Susan Walsh/Associated Press
President Trump welcomed the college football national champion Clemson Tigers to the White House in January with a fast-food feast served buffet style in the State Dining Room.
Presidents do not directly write the nation's dietary guidelines for Americans, which are updated every five years by federal law. Still, you wonder what the 2020 version will advise, given how President Trump serves lunch dripping in saturated fat, grease, and salt to top athletes.
When Trump hosted Clemson University's national collegiate football title team in January, the government was in partial shutdown, so a meal could not be catered by White House staff. Trump feigned to the team that perhaps first lady Melania Trump and second lady Karen Pence could have made them “some little, quick salads.” Trump then joked, “I said you guys aren’t into salads.”
Instead, Trump ordered from the four food groups that were the staples on his 2016 election campaign: McDonald’s, Kentucky Fried Chicken (KFC), pizza, and Diet Coke. He boasted to the Clemson players that he ordered 1,000 hamburgers. “All-American companies,” he said. “Burger King, Wendy’s, and McDonald’s. We have Big Macs. We have Quarter Pounders with cheese. We have everything that I like, that you like. And I know no matter what we did, there’s nothing you can have that’s better than that, right?”
There was plenty of laughter from the football players, perhaps to be polite and perhaps because they actually eat much better than that on campus. The team receives far more nutrition education than the average American, from culinary coaches and an “executive performance chef.”
In a nation where two-thirds of adults and a third of children are overweight or obese, Trump's banquet really wasn't funny. According to the 2015 guidelines that are currently in force, poor diet and lack of exercise are likely related to preventable chronic disease in nearly 120 million American adults, including Type 2 diabetes, heart disease, high blood pressure, and cancer. The direct and indirect costs, in medical care and lost work time, not to mention sheer suffering, run hundreds of billions of dollars.
Ordinary Americans, especially the disadvantaged, live in a separate universe from Clemson's performance chefs. Most parents want to be good quarterbacks for their children, but too often they are sacked by an all-out marketing blitz of junk food, processed food, and sugary drink companies. With a fast-food president as dietitian-in-chief, those special interests surely see their best opportunity in recent memory to undermine the healthiest of science-based recommendations. If they have it their way, the symbol of the all-American diet will remain a Big Mac, Coke, and fries.
EVEN UNDER THE PUBLIC-MINDED Obama administration, the political food fight over the 2015 guidelines is instructive. With first lady Michelle Obama promoting healthy eating and exercise, many public-health experts hoped for the strongest guidelines science could support. There was significant progress on child nutrition with the bipartisan Healthy, Hunger-Free Kids Act of 2010. That act required school lunch nutrition to be consistent with the dietary guidelines issued by the Departments of Agriculture and Health and Human Services.
Most studies found that students took to the healthier offerings, increasing consumption of entrees, fruits, and vegetables and reducing food waste. The Obama-era USDA said that between 2008 and 2014, three million more students ate school breakfast.
The 2015 Dietary Guidelines Advisory Committee (DGAC) appointed by Health and Human Services Secretary Kathleen Sebelius and Agriculture Secretary Tom Vilsack also offered hope. The committee clearly said Americans “should be encouraged and guided to consume dietary patterns that are rich in vegetables, fruit, whole grains, seafood, legumes, and nuts; moderate in low- and non-fat dairy products and alcohol (among adults); lower in red and processed meat; and low in sugar-sweetened foods and beverages and refined grains.”
The DGAC broke new ground by specifically saying that added sugars should be no more than 10 percent of daily intake. For emphasis, the committee said, “Added sugars should be reduced in the diet and not replaced with low-calorie sweeteners, but rather with healthy options, such as water in place of sugar-sweetened beverages.”
Just as groundbreaking, the DGAC directly connected diet to environmental sustainability, noting that the global production of food accounts for 80 percent of deforestation, more than 70 percent of freshwater use, and up to 30 percent of human-generated greenhouse gas emissions. “Creative, evidence-based strategies are needed to reverse these alarming trends,” the committee said.
After reviewing studies around the world, the committee found that “a diet higher in plant-based foods, such as vegetables, fruits, whole grains, legumes, nuts, and seeds, and lower in calories and animal-based foods is more health promoting and is associated with less environmental impact than is the current U.S. diet.” But at the end of the day, the advisory committee is only that: advisory.
Once the DGAC report was submitted to USDA and HHS, lobbyists ate away at it like carpenter ants to downplay the relationships between meat and sustainability as well as soda and obesity.
Karen Perry Stillerman of the Union of Concerned Scientists (UCS), wrote that during the two-year process that produced the 2015 guidelines, food and beverage companies and trade associations spent more than $77 million lobbying Congress. Of that, the meat industry spent $4.5 million and the soda industry spent nearly $24 million.
SCORES OF CONGRESSIONAL REPUBLICANS wrote to Vilsack and HHS Secretary Sylvia Burwell to say the committee wrongly vilified red meat and ignored the alleged benefits of lean meat. They also said the committee had no business injecting sustainability into the guidelines. The signatories collectively received $3.1 million in contributions from agribusiness, from 2013 through 2014, according to the Center for Science in the Public Interest.
Republicans responded with an appropriations act that banned sustainability from the guidelines and limited the scope of funding to “nutritional and dietary information.” In a press release even before the act was passed, Vilsack and Burwell capitulated on environment and sustainability.
When the final guidelines were issued, there was nothing specific about cutting consumption of red meat and processed meat, which are linked to cancer, cardiovascular disease, and diabetes. In 2015, the World Health Organization classified processed meat as carcinogenic and red meat as “probably carcinogenic to humans.”
The final guidelines did keep the committee's recommendation for Americans to reduce added-sugar intake to 10 percent of daily calories. But there were no concrete, top-line examples or explanations in the executive summary.
Buried in the guidelines was this data point: Sugary beverages account for nearly half of added sugars, and added sugars account for 270 calories, or more than 13 percent, of calories per day. The too-few details on soda disappointed 2015 DGAC members such as Frank Hu of Harvard's School of Public Health. Studies overwhelmingly linked sugar-sweetened beverages to obesity, while Centers for Disease Control and Prevention mapping showed a clear correlation between soda consumption and obesity.
Hu also lamented that the deep-sixing of environmental sustainability was “a hugely missed opportunity to educate the public about the environmental impact of their food choices, and to create a food system that is more sustainable and conducive to the health of both humans and the planet.” Hu directly blamed “political pressure from Congress and the meat industry.” (Disclosure: My wife is a researcher at the school and has co-authored a paper with Hu.)
Sarah Reinhardt, UCS's lead analyst of food systems and health, estimated that if the USDA and HHS published guidelines on processed meat and added sugar alone, it would save 3,900 lives a year and $1.5 billion in medical costs from colorectal cancer, and 19,000 lives and $16 billion in health care costs from Type 2 diabetes. Helping people eat enough fruit and vegetables could have saved 110,000 more lives and $32 billion in health costs.
Other estimates detail the current toll of our politically manipulated malnourishment. A 2017 study by an economist at the federal Agency for Healthcare Research and Quality and researchers from Cornell and Lehigh Universities found that the nation’s share of health care costs spent on treating obese adults rose from 20.6 percent in 2005 to 28.2 percent in 2013. The total costs to treat adults for obesity-related illnesses rose from $212.4 billion in 2005 to $342.2 billion in 2013.
Amid the spiraling overall cost of health care, a 2018 Milken Institute report updated the direct chronic-disease costs of obesity and overweight to $480.7 billion in 2016. With further indirect costs of $1.24 trillion because of lost economic productivity, the total chronic-disease cost of $1.72 trillion equals 9.3 percent of the U.S. gross domestic product. The report said combating those trends requires “a societal consensus in favor of healthful eating and exercise.”
A 2017 study by Tufts University, the University of Cambridge, and Montefiore Medical Center in New York City estimated that poor diet was associated with nearly 320,000 deaths from heart disease, stroke, or Type 2 diabetes in 2012. The highest proportions of those deaths were related to “excess sodium intake, insufficient intake of nuts/seeds, high intake of processed meats, and low intake of seafood omega-3 fats.”
Put another way, the number of American lives lost in just one year involving poor diets exceeds the 291,000 American combat deaths in World War II. A Lancet-commissioned study published earlier this year said, “Unhealthy diets pose a greater risk to morbidity and mortality than does unsafe sex, and alcohol, drug, and tobacco use combined.”
The Republican Party is literally supported by red meat. The meat-processing industry has given 79 percent of its nearly $17 million in contributions since 1990 to Republican congressional candidates, according to the Center for Responsive Politics.
In the 2018 election cycle, the top eight contributors to congressional candidates from the food and beverage industry included the National Restaurant Association, Coca-Cola, McDonald’s, Wendy’s, the National Confectioners Association (the candy lobby), and Bloomin’ Brands, the parent company of Outback Steakhouse and several other restaurants. Nearly 72 percent of the $5 million they gave went to Republican campaigns.
Republicans receive 100 percent of contributions from the parent companies of Pizza Hut, Wendy's, and Taco Bell; 97 percent from Waffle House; 93 percent from the Burger King franchisee association; 92 percent from the KFC franchisee association; and 66 percent from the American Beverage Association.
We will soon see if this lopsided support bears fruit (even if fresh fruit is appallingly scarce at most of the above entities) under Agriculture Secretary Sonny Perdue, who is trying to roll back nutritional requirements for school meals. In a bizarre crusade against whole-grain and lower-sodium foods, he has claimed, “Kids aren’t eating the food, and it’s ending up in the trash.” But his own USDA researchers produced a report this year that in effect debunked his tirades. The report found the opposite: The more nutritious the meal, the more popular those meals were with students.
THE PROCESS OF ISSUING the 2020 Dietary Guidelines starts with the 20-member 2020 Dietary Guidelines Advisory Committee (DGAC) picked by Perdue and HHS Secretary Alex Azar. The committee was announced in February. The administration kept the full list of nominees and nominators secret until June when Politico was given a copy obtained under the Freedom of Information Act by the Physicians Committee for Responsible Medicine, which advocates for plant-based diets.
On paper, the committee looks balanced, with nine of the 20 members having been nominated by the American Society for Nutrition: Barbara Schneeman, a former U.S. Food and Drug Administration director of nutrition and labeling; Jamy Ard of Wake Forest University; Regan Bailey and Richard Mattes of Purdue University; Heather Leidy of the University of Texas; Carol Boushey of the University of Hawaii; Teresa Davis of Baylor College of Medicine; Kathryn Dewey of the University of California, Davis; and Sharon Donovan of the University of Illinois.
The mission of the nutrition society is to “improve health around the world through high quality science based nutrition knowledge, engagement and influence.” But financial influence within the organization has been highly controversial in recent years, with 32 corporations listed as “sustaining partners,” contributing at least $10,000 to the group. The sponsors include Pepsi, Kellogg, General Mills, Mars, Nestle, Mondelez, Monsanto, Cargill, DuPont, Pfizer, the National Cattlemen’s Beef Association, the Sugar Association, and the National Dairy Council.
Tied for second place in getting nominees onto the panel were the Grocery Manufacturers Association, consumer goods and food giant Unilever, the International Life Sciences Institute (ILSI), and the International Food Information Council (IFIC) Foundation. Each claimed three spots (most nominees had multiple nominations). The American Beverage Association, the Academy of Nutrition and Dietetics, and SNAC International (the global trade association for the snack food industry) each placed two nominees on the committee.
In all, 15 of the 20 advisory committee members have direct industry ties or nominations from industry-supported groups or glowing public praise from industry-backed groups. It is normal to have this level of industry presence on the nation's most important food panel, whether the administration is Democratic or Republican, since it has become increasingly harder to be a food scientist without industry funding.
According to 2019 USDA data, after the early 2000s, public funding for agricultural research and development was put on a starvation diet. Meanwhile, private funding mushroomed to about $12 billon in 2014. The private-to-public funding disparity had former U.S. Secretary of Agriculture Dan Glickman and former Food and Drug Administration Commissioner David Kessler calling for a new federal nutrition institute in a February New York Times op-ed.
Noting that obesity has become the top disqualifier for military service, they pointed out that a nation that spends $40 billion a year on candy and hundreds of billions of dollars on health care related to obesity must spend more than the $1.5 billion currently spent on studying nutrition. “Establishing a place to research nutrition is also crucial to retain American competitiveness,” they wrote.
Despite Perdue's pledge “to have professionals on either end of the spectrum, both from the plant-based and the meat-based side of the equation—making recommendations,” academics and public-health groups without industry connections are in the minority. Purdue and Azar send an ominous message when SNAC can snag two spots on the committee, while the American Public Health Association is shut out.
While the interests of SNAC, the Grocery Manufacturers, Unilever, or the American Beverage Association are fairly predictable—to protect the profits of many of their unhealthy or marginally healthy products—the best understanding of industry's web around scientists comes through the innocuously named International Life Sciences Institute and the International Food Information Council Foundation.
ILSI claims a quarter of the new DGAC. It nominated the chair of the committee, Barbara Schneeman, the former FDA official, and the vice chair, Ronald E. Kleinman, the physician-in-chief at Massachusetts General Hospital for Children. Kleinman is also on the board of trustees of ILSI's Research Foundation, while Schneeman is a government liaison. ILSI also nominated Davis, and Donovan and Bailey are ILSI North America scientific advisers.
ILSI North America says it “advances food safety and nutrition science for the benefit of public health.” But that claim is gutted by the fact that it was created in 1978 by a Coca-Cola executive “to unite the food industry” in what proved to be manipulation of science and government health recommendations for its now more than three dozen corporate members. Most of the above-named sustaining partners of the American Society for Nutrition are also members of ILSI—plus Hershey, Archer Daniels Midland, Campbell Soup, Kraft Heinz, Red Bull, Keurig Dr Pepper, Ocean Spray, and Welch’s.
Another example of the industry's manipulation of research is an ILSI-funded study that made its way into the Annals of Internal Medicine in 2017. It said sugar intake guidelines are based on “low-quality evidence” and are thus “untrustworthy.” And an investigation this year for the British Medical Journal and the Journal of Public Health Policy by Susan Greenhalgh of Harvard found that ILSI helped redirect China’s chronic-disease science from a paradigm that focused on diet to Coke’s narrative—debunked by most public-health experts—that blames lack of exercise instead of sugary drinks for obesity. Overweight and obesity in China doubled from 20.5 percent of adults in 1991 to 42.3 percent in 2011.
Meanwhile, the journal Globalization and Health has just published a report on ILSI’s resistance to any public-health measures to reduce sugar consumption and efforts to downplay the dangers of glyphosate-based pesticides such as Monsanto’s Roundup. Cancer-stricken plaintiffs who used Roundup have begun winning multimillion-dollar judgments in the United States.
The report concluded that “ILSI should be regarded as a lobby group and that academics and researchers, policy makers, the media, and the public should view ILSI's research as promoting the interests of the food, beverage, supplement and agrichemical industries, while its actions promote its members' interests and counter healthy public policies.”
Potential industry influence will also permeate a new area in the 2020 guidelines—recommendations for pregnant woman and children from birth to 24 months. One major recommendation in these new guidelines should mirror the guidance by the American Academy of Pediatrics and the World Health Organization, namely that babies ideally should be breastfed their first six months for maximum nutrition.
But the Trump administration shocked the pediatric world last year by at first refusing to sign what should have been a perfunctory United Nations resolution encouraging breastfeeding and urging countries to end “inappropriate promotion of foods for infants and young children.” The U.S. signed on after the language to end inappropriate marketing was removed.
This move raises the legitimate concern that either the Dietary Guidelines Advisory Committee or the administration will shape the final guidelines to somehow extol the virtues of corporate infant formulas. DGAC member Sharon Donovan has been a consultant to infant formula makers Mead Johnson, Abbott Nutrition, and Pfizer. She has conducted Mead Johnson–funded research and edited informational materials for that company.
Also on the committee is Steven Heymsfield of Louisiana State University, who has served on the scientific advisory board of weight-loss product Medifast. It is interesting that USDA and HHS essentially gave two spots to food-replacement specialists when a 2015 study by Johns Hopkins University researchers found that very few commercial weight-loss programs, with the exception of Weight Watchers and Jenny Craig, demonstrate long-term benefits. The study found that any short-term benefits of Optifast and Medifast attenuated after six months.
And in another twist, Heymsfield is also the 2018–2019 president of the Obesity Society. That society boasts five members on the DGAC: Heymsfield, Ard, Mattes, Elizabeth Mayer-Davis of the University of North Carolina, and Elsie Taveras of Massachusetts General Hospital.
The Obesity Society is already under fire from critics for accepting corporate funding from Coca-Cola and PepsiCo, and having once staged “engagement councils” with members representing PepsiCo, Monsanto, Nestle, Dr Pepper, Atkins, Mars, and Campbell’s Soup. Last year, Pepsi underwrote a special issue of the society’s research journal titled “Low-Calorie Sweeteners and Weight Management.” The society vigorously denies that industry support is connected to its casting doubt on the efficacy of taxing sugar-sweetened beverages. Taxation has clearly cut tobacco consumption, and a federally funded study last year said soda taxes looked “promising in combating obesity.” The effectiveness would likely depend on the level of taxation.
And that brings us back to meat, that source of intense debate in 2015. The 2020 panel has several members with meat-industry connections. DGAC members Davis and Leidy have advised or spoken at “Protein Summits” meant “to explore the misperception that Americans over-consume protein.” The summits have been sponsored by the National Pork Board, the Beef Checkoff, the Egg Nutrition Center, Hillshire Brands, the Dairy Research Institute, and the Global Dairy Platform.
Another DGAC member, Lydia Bazzano of Tulane, was nominated by Atkins Nutritionals, known for its low-carbohydrate, meat-focused diet.
In another study funded by the National Pork Board, Leidy found long-term health benefits of pork-based breakfasts in adolescents. The comparison group was low-hanging fruit for improvement—adolescents who skip breakfast. Unabashedly, the Pork Board—which is hardly rushing to compare pork with fruit-based breakfasts—proclaimed “high-quality lean pork” to be a “key component of daily healthy eating.”
Trumping up the health benefits of “the other white meat” is a Trojan horse for the pork industry to pig out on sales of bacon. While the average American family buys fresh pork, such as tenderloin, shoulder roast, or ribs, just six times a year, the number of Americans who consume at least three pounds of bacon a year rose by nearly 50 percent from 2011 to 2018, from 44 million to 63 million. The Wall Street Journal noted in 2017: “With the rise of low-carb high-protein diets, fatty bacon made a comeback.”
If the Trump administration lays a heavy hand on either the committee or the final recommendations, there seems little chance for proponents of healthy diets to stage a comeback. UCS has reported on how Perdue has stacked the USDA with executives and lobbyists from the world of pesticides, corn syrup, and junk food and sided with Big Pork over small farmers and Big Dairy and others over children in the relaxing of rules on school lunches.
Perdue's creation of an industry echo chamber has been so discouraging that employees at the top research arms of the USDA, the Economic Research Service, and the National Institute of Food and Agriculture have quit in massive numbers. Under the Obama administration, the two agencies together employed 700 people. That number is reportedly down to 450 amid attempts by Trump to slash ERS funding by half and Perdue’s plan to move the ERS and NIFA out of Washington and to USDA’s Kansas City region. That is on top of a move in 2017 to eliminate the USDA’s Center for Nutrition Policy and Promotion as a stand-alone scientific division and merge it with the Food and Nutrition Service. Critics say the move renders CNPP more vulnerable to industry-influenced politics.
Perdue's claim that he is making the move to save money and move scientists closer to agribusiness “stakeholders” has been assailed by critics who see this move as divorcing USDA scientists and economists from collaboration with those from other cabinet agencies. In a Washington Post op-ed in June, two former chief scientists at the USDA, one under Obama (Catherine Woteki) and the other under George W. Bush (Gale Buchanan), wrote:
Food and agriculture in the United States face perennial challenges from a multitude of sources: pests, diseases, droughts, flooding, brutally competitive markets and trade disputes. It is disheartening to think that the science underpinning these vital contributors to the U.S. economy, and to the health and well-being of every American, is under threat from the very government department overseeing them.
When chief scientists, particularly one who served under Bush, are this concerned about a deck stacked against their colleagues, one can only hope that the scientists that Perdue and Azar have picked for the 2020 Dietary Guidelines Advisory Committee can be objective. The 2015 committee, with major backing behind the scenes by many career researchers in USDA and HHS who were on teams for data analysis and nutrition evidence, certainly displayed such independence. Regardless of their industry connections, that committee knew that the health and well-being of every American was at stake.
In a nation that loses more people every year to unhealthy diets than the total of American combat deaths during World War II, the 2015 committee delivered findings that industry did not want to hear. A diligent 2020 committee will almost assuredly deliver findings that this particular administration probably does not want to hear. While serving junk food to Clemson's football team might have been a joke, destroying the nation's health is not.
Derrick Jackson is a Prospect board member.
