September 10, 2024 – Throughout the fall, Harvard Chan faculty will share evidence-based recommendations on urgent public health issues facing the next U.S. administration. Jerold Mande, adjunct professor of nutrition, offered his thoughts on policies around ultra-processed foods, which now make up about 70% of the items in grocery stores, from hot dogs to breakfast cereals to snacks to packaged bread. Consumption of ultra-processed foods has been linked to a number of physical and mental health issues and early death.
Q: Why are ultra-processed foods a pressing public health issue?
A: What we are eating is making us sick, and ultra-processed foods seem to be a large driver.
Today, Americans are living shorter lifespans than people in peer countries, and shockingly so. Why is this happening? Deaths of despair—caused by opioids, alcohol, gun violence, mental health—are certainly taking a toll, and we need to address them. But the primary culprit is overwhelmingly chronic diseases caused by our food.
Our kids are really sick too. They have obesity and diabetes, and they even have fatty liver disease, which would have been unthinkable in children a few decades ago.
Q: What challenges does the next administration face around ultra-processed foods?
A: One problem is that there is not a single government authority tasked with making sure that our food doesn’t make us sick. There are different agencies working on different parts of the problem, but they’re not doing it in a coordinated or effective fashion.
In addition, we don’t invest in nutrition science. The National Institutes of Health [NIH] spends less than 5% of its budget on nutrition research, compared to billions and billions on heart disease, cancer, and diabetes, which are largely caused by our diet.
This is not an accident. It’s the result of a concerted lobbying effort by industries, particularly the food industry and our sick care industry. That puts any administration in a difficult position, because they are trying to solve a problem with incomplete science.
Q: What are your top policy recommendations to address ultra-processed foods?
A: Invest in research
First, we need to invest in nutrition research, starting with building a 50-bed facility where scientists from the NIH and USDA [United States Department of Agriculture] can comfortably house and feed study volunteers to rigorously measure how carefully controlled diets affect people’s health.
Think about COVID-19. We developed a vaccine in less than a year because we put in place incredible resources to tackle that problem. You would think that shorter lifespans and sick kids would make us want to get to the bottom of the ultra-processed food problem, too.
Prioritize children’s health
From day one, the next administration should prioritize making Americans’ lifespans the longest in the world. I believe we should start by focusing on children and work towards ensuring that every child in America has a healthy weight and is in good metabolic health when they turn 18.
Strengthen nutritional standards
We already have in place the WIC program [Special Supplemental Nutrition Program for Women, Infants, and Children], which provides food for low-income women and almost half the infants in the U.S., and which has great nutritional standards. WIC could be strengthened if more eligible children participated. Today, while more than 80% of eligible infants participate, that number steadily drops to just 24% by age four. We could increase those rates by enabling more WIC participants to purchase their food and complete their health visits online. The Food and Drug Administration [FDA] must also update its definition of whole grains—which WIC relies on—and prohibit claims of “whole grain” on products that do contain some whole grains but that are ultra-processed, calorically dense, and hyper-palatable. And USDA should not allow those products to qualify as whole grains for programs including WIC, CACFP [Child and Adult Care Food Program], and school meals.
The CACFP needs stronger nutrition standards to improve the quality of meals served in childcare centers and after school programs and adult day care centers.
Then we should focus on school meals, which for many children are the healthiest meals of the day, thanks in part to stronger standards introduced by Michelle Obama, although some of that progress has since been reversed. Some states have made school meals universal; if more did that, it would make a big difference.
Regulate promotion of ultra-processed foods
The biggest lever we need to use is USDA’s $120 billion Supplemental Nutrition Assistance Program [SNAP], which gives low-income families money to spend on groceries.
We could leverage it to increase healthy eating not just among SNAP participants but for all Americans, in the same way we leverage Medicare to improve our overall healthcare system. For example, grocery stores that participate in SNAP shouldn’t be allowed to promote unhealthy foods like sodas with prominent displays. If anyone doubts the marketplace power of SNAP, Walmart changed its business model to access SNAP funds. For years, it didn’t sell food, but in the 1980s, it recognized that its customers were coming in and out of its stores with billions of dollars in their pocket, their SNAP benefits, but couldn’t use them at Walmart. So, it started selling food and today it’s the nation’s largest grocer and recipient of SNAP funds.
Set strong dietary guidelines
The new administration will put out the next dietary guidelines. It’s important that they set a policy around ultra-processed food. If they remain silent, it’ll be another decade or two before our kids can benefit from needed policy changes.
The next secretaries of health and agriculture could say, ‘We don’t know why but ultra-processed food is making us sick.’ That’s all they need to take the next step and set some guardrails in the new guidelines.
Q: What’s the evidence supporting those recommendations?
A: In 1990, the Centers for Disease Control published the first complete map of obesity rates in the country. Not a single state had an obesity rate as high as 15%. Today, almost every state is over 30%, with about half over 35%. Almost half of Americans have diabetes or prediabetes.
What happened in only 34 years? Our genes didn’t change.
One important piece of evidence comes from an NIH study. In 2018, scientists asked a group of adults to stay at the NIH Clinical Center for four weeks. Participants were randomly assigned to either an ultra-processed diet or an unprocessed diet for two weeks, followed by the alternate diet for two weeks. The meals had the same calories and macronutrients, including sugars, fats, sodium, carbohydrates etc., and participants could eat as little or as much as they wanted.
The researchers found that when the participants were on the ultra-processed diet, they ate on average an extra 500 calories a day, which is almost an additional meal a day, and gained an average of two pounds.
We still don’t know what it is about ultra-processed foods that causes health issues. We have indications that it might be caloric density and the hyper-palatability.
These are foods that are being designed to make people addicted, much like the tobacco industry was doing with cigarettes. And certainly, the fact that many ultra-processed foods are also high in fat, sugar, or salt [HFSS] is particularly concerning.
We need more research, but I think the reason why ultra-processed foods are harmful is in the intersection between HFSS foods and ultra-processing. Those are the foods that caused the obesity endemic, our shorter lifespans, and our kids being so sick. Those are the foods the government needs to regulate.
Q: What do you hope could be accomplished to address the ultra-processed food problem in the next four years?
A: The FDA and USDA don’t need additional statutory authority to start regulating.
The law is very clear: It prohibits substances that may render a food injurious to health. These agencies have interpreted that to go after contaminants that cause acute illness, like food poisoning. They do that well. But they’re not looking at chronic illnesses caused by food, which are the number one preventable cause of death in our country.
We successfully dealt with tobacco as a public health problem and now we need to deal with the food our children are eating. That’s what administrations are for. They are supposed to solve big problems and have the resources to do so. And hopefully whoever gets elected will do just that.
Photo: iStock/beats3
This panel discussion hosted by the Harvard Chan Studio looks at the dangers of ultra-processed foods and offers tips for healthy eating.