E214: USDA Food and Nutrition Service Director Caree Cotwright - Championing MyPlate

13 sep 2023 · The Leading Voices in Food

00:16:37

Our guest today is Dr. Caree Cotwright, director of Nutrition Security and Health Equity at the Food and Nutrition Service at the US Department of Agriculture. Dr. Cotwright is leading a USDA-wide approach to advancing food and nutrition security in the United States. Part of her responsibility includes the charge from Secretary of Agriculture Tom Vilsack to make MyPlate a household name. MyPlate is the official visual reminder of the US government to make healthy food choices from each of the five food groups. Now, this turns out to be a tall but important order. About a quarter of US adults have heard of MyPlate, according to a recent survey.

Interview Summary

You came to USDA while on leave from the University of Georgia (UGA) where, by the way, you were the first Black woman in the Department of Nutritional Sciences to earn tenure. Congratulations for this, and please know how much I appreciate the important role that you've played in our field. So, let's start with discussing what drew you to food policy and what makes you excited about your role in public service at USDA?

I am really excited about this role because it's just a privilege. When I think about the fact that USDA has the title or has a position for the director of Nutrition Security and Health Equity, I get excited about that. It's been a privilege to work on advancing all of the things that have come about because of the White House Conference. I came to nutrition policy really in a kind of a roundabout way. I was working on my master's at UGA and I was doing an internship at the Center for Science and the Public Interest (CSPI). At that time, I was wanting to write on the Nutrition Action Health letter, but they had someone who was mentoring in nutrition policy and that someone was Margo Wootan. She kind of took me under her wing and helped me to learn about what nutrition policy was.

After completing my master's and my PhD, I did my postdoc, and then did a RISE fellowship at the CDC. I was working on disseminating policy around early care and education obesity prevention policies and just really to understand the keen role that policy plays in the advancement of nutrition and policies in general. That was really eye-opening for me. I knew that during my role at University of Georgia as a faculty member that I would focus on both policy and intervention. I've had such a wonderful experience of being able to use different creative approaches, but also using policy. Some of those approaches have earned me the opportunity to talk to a variety of communities in different ways, including having a TED Talk. It's just been a joy to do this work.

You've had so many interesting experiences and I could see how you'd be passionate about food policy after spending time at CSPI, especially with Margo Wootan. There aren't many people that know food policy like she does. But one thing I wanted to ask you about is one of the highly novel part of your work and your approach to nutrition has been to incorporate the creative arts, including storytelling. Tell us about this if you would.

Storytelling has always been near and dear to my heart. When people ask me about that question, I've been doing it since I was about five years old when I was asked to come and give the commencement speech for my nursery school. I wasn't afraid, it was fun for me, and I just said, "Wow, this is really something that I can do." I enjoyed connecting and engaging with others. As I think about my work, I know that telling stories and using creative approaches to meet people where they are helps us to promote a variety of topics. Of course, it's kind of entertainment education, but using these approaches is a catalyst to get people interested in what we're doing. We know we're competing with so many things that pull people's attention now.

Some of the things that I've done are I have a play about nutrition for young children, I have a hip hop song. I tell stories even in my speeches because I know that when I can connect, people will remember that story. And that's so important. Through my work, I promoted the Child and Adult Care Food program. I worked on the SNAP-Ed program at University of Georgia. We've done creative things like having skits and have enough care to call Healthy Bear that the children relate to. Even in some of our work that I've been blessed to have and had the privilege to work with Robert Wood Johnson Healthy Research to have social media and to use all of these approaches, but to use it to promote health and use it to promote healthy messages and messages specifically about nutrition. That creativity and those approaches are things that I bring to my current position in thinking about how do we engage the public, especially as we continue forward with advancing nutrition security and health equity, as well as making MyPlate a household brand?

I love that creativity. I think back on memorable speeches I've heard or talks I've listened to and things, very often, it's the stories that you remember. The fact that you're recognizing that, appreciating that, and perfecting it, I think is really impressive. I'm glad to learn a little bit more about that. Let's talk now about your federal service at the CDC. This was another experience that I know helped shape your interest and your passions and your desire to return to public service at USDA.

That's a wonderful question. It was such a wonderful opportunity to come to CDC at a time we were on the cusp of really thinking about how do we develop and disseminate policy related to obesity prevention for our youngest children, age zero to five. I had just finished a postdoc in community-based participatory research at Morgan State University working with Head Start children. At the time when I got to CDC, we had former First Lady Michelle Obama working on Let's Move! One of the key initiatives was Let's Move! Child Care. We modeled the initiative and the work we were doing related to policy on the work of an outstanding researcher. Her name is Dr. Dianne Ward. Not only was she an outstanding researcher, she became a mentor, colleague, and friend of mine. I just have so much admiration for the work that Dianne Ward did and the trailblazing efforts that she did to advance policy in the early care and education setting related to obesity prevention, but also in equity.

So we were working on these things and my task was to go around to stakeholders all across the country and make sure that they understood what we were saying. So again, bringing in that community engagement and the training that I had, I said, "We can't just put this on a website and say, 'Hey everybody, you should go out and do this.' We have to go in and teach people and train people and explain it." Fortunately, my mentor there, Dr. Reynolds and Heidi Blanck, they agreed. I was able to go out and help to disseminate the policy, and again, it gave me such a strong and firm understanding of how to really relate.

I'll tell you just a quick story. At the time, I didn't have kids, Kelly, and we were talking about these obesity prevention policies and we said, "Okay, no screen time for children under two," and those things. It wasn't until I had kids and I thought, "Well, how do you do that?" Because it has to be realistic and you have to think about how these policies work on the ground. As I talk to childcare providers, as I talk to stakeholders, as I talk to people working at the state level across the country, we help gain an understanding for just how these policies will go into place and gain support for policy implementation because we can't do the work without the people who are working on the ground level.

Two things I want to make note of that you just said. First is if it's easy to to talk about how children should be fed and learn about food until you have them, and then all of a sudden, it gets a lot more complicated, I know. But the other thing I'm grateful that you did was to pay tribute to Dianne Ward. Many of our listeners may know she was a professor at the University of North Carolina at Chapel Hill and recently passed away. There are people all over the country in the world who were just broken hearted by this because she was such a dear friend and colleague to many of us, and just a completely inspired researcher who wanted to make a difference in the world and really did. It's not surprising that she touched you and your professional career in such positive ways and that's true of a lot of us. I'm really happy that we were able to talk about her for a moment. So thank you.

Thank you. Thank you for allowing me the opportunity.

Let's talk more about your current position at USDA now. Can you tell us what your primary responsibilities are and what your vision is for your work ahead?

Yes. My primary responsibilities are to advance the work of food and nutrition security and health equity. I know that's a part of my title, but we really are working to make sure that people are able to get access to the food they need. Our definition is that nutrition security means that everyone has equitable access and consistent access to healthy, safe, and affordable food that is optimal for their wellbeing. We do this at USDA through four pillars. We think about having meaningful support for nutrition and nutrition education, making sure that people have access to that healthy, safe, and affordable food, making sure that we work through collaborative action through partnerships, and then making sure that we prioritize equity every step of the way.

When you think about USDA and the programs that FNS has and the programs that we are working on in our mission area, we have lots of opportunities to advance nutrition security because our work is just so closely related. I work very closely with our programs and I work a lot with our stakeholders, both internally and externally, to make sure that people are aware of the work that we're doing. But not only that, that we are leveraging things like the historic White House Conference, making sure that we have lots of commitments from people all over. We've had over $8 billion of commitments. But making sure that with our stakeholders and our partners, that we lean into new creative approaches that will help us to reach our goals. We have some really big goals to end hunger, to improve nutrition, physical activity, and to reduce diet-related diseases and disparities. We are holding ourselves accountable and making sure that we're getting the word out and making sure that we're partnering in very meaningful ways.

A part of my larger vision is a part of the secretary's vision, which is to make MyPlate a household brand. We think about what does that mean? We want to make sure, you said early on that about 25% of Americans are aware of this tool, but we want to make sure that not only are they aware, but they use the wonderful resources that are attached to MyPlate because it is our federal symbol for healthy eating.

It's heartening to hear about your vision and to understand the kind of progress that's being made to advance food and nutrition security, and also to specifically leverage some of the commitments that were made at the White House Conference. In addition to what the federal government can do, are there things that individuals can do like our listeners, for example, or the ways they can help?

Yes, and I'm so glad you brought up your listeners because that's so important. So every voice matters. And so all of our actions add up collectively. I've heard up from some wonderful, wonderful people in West Virginia and Oklahoma, just all across the country. When I go out and speak and I tell people, "You have to help me with this mission of making MyPlate of household brand." They sent me back things that they're doing. Creative things like setting up kids farmers' markets, popup markets in places like hardware stores that don't traditionally do that. But they will set it up and let a farmer come in and set up a popup shop, and then they provide the tokens through some of our wonderful programs like SNAP-Ed and FNA. When we think about these creative solutions where there are already existing things, but we're solving a problem, we're solving that access problem. Just thinking about that and making sure that we are all collectively working together, we want to hear from you. We want to hear from you. I always give out my email. It's [email protected]. We want to hear from your ideas. We also have our pillar pages on our website. If you just look at nutrition security at USDA, we have our pillar pages so you can learn more. But we also have a very short video where we're talking about the work that we're doing and highlighting that work, and a blog that is attached to that. So again, if you're wanting to promote efforts that we're doing, that's a very quick synopsis and a short way to get it out there to people to spread the word and increase awareness about all of the wonderful things that we're doing to advance food and nutrition security.

I never thought of my hardware store as a place to learn about nutrition, but why the heck not? Let's talk about MyPlate a little bit more. What's your role and how are you going to go about trying to make MyPlate a household name?

It's a very multi-pronged approach. My role is to bring those creative approaches. One of the things I love about this position is that it's a culmination of so many of the things that I've already been doing. Using my creativity, thinking about the equity focus, and working with our Center for Nutrition Policy and Promotion. They're a wonderful team. They've already been doing wonderful things on MyPlate but helping to amplify that work and helping to get it out there so we make it a household brand. We have a multi-pronged approach where we'll be using social media. I told you I was able to use that in my research. Not only that but doing things where we're celebrating the great work that people are doing around MyPlate. Like for example, I know in Oklahoma, they had a wonderful day at the capitol and the lieutenant governor was working with students to put food in the right MyPlate categories and making sure that people are aware of them. There are artists making songs about MyPlate. And so, making sure that we are making the public aware of what we're doing. With this multi-pronged approach, we'll be doing listening sessions. We're hearing from people about what can we do better? What do you really like? Are here things that we can change? Really hearing from the community on that level. Then, also thinking about industry and how can industry partner to promote MyPlate and promote those food categories so that people have an understanding of MyPlate and the branding of the icon. Making sure that people recognize MyPlate and the icon and are knowledgeable about the resources that we have. I'm really excited about doing partnerships because this is a one USDA approach. We're going across all levels to make sure that we get the word out about MyPlate. And we do have a MyPlate national strategic partnership with partner organizations all over the country that are already helping us to do this work. We want to attract new partners, to have new partners to come in, and lean in to help us to amplify MyPlate and all the wonderful resources for the public.

I'm assuming it's pretty easy to find out about MyPlate online, is that right?

It is. It's myplate.gov. It is very simple. All of our materials are branded with that, but it's very simple. You can remember MyPlate, you can remember our website. So it's myplate.gov. You can go directly there and find all of our wonderful resources, and we'll be having more, as I said, on social media. I don't want to forget this point too as well, Kelly. There are cultural adaptations. When I'm out in the field, people ask me about, what about for my culture? What about for the things that I eat? How is MyPlate relevant to that? What I love about MyPlate is that it's so adaptable. During our listening sessions and the work that CNPP is doing, we are working to address that as well. Again, meeting people where they are, having them understand that your cultural foods are healthy foods too, and how do we use MyPlate to guide our healthy choices when we're making our meal choices. Again, you look at the plate, half the plate is fruits and vegetables and that can be from a variety of sources and a variety of cultures and preparations and lots of different foods. And so we want to make sure that people are understanding that and that we get the word out there.

Bio

Dr. Caree Jackson Cotwright serves as the Director of Nutrition Security and Heath Equity for the Food and Nutrition Service at the United States Department of Agriculture (USDA). In this role, Dr. Cotwright leads a whole-of-Department approach to advancing food and nutrition security. She also serves as one of two Departmental representatives on accelerating action on the White House Conference on Hunger, Nutrition, and Health goals to end hunger, improve nutrition and physical activity, and reduce diet-related diseases and disparities and implementing the corresponding National Strategy. Her work includes building public awareness of USDA’s actions to advance food and nutrition security, as well as collaborating and building partnerships with key stakeholders to maximize our reach and impact. Dr. Cotwright is on leave as an Associate Professor of Nutritional Sciences in the University of Georgia’s College of Family and Consumer Sciences’ Department of Nutritional Sciences. Her research centers on promoting healthy eating among infants through age five-years-old with a particular focus on accelerating health equity among historically underserved populations via community-based participatory research and focusing on developing, implementing, evaluating, and sustaining best practices and policies in the early child education setting. She has developed a variety of innovative interventions, which use theater, media, and other arts-based approaches. She is the author of numerous peer-reviewed publications and secured over $1M in grants focused on obesity prevention and health equity from Healthy Eating Research, a national program of the Robert Wood Johnson Foundation, and the USDA. From 2010-2013, she worked as an ORISE Research Fellow at the Centers for Disease Control and Prevention Division of Nutrition, Physical Activity, and Obesity, where she was highly engaged in the early care education elements of the First Lady Michelle Obama’s Let’s Move! initiative dedicated to helping kids and families lead healthier lives. Dr. Cotwright holds a PhD in Foods and Nutrition and Community Nutrition and MS in Foods and Nutrition both from the University of Georgia and a bachelor’s degree in Biology from Howard University and is a Registered Dietitian Nutritionist. She lives in Athens, GA with her loving husband and adorable three daughters.

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E270: Do food labels influence kids' snack shopping choices?
16 apr· The Leading Voices in Food
As any parent knows, it is really important to help our children to make healthy food choices. I know as a father who cooks for my child, it is really critical that I introduce her to fruits and vegetables and encourage whole grains and try to manage the amount of additional sugars, but it's hard. We do this with the goal of trying to make sure that our child is able to eat healthy once she leaves the home. That she's able to make healthy choices there. But it's not just about the future. My child is making choices even today at school and outside of school, and the question is, can we help her make those choices that are going to lead to healthy food outcomes?

Do food labels on products encourage children to make healthy food choices if it indicates good ingredients? Or would labels that warn against nutrients of concern actually discourage kids from using those or consuming those products? Today we're going to actually explore those questions in a particular context- in Chile. In 2016, the Chilean government implemented a comprehensive set of obesity prevention policies aimed at improving the food environment for children. Last year on this podcast, we actually explored how the Chilean food laws affected school food purchases. But now today, we're going to explore how food labels are influencing youth outside of school. It is my pleasure to welcome back my colleagues, Gabriela Fretes, who is an associate research fellow at the International Food Policy Research Institute, or IFPRI; and Sean Cash, who is an economist and chair of the Division of Agriculture, food and Environment at Tufts University at the Friedman School of Nutrition, Science and Policy.

Interview Summary

Gabi and Sean, I'm excited to discuss our new paper, Front of Pack Labels and Young Consumers an Experimental Investigation of Nutrition and Sustainability Claims in Chile that was recently published in a Journal of Food Quality and Preference. Gabi, let's begin with you. So why look at Chile? Can you explain the focus of the Chilean labeling and food environment policies there?

So, the setting of our study, as in the previous study, was Chile because recently the country implemented the law of food labeling and advertising, which includes three main components. The first one being mandatory front of package warning labels on packaged goods and beverages. The second one being restrictions on all forms of food marketing directed to children younger than 14 years. So, including printed media, broadcast, and also all digital media. And the third component being at school regulations at different levels including preschool, elementary, and high school levels.

Briefly, food manufacturers in Chile must place front of package labels on packaged foods or beverages that are high in specific nutrients of concern, including added sugars, saturated fats, sodium, and or energy. This law was implemented in three stages, starting in June 2016. The last stage was implemented in June 2019. So, it has been already six or seven years since the full implementation of the regulation. Specifically talking about the school component because this, yeah, it relates to children and adolescents. The law mandates that foods and beverages with at least one front of pack warning label cannot be sold, promoted, or marketed inside schools. And this includes the cafeteria, the school kiosks, and even events that are happening inside the schools. And additionally, food and beverages that have at least one front pack warning label cannot be offered as part of school meal programs. In addition to this front of pack warning label regulation, Chile also implemented voluntary eco labels starting in 2022 that provide information about the recyclability of food packages specifically. There is a certification process behind this labeling regulation and the eco label can be displayed if the food or beverage package is at least 80% recyclable.

Wow. This is a really comprehensive set of policies to encourage healthier food choices, both at the school and then also outside of the school. I'm excited to discuss further what this may do to food choices among children. Sean, that really brings up the question, why is it important to look at young consumers and their food choices and what makes them unique compared to adults?

Thanks for asking Norbert. This is an area where I've been interested in for a while. You know, young consumers play a crucial role in shaping the demand for food and long-term dietary habits. And young consumers might be more open to incorporating dietary advice into those long-term habits than adults might be. Just perhaps kids are less set in their ways. Children and adolescents are both current, but also future consumers with growing autonomy in what they choose around food as they get older. To marketers, we sometimes would say they might represent a three-in-one market. First, they spend their own money on snacks. What you could think of as the primary market. And how children spend money autonomously is really something that hasn't been studied enough by researchers. Although it's an area where I have tried to make a contribution. Second, kids influence household purchases. This is sometimes called pester power. You can think of a kid in the supermarket begging a parent to buy a favorite snack or a certain brand of cereal. But this can also be more socially positive in that kids might be agents of change within their households. Encouraging perhaps other family members to buy healthier food items if they get more interested in that. And third, this three-in-one market is rounded out by the fact that children represent future purchasing power as future adults. So, the habits that they're forming now might influence what they do when they're older.

Despite this importance for marketers, but also for pro-social behavior change, there really hasn't been a lot of research on youth food purchasing behaviors. And this question that we are looking at here of how kids might respond to front to package labels has been particularly limited.

In this project, we wanted to understand how Chilean adolescents might respond both to nutrition warning labels, but also eco labels, and how they consider price when choosing snacks. We were lucky to be able to recruit a sample of over 300 kids, aged 10 to 14, to participate in these experiments. I know we're going to chat a bit more about what we found, but in general, our results suggest that while price is perhaps the biggest factor in explaining what the kids chose in our experiment, that some of these youth showed preferences for the eco labels, which could be indicative of an emerging interest in sustainability issues.

But overall, understanding these behaviors is really important because the food choices made during childhood and adolescence can persist in adulthood. And this can be really something that helps change long-term health outcomes.

Gabi, let's talk a little bit more about eco labels for a moment. What are they, and how do these echo labels influence children's snack choices? What did they tell us about their awareness of sustainability?

That's a great question, Norbert. Thanks. In our study specifically, we found that eco labels, had a greater influence on adolescents' snack choices than nutrition warning labels these black and white octagons that are displayed on the front of the package of products in Chile. And this suggests that some young consumers are becoming more aware of environmental issues, or at least in our sample. One possible explanation for this could be that eco labels suggest positive emotions rather than warnings, as with the nutrition labels. Which might feel more restrictive. Unlike the nutrition labels that tell consumers what not to eat, eco labels, on the other hand, highlight a product's benefits, making it more appealing. This could be one of the reasons. Related to that, adolescents may also associate eco-friendly products with social responsibility aligning with increasing youth-driven environmental movements that are very prevalent around the world.

However, not all adolescents in our sample responded equally to the eco labels that were presented to them in the snacks. Our study specifically found that those who receive pocket money were more likely to choose eco label snacks. And this could be possibly because they have more autonomy over their purchases and their personal values could be playing a bigger role in their choices. If eco labels are really influencing children and adolescents with choices, one intervention that could be potentially beneficial could be to incorporate sustainability messaging in school food and nutrition education in order to reinforce those positive behaviors. And make them part of the daily food choices that they make. In making sustainable food more affordable, government incentives or retailer promotions could encourage youth to choose more eco-friendly snacks. Given that price, as we saw in our study, remains a key factor for choice. Lastly, not all eco labels are created equal. And this suggests that clear standardization and regulation are needed to prevent misleading claims. And ensure that adolescents receive accurate information about the sustainability of their food choices.

Ultimately, the eco labeling, of course, is not a silver bullet. It's not going to solve all the environmental issues, but it represents a promising tool to nudge consumers. So our better dietary and environmental behaviors.

Gabi, you talked about how the eco labels have a bigger effect than nutrition warning. And overall, the nutrition warning labels didn't really have that big of an effect on snack food choices. Why do you think that's the case?

Yes, this was really one surprising finding in our study. That front of pack nutrition warning labels did not significantly impact children's and adolescents' snack choices. And this kind of contradicts some previous research suggesting that warning labels can help consumers make healthcare choices. And there are several possible explanations for why this could be happening. The first one could be just lack of interest. So compared to adults, children and adolescents may be just more responsive to positive rather than negative messaging. Because negative messages related to nutrition might not seem relevant to them because they feel healthy in the present. They just are not interested in those kinds of messages. The second could be label fatigue. We discuss this in our paper and basically it is because Chile's regulation was already introduced in 2016. Given that it has been already some time since implementation, young consumers may have become habituated to seeing the warning labels on food products. So, like how adults also experience label fatigue, and this is documented in the evidence, children and adolescents might no longer pay attention or pay less attention to the warning. Third possible explanation is it relates to taste and brand loyalty. For this point, research shows that for youth specifically, taste remains the top priority when they choose food. So often outweighing any other factors including health concerns. If a favorite snack, for example, has warning labels but remains tasty and familiar to the kid, the label alone may not discourage them from choosing that snack. And lastly, social and environmental factors. Our study found, as we already mentioned, that eco labels had a stronger influence that nutrition warnings, and this could indicate that children and adolescents are just more responsive to messages about sustainability than to warnings, which they may perceive as less immediate.

Thank you for sharing that. And at this moment in the US there is a conversation about front of pack labels. And the work that you are showing in this paper may even point to some of the things that may happen if we see similar front of pack labels here in the US. I'll be looking forward to see what happens with that effort right now. Sean, I want to turn to you and ask an economist type question. What role does price play in adolescent food choices? Not only price, but the availability of pocket money? And how do you think that should influence policy?

Our study shows that price is the most significant factor influencing the snack choices of the kids in our study. And higher prices definitely reduce the likelihood of seeing a certain product being selected. It was kind of interesting. Interestingly, this effect was consistent regardless of whether the kids regularly received pocket money. Suggesting that even those that don't receive spending money still are paying attention to price. And this was a little bit different from what we found in some other studies that I've been able to work on, in the US and Germany, that suggested that previous experience with pocket money, or getting an allowance, was really important for understanding which kids might be most careful about spending their own money. I don't know if that's something different in the Chilean context than those other contexts. Or if that was just about what the kids in this particular study were paying attention to because we're asking about different things.

But when we look more closely at the kids in our Chilean study, we found some important differences. As Gabi already mentioned, those kids who received pocket money were the ones who were more positively inclined to choosing products with the eco labels. And that suggests that they might be valuing sustainability a little bit more when making their own choices. Perhaps because they're already a little bit more familiar with some of those dynamics of spending their own money. Whereas those without pocket money were more likely to choose cheaper options or sometimes the healthier options like the apples that we provided as an option in our study. And suggesting they're focused more on affordability or health.

So, what this means for policy, given the strong influence of price, it means that policy interventions that focus on price, like taxes on unhealthy foods or perhaps subsidies for healthier options, might be effective tools in guiding better choices for these kids. But also, programs promoting budgeting skills and food literacy might help adolescents make more informed decisions both about the nutrition and the sustainability of the foods they're eating. Finally, since some kids are responding positively to eco labels, integrating sustainability messages with the nutrition education could enhance the impact of food labeling policies. Overall, combining price policies and education labeling strategies could be really effective in driving meaningful changes in children and adolescent food choices.

Sean, thank you. And it's really important to appreciate the differences that may occur when we think about a country like Chile versus the US or in some of your other work in Germany. And understanding that youth culture may be different and may be shaping these behaviors. But it's very clear that all people, it sounds like, are responding to price. And that's a constant that we're seeing here. Sean, here's my final question for you. What is the take home implications of this study?

Well, first and foremost, our findings here suggest that nutrition labeling alone isn't necessarily going to be enough to drive healthier choices among children and adolescents. It can be part of an answer, but policymakers looking to promote healthier food choices might need to compliment labeling with education campaigns that reinforce the meaning of these warnings and integrate them into school-based nutrition programs. That said, I think that Chile has already been a leader in this regard, because the food items that get the warning labels in the Chilean context are the same ones that are subject to different restrictions on marketing or sales in schools, as well. I do think that we're going to see kids and eventually adults just become more familiar with these categorizations because of the consistency in the Chilean law. Also, on the eco label side, leveraging that kind of eco labeling alongside nutrition messaging might be an effective combination to help promote both healthier and more sustainable food choices. And finally we've been talking about new front to pack labeling schemes here in the United States. And it's really important to make sure we learn as much as possible from the experiences with such policies in other countries. Chile's really been a world leader in this regard and so I'm very happy to have tried to contribute to an understanding of how people use these labels through this study and through some of the other projects that Gabi, you and I have all been involved in.

Bios

Gabriela (Gabi) Fretes is an Associate Research Fellow in the Nutrition, Diets, and Health (NDH) Unit of the International Food Policy Research Institute. She received her PhD in Food and Nutrition Policies and Programs at the Friedman School of Nutrition Science and Policy, Tufts University, USA in 2022 and holds a master’s in food and nutrition with a concentration on Health Promotion and Prevention of Non-Communicable Diseases from the Institute of Nutrition and Food Technology, University of Chile. Her research interests are at the intersection of child obesity prevention, food policy and consumer behavior, and her doctoral thesis involved evaluation of a national food labeling and advertising policy designed to improve the healthfulness of the food environment and address the obesity epidemic in Chile, particularly among children. She has worked with a broad range of government, international organizations, academia, public and private sector stakeholders and decision-makers in Paraguay, Chile, and the United States of America.

Sean Cash is an economist and Chair of the Division of Agriculture, Food and Environment at the Friedman School of Nutrition Science and Policy at Tufts University. He conducts research both internationally and domestically on food, nutrition, agriculture and the environment. He is interested in environmental impacts on food and beverage production, including projects on crop quality and climate change, consumer interest in production attributes of tea and coffee, and invasive species management. He also focuses on how food, nutrition, and environmental policies affect food consumption and choice, with specific interest in children’s nutrition and consumer interest in environmental and nutritional attributes of food. He teaches courses in statistics, agricultural and environmental economics, and consumer behavior around food. He is currently Specialty Chief Editor of the Food Policy and Economics section of Frontiers in Nutrition, and has previously served as an Editor of the Canadian Journal of Agricultural Economics as well as the Chair of the Food Safety and Nutrition Section of the Agricultural and Applied Economics Association.
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E269: Children, screen time and wellbeing - many reasons for concern
9 apr· The Leading Voices in Food
The amount of time children and adolescents spend with a screen is absolutely stunning. Lots of people, including parents, health leaders, educators, elected leaders from both parties I might mention, and even children themselves, are highly concerned and are discussing what might be done about all this. I'm delighted to begin this series of podcasts on children and screen time. Today we're welcoming two very special guests who can talk about this topic in general, and especially about what's being done to protect children and adolescents. Several podcasts will follow this one that deal with food and nutrition in particular. Our first guest, Kris Perry, is Executive Director of Children and Screens, an organization devoted to protecting children. In the digital world by addressing media's impact on child development, communicating state-of-the-art information, and working with policymakers. Prior to joining children in Screens, Kris was senior advisor of the Governor of California and Deputy Secretary of the California Health and Human Services Agency. Our other guest, Dr. Dimitri Christakis is a professor of pediatrics at the University of Washington School of Medicine, and director of the Center for Child Health Behavior and Development at Seattle Children's. He's also editor-in-chief of JAMA Pediatrics and both Chief Scientific Officer and Chair of the Scientific Advisory Board of Children and Screens. He's also the co-editor of a new book that I'm very excited to discuss.

Interview Summary

Download The Handbook of Children and Screens: https://link.springer.com/book/10.1007/978-3-031-69362-5

Kris, let's start with you. Could you set the stage and give us some sense of how much time children spend in front of screens, children and adolescents, and what devices are being used and what kind of trends are you seeing?

Yes, I'd be happy to. I had better news for your listeners, but as you might imagine, since the advent of the smartphone and social media, the youth digital media use has been increasing each year. Especially as children get older and have increasing demands on their time to use screens. But let's just start at the beginning of the lifespan and talk about kids under the age of two who shockingly are spending as much as two hours a day on screens. Most spend about 50 minutes, but there's a significant chunk spending up to two hours. And that rises to three or three to five hours in childhood. And eventually in adolescence, approximately eight and a half hours a day our adolescents are spending online.

Also wanted to talk a little bit about middle childhood children, six to 12 years of age. 70% of them already have a social media account, and we all know social media wasn't designed for children. And there are restrictions on children under 13 using them, and yet children six to 12 most have an account already. Over half of four-year-olds have a tablet and two thirds of children have their own device by the age of eight; and 90% of teens. This probably won't be surprising, and yet we should really think about what this means; that 90% of teens are using YouTube, 60% are on TikTok and Instagram, and 55% use Snapchat. I'll stop by ending on a really alarming statistic.

Oh my, there's more?

There's more. I know it! I told you. I'll be the bearer of bad news so that we can talk about solutions later. But, children are checking their devices as often as 300 times per day.

300 times.

300 times per day, and we're talking about screen time right now. And we know that when you're using time to be on screens, you are not doing something else. And we know that childhood is full of challenges and skill building and mastery that requires repetition and tenacity and grit and effort. And the more children are on their screens, whether it's social media or other entertainment, they're not doing one of these other critical child development tasks.

That's pretty amazing. And the fact that the older kids are spending more time on before a screen than they are in school is pretty alarming. And the younger, the really youngest kids, that's especially alarming. So, Dimitri, why should we fret about this? And I realize that fret is kind of a mild word here. Maybe all I'll panic would be better. But what are some of the major concerns?

Well, I don't think panic is ever the right reaction, but the numbers Kris conveyed, you know, I think do paint a, let's say, concerning story. You know, the simple reality is that there's only so much time in a day. And if you think about it, teenagers in particular should sleep for eight to 10 hours a day at a minimum. They really should be in school six and a half, seven hours a day. And then when you add the numbers, Kris conveyed, you realize that something's giving because there isn't enough time left to spend eight and a half hours a day. The two things at a minimum that are giving are sleep. Kids are losing sleep to be on screens. And I'm sorry to say that they're losing school while they're on screens. We just published a paper that used passive sensing to see where and when children are on their screens. And found that the typical child in the United States spends an hour and a half during the school day on their device. And it's not, before any of your guests ask, on Wikipedia or Encyclopedia Britannica. It's on the usual suspects of social media, TikTok, etc. So, you know, we talk about displacement, and I think it's pretty obvious what's being displaced during school hours. Its time focused on learning if it's in the classroom, and time focused on being authentically present in real time and space if it's during recess. School hours are precious in that way, and I think it is concerning that they're spending that much time in school. And I told you the median. Of course, some kids are above that, a significant half of them are above it. And at the high end, they're spending 30 to 40% of school time on screens.

Now, some schools have enacted policies. They don't typically enforce them very well. One of the things that drives me nuts, Kelly, is that as an academic, you know we love to argue amongst ourselves and hem and haw. And this issue about whether or not there's such a phenomenon as digital addiction is still being hotly debated. Honestly, the only behavioral addiction that's being seriously considered at this point is gaming disorder. The DSM-5 didn't consider gaming, considered it, but didn't include, it said it needed further study in 2013. In 2022, the WHO did include gaming disorder as an ICD-11 diagnosis. But just as further evidence how slow science is compared to technology., I mean gaming, while it's still an entity, represents a small fraction of most people's screen time. And the numbers that Kris conveyed, a small fraction of that for some on average was gaming. For some people, it's their screen use of choice, but for many, it's social media. YouTube, although I consider YouTube to be a social media, etc. And at the high end when you hear the numbers Kris conveyed in my mind that's a behavioral addiction any way you define it.

Well, and if you think about things that we all agree are addictive, like nicotine and alcohol and heroin, people aren't doing it 300 times a day. So it's really pretty remarkable.

And that's exactly right. One of the salient criteria for those addictions is that it's interfering with activities of daily living. Well, you can't be on a screen for nine hours a day when you're supposed to be asleep for 10 and at school for six without interfering with activities of day. The math isn't there.

And things like being physically active and going out and playing.

That's right. It doesn't add up. So, you don't need the DSM-5. You don't need a psychiatrist. You need a mathematician to tell you that there's too much time on this thing.

Alright, so Kris, talk to us if you will, about the Children and Screens organization. I have a lot of respect for the organization and its work. Tell us how it got started and what its objectives are.

Well, it's so great to be on this show with you and get to see you in your day job, Kelly. Because you've been an advisor, like Dimitri, to the institute almost since its inception, which is in 2013. As you know, our founder, Dr. Pamela Hurst-Della Pietra, really became concerned as a parent about the way digital media was impacting her children and sought out some answers. Well, what does this mean? Why is this happening? What should I do? And found out that this, of course, is 2013, this is a long time ago. There wasn't that much research yet. And it was multidisciplinary. In other words, there might be a study among neuroscientists or developmental psychologists, even ophthalmologists. But there really hadn't been, yet, a concerted effort to bring these different disciplines and the research together to try to answer some of these hard questions about the impact on kids. And lo and behold, here we are, almost 13 years since the advent of the smartphone and social media. And there is an astounding amount of research across disciplines. So, what we do at the institute is we try to translate it as fast as we can and make it actionable for parents, providers, and policy makers. And we do that through our Ask the Experts webinar series where we bring the experts themselves directly to our audience to talk about these impacts and answer questions. We also create printables, you might say, like tip sheets and Research at a Glance Digest, and newsletters and FAQs and we've upgraded our website to make it very navigable for parents of kids of all ages.

I even started my own podcast this year, which has been really fun. Dimitri was my first guest, so it's great to see him here. And we have convenings. We're having our third Digital Media Developing Mind Scientific Congress this summer where the experts come together in person to discuss issues. And we really try to focus them on advancing research and supporting it, translating it, and positioning the issue as a policy priority. We'll be in Washington, DC where we know lawmakers are grappling with the impact of digital media on child development, how to make online, products safer for kids and protect their data. The Institute is in the middle of all of this, trying to facilitate more discussion, more results and more support for parents primarily.

Kris, a couple of things occur to me. One is that the breadth of work you do is really very impressive because you're not only having very hands-on kind of in the real world ex advice for parents on how to navigate this world, but you have advice for and helpful resources for policy makers and for researchers and people. It's really quite an impressive breadth of work. The other thing that occurred to me is that I don't think you and I would have any podcast career at all if it hadn't been for Dimitri helping us out. So thanks Dimitri. Yeah. So, let me ask you, Dimitri, so I know that both you and Kris are committed to an evidence-based approach to making policy.

Yeah.

But technology advances way more quickly than scientists can evaluate it. Much less come up with policies to deal with it. And by the time research gets funded, completed, published, you're on to eight new levels of technology. So how does one handle this fundamental problem of pace?

It's a really good question. I mean, I can tell you that we should at a minimum learn from the mistakes we've made in the past. And, you know, one of the most critical, frankly, that most people don't really understand is that we talk about the age at which children get social media accounts in this country. Kris pointed out that actually pre-teens routinely have social media accounts. Social media companies do very little to age gate. They're trying to do more now, but even the age at which we've accepted it is being normative is 13. Few people know where that comes from. That doesn't come from talking to pediatricians, psychologists, parents about what age is the appropriate age. It comes entirely from COPPA (Children's Online Privacy Protection Act), which basically was the original privacy act that said that before the age of 13, companies could not collect data from children. So, because these companies were interested in collecting data, they set the age at 13 so as to not have any constraints on the data they collected.

Well, that's not even common sense-based policy, let alone evidence-based policy. And it's never been revisited since. It's very troubling to me. And as things move forward, I think we have to learn from those mistakes. Medicine has a maxim which is do no harm. We use that phrase a lot and I think it's a good one in this case. I think it's a particularly good one as we see the new technologies emerging around artificial intelligence. And you know, again, like any new technology, it has incredible upside. We made the mistake and we're still paying for it, about not appreciating the downsides of social network sites, and frankly, the internet in general. And I would hope we put guardrails in place now. And if you will apply the same standard we apply to other non-technology based products. You can't introduce a new pharmaceutical to anybody, let alone to children, until you show it's safe and effective. You can't bring toys to the world that are dangerous. Why do we have more safety precautions around toys than we do around websites for children?

You know, a lot of it involves changing defaults, doesn't it? Because if the default is that government or somebody out there has to prove that something is harmful before it gets taken away. That changes everything then if you began at a different point where these companies have to prove that these things are safe.

Correct.

Or they're permitted. Then the companies would find workarounds and they would play games with that too, but at least that would help some.

Well, it would help some. And at least we'd be philosophically in the right place. By the way, Kris didn't say it, so I'll say it. You know, the mission of Children and Screens, lest we sound like Luddites here, is not get kids away from technology. Take away their smartphones. We all recognize that technology is here to stay. I think all of us appreciate the incredible upside that it brings to children's lives. The mission of Children and Screens is to help children lead healthy lives in a digital world. And part of the reason she and I often talk about the concerns we have is because the pros make the case for themselves. I mean, you know, no one needs to come here and tell you how amazing it is that you could Google something or that you could get somewhere with GPS. I mean, we know it's amazing and we all rely on it. And none of us are ever talking about getting rid of that stuff.

That makes good sense. It's like, you know, children benefit from the fact that they can get around with their parents in the automobile. But you want to have car seats in there to protect them.

Exactly. And that's exactly right. There needs to be assurances of safety and they're none. I mean, they're really virtually none. The age getting is a joke. And even if we accept it as effective, the age set of 13 is too young, in my opinion. We started this conversation talking about these medias being addictive, I believe they're addictive. There are legitimate academics that will debate me on that, and I'm happy to join that debate. But as I said before, it's a tough argument to win when people spending upwards of 10 to 16 hours a day doing it. I don't know what you call that besides addictive. We can argue about what percentage are doing that, but nevertheless, once you accept something as addictive, for other addictive things we immediately age gate it above 18 or 21, right?

Mm-hmm.

We don't believe that the teenagers have the ability to regulate their alcohol or tobacco or gambling, all of which we accept are addictive. In fact, in the case of alcohol, we raised the age from 18 to 21 because we thought even 18-year-olds weren't able to do it. And yet somehow for this behavior, we think of it as just so different that it doesn't require greater cognitive capacity. And I don't believe that.

Yeah, very good point. Kris, let me ask you a question about how you and your colleagues at Children and Screens set priorities because there are a lot of things that one could potentially worry about as outcomes. There's violence that kids see on social media. There's cognitive and brain development, social developments, social interactions, and bullying. Mental health, body image, diet, all these things are out there. How do you decide what to work on?

Well, we try to work on all of it. And in fact, we've built up a fair amount of expertise and resources around almost 25 different topics. And we also understand that, you know, childhood is a long period of time. Birth to 18, birth to 21, birth to 25, depending on who you talk to. So, we're able to take those 25 topics and also provide deeper, you might say, resources that address the different stages of development. We're really trying to do as much as we can. What's been interesting over these last few years is trying to figure out when to be reactive, when to be proactive. And by being proactive, we go out looking for the research, translating it, digesting it, and creating materials with it that we think are really accessible and actionable. At the same time, as Dimitri points out, there are policy windows and there are opportunities that present themselves that you have to react to. If you just only talk about what you want to talk about to each other you're missing some of these external opportunities to inform policy and policy makers. Help influence the way that parents and providers are talking about the issue. Framing it in such a way that engages youth and makes them want what we want for them. We're really excited by increasing opportunities to partner in coalitions with others that care about kids and teachers and nurses and doctors. But we also are speaking directly to leaders in states and school districts at the federal level, at the local level. You would be, I'm sure, not surprised to hear that we are contacted every day by groups that support parents and families. Asking for resources, asking for support, because they're seeing the impact now over many years on their children, their development. Their academic ability. Their cognitive and analytical ability. Their social emotional ability. Their ability to pay attention to tasks that we all know are critical in building that foundation for essentially, you know, future success. The Institute is being pulled in many directions. Ee try really hard to be strategic about what are people asking us for? What does the research say and how can we get that to them as quickly as possible?

Dimitri - Can I add to that? You know, I want to emphasize that the concern around the effects of screen use on children's lives is shared by parents on both sides of the aisle. 75% of parents are concerned about the impact of screens on their children's lives. 35% of teenagers are concerned about their dependents on screens and that it has a negative effect on their lives. Actually by some studies, some surveys, even more than 35 to 50% of teenagers are concerned. And both sides of the political aisle agree in large part of this. And Kris and Kelly, you guys are the policy wonks, you can speak more to that. So it's a serious indictment on us as grownups and as a society that we have not done more to deliver on this issue. Why? When there's bipartisan agreement amongst many policymakers. This is not a political [00:22:00] issue to speak of and there is widespread concern on the part of parents and even teenagers. Why is nothing happening? Well, one has to look no further than where the money is. And that's a problem. I mean, that's a serious indictment on our political system when we can't deliver something that is needed and basically wanted by everybody but the industry itself.

We'll come back and talk in a few moments about the policy issues and where industry gets involved here. But let me take just a bit of a detour from that and talk about the book that I mentioned earlier, because I think it's such a valuable resource. Now, when I mention the name of this book I'm urging our listeners to write this down or to remember it because you can get the book at no cost. And I'll come back, Kris, and explain what made that possible and why the decision was to make this an open access book. But Dimitri, let's begin with you. So you, along with Lauren Hale, edited this book that's entitled, The Handbook of Children and Screens: Digital Media Development and Wellbeing From Birth Through Adolescence. I think it's an extraordinary piece of work, but tell, tell us about the book.

It was an extraordinary undertaking. There's I think 178 or 180 authors. Literally, it's a who's who of experts in children and media research in all disciplines. It represents pediatrics, psychiatry, psychology, communications experts, demography, lawyers, neuroscientists. I don't know who I'm forgetting. Every single discipline is represented. Leading scientists in all of those areas. Virtually every topic that someone might be of interest to people. And we deliberately made the chapters short and easily accessible. So, it is, I think, a great resource for the constituents we serve. For teachers, for parents, for researchers, for policymakers. And it is free. The hardest part of it, to be honest, as an editor, was getting peer reviewers because unfortunately, every expert was conflicted since they all had an article in it. But it was a long time coming. And again, this was really the brainchild of Pam (Pamela Hurst-Della Pietra) and we're grateful to have brought it along.

So, you go all the way from the neuroscience, how children's brains are reacting to this, all the way out there into the public policy and legal arena about what can be done about it. And then kind of everything in between. It's remarkable how much the book covers.

It's almost a thousand pages. I mean, it is a tome to be sure. And don't forget to mention, Dimitri, we aren't even two months post publication, and we have 1.6 million views of the document, despite its gargantuan size. I think that is really a tribute to experts like you and others that have really studied this issue and can speak directly to its impacts. It's been great to see the success so far.

You know, not a small number of those views is from me logging on.

And then a million from me and then we got there. So, it is free because it's online and you can download it. You can also order a hard copy for I think, $60, but I'm not sure why you would do that if you can download it for free. But it's up to you.

So, Kris, it's unusual for a book like this to be made open access and free to the general public. What made that possible and why was that so important?

We want the maximum number of people to use it and treat it like the premier resource that it is. And the only way you can really do that is to fund it to be open access and find a publisher that does open access publishing, which we did with Springer. I mean, most journal articles are behind a paywall and publishers do require you to purchase either a subscription or the document itself to download it or order it. And we just really wanted maximum access. So, we funded it to be published in that way. And I think honestly, it helped us even sort of create it in the first place. People want to be a part of something that has that level of access and is available so widely. So, I think it was a kind of mutually beneficial. It gets more people to read it, but it got more people to write for it too, I think. Right, Dimitri?

Dimitri - I agree. I mean, you know, the numbers 1.6 million are extraordinary. I mean, Kelly, you've been internal editor. I mean, as a editor of JAMA Pediatrics, if an article gets 70,000 views, it's in our top 1%, you know, 200,000 views is 0.01%. 1.6 million in growing is really extraordinary.

And that's about the number of people that read my articles. 1.6.

And of course, they're not all scientists. I mean, many of them are parents and maybe are policy makers, but that's Kris's point, you know. The moment anyone hits a paywall, even if it's a dollar or two, they're going to walk away. It's great to see it get so much traction.

Alright, so again, for our listeners, the title of the book is The Handbook of Children and Screens. And it's really a terrific resource. Alright, so let's turn our attention to a really important matter. And we've sort of touched on this, but who's in charge of protecting our children? You know, Dimitri at the end of the day help survey this landscape for us. I mean, is it congress, is it the administrative branch of government? What role do the courts play? Are there legal actors taking meaningful action? What's being done does it come anywhere near, meeting the need. Tell us about what that landscape is like?

Well, there isn't adequate protections for children. And we talked a little bit about that earlier. There's been an enormous loophole, unfortunately, created by Congress when they added the Section 230 to the Communications Decency Act in 1996. And that was put in place essentially to provide protections for internet companies. And it basically said that they should be treated like bookstores and not publishers. That they weren't responsible for content they were just conveying it. And what that means, in effect, was that the companies had sort of carte blanche to do whatever they want. And they've used that very effectively, legally, to argue that any restriction, any culpability on their part, is protected by that Act. That they're exonified for any ill that occurs as a result of their product.

The only exception that's been made of it, to date, was around sex trafficking on back page, if anyone remembers that. But other than that, social media sites and internet sites in general have been able to say that they're not liable for anything that's done. And I think that was a huge mistake that was made. It needs to be rectified. It's being challenged in the courts presently. My own belief is that, and I'm not speaking as a lawyer, is that when that law was passed, it was under the assumption as I said, that they were just conveying information. No one at the time foresaw the development of algorithms that would feed the information. It's really not a bookstore when you are making recommendations. Once you start recommending things, I think you're no longer merely a purveyor of product. You're actually pushing it.

So, Kris, tell us about the Children and Screens and the role the organization plays in this space. And how do you deal with policy and is it possible to be bipartisan?

Yeah, I mean, it's essential. There's no way to get anything done, anywhere on these policy matters at a population level without working in a bipartisan or non-partisan manner, which is what we've always done. And it's easy to do that when you're following the science, not ideology. And you're putting the science first and you're creating resources and tools and support for those mostly staffers, honestly, that are trying to help their bosses get smarter and better at talking about these issues as they evolve and become more complicated over time. It takes more effort to staff a lawmaker on this front. And they're very anxious to learn and understand because they're meeting with parents of children who have been harmed. Or frankly didn't even survive their childhood because of the social media platform. There's great urgency on the part of policymakers. We've heard everything from school phone bans to outright social media bans proposed as policies. And one thing I like to come back to is it's one thing to want to take action and make your best guess at what would have the best impact. But it's another thing to study whether or not that policy actually achieved its result. And it's a part of this that by staying bipartisan, nonpartisan allows us to say, 'Hey lawmaker, if you're able to get that to happen, we'd really like to come in and help study whether or not your idea actually achieves the results that you wanted, or if it needs to be adjusted or amended over time.'

Fantastic. That's so important to be doing that work, and I'm delighted the organization is doing it. Let me ask a question here. If you think about some of the areas of public health that I've been following, like tobacco, for example. Opioids more recently. Vaping products. And in the case of my own particular work food policy. The administrative legislative branches of government have been almost completely ineffective. If I think about food policy over the years, relatively little has been accomplished. Even though lots of people have worked really hard on it. Same thing happened with tobacco for many years. Opioids, same thing. And it's until you get the third branch of government involved, the judiciary, and you start suing the actors who were causing the harm do you get much action. Not only do the lawsuits seem to have an effect, but they soften the ground for legislative things that then can occur because public opinion has changed. And then those things help make a difference as well. What do you think about that kind of issue in this space?

I think you're exactly right. I mean, I think the failure of our legislative branch to enact policy leaves us with very few options at this point anyway, except to try to pursue it through the judiciary. There are challenges there. First and foremost, it's a big and well-funded industry, not unlike tobacco or big food, as you mentioned and there's this Section 230 that's given them kind of blanket immunity to date. But there are many, many very large pending cases in several jurisdictions brought by individuals, brought by school districts, brought by states. And those, at least provisionally have gotten further than prior cases have with which have been thrown out based on Section 230. So, we'll see what happens with that litigation. But right now, my guess is it's the best chance we have to set some guardrails. And I think there are plenty of guardrails that could be set. Everything that these companies have done to make their products addictive can be undone. Can be made protective. The tobacco company deliberately designed their products to be addictive. While they tried to make the claims that they were less addictive, you know. They made light cigarettes that had holes in the filter so that it would diffuse the carbon and nicotine, but people quickly learned they could cover those up with their fingers and think they were smoking light cigarettes, and smoke more of them. There's a lot of things that can be done in this space to undesign the problematic nature of the products. And quite apart from the financial settlements, which will get companies attention, I hope that that's part of any settlement if it gets that far.

It'll be interesting to see where those go. And, also historically, one important part of these lawsuits is what gets turned up in discovery. And what sort of intent the companies have and how much do they know about harms. And how much do they know about addiction and things like that. And how they might have proceeded in the face of that information that then doesn't get disclosed to the public. In any event, we'll see where that goes. Dimitri, what about the argument that responsibility resides with parents. It's up to parents to protect their kids from this, and government doesn't need to be involved.

I've never understood that argument. I mean parents obviously are children's most important safeguard, but as a society, we enact policies and laws to assist parents in that. I mean to me, if I made the argument, well, why, why do we have minimum ages of drinking. It's parents' job to make sure their kids don't drink. How would that possibly play out? Look, it's hard enough as a parent anyway, because kids do get around these laws. But we still have them and it's a lot easier as a parent. I think most parents would agree their life's made easier by minimum age restrictions on certain things. We have seatbelt laws. I mean, why do we have seatbelt laws? Why don't we just tell its parents' job to make sure their kids buckle up? The truth is its society and parents working hand in hand to try and keep children safe. And I think it also helps parents to be able to say that there are laws around this, and I expect you to follow the laws. So, I don't think it's an either or.

Okay, well, I think that's a very good way to frame it. There are many, many precedents where we protect children. And why not do it here too? So let me end with a question I'd like to ask both of you. So, in this sea of concerns that we've discussed, is there a reason for optimism? And Kris, let me start, start with you. What do you think?

Absolutely. I think the young people I've met that are leading among their peers are incredibly impressive and are armed with the research and their energy and their own lived experience in ways that are very compelling. At the same time, I think the vast amount of research that has now been compiled and translated and acted upon, whether in courtrooms or in state houses, it's becoming more, and we're all getting more steeped and aware of more nuanced information. And finally, I would just say, there is a tipping point. We are reaching as a society, adults and kids alike, we are reaching a tipping point where we can't withstand the pressure of technology in every aspect, every corner of our day, our life. And we want relief. We deserve relief. And I think that's what's going to take us over the finish line.

Good. Well, I'm glad to hear those optimistic notes. Dimitri, what about you?

I can find reasons to be optimistic. I mean, look, the reality is that technologies have enriched our lives in many ways. And I think if we put guardrails in place, we can make sure that future ones do even better. I have a piece coming out in JAMA Pediatrics around the use of AI, which people are very concerned about, I think rightly. But specifically, about the use of AI and people with intellectual developmental disabilities, making the use case, that there are ways in which it could be extremely beneficial to that population. A population I care deeply about in my role as the Chief Health Officer at Special Olympics International. And in particular, let's say in terms of the doctor patient interaction where it could facilitate their communication with their provider, and it could also help the provider better communicate with them. Look, that use case isn't going to be a priority for the purveyors of artificial intelligence. It's a small, non-lucrative use of a technology. But it's a good one. And if we created the right incentives and put in the right guardrails, we could find many other ways that technology can serve the needs of all of us going forward.

I think the problem is that we've tended to be reactive rather than proactive. And to not start with the do no harm first premise, particularly when it comes to children. AI is another example of that where I hope we don't make the same mistake we made with social media.

Bios

Kris Perry is the executive director of the Children and Screens Institute. Kris most recently served as Senior Advisor to Governor Gavin Newsom of California and Deputy Secretary of the California Health and Human Services Agency where she led the development of the California Master Plan for Early Learning and Care and the expansion of access to high-quality early childhood programs. She led systems change efforts at the local, state and national levels in her roles as executive director of First 5 San Mateo, First 5 California and of the First Five Years Fund. Through it all, Perry has fought to protect children, improve and expand early learning programs, and increase investments in low-income children. Perry was instrumental in returning marriage equality to California after the landmark 2013 U.S. Supreme Court ruling Hollingsworth v. Perry, which she wrote about in her book Love on Trial (Roaring Forties Press, 2017).
Dimitri Christakis, MD, MPH is the Children and Screens Institute’s inaugural Chief Science Officer. He is also the George Adkins Professor at the University of Washington, Editor in Chief of JAMA Pediatrics, and the Chief Health Officer at Special Olympics International. Christakis is a leading expert on how media affects child health and development. He has published over 270 peer reviewed articles (h-index 101) including dozens of media-related studies and co-authored a groundbreaking book, The Elephant in the Living Room: Make Television Work for Your Kids. His work has been featured on Anderson Cooper 360, the Today Show, ABC, NBC, and CBS news as well as all major national newspapers. Christakis received his undergraduate degree at Yale University and his medical training at the University of Pennsylvania School of Medicine and completed his residency and Robert Wood Johnson Clinical Scholar Fellowship at the University of Washington School of Medicine.
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E268: Why Corporate Control of Agriculture is Cause for Concern
26 mar· The Leading Voices in Food
How big is too big? When it comes to corporate concentration many observers raise concerns about the tech industry. However, in the new book, Titans of Industrial Agriculture: how a few giant corporations came to dominate the farm sector and why it matters, political economist Jennifer Clapp draws attention to the overwhelming shadow a small handful of transnational corporations cast over the global agricultural sector. Professor Clapp argues that these corporations hold concentrated power over the agricultural sector that keep industrial agricultural practices entrenched in patterns of production, despite the concerns of the social, ecological and health impacts to society. She explains how we got to this point and what it might take to make changes. Jennifer's work at the intersection of the global economy, food security, and food systems, and the natural environment, looks specifically at issues of global governance. She is currently a member of the International Panel of Experts on Sustainable Food Systems, and a member of the Scientific Advisory Committee of the UN Food Systems Coordination Hub.

Interview Summary

Norbert - Jennifer, let's just jump right in and I'd love for you to help our listeners understand a little bit more about your book. You write about corporate concentration in the agricultural input sector. Can you explain what this involves and what products are we really talking about?

Yes. The book is about what we call the agricultural inputs industry. And that's really four different product types typically, and maybe a fifth that we can talk about. So, one of them is farm machinery, and that's really referring to things like plows and tractors, harvesters, etc. That kind of machinery on the farm. The second industry is the fertilizer industry, which is all about, you know, the nutrients that we bring to the soil through fertilizer products like nitrogen, phosphorus, and potash. And the seed industry. That's another industry that is a key input for farmers. And then also pesticides. And when we talk about pesticides, we're referring to things like insecticides, chemicals that kill insects, but also chemicals that kill weeds and fungus. And so those are the four sort of big inputs that I talk about in the book. But also, the book covers a fifth input, an emerging input, which is data. And this is, especially as we're seeing the datafication and digitalization of farming. Increasingly data has now become a commodity that is bought and sold as an input into farming.

Norbert - Great. I have to ask, what drew you to the input industry? I mean, let's be honest, that's not the thing that most people get excited about. Why should we be concerned?

Yeah, that's a great question. I've actually had a very long interest in the seed in chemical industry. That goes way back to the start of my career because I did studies in agriculture for my PhD dissertation. But then I got quite interested in toxic waste and then that sort of drew me to this question of the global pesticide trade. And when I learned that, you know, oftentimes, like in the US there might be a banning of a pesticide that's no longer in use. But it was still being traded globally. And this, I found this very fascinating and how that industry worked. And that kind of drew me into understanding the connections between seeds and chemicals. And then when the digitalization of farming came along and in recent decades it became really clear that it wasn't just chemical and seed industry involved in that digitalization. It was also the fertilizer and the farm machinery sector. It made me want to understand the interconnections between these industries. I know it's like, maybe a bit specific, but they have huge consequences in terms of the way our food systems look like. And so that really drew me to understand where did these inputs come from? And why are they controlled by just a few large companies?

Erika - Jennifer, I want to ask you a question about why this sector, especially related to the inputs, is so important when we're talking about food systems. And especially their social and ecological dimensions. And specifically in the book, you tease out many of the social and ecological costs of inputs such as pesticides. Also the social and ecological consequences of even farm machinery. So it would be great if you could elaborate on their importance.

Thanks, Erika. That's a great question and that's part of the reason why I was really drawn to study these inputs. Because I'm in a school of environmental studies, I'm very interested in these interconnections between food systems and environmental outcomes. I was really interested in learning more about where these industries came from, and as I was teasing out where they came from. And how they became dominated by such large companies, I also learned in much more depth about the ecological consequences of these inputs. I can just say a little bit about some of them because these consequences are so big that we almost forget to talk about them. They become embedded in the product itself. And so, one example is farm machinery. Farm machinery was originally seen as quite revolutionary and that it allowed farmers to harvest their fields much more quickly than they used to be able to before. But that also meant then that to make the equipment efficient and pay for them they might as well extend the size of their farm. And as farmers extended the size of their farm, in the US anyway, they moved west and displaced its indigenous people from the land, in terms of taking that land for farm production. But also, as farms began to consolidate and get larger, as mechanization continued, it also displaced others from the land. Poor farmers, black farmers, those who were renting land and didn't have access to their own. And so, people who were marginalized and we still considered marginalized in society today, were really being displaced from the land as a direct consequence of farm machinery. It's not that farm machinery is like necessarily something that we want to do away with today, but I think we need to recognize those historical connections. And really understand that when, you know, you see a book for a small child about farming and there might be a picture of a farmer and it's usually a white guy sitting on a tractor. We can forget that image has a lot of baggage associated with it in terms of displacement and inequality. And I think we need to recognize that. But it does not just stop there. There's also plowing disturbs the soil, heavy machinery compacts the soil so it can harm fertility of the soil as well. And the machinery part of the equation has long been a source of inequality in terms of being very expensive for farmers. It's been one of the main reasons farmers have often been driven into debt. Farm machinery might have been liberating in one sense to allow increased production, but it did come with costs that we should acknowledge.

We also need to recognize the ecological and social costs associated with the fertilizer industry. And this industry goes way back to the 1840s and we saw the rise of the guano trade. And we can think immediately of the working conditions of the workers who were digging the guano in the Chincha islands of Peru. And often they were coming from Asia and facing really harsh working conditions. But then when we saw the rise of synthetic nitrogen in the early 20th Century, the cost shifted in a way towards the cost of fossil fuels. The huge amount of natural gas used in the synthesis of nitrogen. And also, the climate consequences of the nitrous oxides that come from the application of synthetic nitrogen into the soil. So again, there's like enormous ecological and social impacts from that particular input.

Similarly, when we talk about seeds, the hybridization of seeds in the 1920s and 1930s also raise huge concerns about plant genetic diversity. And we know that in the last century or so we've lost around 75% of plant genetic diversity for crop genetic diversity. And this is because of the way in which we started to see the uniformity of the genetic makeup of seeds. The monocultural planting of seeds really reduced that kind of diversity. And then intellectual property protection on seeds that came with the hybridization of seeds also led to a decreased ability of farmers to save their own seed and exchange their own seed with their neighbors. So again, social ecological costs.

And finally, when we talk about pesticides, we have seen enormous issues with respect to pollution runoff. This kind of bioaccumulation of these toxic chemicals that have enormous health consequences.

So, all of these inputs have very large impacts in terms of their social and ecological costs. And we can even extend that to the issue of data today. There's a lot of concern about data platforms for digital farming where farmers are signing away the rights to the data that are coming from their own farms. And they don't have the kind of interoperability with other data sharing systems. And there's also a lack of clarity about who owns that data.

So again, there's big issues with respect to these inputs and how they are affecting both social and ecological dynamics within the food system.

Erika - Thank you for helping us understand the social and ecological impacts of these inputs into the farming industry.

Norbert - This is a really rich conversation and I want to understand a little bit more. There's a big part of your text that's about the concentration in the input sector. What does it look like today and was it always this way?

That's a great question because it's almost a trick question because we tend to assume that this high level of concentration that we see today is something that's new. But what I found in my research is that the high degree of concentration actually has a long history that goes back about a century or more in some cases. And when we're looking at each of these sectors, the farm machinery, for example, is controlled. Most of the market is controlled by about just four firms. And they control around 50% of the global market. But when you look specifically at national markets in the US, for example, John Deere, you know, the largest company that makes farm machinery, it controls over 50% of the tractor market. So that's just one firm alone. It's similar dynamics when we look at fertilizer, seeds and pesticides and fertilizer, for example. Just two firms control a hundred percent of North American potash production. The four key companies control a large amount of the global fertilizer trade. In seeds, it's also very similar and in pesticides. In the seeds and pesticides that's especially interesting because since the 1980s and 1990s, the seed and pesticide companies actually merged with each other. We can't even say there's a set of seed companies and a set of chemical companies. It's actually seed and chemical companies. That's one set. And they control around 60% of the global seed market and around 70% of the global pesticide market. And that's really what prompted me to want to work on this book is that after 2015, there was a set of mergers in the seed and chemical sector that concentrated those firms even further. They used to be dominated by six firms. We used to call them the Big Six, and then they had major mergers where Bayer bought Monsanto, Dow and DuPont merged and formed Corteva. Syngenta group was bought by Chem China, and then bought by Sino Chem, a big Chinese chemical company. And then BASF bought up all the bits that the other companies were forced to sell to pass regulatory hurdles. And so, we ended up with a Big Four. And these companies produce both seeds and chemicals and have a quite an enormous impact in terms of their market dominance.

Norbert - Wow. This is really important and I think it's a topic that many of us who look at the food industry aren't paying attention to. And I'm really appreciative of you laying out this concentration that's taking place. Jennifer, when reading the book, I was really struck by the fact that this is not just a book about the farmers themselves and the farming industry and the companies that provide the inputs. But you also touch upon the role of universities and university science and scientists; and also the role of government in helping to fuel or seed innovation in this sector. And, you know, here I was hoping you could talk about this important role for universities and also the government given that we're in a current moment where we're seeing a retrenchment from investments by government, and also the ability of universities to continue to seed innovation. So I was hoping you could share some of your insights.

Yes, it's certainly an interesting time on the landscape of spending on innovation and with a retrenchment of state pulling back away from supporting technological innovation and other innovations. And that's certainly true in the farm sector, and that's very different from the situation if we go back to the 1800s and see, as you mentioned, the role that the state played in terms of really trying to support innovation in these sectors. And what I argue in the book is that these firms, they got big in the first place, and they were able to consolidate in the first place, through a series of what I call market technology and policy factors. And it's kind of messy. I put them in these three big categories. But in terms of these market factors, that's what most people tend to think about when they think, 'oh, a firm got big. Maybe it's just more efficient. It's able to produce products more cheaply and therefore it just grew to be big.' And that's much more complicated than that of course. And that's because, as you said this role of technological change in which universities have played a really important role. And government support and throughout history in the US, a lot of the book focuses on the US because we have good information and data there. And the US set up the land grant college system really to support development in the agricultural sector. And that gave us, you know, a lot of the innovations that led to, for example, the hybridization of seeds. And the corporations that took up that innovation that the state supported through university research, those firms also work directly with universities in many instances, to have these kinds of collaborative relationships, to develop, herbicides, to develop seeds, to develop further farm machinery, etc. So that role of technological innovation is really important, and that innovation doesn't just come from nowhere. It doesn't just pop up. It doesn't just show up one day. Right? It comes from investment. Investment in universities and research and development. And so that has been a really important strand to develop this kind of industrial agriculture. And now we know from university research, etc., that there are some problems associated with it. Yet it's proving hard to get that kind of funding to spur a new transformation towards a more sustainable agriculture because we're not giving that kind of state support, and support to universities to do that research and innovative work to lead us towards more sustainable agriculture.

So, I think there's a lot there that we need to work on. And that's some of the recommendations that I make at the end of the book. Is that we need to shore up that kind of public investment in innovation, in alternative systems to address some of the problems.

So just let me tag on another question from that. Just what are the consequences then for having just a small number of firms dominating this sector and no longer having these investments in innovation?

Yeah, so what we're seeing increasingly as the state has pulled away from supporting agricultural research, is that most of that agricultural research now is being done by private corporations. And the big concern there is that as you have a smaller and smaller number of very large firms dominating in the sector, their incentive to innovate actually weakens. It weakens because if there's not a lot of players in the marketplace that are doing innovative work, there's just not a lot of competition. And so why would you innovate if you don't have to? If you're already a monopoly and you're able to sell your product, there's not a lot of incentive to innovate in a way that might then decrease the sales of your old products. And so, what we're seeing is a shift in innovation from the private sector, away from these kinds of transformative innovations and much more towards what we call defensive innovations. They're innovating in ways that actually enable them to sell existing products. And many would say that the rise of agricultural biotechnology was actually that kind of a defensive innovation. It was modifying seeds to make them resistant to the application of existing herbicides. And so there was innovation, but it was actually spurring further sales in an existing product. And part of the reason for that was that it became very expensive for these companies. The regulatory hurdles became quite expensive for them to develop new herbicides. And so, they were like, 'oh, it's cheaper and faster to work with seeds. Why don't we do it this way and then we'll continue to sell the herbicides.' Which by the way, got them a lot more profit than selling the seeds. So that's why they bought up a lot of the seed companies and really consolidated in that period.

And there's a longstanding concern among competition regulators, the regulators that try to prevent a huge concentration in the economy, about this question of innovation. And it's very relevant in the agricultural sector. There's this sense that if you allow too much concentration to happen, it can dampen that innovation and that takes away that dynamic, innovative spirit within the sector. It's definitely a big concern.

Norbert - Jennifer, I really appreciate this. Earlier in my career I was a part of some research related to biotechnology and innovation that happens there. And one of the things that I learned about is this idea of building thickets. These sort of patent thickets where you create a series of patents that actually make it difficult for others to be able to innovate in that same way. There are these real challenges of this kind of defensive innovation. And that's just one of the challenges that you bring up in the book. And I am interested in understanding, as sort a last question, what are some of the recommendations? You mentioned public sector funding of agricultural research and many of my colleagues in my discipline have said we need more research for agriculture. Are there other areas of recommendation to address some of the concerns you raised in the book?

Thanks, Norbert. Yes, definitely. And I definitely do call for greater public support for agricultural research. And that's something within the agricultural sector. And I think there we really need to focus efforts on alternative agricultural production methods. For example, agroecology, which tries to reduce the amount of external inputs, not to increase them, by using nature's own processes to achieve the same functions of diversity and pest control, etc. And what's troubling is that when the firms don't have that incentive to innovate, you know, they're definitely not going to innovate in ways that would reduce their profits. They're not going to do that. The public sector has to step in if we want to see that kind of research done. But we also need measures outside of that food and agriculture system that will benefit food and agriculture. One area is stronger antitrust policies. Policies that would prevent further mergers and acquisitions that would allow those firms to continue to get bigger and bigger. Those antitrust policies are used largely, we've got merger guidelines, for example, in North America. And in Europe, when two firms want to merge, they have to get regulatory approval to do so. And those merger guidelines really walk the regulators through what would be a merger that might dampen competition, that might weaken innovation, you know, that kind of thing. It's important that we make those rules stronger. They had become progressively weaker after the 1980s. There was this move in the regulatory space that was this kind of idea that maybe it's okay if firms get really, really big because they can benefit from economies of scale. Maybe they can bring down consumer prices and maybe we shouldn't worry so much about these other areas of control. And there's been a bit of a shift in view around this in recent years where we've seen the rise of concern about these very big companies, especially with what we see with the big tech companies taking control over all these aspects of our lives. And people are saying, wait a minute, maybe we don't want to have this just a few companies controlling so much of our lives. And so, you know, we need to think about other ways to enforce antitrust policies to make them stronger so that we foster more competition and not just focus on whether something's more expensive or not.

And that's, I mean, it's a bit of a hard thing to explain to some people. Obviously, people want to see lower prices. But the idea that we have to get across is that when competition dies, when it's not there, that's when the monopoly can really raise prices. And so, we need to have that competitive marketplace in order to spur innovation and also to bring prices down. That's really important and that's a kind of agenda item that's involves food and agriculture, but it's outside of the food and agriculture sector. It encompasses more. And another area where I think we can do more is to reign in the kind of undue corporate influence on the policy process. And that's arising out of a concern that as we're seeing fewer and fewer dominant companies in the food sector, and in other sectors as well, they tend to gain more political power to influence the policy and governance process. And so, what we're seeing is heightened lobby activity. Sponsoring of scientific studies and yes, coming back to the question about universities. But as corporations get bigger, they can shape science in ways that can help them win regulatory approval for their products. We need broader policies on conflict of interest to prevent large companies from taking over the policy process. And I know that's a really salient topic in the US right now, given what's going on in the broader politics. And I think it is a broader politics issue that needs to be seriously addressed if we want to support a more transformative form of food and agriculture. These kinds of policies like stronger antitrust, better conflict of interest policies, and also support for public agricultural research are all really important steps. I don't think any one of them on their own is going to do the trick in terms of spurring this desperately needed transformation in our food systems. But together, I think, they can bring us closer to that goal.

Bio

Jennifer Clapp is a Tier I Canada Research Chair in Global Food Security and Sustainability and Professor in the School of Environment, Resources and Sustainability at the University of Waterloo, Canada. Dr. Clapp is currently a member of the International Panel of Experts on Sustainable Food Systems (IPES-Food) and a member of the Scientific Advisory Committee of the UN Food Systems Coordination Hub. From 2019-2023, she was a member of the Steering Committee of the High Level Panel of Experts on Food Security and Nutrition (HLPE-FSN) of the UN Committee on World Food Security, and served as Vice-Chair of that body from 2021-2023. Dr. Clapp has published widely on the global governance of problems that arise at the intersection of the global economy, food security and food systems, and the natural environment. Her most recent research projects have examined the political economy of financial actors in the global food system, the politics of trade and food security, and corporate concentration in the global food system. She has also written on policy and governance responses to the global food crisis, the political economy of food assistance, and global environmental policy and governance. Her most recent books include Food, 3rd Edition (Polity, 2020), Speculative Harvests: Financialization, Food, and Agriculture (with S. Ryan Isakson, Fernwood Press, 2018), Hunger in the Balance: The New Politics of International Food Aid (Cornell University Press, 2012), Paths to a Green World: The Political Economy of the Global Environment, 2nd Edition (with Peter Dauvergne, MIT Press, 2011), and Corporate Power in Global Agrifood Governance (co-edited with Doris Fuchs, MIT Press, 2009). Her forthcoming book, published with MIT Press (2025), is titled Titans of Industrial Agriculture: How a Few Giant Corporations Came to Dominate the Farm Sector and Why It Matters.
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E267: Nzatu uses bees and ancient grains to uplift African farmers
24 mar· The Leading Voices in Food
The climate crisis is devastating the ability of African farmers to support themselves and their communities. Farmers struggle with a lack of running water, electricity, communications, and public transportation. Entire communities are often cut off from the larger world, exacerbating and extending the poverty crisis that grips large parts of the continent. To overcome these issues, our guest, Gwen Jones, co-founded Nzatu Food Group, a regenerative agriculture business designed to protect biodiversity and mitigate climate change. Nzatu Food Group has done some remarkable pioneering work. Gwen is connected to 15,000 Sub-Saharan farmers across 15 countries through beekeeping, sustainable agricultural and conservation training, and by building an increasingly international market for farm products.

Interview Summary

So please begin by telling us why you and your sister founded this initiative and about its unique strategy for helping farmers.

Well, firstly, our strategy is based on an engage-to-support premise with an approach that focuses on uplifting farmer livelihoods. As you know, farmers are critical actors in agroecological transformation and important stewards of biodiversity. 80% of the world's food production is done by smallholder farmers, yet only a mere 3% of climate finance goes to our food systems. So, this presents a key avenue to increase intervention in this space through public policy and unlock climate transitional finance.

Helping farmers is so, so important, especially with these small farms. Tell me more about your own history and what led you to start your organization?

Denise, my sister and I, who are the co-founders of Nzatu, we come from a rural community in Southern Zambia. And we grew up alongside smallholder farmers. We understand inherently what the challenges, but as well as the opportunities that smallholder farmers face. What started off very informally helping our relatives and our tribal communities became Nzatu, we started it off by showcasing to our relatives and our farmers on how they could increase their income with simple interventions by keeping bees. And through training and education, we were able to show farmers that through the income on bees, they would earn three US dollars per kg on honey. Which gave two harvests a year compared to 20 US cents on maze. Which was a rain fed and only produced one harvest a year. It made economic sense for them to also keep bees alongside their maize production. And in this way, it would help with economic shocks and help to give a diversified income. So, we were so excited to share this with our farmers. And it grew like wildfire as you can imagine. The farmers in our program were more prosperous. And, from the income that they got from the honey, they were able to get better inputs for other production. And that engagement helped to bring other interventions as well to the communities.

So, how exciting that you were able to make such an important transformation. And I can see why farmers would be grateful for that sort of help. Tell us if you would, about the climate crisis and how it's affected African farmers?

In some cases, there's too much water from flooding. In some cases, too little water. So, you know, that volatility- how do you plan with that? In one year, you would have flooding and, so your crops would be washed out in the following two or three years you have absolutely no rain. There is just no way to plan in such kind of situations. Farmers are the ones that are mostly affected by climate change, and all we can do is just be there as a support mechanism. How can we work around that? How can we bring in the in-between periods, bringing in higher yielding seed where they can at least recoup whatever they can do in that season? It's very, very difficult for the farmers.

Tell us about your vision of regenerative agriculture. What does that concept mean in your context, and how can you help farmers adapt to this changing climate?

Yes. We started off in a very, very grassroots way. I was always fascinated to understand the ancient grains of Africa. Africa has 26 lost crops. These lost crops are including millet and sorghum and Teff and fornio. These are the indigenous grains of Africa. Indigenous to the diet, but indigenous to the environment. They're very drought resilient and also, they fix nitrogen into the soil. So, they help to bring more resilience and soil health, which is what is lacking in Africa across the continent. We have vast soil degradation, which is also contributing to climate change. By reintroducing what is already inherent in the food history of Africa, it's a very key intervention. Sometimes is the smallest innovation that can bring about the biggest change. Is bringing back the food that is indigenous to communities. There is a resistance though, because our communities have gotten used to maize. I myself are very used to having nshima, which is made from corn, which only offers 3% nutrition. And it's very hard to change that staple to go to, let's say, nshima using sorghum or millet because the taste, is a palate issue. But we have to bring in recipe days. How can we train farmers to use this in their everyday diets? It starts off with that connectivity. How can we help children to take boiled cowpeas to school? You know, making sure that they can use cow pea flour to make cookies and sausages and innovative ways to bring in the recipes on how they can use these crops. It's not enough to just say you've got to, you know, grow the intercrop with ancient grains, because of the nitrogen fixing aspect. You've also got to bring that cultural acceptance by connecting with communities and helping them find ways on how they can prepare their food. So that when you talk about innovation, it's cuisine innovation as well. Not just, soil health and using big words like carbon capture, etc. It's also about the everyday tactile innovation in a simple thing like having recipe field days in our communities.

You spoke, especially about introducing, well reintroducing, if you would, indigenous grains. Why were they lost in the first place and what have you done?

The crops were lost through commercialization. Maize was introduced as an export cash crop to support the war efforts in Europe. And along that commercialization, the tools and the inputs that were needed to produce maize is what was commercialized. And communities also had to pay the Hut Tax in Maize. So, because of those at policy level and at export level, the change happened slowly over time because it was easier to grow the crops that were meeting the mandatory requirements. Sorghum and millet became a second or third crop to produce because it wasn't something that was a mandatory crop. And over time, maize replaced the nutritious grains of sorghum and millet. I'm just taking like one example of that. The commercialization aspect.

Well, there are generations with little experience eating these products or growing them. Is that right?

That's true. Like I said, me included. Even though, academically I know and scientifically I understand that sorghum and millet is of higher nutrition, it's having that paradigm shift changing the dietary approach to it. And that is one of our key interventions that we can make in our communities. But by having this face-to-face contact with our farmers, we are able to pass that information on. We're able to transfer that knowledge and bring about including sorghum and millet. So, as you know, Nzatu works mainly with coffee farmers. Coffee is one of our main crops that, that we are engaged in. And our coffee producers focus mainly on coffee. Our work is by encouraging farmers to grow the millets and sorghums so that the coffee farmers themselves will start consuming millet and sorghum. But as well as finding a market for them for those crops.

And are the farmers receptive to the reintroduction of these grains?

It is challenging because as you can imagine, how you harvest coffee and how you harvest millet and sorghum is completely different. Millet and sorghums and most of the ancient grains, the grain is very small. It's having the tools, the harvesting techniques and the weeding techniques. There's so much involved in it. And this is where climate transitional finance can really help.

Tell us more about the process. How does your organization go about doing these things?

We engage with farmers. Most of the farmers that we're involved in are already practicing mulching and other organic practices and regenerative agricultural practices. It is much more common than we think. Farmers are already conservation in nature because it's inherent in traditional African practices. What we are doing is we are just really enhancing the knowledge that they already have and bringing out the historical practices. For example, when it comes to wildlife conservation, Africans in the tribal communities are already totemic in nature. Meaning that families identify with different animal groups. There is already an indigenous wildlife conservation that already is practiced for hundreds of years in the village. If your family has a totemic nature of, let's say, kudu, that is an animal that is sacred to your lineage and you would never hunt that kudu, et cetera. So that those age-old practices have been there for centuries. And it's really inculcating and bringing back that cultural understanding when it comes to the cuisine, when it comes to the wildlife totemic nature of those communities. It is truly lost knowledge that we are really committed to bringing back into our communities.

And as farmers begin to grow these products, is there a market for them?

Yes. This is where I know I get so excited just about the day-to-day work that we are doing. But we are a business, at the heart of it. We really have to make a profit somewhere. And we take product to market. Our team, we have an amazing team across Africa and in Europe and here in the US as well as Asia. And consumers today have become more conscious. They're looking at products that have an environmental and social value. And we communicate this through our brand positioning. Nzatu's brand is about taking that story to the consumer so that we can avail the product on the retail shelves by giving them the story of what happens in the field. Nzatu is the voice of the farmer. We are there to tell the farmer's voice to the consumer so that we can engage with consumers on every retail shelf that we can.

As a consumer, I would find it appealing to know more about the history of the grains that I see at the store or other products for that matter. And about the farmers who grow them. How are consumers responding?

Yes, the thing is, you know, how do we communicate? Consumers are more interested in how we can help a single farmer. Yes, there is an interest to know about how we reduce carbon emissions, etc. But if you can also add the story to it, that by helping a single farmer, you are reducing carbon emissions. You are helping to bring in higher livelihoods. You are helping to bring in increased health and safety measures to the production methods of those products. You are helping to uplift communities. Children are going to school. You are helping to reduce wildlife poaching. All by that single dollar that you are spending on that product. That is what the consumer of today wants to do is how can I make a difference in the way I live and in the way I consume? And that is our goal with Nzatu, is connecting that story to the consumers today.

What are some of the challenges that your organization faces?

Yes. You know, the higher the dream, the bigger the challenges. There's so many, ranging from trying to find ways that we can provide better honey straining equipment to our farmers so that they can offer better quality honey. But that's at a very micro level. On a macro level, the challenges are how do we get to change policy so we can increase climate transitional finance for farmers? As I mentioned earlier, only 3% of climate finance goes to food systems. How can we increase that number? And, you know, Kelly, one of the biggest problems that farmers face is with all the EUDR regulations, etc., that are in place now, and scientific based initiative targets and all, how does a farmer in rural Zambia- how are they able to change their method of production to meet those stringent targets? That takes money. It takes investment in their practices to be able to change from chemical-based agriculture to organically driven agriculture and regenerative agriculture. How do they access the inputs, the seeds to be able to intercrop with leguminous crops. That takes investment. You know, and then if they're only getting 20 US cents per kg from maize with rain fed agriculture, how is a farmer supposed to be able to now even think on investing? There is no money. This is the biggest challenge we face the smallholder farmers are the stewards of biodiversity. They need to be financed. They need to be equipped to be able to accelerate the change because really, they hold the power in their hands. And for us, this is where it's the most exciting, is if we can support the farmers to do what they need to do out there then it's a win-win for everyone. It's a win-win for the farmers. It's a win-win for the consumers. It's a win-win for our partners. We are partnered with art Cafe in Italy, who's our roasting division and Urban Afrik, who are our logistic partners. So, we have the system in place that at every point we have partners that have the same philosophy as we do to support and address climate change.

You mentioned investment in agriculture and in financing. Who are the players in this space? Must the funding come from international organizations or from the country Governments themselves?

The main actors are already in place, like IFC (International Finance Corporation), World Bank, are already channeling that money towards that space. They're committed, they're active in that space. But I would also encourage family offices, climate smart funding, social impact funding. The groups that are involved already in agriculture, the ones that are already engaged and already have the due diligence process in place to actually track that. But also, Kelly, I think that Ag Tech, it would be a very important component with the technology that exists today, whether it's through blockchain or any type of digital tech finance that can enable this. Because it's also tracking, you know, and the data needed to actually support this. It's an entire ecosystem that we need. Using digital tools to help to map out soil health and how we can improve soil health right up to the consumer tracking the story. But at the genesis, how do we finance the innovation on the digital tools? How do we finance better seed and how do we get it to the farmers in term terms of storage? How do we harvest so we can reduce waste? It's an entire ecosystem that is required. There is no one answer, but where does it start? It starts at the top. It starts with the awareness. It starts with telling the story so that we all have a stake in it to change.

Bio

Gwen Jones is the co-founder of Nzatu and Chief Partnerships Officer. The daughter of a Zambian mother and English father, Gwen grew up in Zambia, along the banks of the Kafue River. Alongside her sister and business partner, Denise Madiro, Gwen experienced firsthand the immense challenges sub-Saharan African farmers faced every day. Gwen moved to the United States more than 20 years ago and has spent her entire 30+ year career focused on global food security and community development initiatives throughout sub-Saharan Africa. Nzatu is Gwen’s latest initiative. As the climate crisis worsens, rural farmers are at even greater risk. Together, Gwen and Denise decided to do something about–and that’s where Nzatu comes in. Gwen and Denise have a vision that regenerative agriculture can be a nature-based solution, which can and will create value in Africa, for Africa. Her leadership helped foster partnerships with Artcafe, which is roasting coffee beans grown by Nzatu-supported farmers, and Urban Afrique, which is helping bring Nzatu’s products to the U.S. market.
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E266: What's next for school meal quality?
13 mar· The Leading Voices in Food
The food and nutrition landscape in our schools is really important. School meals affect the health, wellbeing, energy, vitality, and ability to learn for millions and millions of children. And for those whose family struggled to buy food, the importance of school meals cannot be overstated. This makes decisions about what foods are served in schools and where they come from. Highly consequential and raises issues about national and state nutrition policies, the influence of big food companies in shaping this picture and lots more. It's a good time to unravel all this, which we can do today. Thanks to two experts with us. Dr. Marlene Schwartz is Professor of Human Development and Family Sciences and Director of the Rudd Center for Food Policy health at the University of Connecticut. Mara Fleishman is CEO of the Chef Ann Foundation, where she has been a leader advancing school food change, advocating for scratch cook meals that promote children's health and for more sustainable food systems.

Interview Summary

In discussions about school food, it seems there first came a nutrition part, which in more recent years has been joined with a concern about where foods come from. Better connections, say between schools and low whole food systems. Let's talk about both, Marlene, let's start with nutrition. You have been a pioneer in working with schools, an interest that goes back a number of years. What was this food environment like in schools before change began to occur? It was my impression it was sort of a free for all.

So, yes, I would agree that it was a free for all. The actual school lunch, what we call the reimbursable school lunch, which is the meal that the federal government gives states and then states give the local food service directors funds to support, that has actually always had nutrition standards. But historically the problem was under nutrition. The standards were very focused on making sure students had enough to eat. There were no maximums. It was really all about making sure that there was at least the minimum number of calories and foods available. But the other foods that were sold in schools, which we call competitive foods, so these are foods that were vending machines and school stores and fundraisers and things like that, were hardly regulated at all. And that is really where we saw a complete free for all. We saw ice cream and chips and soda and sports drinks and things like that. And I remember going to one school here in Connecticut and counting 13 vending machines in the high school. It really was remarkable the amount of unhealthy food that was being sold in schools.

You know, I was thinking of that same thing when I was living in Connecticut, I went to my son's high school, a different school than what you're talking about. And I forget the number of soft drink machines they had around the school, but it was in the teens. And when I was a boy, I don't remember any soft drink machines in my schools. Maybe they hadn't been invented yet. I'm so old. But it was really pretty remarkable how much access children had to these things. And as I understand, the importance of those machines in the schools to the companies was more than just what food was being sold. There was a real branding opportunity. Is that right?

I think that's exactly right. And I remember over 20 years ago when we were talking to some of the soft drink companies about the vending machines, they were quick to point out that they didn't make all that much money selling soft drinks in schools. Which I felt was them basically admitting that they weren't there because of the income from the sales in schools. But rather it was a hundred percent branding. And that was also really evident by the fact that you had to have a contract. So, the school districts had to have contracts with Coke or Pepsi or Cadbury Schwepps to only sell that company's products. It was blatantly obvious that this was all about marketing and marketing to an audience that they had to go to school, and they were going to be exposed to those logos every time they walked past one of those machines.

Yeah. I remember in those days it felt like a victory when the companies agreed to change what was in the machines, but it was what was on the machines that was more important. So, you know, once again, that was a sign of the industry having upper hand. Let me ask you a different question. So there have been some important systemic changes discussed in context to school meals, ones that really could affect the nutrition landscape nationwide. And I'm thinking in particular universal free school meals. Can you tell us what this means and why it's important and what do you think ought to be done?

Sure. So universal free school meals, or as the advocates call it Healthy School Meals for All, is a policy that is providing meals at no cost to all students. So typically the way it works in most school districts is there's three categories of payment. There are students who pay quote, full price. There are students who pay a reduced price and there are students who receive the meal at no cost, and it has to do with the income of their household. But what has been shown, interestingly most significantly during the pandemic, there was a policy from the USDA that all students would receive meals at no cost because we were clearly in a national crisis. And in some ways, it was this silver lining of that time because what it showed, those of us who study school meals, is how wonderful it is to be able to provide meals at no cost for everyone there. There are a lot of benefits. Some of it is just the administrative burden of having to figure out each and every household and which category they're in is lifted. You don't have to track which student is which as they're picking up their lunch. But it also really removed the stigma. One of the most surprising things that we've seen in our data is that even students who would have gotten their meal at no cost already were more likely to take a meal when it was provided at no cost for everyone. Because it just became part of what you did. Everybody was eating the school meal. And I think that it always leads to higher rates of participation among all of those sorts of categories of kids. And I think it also really allows the people running the food service to focus on preparing the food and making it the best it can be and not having that burden of the paperwork.

And will there come a day, in your belief where this will happen?

I hope so. What we've seen is that a number of states, I think it's eight right now, actually passed state policy to keep universal free school meals after the federal guidance that had been out there was lifted after the pandemic was over. And so \ my hope is that they'll really demonstrate the benefits and that other states will join in. There's certainly a lot of advocacy in a lot of other states to try to do this. And some of the benefits that have also been shown are outcomes like attendance and academic achievement and just really showing that just like we use our public funds to fund the teachers and the building and the water and the library books. It's sort of seen as a basic tool that the school needs to make available to students so that they can succeed academically. And I think that shift in attitude as opposed to seeing the lunchroom as this sort of separate thing from the rest of the school building. I think that shift in attitude will be really helpful overall.

That makes good sense. Mara, let's turn to you. I'm really eager to hear about the work of the Chef Ann Foundation. I've followed its work for a number of years, but I'm eager to hear what the most recent iteration of this. So, I'm hoping you can tell us, and also give us some sense of why you got interested in these issues.

Well, the Chef Ann Foundation is actually celebrating its 15th birthday this year. And we help school food programs move from serving more processed heat and serve food to serving more freshly prepared scratch made meals in schools. And we do that through looking at what are the barriers to school food programs actually serving this freshly prepared meal. And there are a number of barriers: training, skill sets, equipment, access to healthier food, local farmers. The reimbursement rate, you know, how much money they get actually for serving these meals.

What about the power of the companies that are providing the prepared foods to schools?

Yes, that's a big piece. So those are very loud voices that have a [00:09:00] lot of power behind them. Through the passing of the Healthy Hunger-Free Kids Act in 2010, there was an increase in nutrition standards change and what Marlene was saying is that while there was some basic before that, after Healthy Hunger Free Kids Act, we had saturated fat standard, sodium, whole grain. But what happened was these big food companies just kind of R&D'd their food to meet these standards. So, we are in a better place today, right? Because we are serving more whole grains. We are serving less saturated fat, less sodium. But one of the big things that the passage of that Child Nutrition Reauthorization did not do was really reduce ultra processed food in school. And that I think is the next horizon for school food, is how to actually help them reduce that ultra processed food. Because there is, you know, a lot of research out there, I'm sure Marlene is familiar with this, that is linking more ultra processed food to diet related disease. So, we go in and really help these school food programs with more culinary training, we do assessments to tell them what kind of equipment they need to serve fresh food. A lot of it is financial training. So, when you're serving a chicken nugget. One chicken nugget that meets the standards. You bring it in frozen. All you have to do is reheat it and put it on the line. If you're making a chicken strip from scratch, you know you have to buy the chicken, you have to buy the breadcrumbs. You have to buy all the ingredients. You have to start looking at your program through a different lens. Your financial modeling is different. Your labor resources are different. Meeting meals per labor hour is different. We provide training on all these fronts to help them run that program.

Well, it sounds enormously beneficial. How much do, in the modern day, how much do schools care about these things and how much do parents care about them?

Well, I think something that's really exciting, and I think we have the best vantage point for it, is that schools, parents, communities, even government cares way more about it today than they did when the Chef Ann Foundation was launched. We were definitely considered more of a niche nonprofit organization that only worked with kind of districts that were very progressive. But today, we have, waiting lists for our grants. we work in every state in the country. And we now have a cooperative agreement with the USDA, which would never have really been possible 15 years ago. They just weren't looking for partnerships with organizations that were pushing the envelope to this level. So, I think now's our time.

It's so nice to hear that because I remember back when the Chef Ann Foundation got started. And that niche role that it played was clear, but there was so much hope that it would expand and it's really nice that it has. And the fact that you're in every state and the USDA is working with you, those are all really good signs. Well, let me ask you another question. This one about equity. How does this work fit into an equity point of view?

I mean, that's pretty much the heart of the matter, I think in many ways. I started this work because I worked for Whole Foods Market for 13 years and I was very interested in food systems work. I have three children and my oldest, who's now 23, when she started in kindergarten, I went to lunch with her. They were serving, this was before the Healthy Hunger Free Kids Act, they were serving a very highly processed, high sugar, low protein meal. And I was looking around at the cafeteria really looking at who is eating this meal and thinking to myself, what are we doing here? We are not providing the same springboard for every kindergartner to thrive and meet their true potential, right? There were kids coming to school with their very healthy packed lunches and little baby organic carrots and whole wheat bread and no-nitrate turkey sandwiches. And then there was a whole host of kids eating this very ultra processed high sugar, low fiber, no protein meal. And the equity issue that you're speaking of was right there and very blatant. And if we're not going to provide children that same springboard to thrive from, which, you know, is what K 12 is about, right? That's what we're trying to do for everyone then we have some big issues. And to Marlene's point, we disregard food in that equity issue. So, we don't make higher income kids pay for their bus rides or anything else. And we don't kind of create that divide. We don't devalue anything as significantly as we do food. And it's what makes you thrive.

I heard once a very interesting statement from a physician who worked on brain development. And he said that if children are not fed correctly during critical stages of their development amounts to a life sentence. That there are just certain things that will never recover no matter what happens. Having a better school food environment helps erase some of that for sure. Not all of it, but at least some of it. And then each of the children are more on a level playing field in terms of their academic achievement because some aren't so much more burdened by a terrible food environment. I can see why this would, would really be so important. Marlene, let's talk about what changes have been made. Both you and Mara have alluded to this, but specifically what's happened over the years in terms of school meals and have there been studies on the impacts on children?

Sure. Well, I completely agree with Mara that the Healthy Hunger Free Kids Act was a really bright spot, certainly in, in my career, in terms of seeing changes to school meals. So, as I mentioned before, we used to have only minimum calories and things like that. And now we finally have maximum calories based on the age of the child as well as sodium, saturated fat, increasing whole grains, low fat dairy, things like that. The other thing with the smart snacks, so the competitive foods that started to have nutrition regulations. That was a perfect example though of where the companies use their research and development dollars to essentially make a Dorito that fit the standards and a cookie that fit the standards. And I think in some ways that has highlighted the fact that our society is starting to look much more skeptically at highly processed foods. Because I remember standing in my kids' high school a number of years ago after smart snacks went into a fat, and I was in front of the vending machine, and a parent came up to me who knew this was what I studied and said: 'What are you talking about? That school food is healthier. Look at that!' And sort of pointing to all the packaged chips and cookies and other snacks. And I tried, I was like, well, but those are reduced fat Doritos and those cookies are lower in sugar and probably have some whole grains and nobody cared. Parents basically can recognize junk food when they see it. I one hundred percent agree that processed food is the next dimension that we need to really be able to assess, measure it so that we can start to regulate it. And to have that be a new way in which we try to manage the quality of school meals.

Before we get to the issue of what sort of research has been done to show the impact on kids, let me follow up on the Doritos example. Well, it sounds like what we were talking about earlier with a Coke machine being so important because of the logo and branding and stuff like that. Sounds like exactly the same things that work here. That the company wants to have Doritos in the school, not because they sell so much or make so much money. But that they brand, it's a chance to brand that particular product or that particular company. And then of course, kids want those when they get out of school and they talk to their parents about getting them. So, it seems like the fact that they get reformulated to be a tad healthier isn't much of a victory is it.

No, and I feel like it's almost like the worst of all situations. So, we've done some research on this at the Rudd Center and have a graphic where we show like the school version and then the grocery store version. And it's completely clear that it's the same branding. Nobody would mistake or not think it was the same product. But the grocery store version is not as healthy as the school version. So you're simultaneously - if someone were to know, for example, that about smart snacks and the nutrition standards they could say, well, they sell it in schools maybe it's better. They might be more likely to buy it in the grocery store, but of course what they're buying in the grocery store is worse. And then if you ask folks from the food industry, which I've done, well, why don't you just reformulate all of it? Why don't you only sell the school version in the grocery store? They say, 'oh, well, we are just worried that people won't like it because it's not, you know, as palatable.' It's like a lose-lose proposition. I would like, personally, to see all of those foods removed from schools. And to answer your question about the research though, it's really promising. I mean, there have been a couple of studies that I always go to, to sort of document the positive impact of the regulations that came from the Healthy Hunger Free Kids Act. One was a study showing that basically the meals that students eat in school for most American children are the healthiest meals that they eat all day. So that it's sort of the best source of nutrition. And then another study that was looking at BMI trajectories over time and found that particularly among lower income children there was a measurable impact on BMI in terms of reducing the risk of childhood obesity after the Healthy Hunger-Free Kids Act regulations were put into place. So, I feel like when you have those sort of large national data sets and you can look at impact across the country, it's pretty clear that even though we of course, want to see more change and keep going forward, even the changes we've made so far have had an important impact.

Do you think the changes are sufficient to produce impacts on learning and academic achievement and things like that?

We have a hard time having enough data to really get at that very specific outcome because so many things have impact on academic achievement. But there definitely have been some studies that have been able to show some impact. But it's a tricky thing to measure.

Mara, let's talk a little bit about how the school can be part of a vital and healthy food system overall. Tell us about your work in that space.

We look at health in its kind of larger capacity, right? So direct related nutrition results with kids eating certain foods. But in addition, the school lunch program is funded to the tune of $17 billion a year, right? So, if we think about spending those dollars in the food system and how we're going to change the food system we have to really think about how we empower these school food professionals to make the best choices they can to affect change. With approximately about a $4.30 reimbursable rate price of a lunch, it's not easy right now. Labor prices are going up and you have to pay for labor out of that. You have to pay for food cost out of that. But you can prioritize your choices.

Some of the things that we work with districts on are what are their top 20 highest volume purchases in the school food program. And how can we look at that top 20 and make some adjustments to purchase things that can impact the environment in a more significant way. Often it is animal protein that's in their top 20. That is really an opportunity for districts to make better choices. Local choices. Higher quality choices. You know, choices that impact not only the health of the environment, but the health of their local economy. But it is challenging because your district has to be able to manage raw animal protein. A lot of the processed animal protein products coming to the districts are pre-cooked, and so they don't have to always know how to manage in a kitchen raw animal protein. And that's usually this barrier that we help districts get over. But once we do, there is this huge opportunity for them to purchase higher quality animal protein. Also fruits and vegetables, right? I always get asked this from parent groups who are looking to change school food. Why can't we just purchase everything organic in schools, right? So that's hard on $4.30, right? You can't. But you can make choices and you can look at the highest volume products or the products that are more affected by pesticides, right? So, if you have a salad bar you know you're serving lettuce every day. You can move to serving an organic lettuce, and that is a huge opportunity to move forward. I think things like that are how we look at the food system in terms of school food. But it's really important not just for us food systems people to be looking at it like this, but for us to be training and teaching the school food professionals about their job and the impact they can make, both on student nutrition and environmental impact. And that's a lot of what we do in our workforce development initiatives.

How does seasonal things figure in? Because schools are in session during the months when it's colder in most parts of the country, and the agricultural system isn't going full bore like it might in the summer months. How do you deal with that?

It's really a great point. I know whenever I bring up any kind of exemplary food program in California, people say to me, 'Ugh, California. You can do a lot in California, but what can you do elsewhere?' Well, here where I live in Boulder, the Boulder Valley School district serves close to 15,000 lunches a day. They have 55 schools. It's kind of that perfect midsize district example. And they purchase 40% of their products locally. This is a Northern Climate District. This is Colorado. It takes time. It takes a real steadfast plan. But you, you know, you can purchase potatoes through December. There's a lot of indoor growing right now locally too. So that's also this great opportunity to purchase things like if you have a salad bar purchase, things like lettuce locally, all year long. There's, there's a lot of local wheat production that is happening these days in northern climates and then it's getting milled and processed into different products that you can buy locally. It's very much possible. Can you get to a hundred percent local procurement? Not right now, not at the current reimbursable rate, but there's a lot of room for improvement even in northern climates.

When the schools are buying such foods that come from local sources, are they buying directly from the farmers or is there some agent in the middle?

It depends. Mostly for local farmers, small local farmers, they're buying direct. And that's a challenge for small and even some midsize districts because of their capacity, their procurement capacity, their administrative capacity. But it is possible. Obviously, it's in some ways easier for big districts like, you know, LAUSD (Los Angeles Unified School District). We work with LAUSD. It's an amazing district that buys a lot locally. But they have the volume, they have the capacity, they have the administrative support. That's why a lot of our work focuses on small and midsize districts to actually provide them with that kind of structure and support to do it. And to really prioritize the buying processes through their local purveyors. There are some local distributors that have more local products than others. You know, gold Star is a distributor on the West coast that has more local products. But in reality, the prime vendors for these districts are mostly Sysco or US Foods. And they don't carry a ton of local farm product for these districts. So, they're really going to have to create those partnerships.

I'm thinking of the farmers and what impact it might have on them. And I could imagine for some farmers at least, it would provide a reliable income source and a reliable customer for their products, which would be helpful financially. And I imagine, although I don't know that there are probably cases where the schools are inviting the farmers to come in and meet the kids, and that's probably good for everybody. Does that kind of thing happen?

Yeah, I mean that is huge and as I kind of talked about ultra processed food being the next horizon to look at reducing in school food, I also think how we work with school food programs to connect them and actually have them be stronger customers of local farmers is also this next horizon. One of the new projects that we're working on is called Values Align Purchasing Collectives. So, we're currently doing assessments to determine how we can group small and mid-size districts together to form buying cohorts, basically, to purchase from local farmers. So how can we get them to look at serving some of the same menu items, purchasing together, working together to relieve some of the administrative stress on the districts, but also on the farmer side. So how do we create hubs to do and look at creating a process that can better support? And I think that's the future.

Oh boy. That sounds like a very exciting development. Marlene, just you have something you wanted add?

Yeah, I'm just so exciting to hear all of that. I was going to mention that we have a new project in Connecticut looking at farm-to-school practices across the state, and really trying to work with districts on both the procurement part of it as well as incorporating more into the classroom. So having that connection with local farmers, having that being part of the sort of educational curriculum. And then really what I've always thought was the goal was to have the cafeteria more of a learning lab. Not having it as this, I guess I said before, separate part of the school, but rather incorporating nutrition education, incorporating this is where that apple came from and teaching students where the food is from and particularly if it's from a local producer. I think there's a lot of excitement around there. I think the USDA is funding a lot of states to do more work in this area, and so it's a pretty exciting time.

You know, connecting up what the two of you have just said, Marlene, I remember in the time I was living in Connecticut. Connecticut has a lot of small to midsize towns that are feeding kids and the collaborative that Mara was talking about sounds like it might be a really interesting solution in that kind of a context.

I completely agree. I know some of the New England states, and maybe this happens in other parts of the country too, but it does feel like each school food authority is tiny. I mean, we have towns with one high school and to try to have any kind of buying power when you're so small, I think, is a real challenge. So, I know there are some collaboratives in Connecticut, but absolutely supporting, bringing people together to try to negotiate the best prices and things like that, and make those relationships with the local farmers. It feels like a really great strategy to pursue.

I'd like to ask you both, what is it going to take or what does it take to make these things happen? You're talking about some very good things when they do happen, but what does it take to make them happen? And Mara, let's start with you. What are the factors you think are really important?

We approach our work from a systems perspective. What is the system and what is the biggest barriers in the system that we can kind of selectively tackle, and kind of dig into from a programmatic engineering perspective. For us, and Marlene, I love that you brought up the lunchroom as a classroom, because I think that is really important. I think that's the kind of the ultimate goal and we're so grateful for programs across the country that are working on that kind of thing. What we want to stay focused on at the Chef Ann Foundation is school food professionals. We want to actually educate them. We want to figure out how to provide more professional development, learning, education so that they can start looking at their jobs differently. And the country can start looking at what they're doing differently; and start really looking at the value that they're providing during a school day.

So, what it takes, back to your question, is it really takes breaking down the problem to understand how to put some pieces together to test out programs that can look at breaking down that barrier. And for us right now, we're doing a lot with workforce because what we believe is that in 10 years from now, if we have a workforce in school food that has a different perspective of their job, has different skill sets, is a kind of a different workforce than is right now, than a lot of these things we want to tackle as food systems people will be a lot easier.

That makes good sense. And Marlene, you've been involved for many years in local and state and national policies. In your mind, what sort of things lead to change?

So, that's a good question. I would love to be able to say, oh, it's the research, clearly. That people do studies and they document, this is what we need to do. I think that's necessary, but not sufficient. I think the real answer is parents and people. I had a similar experience going to my daughter's when she was in first grade going and having lunch at her school and looking around and thinking, oh my goodness, what are we doing? I think that it's the fact that even though this is my profession, this is something I study, It's deeply personal. And I think there's a lot of passion behind the importance of making sure our children are healthy. And if I think about the policy makers along the way who have really been the ones that have made the biggest difference, it was off often because they cared about this deeply, personally. And so, I think continuing to tap into that and reminding people how important this is, is how you get the political will to pass the policies that make the real changes.

Well, you know, you both made that really important point about how important parents can be. But really impressive that this started as a personal thing, and you were caring for the welfare of your children and that helped inspire your professional work and look where it's gone. It's really very impressive. I'd like to end with a following question. Are you hopeful for the future? Mara, let's start with you.

I am very hopeful for the future. I think when you look at what's important to our society, school food is often the answer. I feel like when you look at achievement, school food is often the answer. When you look at diet related illness, school food is often the answer. When you look at building local economies, school food is often the answer. And I am really hopeful because I think there's a lot of incredible work being done right now, and we are moving past piloting and we're moving into research. And we're moving into institutionalizing the work. And I think you can see that through policies, through USDA cooperative agreements with organizations and work that they're doing and through the guidelines. And through the excitement and integration you're seeing in communities with superintendents, school food directors, parents, and advocates.

And Marlene, are you hopeful?

I am hopeful. I mean, if I think back to, you know, kind of the early days of working on this issue, I feel like we were met with a lot of skepticism. People felt like, oh, the industry's so powerful, you'll never be able to do anything. I feel like there have been a lot of changes. And I think another shift that I've sort of seen over the course of my career is early on, because of the rates of childhood obesity increasing, a lot of these initiatives that was the hook, that was sort of the anchor. And there were positive things about that because it was such a dramatic change that had occurred that you could point to. But sort of the downside is it wasn't just about that. It's about all children. It doesn't matter what your body weight is, it's about diet quality and having food security and getting adequate nutrition. I feel like we've broadened a lot in the field in terms of how we think about the reason why we're doing that. And that has made it much more inclusive, and we've been able to talk about, as Mara said, how it's affecting lots and lots of things outside of individual children.

Bios

Marlene Schwartz

Marlene Schwartz, Ph.D. is Director of the Rudd Center for Food Policy & Health and Professor of Human Development and Family Sciences at UConn. Dr. Schwartz studies how nutrition and wellness policies implemented in schools, food banks, and local communities can improve food security, diet quality, and health outcomes. Dr. Schwartz earned her Ph.D. in Psychology from Yale University in 1996. Prior to joining the Rudd Center, she served as Co-Director of the Yale Center for Eating and Weight Disorders from 1996 to 2006. She has received research grants from a variety of funders including the Robert Wood Johnson Foundation, the United States Department of Agriculture, and the National Institutes of Health to study federal food programs, school wellness policies, the effect of food marketing on children, and strategies to address food insecurity and diet quality. She is also the recipient of the 2014 Sarah Samuels Award from the Food and Nutrition Section of the American Public Health Association; the 2020 Faculty Service Award from the Department of Human Development and Family Sciences; and the 2021 Community-Engaged Health Research Excellence Award from the Institute for Collaboration on Health, Intervention and Policy at UConn.

Mara Fleishman

Mara Fleishman’s career in food systems advocacy started in her early 20’s when she looked to the power of food after being diagnosed with an autoimmune disease. Mara has over 20 years of experience in leading systems change initiatives in the for-profit and non-profit sectors including over a decade at Whole Foods Market where she served as Global Director of Partnerships. In Mara’s current role, CEO of the Chef Ann Foundation, she has spent the last 10 years fighting for healthier food for our nation’s kids. Mara’s niche is system-based change and although she takes on many roles as a leader, her favorite is programmatic engineering; breaking down problems to their foundation and building programmatic solutions through dynamic and integrated approaches. This type of programmatic engineering can be seen through the work of the Chef Ann Foundation, an organization recognized as the national leader in driving fresh, healthy scratch cook food in schools.

Mara also serves on regional and national boards, has spoken at conferences and academic institutions across the country, and has been recognized in publications as a champion and national advocate for change.
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E265: Exercise vital to quality of health - especially during weight loss
26 feb· The Leading Voices in Food
Everyone knows that it's a good idea to be physically active, but behind that basic knowledge lies a fascinating field of research on the role that physical activity plays in health and in weight control, along with answers to questions such as how much exercise I should get, is there a best time of day to do it, is one type of exercise better than others, etc. Few people can rival Dr. John Jakicic in expertise in this arena. John is a professor in the Department of Internal Medicine in the Division of Physical Activity and Weight Management at the University of Kansas Medical Center. His work has led the field for many years.

Interview Summary

John, I'm not an expert myself on physical activity, but I've been a fan of yours and others in your field for many years. And it just seems to me that it's a vibrant, active, exciting field where almost every day some new finding comes along that confirms the benefits of physical activity or discusses different ways to do it. Can you give us an overview of why being physically active is such a good thing?

I think that if we could take the benefits of physical activity from a health perspective and bottle them up into one pill, we would probably have the most powerful pill that was ever invented. And I think that the reason for that, Kelly, is physical activity pretty much touches every system of the body. Every anatomical physiological system of the body in some way is touched by physical activity. And as long as you're not kind of overdoing it, abusing it, the body is adapting to allow you to do that activity. There's a lot of things that we do where we try to counteract certain things with medications and surgeries. But the one way that we can make the physiology of the body adapt and become healthier, the one real way to do that is through physical activity. And I think it touches so many systems that way, that's why I think we keep hearing about all the pure benefits that we can get from this activity.

Okay. It sounds like it would be easier to have a discussion on or try to find somewhere physical activity is not beneficial. And it's interesting that the body makes room for physical activity by adjusting to whatever the demands of it are. I'm assuming there's some evolutionary reason for this. That people evolved having to be physically active just to get by in day-to-day life. But is that true? Have we inherited something in that regard?

I think we have. And we went from hunter gatherers where you had to take your body and go out and find the food you needed to eat, to we don't have to hunt and gather very much anymore, at least in the US and other developed countries. The most hunting and gathering we do is go to the fast-food restaurant or the grocery store. The body has adapted to that. And I think that's one of the reasons that the body is so resilient. Now you think about it, Kelly, somebody who's had a pretty major coronary event. What's the one thing that gets recommended for them? Become more physically active, start exercising. And the body starts to bring itself back. Not maybe to the way it was before that, but it helps to regenerate the body in ways that other kind of things just don't do it. I think that there's definitely this physiology underpinning that we really need to keep thinking about.

Speaking of coronary events, and you probably know this history way better than I do, so correct me if I'm wrong. But I remember hearing about the important historical role that a cardiologist named Paul Dudley White played with Dwight Eisenhower when he was president. And as I understand the story, Eisenhower had a heart attack, and the prevailing wisdom of the day was let you rest for a really long time after a heart attack. Like the heart was worn out and needed to recover and mend itself. But he reversed that, put that on its ear, didn't he?

Yes, he did, and I think that kind of laid the groundwork for where we are with cardiac rehabilitation and cardiac treatment along the way. And that was probably the groundbreaking thing that happened where don't be afraid to start moving. And that has now evolved to diabetes, cancer treatment. You start to name all the conditions where it seems like activity is good. Even if you've had these conditions, as you go through your treatment plan.

We've focused mainly so far on the physical benefits of physical activity. What about the psychological ones?

I think that there's probably so many of those too, Kelly, and this is maybe where you know more than I about some of these types of things. But there's such great data that came out, maybe 20 years ago, where we were seeing studies coming out looking at depressive symptomatology, for example. And some of the stunning findings they were that people, even with known depression, could benefit and actually reduce their depressive symptomatology with at that time aerobic forms of physical activity. I think it's evolved to all types of different forms of physical activity. So, we have these depressive symptoms that can be dealt with, or maybe even prevented. We've seen it with mood and enjoyment, you start to just start going down the list. And I think the most evolving field that we're seeing right now is just in terms of the entire brain. You know, brain functioning, cognition. And we're realizing that the brain itself is an organ and physical activity in some way is actually impacting that as well. So, it's not just the physical, it's the emotional, it's the psychological. It's this overall wellbeing that we like to talk about.

You mentioned the work on the brain. Is this effect that you're talking about showing up in studies of risk for dementia and Alzheimer's and things like that?

It absolutely is. And I think we're still trying to completely understand the mechanisms by which this is occurring. Is it because activity is having some effect on inflammatory markers? Is it having something to do with blood circulation in the brain? Is it affecting other biomarkers that we hadn't thought about before? But yes, absolutely. It's affecting cognition. It's affecting dementia. It's affecting Alzheimer's. And we're finding that this is a really important thing for older adults. And I think the field is exploding at this point in this space.

Let's get back to the physical benefits of exercise and talk about how they occur. One might think that physical activity exerts its influenced by affecting something like a risk factor, which in turn is what's affecting health. So, you're being physically active, it helps regulate your blood pressure and it's the regulation of blood pressure that's producing the overall health benefit. So, it's exercise does X, fill in the blank, and then that creates Y benefit. But is there a direct line between the exercise and the physical health? It doesn't go through risk factors like that. How does that work?

Yeah, I think that it somewhat depends upon what the outcome is that you're looking for and what you're trying to move. And it gets a little, I'll say wonky. Because at some point there are intermediaries along the way that are probably impacted. Just for example, we've done studies in the field of obesity with physical activity that found that not only is the activity affecting the risk factors, the blood pressures, the insulin, the glucose. But it's affecting like the cardiac tissue itself. It's affecting the factors that are affecting that cardiac tissue. It's affecting the blood vessels themselves. Now, they're clearly intermediaries, but they're probably not the traditional risk factors we're thinking about. They're probably more signaling mechanisms, mitochondrial factors, these types of things that are more physiologically based as opposed to what we would consider our traditional risk factor base. I think the thing that we've known now for a long time, you go back to some of the Harvard fatigue laboratory studies where they were actually trying to get performance out of individuals. How do you get people to perform at a higher performance? Basically, the equivalent of being an athlete nowadays. And what you find is that, yeah, that's how you get people to perform at a high level. But that's also how you get people healthy in everyday life. We really learned how if you stress the body a little bit, the body adapts and makes it stronger as you go forward.

It's good to know that, and it doesn't hurt to get wonky sometimes. That's a very interesting description that you gave. You mentioned weight control. Let's turn our attention to that for a minute. You were the lead author on a consensus statement from the American College of Sports Medicine. A very highly regarded organization, on the role of activity in body weight. Let's talk causation. Most people appreciate the key role of diet in the genesis of weight problems, but less so the role of physical activity. How important is it?

I think it's critically important, but I also want to be very cautious about saying that it's more important than diet or energy intake. I don't like to take that stand because I think there's inputs coming from all angles here that are regulating body weight. And I think that we can get ourselves in a little bit of trouble if we say, what's only this, or it's only that, that it's one thing. It's a little bit of everything. And I think that what we're finding a bit in our research and others as well is that there's a variable response depending on the person. We know that if a person becomes active over six months without intentionally trying to change anything on their diet, they're probably going to lose a couple of kilograms. Two, three kilograms, maybe a little more depending on how much they do. But there are going to be some people that lose a lot more. Some people are going to lose a lot less. The question is, why is that? And in some of our work, Kelly, we have found, and others have found this as well, is that for some people, when they become physically active, the body has this adaptation where it says, hey, wait a minute, this is great. It can kind of turn off or help to better regulate the hunger satiety signals. But for other individuals, when they start becoming more active, all of a sudden they start to become more hungry. And, in that individual, if we ignore the intake side, if we ignore the dietary component, that person could start being active, but their body weight may never move because there's this counter regulatory mechanism for that person.

So, it's critically important to help with regulation of body weight, but how much and how often may vary. And I think the other key factor, Kelly, is I think you've heard me say this before, but I'll say it again. And that is activity can affect some of the health parameters and the outcomes we're interested in, that weight may not affect, or diet may not affect. If we're really thinking about a holistic outcome for patients, we've got to have activity as part of that discussion.

Plus, when you get diet and activity working together, I imagine you get this virtuous psychological and biological cycle. That if you're being physically active, you feel better about yourself. And you don't want to undermine your diet, so you stick to your diet better. That helps you be more physically active. Just a lot of things working in sync.

There's a lot of things when they start to come together. Your body can regulate itself pretty well. It's when we start to force other things into the system that kind of mess it up a bit. And I think the other challenge here is that I think over the years, many individuals don't know what hunger feels like. And so, we've lost that sense. But being active helps to help you to counter regulate that for many individuals. So, it's not just about the energy expenditure. It's not just about the effect it has on weight. It's about some of the other factors that are being affected that help to let the body get a little bit more on cruise control and let it do what it's supposed to do.

We've talked a little bit there about how these two systems, the diet and physical activity, might interact psychologically. And let's get a little more wonky and talk about the biology of it. I remember some studies, and I have a vague recollection of these because they were done a long time ago. And I thought they were done by Jean Maier's lab and at Harvard in the sixties and seventies, where they took lab animals, which of course is a way to isolate the biology because you don't have human psychology to worry about. And they had animals that were on a particular diet and then they either allowed them or forced them to be physically active. I forget which. And my recollection is that the animals started choosing a different mix of nutrients because they were physically active. And that mix of nutrients became a healthier profile for the animals. I'm not sure I'm remembering that right. But how are these two things linked biologically, do you think?

I think that they really link a lot biologically. And I think that we completely 100 percent don't fully understand it all. But I think, sometimes when we think about body weight regulation, the first thing we think about is cutting the calories, and then throwing the physical activity on top of that. And I think that sometimes maybe what we need to do is feed the body and put the activity on top of it so that we have enough energy coming through the system when we talk about it. And Maier's lab looked at this in terms of energy flux. So, if you feed the body enough and then have enough energy burn on the other side of it, that helps to regulate body weight a lot better, it appears, than someone who's trying to always restrict their calories and add all this activity. At some point, the body's going like, feed me. I need to eat at some point. These two things are not independent. And I think, Kelly, you know how it's been treated for decades. You have diet and you have activity and never show these things cross paths. And the reality is that we need that cross pollinization. We need these things talking to one another because that's how the body's properly regulating these things.

Yeah, that strikes me as a particularly important and exciting area of research with the way these two systems come together. And you just confirmed that. I know over the years people have written a lot about how physical activity might be especially important in people maintaining weight loss. Can you tell us more about that?

Yeah. And we contribute a lot to that. We talked a lot about this, and we found, at least in secondary analyses or observational data, how important the activity is. It seems to be a very important predictor. And the question becomes, well, why? Why is that? Why is it so important? I think part of it is, you know, that as people lose weight. And you've been involved in many of these studies too. You lose weight and you're cutting these calories back. You can only maintain this kinda low calorie intake for so long. And at some point in time, either you intentionally or unintentionally start to eat more calories. And these higher levels of activity, I think, help to give us some ability to kind of counter that intake. The activity becomes important that way. But also, and it takes us some time to get to that point in time. One, it's a calorie burn. But also, if you start thinking about substrate utilization and other things, what energies are we burning, what we do know is that individuals who become more at least cardiovascularly fit, also have an improvement in their ability to utilize fat as an energy source. So, they're going to become a bit more efficient at using fat and not always having to kind of struggle, you know, to do that. And, the other factors that really help to regulate weight, and there's a lot of them, don't get me wrong, we can't talk about them all today. But you start to think about how insulin and glucose regulation might be impacting hunger satiety, but also body weight regulation, and activity we know increases insulin sensitivity. You don't need to be dumping as much insulin into the system. I think there's all these factors that come into play and it hits that crescendo, I'll guess. When after you've done it for a period of time and these adaptations have happened after about 3 to 6 months, you'll start to get many of these adaptations occurring.

People are going to get excited when we're talking about substrate utilization. But let's go into this a little bit more. And actually, it was the next thing I was going to ask you anyway. Whether people, when they're burning calories, I mean, they're losing weight, are they burning fat or protein or, what's the body doing is a really interesting issue. And I know that's especially important in the context of the new weight loss drugs. So, let's talk about that. We've done several podcasts on the new generation of the GLP drugs like Ozempic and Wegovy and Mounjaro and Zepbound. So why is physical activity especially important when people are using those drugs in particular?

Yeah, so much of what we know about activity within the context of those medications is a bit hypothetical. A bit hypothesis driven. A bit this seems like the best practice because there have really been virtually zero studies, we keep looking at this, that have been published that have been appropriately well designed, appropriately powered kinds of studies. The one study that has been out there had people lose a lot of weight on basically a low energy diet and then added activity and the medication after they've already lost a lot of weight. It's really not the way these medications are really being used. And so, in our consensus paper from the American College of Sports Medicine, we talked about what we don't know as much as what we do know. And I think that activity becomes critically important in the context of these medications because beyond what it does for body weight, true body weight, the medications are taking care of helping people to lose weight. But as we hear about these weight loss medications, there is some concern about the loss of potentially lean mass. We don't know if it's muscle or not, but there's a potential that some of that is muscle.

I just heard some data over the weekend about some of the newer medications that are being looked at in phase two and three trials, where there's some concern about bone loss at this point as well. So, you start to think about that and you say what could you do to maybe not completely counter it, but to blunt the loss. And we know that activity affects all those things in very positive ways. The challenge you run into though, Kelly, is activity affects those things in very positive ways when there's adequate nutrients coming in. But if all the nutrients are coming in are being used for energy, there's very little to have as a building block.

So, we have to be careful about saying that exercise is going to prevent loss of muscle, prevent loss of lean, prevent loss of bone. It may help to counter regulate that, but I think that what's more important is whatever muscle and lean tissue and bone tissue you have left let's make it as healthy as it possibly could be. Because as you and I both know, individuals without obesity actually overall have less muscle mass than individuals with obesity. The difference is in their quality of their muscle. And so, let's make the muscle that is retained high quality as opposed to focusing so much on the volume

It sounds like the combination of really being vigilant to protein intake and physical activity is a pretty good way to help counteract some of the negative effects of the drugs on the potential loss of muscle mass.

I think that there's a chance that it could help. But if worst case scenario, we don't know if it's completely countering that, but it might blunt it. But the bottom line though is that even if it's not blunting it, even if it's not stopping it you're going to make the muscle stronger. You're going to make the muscle more functional, make the muscle more efficient with the muscle you have left with activity. And an example of that Kelly is, probably 30 years or so ago now, we published some papers on the very low-calorie diets, the five to 800 calorie a day diets. And we added resistance training, cardio training, or the combination to those diets. And, with a 20, 30-kilogram weight loss over three to six months, we saw losses of lean mass even with the exercise training. But the people who weight trained got stronger. The people who did cardio training got more fit. The people that did both had both effects. You still get the effect of the activity without focusing so much on the mass, but focusing on what I'll call the quality.

I had this image in my mind while you were talking, if muscles had a face, they'd be smiling at you if you're physically active, because you're helping make them stronger and more vital. And, it just so many good things happen, don't they?

That's it. I think that's exactly what I think the message should be because we're not trying to train athletes here. We're trying to train everyday humans and their everyday walk of life. So, how can we focus on making them the healthiest and most fit and most functional that they can be? And I think that's a lot different than trying to say, we're going to send you to the gym five days a week and really hammer you to try to preserve this. Most people can't do it and won't do it. What can we get from this? And I think this quality issue is really where we should be focusing our effort.

Let's get a little bit into the nuts and bolts, toward the end of this conversation about what type of exercise people might think about doing. We're bombarded by information: low versus medium versus high intensity. For how long should you do it a day? How many steps should you get? Strength training versus aerobic exercise? You just mentioned that. And of course, how to get it and stay motivated. So how do you respond to the question? What do I do?

Yeah, a very difficult question. And I think part of that comes from just the media is not understanding so they look for a good story. But part of it also comes from within the exercise community. Similar to what you see in the nutrition community, what's the optimal diet for someone, right? And so, you have people who are advocating for one type of activity versus another activity. And as I go out and I talk about this, I think this is critically important, Kelly. There's not one perfect exercise that will give you all the perfect health benefits. If you want to strengthen the muscle, you need to overload it with resistance. If you want to make the cardiovascular system strong, you need to stress it with some type of cardio activities. If you want the muscles to become pliable and the tendons and ligaments to become pliable to prevent injury and so on, you've got to do stretching, Yoga, tai chi type of activities, right? And you can go on and on and on. And in fact, if you want the brain to function, if you want the cognitive effects, you need to do things that make the body think a little bit and tie the brain to the movement that you're doing. Right? So, it has to be like a mindful type of movement, maybe a yoga or something like that. There's not one perfect activity, but I think that a little bit of all those activities is probably better than any one of them by themselves. That's the way I think about it. Now that's hard for people. Also, I think that for people that are starting out who probably have had bad experiences with exercise, bringing back to physical education class possibly, right? Get up and move more. If you can get up and move more, that's the gateway. Right? Get up and just start moving around more. If you can't get up and move more, there are things you can do. And if you're wheelchair bound or have mobility limitations, there are things that can be done in a seated position and so on. It's about getting started. The, the hardest part is taking that first step. Right? The hardest part is putting on those walking shoes and getting out the door. Once you're out there, people usually enjoy it. And I'll just give you an example. Kelly of when we did our bouts and you're familiar with our study where we did the 10-minute bout study where we asked people just to do 10 minutes. We found very quickly that individuals who started doing small 10-minute bouts and we're doing well, were turning those bouts into 12-minute bouts, 14-minute bouts, 15-minute bouts. So, it's about getting that first step. Don't think about this being this whole complex thing. Let's get started and build on it to a lifestyle of activity.

And if people are in search of a trustworthy place to look for information on physical activity, where would you suggest they go?

First, if they're looking for a website type of thing, I would point them to the American College of Sports Medicine. There's a program out there called exercises. Medicine has great resources, but also if they're looking for good advice, and it's, a lot of people can give good advice, but the American College of Sports Medicine has the premier certification in this space. Individuals who are getting American College Sports Medicine Certification, whether it be a personal trainer or clinical exercise physiologist, are going to be, in my view, the people who have the kind of the right perspective to try to help individuals with variety of different disease states.

That's very helpful to know. Let me peer ahead into the future a little bit and ask you, where do you see your field going? What will the future bring, you think?

There's a big study going on called the molecular transducers of physical activity. It's they. I call it the motor pack study. We were involved in that for a while, and that's to try to create a molecular map of how activity actually affects the body. Kind of like where we started today. We're learning a lot about this. And I think that what we're going to find in, and not just in that study, but across the board is this idea that again, there's not one perfect activity. But that the body responds to activity, depending on what it is that you're asking it to do. And I think that the holy grail, Kelly, is no longer what activity is should I do? I think the holy grail goes back to maybe where your roots were and my roots were, and that is how can we help individuals to initiate, engage, and sustain? I think it's about the intervention and translation of these findings. And that's the holy grail for our field because we know activity is good for us. It's about how do we get individuals to understand, engage, sustain, and overcome the barriers that they face. I think that's where the field has to go.

Bio

John M. Jakicic, PhD is a Professor at the University of Kansas Medical Center in the Department of Internal Medicine and the Division of Physical Activity and Weight Management. He has an interdisciplinary research program that examines lifestyle approaches to the prevention and treatment of chronic health conditions, with a particular focus on the role of increased physical activity and reduced sedentary behavior on these outcomes. Central to this research has been a focus on interventions for weight loss and weight loss maintenance, and this has more recent application to medical treatments for obesity that include metabolic and bariatric surgery and contemporary anti-obesity medications. He has served on numerous national committees focused on obesity, physical activity, and other chronic health conditions, which included his appointment by the US Department of Health and Human Services to the 2018 Physical Activity Guidelines Scientific Advisory Committee. He authored the 2024 American College of Sport Medicine’s Consensus paper and the 2001 position paper focused on physical activity and obesity and co-authored the 2009 position paper. He has also contributed to other consensus papers and clinical guidelines for the prevention and treatment of obesity. Dr. Jakicic has over 300 peer-reviewed publications and book chapters. Based on statistics provided by Google Scholar (effective August 11, 2024): 1) his research has been cited 50,192 times, 2) his H-Index is 95, and 3) his i10 Index is 258. Dr. Jakicic earned his doctorate in exercise physiology in 1995 from the University of Pittsburgh, and he is certified as a Clinical Exercise Physiologist by the American College of Sports Medicine.
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E264: Citizen engagement in post-Brexit UK food and farming policy
17 feb· The Leading Voices in Food
Today we're exploring civil society's efforts to shape the food system and land use in the United Kingdom. Our guest today is Sue Pritchard, Chief Executive of the Food, Farming, and Countryside Commission (FFCC). The deeply grassroots work of the commission brings people together to find practical solutions to climate, nature, and health challenges. The goal is to shape fairer and more sustainable food systems and a just transition for rural communities and the countryside.

Interview Summary

Well, Sue, I am really interested to start off learning a little bit more about you. Can you tell us why are you interested in food and farming and the countryside?

So, I'm talking to you from Wales, from my farm in Wales. I live and work on a small, organic, conservation orientated farm that produces native breed cattle and sheep. It's so authentic. I have a duck in my office with me at the moment. So, if any of your listeners hear any odd sounds, I promise you that's her, not me. I come from a family in Wales, which either went down the mines or farmed and had small holdings. My father went down the mines, but we always, as a family longed to get back to our deeply felt roots. And it was about 27 years ago that my parents and I, my family, were able to buy our farm here in Wales, which is, I suppose, the culmination of a dream. And although we were not naive about farming, when you're deeply embedded in the everyday life of the farmer and operating in the farming system (the food and farming system) you learn some different things pretty quickly. And so, for a fair few years, I was working out how to make the farm work economically. But also, how the farm could make a really good contribution to tackling the climate crisis and the nature crisis. How we could sequester more carbon on the farm. How we could build more natural infrastructure on the farm to help nature thrive here again.

You will recall, the UK had its own political, should we call it a little, a minor apocalypse back in 2016, when the UK voted to exit the European Union. And, the implications of that vote were pretty, pretty, extraordinary for farming and for food systems and the environment. As a result, civil society, business organizations got together and were able to get some philanthropic funding to set up a commission (Food, Farming, and Countryside Commission) to shape a different future for food and farming and the countryside outside of the European Union. And when that job was advertised, it was my dream job, bringing together, as it did, the future of farming, the future of food systems, and being able to impact and influence policy at a really, really critical time.

I want to make sure I understand a little bit more about what's happening. Because of Brexit, that means the UK is no longer part of the common agricultural policy and is now needing to reconstruct its agricultural policy structure. It sounds like the commission was brought in to do some of this work. I would like to understand what in particular challenges are facing the food and agriculture scene in the UK post Brexit.

I think that the first thing that we were able to do in the work of the commission was to start talking about food as a system. That was relatively unusual in the UK. One of our leading thinkers, Professor Tim Lang, used to say that the UK's food policy was basically leave it to Tesco, which is one of our big supermarkets. It was essentially left to private markets to determine the kind of food that we had on our plates. It was clear that that strategy was not working anymore. And given the really quite startling system changing implications of that particular vote, we were able to take a different perspective on food systems and start thinking about food as a system. We talked about, as it says on the tin, food and farming and the countryside, but we also talked about food and farming's relationship with climate, with nature, with health and wellbeing, and with equity and justice.

In bringing that more, if you like, systemic view into people's consciousnesses, we were able to demonstrate really how central food policy is to UK's economy, health and wellbeing of UK citizens. Perhaps in a way that had not been done with quite the same heft as before. Lots of people have been trying but hadn't quite landed center stage in policy terms. And we were able to show through our work and then our reports, the relationship between food and farming and diet-related ill health. Farming systems and the climate crisis. Farming systems and biodiversity loss and the nature crisis. And also, starting to reveal the inequities, the inequalities embedded in the food system when we start looking not just within our own borders in the UK, but beyond our borders to how the UK trades with the rest of the world.

Because countryside is one of the major themes, it's in the title of Food, Farming and Countryside Commission, and I've spent a little time in England and the countryside. And I'm from a rural area and the United States, and I'm interested to understand how you all are thinking about the needs or the challenges, or even the opportunities that the countryside faces in the UK.

One of the things that I realized when I started this job back in 2017 was that for many people in London, the countryside is just the gap on the map between the cities. They had very little understanding of the contribution of the rural economy, the importance of the rural economy, particularly the countryside's importance, criticality, even for tackling the climate crisis, tackling the nature crisis. It's there where a lot of the problems occur, but also where a lot of the solutions can be found too. And so, talking about the countryside, not as a kind of poor relation to the rest of the economy, but actually central to a version of the future that was able to be more resilient, more adaptive to whatever kind of scenarios might unfold. That felt like a pretty important thing for us to be doing. And when we were conducting our work in those early days, we did all the usual things that a commission might do. We did a literature review, we held workshops, we held all sorts of kind of formal research processes. But we also set out around the country, around the UK on a bicycle. My researchers set out around the UK on a bicycle. Because we wanted to do something pretty iconic to show the richness, the diversity, the variety, the political salience and the economic salience of the countryside to policy discussions in Westminster. I think one of our successes has been to bring those voices into policy decisions. And to give them much more gravity, I think, in policy considerations that often feel very distant in London.

How have they shaped the way you all have done the work at the FFCC? Are they altering or informing the work in different ways?

Yes. Absolutely. We work with citizens in a number of different ways. So that first moment, the kind of bicycle tour around the UK was if you like, a symbolic moment of connecting with people in their communities. Going out to where people are, letting them tell us in their terms, what mattered to them, what they cared about, what they were concerned about. But in a really kind of barefoot ethnographic way, I think, being able to hear directly from folk. But we also built long term relationships in three, if you like, sentinel parts of the country: in Devon, in Cambridgeshire, and in Cumbria. Different parts of the UK reflecting different kinds of priorities and different pressures in the countryside. Devon is a grassland community, it's very touristy. Cambridgeshire is one of the bread baskets of the country, but with huge pressures on housing and infrastructure. And Cumbria is the uplands, the high mountainous uplands that people understand as a holiday hotspot. But working in those places in depth over for five years now, we have been able to both test out policy ideas in, in real places, in real time. Our land use framework project is a case in point. In thinking about how we make better decisions about land, we worked with people for whom those decisions are incredibly material. It's about what happens in their communities, what happens around them. We were able to develop policy contributions based on testing different options, different possibilities with people in places. And of course, we were able then to bring forward their ideas, their thoughts, and their really practical activities to the view of government, to the view of policy makers and to businesses. It was a kind of reciprocal relationship, testing out ideas in communities, but also bringing community ideas into government, into policy makers. You know, demonstrating how people are already doing things, already doing really interesting and radical and progressive things, whether or not government is supporting them or not.

More recently, we've embarked on a very, very substantial project. It's called the Food Conversation and the Food Conversation is a project that was designed to really test out the answer to the question, so what do people really want from food? I wonder if you have the same experience in the United States, Norbert, but certainly in the UK, we hear over and over and over again, particularly from lobbyists, but often from government, that people don't really care about food. People just want cheap food. They just want convenient food. Nobody wants to be told what to eat. Nobody wants a nanny state. And those kind of toxic narratives, those devices were being used over and over again to limit government's appetite for policy intervention. And after this happened, again about two years ago, after the government commissioned its own national food strategy and then declined to respond in any meaningful way to it, I rather spat the dummy in in leadership terms and decided we were really going to have to test out this narrative, this way of framing food policy change. So, we set out 18 months ago, on the biggest civil society dialogue that the UK has ever seen. We conducted 12 citizens assemblies around the UK asking people directly, so what do we really want from food? In academic terms, it's kind of like a meta review, because what we've done is show citizens the kind of research that's been done over the last 10 or more years. The research has been done by experts in the UK and internationally that show the impacts of the food system on climate, on nature, on our health and wellbeing. And we've asked them what they think about the recommendations that those research reports have made. All of those recommendations that have been kind of discounted by governments because 'no one wants the nanny state.' You have to imagine my air quotes there. And of course, in conducting that conversation, we found really quite quickly that toxic narrative is not true at all. When you reveal to citizens the complexities and the interdependence of the food system with their health, with the state of their high streets, you know, what, what's being sold to them and how. When you explain how that impacts on farmers and growers, primary producers. When you explain how it impacts on communities all around the world, often very vulnerable communities around the world. When you explain how it impacts on the climate and nature, people are pretty, pretty shocked and pretty horrified.

And most interestingly, when you show people how the food system has become more commodified, more consolidated in fewer and fewer hands. More financialized by a small number of global agribusinesses who are continuing to make eye watering profits, while, for example, in the UK, our own health service is buckling under the strain of diet related ill health, obesity, heart disease and so on they are furious. They say, why don't we know and why doesn't anybody else do anything about this? And so that piece of work, well, this phase of it is coming to a conclusion. We've got, oh, 500,000 words worth of material generated by citizens contributions. And that culminates in a summit, the Citizens Food Summit in London on the 19th of November when we'll be sharing citizens perspectives. And indeed, business perspectives too, civil society organization perspectives. Because lots of businesses are lining up alongside citizens saying this needs to be different. We need to change this. And we're sharing those insights with policymakers. And the intention is to strengthen their arm in taking a proper systems view of food policy in the UK and starting to act as if food policy really matters. Because it does.

This is impressive work. This idea of listening to citizens and sharing with their government officials their views of the food system. In some ways. It's so basic you would thought this would be going on already. And yet we all know that this doesn't happen frequently. It's an exciting enterprise that you all have engaged. I would be interested to see what happens after the November gathering.

Very, very happy to share that with you. The way that we've designed it... you'll be familiar with citizens assemblies. They're usually national interventions. They bring people together from across the country. They happen over a period of weeks. They report and then, and then they finish. We've designed ours somewhat differently. We designed ours in places, so 12 around the country. Brought together citizens in those places, as well as the anchor institutions. Organizations that can actually get on and do stuff without waiting for government or big business to act. And so, we've been both listening to citizens, but we've also been doing a little bit of movement facilitation, if you like. We're helping to build food movements, along with our colleagues who are also doing this work in places around the country. And so already we're seeing citizens taking the opportunity to carry on talking to each other, to set up initiatives in their own community. To connect with the initiatives that already exist that they might not have known about. To talk to local policymakers and local leaders about how they can do things differently. So, it was really important to us to kind of learn from the successes and perhaps some of the failures of previous assemblies and dialogues to say, what needs to happen so that change can happen as a result of this, so that citizens efforts, citizens contributions, very generous contributions of their time and their insight actually make something happen.

You know what, I realize that this sounds very similar to the work of food policy councils here in the US. It's a similar sort of structure. But I'm interested, it's something you said earlier on, and I want to draw attention to this issue. I have my own experience that these efforts, lots of different folks come to the table with varying concerns and sometimes conflicting concerns. If you think about the economic gradient where there are people from higher income households and maybe lower income who are experiencing the food system differently. While they share a lot of concerns, there are some big differences. And I'm interested to hear how you all are dealing with that diversity of thought and experience.

Yeah. So, the way we selected our participants was through the sortition process. We sent out 120,000 invitations around the UK. We got a very high level of response rate to that. But from that number, we selected populations that really reflected their communities. And in some communities, we waited for the seldom heard voices. We wanted to make sure that we really pulled in those people who are less likely to be asked or invited or included in these sorts of initiatives. We built that, if you like, reflection of community in each of the assemblies around the country. We invested in quite a bit of context setting at the start. Helping people get to know each other, connect with each other, understand each other a bit, their own experiences and perspectives on the food system. And then getting people on the same page in terms of, you know, the context of food. What we found, and in fact the professional organizations, specialist organizations that have worked with us on this project have been really startled by it. The consistency of perspective across political backgrounds, educational backgrounds, socioeconomic backgrounds, protected characteristics, race, class, gender. The consistency of response to food systems issues is the highest that our professional advisors have ever seen. And, and that's, that's been really, really fascinating to me.

I think it is because, and this goes back to the reason why we wanted to do this work in the first place, very often we end up talking about big, abstracted issues. Even climate and nature can feel big and abstracted. And the political economy of food, very abstracted. When you come back to it, we all have a stake in food. We all have skin in that game. If you frame the conversation in the right way, everybody can participate. And like many things in life, actually, we all want the same things. We want a safe, secure, healthy life. We want to be able to live in a safe, secure, healthy environment for ourselves and for our families, our children, our loved ones. And of course, food is the very thing that connects us. You know, food is at the heart of our celebrations. You know, how we choose to be together when we gather in communities. And we do that so often over food. It's one of the very, very, very few things that connects us and we have a shared experience. So, whether or not you're poor or rich, you will celebrate with food. Whether you're poor or rich, you will want to nourish your children in the best way you possibly can. There are so many things that connect us.

Interestingly, and this was a kind of side benefit of this work, in a country which, I think, like yours, can feel incredibly polarized and at risk to populist politics that seeks to divide us over and over again. The conversations around food and food policy and how we might want food to be different in our communities, really united people. And it really showed people as being more thoughtful, more respectful, more insightful, more considered than very often we are led to believe right across the political divides. There's something very kind of visceral and you know heart centered about food that does help people connect.

Getting quickly then into the technical stuff. How do we make decisions about policies? We said to people here are all the policy ideas. There are hundreds. There are hundreds of policy ideas. We can group them together in categories, health, nature, farming, and so on. And we invited people to categorize them using a really simple taxonomy. Should government's business just do it? This is obvious, just do this thing. Should they test it? It needs a bit more research. We need to test this out a little bit more, in more detail. Or should we debate it? Is this actually quite complicated, indeed contested? And we need a better process to making some choices around this. People were able to look through those policy choices with some real thought and insight. And there's remarkable consistency between people about things that we just ought to get on and do. Things like formulating children's foods in schools. That there ought to be some really clear guidelines about the quality of food that's available for children in preschool and school. That doesn't exist at the moment. People don't understand why on earth that doesn't happen. For some big issues, like should we introduce universal basic income for farmers to make sure they have a level of income that doesn't make them vulnerable to, you know, price gouging by companies? People said, oh, that's quite complicated. We'd have to work out what that would look like, what impacts that would have on the rest of society. But it's an idea worth exploring further. So they explored everything from really, really basic stuff through to big economic issues that could be really quite transformative in a country like ours.

Bio

Sue Pritchard is the Chief Executive of the Food, Farming and Countryside Commission in the United Kingdom. Sue leads the organization in its mission to bring people together to act on the climate, nature and health crises, through fairer and more sustainable food systems, and a just transition for rural communities and the countryside. Sue’s background is in combined research and practice in leadership and organization development for systems change, working with leaders across public, private and not for profit organizations, especially on complex partnership projects. She is a Trustee of UK’s CoFarm Foundation and is an independent Governor at Royal Agricultural University. She lives on an organic farm in Wales where she and her family raise livestock and farm for conservation.
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E263: Explore the Daily Table non profit grocery store model
5 feb· The Leading Voices in Food
Today, we're going to explore Daily Table, an innovative non profit grocery chain dedicated to providing fresh, convenient, and nutritious food affordable to everyone, even those on the Supplemental Nutrition Assistance Program, or SNAP. In today's economic climate, where rising food prices are impacting households across the country, the concept of a non profit grocery store seems to fill a real need. Our guest today is Daily Table CEO, Sasha Purpura, a software engineer who spent 15 years in the tech industry and product management and development roles.

Interview Summary

Sasha, it is such a pleasure to connect with you. I'm intrigued to hear more about where Daily Table is today because I too was a Daily Table shopper. So, let's begin just hearing about what Daily Table is and what's the driving mission of the organization.

Absolutely, Norbert. Simply what's driving the organization is the belief that everybody deserves access to healthy food. Daily Table is such a simple solution, but so incredibly innovative. It's a grocery store where everybody can afford healthy food. To me, seems like that should be there already. Unfortunately, it isn't.

Historically, the way we have addressed hunger in this country is food pantries. And food pantries play a critical role and they're very necessary. However, there's spaces designed for people with low income. To say you're low income, you can't afford food, come here. And we know that 40 percent of the people that qualify for food pantries won't go to a food pantry because of that stigma. And because they want agency. They want the dignity of providing for their families and choosing what they want to eat. So Daily Table creates that shopping experience.

People who don't use food pantries, they shop for themselves. And the sad reality is they have not been able to choose healthy food every day. They can't. It is not affordable. If you are lower on the income scale, you cannot afford to put fruits and vegetables on your table every day. Daily Table makes it possible for every person to afford to put fruits and vegetables on their table every day.

And we are a normal grocery store. Anybody can come in there. We welcome everyone. It is not set up for people with a low income. It is a shopping experience. It is bright and colorful. It is dignified, enjoyable. Let's go look at all this beautiful produce. Daily Table dedicates a third of its footprint in each store to produce. Think about any grocery store you go into. That is not the case. We are focused on healthy, beautiful, fresh food. So, it's produce. It's proteins.

And then finally, we have a commissary kitchen in our Dorchester store. It serves all of our stores, and we make healthy meals. A lot of people working two jobs cannot cook for themselves. Don't have the resources. And unfortunately, in many cases, turn to fast food, which isn't even that affordable these days. We make a chicken meal with a big chicken leg and 2 sides starting at $2.99. We have a large garden salad for $2.99. We have smoothies. We have soups that aren't extremely high in sodium. So, we provide healthy, tasty, prepared meals alongside fresh produce.

If you can cook it, it's the ingredients are there. If you can't cook it, we cook it for you. And so Daily Table, our mission and what we do every day, is ensure that healthy food is truly affordable to everybody.

This is really a useful way of hearing about what Daily Table is. As someone who used to live in Boston, I would visit the Dorchester store. And I remember all they asked is to tell us what zip code you're from and we would go shopping.

We don't even ask that anymore.

Oh, you don't even ask that anymore! That is awesome. And, you know, what's great it was easy to take my very young daughter at that time into the store and feel good about what we were getting. And my wife was like, can you believe these prices?

In a good way!

In a very good way. And so, it was always a positive experience. And it was great to know that there were people in that local community that were in the store. That were part of the staff. And it was a great place to visit. So, I'm glad to be able to connect with you on this. But I got to ask this question, how did a software engineer all of a sudden end up in a nonprofit grocery store? What happened? What drew you to this work?

Well, it wasn't all of a sudden, but it was definitely a path. I met my husband when we were working at Nokia. I was in product management at the time. And in 2005, he quit to start an organic farm. A dream he'd always had. Went to it full time, that's how he makes his living. And he'd always had a big garden and just been a food person and I learned through him. I'd work with him on the weekends and getting the farm started and go to farmer's markets with him. And I, I discovered food in a way I'd never really understood it. I fell in love with it. I fell in love with the way that food creates community. I mean, it is the center of community. It's how we show love. It's how we come together over holidays. But to work with my husband creating this really beautiful produce, healthy, and to share that and just, just at a farmer's market, see how people come together that don't know each other. And 'how do you use collard greens? Or what is this vegetable?' It was just life. It was just life and I wanted that. So, I quit in 2009. I worked with him on the farm for a couple of years while I went back to school just to expand my network and nonprofit and other things. And in 2012, I began as an executive director of another hunger relief organization. And what was amazing, what is amazing to me, whether it's at a food pantry or Daily Table or a farmer's market, it is the same experience. It is people coming together around food and sharing. And it is beautiful and it, it creates healthy communities. It's not just nourishing us physically, but that's critical. By the way, healthy food is the cheapest form of healthcare. If we would just invest in that. But it also nourishes a community. It's mental health. It's sitting around the table with your family. It's cooking. It's not being hungry. And so, to go from the one extreme of a local organic farm in a farmer's market that isn't cheap. You know, my husband isn't making money off of it. He's not getting rich, but the food, it takes a lot to grow food.

So, to go from that experience and bringing together people who can afford farmer's market prices and seeing that same experience in a food pantry or at Daily Table, it is, it's about food. It's not about money and it should be accessible to all. It is really amazing. I loved the two years on the farm and bringing access to local food to people. And to now do that to folks who otherwise simply couldn't get access to healthy food. It's, it's just an incredible honor to be a part of that.

Thank you for sharing that. And thank you for sharing part of your story. I'm interested to go back to Daily Table and understand how is it different than other nonprofit organizations, especially in the food justice space? Help us to appreciate that you gave us a bit of an idea when you were talking about comparing it to food pantries. But I'd like to hear sort of more of your thoughts on that.

Well, my thoughts are not so much are how are we different, but how do we fit into the emergency food system? One of the beautiful things... I'm in Cambridge, Massachusetts, Daily Table is at Cambridge and Boston and Salem. And I've worked now for 12 years in this field in Northeastern United States, Massachusetts. And what I've discovered is there is a network of food justice, hunger relief organizations. And we are an incredibly large community of people that care about the same thing and working together. So, we need a lot of different solutions. SNAP, as you mentioned, the supplemental nutrition access program, that is hunger relief, right? That lets people have access to purchasing food. Then there's Daily Table where you can use your SNAP benefits to buy produce. To buy very healthy food at very low prices. Then there's a food pantry for people that perhaps don't even have access to SNAP. They can go to a food pantry and access food, or people can shop at Daily Table and supplement what they're buying a Daily Table at a food pantry.

We work with an organization called the Boston Area Gleaners that uses volunteers to rescue food off of farms. And has their own farm now and grows some produce that we sell at Daily Table. We work within a network of different types of food justice organizations that are serving people in different ways and meeting them where they are. We work with Fresh Truck, which is a mobile market that goes into communities with a truck with fresh produce on it, right? So, all of these things are necessary. I would say Daily Table is absolutely critical to serving all of those people who are not comfortable getting free food. The last organization I worked for was called Food for Free, and it was wonderful, and it served hundreds of thousands of people. But there are hundreds of thousands of people that are not going to take food for free and Daily Table assists folks in that way.

Yeah. I am really appreciative of the way you've talked about this. And sometimes I get a sense that there is competition in this space. And what you're talking about is, no, we're actually all part of a large network and that we're serving different needs and that we are stronger together. Finding ways of collaborating and giving people options and in the community. I find this really encouraging. Thank you. I'm so excited to hear more about this and to think about what that means as we go beyond the Boston area. Beyond the Northeast. And talk about replication, but I don't want to get ahead of myself. I've got to ask. This can't be easy, I mean, to offer these products at the low prices that you do and the fact that they're all nutritionally oriented. And I'm interested to learn what are the challenges of providing and doing the work that you all do at Daily Table.

There are many, but they are luckily balanced by the joys of doing the work. One of the ongoing challenges is fundraising, right? We are a nonprofit. We work with local partners, and they give us deals in many cases. Little Leaf Lettuce, this incredible hydroponic lettuce grown out of Devons Massachusetts, ensures that we can have the absolute lowest cost little leaf at our stores every day. The same stuff you could buy at Whole Foods for twice the price. So, that's some of it, but we buy a lot of our food from a distributor, just like anybody else. And as we all know, there has been tremendous food inflation since the pandemic. And that has made our costs go through the roof. And we have not been able and not wanted to pass those costs onto our customers, so we are a nonprofit and we have to raise money. And that's that's part of why you feel like there may be competition, right? All of these nonprofits rely on the community. We rely on foundations. So, it is always a challenge for us to ensure we are continually investing in letting people know we're a nonprofit. That can be hard. We're a grocery store. We make two thirds of our revenue through store sales. That's incredible. Every time you shop there, you're giving to our organization. But we need to raise a third of our revenue through philanthropy. So that is an ongoing challenge. And more specifically, we have had this amazing program called Double Up Food Bucks. Which means people shopping with SNAP can get half off of produce. And it is incredible to see, as we launched that program, how much SNAP shoppers increase their produce spending. It just showed if food is affordable, people will buy it. If healthy food is affordable. Unfortunately, at the end of September, we lost funding for that program. And we had to pause it. We were able to keep it going in Cambridge, thanks to funding from the city of Cambridge. It has been devastating to our clients who have come to rely on not only low-cost vegetables, but being able to get twice as much as the dollar would normally get. Luckily, we did a GoFundMe, and we had tremendous response from people. And now the city of Boston is willing to step up and help us fund that. I'm hoping, fingers crossed, that that program relaunches in the next week or two. But that is another program that's going to require ongoing funding. And it's a challenge for every nonprofit, I think. I feel confident that if we get the word out about Daily Table, it's an exciting organization to support. And what's wonderful is you can support it by going there and getting great prices on healthy food.

I am encouraged by how you all are thinking about these challenges and how you're finding innovative ways of expanding the work that you're doing. And I got to say, when I was in Boston, I lived in Somerville. I was there at the grand opening of your second location. I didn't realize that you all have expanded.

Yes. Dorchester is 2015 and then Roxbury, which you just referenced and Nubian Square opened in 2018. Then in 2021, January, I remember I was there. It was in Cambridge, and I knew I knew the founding was happening, and I was at the ribbon cutting. We all had our masks on and we were standing 6 feet apart, but Central Square Cambridge opened. And then last year in September, we opened Salem, Massachusetts, which was up on the North Shore. Our first non urban store.

I mean, you clearly have figured out how to make this work. You're overcoming some of these challenges. But some challenges still exist because of the need to continue to fundraise. You know, I'm interested to know, where do you see Daily Table, the network of organizations, going into the future? And I've just got to ask, how are you thinking about expanding?

Sure. Some people don't know, Daily Table was founded by Doug Rauch. And Doug Rauch was the former president of Trader Joe's North America. And when Doug was at Trader Joe's, it was a small chain on the West Coast. And Joe, the CEO, asked Doug to head out to the East Coast and see if he could get a foothold for Trader Joe's here. And that's what he did. And now, as many people know, Trader Joe's is all over the country. And that is our dream of Daily Table. I mean, it is... it is needed in so many cities in Massachusetts. In every single state in this country, and in so many cities in every single one of those states. We have received outreach from throughout Massachusetts from California from Denver from Texas from Maine. And so, we absolutely believe that a Daily Table should exist everywhere across this country, deeply in Massachusetts and in other states as well. And our hope is in, you know, the not-too-distant future, to open a store outside of Massachusetts to show people this is not a Boston based thing. This is what can be a national solution. And then to over time start to expand throughout Massachusetts and throughout the country. Now, that requires funding as we know. But I think with the outpouring we've seen from different states and cities saying, we want this, we believe that it is possible to find that funding. And to really expand our network across the United States over the coming years and decades.

BIO

Sasha started her career as a Software Engineer and spent 15 years in the tech industry in Product Management and Management roles. In 2005, she helped her husband launch an organic farm and through that experience discovered a true passion for food and its ability to nourish not only one’s body and soul, but communities as a whole. Driven by this new passion, she left tech in 2009 and, after acquiring her MBA in Organizational Sustainability, went on to lead Food For Free. Over her 10 years as the head of the organization, she transformed it from a small, grass-roots program primarily serving Cambridge to a regional leader in food access. She has long admired Daily Table and was honored by the opportunity to join the organization as CEO in early 2024.
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E262: Impact of skimming and shimming fraud on SNAP recipients
30 jan· The Leading Voices in Food
On our podcast, we have often talked about the Supplemental Nutrition Assistance Program, or SNAP. In many of those conversations, we've talked about the benefits and eligibility, and ways to improve the work that SNAP does to help low-income families meet their food needs. In today's podcast, we're going to turn our attention to a particular challenge, and it's the SNAP skimming fraud. To help us understand this and the larger context of SNAP, we have the great pleasure of talking with Salaam Bhatti, who is the director of SNAP at the Food Research and Action Center, or FRAC.

Interview Summary

So, let's provide a little bit of level setting for our listeners. Can you tell us what role SNAP plays in the lives of individuals who are facing low income or food insecurity?

Yeah, Norbert, the problem with being in the richest, most powerful nation in world history is that we are facing a food and hunger crisis. We have the means, we have the resources to solve for it, but we haven't. For the record, the USDA, the United States Department of Agriculture, did a study last year. They do this study every year where they report food security in the country. In 2023, 86.5 percent of U. S. households were food secure. The remaining 13.5 percent, which is 18 million households, were food insecure. And this was an increase from 2022. So, 86.5 percent of food security is barely a B+. To be in the most powerful wealthiest nation in the world and we're barely getting a B+ in this space is unacceptable. And so, we saw some really interesting policies happen during the pandemic. We saw emergency allotments come in for the SNAP program, where all households received the maximum benefit amount for their households. And that, unfortunately, sunset. When that emergency allotment was in place, food insecurity-surprise, surprise-decreased. But not just that, we also saw Medicaid healthcare spending costs decrease as well. Because who would have thought that when people had food security, they didn't need to go to the emergency room because their blood sugar was low. So, we're experiencing a lot of challenges where we've seen the government show its hand that it can end poverty. It can end hunger. It just chooses not to.

We know that SNAP is an entitlement program. It's available to anyone who meets the eligibility requirements. But we know that everyone who's eligible doesn't participate in the SNAP program. Can you help us think about how more people can be enrolled who are eligible. And maybe we even need to think more broadly about what is eligibility? What are your thoughts about this?

In a given month these days, about 42 million people participate in SNAP. That's a lot of people. I would say that 42 million people are participating in it every day, but unfortunately, SNAP benefits do not last the whole month. By the third week of the month, people's SNAP benefits have been exhausted.

Now, taking a step back, in case the listeners don't know how SNAP benefits work, it's a, as you said, a government program. And it comes in the form of an electronic benefits transfer card, an EBT card. It looks like a credit card, looks like a debit card. But really, it's more like a hotel card key, because it doesn't have the security measures, which we can talk about later in the show. It doesn't have the security measures that a credit and a debit card have. It is essentially a glorified hotel key. It's got the magnetic stripe on the back, circa 20 years ago. Maybe 15. I'm dating myself. I don't know how long ago it was we were swiping the cards. But all you gotta do is you swipe the card and you type in your PIN. And then you can use it at the EBT retailer. That is in a nutshell how 40 million people are utilizing SNAP benefits every single month.

The program itself is also vital to retailers as well. We've seen that every dollar of SNAP benefits generates about $1.54 in economic activity during an economic downturn. So that means that when somebody is using their SNAP benefits at the grocery store, it's helping that grocery store keep the lights on. You know, employ the cashiers. And we need to employ cashiers, enough of this self-checkout stuff. It helps to pay the truck driver who's transporting the produce to the store. And it ultimately even helps pay the farmer for growing the crop. So, it's a great investment from the federal government into not just our households to help them put food on the table, but really into the whole local economy. And it is immediately used directly by the people and helps so many people.

Now so, to your question about how do we enroll more people? Well, luckily we are at a time where the USDA reports that in the fiscal year 2022, 88 percent of eligible individuals were participating in SNAP. And that is the highest participation rate we've seen since they started tracking this in the past 50 years. That's great. But again, it's just a B+ so we can do better. There is room to improve. In the study, it showed that older adults, those who are over 60, they're participating at lower rates with only 55 percent of eligible members in that age category participating. We also have so many military families and veterans who are eligible, but don't participate.

This SNAP gap is something that our partners are working throughout the states, throughout the entire country. We're working in partnership with a lot of federal agencies and partners as well. So, how do you ultimately close the SNAP gap? We're seeing a lot of targeted outreach. Seeing a lot of education efforts, but, you know, with 88 percent of eligible people participating, what's going on-on the local level? And unfortunately, Norbert, we've seen that state agencies which administer the SNAP program are unfortunately understaffed and they're underfunded. I used to be a state advocate at the Virginia Poverty Law Center. And when I was, hustling in the halls and lobbying for a million households with low income, I became friends with our social services agency because we had similar goals. We wanted to help households with low income. And we came to learn that the agency that we are relying on to administer the program was never getting their budget met by the legislative assembly. So, what we did was we got into partnership with them to advocate for their budget so that they could retain their staff, and so that the staff could do the job. That is something that we have to do across the states. Support these social service agencies in getting the funding so that they can have the staffing so that they can administer the programs in a timely way.

Unfortunately, I don't know if you've seen this but earlier this year, the USDA Secretary Vilsack sent out a letter to like 44 state agencies, including D. C. and Guam. Being very concerned about their timeliness issues because they're supposed to complete the application reviews and determine eligibility within 30 days. And that's for a normal SNAP application. You have seven days for expedited applications. And 44 of these agencies were not meeting the mark. That's bad for, in terms of deadlines, but even worse for the families experiencing the food insecurity. So that is a very layered answer. It's the seven-layer dip answer of how we increase participation. Well, we need more staff to, to help that out.

I hear that, and I'm really grateful for how you hit it at this point, and I want to draw a little more attention to it. While you talk about 88 percent participation, it looks different on a state-by-state level. Some states have a higher level of participation, other states don't. Do you think it's really the ability of those state agencies to provide that support, or do you think there are other factors that may be influencing the differential participation rates across states?

Yeah, so we saw a big retirement, the great resignation, that happened during the pandemic. There were so many state agency employees, you know, who were, who were doing the job because they were passionate about it. They were also at retirement age. So, we saw quite a resignation happen. Because it was incredibly difficult. It was traumatizing to be involved in this space. And so, they resigned, or they retired, or they moved on to somewhere else. The new workers came in and they learned the programs with the flexibilities that were provided during the pandemic. Now, they have to relearn the program because all those flexibilities are gone. So, we're seeing a lot of administrative burden taking place within these agencies.

I have a colleague, Carolyn Barnes, who's worked on this idea of administrative burden and the challenge of what's sometimes referred to as street level bureaucrats. The people who are on the ground who do the administration of these programs and the challenges that they face and the ways they engage folks. I appreciate hearing more about this. And I'm going to ask a potentially controversial question then. What if we took that responsibility out of the hands of state agencies and privatized that? What would that look like?

Oh, and people have tried that. Governments have tried that, and it's always resulted in net losses. Not only has it cost the states more, but it has also led to the participants not receiving their benefits, or receiving less than, or receiving an error of more than. So many errors have resulted, which has made the program and administration worse. Which is an interesting question because a lot of people don't know that there are skilled employees at the helm within the agencies that are working on these eligibility determinations. They're known as merit-based staff. And every now and then you'll see a Farm Bill, that's the piece of legislation that houses the SNAP program, it'll come in and they'll try to privatize parts of the program. In the guise of, 'Oh, we're just wanting to help the agencies out and get the benefits to the people.' But listen, the several states that have privatized their benefit programs have learned the hard way and they've done away with those privatization efforts.

Okay. I want to turn our attention to something that you hinted at, and we talked about at the top of the program. This idea of skimming or the SNAP skimming fraud. And this is not something that participants are doing. It's something that's happening negatively to participants. So, could you tell us a little bit more about this skimming issue?

You know, skimming is a very serious problem that has affected all types of consumers. It's a device that gets put on the point-of-sale system, like that thing that you insert your card into or swipe at the checkout. And it's indistinguishable from the actual point of sale system. You could have a trained eye and still not be able to tell that this point-of-sale system has been compromised.

So, what happens is when somebody uses a compromise point of sale system, their information, their card number, their pin is all taken. And within the same day, within an hour, you'll see the benefits are extracted. Usually in an entirely different state, and just the account balance is completely wiped out. The SNAP participant does not find out. If they don't check their account balance, they won't find out until the next time they're at the grocery store and they've done their, you know, 30 minutes of 45 minutes of shopping, with their kids in tow, and they've put everything on the conveyor belt and they're checking out and they swipe their card. And it says your payment is declined. And that is an awful harrowing situation that people are subjected to in the richest nation on the planet. They can't even use their government benefits to put food on the table. And then the process that currently exists to replace those stolen benefits is a lot of administrative burdens there as well. Where you have to you go home without the food, you fill out a piece of paper to say what happened, and then it takes weeks for you to get your benefits replaced. And God forbid that this happens to you more than twice in one year because the current resolution from Congress only allows two benefit replacements every year.

But I mean, Norbert the question might be, who's stealing all this stuff? And why aren't the states doing something about it? Or why isn't the SNAP participant doing more to protect themselves? What we have to understand is that there are federal authorities, the FBI, are looking into this. They are investigating this because tens of millions of government dollars have been stolen. Over 120,000 households have been affected. This is big. This is bigger than the SNAP participant. This is bigger than the state. This is bigger than the retailers. And so, there's a lot for the federal government to do not just in replacing the benefits. Because that's you know, you we have a hole in the boat and we can't throw money at the hole. We need to fix the hole. So, what are we looking at here? We're looking at the opportunity to Secure our cards, secure the EBT card, by moving to chip. So, that is the next big thing

You know what I appreciate out of this conversation is the experience of individuals who are using their SNAP benefits and they go to the store and the pain of discovering that their SNAP benefits have been expended. Not by them, but through some other means. I know the experience of having identity theft and, losing a credit card and not being able to do it. But I'm not in a situation where that means I'm not able to put food on my table. So, thank you for bringing our attention to the individual tragedy of that experience. And I think that's something important. But what you're also hinting at is that this is not some small-time incident. This is something much bigger. And of course, the federal government has a deep interest in trying to address this issue. And there needs to be some fix. And how this fix occurs also needs to be cognizant of the individual experience of low income individuals who are just struggling to make sure that they're able to solve this food problem.

Yeah, you were talking about identity theft and when identity theft happens in the private sector things are resolved pretty quickly. If your credit card is hacked, nowadays you can just go online and say dispute charge and everything's taken care of within 24 hours. But can you imagine like not getting food benefits, like your debit card, your bank account being emptied, and you don't get everything back for weeks. It's mind numbing. It's really awful to think about.

You've mentioned some technology fixes. And seems like they're pretty well known, the chip technology. Are there other fixes or in terms of technology or security systems that could help prevent this skimming challenge?

One of the other challenges we're facing with the skimming is that the replacement benefits are temporary, it's going to expire on December 20th of this year (2024). And this is an extension that happened after the original replacement benefits, which was just under two years. These short-term fixes, or these short-term replacement benefit strategies are not what we need. We really need a permanent replacement benefit because no matter how secure the card gets, criminals are just going to be creative, and they will attack every single type of card as they continue to do with chip cards. Because we're talking about skimming, there's also something called shimming. S H I M M I N G. And that's when the point-of-sale system isn't compromised from the top, but from within, where you insert the card. That's shimming. So, that's something that exists as well. Chip cards will go a long way to decreasing the benefit theft when chip cards rolled out in the private sector it reduced theft by like around 90 percent. We're hopeful and optimistic that similar patterns will emerge there. But that's of course not 100 percent. It's not AA+++ It's a reason for why permanent replacement benefits need to continue. When it comes to chip card benefits, your listeners might be like, wait, wait, wait, this is 2024. We still have cards that haven't gone chip? It's because there's so many layers in the financial sector of what's going on the back end of these cards. So thankfully there was this massive process known as the x9 process where the entire industry came together. All the card manufacturers, grocers, convenience stores, retailers, banks, us humble nonprofits, and we came in to talk about what needs to be done. And so, they finally released the standards just over a month ago. And now we have two states in the running California and Oklahoma to roll out chip cards in the new year. All eyes are on Cali and Oklahoma to see how it goes before, I guess other states are going to hop on. The chip card is going to be the next big thing in the SNAP benefits world.

Thank you for sharing this. I want to ask you one additional question about this technology issue. And it's related to a project I'm working on. It's the idea of online grocery shopping and the expansion of the SNAP benefits for online grocery shopping. And I'm wondering if there's any relationship between what you're seeing in skimming and the ability to use online grocery shopping. Or are these completely disconnected?

I haven't seen anything regarding theft online, it's all been physical. We are seeing some promising things coming out of online shopping, especially for people who are living in areas without food access. Once we can bridge that gap of getting fresh food, like the produce and meats and chicken and fish, to people who are far away from grocery stores, then we've found the magic solution. But it's a promising trend on the online delivery space.

Oh, that's awesome. I want to ask you just more generally about SNAP and where FRAC is right now. Where are you all thinking about in this space? And then what are ways that you can get just regular everyday people to help in the policy work of eliminating food insecurity?

For more than 50 years, FRAC has been working to improve health, nutrition, and the well-being of people who have been struggling with poverty related hunger in the United States. Now, we have made tremendous strides in the fight against hunger. We've played a critical role in expanding SNAP. We've secured increased benefits for households with low incomes through landmark legislation, litigation. But unfortunately our work is far from over and we are really trying to work ourselves out of jobs. We cannot do it alone. We really need all hands on deck, especially as we are seeing in this upcoming Farm Bill effort some cuts that are being suggested or offered to SNAP benefit. We really need all hands on deck to protect this program. To build a nation free from hunger we encourage your listeners to go to frac.org, frac.org. Sign up for our action network and urge your members of Congress to prioritize ending hunger in America. Now, I know that oftentimes we're not sure what we should be saying to our Congress members. Our action network tells you all the things and it helps you really quickly and easily customize templates. Send in your own messages to your members of Congress. And also learn about hunger in your state and the solutions that exist as well. So, what will it achieve for you at the end of the day? Your efforts will advance bold and equitable policy and program solutions. And provide technical assistance and training to thousands of anti hunger advocates across the country, because we're collecting your stories. And your stories help impact Congressmembers. It helps us win their hearts.

Bio

Salaam Bhatti joined FRAC in November 2023 as the SNAP Director. In this role, he works to strengthen SNAP access and benefit adequacy. Salaam works closely with the Interim President to develop, lead, and track annual work plans; set and meet unit goals; collaborate with other unit Directors to assist in achieving FRAC’s strategic plan goals; and expand the unit’s innovation and work. Salaam joined FRAC after working at the Virginia Poverty Law Center (VPLC). While at VPLC, he successfully lobbied to fully repeal the drug felon ban for SNAP and TANF, twice achieved record increases to TANF cash benefits, subsidized reduced-priced school meals, repealed the TANF family cap, ended lunch shaming policies in schools, and received a unanimous vote to expand SNAP for over 20,000 families. Salaam also helped develop a mobile-friendly, SNAP screening tool which is used by tens of thousands of people & multiple non-profits and has been rolled out to be available for all states and D.C. He received the Young Alumni Achievement Award from Albright College for his work in alleviating poverty and promoting Muslim-Jewish relations. Salaam also received the inaugural Stuart A. Freudberg Award for Regional Partnership for his work with Maryland and DC Hunger Solutions to address food insecurity across the metropolitan Washington area from the Metropolitan Washington Council of Governments. Salaam has a J.D. from Touro Law School, is barred in New York and Virginia, and received his Bachelors in Political Science and International Relations from Albright College (with a year abroad in the University of Aberdeen).
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E261: Here’s what you don’t know about food safety
23 jan· The Leading Voices in Food
For many years in talks that I gave, I showed a slide with an ingredient list from a food most people know. Just to see if the audience could guess what the food was. based on what it was made of. It was very hard for people to guess. A few people might come close, but very few people would guess. And it was pretty hard because the food contained 56 ingredients. This is in one food. And the ingredient list had chemical names, flavorings, stabilizers, and heaven knows what else. But 56 things in one, just one food in the food supply. Pretty amazing to think what kind of things we're bombarded with in foods we eat in our everyday lives. So, one key question is do we know what all this stuff does to us, either individually or in combination? So, how does ingredient 42 interact with ingredient 17? Even if we happen to know what they do individually, which we may not. And, who's looking out for the health of the population, and who has regulatory control over these things? Today we're joined by the author of a new article on this topic published in the American Journal of Public Health. Jennifer Pomeranz is an attorney and is Associate Professor of Public Health Policy and Management in the School of Global Public Health at New York University. The food, by the way, was a chocolate fudge Pop Tart.

Interview Summary

So, who has regulatory oversight with these things that are added to foods?

The FDA has the authority over all of those packaged foods. So, Pop Tarts, all of that type of packaged foods and the ingredients in there.

Can you explain the nature of their authority and the concept of GRAS and what that stands for?

Yes. So, there are two main ingredients in our food, but there is also color additives and other things that we didn't get to in our study. But the two main ingredients are called 'food additives' and then 'generally recognized as safe' or GRAS substances. And these are the two ingredients that are in all the processed foods. They're both complex substances, but they're regulated differently. GRAS is assumed to be safe. And food with GRAS substances is presumed to be safe as long as there's a generally agreement among scientists that it's safe, or if it's been in use in food since 1958. Food additives, on the other hand, are presumed to be unsafe. And so, foods that have food additives must have the food additive be approved for the condition of use. So actually, the FDA issues regulations on the food additives.

Is it true that the FDA authority covers lots of these chemical type things that get put in foods that we discussed? But also, things that occur naturally in some things like caffeine?

Yes. And so, caffeine is considered GRAS or generally recognized as safe. The FDA has a tolerance level for cola-type beverages for caffeine. It actually doesn't enforce that as you see, because we have energy drinks that far exceed that type of level. So, there's different types of GRAS substances. But they can be very complex substances that are actually not so different than food additives.

Who decides at the end of the day whether something's safe or not? You imagine this battalion of scientific experts that the FDA has on hand, or consults with, to decide whether something's safe or not. But how does it work?

Unfortunately, that's not exactly the case. When it comes to food additives, the industry must petition the FDA and provide evidence showing that it's safe. And the FDA promulgates a regulation saying that it agrees it's safe and it can be used for the things that it set forth in the regulation. For GRAS, there are two mechanisms. One is the industry can notify the FDA that it thinks something's safe. And then it actually goes through a similar transparent process where the FDA will evaluate the evidence submitted. Or, shockingly, the industry can actually decide that it's safe for themselves. And they don't have to notify the FDA. And they can add it to their food without the FDA or the public actually knowing. Now they might disclose this on a website or something, but it's actually not even required to be based on peer reviewed literature, which is actually one of the concerning aspects about this.

Concerning is polite language for what one might call shocking. So, in the case of some of these things that go into the food, the industry itself decides whether these things are safe. And in some cases, they have to at least tell the FDA that something they declare as safe is going into the food. But in some cases, they don't even have to do this.

Right. So, they only have to if they've determined that it's a food additive. But actually, the industry itself is deciding that it's a food additive versus GRAS. Once it made the decision, it's GRAS, it doesn't even have to notify the FDA that it considers it safe. If they do, they are supposed to rely on their own research saying that it's safe. But actually, there's some alarming parts about that as well. The other outside research that's not my own found that the panels of experts that they employ, 100 percent of the people on those panels have financial conflicts of interest. So, that's already worrisome.

They're receiving money from the food industry in some way.

Yes. To say that the ingredient is safe. Another scary part is that if they do notify the FDA and they're not happy with how the FDA is reacting to their GRAS notification, they can actually request a cease and desist. The FDA will issue a cease and desist letter, and then they can actually go to market with that ingredient.

Pretty amazing. Like loopholes that not only a truck can go through, but a train and everything else. That's really pretty remarkable. So one could say that the risk built into this system is hypothetical, and it works pretty well. But is that true? I mean, are there cases where things have gotten through that probably shouldn't have? Or is it just that we don't know?

I think there's a lot of unknowns. The Environmental Working Group does that research and they have identified things that they find to be concerning. A lot of it is that we actually don't know what we don't know, right? So even the FDA doesn't know what it doesn't know. And that is, is part of the concern, that you can't just identify this by looking at the nutrition facts label where they list ingredients. Sometimes they just use terms like spices, flavorings, colorings, chemical preservatives. But that could be masking an ingredient that has never been examined and for which It's unclear that it's actually safe.

I know there have been some policy efforts in places such as California to prohibit use of some of these things that have otherwise been considered safe by the FDA, or perhaps just by industry. Is that true that's happening more and more?

Yes, actually there has been. Because of the gap in the FDA's oversight, we are seeing states, and it's actually a pretty shocking situation, that California banned four ingredients that the FDA did not. And it's saying that those ingredients are not safe to be in food in California. And given what a huge market California is, the thinking is that the industry will have to change their ingredients across the nation. And frankly, they've already taken those ingredients out of the same foods in Europe, where those ingredients are not allowed.

So how much do you trust this self-policing by the industry?

To be honest, I'm quite concerned about it. The FDA has the authority to review substances post market, so after they're already in the ingredients. But we see that it can take years or even decades. In the case of, remember, partially hydrogenated oils, which were artificially produced trans-fat. It took decades for them to get that removed from the food supply, despite significant research showing that it had caused health harm. So, even when there is evidence of harm, it takes quite a long time for the FDA to remove it. And in the case of another ingredient recently where California banned it, then the FDA decided to ban it. So, it does worry me that even their post market authority is not being utilized to the extent that it should.

Let's think about what a good set of defaults might be and how this might actually play out in practice. If you'd assume these things that go into foods are not safe by default, then the question is what would it take to make sure they're safe before they're allowed in the food supply? And it would take toxicology studies, studies with lab animals perhaps, studies with humans. I don't know exactly how these things are tested, but one can imagine it's not an easy or a quick process. Nor probably an inexpensive one. But somebody would have to do it, and if government can't do it, you can't rely on industry to do it. I wonder if the default might be fewer things in the food supply and whether that might not be a pretty good thing?

I love that you said that because that's the conclusion I came to as well. Why do we need all these new ingredients? We already have ultra processed foods, which are by definition contain all these ingredients that we don't really know what they are. And why do we even need new ingredients? I think they could even put a moratorium on new ingredients and say, let's take a, take an analysis of what we've got in the food supply at this point. And to be honest, it would take Congress to act to change FDA's authority to give them more authority to do what you just suggested. And of course, resources, which would be personnel like you described.

So maybe that chocolate Pop Tart that has 56 ingredients could get by with 41 or 32 or 17. And you know, maybe we'd be just fine having it with fewer ingredients. One interesting thing that I've heard about, but I'm not an expert in because my background isn't law, is I know it's possible for outside parties to bring lawsuits against government for failing to execute its duties. Has there been any talk about possible lawsuits taking on the FDA for failing to protect the public's health with regard to these things?

Well, actually, there was a lawsuit already. These consumer protection organizations sued the FDA, arguing that they weren't protecting the public. And that they were actually ceding authority to the industry, which, they by definition are. But according to the law, because Congress didn't require them to review these ingredients pre market, the court found that the FDA did not violate the Food, Drug, and Cosmetic Act. And so, they were operating according to the law. But also, to your point, I could see other lawsuits would be possible about them not actually exercising their post market authority to protect the public. Those could be from private lawsuits or a state attorney's general. There are different ideas there.

So, what do you suggest going forward?

You know what? Don't eat the Pop Tart. I think you got to avoid the many truly ultra processed foods and go for the lower processing levels. It's kind of that original advice. If you can't understand the ingredient list, maybe pick something different. And there are options within the same categories, right? There are potato chips that have three ingredients and there's potato crisps that have something like 12. So there are different options in that way.

Bio

Professor Jennifer Pomeranz is a public health lawyer who researches policy and legal options to address the food environment, obesity, products that cause public harm, and social injustice that lead to health disparities. Prior to joining the NYU faculty, Professor Pomeranz was an Assistant Professor at the School of Public Health at Temple University and in the Center for Obesity Research and Education at Temple. She was previously the Director of Legal Initiatives at the Rudd Center for Food Policy and Obesity at Yale University. She has also authored numerous peer-reviewed and law review journal articles and a book, Food Law for Public Health, published by Oxford University Press in 2016. Professor Pomeranz leads the Public Health Policy Research Lab and regularly teaches Public Health Law and Food Policy for Public Health.
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E260: Food Recovery Network Urges Food Date Labeling Reform
14 jan· The Leading Voices in Food
I don't know about you and your household, but in my home, we have a long history of opening the refrigerator and discovering pasta sauce or mayonnaise that we don't remember when it was put in the refrigerator, when we last opened it, and we're confused. We open the container; we smell it; we check out the date label. And if we're confused, we have a mantra: when in doubt, throw it out. But aren't those date labels supposed to help us make good decisions about whether or not a food product is safe? Currently, there is no federal regulation on what those labels should say. Best Buy, Use Buy, Sell Buy, or what have you. However, there is legislation in the Congress called the Food Date Labeling Act to help us address this issue. And today's guest, Regina Harmon, will help us explore this particular issue. She is the executive director of the Food Recovery Network, the largest student led movement fighting food waste and hunger in the United States.

Interview Summary

First, some of our listeners may not be familiar with the Food Recovery Network. Could you tell us more about the organization and what it hopes to accomplish?

Absolutely. Thank you so much. Food Recovery Network was started in 2011 by college students at the University of Maryland who saw a couple of things happening. They saw a lot of food waste on their college campus, and they also saw a lot of people who were experiencing hunger in their communities. And so, they thought, hey, instead of throwing this perfectly good food away, what we could do is package this food up and give it to those in our neighborhood that we know need some help. And that's how Food Recovery Network was started. They started at the University of Maryland, one dining hall, one carload of food. They started calling other friends that went to different colleges and universities across the United States. And over the last decade and some change, we've grown into, as you said, the largest movement of students who are fighting food waste and hunger. We have about 200 college campuses that have food recovery network chapters. We've recovered over 16 million pounds of food through the power of young people. And today we also help other sectors that would like to also do the right thing with their surplus food. We help farms, we help corporate events, large scale events, we help conferences. You name it, wherever there's surplus food, Food Recovery Network can help make sure that food doesn't go into landfill and helps feed those in need.

I would love to hear a little bit about who you are able to serve through the Recovered Food. Are you working with food banks? Are you working with the pantries directly? Tell me a little more about that connection.

It's a beautiful connection. We have about 400 nonprofits all over the United States. That directly receive the surplus food that we donate. We go to the sites where the food is. So again, in college dining halls, large scale events, you name it, and that food is packaged up safely. And then it's brought to what we call hunger fighting nonprofits. These are nonprofits on the front lines in all of our communities that are in some way feeding our neighbors in need. These are homeless shelters, soup kitchens, food banks. These are domestic violence shelters. These are afterschool programs, churches, anywhere that can also handle the food safely and then distribute it to our neighbors directly. So through that, we've been able to meet so many incredible people, and a lot of times volunteers themselves who work at these incredible locations that again, are just helping those who need support to make their ends meet.

Great. This is really important work. Thank you so much for the work that you all are doing. So, how does the Food Recovery Network activate to end food waste and make a positive impact on the environment?

There's a lot of things that are happening here. You know, millions of tons of food is wasted every single year. And I know we'll get into the Food Date Limiting Act in just a moment, but every part of our food system, there's food waste. On farm fields, during transportation, at supermarkets, in our own homes. And so, a lot of times, most of the time, the majority of the time, all of the food that is wasted is actually thrown into landfills. You know, we see those images of whole entire tractor trailer trucks of food being dumped into landfill. And that is the problem. The majority of food, much of which is still perfectly good to eat, perfectly good to consume, is being driven into landfill, where it then is covered up, it begins to rot, and this is where the environmental harm starts. The food rots, and it creates additional CO2 into our environment and other greenhouse gases that is really difficult for our environment to reabsorb because it's happening at such an increased rate. And that is directly causing what we now know as global warming.

Food all across the United States, all across the globe, is the third largest emitter of CO2 gases. And so that is the environmental issue that Food Recovery Network is addressing. It's directly harming our atmosphere. But then when we take that step back and we think about all the water it took to grow these plants, all the fuel it took to transport the food, all the fertilizer it took to put into the soil. All of those precious resources are also wasted, and we need to reclaim those resources year after year after year for food that ultimately we are going to throw away, have it cause harm by rotting and going into our atmosphere in the form of CO2 gas. So, it is a really disturbing cycle. Our mission is to recover surplus food to feed everyone who is hungry so that precious food isn't going into landfill unnecessarily and causing all of that environmental harm.

Yes, this is what I find really critical about the work that you all are doing because of the greenhouse gas emissions from decomposing food and landfills is really problematic, but I'm so grateful for the way you talked about how there are losses, if you will, all along the supply chain from on the farm to the final consumer. I remember even talking to a farmer in Virginia who said, it really breaks his heart to see food wasted. He put a lot of effort, his blood, sweat and tears into that production to see it wasted was just disappointing. And that's going beyond the environmental costs to just thinking about the value of someone's labor. I really appreciate what you all are trying to accomplish. But it sounds like you all are involved in the day-to-day work of preventing it from going into the landfill and trying to get into the hands of people. How is it that you all are involved in policy? I'd love to hear how you all are thinking about date labeling and the law that is in the Congress to try to address this challenge.

Thank you so much, Norbert, for that question, because, yes, we are here to feed people through recovering food and donating it and helping our neighbors and being in community with our neighbors. That absolutely must happen. There's 47 million people who are food insecure all across the United States. We all know somebody who is food insecure. We might not know it. But we do. 47 million people. So that act of not wasting our precious food and bringing it back further into community is vital.

And then at the same time, Food Recovery Network, we are involved in advocacy to begin to correct a system that allows for this food waste and food loss. At the policy level is where we can really begin to recapture all of this precious food that our incredible farmers across the United States are growing for all of us. So, we got involved with the Food Date Labeling Act several years ago, and it has, you know, come up in our Congress a few different times. And we see this as a beautiful way to help reduce confusion around why food is being wasted in the first place. And in particular at the consumer level - our homes. You know, 80 percent of households at some point, they're going to be confused because of a date label. Again, your story emphasized that so wonderfully because it's something that we've all experienced. About 80 percent of homes are having those same kinds of conversations. The majority of people do believe that date labels are already standardized, and lo and behold, they are not. And so, what we're trying to do, we're lending our voice to support the Food Date Labeling Act, so that we can begin to standardize these date labels. And then prevent millions of tons of food from going to waste in the future every single year unnecessarily.

This is the way that I can imagine doing the work that you all are doing, not just on the physical movement of food, but also thinking about the policies that can help support the work that you're doing. It takes sort of that broad spectrum of approaches to really affect this challenge. But I've got to ask, and I hear your passion. I hear your great concern. Can you help us understand why the urgency now? Why, why try to find a permanent solution to food waste today? What's the impetus?

You're absolutely right, Norbert. The time is now. We are getting many messages. I will speak from the perspective of our students. So, this is Gen Z, Gen X, Millennials, you know, young people that are on the front lines of this movement to say, we can no longer waste precious food. We were all born [00:10:00] into millions of people being food insecure. That's wrong. And we know that we can do something about that. We have the simple solution of at least redirecting our precious food to help those in need. So that urgency is now. People are hungry right now. And we have our chapters all across the United States that are doing a food recovery right now. At some point in the day, there's somebody who is doing the right thing to help say, I can help feed my neighbors in need. There's nothing more urgent than that.

We know all the hardships that come with being food insecure. And then when we think about our planet. That urgency is now. I tell people all the time if we can all get on board together in this wonderful community to say, we don't need to waste food any longer. We have the solutions to no longer throw away precious food, and we can begin to, as you said earlier, I love this. To keep that value of the food every single step in the process from seedling to going into our mouths. If we can keep the value of that food, we can really reduce food going into landfill unnecessarily. And then when we can begin to think about that as how we view food, you know, what other problems can we solve together to make our communities thrive for one another?

But in particular with the environment, the time is now. Our food waste is causing environmental harm. We can mitigate that environmental harm by stopping this dizzying, disturbing cycle of wasting food. We're wasting our potable water. We're wasting our fertilizer. We're wasting fuel, gasoline through transportation. And then this food is rotting and it is causing environmental harm, which is going into a larger, broader system of our storms are worse. Our storms are longer. They're starting earlier. They're ending later. They're in places that they weren't before. This is all part of. the environment that we can help to stem the tide of what we are experiencing as a species. So that's another reason why the immediacy is now. Let's not make this worse for the young folks in our lives. Let's not make this worse for the people who have yet to be born. We can do something now.

This podcast is co sponsored by the Recipes Food Waste Research Network project led by American University and funded by the National Science Foundation.

Bio

Regina Harmon has been the Executive Director of Food Recovery Network since 2015 and has been a pivotal voice in raising awareness and harnessing action to reduce food waste, end hunger, and positively impact the environment. She has been invited to share her insights with media outlets such as CNN and Al Jazeera and was recognized as one of the most influential leaders in the food industry by SELF magazine and Food Tank. Apart from her position at Food Recovery Network, Regina is also a board member of Food Tank and Earth Island Institute, serves on ReFED’s Advisory Council, and is a member of the Philadelphia artists' collaborative Pink Noise Projects. Regina emphasizes the need to address the racial disparities in the food system that disproportionately affect the health and economic outcomes of Black, Latinx/Latine, and Native American communities, highlighting the importance of working together to bring about change. Regina holds an MA in Literary and Cultural Studies from Carnegie Mellon University and a BA in English Literature from the University of Maine at Augusta.
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E259: Your state of the science on weight loss drugs
9 jan· The Leading Voices in Food
About two years ago, we released a podcast with Dr. Thomas Wadden of the University of Pennsylvania describing work on a new generation of medications to treat diabetes and obesity. They were really taking the field by storm. Since then, much more is known since many additional studies have been published and so many people have been using the drugs. So many, in fact, the market value of the Danish company, Novo Nordisk, one of the two major companies selling the drugs, has gone up. It is now greater than the entire budget of the country of Denmark. This single company is responsible for about half of Denmark's economic expansion this year. So, a lot of people are now taking the drugs and this is a great time for an update on the drugs. And we're fortunate to have two of the world's leading experts join us: Dr. Wadden, Professor of Psychology and Psychiatry at the University of Pennsylvania School of Medicine and the inaugural Albert J. Stunkard Professor of Psychiatry at Penn. Joining us as well as Dr. Robert Kushner, a physician and professor of medicine at Northwestern University and a pioneer in testing treatments for obesity.

Interview Summary

Tom, you and I were colleagues at Penn decades ago. And I got frustrated the treatments for obesity didn't work very well. People tended to regain the weight. And I turned my attention to prevention and policy. But you hung in there and I admired you for that patience and persistence. And Bob, the same for you. You worked on this tenacious problem for many years. But for both of you, your patience has been rewarded with what seems to me to be a seismic shift in the way obesity and diabetes can be treated. Tom, I'll begin with you. Is this as big of a deal as it seems to me?

Well, I think it is as big of a deal as it seems to you. These medications have had a huge impact on improving the treatment of type 2 diabetes, but particularly the management of obesity. With older medications, patients lost about 7 percent of their starting weight. If you weighed 200 pounds, you'd lose about 15 pounds. That was also true of our best diet and exercise programs. You would lose about 7 percent on those programs with rigorous effort. But with the new medications, patients are now losing about 15 to 20 percent of their starting body weight at approximately one year. And that's a 30-to-40-pound loss for a person who started at 200 pounds. And with these larger weight losses, we get larger improvements in health in terms of complications of obesity. So, to quote a good friend of mine, Bob Kushner, these medications have been a real game changer.

Thanks for putting that in perspective. I mean, we're talking about not just little incremental changes in what treatments can produce, which is what we've seen for years. But just orders of magnitude of change, which is really nice to see. So, Bob what are these medications that we're talking about? What are the names of the drugs and how do they work?

Well, Kelly, this transformation of obesity really came about by finding the target that is really highly effective for obesity. It's called the gut brain axis. And when it comes to the gut it's starting off with a naturally occurring gut hormone called GLP 1. I think everyone in the country's heard of GLP 1. It's released after we eat, and it helps the pancreas produce insulin, slows the stomach release of food, and reduces appetite. And that's where the obesity story comes in. So pharmaceutical companies have taken this hormone and synthesized it, something similar to GLP 1. It mimics the action of GLP 1. So, you could actually take it and give it back and have it injected so it augments or highlights this hormonal effect. Now, that same process of mimicking a hormone is used for another gut hormone called GIP that also reduces appetite. These two hormones are the backbone of the currently available medication.

There's two on the market. One is called Semaglutide. That's a GLP 1 analog. Trade name is Wegovy. Now, it's also marketed for diabetes. Tom talked about how it is used for diabetes and increases insulin. That trade name is Ozempic. That's also familiar with everyone around the country. The other one that combined GLP 1 and GIP, these two gut hormones, so it's a dual agonist, the trade name for obesity is called Zep Bound, and the same compound for diabetes is called Mounjaro. These are terms that are becoming familiar, I think, to everyone in the country.

Tom mentioned some about the, how much weight people lose on these drugs, but what sort of medical changes occur?

Just to reiterate what Tom said, I'll say it in another way. For Semaglutide one third of individuals are losing 20 percent of their body weight in these trials. For Tirzepatide, it even outpaces that. And I got a third of individuals losing a quarter of their body weight. These are unheard of weight losses.

And with these weight losses and these independent effects from weight, what we're seeing in the trials and in the clinic is that blood pressure goes down, blood sugar goes down, blood fats like triglyceride go down, inflammation in the body goes down, because we marked that with CRP, as well as improvement in quality of life, which we'll probably get to.

But really interesting stuff is coming out over the past year or two or so, that it is improving the function of people living with congestive heart failure, a particular form called a preserved ejection fraction. We're seeing improvements in sleep apnea. Think of all the people who are on these CPAP machines every night. We're seeing significant improvements in the symptoms of sleep apnea and the apneic events. And lastly, a SELECT trial came out, that's what it was called, came out last year. Which for the very first time, Kelly, found improvements in cardiovascular disease, like having a heart attack, stroke, or dying of cardiovascular disease in people living with obesity and already have cardiovascular disease. That's called secondary prevention. That, Tom, is the game changer.

Bob, I'd like to go back to Tom in a minute but let me ask you one clarifying question about what you just said. That's a remarkable array of biological medical benefits from these drugs. Just incredible. And the question is, are they all attributable to the weight loss or is there something else going on? Like if somebody lost equal amounts of weight by some other means, would these same changes be occurring?

Those studies are still going on. It's very good. We're thinking it's a dual effect. It's the profound amount of weight loss, as Tom said. Fifteen to 21 to even 25 percent of average body weight. That is driving a lot of the benefits. But there also appear to be additional effects or weight independent effects that are working outside of that weight. We're seeing improvements in kidney function, improvement in heart disease, blood clotting, inflammation. And those are likely due to the gut hormone effect independent of the weight itself. That still needs to be sorted out. That's called a mitigation analysis where we try to separate out the effects of these drugs. And that work is still underway.

Tom, one of the most vexing problems, over the decades that people have been working on treatments for obesity, has been long term results. And I'm curious about how long have people been followed on these drugs now? What are the results? And what was the picture before then? How do what we see now compared to what you saw before?

The study that Bob just mentioned, the SELECT trial followed people for four years on Semaglutide. And patients achieve their maximal weight loss at about one year and they lost 10 percent of their weight. And when they were followed up at four years still on treatment, they still maintained a 10 percent weight loss. That 10 percent is smaller than in most of the trials, where it was a 15 percent loss. But Dr. Tim Garvey showed that his patients in a smaller trial lost about 15 percent at one year and while still on medication kept off the full 15 percent.

I think part of the reason the weight loss in SELECT were smaller is because the study enrolled a lot of men. Men are losing less weight on this medication than women. But to your question about how these results compare to the results of earlier treatment, well with behavioral treatment, diet, and exercise back in the 70s beyond, people lost this 7 or 8 percent of weight. And then most people on average regain their weight over one to three years. And the same was true of medication. People often stopped these earlier medications after 6 to 12 months, in part because they're frustrated the losses weren't larger. Some people were also worried about the side effects. But the long and short is once you stop taking the medication, people would tend to regain their weight.

And some of this weight regain may be attributable to people returning to their prior eating and activity habits. But one of the things we've learned over the past 20 years is that part of the weight regain seems to be attributable to changes in the body's metabolism. And you know that when you lose weight, you're resting metabolic rate, which is the number of calories your body burns at rest to maintain basic bodily functions. Your resting metabolic rate decreases by 10 to 15 percent. But also, your energy expenditure, the calories you burn during exercise decreases. And that may decrease by as much as 20 to 30 percent. So, people are left having to really watch their calories very carefully because of their lower calorie requirements in order to keep off their lost body weight.

I think one thing these new drugs may do is to attenuate the drop both in resting metabolic rate and energy expenditure during physical activity. But the long and short of it is that if you stay on these new medications long term, you'll keep off your body weight. And you'll probably keep it off primarily because of improvements in your appetite, so you have less hunger. And as a result, you're eating less food.

I'd like to come back to that in a minute. But let me ask a question. If a person loses weight, and then their body starts putting biological pressure on them to regain, how come? You know, it's disadvantageous for their survival and their health to have the excess weight. Why would the body do that?

Well, our bodies evolved in an environment of food scarcity, and our physiology evolved to protect us against starvation. First, by allowing us to store body fat, a source of energy when food is not available. And second, the body's capacity to lower its metabolism, or the rate at which calories are burned to maintain these basic functions like body temperature and heart rate. That provided protection against food scarcity.

But Kelly, you have described better than anybody else that these ancient genes that regulate energy expenditure and metabolism are now a terrible mismatch for an environment in which food is plentiful, high in calories, and available 24 by 7. The body evolved to protect us from starvation, but not from eating past our calorie needs. And so, it's this mismatch between our evolution and our appetite and our body regulation in the current, what you have called toxic food environment, when you can eat just all the time.

I guess you could think about humans evolving over thousands of years and biology adapting to circumstances where food was uncertain and unpredictable. But this modern environment has happened really pretty rapidly and maybe evolution just hasn't had a chance to catch up. We're still existing with those ancient genes that are disadvantageous in this kind of environment.

Bob back to the drugs. What are the side effects of the drugs?

Kelly, they're primarily gastrointestinal. These are symptoms like nausea, diarrhea, constipation, heartburn, and vomiting. Not great, but they're generally considered mild to moderate, and temporary. And they primarily occur early during the first four to five months when the medications are slowly dose escalated. And we've learned, most importantly, how to mitigate or reduce those side effects to help people stay on the drug.

Examples would be your prescriber would slow the dose escalation. So. if you're having some nausea at a particular dose, we wait another month or two. The other, very importantly, is we have found that diet significantly impacts these side effects. When we counsel patients on these medications, along with that comes recommendations for dietary changes, such as reducing fatty food and greasy food. Reducing the amount of food you're consuming. Planning your meals in advance. Keeping well hydrated. And very importantly, do not go out for a celebration or go out to meals on the day that you inject or at least the first two days. Because you're not going to tolerate the drug very well.

We use that therapeutically. So, if you want to get control on the weekends, you may want to take your injection on a Friday. However, if weekends are your time out with friends and you want to socialize, don't take it on a Friday. Same thing comes with a personal trainer, by the way. If you're going to have a personal trainer on a Monday where he's going to overwork you, don't take the injection the day before. You'll likely be nauseated, you're not eating, you're not hydrating. So actually, there's a lot that goes into not only when to take the dose and how to take the dose, but how to take it to the best ability to tolerate it.

Two questions based on what you said. One is you talked about these are possible side effects, but how common are they? I mean, how many people suffer from these?

Well, the trials show about 25 to 45 percent or so of individuals actually say they have these symptoms. And again, we ask them mild, moderate, severe. Most of them are mild to moderate. Some of them linger. However, they really do peak during the dose escalation. So, working with your prescriber during that period of time closely, keeping contact with them on how to reduce those side effects and how you're doing out of medication is extremely important.

And the second thing I wanted to ask related to that is I've heard that there's a rare but serious potential side effect around the issue of stomach paralysis. Can you tell us something about that?

I mentioned earlier, Kelly, that these medications slow gastric emptying. That's pretty much in everybody. In some individuals who may be predisposed to this, they develop something called ileus, and that's the medical term for gastric paralysis. And that can happen in individuals, let's say who have a scleroderma, who have longstanding diabetes or other gastrointestinal problems where the stomach really stopped peristalsis. In other words, it's moving. That's typically presented by vomiting and really unable to move the food along. We really haven't seen much of that. We looked at the safety data in a SELECT trial that Tom mentioned, which was 17,000 individuals, about 8,000 or so in each group. We really did not see a significant increase in the ileus or what you're talking about in that patient population.

Okay, thanks. Tom had alluded to this before, Bob, but I wanted to ask you. How do you think about these medicines? If somebody takes them, and then they stop using the medicines and they gain the weight back. Is that a sign that the medicine works or doesn't work? And is this the kind of a chronic use drug like you might take for blood pressure or cholesterol?

That's a great way of setting up for that. And I like to frame it thinking of it as a chronic progressive disease, just like diabetes or hypertension. We know that when you have those conditions, asthma could be another one or inflammatory bowel disease, where you really take a medication long term to keep the disease or condition under control. And we are currently thinking of obesity as a chronic disease with dysfunctional appetite and fat that is deposited in other organs, causing medical problems and so on. If you think of it as a chronic disease, you would naturally start thinking of it, like others, that medication is used long term.

However, obesity appeared to be different. And working with patients, they still have this sense 'that's my fault, I know I can do it, I don't want to be on medication for the rest of my life for this.' So, we have our work cut out for us. One thing I can say from the trials, and Tom knows this because he was involved in them. If we suddenly stop the medication, that's how these trials were definitely done, either blindly or not blindly, you suddenly stop the medication, most, if not all of the participants in these trials start to regain weight. However, in a clinical practice, that is not how we work. We don't stop medication suddenly with patients. We go slowly. We down dose the medication. We may change to another medication. We may use intermittent therapy. So that is work that's currently under development. We don't know exactly how to counsel patients regarding long term use of the medications. I think we need to double down on lifestyle modification and counseling that I'm sure Tom is going to get into. This is really work ahead of us, how to maintain medication, who needs to be on it long term, and how do we actually manage patients.

Tom, you're the leading expert in the world on lifestyle change in the context of obesity management. I mean, thinking about what people do with their diet, their physical activity, what kind of thinking they have related to the weight loss. And you talked about that just a moment ago. Why can't one just count on the drugs to do their magic and not have to worry about these things?

Well, first, I think you can count on the drugs to do a large part of the magic. And you may be surprised to hear me say that. But with our former behavioral treatments of diet and exercise, we spent a lot of time trying to help people identify how many calories they were consuming. And they did that by recording their food intake either in paper and pencil or with an app. And the whole focus of treatment was trying to help people achieve a 500 calorie a day deficit. That took a lot of work. These medications, just by virtue of turning down your appetite and turning down your responsiveness to the food environment, take away the need for a lot of that work, which is a real blessing.

But the question that comes up is, okay, people are eating less food. But what are they eating? Do these medications help you eat a healthier diet with more fruits and vegetables, with lean protein? Do you migrate from a high fat, high sugar diet to a Mediterranean diet, or to a DASH like diet? And the answer is, we don't know. But obviously you would like people to migrate to a diet that's going to be healthier for you from a cardiovascular standpoint, from a cancer risk reduction standpoint.

One of the principal things that people need to do on these medications is to make sure they get plenty of protein. And so, guidance is that you should have about 1 gram of dietary protein for every kilogram of body weight. If you're somebody who weighs 100 kilograms, you should get 100 grams of protein. And what you're doing is giving people a lot of dietary protein to prevent the loss of bodily protein during rapid weight loss. You did a [00:20:00] lot of research with me back in the 80s on very low-calorie diets, and that was the underpinning of treatment. Give people a lot of dietary protein, prevent the loss of bodily protein.

The other side of the equation is just physical activity, and it's a very good question about whether these medications and the weight loss they induce will help people be more physically active. I think that they will. Nonetheless for most people, you need to plan an activity schedule where you adopt new activities, whether it's walking more or going to the gym. And one thing that could be particularly helpful is strength training, because strength training could mitigate some of the loss of muscle mass, which is likely to occur with these medications.

So, there's still plenty to learn about what is the optimal lifestyle program, but I think people, if they want to be at optimal health will increase their physical activity and eat a diet of fruits and vegetables, leaner protein, and less ultra processed foods.

Well, isn't it true that eating a healthy diet and being physically active have benefits beyond their impact on your ability to lose the weight? You're getting kind of this wonderful double benefit, aren't you?

I believe that is true. I think you're going to find that there are independent benefits of being physical activity upon your cardiovascular health. There are independent benefits of the food that you're eating in terms of reducing the risk of heart attack and of cancer, which has become such a hot topic. So, yes how you exercise and what you eat makes a difference, even if you're losing weight.

Well, plus there's probably the triple one, if you will, from the psychological benefit of doing those things, that you do those things, you feel virtuous, that helps you adhere better as you go forward, and these things all come together in a nice picture when they're working.

Tom, let's talk more about the psychology of these things. You being a psychologist, you've spent a lot of time doing research on this topic. And of course, you've got a lot of clinical experience with people. So as people are losing weight and using these drugs, what do they experience? And I'm thinking particularly about a study you published recently, and Bob was a coauthor on that study that addressed mental health outcomes. What do people experience and what did you find in that study?

I think the first things people experience is improvements in their physical function. That you do find as you've lost weight that you've got less pain in your knees, you've got more energy, it's easier to get up the stairs, it's easier to play with the children or the grandchildren. That goes a long way toward making people feel better in terms of their self-efficacy, their agency in the life. Big, big improvement there. And then, unquestionably, people when they're losing a lot of weight tend to feel better about their appearance in some cases. They're happy that they can buy what they consider to be more fashionable clothes. They get compliments from friends. So, all of those things are positive.

I'm not sure that weight loss is going to change your personality per se, or change your temperament, but it is going to give you these physical benefits and some psychological benefits with it. We were happy to find in the study you mentioned that was conducted with Bob that when people are taking these medications, they don't appear to be at an increased risk of developing symptoms of depression or symptoms of suicidal ideation. There were some initial reports of concern about that, but the analysis of the randomized trials that we conducted on Semaglutide show that there is no greater likelihood of developing depression or sadness or suicidal ideation on the medication versus the placebo. And then the FDA and the European Medicines Agency have done a full review of all post marketing reports. So, reports coming from doctors and the experience with their patients. And in looking at those data the FDA and the European Medicines Agency have said, we don't find a causal link between these medications and suicidal ideation.

With that said, it's still important that if you're somebody who's taking these medications and you start them, and all of a sudden you do feel depressed, or all of a sudden you do have thoughts like, maybe I'd be better off if I weren't alive any longer, you need to talk to your primary care doctor immediately. Because it is always possible somebody's having an idiosyncratic reaction to these medications. It's just as possible the person would have that reaction without being on a medication. You know, that, that can happen. People with overweight and obesity are at higher risk of depression and anxiety disorders. So, it's always going to be hard to tease apart what are the effects of a new medication versus what are just the effects of weight, excess weight, on your mood and wellbeing.

You know, you made me think of something as you were just speaking. Some people may experience negative effects during weight loss, but overall, the effects are highly positive and people are feeling good about themselves. They're able to do more things. They fit in better clothes. They're getting good feedback from their environment and people they know. And then, of course, there's all the medical benefit that makes people feel better, both psychologically and physically. Yet there's still such a strong tendency for people to regain weight after they've lost. And it just reinforces the fact that, the point that you made earlier, that there are biological processes at work that govern weight and tendency to regain. And there really is no shame in taking the drug. I mean, if you have high blood pressure, there's no shame in taking the drug. Or high cholesterol or anything else, because there's a biological process going on that puts you at risk. The same thing occurs here, so I hope the de-shaming, obesity in the first place, and diabetes, of course, and then the use of these medications in particular might help more people get the benefits that is available for them.

I recommend that people think about their weight as a biologically regulated event. Very much like your body temperature is a biologically regulated event, as is your blood pressure and your heart rate. And I will ask people to realize that there are genetic contributors to your body weight. just as there are to your height. If somebody says, I just feel so bad about being overweight I'll just talk with them about their family history of weight and see that it runs in the family. Then I'll talk to them about their height. Do you feel bad about being six feet tall, to a male? No, that's fine. Well, that that's not based upon your willpower. That's based upon your genes, which you received. And so, your weight, it's similarly based. And if we can use medications to help control weight, cholesterol, blood pressure, blood sugar, let's do that. It's just we live in a time where we're fortunate to have the ability to add medications to help people control health complications including weight.

Bob, there are several of the drugs available. How does one think about picking between them?

Well, you know, in an ideal medical encounter, the prescriber is going to take into consideration all the factors of prescribing a medication, like any other medication, diabetes, hypertension, you name the condition. Those are things like contraindication to use. What other medical problems does the patient have that may benefit the patient. Patient preferences, of course and side effects, safety, allergies, and then we have cost. And I'll tell you, Kelly, because of our current environment, it's this last factor, cost, that's the most dominant factor when it comes to prescribing medication.

I'll have a patient walk in my room, I'll look at the electronic medical record, body mass index, medical problems. I already know in my head what is going to be the most effective medication. That's what we're talking about today. Unfortunately, I then look at the patient insurance, which is also on the electronic medical record, and I see something like Medicaid or Medicare. I already know that it's not going to be covered. It is really quite unfortunate but ideally all these factors go into consideration. Patients often come in and say, I've heard about Ozempic am I a candidate for it, when can I get it? And unfortunately, it's not that simple, of course. And those are types of decisions the prescriber goes through in order to come to a decision, called shared decision making with the patient.

Bob, when I asked you the initial question about these drugs, you were mentioning the trade name drugs like Mounjaro and Ozempic and those are made by basically two big pharmaceutical companies, Novo Nordisk and Eli Lilly. But there are compounded versions of these that have hit the scene. Can you explain what that means and what are your thoughts about the use of those medications?

So compounding is actually pretty commonly done. It's been approved by the FDA for quite some time. I think most people are familiar with the idea of compounding pharmacies when you have a child that must take a tablet in a liquid form. The pharmacy may compound it to adapt to the child. Or you have an allergy to an ingredient so the pharmacy will compound that same active ingredient so you can take it safely. It's been approved for long periods of time. Anytime a drug is deemed in shortage by the FDA, but in high need by the public, compounding of that trade drug is allowed. And that's exactly what happened with both Semaglutide and Tirzepatide. And of course, that led to this compounding frenzy across the country with telehealth partnering up with different compounding pharmacies. It's basically making this active ingredient. They get a recipe elsewhere, they don't get it from the company, they get this recipe and then they make the drug or compound it themselves, and then they can sell it at a lower cost. I think it's been helpful for people to get the drug at a lower cost. However, buyer beware, because not all compounded pharmacies are the same. The FDA does not closely regulate these compounded pharmacies regarding quality assurance, best practice, and so forth. You have to know where that drug is coming from. Kelly, it's worth noting that just last week, ZepBound and Mounjaro came off the shortage list. You no longer can compound that and I just read in the New York Times today or yesterday that the industry that supports compounding pharmacies is suing the FDA to allow them to continue to compound it. I'm not sure where that's going to go. I mean, Eli Lilly has made this drug. However, Wegovy still is in shortage and that one is still allowed to be compounded.

Let's talk a little bit more about costs because this is such a big determinant of whether people use the drugs or not. Bob, you mentioned the high cost, but Tom, how much do the drugs cost and is there any way of predicting what Bob just mentioned with the FDA? If the compounded versions can't be used because there's no longer a shortage, will that decrease pressure on the companies to keep the main drug less expensive. I mean, how do you think that'll all work out? But I guess my main question is how much these things cost and what's covered by insurance?

Well first how much do the drugs cost? They cost too much. Semaglutide, known in retail as Wegovy, is $1,300 a month if you do not have insurance that covers it. I believe that Tirzepatide, known as ZepBound, is about $1,000 a month if you don't have insurance that covers that. Both these drugs sometimes have coupons that bring the price down. But still, if you're going to be looking at out of pocket costs of $600 or $700 or $800 a month. Very few people can afford that. The people who most need these medications are people often who are coming from lower incomes. So, in terms of just the future of having these medications be affordable to people, I would hope we're going to see that insurance companies are going to cover them more frequently. I'm really waiting to see if Medicare is going to set the example and say, yes, we will cover these medications for anybody with a BMI of 40 or a BMI of 35 with comorbidities. At this point, Medicare says, we will only pay for this drug if you have a history of heart attack and stroke, because we know the drug is going to improve your life expectancy. But if you don't have that history, you don't qualify. I hope we'll see that.

Medicaid actually does cover these medications in some states. It's a state-by-state variation. Short of that, I think we're going to have to have studies showing that people are on these medications for a long time, I mean, three to five years probably will be the window, that they do have a reduction in the expenses for other health expenditures. And as a result, insurers will see, yes, it makes sense to treat excess weight because I can save on the cost of type 2 diabetes or sleep apnea and the like. Some early studies I think that you brought to my attention say the drugs are not cost neutral in the short-term basis of one to two years. I think you're going to have to look longer term.

Then I think that there should be competition in the marketplace. As more drugs come online, the drug prices should come down because more will be available. There'll be greater production. Semaglutide, the first drug was $1,300. Zepbound, the second drug Tirzepatide, $1,000. Maybe the third drug will be $800. Maybe the fourth will be $500. And they'll put pressure on each other. But I don't know that to be a fact. That's just my hope.

Neither of you as an economist or, nor do you work with the companies that we're talking about. But you mentioned that the high cost puts them out of reach for almost everybody. Why does it make sense for the companies to charge so much then? I mean, wouldn't it make sense to cut the price in half or by two thirds? And then so many more people would use them that the company would up ahead in the long run. Explain that to me.

That's what you would think, for sure. And I think that what's happened right now is that is a shortage of these drugs. They cannot produce enough of them. Part of that is the manufacturing of the injector pens that are used to dispense the drug to yourself. I know that Novo Nordisk is building more factories to address this. I assume that Lilly will do the same thing. I hope that over time we will have a larger supply that will allow more people to get on the medication and I hope that the price would come down.

Of course, in the U. S. we pay the highest drug prices in the world. Fortunately, given some of the legislation passed, Medicare will be able to negotiate the prices of some of these drugs now. And I think they will negotiate on these drugs, and that would bring prices down across the board.

Boy, you know, the companies have to make some pretty interesting decisions, don't they? Because you've alluded to the fact that there are new drugs coming down the road. I'm assuming some of those might be developed and made by companies other than the two that we're talking about. So, so investing in a whole new plant to make more of these things when you've got these competitor drugs coming down the road are some interesting business issues. And that's not really the topic of what we're going to talk about, but it leads to my final question that I wanted to ask both of you. What do you think the future will bring? And what do you see in terms of the pipeline? What will people be doing a year from now or 2 or 5? And, you know, it's hard to have a crystal ball with this, but you two have been, you know, really pioneers and experts on this for many years. You better than anybody probably can answer this question. Bob, let me start with you. What do you think the future will bring?

Well, Kelly, I previously mentioned that we finally have this new therapeutic target called the gut brain axis that we didn't know about. And that has really ushered in a whole new range of potential medications. And we're really only at the beginning of this transformation. So not only do we have this GLP 1 and GIP, we have other gut hormones that are also effective not only for weight loss, but other beneficial effects in the body, which will become household names, probably called amylin and glucagon that joins GLP 1.

And we not only have these monotherapies like GLP 1 alone, we are now getting triagonists. So, we’ve got GIP, GLP 1, and glucagon together, which is even amplifying the effect even further. We are also developing oral forms of GLP 1 that in the future you could presumably take a tablet once a day, which will also help bring the cost down significantly and make it more available for individuals.

We also have a new generation of medications being developed which is muscle sparing. Tom talked about the importance of being strong and physical function. And with the loss of lean body mass, which occurs with any time you lose weight, you can also lose muscle mass. There's drugs that are also going in that direction.

But lastly, let me mention, Kelly, I spend a lot of my time in education. I think the exciting breakthroughs will not be meaningful to the patient unless the professional, the provider and the patient are able to have a nonjudgmental informative discussion during the encounter without stigma, without bias. Talk about the continuum of care available for you, someone living with obesity, and get the medications to the patient. Without that, medications over really sit on the shelf. And we have a lot of more work to do in that area.

You know, among the many reasons I admire the both of you is that you've, you've paid a lot of attention to that issue that you just mentioned. You know, what it's like to live with obesity and what people are experiencing and how the stigma and the discrimination can just have devastating consequences. The fact that you're sensitive to those issues and that you're pushing to de-stigmatize these conditions among the general public, but also health care professionals, is really going to be a valuable advance. Thank you for that sensitivity. Tom, what do you think? If you appear into the crystal ball? What does it look like?

I would have to agree with Bob that we're going to have so many different medications that we will be able to combine together that we're going to see that it's more than possible to achieve weight losses of 25 to 30 percent of initial body weight. Which is just astonishing to think that pharmaceuticals will be able to achieve what you achieve now with bariatric surgery. I think that it's just, just an extraordinary development. Just so pleased to be able to participate in the development of these drugs at this stage of career.

I still see a concern, though, about the stigmatization of weight loss medications. I think we're going to need an enormous dose of medical education to help doctors realize that obesity is a disease. It's a different disease than some of the illnesses that you treat because, yes, it is so influenced by the environment. And if we could change the environment, as you've argued so eloquently, we could control a lot of the cases of overweight and obesity. But we've been unable to control the environment. Now we're taking a course that we have medications to control it. And so, let's use those medications just as we use medications to treat diabetes. We could control diabetes if the food environment was better. A lot of medical education to get doctors on board to say, yes, this is a disease that deserves to be treated with medication they will share that with their patients. They will reassure their patients that the drugs are safe. And that they're going to be safe long term for you to take. And then I hope that society as a whole will pick up that message that, yes, obesity and overweight are diseases that deserve to be treated the same way we treat other chronic illnesses. That's a tall order, but I think we're moving in that direction.

BIOS

Robert Kushner is Professor of Medicine and Medical Education at Northwestern University Feinberg School of Medicine, and Director of the Center for Lifestyle Medicine in Chicago, IL, USA. After finishing a residency in Internal Medicine at Northwestern University, he went on to complete a post-graduate fellowship in Clinical Nutrition and earned a Master’s degree in Clinical Nutrition and Nutritional Biology from the University of Chicago. Dr. Kushner is past-President of The Obesity Society (TOS), the American Society for Parenteral and Enteral Nutrition (ASPEN), the American Board of Physician Nutrition Specialists (ABPNS), past-Chair of the American Board of Obesity Medicine (ABOM), and Co-Editor of Current Obesity Reports. He was awarded the ‘2016 Clinician-of-the-Year Award’ by The Obesity Society and John X. Thomas Best Teachers of Feinberg Award at Northwestern University Feinberg School of Medicine in 2017. Dr. Kushner has authored over 250 original articles, reviews, books and book chapters covering medical nutrition, medical nutrition education, and obesity, and is an internationally recognized expert on the care of patients who are overweight or obese. He is author/editor of multiple books including Dr. Kushner’s Personality Type Diet (St. Martin’s Griffin Press, 2003; iuniverse, 2008), Fitness Unleashed (Three Rivers Press, 2006), Counseling Overweight Adults: The Lifestyle Patterns Approach and Tool Kit (Academy of Nutrition and Dietetics, 2009) and editor of the American Medical Association’s (AMA) Assessment and Management of Adult Obesity: A Primer for Physicians (2003). Current books include Practical Manual of Clinical Obesity (Wiley-Blackwell, 2013), Treatment of the Obese Patient, 2nd Edition (Springer, 2014), Nutrition and Bariatric Surgery (CRC Press, 2015), Lifestyle Medicine: A Manual for Clinical Practice (Springer, 2016), and Obesity Medicine, Medical Clinics of North America (Elsevier, 2018). He is author of the upcoming book, Six Factors to Fit: Weight Loss that Works for You! (Academy of Nutrition and Dietetics, December, 2019).

Thomas A. Wadden is a clinical psychologist and educator who is known for his research on the treatment of obesity by methods that include lifestyle modification, pharmacotherapy, and bariatric surgery. He is the Albert J. Stunkard Professor of Psychology in Psychiatry at the Perelman School of Medicine at the University of Pennsylvania and former director of the university's Center for Weight and Eating Disorders. He also is visiting professor of psychology at Haverford College. Wadden has published more than 550 peer-reviewed scientific papers and abstracts, as well as 7 edited books. Over the course of his career, he has served on expert panels for the National Institutes of Health, the Federal Trade Commission, the Department of Veterans Affairs, and the U.S. House of Representatives. His research has been recognized by awards from several organizations including the Association for the Advancement of Behavior Therapy and The Obesity Society. Wadden is a fellow of the Academy of Behavioral Medicine Research, the College of Physicians of Philadelphia, the Obesity Society, and Society of Behavioral Medicine. In 2015, the Obesity Society created the Thomas A. Wadden Award for Distinguished Mentorship, recognizing his education of scientists and practitioners in the field of obesity.
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E258: Do 'market driven epidemics' drive your food choices?
19 dec 2024· The Leading Voices in Food
For much of history, the word 'epidemic' applied to infectious diseases. Large numbers of cases of disease caused by organisms such as bacteria and viruses that spread through water, air, or other means, sometimes transmitted from person to person, or back and forth between people and animals. Then came epidemics of chronic diseases such as obesity, diabetes, heart disease - diseases occurring in very large numbers and created not by infectious agents, but by drivers in our day to day lives, such as a bad food environment. A new paper was just published in the PLOS global health literature that I found fascinating. It focuses on another use of the concept of epidemics: market driven epidemics. Let's find out what these are and find out a little bit more about their implications for our health and wellbeing. Our guests today are two of the authors of that paper. Dr. Jonathan Quick is a physician and expert on global health and epidemics. He is an adjunct professor at Duke University's Global Health Institute. Eszter Rimanyi joins us as well. She works on chronic disease and addiction epidemiology at Duke university.

Interview Summary

Access the PLOS article “Dynamics of combatting market-driven epidemics: Insights from U.S. reduction of cigarette, sugar, and prescription opioid consumption.”

So, Jono, let's start with you. Tell us what you mean by market driven epidemics.

The pattern is familiar to people. There is a product that that humans like and the business community says we can make a lot of money on this unmet need. And so they do that and they start selling a lot of it. And then people start noticing that this thing that the humans like is killing some of them. And so, the scientists do the public health. And then the business community says these scientists are going to kill the golden goose. They buy up other scientists and try to defend themselves. And then it goes on and on before we really bend the epidemic curves. This pattern of consumer products that have harmful effects, those products are major contributors to the root causes of at least a million deaths a year in the US, and over 20 million deaths worldwide.

So, to try to look at this from an epidemic point of view, we first established a case definition. Our definition of market driven epidemic is a significant increase in death, disability and other harmful effects on humans and human health and wellbeing. It's arising from a consumer product whose use has been accelerated by aggressive marketing. Whose harmful effects have been denied or otherwise minimized by producers. And for which effective mitigation is possible but actively opposed by producers.

So, we looked at the natural history of this, and we found five phases through which these epidemics pass. There's market development, either inventing a new product, developing a product like prescription opioids, or transforming an existing product like tobacco. Phase two is evidence of harm. First, there's suspicion, astute clinicians, whistleblowers, and then eventually proof of harm. Phase three is corporate resistance. Companies deny harm, seek to discredit accusers, commission counter science, manufacture doubt, mount legal challenges. All the while deaths and social upheaval and economic costs are mounting. And finally, our next phase four is mitigation. We get some regulatory efforts going, and there's a tipping point for the consumption and resulting deaths. And then finally, phase five of this is market adaptation. In a response to decreasing or threatened consumption, companies and consumers typically seek alternatives. Adaptations can be positive or negative. Some are healthier, some are equally or more harmful.

Thanks very much for that description. It really helps explain what the concept is all about. You chose three areas of focus. You could have chosen others, but you chose cigarettes, sugar, and prescription opioid use. Why those in particular?

We wanted to identify differences in these market driven epidemics in a few product categories. We wanted to look at distinctly different consumer experiences so we could see what worked and what didn't in terms of bending the epidemic curve. We picked nicotine delivery, food, and prescription medicine. And to choose within those categories we established five inclusion criteria. So, number one, the product had to have proven adverse health effects. Number two, there needed to be well documented histories of product development, marketing, mitigation efforts, and so forth. Number three, the product needed to meet the overall case definition. That is, companies knew they were doing harm, continued to do harm, and fought that harm. Number four, there needed to be long term data available for product consumption and associated impact. And number five, most important, we chose products for which mitigation efforts had already resulted in significant sustained reduction in product consumption. Based on these three criteria, cigarettes, sugar, and prescription opioids came out as the ones that we studied.

Thanks. I really appreciate that description. And when we get to the punchline in a minute, it's going to be interesting to see whether the behavior of the industry in this natural history that you talked about is similar, given that the substances are so different. We'll get to that in a minute. So Eszter, I'd like to turn to you. What kind of information did you pull together to write this paper?

I think I looked at over a thousand different documents. But there were two clear types that I interrogated to pull together all of our background data. The first category was publicly available data, so that could have been a clinical study, epidemiological study, advertisement by the company, CDC or other government reports, mortality data, etc. But then there was also a distinct different type of data that we really looked at and that was really useful for putting together these pictures of the natural history, which was internal documents. In some cases, these could have been leaked by an internal employee, which was the case with the so called 'brown documents' with tobacco. But it also came from sometimes court hearings or as a result of lawsuits that the companies had to release internal data. It was really interesting to compile together the different sides, of the outside look from CDC reports, and then the insider scoop from Purdue Pharma. So, it's a very well rounded, interesting way to find all this data.

I admire your effort. It's a big job to do a normal scientific review where you might have 50 papers and you were looking at things that were much harder to obtain and a vast number of things that are really quite different in character. Boy, congratulations for just reading all those things. Tell us what you found.

Gosh, so even though there's so many distinct differences between a lot of these epidemics, what we actually found was that there was a lot of narrative similarities. And because of that, we could really create this holistic, but also really well-fitting idea of market driven epidemics. A lot of the corporate strategies were either mirrored, imitated, or in some cases quite literally lifted over because of overlapping ownership between the companies.

One of the things that we really wanted to hammer into our article was that producers not only created their product, but they also manufactured doubt. Which means that they created, on purpose, public hesitancy around their product even when they internally knew that it was harmful to health. They wanted the public to be on the fence about what the health impact of their product was. There was a lot of different ways that they achieved that goal. Sometimes it was through showing propaganda films in high schools. Which I still can't believe that happened and then that was legal. But also in different ways, like co-opting science, paying scientists to publish articles in their favor. I know a really famous example of this that has now been public is that two Harvard researchers in cardiovascular disease published saying that sugar was not harmful to health. So, there's a lot of different ways that they achieved it, but the goals overall were very similar by all the companies.

You know, you mentioned overlapping ownership. And so, you might have been referring specifically to the ownership of the food companies by the tobacco companies.

Correct.

Because it happened a while ago, that's not something that was well known. But there's a fascinating history there about how the tobacco industry used its technology to maximize addiction and used that to develop food products and to change the DNA of the food companies in ways that still exist today, even though that ownership ended many years ago. I'm really glad you pointed that out.

Yeah, exactly. I think there's this shared idea that there's a turning point for companies. Where they know internally that their product is causing harm. And what really tips them over into becoming market driven epidemics is not actually coming out and saying that there's an issue with their product or not improving it. But you know really digging that information into the dirt and saying no we're going to protect our product and keep giving this out to the public despite the harms.

You know, maybe we can come back to this, but the fact that you're finding similarities between these areas suggests that there are contingencies that act on corporate executives that are similar no matter what they're selling. And that's helpful to know because in the future, you can predict what these companies will be doing because there are many more similarities than differences. Jono let me ask you this. You've talked about this appalling period of time between when there are known health consequences of use of some of these things and the time when meaningful action occurs to curb their consumption and to rein in the behavior of the companies. How long is this gap, and what explains it?

Kelly, this is one of the most fascinating things about this study. And it really highlights the importance of taking an epidemiologic approach. This is a behavioral epidemic, not a viral one. But it has so many characteristics. One of the key points is that is how important time is. And we see that in any epidemic curve when things start going exponential. If we take cigarettes, okay, the harms of cigarettes had long been suspected. But the first credible scientific publication was by a US physician, Isaac Adler, in a 400-page 1912 book where he first associated cigarettes with cancers. Fast forward over 40 years to British scientists Doll and Hill, and they did the epidemiology which definitively and convincingly links cigarette cancer with smoking deaths. So that gap was incredible and so that's one of the first examples. Once those articles were published, others followed the initial one. It took about a decade until the 1964 Surgeon General's report on smoking and health. And that was quickly followed by a series of federal actions. So, 1964, '63, '64 was the tipping point. Five decades after the initial suspicion.

For sugar, the journey from suspicion to compelling evidence was more complex. There was a big debate between researchers, clinicians, scientific journalists, that began in the '50s. A diabetologist from Britain John Yudkin, argued in the 1957 Lancet piece, it's sugar that's equal or larger than fats. An American physiologist, Enzo Keyes, says au contraire. He said it on the cover of Time Magazine. From 1950 to 2000, there was this debate back and forth. Finally, sugar consumption in the US peaked in '99 when a sugar wary group of researchers, journalists, and advocacy groups began becoming really vocal. And that was the tipping point. The actual compelling science, it came a few years after the preponderance of folks engaged said, no, it's sugar. You got to do something.

And finally, with prescription opioids: 1997, rural doctors Art Van Zee and another fellow, alerted Purdue Pharma, the producer of OxyContin, about rising overdoses. A year later, there was a publication that said the sustained release version of OxyContin, which was a hydrocodone that was sustained release, that they first tried it with morphine, and they had evidence from there that the sustained release drugs were a problem. And again, it was over a decade later that mounting prescription opioid deaths in the US convinced CDC to declare an epidemic of [00:14:00] opioid prescribing. This gap, if you look at it, to summarize, for cigarettes, the journey from credible suspicion of harm to consumption tipping point, five decades. Sugar, four decades. Prescription opioids, fourteen years. But the key thing is that the power of collective action, because today, only one in eight Americans smoke, and it was nearly 50 percent at the peak. The US consumption of sugar, which increased by 30 pounds between the year 1950 and the year 2000, when all this debate was going on. We picked up an extra 30 pounds of sugar consumption per person per year, but within two decades, that was cut back. We gave back 15 pounds of that. And now prescription opioids have gone back to a medically defendable level, having risen to 8 to 10 times that in the peak of the prescription opioid epidemic.

Hearing you talk about that, it's nice that there's sometimes light at the end of the tunnel. But boy, it's a long tunnel. And that you can count the, the number of deaths during that tunnel period of time in the millions. It's just unspeakable how much damage, preventable damage gets caused. Now, and I'd like to, when I come back to wind up this podcast, I'd like to ask each of you, what do you think might be done to help narrow that or shrink that time gap and to prevent these long delays and to help address these corporate determinants of health. But before I get there, Eszter, you know, I'd like to follow up on the conversation we had earlier. You know where it's clear that sugar and tobacco and opioids are all quite different substances, but the companies, the natural history of these things looks quite similar. And you mentioned in particular the industry attempt to plant doubt. To create doubt in the minds of people about the stories they were hearing of the dangers of these things, whether they were true or not. And were there other things that the industry was doing during that time that you noticed might have similarities across these areas?

Oh my gosh, so many. I have to go through all the examples in my head and make sure that I have a very crisp message out of all of them One of the ones that is interestingly being employed today in a very different epidemic with firearms and guns, is this idea of whose choice is the consumer product in its use. And today there's a lot of ideas that were initially created by tobacco, and then used by food, that are currently being used by gun lobbyists talking about individual freedoms. So with some of the previous market driven epidemics, like tobacco and prescription opioids, it's a way easier argument to make that the individual at some level does not choose to use the product. Maybe in the beginning, the first couple uses were their individual choice, but then there's on purpose, a really strong withdrawal response in the body and socially. The individual kind of had to continue using the product. But some of those ideas are being used today with firearms. The idea that somebody has the liberty to use this product or to purchase this product, which undoubtedly causes harm. You know, it's probably not really good for public health if this argument exists. And, in the cases with firearms, which I think is a little bit ironic and sad, a lot of the people that buy guns for their own self-defense actually experience those guns turned around and used on them, usually by the perpetrators of aggression. These ideas of individual freedoms usually backfire to the people that are consuming the products. It's interesting to me that a lot of these ideas were initially created for very different products, but are being used in the current day.

So interesting to hear you say that because here we have yet another area where there are similarities with the firearms. And the companion argument to that idea that it's your personal liberty to use these things is the argument that there's overreach by government, big brother, things like that. When government wants to, you know.

Yeah.

It's so interesting.

So one point on that. The market economy was never meant to be a free for all. Because the reality is that the market economy has brought billions of people out of poverty and saved more lives than most health interventions. But the problem is, as I said, it wasn't meant to be a free for all. And it depends on having good consumer information and when companies are distorting it, they're basically taking away the informed choice, which is critical. The other part of it is, when they are purposely engineering their products for maximal addictiveness, which is done with clicks and social media, and was done purposefully with the nicotine content in cigarettes, then you don't have a real informed choice. The freedom of choice. You've had your brain pleasure center hijacked by, by purposely addictive products.

Right, and you didn't mention food, but there's another example of substances that are created to hijack the reward pathway in the brain.

Absolutely.

I'd like to ask each of you, what in the heck can we do about this? I mean, you've pointed out a massive problem. Where the number of lives that are sacrificed because of corporate behavior, just enormous numbers. What can we do about it? Jono, I will start with you. And, you know, you've written this very highly regarded book called The End of Epidemics. And you've talked about things like bending epidemic curves and accelerating shifts. But tell us more. What do you think can be done in the case of these market driven epidemics like we're talking about?

Well, I think it's important to realize that both kinds of epidemics, viral and behavioral, are communicable. Both involve a lot of rumor, blame, uncertainty. And as we've talked about both cause deaths in the thousands or millions. And we haven't talked so much about the significant social disruption, and the cost. Trillions of dollars in economic losses and additional health burdens. So let me focus on four kinds of key actors because when it comes down to it, it's groups that that really start acting against these things. The first is the research community and its funders. You won't be surprised given the time it takes to get the evidence because what's clear is without clear evidence of product associated harm, we're not going to move the political agendas. We're not going to get public support for epidemic curves. So, we have really good researchers working in these areas. They need to guard against groupthink. That's what happened with our salt sugar 50 years of chaos discussion. And conflict of interest because companies do try to undermine the database.

The second is the funders of research, foundations and all, and national health services need to have an early warning system and an annual research roadmap in this area. I think Eszter will probably talk about the importance of public health leaders, because she's looked a lot at that. Another community though is the different civil society groups that are active. Because there's Mothers Against Drunk Driving, there's the Sandy Hook group on gun shooting, and there are a variety of interest groups. But what we realize is that there are lots of different strategies for how you move decision makers and all. So, more information sharing from those groups, civil society groups and all across. And finally, companies. It's actually in their interest to be more forthcoming earlier on. With tobacco, with prescription opioids, and now with baby powder, with talc, what we're seeing is companies at risk of bankruptcy paying billions of dollars. And if their CEOs aren't looking at that, then their board needs to be.

Can I ask you a quick question about that? When the chickens come home to roost, and those bad things befall a company, you know, really seriously damaging lawsuits, or the possibility that perhaps sometime the executives will go to jail for corporate malfeasance. You know, the behavior that caused all the millions of deaths occurred 15 CEOs before them. So, if you're a CEO and you know you have a certain shelf life as CEO, you want to maximize profit during that time. And by the time anything happens negatively to the company, you're on vacation, you're retired, or you're gone. So how do you deal with that?

Here's the thing, it's having criminal and civil liability that can go back to the individuals involved. From a different sector, an example. The German executive who was head of Volkswagen over a decade ago when they cheated on their environmental issues. He's been criminally charged today, a decade later. And I think that sort of personal accountability, it'll be hard to get, but that's the kind of thing that will make CEOs and their boards, if their boards also become responsible for hiding information in a way that it resulted in deaths. I think that, unfortunately, that kind of hammer, although it's going to be hard to get, that's probably what's needed.

Okay, that makes good sense to me, and I'm glad I asked you that question. And I appreciate the answer. Eszter, anything you'd like to add to what Jono said about what could be done.

Yes. One of the amazing things about market driven epidemics was when we were creating the paper, we created a table of all the different types of actors that could have very successful mitigation. And that table actually ended up being cut from the paper because it was so long that the editor said that it might distract from the rest of the paper. But that's actually a very positive message because there are so many actors that can have positive change, I'm going to highlight a couple of them because I think there's a few things here that are fairly good core messages that we can take away.

One of the ones is the need for a trusted public health authoritative voice. I think nowadays there's a lot of commotion over how much we trust the government. And how much we trust, for example, the head of the CDC and the types of data they're talking about in terms of public health. But in the past, when we had a very trusted public health voice, that was really crucial in getting consumers to change their behavior. For example, in the 1964 Surgeon General's report, seemingly overnight changed people's behavior. Before then, smoking was a common, everyday social event. And after that, people started viewing it as a deadly, bad habit that some people had. And that type of change was really hard to get in the modern day. When we were talking about public health crises that were viral. So, I think one of the things that we really need to get again in the modern day is this trust between the people and public health voices so that when we have such good forthcoming information those statements actually mean something. So much so that the consumers change their behavior.

Another thing is with us individuals who maybe aren't part of public health, we actually play a pretty big role in how much other people consume these different products. I remember when I was researching cigarettes in particular and the intersection with social media. I think if somebody under 18 saw a peer smoking and posted that to Instagram, that doubled their likelihood of trying out smoking for the first time. You have to be really careful with how you show yourself in the presence of others, and online too with a new digital age. Because you might tip the scale in somebody trying out a product for the first time. Which then if it has a very strong withdrawal effect, you know that person might have to might feel that they have to continue using that product to avoid withdrawal. I think as an individual, you can be more mindful about if you have a certain product use that you don't want others to also pick up, to maybe not do it or not show it as much so that other people aren't interested in doing that.

Okay, the last really positive message I have is that I think as my generation gets into higher positions of power, even within corporations, I think Gen Z and Gen Alpha and other young people have the sense of responsibility for others and for the planet. And I think if there was a young person in power in a corporation and saw that oh no this product that we've had is now there's evidence that's harmful. I think there would be more accountability and more of a want to do something that's good for the planet and for people. I'm hopeful that, maybe 50, 60 years ago, if people were more in favor of kind of brushing things under the rug, then maybe the young generation won't be as into those ideas. And we'll actually want to be accountable and do what's right.

BIOS

Jonathan D. Quick, MD, MPH (“Jono”) is adjunct Professor of Global Health at the Duke Global Health Institute, where he teaches global health policy, serves on foundation grant advisory boards, and mentors students. Dr. Quick’s current research and writing focuses on market-driven epidemics, from tobacco to opioids to social media. He is also Affiliated Faculty in Global Health Equity, Brigham and Women’s Hospital/Global Health & Social Medicine, Harvard Medical School. Dr. Quick is the author of The End of Epidemics: The Looming Threat to Humanity and How to Stop It (Australian, Italian, Korean, South Asia, U.K. and U.S. 2018/2020/2021 editions), creator of MDS-3: Managing Access to Medicines and Health Technologies and an author of The Financial Times Guide to Executive Health, Preventive Stress Management in Organizations, as well as more than 100 other books, chapters, and articles in leading medical journals.

Eszter Rimanyi is a chronic disease epidemiologist working with Dr. Jonathan D. Quick at the Duke Global Health Institute. Her research interest centers around Market-Driven Epidemics, including tobacco, sugar, opioids, and breastmilk substitute/infant formula. She is currently working on applying the market-driven epidemics approach to new epidemics, such as social media and firearms. Rimanyi has authored scientific papers in journals such as PloS Global Public Health and MDPI.
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E257: Embracing convergence in the RECIPES Network
4 dec 2024· The Leading Voices in Food
In 2021, American University and 15 partner institutions across the U. S. launched the Multiscale RECIPES Research Network with the goal of transforming our wasted food system into a sustainable and resilient one. Food loss and waste is a complex problem spanning societal issues such as food insecurity and food recovery, sustainable farming, food packaging and transportation, food marketing, sales and consumer preferences, family dynamics, and corporate profits, among others. A fascinating part of the RECIPES Network vision is a purposeful focus on convergence, making the research process more effective and creative in designing solutions to big problems such as these. In a recent article in the journal Ecology and Society, team members evaluated how well the network's intentional convergence efforts have worked thus far.

Interview Summary

Norbert Wilson - It is my great pleasure to welcome my colleague, Amanda Wood, who is a research scientist at the World Food Policy Center.

Amanda Wood - Thank you, Norbert. I'm looking forward to this discussion today. Our guests come from the University of Illinois Institute of Technology Food Systems Action Lab. Weslynne Ashton is a professor of environmental management and sustainability at Illinois Tech and co directs the Food Systems Action Lab. Azra Sungu is a design researcher and strategist at the Food Systems Action Lab, who just defended her doctoral dissertation. So, our biggest congratulations to Dr. Sungu. Thank you so much for being here today. So first, I want to start by saying the RECIPES Network has gone about their work a little bit differently than most traditional academic projects by taking a convergence approach. Weslynne, would you talk about what convergence is in research, and why is this approach useful for tackling complex societal challenges like food waste?

Weslynne Ashton - Convergence is an approach that really tries to integrate the best of many different disciplines. The way that they see, approach, and tackle problems. And tries to integrate them in a really holistic way, right? Like, we often operate in silos and universities and this is a way of trying to get out of that. But more than working side by side on the same topics, it really tries to pull ways of working and ways of knowing across these different disciplines. For the topic of food waste, which as Norbert described is incredibly complex, right? There are so many different dimensions. They're scientific, natural science, social science, anthropological, political science. So, there are these technical aspects, economic aspects, social aspects, as well as cultural and spiritual aspects that we really don't talk about that often. And so, a convergence approach tries to say, how can we bring together the way all of these different disciplines approach understanding and developing solutions so that the solutions we develop can be more holistic. And more likely to take hold because they are considering these different perspectives.

Amanda - A lot of individuals might not see food waste as this complex challenge. They throw their leftovers in the bin and that's food waste to them. But as you say, challenges of food waste and food loss extend all the way across the food system. So, we definitely need that more holistic approach. Thanks for that bigger picture. Norbert, over to you.

Norbert - Azra, I'd like to turn it over to you and ask you a question about design. And I've got to say, this is the first project that I've ever worked on where I've worked with design scholars. And so, I'm excited for you to share with our audience what actually is design. And how do you see design fitting in the context of the work that we've been doing?

Azra Sungu - Thank you. Yes, it's been very exciting for me to part of such a transdisciplinary group as well. And probably in over 12 years of design education that I got, that was the most frequent question. Like my family and everyone that's asking, like, what is it that you do actually? So, I think it's really important that we clarify that because design in this context is a little bit different than the design of products and services.

In a way, we could say that it carries similar principles, but in recent years, design has been gaining visibility as a creative and collaborative problem-solving approach. So, some of the key mindsets, methods, and processes of design have been distilled into more accessible toolkits that allow more people from various backgrounds and expertise to get together and collaboratively explore problems of different kinds and approach them in more creative ways. So, we can say that, yeah, this adaptation of design found applications in different fields, such as entrepreneurship. We see that picking up in education or even apply to issues related to social justice. And I would say that what makes it different from other problem-solving approaches is that it centers a deep understanding of humans, their needs, their interactions, their behaviors in every step of the process. So, from framing the problem to testing out the solutions. And in design, we combine this human centered approach with a hands-on process where we iteratively explore a solution by making things and experimenting in a more open-ended way, rather than like planning everything and applying the solution at the end.

So, in the context of convergence, I think of convergence as a collaborative search for ways for reshaping the systems that we live in. And if I pick back on what Weslynne just said, yeah, the design can help ground this search in the real lives of people so that the solutions we envision can be adopted and also actualized by people who are driving this change on the ground. So, it can support a more action oriented approach to knowledge production.

But another role of design, which we speak more of in the paper, is designing the conditions for this form of collaborative research and knowledge production. Designing the spaces where people can build relations to build really confidence to think outside of the box. And I see it as giving people the tools and processes to tap into their collective creativity. And that you can't really get out of a toolkit. That's a deeper and relational process.

Norbert - Thank you for sharing that. And I am really pleased that we've had the opportunity to not only work with you all, but folks at MIKA to think about design in this network. And can you give us an example of how you all were able to use design to help us work better together, to move us closer to convergence?

Azra – Yes. I guess in the first two year of the RECIPES where we explored design's role in the context of convergence, it's applied more to the second part of design's role that I mentioned earlier. So, creating the conditions for convergence to happen. And I think we're in the process of shifting to applying design to the solutions and like this iterative process itself.

I would say that there are five components that we identified in our investigation. And I always like to joke that like, we can't just throw people in a room and expect them to collaborate and come up with results. And let's remember RECIPES as a network started during the pandemic. We didn't even get a room to be together in until two years later. So, in this context, a key role of design was really convening people and connecting them to build that capacity and trust in each other to collaborate. And like trust one another to jump into a very open ended and ambiguous form of inquiry. Because this is what happens when we tackle such complex challenges as wasted food. And the other role is perhaps, yeah, in this exploration giving a shared vision to people to move towards. And enticing possibilities in this vision that may not be in our immediate horizon. So again, like how we think outside of the box and envision possibilities that may not seem evident. But that might be the root of more transformative change.

And the third role is probably one that relates to storytelling and visualizing. So, as we gather a group of people with such mixed disciplinary expertise and mixed personal backgrounds, we don't necessarily talk the same language. Even if you're approaching the same problem. So even when we talk about wasted food, it might seem so evident, but we might focus on completely different sides of it. And yeah, we have like mathematicians, chemists, engineers, social scientists in the same room. And when we're collaborating with such mixed group of expertise, design can create the interfaces, the visual language for us to be able to speak of the same thing and communicate ideas. But also, like foster flow and dissemination of ideas between these different conversations by telling the stories and capturing the ideas and really distilling them in a more relatable and accessible way. Because God knows we have a lot of meetings, and somebody needs like shepherd those conversations.

And the last ones are probably like making and prototyping. Which I think is very, very core to design practice, right? We just materialize things, whether it's in a visual format or whether it's like really getting hands on and making something that we got a taste of in our first network meeting that was in person.

I think one process where this manifested really beautifully was the creation of guiding principles and community norms that was a very collaborative and co-creative process where Network members really shaped how they would like to work together and create together and set the conditions for that. So, in this process, designers collaborated with other researchers in the network to set these workshops to gather different perspectives and ideas of network members on what it means to be in a good collaborative research environment. And this was a very iterative process. We created multiple drafts, materialized this, and brought that back to the network and gathered input and feedback. So, it was I think along a process of over a year, it was taking shape. And at the end we had this artifact that was co-created with people from various areas of expertise and had everyone's input that helped lay the groundwork for a more authentic and genuine collaboration.

Norbert - I want to pick up on one thing you said, Azra. Yes, there were a lot of meetings. So many meetings. But they were really important for us to figure out how to work. But one of the things I found really challenging being a part of the network and as I interacted with the design process is I wasn't comfortable with the storytelling. I wasn't comfortable with this sort of new way of being because it wasn't the way I was trained, right? But over time, I found it sort of expansive. And I love there was a conversation we had before we started our recording, this idea of being my whole self in the process. Of being my whole self in the project. And I, I really have enjoyed, and I will use the word 'enjoyed' working with this network because I'm fully myself in many of these settings. So, I want to thank you all for helping us do that and opening up new ways to work with other people beyond the network.

Azra - Thank you. Yes. And a question I think that they ask very often when hiring designers is like, are you comfortable with uncertainty and ambiguity? And I always like to say, no. Like nobody's really comfortable with uncertainty and ambiguity. But I think it's really about building the confidence to jump into that together. And that happens by building trust. It's not just about producing knowledge and transferring that between one another, but how do we approach this in a more relational way? And I think that's the transformative shift that's happening with a more convergent approach to research. Great. Thank you.

Amanda - Sounds like it was a transformative experience for many involved. Good to hear. Weslynne, let me shift back to you so we can dig into some of the results of the paper. In your view, how did the integration of design really enable the network's convergent approach? And is there anything that didn't quite work?

Weslynne - Yes, so Azra's pointed out to several things that the design team did. I would add that we had a dedicated design team, right? That was really important because there was this group who that one would help to facilitate these meetings, right? And get people to come in, structure exercises to get people to talk to each other. Create whiteboards where people could, you know, say what they're thinking, whether that's in a larger group or in a smaller group. And then behind the scenes, they would distill and synthesize all these whiteboards from all the breakout groups into something that was actionable, right? And I think like, that's really one of the powers of design. It's not just talk, right? It's how do we take this talk, take people's ideas, and synthesize them into something that we can create actions around, right? So, the example that Azra gave of the guiding principles and community norms, you know, looked like several brainstorming sessions and breakout groups where people had a document, a kernel to react to. And weigh in on what are the values and the principles that they thought were important for us to have in this network to guide how we worked, not only with each other, but also with external partners. And to iterate, right, iterate on those prototypes and bring something back to the group that, that we can hold up and say, yeah, this is something that, you know, like we all agree to at least for now, right? In a year we might learn something else and want to come back to this and change it. But having that dedicated team was really important.

I'd say another thing that convergence puts forward is the importance of integrating the next generation of scientists, of researchers, into practice. And so, I think one of the things that we did well in the structure of the network. So, we were structured in different thematic clusters. But there was a student cluster where all the students from all of the disciplines came together, including the design students. And it turned out that the design students gave some training to the other students in design methods in facilitation. And that actually I think is perhaps one of the most beautiful examples of convergence in the network. So that the students were able to understand each other's work in a much deeper way. And think about how they might use design in this work.

So, what design did well, and reiterating on what Azra said, it's really creating these enabling conditions, right? For people to feel comfortable, to show up as their whole selves. To make it okay to take a risk and say something crazy, something out of the box. Because someone would be able to synthesize that into a hole later on.

I think there were perhaps like a couple instances, like within some of these thematic clusters where we had initially thought, okay, we're going to put a designer in each of these clusters and use that as a way to integrate some design thinking into each of these groups. But there were some of the groups that were like really so highly technical and so highly focused that it was hard for the designer, who does not have that technical background, to get a toehold in that group. And so, where we kind of merged is that we had our co-design cluster as the primary place where people who we're designers or we're curious about design could come to learn. And then can take that back to the groups that they were working in. Rather than trying to plug design into every single one of the clusters.

Amanda - I really appreciate these insights, especially underscoring the importance of having specific roles to help facilitate. I think, often as researchers when you're applying for grants, either the funder doesn't allow you to apply for a facilitator role, or you think, oh, we have too many important other researchers that we need to fund. And I think this project was a great example that, I think Azra said it before, collaboration doesn't just happen when you throw people in a room. And this project really highlighted the value of having those design experts in the group. Helping everyone along on that journey. I hope that these learnings can go out to both funders and other research groups. But I'd like to ask both of you a question now. In the paper, you write that the pairing of convergence and design is a natural fit, but not necessarily a seamless one. What kind of tensions or challenges did the Network face when using design to foster convergence? And Weslynne, let's start with you.

Weslynne - One of the important tensions, I think, is on this role of a designer, right? So, often when designers show up in spaces, it's as a graphic designer. So, someone who's visualizing the process making illustrations. It's as a facilitator, right? So, someone who's structuring the conversation to be more productive, to help people be more collaborative. And the tension that we see is that that's not the only role of design, right? Design research in and of itself is an important research area that adds value to projects, right? And whether that is using a human centered design research approach, right? Where we're plugging in designers into a research project. For example, to learn about how employees are behaving, right? And if we wanted to change a particular food waste prevention strategy in grocery stores, we need to engage the employees to understand their perspectives, right? So, designers help to integrate that approach as a research method. And so, you know, this tension here is that we can have some designers working as facilitators of this network convergence, but we also need designers as researchers who are contributing to the research questions and research methods that we're trying to converge in the process.

I'll say one more and then I'll pass to Azra to, to see what she would add. This is a National Science Foundation funded project, right? And there is an inherent tension that the type of research that NSF tends to fund is very STEM focused, right? So, it's science, technology, engineering, math. And there is social science, but certainly, you know, like, we have a dominance of science and technology as the predominant set of disciplines in this group. And so that means that the social scientists, the designers are kind of at the fringes. And one of our challenges was to really create a space where all of these different disciplines have the ability to come in on an equal footing. I'm sure Azra would like to add a couple more.

Azra - Yeah, thank you. I could build up on what you just said about like how design's role is understood. Yeah, when I was first talking about design, I talked about how toolkits made it more accessible. Like processes of human centered design and design thinking to be learned and adopted by people who are non-designers, and really gain more visibility to design. It was a blessing, but also a barrier for people to understand broader expertise of design, right? Like what, what we learned in 12 years of school cannot necessarily be translated to toolkits. And there is in the design field itself, over the past decade, there has been different branches that are emerging that are specifically dealing with the complex issues that we try to tackle through convergence research. So, we have specific areas of expertise. Like, systemic design, who tries to use design processes to understand systemic dynamics and patterns. We have transition design who tries to understand how long-term transition processes can be fostered in more creative and inclusive ways. Or we have life centered design that some of the researchers from MIKA are leading that are going beyond human centered design approach, but like saying, how can we center the life itself? How can we consider the needs of non-human beings in our design processes? And I think it's going to be a lot longer process for like these different areas of expertise of design to gain more visibility. But it's also, yeah, a mutual understanding that gets fostered as we work together.

And perhaps the second thing I could add, I've been talking a lot about unlearning and unmaking recently. And it's probably the stage that I met at the end of PhD journey, where I realized how much unlearning it took. And I think the same applies to convergence research, because here we are trying to cultivate a completely different way of working that goes beyond disciplinary boundaries, that goes beyond geographic boundaries that sometimes goes beyond like the hierarchies that we're used to in academia. And there are certain structures and mindsets that come from traditional scholarship that can get into way of such authentic collaboration and open-ended way of working, right? We work with a certain funding structure. We work with certain expectations of progress and success from academia. And that might conflict sometimes with like a very open-ended exploration and experimentation that might also include failure and not getting anywhere at the end. So, yeah, I think there are some structures and mindsets that we need to reevaluate. We want to cultivate a broader culture of convergence.

Amanda - Thank you. I have to admit as a researcher, I was probably one who did not appreciate all of the nuances of design. So, this has been a very enlightening conversation. But also, just the emphasis that this is going to take time. It's not necessarily that you get in your first convergent project and wow, you've now done the perfect model of convergence. You're learning as you go. As you said, sometimes failure is involved. And so, it's just the journey that you're on. Thank you so much for those reflections.

Norbert - Weslynne, I want to come back to you and just think about something that was already said. This idea of we can't just simplify design as a series of tools that you could just kind of pick up and put into something else. And appreciating the complexity, the richness of what design as a discipline is, I'm interested to know how do we best use design, recognizing that it's a huge area? How do we use it authentically to address issues like convergence in the research team? And I want to even push that a little bit further. I mean, because some of our listeners are not researchers. They're not part of research teams, but they're designing policy. They're designing or they're a part of policy efforts. I'd be interested to think about what design can offer to any sort of group of people coming together to solve complicated challenges.

Weslynne - I'm going to bring this into my teaching because I think like as a lecturer in a design school, one of the things that, that I emphasize in thinking about systems, thinking about how designers show up, is that there are many different types of expertise, right? So, there's our professional, educational expertise. There's the expertise of lived experiences. And it's often the case that we are biased in terms of one being more important than the other. And I tried to train my students to think about, like, what are their own biases and assumptions coming into situations. So that they can more authentically create space for different viewpoints and different ways of being.

So, if we're trying to map systems and map all of the forces that are important for not only understanding a problem, and not just kind of the symptom of the problem that we see, but the real patterns and structures that are the root cause of those problems. That we have to kind of create a space where people can feel more comfortable to really explore more of those, those root causes. I think in applying design and a convergent research context, and a policy solution development process, that designers can help to create the conditions, create a space, for people from different perspectives to come into that space and be comfortable bringing their knowledge, their ways of being, their ways of knowing into that context. And that's a skill, right? That is a facilitation skill to help people show up in, in that way. I think that there are also these tensions that we came across in this Network, in the course of doing this research, where, you know, we found that it's really important to create a space for reflexivity. So that it's not just about creating these outputs and it's not just about these tasks. But creating a space where people have the time to reflect on what's happening, well, what has happened, and how they can then integrate that back into their practice, right? There can be these cycles of convergence, but there's also a need for divergence, right? And giving people the space to express what they're interested in, do the types of work that they're most interested in. And then come back together to say, okay, how can we bring these things together? I see design as really helping to play an important role in reframing questions. In helping groups dig deeper and reach more robust understanding of the challenges that they face. And then help to make the solutions more actionable, right? And that's not just as a research output. It's not just as a research paper. But really having solutions that work for a diversity of people.

Norbert - I'm grateful for the way you've explained what design is. Both you and Azra have explained what design is and what it can do for us as members of society. And I just think about the current political and social moments that we're in and how design has a role to play in helping us, as you talked about, reframing problems, and finding solutions that benefit a broad swath of society. I didn't realize I was going to become an evangelist for designers. And I'm grateful for the work that you all are helping us think differently about how we do research or how we engage the larger community.

BIOS

Weslynne Ashton is a professor of environmental management and sustainability at Illinois Institute of Technology, with joint appointments at the Stuart School of Business and the Institute of Design. She is the co-director of the Food Systems Action Lab at Illinois Institute of Technology. Dr. Ashton is a sustainable systems scientist, whose research, teaching and practice are oriented around transitioning our socio-ecological systems towards sustainability and equity. She studies the adoption of socially and environmentally responsible strategies in business, and the role of innovation and entrepreneurship in addressing social and environmental challenges. Her research is grounded in industrial ecology and the circular economy. Her current work focuses on increasing sustainability and equity in urban food systems, and developing regenerative economies in post-industrial regions, newly industrializing countries and small island states.

Azra Sungu is a design researcher and strategist at the Illinois Institute of Technology ID Food Systems Action Lab. Her research focuses on narrative-focused approaches for cultivating radical transition imaginaries. Her work uses design to navigate complexity, surface patterns and discover new pathways. Dr. Sungu earned her doctorate from Illinois Institute of Technology.
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E256: ATNI - driving market change towards nutrition
21 nov 2024· The Leading Voices in Food
Now more than ever, it's important to challenge the world's food and beverage manufacturers to address nutrition issues like obesity and undernutrition. Today, we're going to discuss the 2024 Global Access to Nutrition Index, a very important ranking system that evaluates companies on their nutrition related policies, product portfolios, marketing practices, and engagement with stakeholders. The index is an accountability strategy produced by ATNI, the Access to Nutrition Initiative, a global nonprofit foundation seeking to drive market change for nutrition. Our guest today is Greg Garrett, Executive Director of ATNI.

Interview Summary

You know, I very much admire the work you and your colleagues have done on this index. It fills such an important need in the field and I'm eager to dive in and talk a little bit more about it. So, let's start with this. You know, we've all heard of the concept of social determinants of health and more recently, people have begun talking about corporate determinants of health. And your organization really is focused on corporate determinants of nutrition. Let's start with a question that kind of frames all this. What's the role of industry in nutrition, according to the way you're looking at things? And how does the Global Index shine a light on this topic?

Thanks for the question. We're working primarily quite downstream with large manufacturers and retailers. But we hope to affect change across the value chain by working with that group. Of course, when we talk about private sector in food, that's a very, very broad terminology that we're using. It could include farmers on the one hand, looking all the way upstream, all the way through to SMEs, aggregators, processors, manufacturers.

SMEs are what?

Small and medium enterprises, small and medium enterprises, local ones. All the way through to the multinational food and beverage manufacturers. But also catering organizations and restaurants. When we talk about business what we're trying to do is ensure that business cares about portability, and access to safe and nutritious food. And I think we can say pretty safely, based on the data which we'll talk about, that the health aspects of food are still not as, they're not at the forefront like they should be. Yet.

We'll dive in and talk a little bit more about what the index is and what it shows in a minute. But let's start with a kind of broader question. What is the role of diet and consumption of processed foods in influencing health?

Yes, so they say now one in five deaths are related to poor diet. It's arguably now the biggest risk factor related to global morbidity and mortality. We've seen in the last 20 years a slight slowing down of our efforts to combat malnutrition and undernutrition. Whereas we've seen over nutrition, obesity, really taking off. And that's not just in high income countries, but also low- and middle-income countries. So, you know, it might be too little good food and that can lead to at the extreme end of things wasting. It might be too little micronutrients, which can lead to all kinds of micronutrient deficiencies or hidden hunger that leads to many adverse outcomes. Including, for example, cognitive decline or reduced immune system. And then, in terms of diabetes and obesity, we're seeing that really skyrocket. Not only in countries where we have excessive food intake, but also in low- and middle-income countries where they have too much food with a lot of, say, empty calories. Not enough nutrients that are needed. In fact, the recent numbers that we've been working with, it looks like in the last 20 years, obesity rates have gone from about 7.9 percent to 15.9 percent. And by 2030, it might be that 20 percent of global population is considered obese if we don't mitigate that.

Right, and of course that number is many, many times higher in the developed countries. So, you've got a tough job. You talked about the complexity of the food industry going all the way to the farmers, to the big companies, and caterers even, and things. And a lot of different health outcomes are involved. How in the world do you construct an index from all that? Why don't you tell us what the Global Index is, and then some of what you found in the most recent report.

Yes, so the Global Index, we've been running it for 11 years since ATNI was founded. And it has gone through multiple iterations. This latest one was the biggest we've done and we tried to capture about a quarter of the world's market. So, what we did is we took the 30 largest food and beverage manufacturers by revenue. We looked at 52,000 of their products, and that's where we know the market share was about 23 percent global market share. We profiled the foods. We tried to understand their governance structures and how much nutrition features in the way they run their business. We tried to understand, for example, how they market the foods. Are they marketing them responsibly, according to the World Health Organization guidelines? Really dive deep. It's dozens and dozens of indicators where we ask lots of questions of the companies over a 10-month period. And, by doing that, we hope to understand how financially material is nutrition to these companies. We want to give something of use, not only for the companies, but to policymakers. Because we know there's a big role for policymakers to both incentivize the production and the marketing of healthy foods, but also disincentivize unhealthy foods. We want this to be useful for investors. So, we spend a lot of time, through collaborative engagements, working with the shareholders of these companies as well so that they can invest more responsibly in the food company. And then the other group that we hope to eventually work with are the consumer associations. The groups that would represent consumers so that they can put appropriate pressure on the demand side, you know. They can demand healthier food. It's not that we believe by running an index somehow companies are going to start doing everything right. No. We want to provide data and analysis to the sector so that all the stakeholders can use it to help influence change.

That makes perfect sense to have some data driven enterprise to figure out what's actually going on. Otherwise, you're just having to go on intuition. So, what did the most recent index find?

Right, so out of those 30 companies, what did we find? There's some good news. Let's start with the good news before we get into the bad news. There's maybe more bad news than good news. In aggregate, we're actually now seeing that 34 percent of the revenue derived from the products that we profiled, those 52,000 products, is based on healthier sales. Meaning 34 percent could be considered healthier foods. That doesn't sound great, maybe, but consider just 4 years ago when we ran this index, it was at 27%. So, there's some marginal increase and maybe if we can accelerate things, and that's what we're trying to do, it's our big strategic objective. We hope that by 2030, we could say that at least half of business' revenue is coming from healthier food options. There's a lot of changes that need to take place to get to that point, but some companies are doing it.

Also, we noticed a lot more companies are now starting to use a government endorsed nutrient profile model to define the healthiness of the food products, to measure and monitor the healthiness of their food portfolios, and then to disclose that. That's really good. It's the beginning. First step is measure, disclose. The second step would be put targets on that and actually start to get substantive change towards 2030.

But there was a lot of unfortunate news too. We had some backsliding from some of the major companies. For example, low- and middle-income countries actually had the lowest health score. What we think is happening, based on the data we looked at, is that if you're a low-income country, you're getting the lowest healthiness score of these products in your country. So, brand X would be slightly healthier in Europe, but less healthy in the low-income country. So there's a need for regulation there.

Can I stop and ask you a question about that? I've got a million questions just flying out of my head that I'm dying to ask. But what you reminded me of is the history of the tobacco industry. When the policies came into play, like very high taxes and banning smoking in public places in the developed countries, US specifically, the smoking rates went way down. But the companies made more money than ever because they just went outside the US. Especially the developing countries and were selling their products. So, it sounds like the food companies might be engaged in a similar enterprise. But why in these countries would they be pushing their least healthy foods so aggressively?

I'll start with the facts, because there's some speculation here. But the fact is, if you look at your own monitored data, the highest growth of the modern food retailers is in Africa. So, you've got, for example, 80 to 300 percent growth over the last 5 years in Africa of these modern food retail shops. And in Asia, that's, that's already happened. Still happening in some countries. So, you have enormous opportunity for packaged foods, right? Because that's usually what they're selling, these retailers. I think you have some aspiration going on there, too. I think there's consumers who aspire to have convenient foods. They're more affordable now as incomes increase in those settings. Now, regulation is definitely, in general, in those countries, not as mature as it might be in Europe when it comes to colorants, and taxing, say, sugar sweet beverages. So, what you've asked, I think there's some truth to it. I don't want to come out and say that that's exactly what's happening, but we ran the numbers and the healthiness score. So, we use a five-star rating system. The Health Star rating system, one to five. Anything 3.5 or above, we would consider healthier in a diet. 3.4 and below would be considered unhealthy. And the score in low-income countries was 1.8. And in middle to high income, it was 2.4. So, it's quite a, quite a big difference.

That's really very striking. You know, I guess if I'm a food company and I just want to maximize my profits, which of course companies are in business to do, then what I'm going to sell are the foods that people eat the most of. Those are the ones that are triggering the brain biology, the 'over consume'. And the ones that have the greatest shelf life and are easiest to produce and things like that. So, I'm going to make processed foods and push those into new markets as aggressively as I can. So, I'm not asking you to think through the corporate mindset about what's driving this. But it sounds like the data that you have, the end product of all these practices, would be consistent with thinking like that.

We like to think that there could be a role for healthier processed foods. But it has to be in moderation. So, what we looked at is the materiality of nutrition. Are companies actually able to have their business and have a healthier food portfolio? So, before we ran the global index, we did an assessment of this. And what we found is that if you're a mixed food company, and you decide to reformulate so that over time you have a healthier food portfolio, in fact, we found that their capital valuations and how they did on the market was slightly better. Not a lot. Than their say, less healthy counterparts. So, what we see is the beginning of a 'health is wealth' sort of narrative. And we hope that we can drive that forward. And of course, policy would help a lot. If policy would come out and say, let's tax the bad, subsidize the good. Then I think industry is going to fall in line. So, we're not sympathetic with industry because a lot of what's happening is not good. On the other hand, we're realists. And we know that these companies are not going away. And we need to make sure that what they offer is as healthy as it should be. And there's a role for everybody in that.

All right, that's such an interesting perspective. So, you talked about the global findings. What can you say about the US in particular?

What I'd like to do is actually refer to our 2022 US index. So, we did a deep dive just recently; October 2022, right after Biden's Nutrition Conference in DC. And, it wasn't really positive in the sense that we looked at 11 companies. The 11 biggest companies representing 170 billion revenues in the US. And 30 percent of all US food and beverage sales were based on healthier food options. Now, that was 4 years after we ran a 2018 US index. So, 2018, same thing, 30%. There's no change. It's still as unhealthy as ever. I think we need the US to come on board here because it is such a leader. A lot of these companies are headquartered in the US. So, we need to see that healthiness score go up in the US.

You know, it's interesting some of the things you mentioned companies might be doing outside the US would be helpful if they did take place in the US. Like front of package labeling would be one example of that. So that would be a place where American companies are behind the curve, and it would be helpful if they caught up. It'd be interesting to dissect the reasons for why they are. But it's interesting that they are. What are some of the things businesses are doing to improve nutrition outcomes? Let's talk maybe on the more positive side. Do you think there's progress overall? It sounds like it from the numbers that you're presenting. But are there signs also of backsliding? And what do you think some of the successes have been?

Yes, and I think we can get specific on a few. There's a company headquartered in Mexico, Grupo Bimbo. They rose up in the rankings six places between our 2021 Global Index and this one in 2024. They've been reformulating. They've been making their product portfolio healthier overall. It's about 50 percent now. I think some of that was their own initiative, but it was also prompted by a lot of Latin America's regulations, which is great. I think we can learn a lot from Latin America when it comes to front of pack labels and taxes. So, Group of Bimbo was a good success story. Arla, a Danish dairy company, they came out on top in the index in terms of marketing. So, they have basically said they're not going to market unhealthy foods to children under the age of 16. And they try to even go to 18, but it isn't quite being monitored across all digital platforms. And that's the next level is to take it to the digital platforms and monitor that.

And that was a bit disappointing in general, just to find that out of the 30 companies, not one is able to come out and say that they followed the WHO Guidelines on Responsible Marketing 100 percent. The latest index shows that nine out of the 30 companies now, or 30%, nine out of the 30 companies are now using a government endorsed nutrient profile model to define healthy, and then monitor that across their portfolios. And that's a lot of progress. There were only a handful doing that just four years ago. We would ask that all 30 use an NPM, a nutrient profile model, but nine is getting somewhere. So, we're seeing some progress.

Boy, if not a single company met the WHO Guidelines for Food Marketing it shows how tenacious those practices are. And how important they are to the company's bottom line to be able to protect that right to market to kids, vulnerable populations, to everybody really. So it really speaks to keeping that topic in the limelight because it's so important.

We'd like investors to come out and say they will only invest in companies that are moving towards a 2030 target of marketing response. Zeroing in on 1) responsible marketing and 2) the healthiness food product. Zero in on those two things make really clear what the metrics are to measure that.

So, you've mentioned several times, a very important, potentially very important group: shareholders. And you said that that's one of the stakeholders that you interact with. Are there signs out there of activist stakeholders? Shareholders that are putting pressure on the companies to change the way they do business.

Yes. So, institutional investors have the ability to talk directly to the board, right? And they have the power in many cases to remove the CEO. So, they're a powerful group, obviously, and we've worked with over 80 now. And had them work with us to understand what investing in a progressive food company would look like. It's making better and better decisions, continuous improvements on nutrition. We have 87, I think is the latest count, who have signed a declaration to invest like this in a food healthier business. They represent $21 trillion of assets under management. It's a very powerful group. Now are all 80 actively, like you mentioned activist shareholders, you know, pushing, say, for example, for resolution. No. Some are. And they're using our data for that. And we applaud any kind of action towards better nutrition, healthier foods, better marketing using our data. We, as ATNI, do not sign these shareholder resolutions. But we absolutely will make our data available as a public good so that they can be used by this powerful group to yeah, hold the companies to account and hopefully invest in the long term. That's what it comes down to. Because it's true that this will take time for the benefits to come to both business and to people, but it's worth it. And I think the longer-term investors get it. And that's why they're doing these shareholder resolutions and different other investor escalation strategy.

That strikes me as being pretty good news. Let's go down this road just a little bit further, talking about this, the shareholders. So, if the shareholders are starting to put, some at least, are putting pressure on the companies to go in a healthier direction, what do you think is motivating that? Do they see some big risk thing down the road that they're trying to anticipate and avoid? Is it policies that if the companies don't behave, governments might feel more emboldened to enact? Is it litigation that they see? What are they trying to avoid that's making them put pressure on the companies to move in these directions?

That's a great question. When we ran the materiality assessment on nutrition earlier this year, we interviewed many of the investors and it seemed to come down to three things. One, there is coming regulation. There's more and more evidence that when you regulate the food system and you regulate food industry, and you do it in a smart way through a two-tiered levy system, for example, on sugar sweetened beverages. You tax the company, not the consumer. It actually does work. You have a decrease in consumption of these beverages. So coming regulation. The other one is increasing consumer demand for healthier options. Now, that might not be happening yet everywhere. And I think it only really happens when people can afford to demand healthier foods, right? But it seems like it's a trend everywhere as incomes increase and people's knowledge and understanding of nutrition increases, they do want healthier options. So, I think investors see that coming. And the third one is healthcare bills. Now, the investors don't always pick that up. Although in the case of some of our insurance companies who we work with, like AXA, it does. But they see the big macroeconomic picture. And we were talking to one of the investors last week, and they said it's all about megatrends. For them it's about investing in the megatrends, and they see this as a mega trend. This, you know, growing obesity, the cost related to obesity, growing costs related to diabetes and all NCDs. And they don't want to be investing in that future. We need to be investing in a healthier future. I think those are the three things we're gathering from the investors.

So, Greg, there's sort of this jarring reality, it seems to me. And other people have written about this as well. That if the world becomes healthier with respect to its diet; let's just say you could wave a magic wand and obesity would go from its very high levels now to much lower levels or even zero. It means the world would be having to eat less food and the companies would be selling less food. And then you superimpose upon that another jarring reality that people simply buy more, eat more, of less healthy options. So, if a child sits down in front of a bowl of plain cornflakes, they're going to eat X amount. If that's sugar frosted flakes, they're going to eat, you know, 1.5 X or 2 X or whatever the number is. So, how can the companies try to make as much money as possible and be true to its shareholders and shareholders while at the same time, facing these realities.

That's a great question. It goes to the heart of what we're trying to do at ATNI. That's why we say we're transforming markets for nutrition. Because if we don't help support that underlying market change, then we won't get very far in a sustainable way. You mentioned calories and over consumption. And that, of course, is part of the problem, but I think it's equally fair to say not all calories are treated the same and we need to look at the ingredients going into these food products to begin with. You know, why is sugar or any kind of corn derivative such an attractive cheap ingredient to put into food? And so bad for people if it's not eaten with anything else, if it's just an empty carb, for example. It's because of the subsidies, the billions of dollars of subsidies going into sugar around the world. In the United States, a very large subsidy going to the corn industry. And so, corn is then turned into many types of derivatives, many different types of ingredients that go into our foods. So, that's one thing. I think the other is that there's a big role for food policy to level the playing field. We hear this all the time from our industry partners, and we tend to agree. You know if two or three of the 30 companies that we just indexed stick their neck out and do something good, it’ll work for two or three years until the other 27 start to undercut them. And if they're somehow making, you know, better money, bigger profits, more market share it's going to be very tempting for the three that made the good decisions to go back to what they were doing before. We have to change the market structure and end the perverse market incentives.

Makes sense. One final question. What can policymakers do?

I think we've touched on it a little bit. There's the fiscal policy space, which we're very excited about at ATNI. There are over 100 jurisdictions now that have put in place some kind of sugar sweetened beverage tax. But why not expand that take it to any kind of product which is too high in sugar, right? And again, make it like a proper levy on the company and not the consumer. Because that's where the evidence is that it works. Subsidies, you know, there's very few countries which are subsidizing healthier foods. Instead, you're seeing subsidies, as we just mentioned, going to the wrong kind of product. So that's one. And here's a new one: environmental, social, and governance investing metrics. As countries start to mandate the disclosure requirements for publicly listed companies, why not include two nutrition metrics? One on marketing, one on healthiness, so that every food company is mandated to disclose information on these things. That would be a real innovative way for policymakers to help regulate things. And front of pack labeling. You mentioned it yourself earlier. We would agree clear front of pack labels. So, the consumers know what's healthy and what's not.

BIO

Greg S Garrett is the Executive Director of ATNI (Access to Nutrition Initiative), a global foundation supporting market change for nutrition. Greg has held several leadership roles over the past twenty years, including serving on the Global Executive Team of the Drugs for Neglected Diseases initiative (DNDi), directing Abt Global’s health reform in Kyrgyzstan and leading strategy at ThinkWell, a global health organization. During his eight years with the Global Alliance for Improved Nutrition (GAIN), Greg served as Director of Food Fortification and Director of Policy & Financing during which time he established a multi-million-dollar financing facility and managed a portfolio that reached one billion people with fortified foods. Greg serves on the Global Nutrition Report’s Stakeholder Group and is a member of the Blended Finance TaskForce. He holds a BA and an MSc in International Development from the University of Bath, UK.
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E255: Reducing food waste - less seafood wasted than thought in US
18 nov 2024· The Leading Voices in Food
The U. S. is the largest importer of aquatic foods, which includes fresh and saltwater fish, crustaceans, mollusks, and aquatic plants served in restaurants and homes. A critical piece of this global market is the cold chain, keeping these foods chilled or frozen during storage and transport to market. With 44 percent of aquatic foods sold live or fresh globally, the percentage of fresh over frozen aquatic foods creates an extra logistical cold chain challenge. What's more, most aquatic foods become, well, fishy from cold chain disruptions, which can cause perceived food safety concerns, potentially resulting in food getting tossed into the bin. Until recently, research to understand just how much aquatic food gets wasted or lost has been spotty. However, in a recent Nature Food article, researchers argue that aquatic food loss and waste in the United States is actually half of earlier estimates. And that's good news that we'll explore today. This interview is part of an ongoing exploration of food loss and waste.

This episode is co-hosted by environmental economist, Martin Smith at Duke University's Nicholas School of the Environment.

Interview Summary

Martin Smith - So I'm really pleased to introduce our guests for today. First up from University of Florida, a natural resource economist, Frank Asche. Frank is a long-time collaborator of mine and a good friend. And he's also one of the world's leading experts in seafood markets and trade. And honestly, Frank has taught me just about everything I know about aquaculture.

Also today, we have Dave Love from the Johns Hopkins Center for a Livable Future. Dave is someone whose work I'm also very familiar with and is a leading expert in food systems and sustainability. And recently in my classes, I have often said out loud to some student questions that I don't know the answers to. I'll bet Dave Love knows the answer to that question.

Norbert Wilson - So Dave, let's begin with you. Why was it important to develop better estimates and methods of aquatic food waste in the US? Why did your team pursue this research question?

Dave Love - Great question. So, the US government has a goal of cutting food waste in half by 2030. And if you want to know how much you need to cut, you really need to go out and measure. And that's one of the areas of food waste that we really don't know a lot about for many different types of foods. We know the production data. We know how much is produced. We have a pretty good sense of what's consumed, whether that's in an economic sense of being consumed or actually eaten. But we really don't know how much is wasted. And groups come to the table with different numbers, different estimates, and they, they make their way into reports, into national guidelines. But for seafood in particular, the estimates haven't been refreshed in a while. So, it was about time to do that. And this study aimed to tackle that issue from all the stages of the supply chain, from production to consumption, looked at different forms of seafood and among the top 10 species. So, we rolled those species estimates and stage estimates into a national number. So yeah, that that's, that's why we did it. And we were really surprised at what we found.

Norbert - Well, what surprised you?

Dave - Well, earlier estimates were that about half of seafood was lost or wasted in the US and that came from UN Food and Agriculture Organization data. And when we actually crunched the numbers for the US supply, we thought it was more like 22.7 percent is wasted. So, a lot less than the FAO estimate. Which means we're doing a good job in some areas, but there's also room for improvement in others.

Martin - So, Frank, maybe you could tell us a little bit more about the key takeaways from this Nature food paper are?

Frank Asche - It's really that it's important to recognize that we are consuming a lot of different species and they have very, very different characteristics. For instance, the filler yield of a salmon is about 65 percent while for a cod it is about 40%. That makes your starting point really important. Moreover, this thing of looking at the whole supply chain is important because there are different ways to organize it, and there are a lot of potential uses for what food is sometimes wasted. And to look into what different types of producers are actually doing. What different companies that are operating these cold chains that Norbert spoke about are doing. And what they are doing when these things break apart. Kind of, there's all these people in the supply chain that may help us, and some of them do. Some of them aren't very good at it. But it's really nice to find that there are best practices that can really help us a lot of people take the trouble to figure that out and follow that up.

Martin - That's really interesting. And it makes me wonder with all this heterogeneity that you're describing, are large producers better positioned to manage or, or reduce food waste than small producers? Or is it the other way around?

Frank - Oh, I'm a good researcher. So it depends.

Martin - It depends. Of course it depends. It depends!

Frank - If we're going to say anything general then, in wealthy countries, large producers are better. In poor countries, small producers are better. In the sense that when labor cost is low, and food is relatively expensive people are much more willing to eat a fish that is not the best quality. While, if you're a small-scale producer in a wealthy country where labor is really scarce, you tend to focus on your main production process, which is the fillet. While if you become a big producer, then the quantities that potentially gets weighed that become so large that they actually are a useful raw material for new products. And we see big producers developing new products that it doesn't make sense for smaller producers to look at.

You've all eaten your hamburgers. One of the more popular products in recent years is different kinds of seafood burgers. And they are great because they are trimmings and cutoffs and slices that doesn't fit well into that fillet that you're normally thinking about when you're consuming a chunk of fish.

Martin - Yeah, and I think many seafood consumers have had that experience of being at the fish counter and saying, 'Oh, I only want this much,' and they put too much in there and like take a little off. And then you start to ask yourself the question, who's going to eat that little, little bit that gets sliced off. That's really interesting and enlightening. I had another question for Frank. Before we go back over to Norbert. So, in this paper, you describe different points along the food supply chain where the seafood might be lost or wasted. Can you talk a little bit more about that in different points in the supply chain and why there are some of these differences between species? You mentioned the sort of, yield of salmon and cod for a filet being a little different. And so, I'd like you to talk a little more about why different species might, might get different rates of loss.

Frank - I think it starts with this thing here that for most seafood species, there's a choice part that is sort of your preferred chunk of meat. Most species it's a filet, but for a mussel, you eat everything that is within the shell. But it's different. But even for all those species, kind of, there are shrimps with small heads, there are shrimps with big heads, there are fish that gives you really good fillet yield, fish that doesn't. There are fish where there's a lot of useful meat that, say, the head or in the tail, that normally doesn't make it to a store, but it's useful if somebody chooses to use it. And then you have the quality issues. If a fish, say, falls to the floor during the production process, what do you do with that? And, yeah, that's one of those things we learned that in Vietnam, they will give it to a worker, and they will eat it. And Norwegian salmon, they will typically put it into some kind of acid where they use it to make animal foods. Small scale producers will just throw it into the bin. Other producers have good systems which, within the right hygienic control systems, are using what they can and not what they cannot. In general, producers have been getting better, but producers are still one of the key points in the chain. The companies from the producer of the raw fish to the consumer is generally pretty good. And there's fairly little waste in transportation and processing and so on. Then there's a bit more waste in the store. One of the cool little episodes I learned during this project was that one of the biggest items of food loss for fish in US grocery stores were people buying shrimp for the salad, and then deciding that they didn't want the salad anyway, and they are putting it in a shelf somewhere else.

But you and I are the biggest problems. That is, what do we do with what we do not eat when we come home? What do we do with this portion that we put out of the freezer, and we didn't eat all of it. And we are pretty bad when we go to a restaurant too. And too often we don't eat our full portion. We may wrap it, but, but do we actually eat it the next day? In general, we do not.

Norbert - Dave, I have a question. I recognize you as a sustainability expert. So how does understanding the pinch points for aquatic food losses and waste help households, the food industry and, and policymakers?

Dave - Seafood is one of the most expensive proteins. If you go to the grocery store, it's going to be, you know, $9, $10 up to $15 or $20 a pound. And really, consumers don't have that amount of money to throw out. If they're going to buy it, it's in their best interest to eat it. So, we're looking at ways that the seafood industry can package and sell products that are going to help consumers, you know, stretch that dollar. One of the ways is through frozen seafood. Selling prepackaged individual units frozen. And, through this project, I've started to buy a lot more of that type of type of seafood. And you can also buy it now for other kinds of meats. And you just, whatever you want to prepare probably that, that next night you, you know, cut out the packaging, put it in the fridge and a little bowl in case from food safety standpoint in case it leaks. And then you don’t want to leave it on the counter overnight or leave it out for a couple hours.

But so, there are ways that you can package products that perceive what consumers are going to ask for. And you can still get that freshness in seafood, even if it's frozen. Because a lot of frozen seafood is frozen on board the vessel. It's frozen sooner than it actually would be if it was processed in a processing plant. So, you know, I think it's kind of a win-win. We've been exploring cook from frozen as a not just food waste, but also for other angles of sustainability. Because of course when there's waste is also the embodied energy and the embodied water and all the things that go into making that food. And when it gets to the consumer, it's got a lot more of those steps involved.

Norbert - Thanks, Dave. I will say from some of my own research looking at package size, and package configuration that smaller, more readily used products are less likely to be wasted. I can appreciate that kind of innovation in seafood products could also be beneficial. And my family, we're big users of frozen seafood, and the quality is good. So, these are really helpful ways of thinking about how we as consumers can make adjustments to our behavior that can actually mitigate some of the food waste that you all observed. And so, because of this research, what new insights do you have about loss along the supply chain for aquaculture versus wild capture fisheries?

Dave - That's a really good question. I can speak to the production stage. That's one of the areas we looked at where you see the most amount of food loss - at the production stage anyway. But we sort of split it out as the fisheries losses were either discards or bycatch. And from aquaculture, people had not really estimated what food loss looked like in aquaculture. But we looked at disease and mortality as a cause of food loss. We asked farmers, what's your typical mortality rate when you're raising shrimp or salmon or tilapia? We got back their mortality rate, we did some modeling, some estimation and found out when a certain percent of that harvest dies. Not just when they're babies, but when they die close to the harvest period, we'd count that as, as food waste. Because there are ways to control disease in aquaculture. You know, it's not going to be zero. There are always going to be some animals that die. But, if you do control disease, you can cut down on some of this kind of perceived food waste in the process. So, we counted those two things differently.

I would think a good example would be Alaska sockeye salmon. Over the last 10 or 15 years, they've instituted a lot of new methods for reducing damage to fish when they're captured. For example, now you get incentives as a fisherman to put down rubber mats. So, when the fish come off nets, they don't hit the boat hard, they'll hit a rubber mat. Their incentive is to bleed the fish, which helps with quality. And of course, to ice them when they're caught. You know, a lot of the catch of sockeye salmon in the '80s - '90s, didn't necessarily get refrigerated after it was caught. It went to a canning line. And folks eating canned salmon, they couldn't tell the difference. But as the salmon industry in Alaska transitioned to more of a value-based fishery, they increase the quality, increase the percentage of fillets compared to canned. I think a lot of these things go hand in hand with value. As you decrease food waste, increase food quality, you can sell it for more. I think that's a nice transition point for a lot of farms and producers to think about.

Martin - Since we're on salmon, I have a quick follow up on that. I noticed in the paper there is some differences in the rate of food waste for wild caught sockeye and for farmed Atlantic salmon. And in my mind, I immediately went to, well is that because most of that wild caught sockeye is ending up frozen? Maybe it's sold at the fresh counter, but it's been previously frozen. That's certainly my experience as a seafood consumer. And most of that farmed Atlantic salmon is actually sold directly as fresh and never frozen. And so, I'm wondering how much of that is a driver or how much it's really the disease thing?

Dave - It's probably a little bit of both. At the retail stage, if you're going to a grocery store and you're looking at that fresh display case, the rate of waste there is somewhere between five and 10 percent of what's in that display case. It’s going to end up in the garbage. They want to just have a nice presentation, have a lot of different products laid out there and they don't all get purchased. Some grocery stores will prepare that and sell it on a hot bar. Others, their principle is we just want to provide the freshest thing and they are okay with a little bit of waste. For canned and frozen seafood, the rate is more like 1%. And as Frank alluded to, sometimes people pick up a frozen item and they get to the checkout counter and they go, you know, I didn't really want to buy that. And they might slip it into you know, another aisle where it shouldn't be. That middle of the chain, there's not a lot of waste that we saw. You know, wholesalers and distributors, that's their job to deliver food and they really do a good job of it. And then at the upstream stage, the production stage, there's a big range in waste. And it depends on the product forms and at what point is the fish cut and frozen.

Martin - So, I have a question for both of you now, maybe changing topics a little bit. So, reducing food waste, food loss and waste, is an important element of environmental sustainability. I think we all agree on that. And that's particularly in response to climate change. We know that Greenhouse gas emissions associated with our food system are a major contributor to climate change. I'm wondering, sort of looking ahead, what role do you see seafood in general playing in a future in which we might price carbon emissions. We might actually make it costly to buy products that have a lot of that embodied greenhouse gas emissions in it.

Frank - Yeah, pretty well actually. But it depends a little bit on what's your current diet. If it has lots of red meat, seafood is going to do really well because red meat in general have significantly higher carbon emissions. If you're a vegetarian, maybe not that much. So, in the bigger scheme of things, seafood looks pretty good in the category of animal proteins, largely together with chicken. The difference between most seafoods and chicken is not too big. And of course, there's a little bit of variation within the seafood. They of course have a problem though in that nature produces a limited quantity of them. And if the amount completely takes off, there's no way you can increase the supply. So, then it must be aquaculture. And then you are more than slightly better or approximately chicken.

Dave - And I'd say you know, if you want to learn more about this topic, stay tuned. We've got a paper coming out about that. It should be out fall 2024 or early 2025. Similar to the waste piece, we've done the energy footprint, the greenhouse gas footprint, and the water footprint of all the products you see in the Nature Food paper. And we're really excited to share this finding soon.

Martin - That sounds really exciting and I can't wait to see it.

Norbert - I'm curious about your thoughts on how trade incentives or restrictions could be used to remote access to aquatic foods in addition to climate resilience of the food system? Frank, could you give us your thoughts?

Frank - Oh, there's a short answer to that or a complicated answer. So, the short is, of course, you can do like you're done with some other challenges. You also have dolphin-safe tuna and turtle-safe shrimp and so on. And you could basically make it hard to enter the market for people with bad practices. And you can make it easier to enter the market for producers with good practices. But if you go to the more complicated thingy, and particularly if you are also interacting with domestic supply chains, then we do know really well that eating beef is a real environmental challenge. But I still cannot see a world, at least within the foreseeable future, where US policy is going to sort of suggest that we're going to import more seafood so that we can produce less beef. And when you get to all those complicated interactions, yes, you can use trade policies to advance some agendas. But they are certainly going to run into some others, and it's a challenge when there's so large heterogeneity when it comes to what do you think a good food system is.

Norbert - Dave, what about you?

Dave - Well, I sort of come at this from a different angle. You're thinking about local; you know. What's the value of local food and local and regional food systems? And so, in principle, I'd like to suggest that to people to buy their food from regional markets. Because of the connection to place and that's really important. Once you have that connection to place, then you start to value the environment where it comes from. You get a little bit closer tied to the labor market and the folks who grow and produce that food. So, I like to kind of come at it from that perspective. Invariably we're going to have some internationally traded seafood. Right now, 70 percent of seafood is imported. But I think looking at opportunities to support your local and regional fisheries, and your local and regional aquaculture, I think there's a lot of merits to that. Some of them could be climate arguments. And there's lots of other good arguments for it as well.

Frank - I agree with that, but I really think that you should have the caveat that producing your seafood, or really any food under good microclimatic conditions, with good soils or water for that product, gives you food with a much smaller footprint than what you have necessarily locally. And particularly if you're producing something that doesn't really belong that well locally. And it's also really important that, except if you fly your food by air the carbon footprint of transports is tiny.

Dave - Yes, that was, that was one thing we found. With air cargo be really careful. You want to buy live seafood or fresh seafood that's air freighted, that's going to be a big piece of the carbon footprint. And really for consumers, an easy way to chip away at their environmental impact is to cut out stuff that's flown in fresh. But, you know, that flies in the face of what restaurants and grocery stores are trying to sell, which is 'the freshest.' ‘We're going to give you never frozen super fresh.’ So there's a bit of a disconnect there. And I think unlocking that is going to be getting into some of these chefs' minds and talking to them about - you know fresh is important, but how do you want to spin this in a way that you can have it fresh today, but you also can have it fresh in the future. Not just today, but a few generations down the road when it is possible to fly in food from all over the world that have that perfect plate. And you know, this is something that we need to engage with lots of different people on.

Martin - It sounds a little bit like you're suggesting a, a world in which we, we seek to consume fresh local, and frozen global. In the sense that, that you cut down all those, those transportation, greenhouse gas emissions, if you're doing frozen seafood, and you can exploit that sort of natural comparative advantages of different places to farm and different places to catch seafood with those global markets. But, but for the real fresh stuff, there might be some benefits to eating locally, including those, those greenhouse gas emissions.

Dave - When we looked at the trade from Asia, 99 percent comes by container ship. You know, almost nothing's being flown in. And then when you look at closer markets to the US. What was Europe... it was maybe closer to 50 /50 for flown versus shipped by water. And yes, I think South America was similar. I guess the closer you get to the US market, you know, there's that incentive to kind of fly it in and get the price premium. There's definitely a reason to do it, but it does come with a part of the carbon footprint, you know. It's, it's maybe a quarter, maybe a third, you know?

Frank - But as Marty alluded to, as long as there's no cost associated with the carbon footprint as is the case now, nobody will really care. It's first when you actually have a system where there's a price to it that you would expect to see any real change.

Dave - Yes. And, we did some work, sort of a spinoff to this. We looked at the US seafood industry and then they become more carbon neutral. We teased that out for a couple of different sectors: farmed catfish in Alabama and wild caught salmon. And there are steps that producers and fishers can do, but a lot of it's going to have to depend on their local utility. What's the energy mix of the utility? Because that utility energy mix is what feeds the plant. It feeds the energy going to a catfish farm. And they use a lot of electricity, but they don't have a big say in what the Mississippi Electric Cooperative or Alabama Electric Cooperative chooses as its energy mix. So, I think there's, it's really a 360 issue that when you start trying to unpack energy and climate, it goes well beyond the seafood sector really quickly. So, we can be a voice. But it's going to take a lot of people to make systematic change.

Martin - Great. So, I had one final question to ask each of you. And that's really about what's next? And I know we have this other paper that's coming out to look deeply into the life cycle of the different species featured in your food waste paper. But I'm wondering specifically what's next on seafood waste and, and what kinds of things will affect what kinds of policy changes might be on the horizon, what kinds of things will affect change, short of, I guess, what we've already talked about. Which is some, you know, sweeping carbon legislation that, that prices carbon. But short of that, what other kinds of things are going to affect change and what else do we need to know? Let's start with you, Dave, and then then we'll go to Frank.

Dave - I think we sort of laid out the big picture. The estimates for the US supply for different production stages. But I think we really need to drill down into case studies where folks, us and, and colleagues, I know Ronnie Neff is exploring this with you Norbert, but really drill down into case studies that try out some of these ideas that we have. Some of the innovations being implemented and see how they work and maybe scale up the best ones.

Frank - Right. And beyond that is like companies are doing what companies always have been done at all stages in supply chain. As long as new technology makes it profitable for them to be more sustainable, they're going to be more sustainable. So, there's going to be a lot of new packaging and new ways of chilling and so on that will help. But at the end of the day, the biggest challenge is you and I as consumers, and what we both buy. Because that determines what products is going to be on offer. And then how we treat them after we have purchased them.

This podcast is co-sponsored by the Recipes Food Waste Research Network Project, led by American University and funded by the National Science Foundation.

BIOS

Dave Love is a Research Professor at the Johns Hopkins Center for a Livable Future. Dave’s work focuses on aquaculture and fisheries and the environmental, social, health and food system issues related to those industries. He also engages in a wide range of food-related topics including food waste, veterinary drugs and drug residues in foods, antimicrobial resistance, and CAFO worker and community health. In 2012 he founded a research and teaching farm at the Cylburn Arboretum in Baltimore and oversaw the facility from 2012 to 2015. The farm is now called the Food System Lab and is a place where students of all ages learn about urban agriculture. The Food System Lab is a member of the Farm Alliance of Baltimore and sells produce at the Waverly Farmers Market. Prior to joining Johns Hopkins Dave was a postdoctoral fellow with Dr. Kara Nelson, working at the interface of engineering and microbiology, in the Department of Civil and Environmental Engineering at the University of California Berkeley.

Frank Asche is a professor of natural resource economics at the University of Florida School of Forest, Fisheries, and Geomatic Sciences. He is a natural resource economist with a research focus on seafood markets, production of seafood from fisheries and aquaculture and the sustainability of these production processes. Frank is president of the International Association of Aquaculture Economics and Management (IAAEM), editor for Aquaculture Economics and Management and associate editor for Marine Resource Economics. He was also a member of the team that developed the Fish Price Index of the United Nation's Food and Agricultural Organization (FAO).
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E254: Why is food so expensive?
31 okt 2024· The Leading Voices in Food
If you feel like your grocery budget just doesn't buy you as much as it once did, you're not alone. According to U. S. Bureau of Labor Statistics, food prices rose 11. 4 percent last year alone - the highest annual increase in 23 years. The ongoing pinch at the grocery store has been in the news of a lot of media outlets, such as The Wall Street Journal, The New York Times, Times Magazine, Forbes, and so many others. Our guest today, food economics and policy professor David Ortega from Michigan State, is going to walk us through the food price inflation phenomenon.

Interview Summary

We've been hearing a lot about food price inflation. Can you tell us how food prices have changed over the last four to five years, and how that compares to the recent past?

Definitely. So, I think it's always really important to define what food inflation is so that we're all on the same page. We hear this word a lot and we've been hearing it for a number of years now. Inflation is the rate of increase in prices over a period of time - so how fast prices are changing or increasing in a given period. The time frame here is very, very important. Now, compared to last year, food prices are only up 2.1%. And this is for all food, which includes food at home and food away from home. Now groceries, food at home, are up 0.9% compared to last year. And menu prices at restaurants, or food away from home, are only 4.0% higher. Now if you're listening to this, you're probably thinking, ‘well, how can this be given how expensive things are at the grocery store?’ And that's because you are likely thinking about how food prices have changed since the start of the pandemic, right? So, over the past five years, food prices have increased around 26%. And so that's the cumulative effect of inflation that we're all very familiar with at the grocery store.

Wow. You talked about the recent past, and in particular, about the time since COVID. How has this looked historically if you take a longer time frame?

Yes, so if we look at a few years before COVID, food prices generally increase around 2% or so, year over year. Now in the summer of 2022, we experienced double digit increases in food prices. More than 11%, year over year. And that was the highest rate of increase in around 40 years, since the late 1970s and early '80s. So now that's a significant spike and departure from what we would consider to be normal. But the rate of increase has come down to almost pre pandemic levels, which is really great news. But remember the rate of inflation is the rate of increase, so because that rate has come down, it doesn't mean that prices are decreasing necessarily.

They're just not growing as fast as they were before.

Correct.

I have some ideas, but I really want to hear you talk about it. What has led to this significant increase in the last four and a half years or so?

It's really been a convergence of factors. It's not just one particular thing, but really all these factors coming together and sort of compounding on each other. We saw increases in labor costs, and then as we go through the timeline, we had Russia's invasion of Ukraine in February of 2022. And that really sent commodity prices surging for things like wheat, other grains, as well as vegetable oils. And it wasn't just the invasion alone, but we had countries responding with export restrictions on things like palm oil that really just exacerbated the situation. We also have the impacts of climate change. The summer of 2022, and for a few years leading up to then, there was this mega drought in the West and the plain states that affected anything from lettuce prices to the price of meat. Something that we're experiencing to this day. We also have the bird flu outbreak, now the largest outbreak in U. S. history. Egg prices have been through a bit of a roller coaster ride, and we've been hearing a lot about increases in egg prices. That's primarily due to the high path avian influenza outbreak, or the bird flu outbreak.

Now, those are all what I would consider, for the most part, to be supply side factors. But we also have demand factors at play. And that is, that when we look at consumer spending on food, especially over the past two to three years, it's been much higher compared to before the pandemic. Even when you adjust for inflation. Now, this is likely attributed to households. Some of them accumulated savings. We had the fiscal stimulus payments from the government that injected cash into the economy. For a period of time, some households, we could splurge at the grocery store. We've seen, and the data from USDA shows, that consumer spending on food both at home and away from home is much higher in recent years than prior to COVID. So again, it's a combination of both supply side and demand side factors that have contributed to the significant rise in food prices.

This is a really important point that it's not a single factor, but it's this mix of things, which also makes it really difficult to talk about how to disentangle it. And I definitely want to hit on that. But before we get there, I want to know what has the impact of these significant price increases on consumers been?

The first thing that I want to point out is that food price inflation doesn't impact everyone the same. It's really low-income households that are hurt the most by these price increases. And that's because they spend a higher share of their income on food. When we look at the poorest 20% of American households, they're spending over a third of their income on food, compared to the average American household that spends roughly 10 to 12%. Now, when we look at industry data, we see that as a result of inflationary pressures, individuals are making shorter and more frequent trips to the grocery store. They're doing more price comparisons. They're turning and buying more of the private labels, the store brands, that sell at a much more affordable price point. And they're buying fewer premium items. So less of the stocking up that we saw at the beginning of the pandemic. But this in turn can also fuel an increase in the price of those conventional or cheaper items. And that's something that I found in the research that I've done on egg and poultry prices. When prices increase, consumers switch to the cheaper, more conventional items. And that increase in relative demand can put upward pressure on prices. So, we've seen this also reflected in the way that consumers are shopping for food and the prices that they're seeing.

I think this is really critical for us to appreciate that while it is an often talked about issue, price inflation, and it does hurt lots of people, but appreciating that lower income folks are facing this at a much harder way is important. And, having spent time working with the charitable food sector and understanding the experiences of the individuals there, you're regularly hearing people talk about the high price of food and how they're trying to navigate it. And the role that these food pantries can play in helping meet that need, but it just still it's a grind. It becomes really challenging.

Yeah.

Recent economic data actually shows that food price inflation is moderating. So, it's not as hot as it once was. But consumers are still experiencing sticker shock at the grocery store. What's going on here?

So, coming back to the earlier part of the conversation, people are really feeling the cumulative effects of inflation. And again, that's why I find it very important to define inflation as the rate of increase in food prices. Well, the average consumer at the grocery store shopper, they don't really care about the rate of increase. They care about the price level, right? When you see that eggs are $3-4 a dozen that's going to catch your attention. When we look at the last 4, 4.5 years, food prices are up 25%. That's a significant increase.

Now, another reason for this disconnect in terms of what the economic data is telling us and how consumers feel about food price inflation, is the nature of food prices in our interactions with them. We see food prices on a weekly if not more frequent basis. We know when prices are going up. We encounter food prices, we go grocery shopping, much more frequently than we get a haircut or we buy a plane ticket. We see these prices rise. Now, it's also important, coming back to this discussion on the percent increase versus the price level, a 2% increase today is a higher dollar amount than it was a year ago, and certainly 5 years ago. Because the base has increased. It's not just in the consumer psychology. It's when we look at the price level and the increase. Prices are increasing more in terms of a dollar amount today than they were in the past. And so because of this, in many ways, the grocery store has really emerged as the face of inflation here in this country. And it really has impacted just about everybody over the past four or five years.

As someone who hasn't had a haircut in probably 10 years, I really do know that prices have changed fairly quickly when it comes to food. But I don't know what's happening at the haircut. But I really appreciate this. And, but I think the thing that a lot of people struggle with in this conversation is, but inflation is coming down. We've just heard these reports and why aren't food prices going down? But you've made it clear. It was almost like we've reached this high level. It is hard for it to roll back. I mean, we don't expect prices to actually fall, do we?

When we look at specific items, right, it's not uncommon to see, say, the price of eggs decrease when we have a period of low bird flu activity. But by and large, when we look at food as a category, say groceries, there have been some periods in the recent past where food prices decreased, say, 1-2% year over year. But we shouldn't expect prices to decrease to the level that they were before COVID. And that's because the nature of prices. They generally increase from year to year. And that's a good thing as long as they are moderate increases. And as the data have been telling us for a couple of months now, we're looking at food price increases in the neighborhood of what they were prior to the start of the COVID 19 Pandemic.

This is helpful. And it kind of makes me think of something we were talking about earlier. And so I want to ask you this last question. There's been some conversation in policy circles about addressing this problem of food price inflation. What are your thoughts on how policy could be used to make a difference in this situation?

That's an excellent question. We're coming up on an election and there's been proposals on both sides floating around and I appreciate the focus on an issue that is affecting consumers. But we have to look at the policies and what economic theory can tell us about what's going to happen.

The first thing I'll say before I even get to that is that the President of the United States, policymakers, have very little control over food prices, especially in the short term. We really have to look at sort of the longer time horizon. How can we make our food system more resilient to future shocks? Investing in crops that are drought tolerance, right? That climate change is one of the factors that's going to be with us from here on out into the foreseeable future. We have to make those investments now so that we have a much more resilient food system in the future.

In terms of coming back to policies, we have to look at economic theory. There's been proposals to ban, say, a price gouging at the federal level. That's something that I think we have to look at very carefully because there could be some unintended consequences. This is just straight out of Econ 101. Other candidates have proposed tariffs across the board. We've seen what happened when we had the trade war with China back in 2018. It leads to even higher increases in food prices because food producers, food manufacturers, rely on inputs oftentimes from abroad. And so now they're facing higher prices, they're going to be passed on to the consumer. As we look at policies, I think it's really important to look carefully at what some of the outcomes may be so that we don't run into some unintended consequences.

BIO

David L. Ortega is a professor and the Noel W. Stuckman Chair in Food Economics and Policy at Michigan State University. His research program focuses on understanding consumer, producer, and agribusinesses decision-making to better inform food policies and marketing strategies. Dr. Ortega provides timely analysis of forces and events affecting the agricultural and food sectors. He has been called to provide expert testimony before federal and state agencies, including the U.S. Senate and House agriculture committees. He is a frequent contributor to food price inflation reporting at The New York Times and NPR, and is regularly interviewed by prominent media outlets, including ABC News, NBC News, PBS, USA Today, CNN, Forbes, Politico, The Wall Street Journal, Financial Times, Newsweek, and the Detroit Free Press, to name a few. Dr. Ortega earned his Ph.D. in Agricultural Economics from Purdue University.
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E253: Learnings from No Kid Hungry in New York
30 okt 2024· The Leading Voices in Food
When we talk about problems with food insecurity and the food system, we tend to reference challenges at the national or international level. And of course, work at that level really needs to be done. But increasingly, there is a unique focus on regional food system strategies and right sizing solutions to best fit those unique characteristics of a particular locale. In today's podcast, we will talk with Rachel Sabella, director of No Kid Hungry New York. She leads the planning, implementation, and evaluation of the No Kid Hungry campaigns across the state of New York.

Interview Summary

Rachel, it is such a pleasure to have you with us on the show today. We've done several podcasts with No Kid Hungry staff in the past and discussed topics like your Summer EBT Playbook for state governments. I'm really interested to learn more about your work in the state of New York.

Thank you so much for having me, Norbert. We have been so lucky to have No Kid Hungry on here to share the stories. And I'm excited to give you some updates about what we've learned with Summer EBT, and to talk about how things look in New York these days.

So, can you help our listeners understand more about No Kid Hungry New York as an organization? What is your approach to addressing childhood hunger?

No Kid Hungry is a campaign of Share Our Strength. And I have the honor and privilege of representing the organization across the state of New York as we work to create solutions, to draw more attention and awareness, and to help connect more kids and families with meals. We believe that every kid needs three meals a day to grow up healthy, happy, and strong. But too many children, and I know we'll talk more about this, are missing those meals. We really take an approach of working directly with communities. I don't know the right answer for each community. But my job and really my privilege is to work with school districts, with elected officials, with community organizations to look for challenges and work together to overcome them and really change systems.

I can appreciate that local communities look very different and appreciate if you're talking about New York City versus upstate New York. Can you tell us a little bit about how you all think differently about the cities versus the more rural areas of New York State?

I appreciate that question. I think all of my colleagues can hear me say, we almost run two different campaigns in New York. Because the approach in New York City, where there is one school district in five boroughs, but a large concentration of students, the largest school district in the nation, versus the rest of the state, is different. But ultimately, the challenges are the same. How are we communicating with families? What solutions are out there that we can implement? We really focus on listening, sharing tools, sharing toolkits, thinking about, in some communities, what they need are materials translated in different languages, so families understand that SNAP benefits are available, or summer EBT benefits. Or as in other communities, it's how can families get to a centrally located place to pick up meals? We really spend our time learning and listening and sharing these programs so that they can find the solutions that work best.

This is wonderful. I grew up in Georgia, I should just note. And I grew up in rural Georgia versus Atlanta. And we always talked about two Georgias, the Atlanta region versus the rural areas. And I can appreciate just how different some of those challenges are. But you're right, the central issue of access to food is similar and how you address those issues will look different in those regions.

I want to span out and talk about some national data that just has come out. USDA has reported food insecurity rates in the U.S. and we saw that hunger actually increased. And we see that for childhood hunger, food insecurity in general, it has risen since the 2019 pandemic. Why is this happening for children?

It's a challenging time. I think something that came out of the pandemic was right away, people said, families are struggling with hunger. What can we do? The stories on the news. We saw it no matter where you were in the country, with the lines to pick up food. And we saw government responded very quickly. There were expanded SNAP benefits. There were no cost school meals provided to every child across the country. We saw pandemic EBT implemented. We also saw the expanded child tax credit. At a time when families were facing tremendous challenges, there was that support from the government. But many of those programs have now ended. And in these economically challenged times, incomes haven't changed. Some people are still dealing with an unemployment crisis. We hear a lot from families as well that they're underemployed. There may be a job, but it's not that same income. And without these expanded government programs, families are facing challenges.

How is this looking specifically in New York State? Are there specific challenges happening in the state?

I think so, and we have specific challenges in New York, but as we talked about earlier, I think we see every state is facing that. In New York State right now, hunger rose for child food insecurity. We're looking at one in five children in New York State. If we look at New York City, it's one in four children could face food insecurity this year. I often say that hunger hides in plain sight because I hear from people, well, they have a house. Well, with a set budget, they're paying to keep that roof over their heads, they're paying for their electricity bill, and what is the number that can shift in the budget, unfortunately? It's for food. We did a survey earlier this year, and four in five families in New York State found that it became harder to afford groceries. Their incomes just were not remaining at the same levels. And in those surveys, when we dig in a little bit, it was highest in rural communities and parents of school aged children. They are fighting hard for their families, but with all these economic challenges, as a society, we have to do more to help them.

Thank you for sharing those insights. And I remember early in the pandemic, some colleagues at Tufts and I did a qualitative study talking to families who were using little free pantries. Those ‘lending library boxes’ where people were putting food and one of the stories that we heard that kept coming up was. It was about price inflation, which was interesting because this was at the early part of the pandemic, and we did worry what happened to those families as inflation increased. And this was before some of those policies came into place about summer EBT and other food assistance programs. But now that those programs have gone away and inflation is starting to let up, but it's still a challenge for families. I really appreciate the way the campaign is thinking about these issues. You've already mentioned earlier that the No Kid Hungry team has worked on the summer EBT playbook as you prepared for a national launch of that program. Could you first just give us a brief overview of what the playbook is and then how has the rollout gone in New York State?

Even to take it back a step, Summer EBT was a new program launched this year. Every state was eligible to opt into this program, which provided a grocery benefit for eligible children and families. Before this, it was available in certain states that were part of a pilot, and No Kid Hungry had been advocating for this to be nationwide. We also knew that there was going to be a short amount of time for this program to launch. So, what we did was bring all our tools and resources together, our staff members, and we said, what do states need to implement? We partnered with organizations like Code for America, like APHSA, and to really see what is this? So, is it tools to get the word out about the program? Is it about implementation? Is it connecting states that face similar challenges to learn from each other? What the state agencies did this year to implement this program in year one, in about six months, was pretty unbelievable. And we also hope that as we're learning from this, we're going to see even more exciting changes in year two.

In terms of New York and summer EBT, we have been seeing so thrilled to see the uptake of the program, the outreach and awareness for summer EBT in New York. In August, Governor Hochul convened an event to celebrate the launch. We had members of Congress, we had No Kid Hungry, we had families there talking about this program. We heard from families how challenging the summer months have been and how this made that difference to get meals to kids.

We've been working with the New York City Council on doing trainings for staff members. So many people trust their local elected official’s office to get answers. How do I get a new card? How do I check my balance? We are learning a lot, we're seeing materials in different languages, and again, what we're excited to do is recap year one, and how do we learn more and make it even easier for families to access in year two?

This is amazing work, and I, I know it's really a challenge when folks, if you will, leave money on the table. And so, helping people connect to the resources that they have legal rights to is a critical role that you all are playing. What do you hope will happen as you learn from the playbook as it was applied in New York? What do you hope to share with other states in this process?

We want to show other states our best practices, what worked really well, what's something that we would tweak a little differently. We also want to make sure that those states that weren't able to opt in this year, because there were more than 10, I think about 15, that did not opt in. We want them to see what they can do and how they can use this program to connect kids with meals. But also, this money is reinvested in local communities. Families are using it at grocery stores, at local markets. In New York, we're really excited to see how they're using it at green markets, getting those fresh fruits and vegetables, supporting agriculture. This program while it addresses hunger, it's also an economic engine. And we want to make sure everybody understands that and are using those dollars in a valuable way.

I want to ask you a last question, and it's sort of a big question about child hunger. So, what is the outlook of child hunger in New York, and what gives you hope about addressing this challenge?

One of the things that gives me tremendous hope Is when we did our survey of New Yorkers, 93 percent of New Yorkers believe that solving childhood hunger should be a bipartisan issue. They don't see the politics of this in New York. We have seen that increasing the SNAP minimum benefit is a bipartisan solution. We have seen no cost school meals for all children has bipartisan support. I think we see New Yorkers recognize they want to make a difference. We get questions all the time. How can I help? We have media outlets sharing the deadlines, putting the updates out for families. We see elected officials in New York State that are paying attention to what's happening in their backyards and their local communities. And they want to make a difference. I hope that what we are seeing in New York translates into other states, translates to the federal level. There is an excitement right now around school meals, and we're hearing a different dialogue. It's something that people like you and I, we know the difference it makes, but I'm hearing from family, from friends, 'Rachel, I read this story on School Meals," tell me about this. My hope is the excitement, the enthusiasm and the interest really changes the conversation and helps us drive forward solutions that will ensure that someday there is no kid hungry.

BIO

Rachel Sabella has been a respected advocate, strategist and leader for nonprofit organizations for more than 20 years. She has been the Director of No Kid Hungry New York, a campaign of Share Our Strength, since 2018. In this role, Ms. Sabella works closely with stakeholders across New York State to ensure children have access to the nutrition they need to grow and thrive. She oversees grant-making, awareness building, programmatic and advocacy priorities for No Kid Hungry New York and manages relationships with state and local policymakers. Since March of 2020, she developed and oversaw a strategy to distribute more than $9 million in emergency grant funding to organizations across the state of New York and Puerto Rico to connect more kids and families to meals. She has led successful advocacy campaigns at both the city and state levels on issues including expanding access to school meal programs and SNAP in order to connect more New Yorkers with meals. Ms. Sabella also serves as a member of the NYS Council on Hunger and Food Policy and was appointed to Mayor-Elect Eric Adams’ transition team. Prior to this role, Ms. Sabella served as the Director of Government Relations and Policy for the Food Bank For New York City. During this time, she led advocacy campaigns to grow and strengthen resources for anti-hunger programs, which led to unprecedented support for food pantries and soup kitchens in New York City. Her advocacy efforts also led to the creation of 25 school-based pantries that distribute food, menstrual and hygiene products, and household cleaning supplies to families in need.
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E252: Is farm-level environmental impact reporting needed or even possible?
22 okt 2024· The Leading Voices in Food
In today's podcast, we're discussing Fast and Furious. But it's not the movie series starring Vin Diesel. Instead, the catchphrase describes rapidly increasing and somewhat confusing food system environmental impact reporting. Food firms, farmers, and governments all have a clear need for more quantitative environmental impact data in order to measure and understand factors such as carbon footprint, sustainable agricultural practices, and food supply chain processes. But there is no single standard for such reporting and different measurement methodologies make it difficult to assess progress. What's more, greater transparency regarding environmental impacts and food systems will affect trade and supply chains. Our guest today is Koen Deconinck from the Trade and Agricultural Directorate of the Organization for Economic Cooperation and Development, or OECD for short.

Interview Summary

You and your colleagues at the OECD recently published a paper called Fast and Furious: The Rise of Environmental Impact Reporting in Food Systems. Can you tell me a little bit about the paper?

Sure. A while ago we were talking to one of the world's experts on sustainability in food systems. He alerted us that there was a major change happening in how people think about sustainability in food systems. He told us in the past, it was thought of almost as a checklist, right? People would say, here's a list of practices that you should or shouldn't use. And then we'll come and confirm whether that's the case on your farm. Then you either get certified or you don't. And he said, you should pay attention because there's a big change underway. We're more and more moving towards actually quantifying things like what is your carbon footprint? What is your water footprint? And so on. He convinced us that this was actually a major change that was happening. Oddly enough, outside of the role of the practitioners, not that many people have been paying attention to it. That is why we wrote this paper.

This is a really important shift because just thinking about this in terms of economics, evaluating outputs versus the methods that you get to those outputs can have really significant implications for the various actors involved. So, this seems like a good move, but it seems also kind of complicated. I would love to hear your thoughts about that particular move. Why did you think, or why did you all realize this was a challenge and opportunity at the same?

That's a great question. It actually gets to the heart of what we're describing in the paper. Starting with the good news, we do think that this has an enormous potential to improve sustainability in food systems. Because we know from the scientific evidence that there are big differences between different kinds of food products in terms of their average environmental impact.

For example, beef tends to have more greenhouse gas emissions per kilogram of products relative to poultry and then definitely relative to plant based alternatives and so on. You can see these kinds of average differences. But then the data also shows that within each kind of product category, there's huge differences between different farmers.

And what you can do if you start quantifying those footprints is it actually unlocks different kinds of levers. The first lever, if you think about carbon footprints, which is maybe the most intuitive example. The first lever is people know the carbon footprint of different kinds of food products. They could shift their diets away from the products that have a higher footprint towards products that have a lower footprint. For example, less beef and more towards poultry or towards plant-based alternatives. That's one lever.

A second lever is that if you can also start to get even more precise and use data that is specific to each producer, not just an average, then also within each product category, people can start shifting towards the producers that have a lower environmental footprint. So, for example, people will still be drinking milk, but then they can shift towards milk producers that have a lower carbon footprint. And the third interesting lever that you can unlock is if you have that data at a supplier level. Suppliers could then say, well, I changed my practices. I changed my inputs. I've done things differently to reduce my impact. You actually can stimulate innovation by each individual farmer, each individual company in the supply chain to lower that impact. And that is something that you can do if you're quantifying those impacts, and that is very difficult or even impossible to do with this previous checklist-based approach. So that's one of the reasons why we're, we think that this has tremendous potential if we get it right.

That's right. Just saying that you're doing sustainable practices isn't sufficient. It's really critical to evaluate what kinds of greenhouse gas emissions or other environmentally problematic outcomes of that producer or firm is what really matters. But I have to ask you just how difficult, how realistic is it to be able to measure the environmental impact of every farm?

That's a really good question. And of course, if you think about agriculture compared to other sectors, one of the big challenges for agriculture is indeed that there's just so many producers, right? I talked to people who work in the steel industry, and they say that their industry is complicated, but there's basically only 1000 steel factories around the world. That's not that many. The latest evidence suggests that there's more than 600 million farmers worldwide. So clearly, we're talking about a completely different order of magnitude, order of complexity.

And the second difficulty is that when we talk about measurements, for a steel factory, in theory, you could put sensors in the chimney and sort of measure that. For agriculture, that's really not practical. Scientists would sometimes do that because, you know, otherwise it's hard to know what greenhouse gas emissions you have in agriculture. But it's clearly not something that you're going to do on 600 million farms.

So, what people do instead is, scientists would do the primary research. There are different ways of doing that, to try and estimate which kinds of practices have which kinds of environmental impacts. If you have a cow and it has this kind of diet, how much methane is it burping and how is it affected by differences in the kinds of feed that you give the animal and whether it's inside or outside and so on. And then based on that very detailed research, that then gets simplified into a simpler model, a simpler tool, so that the farmer can plug in some key performance indicators from their farm. I can say ‘I have these many cows, this is the feed rations that I'm giving to them. These are the kinds of manure management options that I have.’ And then that tool is a simplified tool that basically gives you an estimate of those emissions. And once you have a tool like that, of course, the challenge is already a lot easier. Because then, if your tool is user friendly and you can sort of focus on just a couple of key parameters that farmers would know, then, of course, you can scale it up. And there are actual examples like that. In Ireland, there is a scheme called Origin Green, which is an initiative by the Irish government to promote exports of Irish Agri food products. They cover something like 90 percent of all the beef and dairy farms in the country. And as part of the initiative, they do the audits anyway, but as part of that initiative, they also quantify the carbon footprint. They basically have farm level data for 90 percent of the farmers. New Zealand similarly has had a big campaign called Know Your Numbers, where they've convinced farmers to use these kinds of calculation tools to get a good insight on how much the emissions are on their farm.

So, it is definitely not straightforward. But at the same time, we do see that it is actually happening. It is actually feasible.

Thank you for sharing that. This is really impressive work that's happening in the European context and in New Zealand. I have to ask, how challenging is this for small or medium sized producers? I mean, both in a European or Northern context, but particularly when we start thinking about the fact that Agri food chains are global and, and so there can be production practices in the Southern countries that would be of concern. How do you think about this in this context?

It is a really important issue. And actually, we've been here before. If you go back something like 20 years ago, and I think you actually did some research on this yourself back in the days, Norbert. There was a big increase in food safety standards, food quality standards. And these were not necessarily public standards. It was quite often retailers who started to impose that on their suppliers. And we did have all those concerns, right? Because on the one hand, it was making food safer and higher quality for consumers. But on the other hand, there was this risk that it would actually exclude, especially the poor producers, the small and medium sized enterprises from those supply chains. There's been a lot of research about that and it turns out that in the end, it was more nuanced than what people feared initially. But of course, we definitely have the same concern now. And there's a few elements to it. One is simply the difficulty of actually quantifying those things. I mentioned a few of these calculation tools and a few of these initiatives. So far, most of the investment in these things has been in high income countries. And even if you look at the underlying science, most of the research has happened in richer countries. So, if you go to tropical agriculture, we even have less scientific evidence that you would use to build a simplified tool like that. Then there's, of course, the challenge of actually getting farmers to use that. So, governments in developing countries typically don't have the same kind of capacity that the government of New Zealand, or the government of Ireland has to help farmers do that. So, there's definitely a role there for development cooperation, technical assistance, things like that.

But there's also another concern, which is that one of the important drivers of the environmental impacts of food products is actually your productivity. There are many parts of the food system where your environmental impacts might be roughly the same, no matter whether you are actually very productive or not. So, if you have the type of variety of rice or wheat that you're using that just has relatively low yields, then, of course, you divide the total environmental impact by a smaller number. So, automatically, your relative impact is bigger. And typically, that is what we find in the Global South. So, typically, the producers there will have much lower productivity levels. And studies do find that they tend to have higher environmental impacts, all else equal. So even if they were able to quantify it, there is actually an additional risk that then they would still get excluded.

What that means is that this rise of quantified environmental impact reporting is something that we need to pay close attention to. And development corporation agencies and everybody else should be thinking hard about how we are going to make sure that producers in the Global South are not only able to quantify, but also able to improve those environmental impacts. For example, through sustainable productivity growth.

This is really helpful. And thank you for sharing that. And you're right. I did think about these issues. I was influenced rather by the experience of increasing food safety standards. I would say one of the differences that we saw with food safety standards was how safe can food be? I mean, we want our food to be extremely safe, but there are always these tradeoffs. With environmental impacts, I think it feels a little different. And I really appreciate the concern of the difference between these small and medium sized enterprises, particularly out of a developing country context. I've got to ask sort of a broader question. Why is all of this happening now? This increase of environmental sustainability measures, both in terms of the technical work and the demand. I mean, what's bringing all of this together?

It is actually a pretty interesting story because it appears that, the way we look at it, there's been some changes on the demand side and on the supply side, so to speak, right? So, there's this growing demand for more information. Consumers are increasingly conscious about these things, even though it's not clear yet if this really translates into their shopping behavior. Civil society organizations, of course, have long been asking for more information on that. Governments, in some cases, are also pushing for that. One clear example there is in the European Union. There is this new rule in the EU. It's called the Corporate Sustainability Reporting Directive. That's quite a mouthful. And one of the things it does is it requires all large companies to report not only their own emissions and the emissions from the energy that they're purchasing, but also their emissions upstream and downstream in their supply chain. People sometimes call this Scope Three Emissions. This has huge ramifications because it means that for the supermarkets, a large part of their Scope Three Emissions are the emissions from food. They would then probably ask the food manufacturers 'well, give us more information on your carbon footprints.' And in turn, for the food manufacturers, a large part of their carbon footprint comes upstream from the agricultural sector. So, everybody would be turning around and asking their supplier and all the way up the supply chain for more information. All the way, not only to the farmer, but even further up to the fertilizer companies and so on.

So, there's definitely this push on the demand side. And, I guess governments and citizens and civil society, those are sort of the usual suspects, so to speak. There's also unexpectedly a lot of pressure from investors. We see organizations of investors pushing hard for more transparency. Their logic is that sooner or later, stricter regulations on the environmental side are going to come. For some of the companies that we're currently investing in, we have no idea how hard that would hit them. So, those companies need to disclose more information because we as investors need to know how much money is at risk if we invest in a business that is, for example, linked to deforestation and things like that.

So, that's the demand side. But what is really interesting is that at the same time on the supply side, it's also becoming easier to actually provide that information compared to five or 10 years ago. Some of this is because people have been working in obscurity for a long time, trying to develop certain methods and databases. A lot of that work has been coming to fruition in just the last few years. For example, there's been development of new reporting standards, there's been development of new databases, there's been development of new methods, people are now using satellites and so on to try and quantify things like land use change, deforestation impacts and so on. A lot of these things are now converging and blending with each other. We do think that the combination of this greater demand and greater supply that is driving what we're seeing now. And of course, some of these initiatives are still at a relatively early stage. At the same time, I think the direction of travel is clear. So, we think that demand is not going to go down. It will keep getting easier to supply that information. We think that this is what explains this fast increase that we're seeing.

This is really intriguing, and it makes me wonder how global value chains are going to be realigned. Going back to this idea of small and medium sized producers who may not be able to have the monitoring, or if you think of even larger firms who feel uncomfortable with having some outside agency evaluating the carbon emissions or other greenhouse gas emissions from their farm. I can imagine that this could realign value chains. Is this a fair assessment? Is this a concern?

I agree with you that this is something people should be looking at. At the moment, there's not yet any data on that. I don't think anybody has really researched that. We see in general that many researchers aren't really paying attention to this trend, which was actually one of the reasons we wrote this paper. But what you're describing is exactly one of the questions we have as well. There are a few ways that this could play out. You could imagine that if it's only some markets that are getting very interested in this kind of information, you might have a situation where companies in a producing country decide to just send the sustainable stuff to the countries that care about sustainability. But they keep producing the unsustainable stuff for all the other markets. In that case, the total impact for the environment might actually be limited. But there could also be other cases where companies think, well, since a large part of our customer base is asking for more sustainability, we might as well make everything sustainable just to be on the safe side. You might have other cases where companies start working backwards because they want to make sure that what they are selling is sustainable. So, you might actually have situations where a retailer starts working with suppliers or where a food manufacturer starts working with suppliers to make sure that their production is sustainable.

This is again something that we have seen in the wake of these food safety standards about 20 years ago. This was a really surprising development and there was a lot of investment from other companies in the supply chain to help farmers start meeting these stricter food safety standards. So, one possibility is that something like that might happen for environmental sustainability as well. At the moment, these are all really just hypotheses. And so I really hope people will start to investigate this more seriously, because I think it is very important also for policymakers to understand what has happened.

I'm really appreciative of you making the point that there is just a great deal of uncertainty in this space and that there is a need for researchers to explore this issue. And I agree the food safety concerns of 20 or so years ago is a good example. But I think there are going to be some differences and I'll be intrigued to see how that plays out. I am interested to understand, are there any risks besides the ones that we've kind of touched on, any other risks or downsides to this movement that we're seeing?

Yes, there are actually. Because the story I told so far was maybe a little bit on the optimistic side. I was explaining how it's becoming easier to supply the information in part because we now have better reporting standards. That is one part of the story. That's sort of the glass half full view of it.

The glass half empty view is that actually, at the same time, there's also a fragmentation. There are also many different initiatives, and this is why we call it fast and furious. So, there's lots of different initiatives that are competing for attention. And you do end up with situations where you might have different ways of calculating certain environmental impact. Different ways of reporting it. And then it's not necessarily clear when somebody is reporting something what exactly they were using as methods. And so that poses an enormous risk, because if every supermarket or every country starts coming up with its own way of doing things, its own way of reporting, then the end result is just going to be confusion and frustration and transaction costs. And then the benefits for the environment won't even be there.

So, it is really important if you want this to go well, that people get together, stakeholders, governments, researchers, to get together and try to align as much as possible on common reporting standards, common methodologies, etc. So that it's clear for everybody that the data that we're looking at is comparable. This is important, and I can imagine if we think about international accords on addressing climate change and how it takes a lot of effort to get agreement on those, you can imagine that when we're talking about these kinds of measures and getting concordance on that, there could be some real challenges.

We've already touched on this, but I'm interested to know, are there other policy implications of the work that this paper is doing? Is there something we should be paying attention to?

Well, one idea that I hope people would start taking seriously is I want people to start thinking in timelines and cycles. And let me explain what I mean by that. There's a lot of different initiatives out there. And you can even start to see a little bit of a hierarchy, how different things, some of these standards are building on other standards. Some of these databases are then in turn using some of those other standards. There's a kind of a logic that is emerging there. One of the problems that happens now is that it's not really clear when all of these elements are going to get updated. So, suddenly one of those standards might get updated and then now all of these other standards that build on that or those databases that build on that are suddenly no longer consistent with that original standard. And then there's some confusion and then it's not really clear whether the data you are using is actually still consistent with the original standard. One idea that I'm advocating for is that people should all explicitly define a certain iteration cycle where they say, look, every four years, for example, or every three years, every five years, we are going to review the standard. We'll give everybody 12 months of warning, and we'll have a stakeholder process, and we'll have a scientific process behind that so it's clear for everybody what we're changing and why. But this way, you know well in advance when each of these building blocks is going to get updated. Then that would make it a lot easier for everybody to make sure that what they're doing is aligned with those standards. And an additional benefit of doing it like that, I think, is these things are moving so fast and there's still so much new science and new technology coming in, that we have to keep the possibility open to keep improving and updating those methods and those standards as well. If you announce in advance that we'll do this on a three year cycle or a four year cycle or whatever it may be, I think that could help us strike a balance between the need for that flexibility, but at the same time that need for stability. Because of course, if things keep changing all the time, then you're never quite sure whether the numbers you're looking at make sense or can be compared. I think that idea would be very helpful. And that will probably require quite a bit of coordination between all the different stakeholders who work in that space. And I think that would be a very good thing to do.

BIO

Koen Deconinck is an economist in the Trade and Agriculture Directorate of the OECD (Organization for Economic Co-operation and Development) in Paris. He was lead author of the OECD report “Making Better Policies for Food Systems” (2021) and has worked on market concentration, seed markets, evidence gaps, resilience, and environmental impacts of food systems. He holds a PhD in Economics from the University of Leuven and has published research in the American Journal of Agricultural Economics, the European Review of Agricultural Economics, Food Policy, and Business History, among others. He currently works on measurement of carbon footprints and other environmental impacts of food.
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E251: The thoughtful transformation of Southern cooking
14 okt 2024· The Leading Voices in Food
Today's podcast is a gastronomic treat. I'm talking with Chef William Dissen, James Beard Award-winning chef and owner of the restaurant, The Marketplace, located in Asheville, North Carolina. William is the founder of four award winning restaurants and draws inspiration from traveling the world, creating dishes that tell a story, surprising guests with inventive food preservation techniques, and bringing classic dishes with explosive flavors to life. He published a debut cookbook in 2024 titled Thoughtful Cooking - Recipes Rooted in the New South. Food and Wine Magazine recognized it as the best spring cookbook and praised how he takes readers on a culinary journey organized by the four seasons of Appalachia's most sought-after ingredients. William also enjoys the fame of being the first and only chef to beat Gordon Ramsay in a cook off on NatGeo TV’s Gordon Ramsay Uncharted Smoky Mountains.

Interview Summary

Will, you were early to the farm to table local foods concept. Some years ago, when I dined at your restaurant, the Marketplace, I liked the philosophy, not to mention the food, would you please tell us what led you down this road?

You know, I'm originally from West Virginia, from the Appalachian Mountains, and my grandparents were, were farmers that lived in very rural parts of the state. I grew up in suburbia in the capital of Charleston, West Virginia, but spent a lot of my weekends on their farm. And they very much lived the Appalachian mentality and culture of farming, of putting things up for the year. You know, they canned and pickled and preserved and fermented and dehydrated, and they foraged and they had honeybees to pollinate their garden. They irrigated with fresh spring water and things that I think now in 2024, hipster DIY trends that people are saying they're doing in bigger cities. But these are things my grandparents were doing to sustain themselves. And I'd say that those ideas and ideals imprinted upon me about not just sustainability and how to treat the earth, but also about how to make food delicious because great food starts fresh.

And from this initial exposure to food customs of your youth what led you to being a chef?

You know I think in those hot sweaty August days, as they say up in the holler of my grandparents’ farm, we'd sit in the front porch and shuck corn and string beans. I really kind of kindled a love affair with food. One of my first jobs I had, I was a newspaper delivery boy and shortly after that I was, you know, trying to hustle to make some more money. And I ended up washing dishes at a local country club. And I think a very similar story for a lot of chefs, one day the garde manger cook or the salad and sandwich cook called out. And the chef said can you make sandwiches and salads? And I thought, sure, I can do that. And haven't really looked back since.

You've been a chef at many fine restaurants in major cities. What led you to Asheville, North Carolina in particular?

After I left West Virginia, I lived all over the place. I was in New York and California and South Carolina and ended up back here where I'm now in Asheville where I have my restaurant, The Marketplace. And one of the things that really stood out to me was the really beautiful region. National Geographic has voted it time and time again as one of the most biodiverse places on the planet. It's actually a temperate rainforest. There are species of wild edible greens and medicinal greens. There are species of lizards and snakes and things that you only find here in this region. It's not just beautiful. It's also a really thriving ecosystem.

Terms like intentional, mindful, and in your case, thoughtful - it's in the title of your book - can be applied to cooking and eating. What does it mean to you?

I'd say in general, it's going back to what I mentioned about my grandparents. And really focusing on being present but also planning ahead. I feel like in this day and age, we're so connected to computers and phones and social media that we've kind of got disconnected from our food system. People say, well, you know, technology is driving the world and we need to be logged in to be able to stay relevant. And I don't disagree with that, but I feel as our society is doing that, we are losing touch with nature. And if you go back one generation, two generations and ask anyone, their grandparents, I'm sure grew a garden. Or were farmers, and they probably went through acts of preservation because there weren't Whole Foods in every corner. It wasn't Amazon delivery. They had to plan ahead, and to be in touch with the time of year enables them to sustain themselves and their families. And certainly, we're fortunate now in 2024 to not have to think that way all the time, but I do think there's a lot of value into being a little more thoughtful about the world around us.

And I think that's really what I want to try to show people with my book, Thoughtful Cooking, is that connecting yourself to the food system enables us to connect ourselves to the environment. Enables to connect ourselves to our local economy, to our community, and to be reconnected with those that make our food. And I think that's an important thing that a lot of us are missing in this day and age.

Please tell us more. What does thoughtful cooking look like in action?

I think thoughtful cooking is kind of multifaceted, right? I think it's being aware of what's in season. Here we are in August and in the Carolinas. What's in season this time of year, right? We have tomatoes and peppers and corn and okra, and we have all these different things that are uniquely delicious and in season. But it's a conversation when I talk about local food and talk about sustainability. I ask people, it's a very cliche question: when would you like to eat a tomato? July? August? Or January, February. And people say, 'Oh, well, of course, July or August. That's when the tomatoes are delicious and they're bright in color and they're ripe and they're juicy and sweet.' And I think those are the things that we're not being as thoughtful about nowadays. About where our food comes from and why things are in season.

So, I think that's one aspect of it. Another aspect of it is it's just taking the time to be mindful of the world around us. I think we're all moving so fast that I want people to be able to slow down and enjoy cooking. Cooking as a father of two, running many businesses, I joke with my kids it feels like a chopped competition in my kitchen. Some days when I open the fridge and I've got 30 minutes to make dinner for a couple hangry kids. But also taking the time to enjoy cooking. I think there's something to be said about slow food and taking the time to cook in your kitchen, open a bottle of wine, turn the music up. Actually connect with people around you rather than just staring and scrolling on your phone. I think it's a way to really bring people together.

And then the other, the other facet of it is, thoughtful cooking is that the way we choose to eat really creates an opportunity to vote with our forks. That there's a lot of advocacy and sustainability you can do just in taking the time to think about where your food comes from.

I can so relate to what you're saying. Not too far from where I live in Durham, North Carolina, there's an unbelievably wonderful farmers market. The state farmers market in Raleigh, which I imagine you've been at, been to one time or another. But what a pleasure it is to go there when the strawberries are just coming into season and then the blueberries and then the peaches and then the apples. Not to mention all the vegetables. And we just this weekend had guests and made a corn and tomato salad with all these wonderful things that were there. It just felt that there's something special about making it when you've gone to buy the ingredients from a farmer who grew them. And you're right, everything, every part of the experience is better doing that. How in the restaurant do you try to accomplish getting people closer to the food and more thoughtful about it?

At our flagship restaurant, The Marketplace in Asheville, the whole premise is local food sustainability. I really like to show that we can create a sustainable business that can last the test of time. And I think we have, as we're celebrating our 45th year this year in 2024. But for me it's taken the time to meet the makers. The artisans who are making cheeses or types of charcuterie. Dairy farmers, vegetable farmers, livestock farmers, fishermen. And taking the time to talk to them about what they do to be a little more thoughtful and inquisitive about how we're eating. Doesn't necessarily mean that we're all eating healthy food all the time, right? But understanding how they're taking care of it.

As you really dive into the food system, there's a lot of things that if you look at what's happening behind the scenes in some of these big, bigger commercial commodity farms - you may not like about people are being treated that are growing the livestock or the vegetables. About how they're treading on the environment in a non-sustainable way. And then also, what's going into the product that's going into your body? Are they putting hormones on or different types of spray or whatnot, you know, to cut the chemicals that could affect your body in the long run.

And I know I'm not a crazy health nut, but I want to make sure that, when I'm eating clean, I feel good. And I think a lot of it too I was very fortunate after I did undergraduate studies at West Virginia university, I went on to the culinary Institute of America for culinary degree. And I took a wine course there. It really imprinted on me about viticulture with how they grow grapes. They study this thing called a Brix level, which is the sugar level in a grape. They use this fancy electronic device called a mass spectrometer that measures the sugar content in a grape. And so, the vintners go around their farms, and test the grapes as they are approaching ripeness. They wait to pull them off the vine until the grapes reach that perfect ripeness because the grapes are higher in sugar. They're naturally sweeter. They're going to ferment into more delicious wine, but every fruit and vegetables has a Brix level. So if we're able to really be in touch with, with nature, with the time of year, when vegetables and fruits are ripe, they're naturally going to taste better. The vegetables are going to be bright in color heavy for their size because they're naturally ripe and sweet and they're just going to taste better. I don't know about you, but that doesn't necessarily make me feel like I'm a health nut. But it makes me feel like I'm in search of great flavor.

Well, it shows how much you appreciate good food and how important good food can be for the way we feel about ourselves. Obviously for the environment and things. You know, I've often thought it would be a wonderful experience to go to a restaurant and have a meal, but before the meal, be able to interact with the farmer. The farmer comes in and talks about whatever she or he has contributed to that particular meal and how the food was created and what their relationship is to the land and whatever practices they use. You get those things outside of a restaurant. But I've always thought it'd be really interesting in a restaurant to do that kind of thing. Maybe that's something you've already done.

We've definitely hosted a number of farm dinners. I actually have one coming up. There's a group out of Santa Cruz, California called Outstanding in the Field. This will be our eighth dinner we've done with them over the years. But we will do a white tablecloth dinner in the middle of a farm field for 200 people and cook over a wood fire. And you know, the hogs and the sheep are grazing the pasture beside it. And the vegetable garden is in other pasture over. And for a lot of people, they've never stepped foot on a farm. And it's a really transcending experience.

I think the answer to this is pretty obviously yes. But it seems like today's youth, like I think about students that I teach in college, are so much more interested in the story of their food than people were just a generation or two ago. But I think I, when I grew up, all we cared about was that we had food. And the, you know, the better it tasted, which basically meant how much it was processed and how much sugar and things it had in it. That was really about all we knew. But now people are asking a whole different level of questions about where their food came from. Do you see opportunities for working with children to help maximize that?

I do, yes. There's an organization that I've been on the board for a long time locally called the Appalachian Sustainable Agriculture Project. They have a subsidiary called Growing Minds Program. And it works to put healthy local food into schools and to teach children about the opportunity to healthy and eat fresh. I think it's a great thing.

I do a lot of food advocacy work as well on Capitol Hill where I go and lobby for different food policy. I've done that at Capitol Hill, you know, and internationally as well. I helped create the Chef's Manifesto for the UN's World Food Policy. And I spoke at a number of conferences around the world about it. But it starts with children, right? If we're able to teach them about eating healthy and eating local, it's going to be something that's ingrained in them forever.

And about local food, I feel like a lot of people say, 'Oh, well, shopping at the farmers market, like that's only for the 1%.' And I feel like I find a lot of great deals in the market. But a lot of farmers markets nowadays, because of different food policy and food advocacy, they have things even with SNAP benefits that they'll do two for one. So, you can really get some great deals at the market as well.

You mentioned you've done some advocacy activity in Washington arguing for certain policies, what kind of policies have you been involved with?

Given that we're in a presidential election year, I always like to tell people I don't really like politics very much, but I really like policy. Because policy is where you can take action and make change. I've done a lot of advocacy work advocating for things like the Magnuson Stevens Act, which provides federal fishery management and sustainability ratings for different species of seafood. I, also worked on the Childhood Nutrition Reauthorization Act, which was to add more funds to school lunches for children. Farm bill. Gosh, I've done so many different things. It's good to get out there. Our politicians get bombarded with different bills and lobbying groups all the time. But I think when they see somebody like myself, I’m a chef, I'm an employer, business owner, real estate owner, it's different than maybe your standard blue suit lobbyists. A lot of times take the time to listen. And many of them come in and eat at our restaurants. So, it's an opportunity to really try to direct change and hopefully when they go to vote for these various bills, they think about the opportunity that they've had to meet with constituents like myself. And hopefully they remember to do the right thing when they place their vote.

You also show how many ways there are to interact with the food system. And ways to try to make improvements, and the scope of your activity is really pretty impressive. So, let's loop back to your book. In your book, you talk about, again in the title, you talk about the New South. What is the New South?

I think a lot of people think of Southern food as shrimp and grits and gumbo and very heavy, rich country cooking. There's a lot of African American influence from the days of slavery. And recipes, ingredients that were brought over during slavery from West Africa, and traditions that arose in Southern cooking from those times. Like everywhere else in the world, the South is evolving and it's one of the most popular places for people to move to within our country, the United States. And we're starting to see this evolution of Southern food, right? It's not just this kind of typical stick to your ribs, Southern cooking anymore. We're starting to see other cultures come in. There's Indian culture, African American culture, Asian cultures that are coming in and they're taking these traditions of Southern food and local food, but then adding their flavors to it. And to me, it's a really exciting time because I’m biased, I love Southern food. I love shrimp and grits. I love these different dishes that are so wonderful. But I love when somebody comes in and they take a recipe, and they add their own touch to it and they tweak it. Because to me, that's, that's adding to our heritage as Southerners. And so, for me, recipes rooted in the New South is this evolution that we're, we're taking Southern food on.

If you wouldn't mind, give us some examples of some of the recipes that are in your book?

I have a number of dishes that I think are really exciting. One of my favorites: I have a red wine braised beef short rib. Serving that with a chili cumin sauce and then a blue cheese and green apple coleslaw. So, it's kind of taking this idea of, you know, of beef and coleslaw, but kind of adding in some other flavors from other cultures. You know, like within that there's a lot of kind of Hispanic flavors as well.

I loved looking through the recipes in your book. And I don't think there was one that I looked at where I wasn't surprised by some ingredient that I didn't expect. Or putting things together in unique ways. The book strikes me as being highly creative. I can just imagine how much work was involved in putting that book together and how long it took. It must sort of be the culmination of a lifetime of work, so congratulations for doing that.

Well, thank you. I think as I mentioned before about the other work I do outside the restaurant. I didn't just want to write a Marketplace restaurant cookbook. I wanted to write a cookbook that talks about, you know, the power of food and the philosophy behind it. But then also have some delicious and creative recipes in there that can be inspiring to folks as well.

BIO

William Stark Dissen is a renowned chef, author, culinary diplomat, restaurateur, and early pioneer of the farm-to-table movement in Asheville, North Carolina, and surrounding regions. His titles also include Seafood Watch Ambassador to The Monterey Bay Aquarium in California, and Official Ambassador for Le Creuset and Mountain Valley Spring Water. Named Fortune Magazine’s “Green Chef of the Year” two years in a row, William’s endeavors in sustainable food and dining, coupled with his passion for foraging and fly-fishing, often take him from the kitchen, into the mountain streams and peaks of the Southeastern, United States, Appalachian region, and beyond. William’s efforts to uplift the principles of food sustainability in his restaurant and network of vendors and suppliers, has not gone unnoticed. It caught the eye of Celebrity Chef Gordon Ramsay, who featured Asheville on NatGeo TV’s, “Gordon Ramsay: Uncharted, Smoky Mountains.” The hour-long episode featured William touring Ramsay through the forest and rivers of Western North Carolina and concluded with the two chefs competing in a peer-reviewed cook-off. William beat Ramsay for the first and only time in the show’s three seasons. Through this experience, Gordon Ramsay named William, “The Most Sustainable Chef on the Planet!”

A career in the culinary arts led Dissen to become an advocate for food policy on Capitol Hill starting in 2010, where he’s lobbied to Congress about the importance of passing legislation, such as The Farm Bill, The Childhood Nutrition Reauthorization Act, and The Magnuson-Stevens Fishery Conservation and Management Act. The Barack Obama administration lauded William as a “White House Champion of Change for Sustainable Seafood” for his work to create healthier oceans. He also serves in the American Chefs Corps in the U.S. State Department, which sees him traveling around the world to promote American food culture and sustainability practices.
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