?  

How about a national educational campaign focused on eating more vegetables, less meat, and much less of ultra-processed foods. We’ve never had such a campaign. Surely it’s worth a try.

Universities 

Tim Spector, a British epidemiologist and the author of several books about food, has written that “academic nutrition is seen as one of the least glamorous or important areas of science” and that most nutrition experts “remain isolated and feel unloved and undervalued by their universities and funding bodies, which are largely funded by the food industry.” Do you agree with this? If so, do you see it changing anytime soon?  

Nutrition researchers are attempting to counter that view by focusing on precision nutrition (science-based dietary prescriptions for individuals), and “food as medicine” (prescribing healthy diets to people with diet-related diseases). These are scientifically respectable and fundable through government sources. My own view is that nutrition research would get more respect if it were focused on public health or the good of society.

Have you, or other professors in your field, encountered resistance from students (or anyone else) to talking about obesity? If so, what do you see as the consequences? 

Students are rightfully calling out stigmatism, inequities, and discrimination in obesity research and practice and I applaud them for doing so. But the risk of disease and poor outcome increases with increasing body weight. We should be doing all we can to prevent obesity, especially among children.

Given that people who are obese and tested positive for Covid had much worse outcomes than those who were not overweight, why do you think obesity has not received more attention from policymakers and medical professionals?  

My own view is that taking on obesity means advising eating less of ultra-processed foods, taxing such foods, requiring them to be offered in smaller portions, and generally discouraging their sales. These are among the most profitable products in supermarkets. No politician wants to take on Big Food or Big Ag.

Looking ahead 

When you think about the next 5-10 years and the intersection of food and human health in the United States, are you more optimistic or pessimistic? What gives you reason for optimism? And for pessimism? 

It depends on the day of the week. I am in despair about the polarization of our society and the creation of blocs of voters who live in two entirely different realities. I am also in despair about food inequities so profound that millions of Americans don’t know where their next meal is coming from, let along whether it is good for them or not.

But when I talk to young people who want to use food to change food systems to make them healthier and more sustainable, I have hope that they will be able to do that.

Do you have a prediction as to what the U.S. obesity rate will be in 10 years? 

Unless we can reverse current trends, we have to expect gradual increases in prevalence to continue.

Miscellaneous 

Why do you think the U.S. obesity rate is higher than in virtually any other country in the world? 

Is that statistic true? I’m not sure. A guess: We have more ultra-processed food available and keep it cheap so it is affordable by everyone. We also are richer on the whole and spend more time on screens or in cars.

What do you see as the biggest myths or misunderstandings about food and nutrition?  

The big one is that healthy diets are impossibly complicated. Actually they are so simple that Michael Pollan can describe them in seven words: “Eat food [meaning not ultra-processed]. Not too much. Mostly plants.”

What are thoughts about the health profile of cultivated meats like the Impossible Burger and Beyond Meat? 

They meet the definition of ultra-processed: industrially produced, can’t be made in home kitchens. The jury is still out on whether they are good for health or society.

Beyond public policy, what do you see as having the most potential to improve Americans’ dietary habits?  

Everything I can think of is public policy. Food companies won’t improve their practices unless they have to.

What do you see as the areas in food, health, and public policy that merit the most study and the most advocacy?  

The three biggest public health nutrition problems facing the world today are hunger/food insecurity, obesity and its related chronic disease risks, and the environmental consequences of how we produce and consume food.

For the general interest reader who wants to know more about the culture of food, and how it intersects with health, do you have a favorite book or books other than your own?  

This is too hard to do without offending friends or colleagues by omission. I post about books nearly every Friday at foodpolitics.com and the site can be searched easily by typing in “Books.”