The Leading Voices in Food

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  Captain and Cat's Explorasaurus on Healthy Food 10.06.2026 30min

  Today we're talking with Kevin Hoban and Jordie Simkovic, the creators and starring characters of Captain & Cat, a popular YouTube kids show with 200,000 subscribers and over 200 million views. The educational show for preschoolers tells stories using entertaining songs and narratives. They've just launched a new series called Explorasaurus: Healthy Food and You, aimed at teaching kids about healthy food and how it's grown. Their first episode about SugarBee apple growers in Washington State has over 500,000 views on YouTube. Interview Summary So, for people who aren't familiar with your show, for those few people out there who may not be, tell us about Captain & Cat, the characters, what they do, and how did you guys get started doing this? Kevin - Gotcha. Well, Jordan and I have been best friends since college. We went to Northwestern University in Chicago, and we were in a band together. We would perform live on campus, in the streets. And we realized that kids would stop and really enjoyed what we were doing. And I think that was the seed of the whole thing was, "Hey, maybe our act that we have, this two-man show is something for kids." And then we graduated. We both moved out to LA. Jordan came out here to act. I moved out here to produce TV shows, and on the weekends, we started performing for kids. Jordie - Yeah. Actually, we did a show called The Bubble Show. And we were doing probably six to eight shows a weekend for about 10 years. And then during the pandemic we started putting our stuff online because all live performances stopped. And for about three years it was nothing and crickets, and really just our parents watching. And then we won the award for best kid song of the year in 2023. And then that kinda put us on the radar of YouTube Kids who invited us to be one of the featured channels on their platform. And for a while we were doing jingles and music and educational songs and stuff like that. And then towards the end of last summer, we had connected with SugarBee Apples and that whole kind of growing cooperative out there about doing an apple song. And they actually were like, "You know what would be even cooler than that? Why don't you come out here and meet the farmers and see the harvest in action?" And we're like, "Whoa, this is really cool." And honestly, it was a life-changing experience. We now say that we have aunts, uncles, and cousins out in Central Washington. And honestly, I grew up in Miami, I went to college in Chicago, and then I've lived in Los Angeles ever since. I had never stepped foot on a farm, really, in any significant way. And just to be able to get exposure to this incredible pocket of people that otherwise I would have never had a chance to see and meet was completely eye-opening. Kevin - I would say I went out there thinking, "This is a huge apple company. They sell them all across the country in every grocery store." I went out there thinking, "Well, this is sort of like a big industrial corporate farm," right? Must be just one giant farm with robots harvesting apples. And what we found was it was a co-op of family-owned farms. Smaller families. We met the families. We met the grandparents, the parents, the kids, the grandkids. And we learned so much about apples and how you grow them. That every apple is picked by hand, first and foremost. Jordie - We honestly expected there was going to be like a machine just going around and shaking the apples off, you know. Because you have no idea. And there's been so much dialogue around factory farming, which has become kind of like the negative word. And honestly, yeah, as Kevin was saying, we expected just a giant faceless corporation there. And it was the exact opposite. Can I ask you guys a question? I'd like to dive in a little deeper than this, because you're saying something that resonates with me very personally. When I moved to North Carolina from Connecticut, I was offered the opportunity through the North Carolina Farm Bureau to do a tour of farms. Two-day intensive tour of farms in Eastern North Carolina. And we went to a blueberry farm that harvests millions of pounds of blueberries a year. Soybeans, corn, hog farmers, chicken. I mean, we did everything. And it was incredibly interesting. And there was the technology part of it, or the lack of technology that I was learning about, just as you related. But there was also a very moving human part of this. The people, I thought, were really interesting. And the generational nature of farming and all. So, tell me a little bit more about the people part of it. How much that affected you. Jordie - We met the farmer who like seven generations back, their family introduced the Granny Smith apple to the United States, you know? It's going back and we literally see it's a whole family working and living very close to where they farm. And so, kind of just, it's Uncle Farmer Peoples now, you know? And so, we were kinda talking to him about chemicals and pesticides and stuff like that off the record because we're like, "All right, so now tell us how much you spraying on these?" He's like, "Why would I ever do anything destructive to this land? This is where my family and I live." Kevin - Yeah. And I think you also picked up on the pressure that these farmers feel to carry on the farm itself. It's been in their family for generations. They need to keep it running. And all of the pressures and anxieties that come with that just to keep this farm afloat. Because again, it's not some huge corporation, it's a family farm that's part of this co-op of other family farms. And they've all kind of banded together to pool their resources to keep everything going, which is just a wonderful... It's a wonderful lesson, I think. These farms rely on people working together day in and day out for their own collective good. Jordie - The guy who runs the packaging facility is the brother-in-law of one of the growers. So, we thought that they were pranking us, because literally every car that drove by, they're like, "Oh, that's my brother-in-law. Oh, that's my aunt. That's my niece," in this little town right off Lake Chelan. And you really see the impact. We actually were just there last week again to film a new segment about apple blossoms and pollination and stuff like that. And one of the coolest experiences we had there was we went to an elementary school. One of the families in the co-op had donated shoes to a lot of the kids in the elementary school, and we helped go distribute them there. It's honestly so cool to see that the same way that LA is built around the film industry, there they're literally built around the apple and cherry industry, and pears. Ever since we went there, I off-camera would not, you would not catch me eating anything other than a SugarBee. And that's the truth. You know, so interesting to hear you talk about this and your experience with the apple production facility and the people being related to one another. It's exactly what I found on a sweet potato farm here. North Carolina's the largest producer of sweet potatoes, and I visited a very large farm owned by a man and his daughter. I mean, they really ran this business. And they were farmers at their heart, but this was $100 million a year business. And they're looking at international trade markets and deciding when to release the sweet potato. I mean highly sophisticated financial decisions they were making. But at the end of the day, they were related to their land, and that's what this was all about. I mean, to say it was a spiritual relationship doesn't... I don't know what word captures it. But it was something very special in that sometimes you think about farmers exploiting the land, and that happens with the big factory farms. But in these cases, you find farmers want to be at peace with their land. And I heard it many times, that they wanted to turn the land over in better condition to their children than it was turned over to them. It's obvious from affectively and emotionally the way you're talking about it and the way I'm talking about it, something very special is occurring here. How do you communicate that in a video, especially to children? Kevin - Well, I think for us, we always lead with the enthusiasm that we have, but then also trying to tease out the enthusiasm that the farmers have themselves. Because some of them are not used to being on camera, and certainly not on a YouTube Kids show. But once we ask the right questions and probe a little bit of, for an example, we just shot with them last week. And we asked for students that we work with around the country to submit questions. And one of the questions was, "Does the farmer talk to his apples?" And we asked one of the farmers that, and he lit up, and you just saw all the sudden that passion that he really does have for his apples. And I think the more that we can bring that out of the farmers, show kids and families how passionate and excited they are about the fruit, that hopefully that will get the kids excited as well. You can imagine the farmer talking to an apple when it's falls from 30 feet on his head. Jordie - They're pretty sturdy up there, honestly. And I think another way to kinda communicate the care is to show how much work goes into it. Because literally, this was informative for us just because going from the blossoms, they go through and prune by hand. And hand select it because there are so many variables involved. And what we found is the confluence of this incredible intergenerational wisdom and technique and craft that has been passed down and honed. Also, kind of meeting within the packaging facility. The technology there is honestly mind-blowing. And I think it's only getting more and more advanced. We shot an episode at a dairy farm. And one of the farms we visited recently had AI milkers - AI robotic milkers. And we're like, "Oh, does this make it so that the cows have a different and negative relationship with you since they're used to robots?" And they're like, "Actually, it's the exact opposite. Now, they're much friendlier with us because they know that we're not coming to do anything, you know. We're not coming to milk them." It's incredible to see. And I recommend everybody getting a chance to go visit a farm and see where their food is made, because it changes your relationship with how you eat, I think. You know, I can see why your offerings to children and their parents would be so popular. Because you guys have this neat sense of wonder. You know, you learn, you're out there, you're meeting interesting people, and these interactions sound like they mean the world to you. And of course, the wonder is something amazing that children have naturally. And if that can keep invigorated for as many years as possible, hooray. Kevin - Yeah. You asked earlier whether you should refer to us as Captain and Cat or Kevin and Jordan. And I think the truth is they've become one in the same. I mean, when we go out there and we film these episodes. Sure, we're in costumes and we're wearing bright colors. But for the most part it's just us, Kevin and Jordan. They're excited to learn about whatever we're talking about or talking to. And there is a natural curiosity that I think we both have. We're not acting, we're not faking it. To go to these farms and see, down one row of apples they're harvesting hundreds of thousands of apples. And they've got to get it done within a matter of weeks. You don't have to pretend, that's just impressive. Yeah. That is just impressive to us. Jordie - And the world is cool out there, honestly. I don't put on anything. We actually pride ourselves on not talking to kids in a silly voice. I talk in our episodes exactly the way I'm talking now. We don't dumb down our content, and we love having kind of complex words and complex ideas, which we then take upon ourselves to translate into simile that helps our audience understand. You know? We're processing all this in real time. And Kevin and I come from an educational background. I'm a teacher at heart, and I've always have been. And it's just amazing to be able to receive and absorb this information, and at the same time relate it to an audience that we believe will catch up with us if we use the right words. Tell me how you remain optimistic. So, let's talk about kids and food. The average child is exposed to tens of thousands of messages over a period of time that are mainly for unhealthy food. They're being given food in schools and elsewhere that is engineered to hijack the brain chemistry to keep them coming back for more. You know, Tony the Tiger is not on plain cornflakes, and the Trix Rabbit is not on an unsugared cereal. And you can go on and on. They're obviously exposed to a very tough environment. Are you optimistic that can get turned around? Kevin - I'm optimistic just based on what we've seen with what we're doing with healthy foods and produce. I think we are trying to, in some sense, be the Tony Tiger of apples, right? We want to be there going, "Hey, apples are really exciting because they're healthy, and they're good for you, and they're sweet." And if we can get kids excited about it, we feel like we've done our part. And what we've seen by this classroom program, we're working with classrooms around the country where we're sending in our content, but we're also sending apples with the help of SugarBee. And then the kids and the teachers have been filming videos and sending it to us about how excited they are to eat apples. And I think kids are wonderful. I have two of them of my own. And they will get excited about what you get excited about as an adult. If you say, "Apples are the coolest, most fun thing I've seen," they get excited about it, too. And they wanna learn, and they wanna share, and they wanna talk about it. Jordie - There's also a really cool, I think, trend that's happening within the produce industry which we've noticed. And we've noticed that since we've gotten in, which is that it's not enough to just be on the shelf anymore. You want to have a branding, and you want to have a logo, and you want to have a messaging, and you want to have connotations around your brand. And I think produce companies are starting to catch up and use a lot of the same marketing tactics and strategies that kinda junk food was using for a long time. And you know what I always say? It's this. If you actually take the time to bite into an apple and really enjoy it, there's nothing sweeter and more nuanced, in my opinion, than that. I think the more we can change the relationship with how and when we eat, the more we'll start to appreciate food that's of a different quality. And I think bringing attention to that, we're obviously swinging since probably the 1950s, maybe even earlier than that, in terms of just mindless, quick-to-go eating. But I think you see that we're changing the way that we think about how and when we eat. And I think that will favor the swing back towards it. And that's why, honestly, I think we're just optimistic people no matter what. If we went out there and did a despairing series about healthy foods, then that's not going to work, you know? But we love what we do, and we really believe in it, so that's our cause for hope. You mentioned interacting with classrooms. So, you could just post your material out there and not get involved with actual children and actual classrooms. Why the decision to do that? And tell us how that works. How do you interact with classrooms, and are teachers responsive? What kind of reaction are you getting? Kevin - Well, this actually came out of a conversation we had with the people at SugarBee. They said, " We would love to get into classrooms to teach kids about healthy foods. We've been asked before to send our apples to classrooms, but we just don't know what to do or how to do that necessarily." And so, we took it upon ourselves to start reaching out to teachers one by one on email, Instagram, TikTok, and say, "Hey, we have this healthy food episode. And we're going to create a worksheet for kids, so they learn how apples are grown. And SugarBee has generously said that they will send a bag of apples to every classroom that wants to be participate in this." And we didn't know how teachers were going to react, if they had the time for that or interest, and the response was overwhelmingly, "Yes, please, and thank you." I think teachers are looking for new lesson plans, interactive lesson plans, and obviously want to encourage kids to be eating healthy. And the fact that we can facilitate this to hundreds of classrooms around the country, it was a win for all sides really. And then we didn't ever ask anybody to film anything or post anything on social media. That's not part of the program. But they took it upon themselves to film videos of either the teachers or the kids thanking us. Thanking Sugarbee for doing this. It was more rewarding than I think we even realized going into this. Jordie - There have been people who reached out to us and got back to us, and they're like, "We just want you to know somebody's offering us a scam of free apples using your name." And we're like, "Actually, that's not a scam. That's a real thing." And I think we all see a huge opportunity. And one of our guiding philosophies and what we've realized is this: at home, you're very set in your ways, and you've created your habits around eating. And it's very hard at that point to disrupt it because at home, you're rebelling against your parents, you're set in your ways, you're not willing to try anything. And that becomes a position or in a place where you kinda dig your heels into the ground and say, "This is what I like, and that's it." But in school, we found that everybody is so open to trying new things. I remember growing up, I would just, anything that they'd put out at snack for me, I would eat. And, because it was a nice break from being in school, you know? And we think that hitting them in this environment is actually much more effective even than hitting them at home with this. And if we're looking to create lasting habits and changing the narrative around these healthy foods. The last thing we want to do is make it feel like you should eat this. Because the second someone tells you what you should do, that becomes the last thing in the world you want to do. Can you give us a peek at what kind of foods you might be wanting to take on next? Kevin - Ooh, spoilers. Yeah, we got some cool ones. We just released an episode this month about Sunkist mandarins. We went to Mandarin Farms in Central California. Same thing, we filmed with the farmers. It's also a co-op, all family farms. We went to the processing plant where they wash the mandarins and sort them and bag them and ship them. And so those mandarins are going to go out to classrooms in the next couple of weeks, and then we've got some really fun stuff planned. So basically, our goal with this is honestly to create a healthy food/product of the month club that we would send into participating schools. It's going to be very, very seasonal because we kind of want to create that sense of it. And luckily, we've got a lot of different brands signed on already. Our summer is looking pretty busy, which is a blessing for us. And really a blessing for the kids that we hope will be learning about this and receiving new foods. It's not too hard to get kids to like the idea of eating something sweet like an apple or mandarins. What about things like broccoli and cauliflower and Brussels sprouts and asparagus? Will you turn your attention to those at some point? Kevin - Absolutely. Yeah. Jordie - Absolutely. Kevin - We're up for the challenge. I know from my own experience with my five-year-old, if you dip anything in ranch, they'll like it. Or, or do a deep fry it. Or deep fry it. Jordie - Right? But it's a pairing issue, you know what I mean? And it's a context issue. So, it's the way you eat it. So raw broccoli is probably not your gateway broccoli. You know what I mean? Right. But you can always find different ways, whether or not it's incorporating it into a smoothie, incorporating it into a sandwich, or anything like that. It's kind of a gateway thing. And there's also a cool thing we're doing. So, for example, we are talking to a potato company. We don't want teachers to have to go home and make mashed potatoes, right? Because that's a barrier to entry, and that's kind of a pain. But what we found is a little workaround with a few of these is like, oh, there's an opportunity to send potatoes into classrooms and have them grow their own potato and get a sense of how it goes. It's not only about trying the food, because honestly, nothing has given me more appreciation for blackberries than trying to grow blackberries myself. You know? And so being part of the process and realizing, wow, the stuff that we're getting is remarkable. And remarkably effective and really delicious and gigantic, and the quantity of it is mind-blowing. So just there's so many different angles that we're getting kids into the idea of farming. And getting their hands dirty, and that's stuff that I feel like is really, really missing from modern society. Your messaging is focusing on how delicious these foods can be, how interesting their story is, who grew them, where it came from, and things like that. Is part of the messaging what these foods do for you? That mean that they can make you run faster, jump higher, whatever. I mean, is there a functional part of what you're trying to communicate? Kevin - Yes, absolutely. We try to say it gives you superpowers. And then with each food that we're working with, we do get into the science and try to present it in a way that's appropriate for young kids. But getting into even what flavonoids are in an apple, we just  did a whole segment of that and all the nutritious benefits. We've partnered with nutritionists. We were just filming with one in Washington to try to expose kids to the ideas that there are, inside of an apple, all of these natural vitamins and things that can help them. And we've even been doing fiber. Now, trying to present fiber in a way that ... doesn't say poop. Jordie - But we've started saying poop on our show, by the way. We're like, "You know what? We can say it as long as it's an academic context," you know? Kevin - Yeah. Yes, exactly. We find the way to toe the line, and quite honestly, kids will lean in if they hear something that makes them giggle a little bit. But understanding, I mean, even for me as a grown adult, understanding that apples are a good way to clean out your digestive system. That fiber is good for that. It's even a good reminder for me at my age to be like, "Oh, yeah." If I'm feeling a little bit of indigestion, maybe I need some more fiber. Jordie - And a cool thing we also did on our Sunkist episode, Captain and I actually dressed up as these ridiculous California surfer bro characters named Sonny Sunkist and Manny Mandarin, and the idea was that we were talking about why it's a perfect snack for surfing. But at the same time, we're also giving kind of the sugar pill treatment, which is like we're doing these ridiculous characters, but at the same time we're actually providing information about why they're so healthy for you. We're doing one about whey where Kevin and I are gonna go and hijack a LA Fitness and as these muscle bros and talk about why whey protein is so rich in protein and calcium and stuff like that. We're always evolving, and each episode ends up being different. But the one thing that we've found is like the story that we can tell of these is really infinite. And will there be any part of your messaging that will talk about foods kids might eat less of? I mean, you're focusing very positively and optimistically, so the answer to this could very well be no, because it just becomes complicated. But you've got lots of kids eating sugared cereals and drinking sugared beverages and things like that. I'm just wondering if that's part of the picture. It needn't be, but I'm wondering if it is. Kevin - I think up until now our thought has been if we can try to get them equally or more excited about the healthy options. Hopefully that's enough to sway them in that direction. And honestly, as a parent, I think just giving kids the idea of getting excited about produce, that they go home to their parents and then maybe the parents' job is just a little bit easier. Because I'm faced with that every day when my daughter says she wants a snack, and she wants candy, and I'm trying to say, "No, how about this apple over here?" If we can be on Team Apple, you know, if we can be the helper to the parents that's encouraging the kids to eat a little healthier, I think that we've done our job there. Jordie -  I think it's never about us wanting to disparage or discourage or make anybody feel bad about their habits, because I think a lot of the problem around our eating habits in this country is that there's a lot of shame involved in it. And you're not only getting a dose of those unhealthy foods that kind of give a quick release of dopamine or whatever. It tricks your body into thinking it's also you're getting a little dose of that shame. And the last thing we ever want to do is to turn into police, you know, and policing each other. Nobody wants to take advice from the police, you know? And nobody wants to feel disparaged or talked down to. It's interesting. We never really kinda thought about it, and obviously we just want to keep it an entertaining and enticing picture rather than any sort of daunting... because when you get into the facts of some of those unhealthy foods, it can really seem a little bleak. And it is. Well, and making foods seem like fun and having] interesting characters associated with them is something the food industry has done successfully forever. It makes perfect sense to do that, but attach these things to the healthy choices. Kevin - Let's use their tricks for good. Lord knows we're steeped in them, you know? Jordie - Yeah. Let's wield that as a cause and weapon for good. I think that's what we're trying to do. Kevin - We've also been learning about the history, a little bit, of produce, of the produce business, and how for so long these companies looked at their products as commodities, right? It wasn't necessarily SugarBee apple, it was, "We're a company that sells apples. We're trying to be in as many grocery stores as you can." Which I understand. That makes sense. But I think what probably was lost in the process was if you're just a commodity and every apple is just a different Red Delicious or Golden Delicious. You're losing that opportunity to put a fun character behind it. And I think you're seeing now a lot more of these even different produce companies coming together. Like avocados from Mexico. I think is a great example that you see a lot more of their branding and their advertising where all of these avocado growers are coming together and saying " let's just market avocados. Let's get people excited about the food itself." Jordie - I think there's also going to be an interesting trend away from going to physical grocery stores that will only continue in the future. So I think if we're ordering online from let's say a whatever warehouse, Amazon warehouse, right? And they have 20 different apples there, it's really important to have brand loyalty. And that becomes things that they're having to consider now. And we just happened to release this series at a really nice time, which they're all trying to do that. Because probably 10 years ago they would've been like, "We don't listen to apples. They sell themselves." You know? But now you're dealing with so much competition and so much branding and so many name things that It can be overwhelming. And at a certain point you might just disconnect unless you know what you're looking for. What I found that historically is that the people selling these foods were pretty splintered. There would be a plum association and an apple association and a pear association. And, they're loosely grouped into a broader produce organization and things like that. But those organizations tend to not to be very well-funded or have a lot of clout because they were so splintered. I wonder if that's beginning to change. Do you see any evidence that the industry as a whole is beginning to unite effectively? Kevin - It's funny. Just on Instagram alone, there are, like, places that it's like, " we just love cranberries so much." And then it's like cranberries from Wisconsin. That has their own little thing, you know? I feel like there hasn't been that coalescence, and I feel like also there's probably some sort of advocacy group. I think it's largely statewide policy as well from what I've gleaned off of this. They're each focusing on their own state policy. Jordie - And then maybe there's a national organization. And this honestly, we are just scratching the surface on this because this is more complex than we could have ever imagined. And we are learning every single day in our talks. And we love to just go out to lunch with the people who are on the business side and straddling the business and the farming side. And the things that they are grappling with are fascinating because all these companies ship internationally. So, you're subject to international law, like weather, there are so many different variables that we're like, "I've never felt so connected to the weather in my life." Well, before talking to you guys, I was having a day of my ordinary level of hopefulness, but it's gone way the heck up now.And you make me feel really optimistic about the future. And I love the work you're doing. And boy, you could have no two more perfect people doing this kind of thing. And also, I wanted to say, I've done hundreds of podcasts, and I think this is the first one ever where I haven't asked a single question from the prearranged script. It just flows so naturally with you two. That's how we do this series, too. Oh, yeah. Farmers will be like, "Can you send us a script of what we got?" And we'll send them just the most generic questions of all time. But the things we end up talking about conversation that grows naturally, in my opinion, is by far the best one. So here we are just talking like old friends, you know? That's nice. Yeah, and it's much more human that way. And that's what registers with people. So, in any event, thank you for the good work you do. And I just hope this incredible visibility you have just continues to grow, and that more and more kids are exposed to it. Congratulations. BIOS Jordie "Cat" Simkovic was born in Miami, FL and has worked in early childhood education for almost 20 years, specializing in children with ADHD and learning disabilities. He is a classical flautist and enjoys studying music, martial arts, and gardening. He majored in political science and international studies at Northwestern University, and was this close to applying to law school, but is glad he didn't, although he still teaches the LSAT. This new series about farming and healthy foods is the culmination of his interest in nutrition, education, and meeting new people all across the country.  "Captain" Kevin Hoban, born in Detroit, Michigan, has spent two decades travelling the world and producing content for networks like National Geographic and the Discovery Channel. As a lifelong camp counselor, he's always had a passion for teaching children in a fun, interactive (and often musical) setting. Captain & Cat's "Explorasaurus" series allows him to share his love of exploring and learning about the world with kids and families! Kevin lives in Los Angeles with his wife, two adorable daughters and his dog, Charlie.
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  E303: Amy Beros on centering community in food banking 10.06.2026 17min

  North Carolina is one of the nation's top agricultural producing states. And it is also a state where one in seven residents don't have the resources to provide food on their table every day. Today, I'm talking with Amy Beros, president and CEO of the Food Bank of Central and Eastern North Carolina - the state's largest food bank. Each year, this organization provides 95 million meals distributed through more than 700 partner agencies, food pantries, congregate meal sites, backpack programs. And they do this in 34 counties in the state. In our conversation today, we will explore the policy issues that this food bank and many food banks face. Interview Transcript Amy, I want to ask a really simple question about what got you to this place. So how in the world did you get involved in food banking? Oh, gosh. Well, you know, when I was growing up, I didn't know what food banking was. But I knew that it was our responsibility to make sure that neighbors helped neighbors. So, I grew up volunteering what I know now is a partner agency of the local food bank in my hometown. And as I moved across the country, I found ways to get involved. When I moved here to North Carolina about 16 years ago, I found food banks. I've been working professionally in food banking for a little over 12 years now. But I believe that food is a basic human right, and it has been my life's work to make sure that we're doing everything we can to ensure everyone has what they need. Thank you for sharing that. And I can imagine over the years, as I've also been involved in food banking but on the board side or as a volunteer, that this is a work that we sometimes think it's just about moving food and providing that. However, there's a whole policy framework that, sort of, surrounds and influences and shapes what food banking and what the work of the partner agencies, the food pantries on the ground, what they do. I wonder if you could help make this a little bit more real for us. Could you tell us a little bit about how policy becomes personal in your work? Can you share a moment when that really came true for you? Oh, I think the most recent blinding moment was last year during the government shutdown. Well, one, there's a lot of noise on TV right now, right, and in the media, but you hear of these massive numbers, and we know that our elected leaders are looking at these numbers on spreadsheets. And we see the humans behind those numbers and their stories. And these are thousands and thousands of stories like the ones that we hear about each day. Last year, during the shutdown, a father of five reached out to me and said, "I have five children. I work at the federal prison. I'm missing my second paycheck. For the first time in my life, I don't know how I'm going to put food on the table." Or the SNAP delay and disruption that we had. For the first time in our history during that shutdown, a mother reaching out and saying, "I don't know what to do. I've told my children to eat everything they can at school because I don't know what we're going to have when we get home, if we don't have these benefits." And that's just two stories and one crisis. And so many of our neighbors are living a crisis every day. These systemic issues. And we see those humans and hear their stories each day. And I think that's when it becomes personal. These decisions, one stroke of a pen, impacts food for hundreds of thousands of neighbors. Thank you for sharing that. I teach a class called the Economics of the Public Sector, and we often talk about policies that provide support to individuals. And it can be easy to talk about these policies as if they're just decisions that policymakers make, but there are real people who are dependent on these policies. And when they don't work or when rules change, it has significant implications for how people navigate. And so, I appreciate the work that you all are doing. I want to take a step back and talk about food banking. And while I know a lot of our listeners are familiar with food banking and food pantries, I do know that people kind of mix those two terms up. Amy, would you just tell us, broadly speaking, what's a food bank, and then what are the partner agencies. And how do they relate to one another? Yes, absolutely. Our food bank serves 34 counties in North Carolina. And as you shared, we work with over 700 partners. We work with growers. We work with over 80 local farmers in North Carolina. We work with manufacturers in North Carolina. We work with all of the retail chains to get food out into the community. And we do that primarily through those partners because they are embedded into the community. And what we're really proud of here, and I think something of how food banking has changed, you know, many people still think of a food bank as a dimly lit church basement pantry. And that maybe was food banking 30 years ago. But today it is part of the modern food system. We are a critical piece of infrastructure within the food system as part of the charitable food system. And one of the things that I'm most proud of is we live in North Carolina, this beautiful agriculture state, and over half of what we distribute each year is produce and protein. And that is what neighbors are asking for, too. Because neighbors want the healthy fresh foods, and it's also the most expensive to buy. And food banking today is not just focused on moving calories and getting pounds of food out to the community. It's focused on meals and nutritious meals and how to provide that nutrition education to make meals healthier. To use the types of foods you would get in a food pantry. For instance, I just learned at one of our nutrition demos this past weekend, you can leave the peel on a sweet potato, blend it up, and make it into a pancake. You never notice that you left it on there, but you get so much more fiber. And we're doing these types of trainings to help people make meals more nutritious, make meals go further, too, that they're getting. It's really a holistic approach. It's about being alongside community partners that are embedded into the community that are providing holistic supports like workforce development, job training, housing support. And we're that food portion as part of those agencies and making sure they have the right food and enough food to get out into the community. It's really helpful to hear the ways that food banking is adjusting. This idea you're no longer just this big organization that takes in a bunch of food and then distributes it through, you know, food pantries and what used to be called soup kitchens. But rather you're working with other community partners, you're working with farmers to find ways of moving food, but also providing opportunities and thinking about this almost as wraparound services. Are there other things that are being provided than just meals? I know I've been in pantries where there have been nurses, and there have been other support services like ways to sign up to SNAP. This is a sort of a series of overlapping and intersecting opportunities to help families meet their food needs, but more than that, their sort of broader set of needs. And I think this is a really critical way of understanding that food banking looks different than, like you said, grandmothers working in a church basement. I know that the work that food banks can serve as shock absorbers. When things go down, when things are problematic, food banks are there to sort of meet needs in a real way. We've seen a great deal of breakdown in policies over the last several months, and both at the state and at the national level. What does this shock look like to you and your partner agencies on the ground? It has been a tough year. You know, our budget went from 27% government funding and support to less than 10% in one year just because of decisions that were made in an instant. And there was no feedback structure. And I think that's one thing that I really pride our food bank on is the community feedback. We're constantly trying to engage with neighbors facing hunger, understand nobody knows what people facing hunger need more than the people who are literally experiencing it every single day. We try to ground all of our decisions in what is the community saying they need of us. And I think that is one of the things that's been so frustrating to see the decisions made this past year at the federal level. There's been no feedback. It's just numbers on a paper. And within, you know, a stroke of a pen, North Carolina lost $30 million for food purchased from North Carolina farmers for schools and food banks. And that was just North Carolina. It was one billion across the nation. And we're impacting people facing hunger, we're impacting farmers at the same time, and we have farmers who are saying, "I don't know if I'm gonna keep my family farm open." With SNAP, you know, we have cuts coming this year for SNAP and changes that are going to be detrimental for so many of our neighbors. And the cost shift to the states that are not prepared to take that. There's not a transition plan place. And SNAP is an economic driver. For every one meal a food bank provides, SNAP provides nine. We can't replace SNAP if we lose those meals. There's no possible way for us to charitable food our way out of that. But I don't think people realize the ripple impact of those decisions. So yes, it's going to impact people facing hunger. And eight out of 10 of those people on SNAP are working families, seniors, people with disabilities, our most vulnerable neighbors. And at the same time, we're going to see rural grocery stores close. We're going to see more farms close because for every dollar of SNAP, it means $1.50 to $1.60 back into the local economy. And that's going to be a detrimental effect that we can't turn around quickly. It's going to be long-term health impacts for neighbors because of the loss of this nutritious food and the loss of jobs. And we can't just flip a switch and turn that back on because of how damaging it's going to be to so many pieces of our economy. And when I say we can't charitable food our way out of it, we were meant to be here in times of crisis to stabilize and to be an ongoing support for people in the community during that time. But we were never meant to replace the safety net. At the same time, we're having all of these changes at the federal level. We're the only state in the country without a budget. There was another multimillion-dollar loss for food banks and farmers that was invested by the state to purchase from local farmers to go back to neighbors in need. And because we have not had that budget, we've not received those funds. And so, it's really been hit after hit, and we're seeing each one increasing need at our pantries. Right now, we know there's over 600,000 people facing hunger in our community, and we're hearing from our pantries 20% to 60% more than they're seeing last year. I think that 600,000 people number is actually very low, and we're going to see that continue to climb, unfortunately, because of all the changes we're experiencing this year. Amy, this is pretty sobering. And I realize that we're talking about issues that are also highly political. And I know you are leading in spaces where you have people who have differences of opinion about what policy should be. But a lot of these people are coming to the work of the food bank, either on the board or in partner agencies or wherever, donors even, because they care about addressing issues around hunger, right? So, how do you build trust? How do you work across these differences to help achieve the goals that food banking is supposed to achieve? I've never met a politician that told me they didn't like food banks or they didn't care about food banks. There's a lot on people's minds, and I think we need to be in front of our leaders more because there's so much coming at our elected leaders that it's hard for them to even understand everything that's happening in the community. It's hard for me to keep up with just what's happening in our sector, and I'm living it every day, because it's been so fast. I often say, you know, we can't be apolitical. We're nonpartisan, but food is political, so we can't be apolitical. But we'll always be nonpartisan, and we have incredible support from both political parties and all sides of the aisle. And I think we can go in, and we can argue all day long about what we disagree on, and there's much that people disagree on. It's filled in a time when everything feels like it can be political, and we're going to walk out, and we're both going to be mad, and neither one of us is going to change each other's mind. And so I think we have to walk into every conversation with what do we align on, and where can we do good together? Because there's always going to be things we disagree on, but I also know there's always things we align on. And how can we choose those things that we align on and do the most impact and the most good possible with that? Because nobody wants to see a child go hungry. No one wants a senior choosing between medicine and their food or their rent. And so how can we focus, and how can we be a voice to tell that human story that they might not be seeing or hearing enough of so that they understand those true impacts, and we can figure out a way to work together on those alignment? Yes. I think those are wise words given just the difficulty we're facing right now to find that common ground. To find ways of working together. I'm grateful for the way you are trying to navigate those differences to achieve the bigger goal. The goals that I think many of us want to see achieved. And so that brings me to this last question I want to raise with you. This is a challenging moment that we're in. I want to know what gives you hope, and where do you see people making real difference, despite the challenges that we face? This is bigger than me, this is bigger than you, this is bigger than the food bank. This is our community. This is the health of our community. And focusing on the health of our community, seeing what happened last year during the shutdown... the community responded in a way that was inspiring and breathtaking for neighbors, because they saw their neighbors hurting. And we are a community food bank. I might get emotional. I do get emotional often. Every day, and I can see them right outside my window right now, we operate because of thousands of volunteers who come here and choose to give their time to us. Thousands of donors who choose to give their money to make a difference in their community. Thousands of food partners who are choosing to work with us. And these more than 700 agencies, we are a community food bank. Our new strategic plan 2030 is called Rooted in Community. And it is grounded in what neighbors said they needed from the food bank, what we are uniquely qualified and able to provide for neighbors right now. And I think seeing that community aspect and seeing the community come together during times like this absolutely gives me hope. And we saw the impact on that on policy, too. During the shutdown, so many advocates reached out and said, "This is unacceptable." And Governor Stein's office invested $3.5 million in our food bank, $10 million across the state during that moment because he saw the need, but he, like we heard from the constituents. And I think seeing and watching how powerful people's voices are, it can't just be the food bank there. It has to be the community members saying, "This is unacceptable in our community." And when we see people come together and align on that, we see change, and that gives me hope. I also think our youth today gives me hope. I just watched a video on C-SPAN that our food bank participated in that two high school students here in Raleigh won an award about building food security in their community. I just talked with a Duke student last week, she's in a feminism and farm class, which is an incredible class that I want to take, I didn't know that existed. And talking about how we can make a change. And I see so many people coming together and truly aligning on what we agree on, and I think with that there comes a lot of power. BIO Amy Beros is President & CEO of the Food Bank of Central & Eastern North Carolina — among the largest anti-hunger organizations in the United States. Amy returned home to the Food Bank following several years of service with Feeding America, where she led nationwide efforts to build food banks' capacity to better serve people facing hunger and poverty. Throughout her career, Amy has maintained a firm commitment to holding the experiences of neighbors at the heart of every decision. She has applied this community-centered approach across critical efforts in food sourcing and access, disaster response, strategic partnerships, and philanthropy — including leadership roles with Inter-faith Food Shuttle, Easter Seals UCP, and Pillars Community Health. During Amy's prior tenure with the Food Bank, she led the multi-year campaign that established the organization's state-of-the-art Raleigh headquarters and ushered in a new era of systemic solutions to hunger in the region. A South Carolina native, Amy holds a Bachelor of Science from Clemson and an MBA from DePaul University. She currently resides near Raleigh, North Carolina with her husband, two children, and rescue dogs. Outside of work you can find Amy lifting weights, spending time with family, or sharing her love for Dolly Parton with anyone who will listen.
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  E302: Do GLP-1 drugs reduce overall healthcare spending? 09.06.2026 18min

  For many people, the FDA-approved drug class called GLP-1s has been a game changer for managing type 2 diabetes and weight loss. An estimated one in eight US adults is using this type of drug, which mimics a natural gut hormone to regulate blood sugar, slow stomach emptying, and suppress appetite. Researchers and the public have been scrutinizing the pros and cons of taking these drugs for many years. One critical question that remains is does the use of GLP-1s translate into lower medical expenses for consumers, healthcare providers, insurance companies, and the government? Today, we're speaking with Duke University health economist Jonathan Zhang on the answer to these questions from his multi-year study of veterans who use GLP-1s. The results are surprising. Interview Summary Jonathan, first, let's talk broadly. Would you briefly describe the kinds of health benefits people are experiencing with GLP-1s, particularly in terms of changes in behavior and overall health? Yes. So GLP-1s are medications that manage body weight and improve metabolic health. The primary health benefits are via better blood sugar regulation and weight loss via reducing appetite. But there's larger health benefits that are much broader. So, trials have also shown that they lower blood pressure, reduce strokes and heart attacks, among other cardiovascular benefits. Overall also improves, so things like obstructive sleep apnea, improvements in inflammation-related measures. And recently it was FDA approved to treat MASH, which is a form of fatty liver disease. Finally, people also report feeling less hungry. They get full faster, fewer cravings, and reduction in what is often called food noise, which can potentially help people make a range of better behavior decisions and changes relating to food and perhaps even beyond food. However, the evidence on that seems to be promising, but new and less strong. Thank you for sharing those. I know a lot of our listeners have heard some of those issues and some of those points about how GLP-1s could change the way we behave, and some of the health outcomes. So, let's dig into your particular study. In your working paper for the National Bureau of Economic Research (NBER) you and your co-authors describe a natural experiment involving patients and doctors in the Department of Veteran Affairs, and their access to and use of GLP-1s. Would you lay out the general parameters of your study for our listeners? Yes, absolutely. So, like many medications, what we know about GLP-1s primarily comes from randomized controlled trials, which have small sample sizes and often select for quite sick patients. As GLP-1s reach a broader population, the population becomes less pro-comparable to those in trials, so the real-world impacts become less obvious. Moreover, there are some outcomes such as healthcare utilization or spending costs that are incredibly important for policy but not directly studied in trials. We were interested in studying in a very large healthcare system, that is the VA, the Veterans Health Administration, the real-world impacts of GLP-1s using readily collected data from the healthcare system and a quasi-experiment. So that is we try to emulate a real experiment where some patients get GLP-1s from their primary care doctor and others do not. And the reason one patient might get it while the other doesn't is because their doctors differ in their likelihood or propensity to prescribe these drugs. And we focus on the Veterans Health Administration, the VHA, because the veteran population is quite diverse, at least in terms of comorbidities relative to the trials per se and also in age, say, compared to Medicare. And GLP-1s are provided in the VA to eligible patients at a pretty affordable cost. So, sort of a nice policy playground for us to think about what outcomes might look like when GLP-1s become readily available and affordable to all Americans. Great. Thank you for sharing that because now we have a good sense of the quasi experiment that you all were able to exploit. That there were providers who had a high tendency to prescribe GLP-1s versus those who didn't. And looking at that difference, you were able to see how GLP-1s may have affected the outcomes that you were interested in. So now tell us a bit about the findings, and I think there's some surprising results here. So, first we replicate many of the findings from the randomized trials for this diverse, veteran population. We see reductions in body weight, we see hemoglobin A1C blood glucose levels improve and blood pressure improvements as well. Even a reduction in heart attacks and strokes for patients with existing cardiovascular conditions, and even a small reduction in moderate drinking risk as well. The trial evidence seems to hold up in this large and diverse population of we have 1.4 million patients that we're studying. Second, despite these improvements though, we do not see a reduction in healthcare spending. This is actually excluding the cost of the medication, the GLP-1. It's not because GLP-1s are expensive. We're taking that out of the equation. Over four years, this is how long we're able to track these patients for, we're able to rule out reductions of more than 7% in healthcare spending. And we see no reductions in whether that's outpatient clinic or in inpatient hospitalization. We also don't see any reductions in emergency department visits more generally, despite seeing a reduction in heart attack and strokes for those patients with existing cardiovascular condition. Jonathan, that sounds great, but it's a little hard to understand. So why is it that you're seeing no real changes in the consumer healthcare spending? What's going on? Yes, we were a little surprised as well. We think there could be a myriad of potential reasons. But first, I want to note that there's also at least three other studies that use real-world data to look at a similar question, and all the studies find no statistically significant spending reductions. And in fact, all of us, we all find a slight positive increase. I think the first explanation is that while heart attacks and strokes are very expensive and obviously, very serious events, they are still thankfully quite rare and thus are not very common in our three to five-year period in which these studies are looking at. But perhaps over ten or twenty years, you could start seeing some healthcare spending materialize. I think that's totally possible. Most cost projection models, whether that's from the CBO or other organizations, they project healthcare spending reductions to accumulate over time. But these models also project immediate spending reduction, which is not yet supported by the data. Another potential explanation is what I would call these behavioral responses. So, you can imagine that a patient sees some improvement in their health, and that changes their expectation of, "Oh, wow, I could actually make some changes to my health." And they actually go and get some more care. This can also be driven by the physician as well. So, sort of, "Look, things are working. This patient's seeing improvements. Maybe we should treat some of your other health problems and issues." This is what I would call sort of a behavioral response. A third explanation could be that some of these patients have conditions that have progressed to be irreversible even with metabolic health gains. So, for example, late-stage kidney disease would be a good example. We find some suggestive evidence that this might be happening in our study. In other words, for these patients where they have some potentially irreversible health conditions, the metabolic health improvements - that's not a primary reason for their healthcare spending. This is helpful. That explains why we're seeing some of these challenges with healthcare spending. And I appreciate your point of taking a longer view may actually reveal some differences. And also, the responses of doctors and patients to the benefits that they gain and how that might expand opportunities for healthcare. So, thank you for sharing that. I want to shift focus a little bit. And it is taking a step beyond the paper, but I think it's a natural extension of the work. As you know, I'm an agricultural economist, and I've been interested in obviously food policy issues. And the fact that we're seeing weight loss, the fact that we're seeing better management of A1C suggests that there's something probably happening with food consumption and food patterns. I'd be interested to learn from you if you have any ideas about what this work suggests about the impact of GLP-1s on consumer food choices. Yes, I think there's a fair amount of both trial and real-world grocery purchase evidence that GLP-1s are impacting consumer food choices. In the randomized trials, GLP-1s reduce, calories consumed, reduce the desire to eat sweet, salty, and savory foods and high fat fast foods in their meals. For example, these trials will look at what people eat for lunch. In real world data, there's a study out of Denmark that found that after patients' first GLP-1 prescription, their grocery store purchases went on to have fewer calories, sugars, saturated fats, carbohydrates, and more protein over the one-year period after they initiate GLP-1s. The share of ultra-processed foods also decreased. The effects were actually quite modest, so there was only about a one percent reduction in calories and a four percent reduction in sugar and a five percent increase in protein in the year after versus the year before in this Danish study. In the US, there's a similar study using kind of this transactional level data as well. And they find that households after they start GLP-1s also reduce caloric intake, fast food consumption, caloric dense processed foods. And there it's a little larger in the US by about five to ten percent. Then the question is, you know, are they shifting towards healthier foods or is it sort of a uniform reduction in calories across all different food classes? And there the evidence is a little less strong. There's some evidence that consumers are shifting towards healthier foods, but if that is the case, the shift is quite small. In both the Danish and the US study, it's roughly looking like a level shift for all different categories. And this is also in terms of not food so much anymore, but there's also been studies looking at alcohol consumption, which has been very interesting and promising. There's a phase two study pilot trial with only forty-eight participants, but the randomized control trial found that among patients with existing alcohol use disorder GLP-1s led to a reduction in the average number of drinks per day. No change in the number of days drinking, but conditional on drinking, the average number of drinks per day declines in the treatment group that get GLP-1s. And then for out of the 48 patients that are also smokers, there's also a reduction in smoking as well in that population. So, very promising early evidence there as well. Jonathan, this is critical information, and I know some colleagues in the Ag econ profession, folks like Brian Roe, Tim Richards and Glenn Townsend have also worked in this space, and some of the work is showing some issues around the quality of protein or overall food spend is going down. And the choices or the responsiveness of people to prices when it comes to proteins. There's some evidence, some causal evidence to suggest GLP-1s are changing the way people are even looking at food markets. And so that raises a really important issue. If consumers are changing when they're exposed to GLP-1s, I have got to imagine that the food industry, grocery stores, food manufacturers, restaurants are making some adjustments. What have you to say on that particular point? So, we're both economists, right? We both, of course, believe that producers and grocery stores are adjusting to demand. We do know a lot less about how the supply side is adjusting compared to the demand, and that's because there's just less data and fewer studies on patients. There's more data and more studies on patients and consumers than on grocery stores and restaurants. I've seen a lot of anecdotal evidence, often reported in the mainstream media or reports from various market research agencies that GLP-1s are having this large impact on the food industry. I've seen claims like GLP-1s are hurting Walmart sales or why are beer company sales down, like AB InBev, and range into things like why restaurants are reducing their portions or recently I actually also saw over the past couple weekends claims of why Coachella portions are smaller because everyone's on GLP-1s. So, the best estimates from last year are that one in eight Americans are using GLP-1s. And if each of these users are cutting back in consumption by 5% to 10%, as in those studies, it's totally plausible this leads to a large population reduction that the food industry just cannot ignore, right? I think it's important to note a couple things. First is that the long-term adherence of GLP-1s is generally quite low, with more than 50% discontinuing within a year in most of the studies I've seen in the US. And after discontinuation, most of these patients will gain back a large fraction of their weight. And in that US groceries transactional study I told you about, they find that after discontinuation, purchases at fast food, grocery, restaurants, et cetera, they go up beyond baseline, in fact. So, beyond six months prior to when they were on GLP-1s. It's still an open question to whether these 5% to 10% individual consumption reductions will become long-term and manifest in the population level, especially if adherence is not very high. Second is that up until very recently, there's been a very strong demographic and socioeconomic profile of these GLP-1 users, right? So, they tend to skew near elderly and also a little bit more female, and generally fall in the middle- or higher-income brackets because previously Medicaid, for example, did not cover GLP-1s, right? Until earlier this year. And it still does not cover it for many states. So, any food industry changes will likely be concentrated in the restaurants and the food chains that sort of have these consumer demographic and economic base. That's something to keep in mind. Certainly, there are examples like, you know, Smoothie King has introduced a GLP-1 smoothie. But even in these clear-cut cases where the producer is clearly trying to appeal to this demand shock, it's still very difficult to disentangle the producer's stated intent from general industry market trends, right? So, general trends like rising cost of living. There's been more demand for protein. You can see protein in everything now, right? Even water. Rise in sort of small plates or family-style tapas at restaurants. Feels like every restaurant's doing this now. Or for example, a decline in alcohol consumption or interest in alcohol consumption, especially among young people around the world. I think some of this is certainly happening. Producers are listening, but it's hard to disentangle the general trends from a specific GLP-1 impact. I'm grateful for you taking some of the hype out of this and thinking through carefully what the economic implications are of this change and recognizing that there's some real important context that people don't stay on these drugs for long. Or there are certain types of folks who are more likely to use them, and therefore we can't assume that there's this massive wave of change that's going to happen, but that there are some responses. These are important ways of framing this discussion. I have one final question. Based on what you're seeing now with the use of GLP-1s and considering their use over time, what would you say is the key takeaway for policymakers? I think there are a few takeaways. Most importantly, I think policy makers should think about the rapid change in profile of patients who are using this drug. Just because it's beneficial for sick patients doesn't necessarily mean it's going to be equally as beneficial for patients who are less sick. One of the findings in our paper is that as the veteran population that starts to initiate GLP-1s in the more recent years, these patients actually are healthier, so their treatment effects are not quite as strong as those who were initiated in the very early period who in our setting were among the sicker veterans. Policy makers shouldn't extrapolate the potential benefits to a broader population since there's so much demand for this drug, right? This also means that some of the downstream improvements like cost savings or even improved labor outcomes like absenteeism or being able to return to work, while these things might seem logical, it's not fair to assume that it's going to be automatic, especially at a population level. Related to that last point, we should encourage additional research on important socioeconomic outcome that might completely change the calculus of the cost benefit of these drugs, right? So, labor force participation, earnings, use of government transfer programs like disability insurance, even some interesting patterns of household formation and fertility. These are all fascinating and important questions. However, it is imperative to note that GLP-1s already have incredible health benefits for many people. While it's possible that these benefits might spill over to broader societal benefits, these benefits should not be presumed. And at the same time, we shouldn't be holding GLP-1s to a higher standard, say, to reduce healthcare spending or increase earnings just because we know that it does a bunch of wonderful things for a range of conditions. So, maybe it does this and this as well, and suddenly we're less excited if there's no evidence of that and that, right? These things have incredible health benefits. Let's appreciate them for that, and we shouldn't be holding them up to a higher standard just because it appears to do so many wonderful things. BIO Jonathan Zhang is a health economist at the Sanford School of Public Policy at Duke University and the Margolis Institute for Health Policy. He is a Faculty Research Fellow at the National Bureau of Economic Research and an evaluator at the Department of Veterans Affairs. He researches how policy can improve mental health and substance use outcomes using quasi-experimental methods.
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  E301: Greg Jaffe on Food and Ag Policy Trends 08.06.2026 22min

  Interview Transcript Kate - Welcome to the Leading Voices in Food podcast. I'm Kate Stanley, a researcher at the World Food Policy Center at Duke University. I'm joined today by my co-host, Katariina Koivusaari, a researcher at North Carolina State University. Together, we collaborate on policy research for the Bezos Center for Sustainable Proteins at NC State. Katariina - Great to have you. Greg, you have been involved in food and agriculture policy in Washington, D.C. for several decades and have worked with both Democratic and Republican administrations. Are food policy politics caught up in party differences depending on which political party is running the executive branch? A very relevant question right now. I guess it would be wrong to say that the political party in office doesn't make a big difference in the policies being carried out by the executive branch. However, in the food and agricultural space, and especially in the areas that I focus on, which is really around these new technologies in food and Ag and how do those get into the marketplace and adopted, that difference hasn't been so big. Let me give you an example or two. I'll take you back first to about 2000, and we had the Clinton administration. We have the regulation at FDA of biotech crops, and they had a voluntary consultation process and there were a number of stakeholders and others who felt that that wasn't sufficient. The Clinton administration interpreted the Food, Drug, and Cosmetic Act to try to turn that into what they called a mandatory consultation, and they proposed a pre-market notification rule. It didn't get finished in, before the end of the administration in January of 2001. Then we had the Bush administration come in, so we went from a Democrat to a Republican. And the Bush administration looked at the same law and looked at that same proposed regulation and said, "We don't have the legal authority to do that." And they withdrew that proposal, and so we still have to this day this voluntary consultation. And I give you that example for two reasons. One, I think what we've seen when it comes to food and policy regulation by different administrations is how they interpret the law. And I can say this in very general, the Democrats have tended to be a little more expansive in how they interpreted the law to try to find more legal authority to do things that they might want to do. And the Republicans have tended to look at that language much more restrictively or look at just exactly what that language said and not try to interpret anything into it. And so, you see that difference here between what happened in the Clinton administration versus what happened in the Bush administration. I mention this example because as many of your listeners may know, right now in this administration, we have the question about voluntary GRAS and whether that's going to become mandatory or not. And some of us who have followed that know that the current FDA has submitted to OMB, to the White House, a proposed rule to make GRAS mandatory. Well, that is-- the regulatory process for those biotech crops is also a GRAS process. It's interesting now that we have a Republican administration who's finding the authority to do that, and we'll see what actually comes out and what the courts do with it. But I think this shows that sort of difference in policies between Democrats and Republicans. But overall, we haven't seen a lot of difference. In this new administration, I think one of the questions people had was what would happen with a technology like cell-cultivated meat? Where would the regulation of it go forward? There's many in the MAHA movement, I think, that felt that that wasn't consistent with what they wanted. But we've seen that those approvals continue to happen. Similarly, pesticides have been an issue in many administrations. Sometimes Democrats have argued to be much more restrictive in the use of pesticides and to make the regulations much harder. And Republicans have oftentimes said to make those easier for the agencies. But what we see is pesticides have moved forward under both administrations. People understand the need for pesticides to produce agriculture. We have some differences in policy, but on the whole, in this area, I think, whether it's Democratic or Republican, they have generally supported following the law. Kate - Greg, you shared some interesting examples of across administrations how we've seen different actions be taken. And I'm curious. Under this administration, for some of these areas you work in, like these novel technologies, what do you see as driving the new federal legislative actions in food policy? The legislative area has generally always been more partisan than the executive branch to some extent. I mean, the executive branch is interpreting laws from Congress; the Congress is setting those. But I think again, in the area of food policy, we've seen many good laws come out that have been bipartisan. And when I look at how did those laws come to be, I sort of see a couple different scenarios. One, and I don't think this is unique to food policy or ag policy, we tend to see legislation when some crisis has occurred. The example I would give in the food space was the establishment of the Food Safety Modernization Act more than a dozen years ago. And to a large extent, that was reaction to a number of outbreaks: spinach outbreaks, peanut butter outbreaks, egg outbreaks. And people getting sick, and some people even dying from those outbreaks. And so that brought a bipartisan coalition together to say, "We need to give more authority to FDA to address our food supply and ensure it's as safe as it could be." So that's one way we've seen that. A second way we see policy change is when a policy is old or that is no longer in favor. And the example I give there is most recently, in this Congress passed the whole Milk for Healthy Kids Act, and that is a definite change in policy from the Hunger-Free Kids Act of 2010. This changes what milks, whether they're flavored, and how much fat they can have and be in the school programs. And I think in both cases, those bills were relatively partisan at the time, and yet they do opposite things. So that would be another reason that we see changes in laws. But the third way, and I wanted to focus a little more on this, is one way the federal government gets involved and Congress gets involved is when states start regulating an area, and we start getting different standards. And then there's a push at the national level to have some sort of uniformity, some sort of have national standard for markets to work properly, for efficiency's sake and so forth. And I can give several different examples. We can go all the way back to the National Organic Law that was passed back in 1990. You had a number of states who had defined organic; they had different organic labels. Congress came together and said, "Hey, let's set up a national organic standard." We had the same thing happen with the National Bioengineered Disclosure Law, that I think happened around 2017 or 2016. In which case you had a number of states proposing legislation. You had Vermont that had passed legislation requiring mandatory labeling of genetically engineered ingredients. And in fact, the law that was passed by Congress was passed, I think, within a week or two of when the Vermont law was about to go into effect. And people felt it was better to come together and have a national standard than have different states doing different things. Because the reality is, consumers and manufacturers don't just purchase things in one state or produce things for one state. They produce it for the nation. We're a nationwide market. And then we see even those kinds of things happening today, and I go back to the pesticide area as another example. We've had different states having pesticide laws or regulations that have been different than the federal situation. We have a Supreme Court case now that the Supreme Court is going to hear in April of this year about whether that's those state regulations are preempted by the federal law. But Congress and the Farm Bill has also put in language that would ensure that the federal standard is the standard that is applied, not having multiple different state standards. So that's been a way that we've seen a lot of things happen in this food and Ag space. Kate - We've seen a lot of food policy action at the state level in the past few years. Katariina and I were on this podcast not long ago talking about state legislation aiming to restrict how cell-cultivated meat products are labeled or even banning those products altogether. We've seen action in a variety of other areas as well. Are there issues that states have started regulating where you think we could see federal action in the near future? I do. I think that the MAHA movement in particular has really set up a situation where we see states taking the lead on a number of issues, and we'll see whether the federal government decides to come in, and particularly Congress, to address those at a national level. For example, in the area of synthetic dyes and food additives, I think there's some 30 states that have introduced bills. And a number of which have passed, either restricting those use at all in any foods, restricting their use in school lunches, having different labeling associated with many of those ingredients. And we've seen some of those laws pass, and we've already seen some court cases. A court case in West Virginia which said that those laws are preempted by federal law. One could envision either something at FDA or in Congress that would set some uniform standard for how this moves forward federally. You mentioned cell-cultivated meat and the three of us were involved in a paper that looked at the state regulation in that area, especially around labeling. And again, if we don't have a lot of those products on the market yet, but as those products get closer and get on the market, I could definitely see a push again to have some uniform labeling. Either again from the federal executive branch or from the legislative branch. And also, in areas like ultra-processed foods is another one. California has passed a law defining how they're going to define ultra-processed foods. We've heard that FDA may issue a definition about ultra-processed foods, but I could also see Congress getting involved eventually and setting a standard. Katariina - I'm sure that in working with US regulatory agencies for so long, you've seen trends develop and persist over time. What would you highlight right now for our listeners? Well, as I said, I've worked very much in this space where we talk about new science, new technology, new kinds of products coming into the marketplace and how do we regulate that? What are the policies and regulations to ensure that that's safe for humans and safe for the environment, and that there's information and access that's necessary for those safe products to, to thrive in the marketplace. And when you look at that, I think I have some observations, I guess, about the US regulatory agencies and what they've done in this area. The first one is that the science tends to move faster in the private sector and in the research community, like you're both in, than it does in the federal government. And so generally, the people in the federal government, who I have the utmost respect for, the career people, tend to always be playing catch up on the science. That the science is moving faster and they're not there. An example I would give is cloned animals. When the industry went to FDA and said, "Hey, can we put these cloned animals into the m- into the marketplace?" FDA sort of said, "Well, wait. We need to look and see whether we need to do a risk assessment to see if there's any risks out there." And they spent a couple years doing that, and they asked for a voluntary moratorium while they were figuring that out. In the end, they figured out that for many cloned animals, there was no risk and there didn't need to be regulation, but they had to catch up. They had to catch up on the science. And I think that's the first thing. It's important for industry and public sector scientists like yourselves to make as much information about new technologies and new products available in the public realm so that those experts in the federal government can stay as close as possible to what is happening. Second is, anytime you have a first-of-a-kind product. You talked about cell-cultured meat, Kate, a little while ago. We can talk about biotech crops. We can talk about a number of genetically engineered salmon. We can talk about a number of different new products of methane-reducing feed additives. The first-of-its-kind is always going to take a little longer to figure out what is that regulatory pathway. It's great to be the first into the marketplace. You get a lot of advantages, but I guess one of the disadvantages is that you probably have a little slower regulatory timeframe. That again bodes for that transparency for that additional information. The third thing I'd mention, and you would think, oh, this is something that is sort of a given and expected, and that is the level of transparency that we have in our federal government. But that's not true. I've traveled around the world, and many governments don't have that. But interestingly, most of our regulations are, you know, they're all publicly available. There's lots of guidance documents out there. We can go online today and see GRAS applications and decisions made at FDA. We can see what information was submitted for cell-cultivated meat crop, meat, meat products, and what decision the agency made on those. We can do that for genetically engineered animals and for genetically engineered plants. And so, we do have a fair amount of transparency, and I impress upon people to use that to their advantage. I think that builds trust for consumers, but also for people in the industry. It helps them learn so they can be as efficient as possible when they go through the regulatory process. And the final thing I might mention is it may look like from the outside the government moves slow all the time. But I think having been inside the government and in the role, I played as the Chief Regulatory Officer at USDA, that slowness, in part, is to make sure that the government speaks as a single voice. We've been talking a lot about FDA, and we talk about USDA, but there are actually some 18 or 20 different agencies that actually regulate different parts of the food supply, for example. A decision made in one agency may have some indirect impact on a decision or a regulatory process in another agency. And so, it's important before major decisions are made or major regulations are promulgated, that we have an interagency review of those things to make sure that the government is speaking consistently with one voice about how they interpret laws; about how they apply risk assessments; about how they look at safety and so forth within the context of their laws. And that sometimes takes some time. It is a big bureaucracy, a big government, and again, that could be looked at upon negatively. But at the same time you can look at upon that positively as an opportunity to make sure that the decisions that are made in one place are consistent with other decisions and other statutes in another place. Katariina - Thank you for sharing that. It's really helpful to get more insight into the policy process. Let me ask you one final question. For organizations seeking to navigate through state and federal regulations in order to bring a food product to market, what are the key, what are key takeaways you would highlight? Well, there are a number of them. First, I would tell companies or public researchers, whoever is bringing a product to market, to be as transparent as possible. Put as much information about your product and your technology in the public record, especially if it's in peer-reviewed journals that are accessible to everybody. That is only going to come to your benefit. That's going to help the regulators. They know that information is out there. They know that other people have that information. They can utilize that to help make decisions about whether there is a food safety or a risk to the environment, and then how maybe to address those risks. So that would be my first response. The second one is, and I think, again, this is something that I thought was going to be universal when it came to interactions between the regulated community and the regulators, but it's not around the world, and that is to consult. All the agencies that I've worked for have open door policies where they say, if you have a question, as you're thinking of bringing a product to market, come in and consult with us. Come in and talk to us. Let us help you figure out what the regulatory pathway is going to be, what the data you are going to need is, why we need that data, and go through all of that. And, in my consulting business, that's one of the things I do. I help facilitate those conversations between one of the agencies and a client. And I think that just the earlier you do that and the more often you do that, the more efficient you will be, the less money you will spend, the quicker your review process will be. And while I have clients who don't always agree with the decisions by the agencies of what information they might need or what regulatory process they have, it's still better to know that upfront and earlier in the process than later in the process. The third thing I'd mention is to be a little creative. The regulators, you know, they're trying to ensure they're representing the public, and they're trying to make sure that a product is safe for human consumption, for animal consumption, for the environment. They don't always have all the answers, and sometimes they are fitting square pegs into round holes because new technologies come along that aren't exactly a perfect fit. But be creative. Try to help them. I think, you know, sometimes working with people like me or others to help think about what a good regulatory pathway would be, what are the potential risks that really need to be addressed here that can be really helpful. The fourth thing is, you know, that the devil is always in the details. The details and the science matter, and that is something that is very important. And so, we want to look for analogies of your product or your technology to other ones that have happened in the past, and that's always good. But also understand the differences. And so, really, I think, sometimes people think, "Oh, they don't need to engage with the regulators as much about exactly what I'm doing," or "They don't need to know all those details." Those details actually do matter, and I do think those are important. And then I would finally say that, you know, it does take time, especially when we're talking about new technologies and new products, to figure out what that regulatory process will be. And we don't have neat situations. Our laws are written a long time ago. We don't want to write a new law for every new kind of product or every new kind of technology. I'm not sure that's the most efficient way to do it. But by not doing that, we're sometimes, as I mentioned earlier, fitting square pegs into round holes. We have a law, for example, the Food, Drug, and Cosmetic Act, dealt with food, but it never envisioned genetically engineered crops. It doesn't talk about biotechnology. We have a meat law that regulates meat at USDA. Didn't think about cell-cultivated meat. And we have to think about how those fit together. And sometimes we can do that without the new laws, and sometimes you need new laws. When I was at USDA, we worked on methane-reducing feed additives. FDA regulates them, but they really don't fit very well. They're not a drug, but they're also not a feed because they don't have a nutritional benefit. And so how do we fit those into the regulatory system? FDA's come up with a temporary regulatory pathway, but there's also a bill in Congress to set up a more definitive regulatory pathway. And we see that for some of these new technologies that we might see some legislation. And then the final point I would just make is to temper everybody's view that a compromise is essential in this area. No one company or no one stakeholder gets everything they want. Governing and the government's job is to, you know, figure out what's the appropriate balance. They want to ensure safety, but they also want to make sure that safe products can get to market and that consumers can get to take advantage of those products, and we can get the benefits from those products. And so all of this is always a balancing. There will always have to be some sort of compromise. And I'm not saying that's a bad thing, just pointing it out as something that people should be conscious of. BIO   Gregory Jaffe is President of Jaffe Policy Consulting, which provides strategic advice on national and international policies involving agriculture and food, with specific expertise in sustainability, climate, bioeconomy, biotechnology, PFAS, pesticides, food safety, and food loss and waste. He recently worked as the Senior Advisor for Regulatory Affairs in USDA's Office of the Secretary and the USDA's Chief Regulatory Officer. He managed a broad portfolio of policy issues, including bioeconomy, biotechnology, biofuels, pesticides, PFAS, food safety, sustainability, and scientific research and development. Before joining USDA, Greg worked for at the Center for Science in Public Interest (CSPI), a non-profit consumer organization working on food and nutrition issues. While at CSPI worked extensively in Sub-Saharan Africa and Southeast Asia on projects funded by USAID and the Gates Foundation. He worked with government officials and stakeholders helping them develop laws, policies and regulations that allow for the adoption of agricultural technologies, including biotechnology. He advised on agricultural policy, sustainability, and trade issues, conducted capacity building, and worked on international treaty implementation.
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  E300: Tackling Food and Nutrition Systems Change at the Kellogg Foundation 02.06.2026 27min

  Kelly Brownell interviews Jon-Paul Bianchi, Director of Systems Change at the W.K. Kellogg Foundation, about the foundation's systems-change approach linking food, health, early childhood, and family economic security to address inequities affecting children and families. Bianchi describes his path from PhD research to policy work and then to Kellogg, and explains how integrated grantmaking focuses upstream on policies, practices, resource flows, narratives, and long-term investment in people and relationships rather than isolated programs. He highlights Vermont's inclusion of food quality in childcare ratings and the foundation's Farm to Early Childhood efforts connecting procurement, regional food systems, and state policy, with examples from states like North Carolina, Iowa, and Wisconsin, and notes Brazil's national local purchasing policy as a model for success. Transcript As I was mentioning before we got started, I've long admired the work of the Kellogg Foundation. Working with the concept of food systems or connecting agriculture with nutrition and thinking about regenerative agricultures. There are a lot of places where your foundation was out front. So, I salute you and your colleagues for that. And it'll be interesting to find out what's happening right now. Tell us a little bit about yourself, and how did you get into the philanthropic work and your work with Kellogg in particular? I'm Jon-Paul Bianchi. I'm the director of the Systems Change team at the W.K. Kellogg Foundation. And what that essentially means is I'm the director of national programs at the foundation. But we call it systems change because we really do see in the different areas of work that we focus on- health, family economic security, food, and early childhood- that these things are all interconnected by some distinct systems. But also, common systems that overlap across them. And so, that's the approach that we take. And I'll spend some time sort of diving into that today. You know, to answer the question of how I got here... you know, a master stroke of luck. I was set to be an academic researcher. I was working on my PhD at the University of Wisconsin. I was ABD and decided that I didn't want to be a researcher and I wanted to work in policy. And I moved to Colorado to take a job sort of sight unseen, being the policy director of an organization that worked in K-12 and children's health, and food and early childhood education. And did that for a few years and learned to translate research into practice; into policy. And was giving a presentation and got a tap on a shoulder from somebody that worked at the Kellogg Foundation who was interested in what I was saying. And we had one conversation, and six months later, I wound up having a new job and leaving Colorado and moving to Michigan. That was 15 years ago. Well, you went into this with a great background having done the science as a graduate student and then into the policy world. And you're right, the intersection of those two is really where the magic can occur. You began talking about this, but let's talk about it a little bit more. So, when you say that there are systems that cut across different problems like food and health and economic security, etc., and I know you structured your team to reflect that cross-cutting kind of view of things. But tell us a little bit more about that. And how is this different than what's usually done, and how does it affect the way your work gets carried out? So, big picture at the Kellogg Foundation, we envision a society where every child can thrive. But we know that there's too many kids and families that still can't access good food or quality childcare, or their parents can't find quality jobs because of inequities that are embedded in the policies and the practices and narratives that shape our systems. And so, having a multi-issue integrated grant making team, it's made us more effective by better understanding the points of intersection and collaboration across those bodies of work. So, our food systems program officers are in the same team, and they work closely with our program officers in early childhood and family economic security and health. And those collaborations strengthen the work in a variety of ways. We have experts in each of those areas, but because they're spending time with each other and working in the same team, they're exposed to, and they learn about each other's work and each other's worlds. And that creates powerful collaborations in the foundation, but more importantly, out in the field. And it helps us to see that we can't fix any of these systems, including food systems, with surface level or patch kinds of solutions. We really have to work together to get upstream and focus on policies, focus on practices, focus on resource flows and narratives that really sustain the inequities that we see. And so, the foundation partners with organizations to dismantle barriers in food systems in the other areas so that children and families can access quality food. But I think we also recognize that's about investing in people. And it's about investing in people over time to drive transformational change in any of these systems, including food. For people listening to this who aren't in the world of philanthropy or academics or science or policy they might be saying, "Well, this kind of makes common sense. Isn't this the way it's usually done?" And in fact, it's not usually done to have this cross-cutting work accomplished the way you're doing it. It's actually a pretty impressive thing. Yes, thank you. And I have a lot of respect for our philanthropic partners and peers, and we work very closely with a lot of large and small foundations. And I think the adage in philanthropy is you know one foundation you know one foundation. So, we do it this way and somebody else will do it differently. And I think there's a lot of connection for us back to our founder. You mentioned Will Keith Kellogg at the top of the call. He was ahead of his time in terms of understanding the interconnectedness between food and the land and opportunity and people's education. And a lot of that came out of his tradition as a Seventh Day Adventist. But also, I think just as a person coming up in the Depression and seeing what happened afterwards and really beginning to understand in his own community of how these things were sort of connected to one another. And so, for us, both inside and outside the foundation, systems change really means betting on people long term to reshape those systems from the outside in. But also, from the inside out. And that's really what we're striving for. You mentioned the history of Dr. Kellogg. The history of that family is so interesting, and what went on in, you know, the sanitarium in Battle Creek, Michigan, and how the concept of breakfast cereals came about. And how the focus on natural foods was so important. It's worth spending a little time even on just Wikipedia to try to find out what that history is, because I find it fascinating. So, let's go back to food and go a little bit deeper and talk about what this systems approach looks like in practice. You're a philanthropic organization. You exist in the context of a capitalist society where businesses are out to do as well as they can. How is the foundation's work different from, say, funding a food pantry, launching a single nutrition program somewhere, which is what typically might be done? Yes, I think what we intend to do and how I think our systems approach is a little different from, say, you know, funding a single nutrition program, is that we mean to design and redesign practice and policy based on how kids and families actually live their lives. Right? So, where food and health and early childhood and family economic security show up together in a community, right? Families experience these things simultaneously in their everyday lives. They don't experience these things in silos. And so, we try to have our team and our work reflect that. So, instead of treating food as a narrow problem to fix with one program, we try to think about how the entire system around a child and their caregivers works or doesn't work and find those opportunities and levers to move that whole system. I'll give you a concrete example that will bring in our colleague Linda Jo Doctor, who you mentioned at the top of the conversation. Early in my time at the foundation, I was a reviewer for the Race to the Top Early Learning Challenge Grant. This was an Obama era competitive grant process for building early childhood systems in states. And the state of Vermont did something really interesting that I had the good fortune to review as part of that team. They included the quality of food and access to fresh, healthy food in childcare centers as part of their quality rating and improvement system for childcare. They didn't just talk about teacher quality or curriculum or reflective practice. They actually said, "If we care about child development, then what children are eating every day in those childcare centers is part of what quality means." That's a systems approach. They connected food policy and procurement directly into early childhood policy and practice so that nutrition and education and child wellbeing were all being advanced simultaneously. I brought that back to the foundation and brought it back to Linda. And we had a really great conversation about it, and then another, and then another, and then another. And that experience helped shape how I think and how many people think about our work at the foundation. And it led to things like the expansion of our Farm to Early Childhood work, which again, leans heavily on procurement as the strategy to drive systems change, but connects it into early childhood policy. Tell us about that. You know, the Vermont example you gave is a terrific one. And you talked about Farm to Early Childhood. What does that mean in practice? In practice for the foundation, it really leaned heavily first on, sort of, understanding the landscape of where there was capacity to connect regional food hubs, farmers and producers and growers to systems of early childhood. At the same time that you have these burgeoning and developing systems of early care and education with regard to financing and sophistication, you have something similar going on in them in the food system movement, depending on the state that you're in. And so, we work diligently in a subset of states to really connect those policy levers, pull them together, and try to create essentially more situations like Vermont, you had partnership at the local community level, at the regional level, and then at the state systems level. So, syncing up the actual practice on the ground, syncing up how the relationships between different organizations are formed and maintained with regards to better food and early childhood. But then also trying to codify that into state policy and practice. And we did that for a number of years and had remarkable success in places like Iowa and Wisconsin and even in North Carolina, and a handful of other states. And we very much saw this as a build off our successful farm-to-school work, but doing it in a system that comparatively in terms of early childhood, was a little more fragile, right? And it wasn't necessarily as easy to do it, but all the more important and helpful because of the age and the vulnerability of the kids and families that we're talking about. The systems approach is very powerful, and so I'm going to ask a question not to be challenging, but to in some ways give you a softball for proving the systems approach. If at the end of the day, the most important thing in a childcare setting is to get healthy food into the bodies of the children so they can thrive intellectually and medically and everything else. Couldn't you accomplish that by just giving a good shopping list, a Costco shopping list to the daycare directors, and they could go buy good foods? And why does it need to be connected with farmers and, you know, the broader connection into the community at large, why is that important? Yes. Well, backing up, I wouldn't want to state, as an early childhood person, that the only thing that, you know, makes an early childhood program high quality would be the quality of the food and that that would, you know, lead to optimal child development and school readiness. I think, you know, there's other things in there that actually matter too. But this is definitely a key component. I would say, you know, to your question, that that system that you named already exists. We have the Child and Adult Care Food Program. We have the ability to subsidize the cost of food, and to have that good shopping list in play. But, I think, what the systems approach does is it asks different questions, right? It seeks to say, where does the food come from? How is it grown? Who is benefiting economically, right? How are schools and childcare centers and farmers and communities connected? And how do we strengthen those, connections and relationships so that we can begin to shift policy and practice so that children and families can reliably have access to good food. And they know that it's coming from the community in which they're situated. And the people on the side that are actually producing the food, the farmers and the folks doing procurement and others, that they're actually connected to it too. And they know where the food is going. And so there is this social kind of interstitial benefit to connecting those systems in a way that I think brings value beyond just you get a healthy meal today. I think it begins to shift culture. And if you could shift culture in the institutions that people are participating in, you can actually shift culture in people. So, you could see if a parent that potentially wasn't exposed to that before, or maybe didn't have access, or didn't know how to get access to that kind of food, if their expectations suddenly shifted because in their childcare program they're getting access to quality food, that then becomes an opportunity to engage in a different way. But it also becomes an opportunity for that parent to become empowered and to come together with other parents and other community members and begin to insist that's a reality in everyday life for them. That becomes a norm rather than an exception. I really like your answer because, you know, in some ways, people in our country have become distant from their food. You know, it used to be you could just go to the store, and there might've been one agent between you and who grew the food. The farmer would deliver it to, and now there are factories and machines that process the food, and 10 steps, and it comes from different countries, and all that kind of thing. And what you're talking about is shrinking that gap again to decrease the distance, so people are more in touch. And you could easily see that if the food is coming from farmers and the daycare providers know that they're going to feel better about the food. They're more likely to tell a story about it to the children. The farmer might come to the daycare center, or the children go to the farm. And you could see there's a lot more going on here than nutrition, and that's the beauty of this systems approach, isn't it? I mean, the children want to have a garden, right? I mean, how many times have we seen that? It seems like a small thing in early childhood, but just that simple act of having a garden and being able to understand how things are cultivated and grown. Even for a small child, and I have two small kids, we have a small garden in our backyard: it's meaningful. And it also, I think, establishes a norm that the tomato that you pick off the vine or the pole bean that you pick off, that you eat, that you find just unbelievably delicious, then that becomes normative for them. That's a normative experience, and kids are not as frightened by things when they encounter it. And I think we have a real opportunity in the early childhood space to link up those two systems to say, "Yes, we can affect change." And I think that, again, back to this notion of investing in people long term, the investment in those kids long term and what they come to expect will be the norm matters very much to how we think about our work at the Kellogg Foundation. So you're talking about both practices and policies and a cross-sector approach to these things. And let's talk about policy for a moment. Where does policy typically break down? And what kind of people need to be at the table, and what sort of partnerships need to be established in order to have better food policy? I think if we take seriously that food policy is cross-sector, I believe that we need to build tables that look like the food system. And that means not just public health experts or nutrition advocates or academics, but farmers and food workers, and those childcare providers and teachers, and leaders in K-12, and tribal leaders, community organizers, local state government officials, right? And the funders, right? The funders who are willing to invest in the long slow work of doing systems change. And, you know, one place I would highlight is in your home state of North Carolina. For years, there was significant investment that helped really build a dense ecosystem. You established regional food hubs and meat processing infrastructure, and anchor institutions into schools and early childhood centers. And a really strong network of organizers and philanthropic partners. And that made it possible to fully integrate farm to early childhood in your state's definition of early childhood. And as an aside, I would say North Carolina was also one of the leading states back when I was first coming into the field of building out a high-quality system of childcare. North Carolina led that. And so, these two things converging is a very powerful example, but again, we're getting back to local sourcing. We're getting back to bigger things than just doing food education, right? Those things are now built into the system. And they're not just a side project of the system. They actually are the system. So, you're talking about a foundation doing a lot more than getting proposals, seeing what needs to be funded, and then sending money out the door. You're talking about connecting people in innovative and unique ways. And building bridges that didn't exist before. And getting people to understand the systems change approach. And it just can lead to so many interesting and innovative things that just weren't possible using traditional models. So, really my hat's off to the work you do, and I can see why it's creating such powerful outcomes. One piece I would be remiss if I didn't say this, right? What makes all those partnerships work or fall apart? Usually, it's not the brilliance of a single policy idea or practice idea. I. Sort of. Sound like a broken record, but I'm going to come back to this. Investing in that people infrastructure that sits underneath it is really important. And the places that we find that make progress in any of the issues we're talking about, family economic security, food, health, Medicaid, early childhood, K-12, right? The places that make progress really do have varied and diverse voices at the table, and they're able to build real trust. And they're able to cultivate champions and also the next generation of champions and the next generation of champions who can move between those sectors, right? And the funders are involved, but they really understand that they're financing relationships and governance and people. They're not financing programs. And I think as a grant maker, that's an interesting distinction to think about. Think we know it implicitly and we know it when we see it. It's a lot harder to stick it in a white paper and define it and disseminate it in Stanford Social Innovation Review, for example. No, I totally agree. In the work that we've done over the years with, uh, community partners in Durham, it's been my impression that they get this systems thing from the very get-go. That they understand that if poverty is too severe, then nothing else is going to work, and if housing is a problem, then these other things are going to be affected in pretty serious ways. And they understand the importance of these. And in a way you're letting the flowers bloom. You're taking, I think, what some people understand intuitively and would like to accomplish, but they've been forced into silos. And then once a funder comes along and can allow this to prosper, I think it's sort of a natural thing that occurs. I think so. And I think the tricky thing there is to not be seduced by the programmatic solution. Like, do you remember several years ago when the notion of collective impact was this very popular term that folks talked about? And it's a good thing. I mean, I think the framework and the model is powerful, and it's a useful thought exercise. But what I found in a lot of collective impact work was that it focused very much on aligning the programs. Sufficiently funding the programs and aligning the programs, but not the human side of design and redesign of how do those programs function, right? Who do they serve? Who's at the table when building them or rebuilding them? Do you have the ability to change them midstream if you feel that you need to? And I think a slightly different approach with systems change is you're sort of engaging in a loose hold of the policies and the practices and the issues to give people and the people infrastructure and the relationships time to come together and figure out how they want to move them individually, and how they want to move them collectively. And that's a subtle difference. That's a nuance that I think has really worked in our particular corner of the world. One thing I bet some people are interested in is how the Kellogg Foundation might be distinct from Kellogg as a company. You've described beautifully the innovative work you're doing. The company is off doing what it does commercially. How do these two things intersect? And what's been the history of the connection between the foundation and the company? Yes. So, when the foundation was founded in the 1930s, Will Keith Kellogg, as you said, he endowed the foundation and created it separate and apart from the company. So, it's an independent philanthropic organization. And so, while we bear the name of Will Keith Kellogg, the foundation does not have a formal connection or stake in the company any longer. As you may know, the company split into two companies a few years ago, one called Kellanova and one called the W.K. Kellogg Cereal Company. And since then, I believe both companies have been acquired. I think Mars now owns Kellanova, and Ferrero, an Italian company, owns W.K. At present, the W.K. Kellogg Foundation does not have any connection to either of those companies because they've been acquired by other groups. And aside from having some stock with the foundation, that was sold to support our endowment, we don't have any formal connections anymore. But I think the proximity of the foundation to the company in Battle Creek, and I think the shared history of Battle Creek and the shared history of Mr. Kellogg's vision is actually important to note. And I think it does matter to how the two institutions are connected. I said this a little while ago in the conversation, but in the 1930s, Mr. Kellogg knew that you couldn't separate food from health and education, family economic security, and he knew this while he was making cornflakes, right? And so he helped make sure in the late 1930s that children in Battle Creek had access to fresh milk in schools at the same time that he was doing work in soil conservation and in building healthy land. And he had a sense of knowing that how the food is grown and how kids are nourished, it's part of the same story. And I think that DNA has pulled forward into the foundation, and it makes it a really special place to work because we still carry that memory of him, and we still carry that vision of him into the work that we do. Thanks. You know, a long time ago, when I first became familiar with the Kellogg Foundation, I wondered about the history and the independence of the foundation from the company. And I pretty quickly came to learn that the foundation, as you said, is quite independent from the company. But you've enriched my knowledge even beyond what I've known over the years, so thank you. That's a fascinating history. So, let's end with one final question. If you fast-forward and kind of look ahead, what do you think is on the way? And what does success look like to you and your colleagues? Yes, it's a good question. I mean, I think if we got this right, you know, 10- 20 years from now, success would look like children and families living in communities where good food is just a part of everyday life. It's normal and reliable and not something that folks are lucky to find. I talked a little bit about how Mr. Kellogg thought about this in the '30s, but we also see what's possible in other places, right? When that vision can become a reality in terms of policy and practice. So, we had done some work in the country of Brazil. And we see now that national policy in the country of Brazil now requires that at least 50% of school food be purchased from local sources, grown with high-quality standards, right? That one decision reshaped incentives all along the food chain. What farmers grow, what institutions buy, what kids eat. That's a powerful example of institutions using their everyday purchasing power to build healthier and a more just system. So, you know, 10- 20 years from now, if we've done our job, it would mean that the kinds of innovations in places like Brazil or North Carolina or even in Michigan with our 10 Cents a Meal program, that those types of things would have become the norm. That schools and early childhood centers and hospitals and tribal and local governments would be routinely buying good, locally rooted food. And that workers and farmers are earning a fair and stable wage, and they have incomes. And the communities most affected by hunger and inequity are actually at the core of leading and designing new systems. And food policy would no longer be a patch on top of the inequity. It would be one of the main ways that we build healthier and more equitable futures for kids and families. BIO Jon-Paul Bianchi is the Director of Systems change at the W.K. Kellogg Foundation (WKKF) in Battle Creek, Michigan. In this role, he leads WKKF's national grantmaking strategy focused on early childhood care and education, health equity, employment equity and food systems. As a longtime philanthropic leader and national expert with a focus on early childhood education, Bianchi provides strategic oversight to the foundation's national programmatic work to support thriving children, families and communities. Bianchi holds a doctorate of Education from Vanderbilt University's Peabody College of Education and Human Development, a master's degree in child development and a bachelor's degree in child and family studies from the University of Wisconsin-Madison. He helped found and currently serves on the board of Valley Settlement in Glenwood Springs, Colorado.
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  E299: Culinary Medicine and connecting med students with patients 30.04.2026 19min

  I'm delighted today to be joined by Dr. Joseph Skelton, professor of Pediatrics, founder and director of Brenner Fit, a program at Wake Forest University School of Medicine. FIT stands for Families in Training, which is a family-based pediatric obesity program. He's the author of a new book on children and their weight, a topic we discussed in a separate podcast. But in this podcast, we're talking about something he teaches at Wake Forest, a course in culinary medicine. This is a fascinating, pioneering area of focus, so let's dig in. Interview Transcript There's a lot of language about medicine and nutrition now, so people talk about food as medicine. There's a move afoot to get more training and nutrition and medical education, and here you are doing culinary medicine. Tell me how all these things differ from one another. Our interest in this here at Wake Forest School Medicine started a little organically with our program. A lot of what we do is focus on family meals. There are decades of research showing the benefits of family meals, not only for the nutrition and obesity risk, but the quality of nutrition, time spent together, parent child communication. Kids are less likely to get pregnant or do drugs and alcohol. All these things from just spending that time together over the meal. And I inherited a small teaching kitchen that was at a local organization that someone before me had gotten funding for. And we, sort of, took it over and used this opportunity to teach families how to cook. And a lot of families know how to cook but trying foods in different ways and to get kids involved and things like that. Then a couple years after that, the local YMCA approached us. They had some space and wanted to do this as a partnership. So I became a fundraising machine for a year or two and took a lot of dinners to raise the funds. And we built this gorgeous teaching kitchen, and we were mainly doing it in the efforts of sort childhood obesity treatment or prevention, getting families, teaching them new recipes, which then kind of extended to that whole key thing of getting families just to be comfortable in the kitchen and spending that time together. And we just started seeing these amazing things. We always say we've converted more kids to Brussels sprouts than I think any other effort of just getting them cooking it a different way. You and I were both probably raised with steamed Brussels sprouts, which I think is an abomination. If you really want to highlight the sulfur smell of a food, then you're going to steam it. And so, we really started to do that. And then students started volunteering. Actually, it was a student, Josh Patman, he's an emergency medicine physician now at East Carolina University, and he was a cook in a professional kitchen college. And he said, hey, could I help volunteer with that? And then more student medical students wanted to do it. And then we all found that you, much like I did, I'm a self-taught cook myself, and the more time you spend in that, the more you learn, the more comfortable you are. And the more you start to know, you know, I can teach med students nutrition all day, but that doesn't teach them how to get nutrition on their patients' plates, into their mouth. And so it really grew from there. And then I, kind of, stumbled upon what other people were doing. It started in New York, but the biggest program started was really Tulane School of Medicine that had it as a very focused way about teaching nutrition through cooking. Not just on a blackboard through PowerPoint slides and stuff like that of like hey, let's teach it in a different way. And the old-fashioned analogy, and actually the medical educators hate this, it used to be see one, do one, teach one. That was sort of the old surgical thing. And so, it's really you got to see how to make a recipe and you got to do it yourself. And what we found that when students start then teaching each other, or teaching patients or teaching community members, it really drives home and gives them a much deeper understanding of what nutrition in the real world is. Let's talk about the need for this. If we go back in time and we think about your parents or my parents, you know, the likelihood is that meals were being prepared from the real foods rather than from a package, let's say, or in a micro. How are things different now for the modern parent that has kept people distanced from their food and where it comes from, and that's led families to be distant because they're not having meals together as much? What does that look like now? Yeah, pulling from our own history, you know, Home Ec is not really a thing anymore. We did this study in our own med students. You know, most of their cooking, nutrition, the nutrition education they're getting tends to be the popular media. They're learning it from social media. Very few students have a degree in nutrition or took a nutrition class. And as much as we have to cram into medical student's education, there's not much room for it. They mainly learn to cook from their families. And what we know is families are cooking less and less for multiple reasons. They're much busier. Especially parents, actually parents of kids of all ages with that. And again, the marketing of food, you know, it's much easier to get ready made meals. And I'm not badmouthing those, you know. We're in talks right now of actually writing a cookbook for families, and one of the things that we promise is we're going to have a chapter on assembled meals. You know, having a pre-made salad with a rotisserie chicken, that's still going to be a better thing to do if you bring that home, sit at a table or at a bar or around a coffee table and eat that meal together. It's still going to be better for your family in multiple ways on multiple levels than eating out. And what I see, it really with families right now when it comes to actually raising "healthy eaters" or raising good eaters is when we... and again, I love a good restaurant, I'm not trying to badmouth that... but when you're going out to eat a lot of kids have endless choices and there's two issues. One is a paradox of choice. Whatever they get, they're always going to think that other thing might have been better. And it doesn't allow them to spread their palate and try different foods and get exposed to different things. And we always laugh... whenever in this field we want to play a drinking game where every time you say complex or complexity, you take a drink because, but it is such a complex issue with parents. You know, with kids and getting meals on the table. And hopefully finding some time, whether it's a breakfast or it's a dinner, but finding that time to come together around a meal. You mentioned the paradox of choice. I was reminded at one point I downloaded this cute app called You Choose or something like that. And it would help you make a decision if you were undecided. It would flip a coin, it would roll a dice. It would do, yes, no, it would do rock, paper, scissors, it would do all these things. And I was at a restaurant once. I couldn't decide between two entrees, so I used it. I did rock, paper, scissors, or something, and I then it said, okay you should choose X. So I ordered X and the second I ordered it, I immediately thought I should have ordered Y. Alright, so tell us about culinary medicine. What does this course look like that you teach? Yeah, the best way to think about it is applied nutrition. Because again, you can understand a ton about nutrition, but if that doesn't change into you getting the foods that you want in front of you, to me it's almost theoretical or scientific. It's applied nutrition. It's this idea of teaching some very basic cooking skills, and then including within that very core elements of nutrition. And for us, we tend to do it by the balanced plate. We think that works really well for families. But having it be very real world. You know, so again, we have recipes... in two weeks, I'm doing one... we're doing a rotisserie chicken and you're breaking it apart and making a chicken salad out of it. We were always teaching using microwavable rice and a couple of the students cornered me and said, this is very offensive to my culture. You need to teach people how to make real rice. But what it looks like for us is about a quarter, almost a third of med students will rotate through these classes. So, it's voluntary. Next year we're actually hopefully going to surpass half of the first-year med school class. That's unbelievable. That's very impressive. Well, especially up until last year I was doing this in my free time and paying for it with fundraising money. But yeah, Wake Forest is really behind this now. But about a quarter to a third of med students. They do five classes. And it's set up and again, that sort of theme of that family meal. They come in and we get stuff cooking. We get stuff in the oven; we get stuff on the stove top. We usually take some time out for a very short lecture. Again, tends to be very practical stuff. We include a lot about social determinants of health and food insecurity. Given what I do, we talk about picky eating. Very little do we go into details about Mediterranean diet and Dash diet and some of the really core things with that. We really just try to keep it about getting that balanced plate of a protein, a starch and a fruit or vegetable on the plate in front of you. They come back and usually finish what they're cooking, and then they sit down to eat together. And unlike when I was in med school and you were in grad school, or when you were teaching, a lot of students don't go to class anymore. A lot of students, they record the lectures so they can listen to them at one and a quarter speed and study in the best way for them. I love getting to know my students on a different level of sitting down. And that's what my really own exposure to medical student education anymore is really through this, which to me is just the ultimate. Being able to sit down, teach them some interesting things, eat a meal with them. Given my chemistry background, I love getting into the science of a lot of the stuff. And I think for them being, you know, sort of STEM kids, it makes a lot more sense. One of my favorite things is the science of grilling, you know, the science of garlic, you know, things like that. And it helps them sort of understand and helps them remember that, and also peppering it with the stories. It just tends to stick that much more when they know the science, they know the story, they know the culture behind it. So, it's five classes. It's all set up that way, that there's a short lecture. They're preparing everything they can and they're eating it. Again, we include some very easy stuff. One of the classes we do microwaveable vegetables because that's what a lot of what their patients are doing. The bagged vegetable medleys. And one, the important thing that we teach them is most of these don't have any seasoning. So yeah, you can microwave them, but you have got to teach your patients throw a bit of olive oil on there, throw a pad of butter, do some salt and pepper, add some other spices to it. And they go nuts with one group will do some more Indian spices. One group will do more sort of traditional, one to do more Asian flavorings to it in our teaching kitchen. It's really teaching very practical things like that. The fun part of that, that's really spun onto the other things that I'll tell you about, is about half of those students that do that- we have about 18 per semester- and about half those students end up volunteering with us. They come to the classes that we have that are community focused. Now some of the students are going through lead teacher training. They get Serve Safe Certified. It's awesome for me and my staff because it saves us a lot of time and overtime that they come in, they let themselves in the kitchen, they set up, they run the class, they clean up, and they can't get enough of it. They absolutely love it. Now you do some celebration of different food cultures in your class. Tell, tell us about that. Including, as I understand, some of the food culture that you grew up with. Yeah. Yeah. That, that's about, that was a big understatement right there. We just love that and that's a great thing. Wake Forest, being a private medical school, kids are from all over the country, from all different backgrounds. And so, we absolutely sort of herald that. One of the things I love doing is class three is a plant-based proteins class. The first class is a general cooking class. The second class has a focus on animal proteins, and again, we're always also cooking vegetables and fruits and starches. The third class is plant-based proteins, and I do that as Southern cooking. And I just love that sort of theme with that. So, we do pinto beans, you know, And the slow cooker. We tell them how to use instant pots, pressure cookers. We do black eyed peas. A lot of these kids don't know that you're supposed to eat that on New Year's Day. I do a vegetarian collard green recipe, taught to me by a local chef. And I think this is probably my number one post that I do in social media is cornbread night. And teaching them how to make cast iron skillet cornbread, which is the only way to do cornbread in my book. And letting them know, sort of, the background of a lot of the stuff. My wife is from South Carolina, so I teach them great thing about cornbread if you're a poor student, is you have a slice with your beans and your collard greens, and then for dessert you put honey on. Which is what I picked up in South Carolina. So, you know, really celebrating that stuff. We have a whole Spanish speaking program, and we have an article written, we just haven't found the right journal for it. It says, leave my tortilla out of this. Instead of, you know, saying, oh, you have to eat less tortillas, celebrate it. Why is that such an important part of not even that culture, but this family's food history and stuff like that. Because food is personal, it's cultural, its family, and it's to be celebrated. We do a fourth-year elective, it's the last full elective of their fourth-year class and a very lucky 20 students get to do that class. And we always have one called Family Night where they bring a dish that's important to them and their family. And it could be like me, it was the roasted chicken that one of my classmates in med school cooked. And I just thought that was so exotic. You know, I never had a whole roasted chicken before. You know, we had a student that had spent the first part of her life in Australia, so she did pavlova and told the history about where the pavlova came from. Now that's considered sort of the national dessert of Australia. And I always remember this one student, he was going to emergency medicine, very quiet kid. And he's over there cooking these porridges. That's the only way I could describe it is just these porridges. We said, what are you doing? And he told the most amazing story. I almost tear up when I talk about it. His grandfather fled Saddam Hussein. He was Iraqi Christian and fled Saddam Hussein and his grandfather lived with them. And this was their afterschool snack. Was this Iraqi dish that his grandfather would make. And there was a sweet one and there was a savory one. And so just stuff like that is... it's fantastic. I just, I can't get enough of that. And they remember that. And so, as students leave us, and I just came from Match Day where they found out where they're spending the next three to seven years of their life. And I always say wherever you're going, learn something about that culture and that food. If you're moving to Cincinnati, you have got to learn about Cincinnati Chili and getta. take something from that. I did all my training in Wisconsin and the Wisconsin supper clubs and how you can tell what a fresh cheese curd is, and it's just... food is fantastic. And we can take that with us wherever we go. And it can give you a way to know your patients even better. And when I hear of a family that they're from West Africa, ah, you like Jollof Rice. And their face lights up and like, oh yeah, where'd you have Jollof rice? So, it's a great way to get to know more about people. So, there's way more to it than cooking technique. I mean, there's, you know, you roast a chicken that this temperature for that long, or here's how long you microwave. It's really a lot more than that, isn't it? It's just like medicine. It's science and an art. And you know that one of my most popular lectures I give does not have to do with obesity but has to do with barbecue and all the different styles of barbecue. And what is just amazing, despite what we know about the science of taking spareribs, which are an incredibly tough cut of meat, and you have to cook them low and slow to get that temperature up. I think it's 189 degrees or higher where you start to get the collagen that breaks down and they turn tender. So yeah, spareribs to be good tender and edible, you're talking four to six hours. But then you go to Tuscaloosa, Alabama and you go to Dreamland Barbecue. They do spareribs over live coals for an hour and a half. I sat there talking to the person doing it. I'm like, you must bake them ahead of time. Do you soak them? And he's just like, nope. And so again, I know the science of that. So how do these jokers do that for an hour and a half, and it turns out in what my opinion are the greatest bear ribs in the world. Oh really? Oh, I'll have to try. I'll have to try that place out. Yeah, there's several. Birmingham has two there. There's several in Southeast and they cook them for an hour and a half. Over live coals. Violating every scientific principle of low and slow. Don't get it. It's fascinating. That sounds really good. Yeah. Well, Joey, thanks very much. One final question. Do you see this... is this a movement in medicine now or more and more people doing this? Yeah, you know, it was really big for a while. Tulane had so much. You know, they were sharing their curriculum and they were doing some good research. And that's where a lot of what you see now as the food is medicine food is medicine or as medicine where hey, we need to find ways to get medically tailored meals in the patient's hands. There's really good evidence of that with diabetes and stuff like that. I think what you're seeing now is, I think especially with some of our efforts in the government right now, is sort of demanding more nutrition education in medical school. And I'm going to double down on culinary medicine because you know what? My students, myself, I don't need to know more about the biochemistry of carbohydrates. I need to know the biochemistry of cooking and how to do that quickly and safely to teach my patients. And also, with that, we have to forget, there's an entire field that's already doing this, you know? Dietetics and nutrition and there's professionals that probably are way better than us. But I think having this increased understanding, especially dwelling in that food space, is going to help us relate to them that much more. So even though I do a lot of nutritional counseling and talking, I still use my dieticians way more. I think they're going to be way better at that. So I think there is a lot of steam building towards that, but we don't need to turn doctors into junior dieticians. But I think we can give them deeper understanding of how food and nutrition affects their health and the broader aspects of that. It's not about the biochemistry of insulin secretion, it's about where are they accessing food and how can they make use of the food pantry near them. And let them know, hey, it's okay when you open a can of beans it's gonna smell like cat food initially, but you know what? You wash that off and actually it's not going taste like cat food. And you know, just kind of be able to work with them. Hey, canned beans are perfectly fine. Guess what? Canned beans now are coming in no salt added and low salt preparations. And here's an easy way that you could take these canned great northern beans, chop up some herbs with olive oil and a chunk of garlic and you can make some fantastic bean recipe that is incredibly filling and healthy and cheap as dirt. Oh, that's really nice. Well, this is an exciting advance in the field and you're really at the forefront of it, and your students are lucky that they have this available to them. So, thanks very much for being with us and sharing your experience. Well and what the big secret about this is, Kelly, is this is fantastic. I love doing it. Our med school really values it, but it's a lot of fun. That's the thing. You can tell just by the way you're talking about it. It is so much fun. And again, I just saw all my students that were graduating. And that some of these I hadn't seen in three years and they're like doing Doctors in the Kitchen and then seeing patients, they're cooking and being able to relate to them in those ways. I just have a text from one of my students going to family medicine, and she's like, this changed the trajectory in my career. And I'm not taking credit for that, but just the idea of giving that experience I think especially in my world to medical students, I absolutely love it. In the end it's a hell of a lot of fun. BIO Joseph A. "Joey" Skelton, MD, MS, FAAP, FTOS, DABOM is a Professor of Pediatrics, and of Epidemiology and Prevention, at Wake Forest University School of Medicine. He is the Founder and Director of Brenner FIT® (Families In Training), an interdisciplinary pediatric obesity treatment, prevention, research, and educational program. He serves as the Director of the Center for Prevention Science in Child and Family Health, Vice Chair of Research for the Department of Pediatrics, Associate Leader of Community and Stakeholder Engagement at Wake Forest University School of Medicine. He is the Editor-in-Chief of the journal Childhood Obesity. He is board certified in Pediatrics and Obesity Medicine. His research and clinical work has focused on the treatment of children with obesity. He has secured nearly $10 million in funding over the past 15 years, has given over 50 national and international presentations, and has over 130 peer-reviewed publications. He enjoys teaching cooking classes that are both fun and informative to anyone who will listen.
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  E298: Your child is not their weight - a parent's guide 27.04.2026 30min

  So going back more than 30 years, I was involved in work on childhood obesity. It was a prevalent problem at the time, but little attention was being devoted to children and weight issues. And it was fair to say that the field, as it were, was an academic backwater. Little was known about short and long-term effects of childhood obesity. The social and emotional lives experienced by the children hadn't really been documented or studied much. There was very little known about treatment or strategies for parents, but thankfully, things are different now. Thanks in part to the work of a number of really innovative people in the field, and one of the most innovative is our guest today, Dr. Joseph Skelton. He's a professor of pediatrics and founder and director of Brenner Fit. FIT stands for Families in Training, which is the family-based pediatric obesity program at Wake Forest University School of Medicine. He's also editor of the Journal of Childhood Obesity is involved in clinical care, research, education, and community outreach. Dr. Skelton has just published what I think is a really important book through the American Academy of Pediatrics, entitled Your Child Is Not Their Weight: Parenting in a Size Obsessed World. I was asked to review the book and was delighted to see it before it was published and just was so happy to see that such a book existed at all, but such a good quality book at entering the picture. Really a very important advance in our field. Interview Transcript There have been some books about pediatric weight issues in the past. Who is this book for and how is it different than what's been out there? I feel overall the big audience for this book is any parent, especially of my generation, that were raised during some really toxic diet culture in the '70s, '80s, and '90s. And so, I think the main folks that that's for is that parent: I want my kids to eat healthy, to be active, to lead healthy lives. But I don't want them to become concerned about their weight to feed into our culture's focus on the ideal body image. I don't want to feed into that. But you know I do want to pay attention to the health habits. How can I do this in a healthy way? How can I focus on health habits with my kid that's not a focus on weight and do it in a way that's backed up by science. You know, that's what parents always want to know. Am I doing this right? Am I causing harm? And it is actually who the book is dedicated to, you know, all those parents that were raised in a toxic diet culture and want to do things differently with their children. So, in modern day America, what is life like for a child whose weight exceeds the standards that we know might be healthy, and for the parents who are raising those children? From personal experience and 20 years of running a program, as well as what the research shows, it can be kind of rough. Despite a lot of the advances that we've made around weight bias we're still in a place that kids are trying to live up to this idealized body image. And then they have all these toxic messages when it comes to nutrition and body image. I think it's rough. We know that kids in bigger bodies tend to have a lower quality life. They tend to have more symptoms of depression, anxiety; and it's because of this world that we live in. You mentioned messages that they might be getting from places like the media, but what are interactions like with peers and teachers and doctors and others in their lives that are affecting how they feel? Yes. So, the adults in their life were raised in that toxic culture. They're my generation and the generation behind me that was raised in that. You know, there's the myth that a smaller body is healthier than a bigger body. And I think we can't break away from that. And I think that still sort of comes through. We still see this as a lifestyle issue, and everyone has an opinion. Everyone has a thought of, you know, well, I did this... and I lowered my cholesterol... I did this and I lost weight, you need to do it too. And I think in the medical profession, because of a lack of understanding, a lack of training - I think that still occurs. I don't do a ton of medical education. I'm getting more and more into it, especially when it comes to areas around nutrition. But that's what I'm trying to avoid in the next generation of healthcare providers and even actually a lot of our community collaborators, teachers, and stuff like that. To get away from that. This is not a simple issue, so don't share advice because sometimes that advice can be damaging or could be wrong. You know, good lord how much I hear about carbs on a weekly basis. And not the carbs I like to talk about, which is around dessert and Carolina Gold rice and all these other food stuff. But it tends to be around sort of demonizing certain foods and just really bad messages that still are floating around out there. Let's dive in a little deeper about what you refer to as toxic diet culture that was especially pronounced in previous generations. What does that mean? Does it affect standards for what the ideal body looks like? What about messages about how much control you have over that yourself, and how responsible you are for your weight? How your self-image should be influenced by how you look? But tell us more about what you mean by that. We wanted this to be a book that didn't necessarily dwell on weight so much, but actually one of the first chapters is to say let's cover how complex weight really is. We know that 50% or more of someone's weight is heavily, heavily influenced by their genetics. Where they live, you know. The amount that our lifestyle affects that is much, much smaller. It's the minority of what goes into our body size. And even that, our habits are so influenced by the world around us. But it's, you know, trying to get people to understand that, hey, body sizes are just different. I love this picture from the Olympics and it was a medalist in gymnastics- it was Simone Biles; you know, the huge media personality of Ilona Maher who is a bronze medalist in rugby; and then one of the women's basketball players. You're talking 4'9", 5'10" and pure muscle and six foot seven, all people at the top of their game. And not only different heights, different body types. And, you know, body type is a hard thing to talk about because there's not standard body types. We're all just built differently. And starting that message at a young age that people are just oftentimes built differently. There's very little control that we have over our weight. And even though there are things that we can do about weight, what you can do is you can focus on your habits for health. And that has just gotten lost. We talk about in the book the, we call it veiled weight talk, and it's basically where you're just substituting the word health for the word weight. And kids pick up on that. They know when their parents and others are talking about weight. And so, a really big thing we want to accomplish is like, Hey, you know, eating for health is important. Being active for health is important. In my world, and I did one part of my early research in this, and we always try to have that message as there's so much more to health than weight. In our medical world right now, our primary outcome on these lifestyle changes that people are making is weight. You mentioned genetics as a contributing factor to who is affected by the problem. Tell me how you look at the food environment out there that people are exposed to now, and things like food marketing and the processing of foods. The availability of all these foods that are contributing to obesity and things. And the reason I ask is, you know, there was a time in our country when the prevalence of childhood obesity was probably close to zero. And there are plenty of countries around the world where that's still the case. But now in many countries there's large amounts of childhood obesity. And it's not as if the genetics have changed. When people move from other countries to the United States, their weight tends to go up. Their genes obviously don't change. There's something pretty toxic about the food environment that's driving this. So, thinking about things that way, does that help parents by shifting some of the blame from them and their children to an environment that they might be able to manage in some way? Absolutely. Because parents…they blame themselves oftentimes. You know, how did I let this happen? What did I do to sort of cause it happen and it's not. So, we do try to shift that of looking at ourselves as the reason blame. But you can kind of look at the - and I'm just going to focus on nutrition as the focus - the broader food environment and how that impacts. We tend to get a lot of buy-in or understanding when you talk about how they are trying to market to kids. And so, for any parent, all you have to do is bring up the checkout line at a grocery store, you know? And all the things that are at the kids' level that is just made to make your life as a parent hard when you're trying to feed your kids well-balanced regular meals but you're just kind of constantly walking through this landmine. It's the same thing with electronics and social media. There are so many things that they have a lot more money than you do to market to you than you do to protect yourself against it. And it absolutely influences it. And the way I talk about this is really when it comes down to snack foods, and using the parenting language that snacks get you between long periods of time between meals, but that got co-opted by companies marketing snack foods. And when you see food, smell food or hear about food, you kind of want that food. And that's what parents have every day to now the point is. Snacks always have to be crunchy, salty, and sweet, and we're supposed to give kids snacks when they ask for it, because that's what these companies tell us about hunger. You know, hunger hits us every time and you have got to have this bar to sort of get through that. Parenting is hard enough and then trying to parent through this when they're directly marketing kids... you know, in most European countries, they're not allowed to market to kids. In some countries it's age eight. Some countries it's age 12 because they don't quite recognize this is marketing, they're want you to buy this. It makes it a lot harder for parents. You know, when I was on the faculty at Yale, I got to know a political scientist. A very impressive person named Jacob Hacker. And he'd written a book called The Great Risk Shift. What he talked about was how government and American businesses have systematically shifted the responsibility for overcoming harm from products from themselves onto the consumer. And that's really true in a way here, isn't it? Because the problem is created by corporations who are marketing unhealthy foods in such high levels. It's not the only cause, but it's certainly an important one. But the responsibility for solving the problem then falls to the parents and the children who have it. And one party has way more resources than the other. As you said, it's really not a fair fight and parents have a very tough battle dealing with these things. Yes. There was a marketing study called The Nag Factor, and I'm an old Simpsons fan, you know. You imagine the people behind the one-way mirror watching things and trying to manipulate. And that's what the nag factor was. How can we get kids to nag their parents more effectively? And what they found is parents that were immune to nagging tended to be the more educated, higher-income parents. And so, they literally had this plan of we need to change how we're getting these kids to nag. We need to give them reasons to nag. And that's when you started seeing vitamin C, high in protein. So, you think the checkout at the grocery store is bad, but then the signage in the commercials each and every day are giving kids reasons they can go to their parents to tell them get me this. Because nagging is not going to be enough for the high-income parents. They have to have some purpose behind it. You know, when I was growing up, the only way I saw advertisements for food was on Saturday morning cartoon television. And there were three channels showing it. Well, it shows how old I am, but now it's just an avalanche of messages on social media, built into gaming, and it's just everywhere. And it's probably pretty hard for parents to control that. Wouldn't you say? Well, now that you've said that, that's what my phone's going to start doing. The next time I open up my Facebook, there's going to be an ad for some sort of food camp because it's listening to us. Absolutely. Oh yeah. There's just no comparison. And I think that's also something very hard for parents, regardless of the topic, is what worked for me that my parents used is different than for my kids. And even between your kids. You know, my 24-year-old and my 20-year-old are completely different kids. You wouldn't even know they're related and different personalities. And so, what worked for one, you can't necessarily apply to the other. And whereas we love the idea of multi-generation households and, you know, being involved and being there to give advice. And you should take the advice of your parents, but it doesn't always apply. It's just a different world. I feel like I need to give credit to my East Tennessee farming roots. There are two stories I always remember my dad talking about when they would go to a car hop. Maybe some of your listeners know what a car hop is maybe they don't. It's like a Sonic, you know, it's the old school drive up. Or for you Atlanta folks, like the varsity drive up. My grandparents would make my dad put on his Sunday clothes. You know, that was how rare they went out is they would actually get dressed up driving into town to go try these hamburgers and these French fries. Versus now you can you DoorDash that 24/7. I mean just what a different world and concept. And I still have to share this other story for my grandfather, who my oldest son is named after, he was a tobacco and sustenance his farmer in East Tennessee. And every time I have a med student that's a vegetarian in my cooking class, I always tell the story of he came home one day, and he was talking to my aunt. He says, you know what? The county agent said one day people are going to be eating soybeans. That's so funny. Soybeans were fed to cattle back then. It's really just how drastically we change and now it's changing even faster. I mean, my grandchildren will be light years different than what my children are. Let's dive back into your book. Tell me about the collaboration with the American Academy of Pediatrics and how did the book come about? They have had two books in the past that were sort of geared towards parents, you know, how to address weight in your kids if your child has a problem with their weight, what can you do about it? Well-written books. They had done well. But they were looking to try to do something different. It was kind of time to sort of update that. And the last book was great by Natalie Muth. It was a fantastic book. So, a lot of my friends were on the 2023 clinical practice guidelines. And when that came out, there was a huge blowback from the eating disorder community. And, again, it's sort of the polarization of our country right now. And, they had asked me to speak at a conference saying, hey, can you try to do something in the middle? They knew that we included elements of the body positivity movement in what we do. We're big adherents and teachers of authoritative parenting. And they said could you try to give a talk that kind of goes in between what we're trying to do with the treatment of obesity that's affecting children's health as well as the body positivity movement. It's kind of, again, speaking of the Saturday morning cartoons, it was kind of those things that everyone stepped back, and Bugs Bunny was still in the front and got volunteered. It was sort of one of those situations. And so, I gave this presentation and they said, hey, well, what do you think about turning this into a book? Would you be interested in writing a book? And I said, absolutely not. I don't have time. And never in a million years would I do it. But this needed to be out there. So, first of all, the AAP asks, as a pediatrician, you do it. And second of all, I feel like this book needs to be out there. Both for who I talked about earlier, those parents that don't want to hurt the kids' feelings, make them hate their bodies, feel like something's wrong with them, which is what a lot of kids say. But it's also for those parents that are wanting to do something. These are the parents that, you know, they want to put their kid on a diet or make a comment to them of you sure you need to have seconds on that? You know, which we know can do damage. And of course, parents, you know, they don't want to hurt their kids and get in the way. And so, it was kind of geared toward those parents that were starting down an avenue that may not have been safe. You know, they don't have access to a good evidence-based program. And so, it's also for those parents that says, hey, your kids aren't little adults. Don't take these weight loss approaches to kids. It's just a different beast. We'll come back in a minute and talk about specific parenting strategy, but you alluded to this blowback from the eating disorders fields and the clinical guidelines. Tell us a little bit more about that, because it's one of the key features that would drive the need for a book like yours. I'm not an eating disorder specialist, but there was a big concern that one of the big recommendations that was new was that you can't have watchful waiting anymore. It used to be, you know, if younger children were starting to gain weight, before you intervene or start into treatment or start to change a lot that maybe just wait to see if, you know kind of the old-fashioned thing, are they going to outgrow it? Are they going to go through a growth spurt? So that was a part of the recommendations. The evidence says that watchful waiting in today's world, you're unlikely to see a kid outgrow it anymore, including bariatric surgery, use of medications and things like that. And so, they felt like this increased focus that this was going to cause pediatricians and parents to focus even more on weight and therefore lead to eating disorders. And then that was coinciding over the previous five years, a lot of studies were coming out and then it got put into a couple of systematic reviews of meta-analyses that showed that kids in bigger bodies, kids with overweight and obesity, had a two to three times higher prevalence of eating disorders. Because typically eating disorders are always thought to occur in underweight or thinner children. But it actually is much higher risk of these in children in bigger bodies. And so, we use that term threading the needle, how do you help families who want to do something about their child's weight for health reasons but not worsening disorders. And so that blowback was really saying, hey, by increasing focus on this, you're going to make things worse with that. And it was kind of surprising. A lot of my good friends were on that practice guidelines and they're kind of taken aback because these are experts in the field. Well-meaning people that for 10, 15, 20 years had dedicated their careers to helping these kids looking for help. And I think any care provider to be accused of causing harm is always, always jarring. Tell us how you navigate that and what sort of advice do you give parents in this book? Yeah, so one is that I call weight literacy. It's sort of understanding this is a complex issue. It's not something you did. This is something that happens. We can't always explain it. There are still things, this is where you read too much of this science, it gets you really paranoid about microplastics and things like that. There are some legitimate arguments to me be made there in endocrine disrupting chemicals and stuff like that. We can't always explain why kids are growing bigger than other kids or at a heavier weight. So, the weight literacy, sort of, understanding this is a complex issue, this is not a lifestyle issue. And the second thing is it's worthwhile to focus on healthy eating and physical activity for health. Sometimes that will see improvements in weight, sometimes it won't. But it's still important to do. That's the idea of getting away from that weight being the primary outcome. We feel like this is a great adjunct for someone who might be pursuing bariatric surgery or medications, because it does give us the opportunity to not keep pushing kids harder on nutrition and physical activity, which could lead to that disorder eating. And I think the final thing is sometimes parents and kids are aligned. You know, give me a 15-year-old girl that wants to lose weight. A 15-year-old girl that wants to lose weight, that is unfortunately a child that's very high risk of developing disordered eating. And maybe the parents really wanted to help. But what oftentimes we see a lot is tension brewing between the parent and child. The parent making efforts to help the child with their health and their weight, and the child interpreting those efforts as you think I'm fat, you think I'm ugly, you think something's wrong with me. And it's causing that tension: you know, you can't eat too much of that. Taking Food away. That movie Spanglish with Adam Sandler, several scenes in that sort of reflect that of just small comments that parents can make. You know, actually wanting to help and how that can hurt children. And what we would hope for a lot of parents is to say how can you do this in a way that can be helpful. And one of our chapters is called how to not talk to your children about their weight. You know, the idea that parents don't need to feel that pressure to bring that up. Now, if their child wants to talk about it, absolutely they need to be there, and we give a lot of tips for that. But, you know, your job as the parent, you don't really have control of your child's weight, but there's lots that you can control and lots that you can do to promote the healthy development of your child. You know there's a heavy dose of compassion in your book. That was one thing that appealed to me about it and impressed me. Because if one thinks about a book for parents on dealing with their overweight children, you sort of default to, oh, this book is probably a diet or an exercise program, or things like that about how the child can change their weight. And you're talking much more here about understanding the psychological world of the child. Being sensitive to possible risks of talking to them in ways that are unhelpful or lead to eating disorders and things like that. It's wonderful that you pay so much attention to those issues. And it's very affirming because you're saying that there are some things parents can do about this in ways that affirm their children, accept them as individuals. It's built into the title of your book that your child is not their weight. And that just means so much, I think. Oh, thank you. That is what we had hoped. I mean, you know, parents love their children and in endless, endless ways. And the parents are the key to their children and their children's health. And I feel like sometimes we push too hard. Now we're doing it for good reasons. We want this child to be healthy. We want to help make some improvements. And we put a lot on the parents' back. And I think sometimes then that pressure then is extended to the children. And a lot of this is trying to get parents some insights of, we know you love your children. Here's how to make sure that your child is being loved. You know, the old parenting typology, and I kind of go through some of that history in there, really kind of gets at that. But sometimes we do or say things that doesn't make their children feel loved by accident of course. And it sort of highlights that, not to make parents feel bad, just so they're aware. I've been guilty of it. None of us are perfect parents. And you know, making sure that our kids are feeling, loved by us. Family-based treatment is obviously the key. And I always think of one of your, one of your hypertension studies, I think from 1983. I still quote it to this day. You know, the idea that even though we talk about family-based treatment, we're usually dealing with a parent and a child. The dyad. Now they're representative of the family and I've always felt like something was, sort of, missing there. And two things really influenced me. One of that is one of my co-authors, Dara Gardner-Edwards, who is a licensed clinical social worker. And they are all about the family. They know how to do family assessments. And so, recognizing there's more than just those parents and the child in the clinic with you. In addition to that, working the whole field, I didn't know about human development and family studies. Didn't know that was a field and actually came from the University of Minnesota. I was one of the early. Strong program. So, UNC-Greensboro, our neighbor over there. I started working with a professor over there, Cheryl Buehler, and we would go meet over sushi and she essentially taught me a four-hour freshman-focused family studies course. And just this whole other world, social science world of family dynamics and recognizing when you're working with that child and parent. You may or may not be affecting the family dynamics in the household, of that family system. And so being able to extend differently and having some more appreciation of the complexity of families and the relationships with families. Hopefully we're helping people understand making changes in health habits, relationships matter. We have a project going right now, led by one of my medical students. She was always impressed, in shadowing with us, of how many siblings were picky eaters. And I brought this up to my team, like, oh yeah, this is a huge stress. You know, this parent is obviously wants to change the habits of the entire family but is obviously focused on this child we have in clinic. But the struggle of having this other kid that's a picky eater really throws off those dynamics. And being able to account for that and that stress that that puts on families, and what can we do around that? Oh, that's so interesting. You know, the more aggressive, dramatic treatments that are being used for adults like bariatric surgery and the GLP one drugs, how do they fit into this picture? Yeah, so we feel like it's a perfect adjunct if someone is pursuing with this with their child, because it still is talking about that parenting approach. And it's not really going to change anything with how you're parenting around these things. You know, bariatric surgery for many years has been done safely and effectively in children. Not that it's always perfect, but again, because of the cost, the idea that it's not reversible and typically you want that done in a center that's very experienced with working with kids. So, access issues tend to be really big with that. It can be very effective for some kids but is not available to everyone. We're in the same situation with the medicines with GLP1s. There's one that has been approved for use down to age 12, and overall, they tend to work very well with kids. But we're in the real world now. We're learning a lot about that. It can be miraculous for some children because it gives them success with their weight. It takes pressure off themselves. We're always trying to prevent that restriction, both in hearing that from another adult or the child doing it themselves, trying to tell themselves to eat less. It's always going to backfire. It's going to increase your hunger and things like that. And having that GLP1 is going to help with that. It's actually going to lower that pressure. And oftentimes they can get in that healthy routine much quicker. In others, it's causing some problems. We are seeing some kids that it is absolutely wiping out their appetite. And we're figuring out now the kids are sort of at risk for that. And you can't do that. The kids gotta eat. But for some kids, they just lose all appetite whatsoever. And they can't not eat. And so, we're still figuring out through the real world. But I think, what we're also finding is the job that we do in these multidisciplinary teams, it's just as important if not more important when you're using medications than when you're not. Let me ask you a big picture question and let me see how optimistic you might feel about how, where things are going. So, think of a physician who is treating people with lung cancer. So, the lung cancer is caused by this terrible environmental influence: cigarettes. And the physician then is in the position of having to treat the people who have that really unfortunate problem. And thank God there are physicians who do that, and there's research showing how to treat it effectively. But of course, it would be better if the environmental insult that's causing the problem in the first place didn't exist. That would make everybody happier, except for the companies that sell the product. So, do you think you and colleagues who are doing similar work are faced with a similar kind of a problem? There are all these environmental things that are helping push this problem in the first place. Thankfully, there's kindness, compassion and effective care available and your book helps push that forward even further. But are you hopeful at all that the environmental situation, you know, all the bad foods and stuff out there is changing in a positive way so that there might be less of the problem, or it might be easier on the children now who deal with the problem? Some people think it's getting worse. Others think we might see some progress. But what do you think about that? My brother is an HR guy and he kind of talks about these different typologies with that. And, I forget, I'm called something like the mad scientist, which is you're very pessimistic in complaining, but you have enthusiasm. I don't really know how to take that. But I think, you know, I'm enthusiastic obviously about this topic and what we can do to help parents. But I'm a little pessimistic when it comes to the broader world. I think there's enough, and not saying that every for-profit company's bad, but I think a lot of history is on my side with that. I don't get paid more the more kids I see and the better success I have. I don't get paid more. My job is to be here to help. But, you know, companies, every time I see a for-profit company that comes out and says safety is our number one priority. Or, you know, your satisfaction is number priority, I'm like, no, it's not. Your number priority are your shareholders. And I think that's a very, you know, jaded way to say, I don't quite trust companies right now because of that. Are there some positives that you see, and do you see some changes being made in some menus? Do you see some different products out there that are really trying to get it healthy? But it's hard. I think I have some trust issues and I think that's well founded. Maybe that's my Appalachian background. I tend to be very distrustful of the large mining companies coming in. That, speaking of your lung analogy, that I think I have some healthy distrust that is well founded. So, I think trying to help, and that's obviously a big movement that we have, of trying to help people be more discerning parents, more discerning consumers. But it's hard because they, like you said earlier, they have a whole lot more marketing dollars to convince you to buy their product than we have trying to convince them to make smarter choices about it. BIO Joseph A. "Joey" Skelton, MD, MS, FAAP, FTOS, DABOM is a Professor of Pediatrics, and of Epidemiology and Prevention, at Wake Forest University School of Medicine. He is the Founder and Director of Brenner FIT® (Families In Training), an interdisciplinary pediatric obesity treatment, prevention, research, and educational program. He serves as the Director of the Center for Prevention Science in Child and Family Health, Vice Chair of Research for the Department of Pediatrics, Associate Leader of Community and Stakeholder Engagement at Wake Forest University School of Medicine. He is the Editor-in-Chief of the journal Childhood Obesity. He is board certified in Pediatrics and Obesity Medicine. His research and clinical work has focused on the treatment of children with obesity. He has secured nearly $10 million in funding over the past 15 years, has given over 50 national and international presentations, and has over 130 peer-reviewed publications. He enjoys teaching cooking classes that are both fun and informative to anyone who will listen.
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  E297: Behind the Scenes of Diners, Drive-ins and Dives 14.04.2026 25min

  It's the story of a guy on a road trip across the country, checking out America's classic greasy spoons. And the adventure is all about finding the restaurant owners and creative cooks serving up the very best of down-home style food. That's the premise of the hit series Diners, Drive-Ins, and Dives starring everyman chef Guy Fieri. Today we're going to talk with the show's creator, two-time Emmy Award winning food journalist and executive producer David Page. Interview Transcript David, I can't wait to talk to you about the show. But before we dive in and talk about the specifics, how long did the show run and how many episodes were done? My impression it's still on and it's always been there. Yes. I created it in 2006, 2007. I did the first 11 seasons and moved on. And funny story, in the first month of the show we had a couple of strong initial outings. And everyone was all excited thinking maybe this will be a hit. A food network executive called me up to tamp down my expectations and said, look, this is all fine and dandy, but this thing isn't gonna go more than a season or two. There's just not that many restaurants. And you know, to quote the great screenwriter William Goldman whose rule of Hollywood is 'no one knows anything.' I did 11 seasons. It's now in season 40 or something, I think. Holy cow. I could just think of enough restaurants around me to do a couple of seasons worth. So, tell us the origin story. How did Diners, Drive-Ins and Dives come about? Well, I had left a career in network news and moved to the Twin Cities because I thought I wanted to be in business for a public corporation. And I took a job as the Senior Vice president at a home shopping channel, and I was all excited, and I hated it. It was just horrible. I did not want to sell second rate gold jewelry to shut ins. So, I quit, and I opened a production company and began to starve because I wasn't selling anything. Then I called Al Roker, who has a production company and who had technically worked for me, although stars don't work for executive producers in the real world. When I was the co-producer of the Weekend Editions of the Today Show. Al was on the weekend show at the time. He hadn't yet moved up to the big show. And I said, hey, Al, I'm starving. You got any work you could throw me? And he said, yeah, I'm doing a lot of stuff for the Food Network. I'll subcontract some of it to you. Which was good for both of us. I got to work, and Al got to take a cut without doing anything. So, that hooked me up with the Food Network. I started working for them and Al and I both knew I wasn't gonna get rich doing a pass-through deal, so I started pitching them directly. And I was getting nowhere. There was this very nice development exec who would talk to me on the phone. And everything I proposed she would shoot down. And one day I'm on the phone with her and we're going through a pitch call and I'm proposing this and proposing that, and she's saying, no, no, no. Finally, the Food Network had asked Al to do a documentary on diners and the history of diners and such. And Al had subcontracted it to me. So, this development exec had a frustration and I think pity for me and finally said to me on this call, don't you have another thing on diners? And I immediately, I said, oh, absolutely. I'm developing a show called Diners, Drive-Ins and Dives. And I told her all about it. And this was like late on a Thursday or Friday afternoon. And she said, 'you know, that sounds good. We have a development meeting Tuesday. Get me a writeup on Monday.' And I got off the phone elated because it was the first time she'd expressed interest in anything. But also, I'd kind of put myself in a jam because I was not developing a show called that. I had literally pulled the title out of thin air. Or a body part, depending upon how scatological you want to get. And that gave me the weekend to try to put a pitch together. So, this was in the old days when you didn't email people, you called them. I did as much research as I could, and I started calling restaurants around the country. And on Monday I sent her a pitch for a one-hour special with, I think, it had seven restaurants in it. And, they had their meeting on Tuesday and here here's, you know, you get lucky. Guy Fieri had just won their second Food Network Star competition. Back then they naively believed that that contest was gonna generate them a new star every year. Someone who would be a big deal for it. In fact, Guy is the only one who ever made it and, when I'm drunk and immodest, I take a lot of credit for having taught him how to make it. But he has immense natural talent. Anyway, they wanted to make Guy a star. And they were trying to get a primetime show for him. And big deal, major league production companies had been asked to come up with proposals, which had not come back yet. They figured, what the hell, let's do a special with Guy just to keep on the air so people wouldn't forget about him. So, they picked up this special from me. It was gonna be a one-shot deal. We did it. I think they were kind of stunned by how well it did. And then something really great happened for me. They looked at the proposals from the big boys and didn't like them. And they were kind of stuck. They were desperate to get Guy on the air in prime time. So, they figured, well, you know, let's pick up a very short season of this thing. And they bought, I don't know if it was eight or 10 episodes, but they committed to that. And very quickly, we became a hit and off we went. It's an amazing story. So many people have seen so many episodes of that show. But nobody would have any idea that's how it got started. It's wonderful to hear about that. Once you got going and got your feet on the ground with this, what were you hoping to accomplish through this show? Well, look, TV's about storytelling. I've been a storyteller, hell, for 50 some odd years now as a mostly broadcast journalist. You learn, if you're any good, that the best stories come from and are about people. I conceive this not as a food show, but as an opportunity for the viewer to meet really cool, passionate people doing something they cared about. You know, independent restaurant owners make a buck 3.80 at best. They're passionate about making good food. If they're any good. They're often trying to keep family legacies alive. And more than anything else to succeed in the food biz you gotta wanna serve people. You gotta wanna make people happy. So, I went out to document the stories of some of the coolest people in America. Now, it was in the food world, which is a world of shared experience. We all eat. Most of us have favorite foods. Most of our favorite foods are the kinds of foods that I featured on Diners. TV is about one thing: hanging out with someone you want to hang out with. That's why Tom Selleck remains a star; whatever crappy TV show you put him in. That's why for your older audience, Tyne Daly kept getting series after series, or James Garner. There are just people you want to hang out with and that's all television is. Guy is someone people want to hang out with. His personality comes through the screen in a particular way. And you know, I said earlier, frankly or implied, that I taught him a lot about how to make TV. I did, but that's because at heart, he is the most naturally talented performer I've ever worked with in 50 years in the business. And was brilliantly able to soak up anything he learned along the way. I mean, it's like a chef. If you're a good chef, a better chef can make you better. But if you're not a good chef, you'll never be a good chef. To be good on TV, you have to have it. I can't define IT, but to quote the Supreme Court justice about pornography, I know it when I see it. And Guy has IT. So basically, this show put together people you wanted to hang out with and brought them into your living room or your bedroom or whatever room you watch in. The show is very compelling and you're right, you get to know the chefs, the restaurant owners in these little places, and there's something wonderfully wholesome about it. It's so good that you came up with this idea. You know, I was reminded as you were talking about a conversation you and I had when we first got to know each other by Zoom a few weeks ago. And I was mentioning I was going to do a self-guided drive called the Blues Triangle Tour. Starting in Memphis going down to Tupelo, over to Mussell Shoals, ending up in Nashville. And immediately you started telling me about places I needed to go. You said, oh, there's this wonderful place in Memphis. It's down an alley and down these stairs. Yeah, the rendezvous. Yes. They have the best Memphis dry rub ribs. I thought, oh my God, I'm, I can't tell you how grateful I am for that recommendation. Well, did you go? I'm going plan my trip around that. And then as I was reading your book, Food Americana, which we've discussed in a separate podcast, you mentioned the hot wings in Nashville. You mentioned former Mayor of Nashville, Bill Purcell, who was an inspiration for the hot wing festival they have there. Well, I happen to know him. And because our professional paths intersected around some health and wellness things, and he's a wonderful guy. So, you inspire me to get back in touch with him. You know, I wrote to him, I said, I'm going to be in Nashville. Let's go out for some hot wings. You know, at the place where they were invented. How wonderful is all this? Well, the story behind them is phenomenal. Apparently, the guy, Prince I guess was his last name... he was not a real faithful husband or boyfriend. I'm not sure if he was married to the woman. But he came in one night after gallivanting around and told his partner, told apparently, didn't ask, to make him some wings. And she was so teed off at him that she made them hotter than hell and he liked them. And you know, an industry is born. Or so the story goes. That's so interesting. Tell us some of your most memorable experiences doing the show. And some of the places you were, the people you met. There must be so many that stand out and you did so many. But give us a few examples. Well, I understand I kind of lost out on part of this after the first season. I, I was back at home base putting the show together. So, okay, my in-person experiences were somewhat limited. Although I made some phenomenal friends in the course of it. Louie Miller's Barbecue in Taylor, Texas. Which, I visited. It's a legacy joint. Opened 80 some odd years at this point in a converted, they always include the word girls, a converted girls basketball gym in this small town in Texas. And when we went to shoot there, Louis Miller had passed away. His son Bobby was running the place. Bobby has now passed away and his son Wayne has the place. But I just fell in love with Bobby, who was, mm-hmm, dry as a bone and hilarious. I mean, Guy says to him, well, what are you gonna cook these over? You know, expecting post oak or mesquite. Bobby looked at 'em and said, wood. I said, oh, so that's how it's gonna go. And, and that's how it went. Now we started at three in the morning. That's when they start the fire. And, you know, we're in the middle of an interview in front of one of the pits, which was at that point, I don't know, maybe 60 years old. And without looking, without checking, Bobby turns around and starts moving briskets from one part of the pit to the other. And either I or Guy said, why are you doing that? How do you know to do that? He said they needed it. It's that kind of innate understanding of his food, his technique, the pit - which had a personality of its own - and he understood it. It was just extraordinary. It's the best barbecue I've ever had. The brisket there is extraordinary. It's unbelievable. They make their own sausage, out of bull meat. You know, again, food of the poor. Barbecue started as a way to salvage tough cuts and meat that was going bad in Czech and German owned butcher shops in central Texas. It was all about making do and the argument has allegedly been that bull meat has a better chew. BS. Once the old Bull was done siren, you had to do something with 'em. Grinding them up into sausage was efficient. And I, I mean, it's fascinating what you learn along the way. Bulls are kinda lean. So, when you make sausage outta bull meat, you actually add fat. That you've taken from other animals to get the right mix. Their sausage is amazing. It's the finest barbecue I've ever had. There's a place in West Lafayette, Indiana, called the Triple XXX Family Restaurant. They added family restaurant to it 'cause when it was just the Triple XXX Drive-In, they used to get phone calls, yeah, from people asking what time the next show was. And the married couple that owns it, they started going there when they were in high school dating. His father owned it at one point. It's basically a burger joint, but much more than that where they make the burgers out of steak. They name the burgers after star athletes from Purdue University right down the street. And they just, their, their love for the business, their love for the community, it's just something really, really special. And, you know, Wayne Miller's become a friend. They've become friends. It, it, it's a delight to see. there's a barbecue joint in Lexington, Kentucky. And I know Lexington because when my daughter was in high school, she was a competitive equestrian. And, Lexington has a pretty big deal horse show every year. And we would go there, and she actually ribboned there. She was damn good at it. But there was a barbecue joint that I found there. I didn't find it on a trip there. I mean, my research department found it. And their specialty was, as is the case in that part of Kentucky, mutton. And we sent a crew down there and Guy and did a segment with them. Like the next year when we were in Lexington, I took the family there and we had dinner. And it turned out I couldn't go there very often because they wouldn't let me pay. And they would just fill the table with all this food because as it turned out, they told me that being on Diners saved them from going bankrupt and shutting down. And I found out that we actually saved a bunch of restaurants, which was not our intent. But I'm damn glad it happened. And by the way, if you've never had mutton barbecue, you gotta go for it. It's fabulous. You know, when you were talking about Texas barbecue, I don't think I've ever come across barbecue I don't like. And, you know, North Carolina has its own distinctive barbecue, and Kansas City and Memphis, you know, all that. But by far my favorite, and I shouldn't say this because I live in North Carolina, but it's Texas barbecue, just like you said. Well, I think we're talking central Texas barbecue because... Yes. In Southern Texas, there's a Mexican style of barbecue, in Southeastern Texas there's the kind of barbecue you're used to because there was an African American migration from the Southeast into that area, so they're making pork. But yes, central Texas barbecue is second to caviar and hallava. Probably the third best substance on earth. Oh my God, I totally agree. I have a good friend in Austin, so I've been down there and I've gone to Lockhart and, you know, Austin and places, and you're right, that Central Texas barbecue is just unbelievable. It, it hijacks every atom in my body. And, and what's incredible about it is in most cases. There's no sauce. No, I was just gonna say... that it's only with salt and pepper. You don't... the meat is so good. Yeah. You don't want to besmirch it with sauce. No, no. At other places you need sauce because the meat's not that good to begin with. Oh, it's just absolute heaven. And again, it was born of a need to do something with bad meat. And, and by the way, interestingly enough, you know, unlike North Carolina barbecue, which was born of whole animals, this kind of barbecue was impossible until the meat cutting industry was born. And pieces of beef were being shipped that were not whole carcasses or half carcasses. This old form of food is actually also a modern form of food that couldn't exist until the industrial age began treating beef differently. You know, I'm dying to make a trip down to Austin, use that as a base and do nothing but barbecue for about three or four days. I don't know if the body can tolerate that, but, oh... Oh sure it can! But I'm going to find out perhaps. Well, you know, there's three Michelin star barbecue joints in Austin now. I interviewed the owner of La Barbecue, which has a Michelin star who was actually married to a woman who is a descendant of Louis Miller's family. And she unfortunately passed away. Her widow runs the place alone now. But they're doing some remarkable stuff. And of course, there's Franklin's, which is famous, which I've never been to. But oh, Obama was the only one allowed to cut the line there. Yeah, I wasn't, I had to stand in line a long time. How good was it? Unbelievably good. I mean, you go up and, you know, Aaron Franklin was there at the counter chopping up the brisket and asked which part you'd like. And you just don't... sauce belongs nowhere near it. The meat is just so tender, so beautiful. But it does raise a definitional issue. He was one of the first to use prime beef. Is that cheating? Barbecue's goal is to make the most out of the least. I don't know. If it's good. It's good. Okay. Cheating or not? It's really good. Okay. Just checking. So, let's get back to food television. Social media has come into the picture, since you began doing the Diners show. How has that changed things? And is TV still the predominant place people are learning about food or is it social? How do the two interact? Where does that work? I think it's mostly social media these days.I mean, look, TV evolved. Food TV evolved into two things. Truly beautiful paeans to food and chefs done generally on streaming channels. And they're fine. They're good. A bit, too dreamy for my taste. They take you out of the real world of your shared experience, but that's okay. I, I like going to museums and looking at pretty pictures. What troubles me is that so much of food TV turned into competition shows and BS reality shows. They glorify, you know, Gordon Ramsey's a great chef. I doubt he runs his real kitchens the way he screams and yells on that show. And given the toxicity in the restaurant kitchen culture, that got a spotlight a few years ago and is still, you know, it hasn't been eradicated. I'm not in love with the glorification of screaming and yelling. But the Bear has the same problem. I mean, this 'yes chef' mentality but it's still the French brigade system and an awful lot of the chefs I enjoy talking to these days will tell you, you don't have to do that. But I think the impetus in food as an audio-visual medium. Or food presented as an audio-visual medium is very much social media [these days. And you know, on the one hand, that's fine. The more interest there is in food. Hopefully the more people may sample my podcast Culinary Characters Unlocked. Look for it wherever you get your podcasts. But look, I confused the folks at the Food Network by insisting that my show be completely factual. You know, if they would ask me to stretch a point or something, I would say no. I held it to the same standards that I held all the reporting to when I was the senior investigative producer at 2020. I believe you should tell the truth. Well, social media doesn't give a damn. Most food shows, frankly, don't give a damn. But you've got influencers who have their own agendas. Who are wheedling free meals out of restaurants. I mean, why the hell glorify to buy chocolate? It's a goddamn chocolate bar, but it's 20 bucks. That's ridiculous. Food has been turned into a designer, accoutrement. It's, you know, it's a YSL designer bag. That doesn't make me happy. But then again as a society it's harder and harder to get people to be interested in actually learning stuff. They wanna be titillated, they wanna be shocked, they wanna be amazed. And look, teaching people stuff or imparting information doesn't have to be broccoli. I believe, frankly, one of the things I'm proudest of is that Diners, while entirely factual, was entertaining as hell. You can do both. But there's no code of honor or honesty or obligation among anybody picking up a camera and going on social media and saying, look at this. Where could it go? How could it be better? Well, don't take money or free meals to go pump places up. Have some expertise in what you're analyzing. I mean, criticism's fine, but if you don't know what you're talking about, the criticism is not valid. And I look to food critics to guide me toward where I want to go and eat and what I should like and help me broaden my palate and my understanding. Is it entertaining? Yeah, fine. It's okay. But again, I'm a grumpy old man telling kids to get off the shed. So David, you know, I'm really grateful you joined us today because the Diners, Drive-Ins and Dives is such an important part of American food television history. And it's amazing to hear how it got started and where it went and your vision of how things could be better. But boy, it's just fun to talk to you about food in general and places to eat and the people. And it is just this wonderful world of connection, isn't it? It, it is. And for example, this conversation, Kelly, I didn't know you till we started talking about doing this podcast, and now you're a new buddy. I love talking food with you. BIO David Page is the President and Executive of Page Productions. He is a two-time Emmy award winning Executive Producer with a focus on culinary projects and a special expertise in creating entertaining and engaging programming that combines the highest production values with the richest storytelling. Page is best known for creating the Food Network hit Diners, Drive-Ins and Dives and executive producing the program for eleven seasons. He is also an author, having written the book Food Americana about the evolution of American cuisine. And he is now producing and hosting the podcast Culinary Characters Unlocked, featuring entertaining but substantive interviews with important people in the world of food. 
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  E296: The Story of Food Americana 08.04.2026 26min

  If someone asked you about French, Korean, or Thai food, you could probably name some signature flavors and dishes. I certainly can. Well, what about American food? What stands out for you there and what IS it, really? Today we're going to dig into the roots of American cuisine with food journalist David Page, who initially was an investigative journalist but turned his attention to food. And he's author of a book called Food Americana: The Remarkable People and Incredible Stories Behind America's Favorite Dishes. But you might also know David's work from television. He was executive producer on the hit series Diners, Drive-Ins, and Dives for 11 years. He has two Emmy awards and has his own podcast series, which is excellent, called Culinary Characters Unlocked. Interview Transcript So, here's the book: Food Americana. It's really a wonderful read and, you know, every case study you go through in the book, like pizza, Chinese food, Mexican food, every one is completely fascinating. I'd love to dive in and hear more about your thoughts about how all this unfolded. So, is there such a thing as American cuisine and how did you come to write this book, Food Americana? Well, the short answer is yes, there's American Cuisine. I came to write it out of personal experience. I became really deeply interested in food when I was posted overseas for NBC News as a producer and traveling from country to country, pre-Internet. And not ever having expected to leave America. I mean, they called me up one day and said, Hey, you wanna move to England? And from there I moved to Germany and then Budapest, Hungary. I was remarkably unprepared for all of the places I was being sent. And I kind of had a study pretty quickly. And I found that one of the best ways to understand a country or culture was through its food. You know, why do they eat so much wild boar in Tuscany? Well, because it was historically a poor region. And if you wanted to eat, you had to kill something. And what you were most likely to find that you could kill was a wild boar. When you go to Strasburg in France, why are you eating Germanic choucroute, which is, you know, pork on top of sauerkraut. Well, that reveals to you that that area went back and forth in terms of which country owned it forever. And that really awakened in me a deep interest in food. When I got back to the States, I eventually ended up creating Diners, Drive-Ins and Dives. And that got me deep into American food, if you will. And, more and more over time, I stockpiled stories and interests and decided as all TV producers do eventually, whether they actually act on it or not. Everyone thinks it's easy to write TV and it's hard to write a book. Those of us who are TV producers carry a chip on our shoulder because frankly, it's harder to write for television. You can't just sit down and type out whatever you want to type out. You've got to figure out the words that integrate with the pictures and that can move the pictures forward. But, you know, we all think we have a book in us, and I said, what interests me? And it was this. And I dived in; thoroughly enjoyed the process. To answer the other half of the question, I came to the conclusion looking at everything that I had put on Diners, looking at every place that I liked eating in various towns, there was a cuisine. It was something we constructed, much like we constructed American democracy out of other countries and cultures. And you know, when you go to a Chinese restaurant in America, all of us have gone with that real bore who looks up and says, this isn't authentic Chinese food. Well, no, it's not authentic Chinese food. It is authentic Chinese American food. Just as, with the exception of something called polpette, which are very small round meatballs, there are no meatballs as we know them in Italy. When the poorest of the poor left Southern Italy to come to the United States in the 1800s, to their shock when they got here, they found out that being poor here was different than being poor there, where even pasta was considered a luxury item and only enjoyed on a Sunday, if ever. Here, poor people could afford meat. And that is what created Italian American cuisine, which is to a great extent based on abbondanza, you know, a whole lot of everything. I live in New Jersey where red sauce cooking means open your belt and, you know, strap in for a few hours of absolute gluttony. And we've done that with bagels from Poland. In Poland, they weren't quite what they are here. But they were similar, and they were sold by Jewish peddlers in the streets on long sticks. Because they had holes in the middle, you could, you could stack 'em on the sticks and young kids would walk around the town square shouting in polish. I don't know the actual words but shouting something that translated as bagels and lemonade. When Jewish immigrants arrived in the United States, packed into the Lower East side into tenements, they did what they knew how to do. And bakers started making bagels which then became far more than a Jewish food. They became a New York food. And then in horribly awful incarnations, they became an American food. I would argue it's still hard to get a decent bagel outside of New York for any number of reasons, but bagels are American cuisine now. They're not the bagels per se that were eaten in Poland. But there's something from another country that we took and made into our own. And by the way, the cuisine continues to evolve. It now includes Vietnamese banh mi. As more and more cuisines are sampled here, they're modified by the lack of availability of original ingredients for the immigrants who are here who have to look for alternatives. And they're modified to suit broader tastes. You know, the original spices of much of Mexican cuisine... and when I say Mexican cuisine, it was basically the food of the Nortenos, Northern Mexico, because as with all countries, Mexico is a combination of cuisines based on regionality. But, when Americans started sampling, quote, Mexican cuisine, unquote, much of it was too hot for us. For the most part, those people who had lived in what was Mexico who were now living in America after the Mexican American war, when America seized half of Mexico. Those who opened restaurants realize that, you know, if you want a broader clientele, you better tone things down. That's the Americanization of another culture's food, and that is American cuisine. I'm hoping you wouldn't mind taking a little detour and talk about how magical it is to connect with a culture through food and through the people you meet in that context. You and I were talking before we started recording and you mentioned a trip you made to Spain and how wonderful this particular connection was. And I was thinking about some things I've done recently that have connected me with people and their history through their food. And there's something very magical about that. But tell us about your trip to Spain because I thought it was very interesting. My wife and I went to Spain a few years ago, and I had worked in Spain a fair amount when I was overseas as a journalist. But I'd never really had the opportunity to do much vacation in Spain. And I can't remember if it was Madrid or Valencia, it may have been Valencia. But we signed up for a half day cooking course. And we showed up and it was taught by somebody's grandmother. I made the mistake of trying to be polite and use my leftover high school Spanish, and I was the only one who in the class who did. So, she decided I was fluent, which I'm not. But she and I had a lengthy conversation during the class, which consisted of her saying things I did not understand in me nodding my head and saying, si. But it was just a remarkably wonderful experience to have my hands on and in and be learning about another culture. You know, one of the things I realized when I first started traveling much of the world for NBC and again, I had never expected to be sent overseas, was that there are a million ways to do things. You know, this is going to sound kind of gross, but until you go overseas and you realize there are different shapes to toilets, you know, people look at the same problem and figure it out in slightly different ways. You learn that there are multiple ways to approach things, to address things, to do things. And first of all, the cooking in Spain is extraordinary. And it's an underappreciated cuisine here in the United States. But, you know, we're in cooking class making a Spanish tortilla, which is not a Mexican tortilla. Mexican tortilla obviously is a disc of dough, either corn or wheat, depending upon the region. A tortilla in Spain is an omelet, but more than an omelet, it's kinda like a frittata. It's a very thick, almost spongy, egg-based product with potatoes in it. And making that and learning how to make that and the way that this teacher had clearly been making it, that she had learned from her mother, who had learned from her mother. You know, you turn it upside down to get it out of the dish. It was just a wonderful experience. And look, I've been fortunate enough to have that experience in any number of countries. This one, wasn't terribly culinary, but I was in Moscow in a bar frequented by locals. And this was under the Soviet Union; it was a long time ago. But they had the bars for Westerners where they took dollars and served the good vodka, which Russians could not get by the way. I mean, there was no Stoli for Russians. But we were in this real low rent bar and a guy sat down next to me with Asian features. And through, kind of, hand signals and some assistance from I guess one of the NBC translators or something, we exchanged life stories. It turned out he was visiting from Siberia to do some kind of business. Had never been to the big city. And he had... everything in the Soviet Union was crappy. I mean, it was made of plastic. He had a plastic briefcase. But he was here on business apparently. And as we got drunker and friendlier and you know, arms around each other and hail fellow well met, he opened his briefcase to reveal that it was filled with salted fish. He had brought his own delicacy from home because you never know what you're going to find in the big, bad city. And sitting at that bar, I had me some Siberian salted fish and it was damn fine. What a neat experience. Oh, it was fantastic. Just fantastic. You've reminded me, and I was mentioning this to you as well, but I love barbecue of all kinds from all places. And the North Carolina form of barbecue is typically pulled pork. And the Eastern part of the state is famous for cooking whole hogs, the Western part for cooking just the pork shoulder. But in the Eastern part they say they talk about cooking everything but the squeal. And there's a local restaurant in Raleigh, which is about a half hour for me and where I live in Durham. And there's a well-known barbecue icon in North Carolina named Sam Jones, who's the third generation of his family to run a restaurant in a little town called Aiden, North Carolina, which is frequently considered the best barbecue place in the state. Sam, at his restaurant in Raleigh, was running a half a day intensive workshop for those of us out there in the world who want to learn more about it. I took that workshop and it was a wonderful experience just like you're talking about. Because not only did I learn about the techniques of cooking the food and I was in their smokehouse, and it was just a great experience. But this fellow, Sam himself, was a really interesting character. And to hear about his family history and what the food means to them and how they learned the traditions and stuff was just absolutely fascinating. And I'm reaching for, I got a copy of a book he wrote on whole hog barbecue. There's Sam himself and with... Daniel Vaughn the writer. Yes, that's exactly right. What a great experience. I feel as you do that connecting with cultures through their food and meeting the people is just an incredible experience. Let's get back to your book now, Food Americana. So, you gave us the example of bagels, you talked a little bit about Chinese food, but give us some more richness to how these foods might have begun and what kind of forms they took in America. And I know you talked about pizza as one example. I thought the pizza one was especially interesting. Part of it is because I spent many years of my career at Yale University and was surrounded by New Haven Pizza, which was unbelievable. Which is called what? Apizza? Apizza. Yes. Well, that's coal-fired thin crust, right? Coal-fired. You know, I could go in one of those restaurants and just order crust and be happy. It was that good. What I found interesting in researching one of the New Haven pizzas that's legendary is clam pizza. And what I learned was that the clams weren't from Connecticut. That they were brought in from someplace else. I just assumed, because, you know, you got the water there that that was a local thing. And apparently it was not, which surprised the hell outta me. I mean, I live on the coast of New Jersey and there's a place down here that does its version of clam pizza and it is local clams. Oh, that's interesting. Pizza was the food of the poor in the South of Italy. Pizza was basically dough with a little bit of tomato. And if you had a couple of bucks that day, that week, maybe you put a piece of lard on top. I mean that, that was it. And when the immigrants began arriving in the United States and found that good food was easier to obtain, that's when pizza started to morph into what we know it as today. Now the wheat in Italy was different than the wheat here. The form of a fire being used was different. I'm trying to remember, I guess it was coal in New York at the time, and wood in Italy. So, you ended up with a different kind of crust in terms of airiness and crispness. But what you also ended up with is a perfect example of the development of American cuisine. Which is every place that pizza went, it was different. It evolved based on what was available in a particular region. You've got pizza in, I think it's St. Louis, maybe Kansas City, where they use kind of a processed provel cheese. I guess it's St. Louis. Because that's what they had. That's nothing. It's not mozzarella. It's not Parmesan. It's the local cheese. Or you have pizza in Old Forge, Pennsylvania, that was created for the miners by a bar owner using what is rumored to have been government cheese. These were poor people. So that's how that developed. You've got Detroit Pizza, which is having a renaissance moment now, but it has its square shape because it was initially baked in these blue steel automotive pans. They may have been oil pans that were liberated either from an auto factory or a parts supplier. You know, Chicago Pizza certainly developed in a unique way, although there are two kinds of Chicago pizza. There's the deep dish that, it's really a frigging casserole. And then there's cracker thin pizza that, that's delightful. But you see pizza developing according to what's around it. I mean, it's the perfect example of local, regional, seasonal. And then as pizza became a self-perpetuating thing, it then became a kind of a palette for creative American chefs to go nuts. The iconic decision being Wolfgang Puck at Spago in Beverly Hills. Putting what would be politely called smoked salmon, what else? New York Jews would call lox on a pizza with creme fresh and, you know, reinventing the world. In fact, the real reinvention of pizza in that way occurred at California Pizza Kitchen in California, where barbecue chicken pizza became a big deal. And pizza continues to evolve. I mean, I had a debate the other day with the owner and chef at an Italian restaurant about whether or not pineapple goes on pizza. And I obviously, I think that Hawaiian pizza with pineapple and ham is a war crime. He argues that doing what he does, which is a not canned pineapple but fresh pineapple that is macerated, chopped, and served with, I think, pork cheek as opposed to ham. Some more subtle, substantial use of pork that is in fact a terrific combination of flavors. And I'm not going to argue with him because that actually sounded pretty damn good. It does sound good. You know, pizza continues to evolve. What's interesting with pizza is, and I have this complaint with so much of how Americans consume food, is that given the choice between a great local pizzeria and BS factory like Dominoes, so much of America picks Dominoes. I mean, at the time I wrote the book a few years ago, 60% of pizza was sold at chains; 40% was sold at independents. But why, why would you possibly pick this cookie cutter piece of crap when somebody down the street from you is doing it right? You just remind me of so much, and when you mentioned Old Forge, Pennsylvania, when I read that in your book, I have a good friend who lives in Philadelphia. And I got in touch with him. I said, oh, I need to come up to Philadelphia, and we need to make a road trip to the Martin Guitar Factory in Nazareth, Pennsylvania. And then go down to Old Forge and try this pizza David Page was writing about and stuff. And it's just fun to do this. And I did this recently. I told you earlier, I'd made a road trip and driven part of Route 66 through Oklahoma. And stopped in this little town El Reno and had the famous Oklahoma onion burger at Johnny's and sat at the counter and talked to the cook. And I enjoyed that as much as any four-star, high end, hundreds of dollars meal. It just, it's fun. Well, but there is a misunderstanding of what good food is. I liked, well, many things about what Pete Wells did when he was a New York Times food critic. But one of the things I really liked was the fact that he evaluated restaurants based on their intent. You could be a three-star taco stand. If the promise you are making to someone is, I'm gonna make you the best goddamn taco you ever had. You have to evaluate that based on that. Not, is it La Verna dining? And frankly, our hangup with and fascination on high end haute cuisine, $350 a plate, little, tiny morsels of shit. I much prefer real food. And, you know, the foodie culture goes nuts for stuff that is fru fru, and they did this, and they did that. Making the perfect hamburger in El Reno, Oklahoma, and you know, I talked about how in Tuscany boar was the food of poverty. Onion burgers, which are considered by some purest to be the finest form of hamburger came out of, I think it was the Depression. It was certainly a time of poverty. Where you stretched a burger by adding onions to the meat. And that's a wonderful, wonderful thing. Now, I don't think it was... is El Reno outside Oklahoma City? Yes. It's within an hour drive. Yeah. It's near Tinker Airbase. El Reno is where, I included this in the book, there is a fabulous sushi restaurant in a gas station. Now the local clientele heavily Air Force people who have been in Asia, but apparently, it's phenomenal sushi. And interestingly enough, I just interviewed the chef owner of three restaurants in Oklahoma. He has a restaurant called Gray Sweater, which is highly upscale, and he has a couple of others. He was telling me that the food scene in Oklahoma has been really, really booming under the radar. And I went to school in Oklahoma. I was thrown out of both major state universities. And you know, back when I went, it was great chicken fried steak. There was some barbecue that was basically Texas barbecue that had migrated North. But I didn't see Oklahoma as culinary heaven. And apparently, it's quite the place to eat these days. I would agree with that. I went to some really fine restaurants when I was there. Plus the people are just lovely. Oh, yeah. And by the way, you talk about American cuisine. And I'm not sure if there was a direct evolution, but clearly it's an Americanized form of schnitzel. It's hard to, if you live in the East coast and you haven't had a chicken fried steak...you have no idea what you're missing. But again, food of poverty. You take a bad cut of meat, you tenderize it by beating the hell out of it with a mallet, then you dip it in egg and flour and you deep fry it. I mean that's... Oh, and the right gravy on that. Oh yeah. The cream gravy. Yeah. And, you know, don't mention it to your cardiologist, but I fell in love with that and as a college student with pure grain alcohol when I was in Oklahoma. So, it did have a couple of things I liked. I might have recorded 300 podcasts or something like that, but none has made me as hungry. This is good, right? Oh, it's great. So, let me end with a final question. And I think I can guess how you're going to answer this, but if you look at American cuisine compared to the things that it descended from, like foods from Italy and Mexico, and China and things. Is it just different? Is it authentic in its own right? Is it better worse? How do you think about that? It is wonderfully different. It has an antecedent. It's like looking at a German Shepherd and also being aware it was once a wolf. They're two completely different species. And some of the traits of one are reflected in the other, but they're different cuisines. I mean, I've spent a lot of time in Italy, thank God. And second to Spanish food, it's probably my number two all-time favorite. But, when you look at American cuisine, red sauce Italian is among my favorites. They're totally different cuisines. Chinese food, the same. You know, there's a great book and documentary In Search Of General Tso, in which the writer, Jennifer A. Lee. went looking for the guy who invented General Tso's chicken in Taiwan. And she found him and showed him what his invention had become in America. They bear no resemblance to each other. He was shocked. But I love general. Now, I can't eat it much because had a diabetes scare and had to lose a bunch of weight. But it's a wonderful dish. It is about as Chinese as Matzo. You know, it's an American invention, but remember, American Chinese food began in California after the Gold Rush when a whole bunch of Cantonese people came over to search for gold and they set up restaurants. Some came to set up restaurants for them, and they realized that Americans didn't eat offal, and much of Chinese cuisine is, you know, a nose to tail. So, they either invented or reinvented chopped suey with Americanized proteins and that's what kicked off the Chinese food boom. And there's this mall in Flushing New York that serves the food the way it's served in China. This stuff, it'll blow your mind. It's extraordinary. But that doesn't make the food that you get at a good Chinese American restaurant invalid. It's just wonderfully different. BIO David Page is the President and Executive of Page Productions. He is a two-time Emmy award winning Executive Producer with a focus on culinary projects and a special expertise in creating entertaining and engaging programming that combines the highest production values with the richest storytelling. Page is best known for creating the Food Network hit Diners, Drive-Ins and Dives and executive producing the program for eleven seasons. He is also an author, having written the book Food Americana about the evolution of American cuisine. And he is now producing and hosting the podcast Culinary Characters Unlocked, featuring entertaining but substantive interviews with important people in the world of food.
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  E295: Food engineering is fueling preventable disease 02.04.2026 47min

  Transcript Paper: Gearhardt AN, Brownell KD, Brandt AM. From Tobacco to Ultraprocessed Food: How Industry Engineering Fuels the Epidemic of Preventable Disease. Milbank Q. 2026;104(1):0202.https://doi.org/10.1111/1468-0009.70066 https://www.milbank.org/quarterly/articles/from-tobacco-to-ultraprocessed-food-how-industry-engineering-fuels-the-epidemic-of-preventable-disease/ Ashley, let's talk a little bit about, just set the stage for what this paper was all about, and since it was your brainchild, you approached Allan and me about being involved. Tell us what you set out to do and why you thought these issues were worth digging into. Ashley - You know, I've just been so struck that when we think of cigarettes, they were something that's so common, so normal that we kind of think, oh, they've always just sort of been there. But truly, they're just taking a natural plant from the ground and through advancements and corporate engineering and technology and knowhow, they took a poisonous plant and made it into the most deadly and addictive drug in human history. And yet that was, you know, just accompanied by tons of debate. It didn't look like other addictive substances. And I just really felt like, man, we're reliving this history right now when it comes to how we've altered our food supply. I wanted to really bring you all together and see if we could really lay that story out of the, the parallels of these two public health crises. We'll get in a minute into the issue of what you discovered, but tell us what you covered, what the paper was meant to do. Ashley - The paper really goes back from how you take the tobacco plant in the field, or the corn in the field, and walks essentially through all the kind of levers that are being pulled to transform it in very specific ways. And through specific technologies and corporate practices that are being shared by modern cigarettes and ultra processed foods. These products maybe look harmless on their face initially, or don't look like they're just maybe pleasurable or craveable. But truly, I would argue that they've crossed thresholds into things that are addictive and clearly damaging many people's lives. Okay, so several decades ago, I don't know who came up with a term, but there was a lot of discussion about similarities between tobacco industry behavior and food industry behavior. And the press started publishing cover pieces that would say food is the next tobacco. And it was a term that the food industry really didn't like, and they don't want that comparison at all. It'll be interesting to see whether they deserve it. You clearly made that connection in this paper. Allan, let's turn to you. Oh my God. I mean, we could do a 15-hour podcast and not cover the history of the tobacco industry. There's so much to say, enough that you wrote a massive book about it. But give an overall sense, if you will, of the kind of tactics and morality of that industry. Allan - Well, as Ashley already mentioned, early in the 20th Century we wouldn't really be thinking much of cigarettes, and they were just a very peripheral sales consumer item. And over the course of the 20th Century, we came to a point in the middle of the century of the 1970s, and '80s where about half of all American adults were smoking cigarettes regularly. I wanted to understand that. How do you take something that's at the very margin of the economy and culture and make it a dominant consumer force? And I think in that way, we have certain parallels to ultra processed foods. But then there were the questions, how do you make it so popular? Is it dangerous to use? Is it addictive? Does it cause disease? And how do you resist regulation and other public health approaches to try to keep people smoking? And I found a lot of evidence in each of those areas, both of how the industry acted. And when you say, you know, it's ultra processed food like cigarettes, we're learning a lot about ultra processed foods. But we know a ton about what the industry did to make the 20th Century what I call the Cigarette Century. And we have seen really important declines in smoking in the last 30-40 years. It's a remarkable public health effort. But at the same time, the industry worked incredibly hard and, in some ways brilliantly, to maintain the popularity of their product. And underlying all this is the idea that nicotine is highly addictive. And the industry came to understand that certainly before consumers did. And as a result, they could engineer, manage, manipulate the addictive character of a product that kills. I think looking for parallels, both in terms of how the industry did it and how perhaps public health law regulation can undo it, is the critical aspect of what we've been working on together. Okay. So, the tobacco industry did more than just take a plant, dry it out, chop it up, and roll it up in some paper. Then people might be driving whatever natural pleasure there would be from that product. But they did more, didn't they? Allan - Yes. And you talked about nicotine in particular. So how manipulated was this industrial process and was it designed to create such high levels of addiction? Allan - Well, for a long time we couldn't be sure about that. And we have learned that the industry had learned sophisticated techniques of industrial production of cigarettes. So, it wasn't like just chopping up tobacco and putting it in paper. You know, they added many additives. They added liquids. They dried it out, they put it in long strips of tobacco for cutting and packaging. And they had innovated the technologies, instead of human beings rolling cigarettes, they were able through machinery and technology to produce hundreds of thousands of cigarettes a day. And then they had to figure out how do we sell this tremendous volume of cigarettes in order to make our industry truly lucrative. So, there were those aspects. And certainly by the middle of the 20th Century, many people realize that - I smoke regularly and I crave my next cigarette and I'm smoking a pack a day, sometimes two packs a day. And people would ask, well, is it a habit? Is it habituating? Is it addictive? And as the science of addiction really grew in the middle of the 20th Century, we began to realize it had all the characteristics of addiction. But we really didn't know exactly what the companies were doing. And what we did learn in the '80s and '90s is that the companies had a precise ability to manage the nicotine in their product. And they did, so that even as they put filters on and they claimed they had safer cigarettes, they were also producing increasingly addictive cigarettes where we have craving, we have withdrawal, we have tolerance. The basic categories, that structure, how we understand addiction. Okay. We'll dive into some of those in a little more detail, but thanks for that background. Ashley, people kind of get it that drugs can be addictive and they know that alcohol can be addictive. They know that cigarettes can. But what about food? Ashley - Yes, so I think one of the things that when I take a step back, is that the reward and motivation system that alcoholic beverages, cigarettes can start to hijack and drive towards compulsive problematic use, that was laid down in the brain to make sure we were getting enough food. It's really sensitive to food reward, energy density. But the thing is you actually consume nicotine probably most days. Nicotine is actually in a lot of plants like tomato and eggplant, but nobody's getting addicted to the chemical in that delivery vehicle. I would argue the same thing's happening. When we look at our research nobody's getting addicted to minimally processed foods like bananas and broccoli, and salmon filets. It's when you're able to process and titrate and hedonically engineer food reward in a way that mimics the intensity and the sensory appeal and the spikes and crashes and the craveability of something like cigarettes, that you start to see people losing control. And when I read Allan's book, my husband was watching over my shoulder. And he's like, you know, if you highlight every single sentence, it's not gonna help you because you've highlighted the whole book. And reading what Allan laid out about how each wave of cigarette addiction, it wasn't because we suddenly discovered what nicotine was, it's because the industry got better at manipulating engineering, designing, flooding the market with it. And then health washing it, so people didn't really understand what they were getting into. And to me, that is what we've done to our food supply. And the result of that has been the astronomical increases in diet related disease and health concerns. Tell us about the concept of ultra processed food and how that fits in. Ashley - Yes. Yeah, that's a great question. So, ultra processed food is a concept that actually came out at about the same time as the Yale Food Addiction Scale, that Kelly and I published together, about how to operationalize who might be showing signs of addiction and certain foods. Carlos Monteiro from Brazil was noticing that his grocery store was starting to be flooded by foods that you could not make in your home kitchen. I have exactly no idea how to make a double stuffed Oreo or a flaming hot Cheeto, or a Cherry Coca-Cola. And as these products that were industrially created with additives and flavor enhancers that are kind of biologically novel, that's when the disease risk started to go up. And so, these foods are so fundamentally changed in they're kind of most archetypal forms of things, like sodas and, you know, your sweet, savory sort of snacks, that a whole new category had to be created for them. To really distinguish them from, you know, grandma's homemade cookies or, you know, an apple or an orange. Ashley, you're brilliant at framing things. And one of the things that I learned from you a long time ago, and I've used a thousand times in discussions with people, is thinking about food, like turning the coca plant into cocaine and into crack cocaine. That if you take the coca plant into its natural form, people can live in harmony with it. You don't really have addiction. But when you process it and it becomes cocaine, then things change dramatically. And when you hyper process it, like the hyper palatable foods and the ultra processed foods, then the crack cocaine becomes incredibly addictive. So that same sort of phenomenon I think applies here. And it's a very compelling way to think about this. Allan, let's get back to the addiction thing and tobacco. One of the most stunning things I remember about the tobacco history. Is the videotape of the seven tobacco company executives testifying before Congress that nicotine wasn't addictive. Swearing, you know, sworn statements about nicotine. Tell us about that and what that kind of meant in history. Allan - It's a great story and it has a kind of visual linkage to many of us who actually saw those congressional hearings. And it was a brilliant sort of performative politics, if you will. And there had been more and more knowledge that the industry was manipulating nicotine to make cigarettes that they were claiming were safer and not addictive, even more highly addictive. And David Kessler, the head of the FDA under Clinton, had really been a major player in this. And one thing I should say is we were learning more and more about the industry because people were suing them. And they would typically lose the suits, but they would get hundreds, hundreds of thousands of documents. And the industry also had whistleblowers who were coming forward and saying, of course we know it's addictive. So, Henry Waxman, a really fantastic congressman who represented consumers invited all seven of the major tobacco CEOs to a hearing on nicotine. And he went one by one - do you believe nicotine is addictive? And they would say, Congressman, I do not believe that nicotine is addictive. And it's like any great prosecutor, he had figured out how to get them essentially to perjure themselves in front of a congressional, and video news audience. And in fact, the Department of Justice considered for some time whether they should be put on trial and indicted for perjury before Congress. But it was so in congress, with what we had come to know, especially experts, but even, you know, parents and the public and citizens had come to know that it was incredibly difficult to get off of nicotine. It just didn't comport with our existing knowledge. And we're not quite to that point with ultra processed foods yet, but I think we have a good chance to get there because as we understand what they're doing better and we have a sophisticated understanding of the characteristics of addiction, that same question will be put ultimately to CEOs of the food industry. Especially those who are producing these highly addictive products. And there are many people who are involved in this. So, they will tell a story of how we understood we could make our product sell better and be used at a much higher level if we could make it addictive. And regrettably, as we learn more about addictive addiction, we not only learn perhaps how to help people who are addicted. But we often learn how to make certain products even more highly addictive. Ashley, let's take what Allan said and apply it into the food arena. So, if you think about the criteria for addiction, like Allan had mentioned: cravings, withdrawal, and tolerance, and, tolerance being the need to have more of the substance over time in, in order to produce the same pharmacologic effect. How do those things apply to foods? Ashley - Yes. There there's very strong parallels there. And I actually have a paper I wrote with Dr. Alex DiFeliceantonio, where we took the 1988 Surgeon General's report on the addictiveness of tobacco and nicotine in particular. And we took what they identified as the necessary and sufficient criteria to prove that it was addictive. It was a watershed moment for tobacco. And the major one is that people consume it compulsively. Meaning, you know, they want to cut down and they can't. They know it's harming them and they can't. Clearly we see that with ultra processed food. That it shifts mood. It increases pleasure. It reduces negative affect through its mechanism on the brain. And I think if you look at any marketing, you know, they're always saying you're craving meet your maker, get your bliss point. You're not you unless you're eating a Snickers. They show that it was highly reinforced. And that is, you know, animals and humans will work really hard to get access to it. With nicotine one of the major points of that is that animals, about 20% of the time, would work to get nicotine over cocaine. And that was quite striking because cocaine is so powerfully addictive. Well in those same models, animals will work for processed sweet taste and choose it 80% of the time over cocaine. It just shows that when we start altering, processing food reward into these unnaturally intensely stimulating packages, our brains were not evolved to protect itself against that. And then the final pieces that's been kind of added over time has been the cravings. I mean, if you think about what is the core of addiction, it's the craveability of it. That they maximize that. So, you can't stop thinking about anything else. And when I read, and we even quote in our paper, spots where, you know, industries, the big food is having webinars and how to turn cravings into corporate wins. And how to take snackers who are consuming, because their cravings feel unmanageable, but here's how you can keep them snacking even though they want to quit. And so, the craving really seems to me, based on my read of what I've seen from the industry, is the core engine of driving and selling ultra processed food. So, these foods, and I've heard you say this, Ashley, you know, they have less to do with the farm and, you know, these sort of romantic ideas of the farmer growing crops and the crops being harvested and coming to a farmer's market. These are really industrial lab-based, you know, heavy duty factory related products. And there's a real question, isn't there, about what you even should call them food. Ashley - Yes, absolutely. I actually grew up on a farm and I never ate anything that we grew on the farm because it was all due to Ag policy. Just, corn to go into high fructose corn syrup, soy to go into soybean oil. And I was surrounded by what looked like lots of food, but in reality, it was not. And some of the things that I learned in writing this paper with you all is just to what degree ultra processing allows them to even control the molecular structure and size of the different starch chemicals. That carby kind of access point in food. Allan talks in his book about how you can treat tobacco. So, you break it down and make it molecularly more bioavailable so nicotine gets more rapidly into the body. That's a huge driver of addictive potential. I found in ours that they were actually using enzymes that mimic what's in the saliva in your mouth. And hitting starches with it. Essentially you were predigesting, pre salivating, essentially the starch creating what's called a starch slurry. And that's a base of so many common ultra processed foods like cereals and savory snacks. Many of these products really have far more in common with that cigarette and have almost nothing in common, you know, with the apple or the can of beans anymore. You know, that image that you said about pre salivating food. I mean, it's in some ways as if the industry is spitting in your food to bypass your own biological mechanisms that occur when the food gets in the mouth and. People get a kind of a yuck response to that, but it deserves that kind of a response. Let's dive into the paper and talk about what you reported, Ashley. You talk a lot about the kind of processes. You just mentioned one of them, but there are a lot more. What are some of the specific techniques to food processing that surprised you when you started digging in. How did you get this information? Ashley - Yes, so one of the functions that actually didn't surprise me, but it made me look at it in new light, is the work on how we really changed the way we saw cigarettes when we realized they weren't just taking a plant and drying it and rolling it up. But that they were actually curating and titrating these just right doses of nicotine. So, you get stimulated, but not too satisfied and you don't feel overwhelmed by the amount of nicotine. When we realized that was very intentional and designed and titrated, that really changed this from a natural kind of product, it's just a plant to, oh, this is an in industry engineered product. They're controlling so much of this. We all know that they are altering the amount of sweetened refined carbohydrates and fats in our food. I mean, that's just plain knowledge. And at levels that go way beyond what exists in nature. But I think I've become very obsessed with extrusion technology. Extrusion is something where they take really high pressure, high shear mechanical impact, high pH, high temperature. And they can break the corn or the potatoes and things into this slurry that is broken down again into this kind of predigested molecular base that on its own is nasty. No one is like, oh, starch, slurry, yes! They need all the sensory and flavor additives to blitz that and texturize it so it can trick your brain into thinking it's appealing. I realized that actually has such a strong parallel to modern cigarette where, as Allan talks about in his book, one of the major technological advances was creating reconstituted tobacco where they take the tobacco scraps and they do the same sort of process to create what they call a tobacco slurry. That was then very easy to manipulate by putting flavor and preservative additives in it, and that's what makes up a large component of modern cigarette. And so, when we look at these processes and those sensory additives, the flavors, that are put in it, cigarettes have more sugar and flavor additives in them by weight than they do nicotine. And so many of those flavor additives are actually in our ultra processed food supply. Why? Because the flavor and sensory profiles are what you start to become really emotionally attached to. And that starts to drive brand loyalty from a very young age. I could go on and on and on. Oh man, we could be here for a day, so I'm really inhibiting myself. I'll be exhausted. I'll have to go get an ultra processed food from this. But it was stunning to me to see how the goals of the engineering were so shared. And I guess it shouldn't surprise us because, you know, we know that the tobacco companies like Philip Morris and RJ Reynolds actually created, manufactured and sold many of our favorite ultra processed foods that are now in our modern food supply, like Fig Newton's and you know, Hawaiian Punch and things. It really came from the same industrial practices. So Allan, I want to bring this back to the tobacco industry in a minute, but Ashley, I wanted to ask you first. I'm going to make a characterization. Tell me if I'm off on this. The industry is kind of manipulating every possible characteristic of a product. Its fragrance, its color, its texture, everything in the ways you mentioned. It becomes this industrialized product much more than a food. People consume it. They get immense reward from it because it's delivering a drug, basically, to the brain very quickly in a very efficient way. People then, of course, want more of that sensation. If tolerance exists, then it means they need more of the food over time in order to get the same reward. And then you've got a public health nightmare on your hand because people aren't just eating a little bit of these foods, they're eating a lot of these foods. And they're designed in order to produce that very impact. Does that seem fair? Ashley - Absolutely. That sums it up quite nicely. Okay, Allan, back to the tobacco experience. This kind of information that Ashley is talking about in the context of food, and you talked about in the context of tobacco. Manipulation of the product. As this kind of damning information became public knowledge, how did that happen in the tobacco arena? And then what was the consequence? Was it, you mentioned whistleblowers; was it investigative journalism? The hearings you mentioned were important. Scientific research, discovery. It sounds like a whole lot of things happened that made this information available to the public, which in turn changed public opinion against the industry. Allan - Yes, I think that's exactly right. It changed public opinion and it changed public policy and it took a long time. So, these are aspects that I think we have to, you know, acknowledge in thinking about public health and especially these powerful commercial interests that spend a lot of money on lobbying. They spend a lot of money on advertising. They know how to get to kids. These are very challenging. I do think, you know, early in the anti-tobacco campaigns, there were a few lawyers who said, well, we're going to sue them because they have misled, deceived, and in some instances probably acted criminally to build their addictive and extremely harmful life-threatening product. And people said, well, you know, it's everybody's decision whether they want to smoke and people quit all the time, so you're not going to do very well. And I think as a young academic type, I was very skeptical of the suits against the companies. But one thing that happened that I think was unanticipated, the lawyers asked for the company's records and their research reports and what people were doing. And they took depositions and the lawyers often lost the case, but they won an incredible archive that was incredibly self-incriminating of what the industry knew. When they knew it and how they continued to act to sell a harmful product. And I think that began to change things. So once you have documents, you know you're going to be more successful in court. Once you have some documents, you can call the CEOs in and say is it addictive? When they say no, you have documentation to challenge them about their own industry. Obviously, education is important. Investigative journalism. A lot of the documents not only came from the court suits, but from whistleblowers who snuck them out of law firms. Some of the whistleblowers came directly from the industry where they said, here's what my bosses told me. They need to know can you make this cigarette even more addictive? And they knew, for example, that taking nicotine out of cigarettes, which is not that difficult to do given the extent of manipulation, had to be something that was resisted. We could end the tobacco pandemic by just removing nicotine. Even if we did, you know, 10% a year. Many people would be able to stop smoking who cannot. But we had to array a kind of knowledge and practice and advocacy that really hadn't existed till the second half of the 20th Century. Ashley, when Allan mentioned these archives that exist on tobacco industry behavior, there's some food things in there, aren't there? Tell us about that connection between tobacco and food companies. Ashley - Yes, so you know, actually, Dr. Laura Schmidt at University of California - San Francisco, has done this just stunning work by using those same tobacco archives. Because they owned alcoholic beverage and ultra processed food and beverage companies she's been able to show really how much these industries kind of spoke back and forth. The different sectors of Philip Morris and RJ Reynolds, you know, they're big conglomerates. They were pulling scientists working on the cigarettes, or the marketers working on marketing cigarettes to kids, and putting them on and intentionally using that playbook to sell their ultra processed foods and beverages. That's very clear and very intentional. They might not say as blatantly. I feel like they learned their lesson a little bit. Oh, we're going to make this more addictive. They use synonyms even out in the public. Some of it that we report in this paper is not hidden. It's industry trade newsletters. It's interviews on 60 minutes with labor scientists where they're saying, yeah, we design these products, so you get a big flavor burst. And then it fades really rapidly because that makes you want to keep coming back for more and more and more. And yeah, addictive is a good word for that. And so there is this moment where it just becomes so implausible that they don't know that they have crossed the Rubicon into something that is hooking people. That plausible deniability that we're just, you know, giving consumers what they want, not actually engineering their desires to override what they know they should have to nourish themselves. It just feels beyond the pale to me to believe that's the case. Allan, look, you mentioned delay. And I'd like to talk about that a little bit more. There's a point in time when the science on something becomes robust. And you're very certain say that tobacco is causing lung cancer and heart disease.  And then you can't change things the next day or the next week. So, a little bit of delay is probably acceptable and to be understood. But the delay in this case between that knowledge and significant public health action policy action wasn't measured in days, weeks, months, or even years. It was decades. And you can count the number of attributable deaths to that delay in the millions. What did the industry do to make that delay as long as possible in terms of planting doubt, conflicts of interest with science and things like that? Allan - This is highly relevant to our moment because I make a few claims in the book. One is that the industry invented disinformation and misinformation. And there's always this way that says, well, I know that study appeared, but we need more information. And this was very clever on the part of the tobacco companies because they said, well, you know, that science shows this, but that science is unreliable. And we need to use different methods. And lung cancer is not a result of cigarette smoking, it's actually genetic. And maybe there are a few people that shouldn't be smoking cigarettes. We should be able to identify what's different about them. They kept finding strategies of delay, manipulation, building uncertainty. There's one of the tobacco documents in this phase that says, from now on, our product is doubt. And what they really needed to do to sell the product was to create doubt about a science that was highly robust and really important to consumers. On the other hand, I think consumers are sensitive to being manipulated. They don't like that. They don't like being tricked. They know these industries, especially tobacco industry, you know, is disreputable. And as that became the case, what did they know and what are they selling. We began to see some slow shifts in public awareness. And, you know, it's so interesting presenting the cigarette problem to a jury in 1970 became radically different than presenting the case against the tobacco companies in the 1990s. And a lot had changed, A lot had been documented and, you know, we never even thought of the idea that a company would scientifically mislead us probably until in any consequential way till the middle of the 20th Century. And now we're incredibly skeptical and I think taking advantage of the public skepticism, both politically and culturally is going to be one of the important issues of pushing back against what I've called rogue industries. They're operating unethically; in many cases, unlawfully. They're misrepresenting what they produce. And they have the idea that having addicted customers is the best customer. And Warren Buffet once said, you know the tobacco industry, that's crazy. It cost a dime to make it. You sell it for a dollar and its addictive. He said, what industry could be more, you know, lucrative than tobacco? Ashley, how do those things apply into the food area now? Ashley - Oh, my brain is just exploding with all the things I want to say. But I think I have an answer to Warren Buffett, which is if you've pulled all those same levers and pretend to people that it's food, and it's because we all have to eat, you know? And I walk around a grocery store and I, in my head, I'm like, if I waved a magic wand, and all the products in here that are masquerading as food but are actually ultra processed, chemically adulterated starch, slurries essentially disappeared. There is so little food in my grocery store. Real food. And it's also expensive. We would be rioting in the streets if we really saw the degree that we're not being adequately nourished or supported in our current environment. And it's the mirage of abundance that is totally hooking us. You know, taking us hook, line, and sinker. And so, you know, I'll have people often say to me, you know, it's food. Like can't really be addictive. We all need to eat. And to me that is absolutely true. Just like we all need pain management. And there used to be a belief, a myth, that if you were in pain, you couldn't get addicted to painkillers like opiates which we now know is incredibly wrong. That just because we need calories to survive doesn't mean that if you manipulate and hedonically engineer those products, that it won't impact the brain in a way that can drive it in compulsive problematic ways. It's so essential for us to carve out, yes, you need real nourishing food. This is real nourishing food and these other things. I'd love it if the grocery store, it's like you're walking around this spot, you know you're getting real food. Sure, you want to go get those Cheetos, go for it. But it's in a very clear designated area that you're not being tricked into thinking that you're eating something that's nourishing you when it's really addicting you. So, people have very strong affective attachments to foods. Particular foods that they like. Some of it is kind of what you grew up with, what your parents gave you, but a lot of it's marketing as well. And you mentioned a Cheeto or Coca-Cola, or a Dorito or a Twinkie or whatever it is. People don't want that taken away from them. Tell me if this is correct, the problem isn't so much that people eat Cheetos. It's that they overeat Cheetos, and then you add to that all the other thing, not just that food. But then you've got a real problem. Could it be a matter of just removing some of the especially troublesome ingredients from that. If you look at the list of ingredients on these foods, there could be 25 or 30 different ingredients. Well, what if, what if 12 of them got taken out or 13 or 15 of them got taken out? You'd still have the food; it would still have its taste. People could enjoy it, but it's not hijacking your biology. Ashley - Yes, I'm very skeptical of that as the response, because as Allan lays out in his book, we were like, okay, if we just get the tar out of the cigarette. You know, it's all fine, Vapes, right? Oh, you're vaping. It's fine. It will be harmless because our reward system is so porous to different levers that signal food reward. We see it with the non-sugar sweeteners. Look, we took all the sugar out, we gave you Diet Coke, we gave you non-sugar sweeteners. It's a get out of jail free card. And now we're realizing how much that messes up our gut microbiome, could potentially lead to earlier brain aging and so, you know, abstinence, clearly making this stuff illegal, that's never the goal. But I think that sense of saying, oh, we can just engineer our way out of this is unlikely. And we have the alternative. You know, for what should be the majority of what we're eating. I love a Reese's Cup, right? I will have an ultra processed food, but it shouldn't be 60% of the food supply, or 70% of what my kids are getting for their calories. And so again, that clear understanding that this is something that's fundamentally different from the food that nourishes us. We have the answer which is real food. If we poured even a tiny amount of the investment, even closing the tax loopholes on things like ultra processed food marketing to kids that they get tax breaks on and invested that into technology to make real food in its original food matrix affordable, accessible, convenient. That stuff is tasty. Have a fresh apple. It's just everything's been wired for that to be the minority of our food supply. That's often unaffordable and we all feel really time poor. These are solvable problems. We've just been shoving all our money towards how we make new flavor additives to sell high fructose corn syrup, starch, slurries. So, we just need to have the right in incentives in mind. Your point is very well taken that government trying to say, okay, let take out this ingredient or that ingredient is stepping into a trap. It makes all the sense to me in the world that that is a trap because. Using that philosophy requires a trust in the industry that if you ask them to take out these 12 things, they're not going to put in 12 new things that might even make things worse. And both of these industries, tobacco and the food industry have done everything but earn our trust so that's a very good cautionary note that you raised. I would say in the tobacco area, the idea of that we think that, you know, vaping will be harm reduction. And there's been a strong political notion that we should be, you know, doing harm reduction. And of course, in many instances, harm reduction can be helpful. But I found in tobacco, that I can't trust the industry to make a harm reduction product that's not going to get kids addicted. That's going to, you know, make sure that we're not using both tobacco and nicotine in the form of vape or other products. And so while many people who I admire in the public health world have said, yes, harm reduction is the way to go. I don't think that's true with tobacco. We have a lot of children and adolescents today who are profoundly addicted to nicotine. So, this discussion has led to lots of, oh my God, kind of observations from both of you. Paints a pretty scary picture of the food supply. How much manipulation there is. And how much harm gets caused by it. I'm hoping we might end on a bit of a positive note if there is one here. I'd like to ask each of you, is there a reason to be hopeful about the future? Allan, let me start with you. You're looking in on this with a unique perspective because of your years and years of working on tobacco. As you look in on the food space and see what's happening, what do you think? Allan - Well, I tend to be an optimist. I believe public policies can make a difference. I believe the courts can be used to serve consumers who have been harmed in the market. So, I have seen those things work to a really significant degree around the cigarette. Especially in countries where we have resources for education, where we can make policies that sometimes work or mostly work. I don't think I ever would've thought when I started this work in like the 1980s that we would've gotten so far. I once said to my son when he was seven, he was taking a flight with me. And I said, you know, people used to smoke on airplanes. And he said, no, that's impossible. And he just couldn't believe the idea that we had let people smoke on airplanes. And I've been collecting cigarette packages that were given out by the big airlines. Of course, you and I, Kelly, remember probably, when they start to put smokers in the back of the plane. But the smoke was wafting throughout it. And a lot of things that seem almost impossible now, were actually reduced through regulation and politics and public health. I'm very hopeful that we can use what we've learned about how to get smoking from 50% of the population down to 15 or 12, as bad as that is. And apply it to other gigantic risks like ultra processed foods. All right, thanks for that positive note. Ashley, what do you think are there grounds for being positive? Ashley - Yes, I'm also a huge optimist. I feel wildly optimistic. I just, from listening to consumer sentiment right now, the degree to which corporations are able to hack our limbic systems, I mean, you see it right now with social media and sports betting. I think in our bones as a society, we're starting to just get fed up. And to me there is nothing that is more clear cut of how industries can manipulate us than taking food, the thing we most evolved to care about and to find rewarding and nourishing, and somehow jacking it up into an addictive, harmful substance. And I have two little kids. I have a five and 7-year-old and I am just as a mom full of rage every time I go grocery shopping because they've just shoved protein in a Pop-Tart, now they're trying to tell me it's a health food. I think we're catching onto them, and I think that there is no way to go but up. And again, we already have the solution. In opiates, we are still struggling to find non-addictive pain management. We have non-addictive food and it's called, you know, minimally processed real foods. So, it's just about putting the incentives in the right place. BIOS Ashley Gearhardt, Ph.D., is a Professor of Psychology in the Clinical Science area at the University of Michigan. She also earned her B.A. in psychology from The University of Michigan as an undergraduate. While working on her doctorate in clinical psychology at Yale University, Dr. Gearhardt became interested in the possibility that certain foods may be capable of triggering an addictive process. To explore this further, she developed the Yale Food Addiction Scale (YFAS) to operationalize addictive eating behaviors, which has been linked with more frequent binge eating episodes, an increased prevalence of obesity and patterns of neural activation implicated in other addictive behaviors. It has been cited over 800 times and translated into over ten foreign languages. Her areas of research also include investigating how food advertising activates reward systems to drive eating behavior and the development of food preferences and eating patterns in infants. She has published over 100 academic publications and her research has been featured on media outlets, such as ABC News, Good Morning America, the Today Show, the Wall Street Journal, and NPR. Allan M. Brandt is the Amalie Moses Kass Professor of the History of Medicine and Professor of the History of Science at Harvard University, where he holds a joint appointment between the Faculty of Arts and Sciences and Harvard Medical School.  Brandt served as Dean of the Graduate School of Arts and Sciences from 2008 to 2012.  He earned his undergraduate degree at Brandeis University and a Ph.D. in American History from Columbia University.  His work focuses on social and ethical aspects of health, disease, medical practices, and global health in the twentieth century.  Brandt is the author of No Magic Bullet:  A Social History of Venereal Disease in the United States since 1880 (paperback, 1987; 35th Anniversary Edition, 2020); and co-editor of Morality and Health (1997).  He has written on the social history of epidemic disease, the history of public health and health policy, and the history of human experimentation, among other topics.  His book on the social and cultural history of cigarette smoking in the U.S., The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product that Defined America, was published by Basic Books in 2007 (paperback, 2009).  It received the Bancroft Prize from Columbia University in 2008 and the Welch Medal from the American Association for the History of Medicine in 2011, among other awards.   Brandt has been elected to the National Academy of Medicine and the American Academy of Arts and Sciences.  In 2015, he was awarded the Everett Mendelsohn Excellence in Mentoring Award by the Harvard Graduate School of Arts and Sciences.  In 2019-20, Brandt was a recipient of fellowships from the American Council of Learned Societies and the Radcliffe Institute for Advanced Study.  He recently served as the interim chair of the Department of Global Health and Social Medicine at Harvard Medical School.  Brandt is currently writing about the history and ethics of stigma and its impact on patients and health outcomes.  
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  E294: Liberatory Agriculture in Afterlives of the Plantation 26.03.2026 27min

  In 1881, African American educator and political leader Booker T. Washington founded Tuskegee Institute in Tuskegee, Alabama. The school's mission was to provide practical education and vocational training in fields such as agriculture and mechanics to African Americans in the post-Reconstruction South. Tuskegee ultimately became a world-renowned agricultural and industrial school for African Americans – and actually for all people. Today, we're speaking with Duke University's Jarvis McInnis about his award-winning book Afterlives of the Plantation: Plotting Agrarian Futures in the Global Black South. Interview Transcript Jarvis, I cannot tell you how much I appreciate this book. And hopefully we'll make a link to the Franklin Humanities gathering (https://youtu.be/rfSy1lWWOwA?si=dVcWH3xDBuBStEEc) that we had for your book launch. As I said at that time, and I'll say it right now, this book resonated with me so deeply because of my rural upbringing. My experience as a son, a grandson of farmers and agricultural workers. And someone who grew up in the 4-H Club down South. Hopefully we will get to some of those topics as we go through. So, let's start off with a real basic idea. Could you give our readers an overview of what the book is? And also, about what you mean by the Afterlives of the Plantation. Yes, absolutely. Thank you so much for that question, Norbert. The book is an effort to think about the cultural and intellectual and political ties between Southern African Americans and Afro-Caribbean people in the late 19th to early 20th Century as they were responding to the legacies of slavery, right? This is the period after emancipation, and across the hemisphere. And so, I'm really interested in the way that they are sharing ideas as they are confronting the new modes of racial oppression that emerged in slavery's aftermath. In the United States, you have Jim Crow, right? Segregation, and other forms of violence and dispossession like lynching and land dispossession and so forth and so on. And then in the Caribbean, in Latin America, you have institutions like the European colonialism, and US imperialism, right? And so that is the afterlife of slavery. They're emancipated, but it's not a period of full citizenship, right? Of full access to the rights and privileges of citizenship. And so in telling that story, I center Booker T. Washington's school, the Tuskegee Institute, which was founded on the site of an abandoned and burned cotton plantation in Alabama in 1881. And this is getting at the second part of your question. I became really fascinated by what it meant to establish a school, to establish a future-oriented institution, that's committed to uplifting Black people. To establish that on the site, on the ruins of a burned plantation. And, in some ways, I became curious about that as an undergraduate student because I'm a graduate of Tougaloo College, in Tougaloo, Mississippi, which is a historically black college much like Tuskegee. And much like Tuskegee, Tougaloo was also founded on the site of a former cotton plantation. And I saw that this idea, or this practice, this logic of transforming these sites of violence into something that is more liberatory and more emancipatory was really a strategy that Black people used throughout the US South and throughout the Caribbean. Throughout much of the Americas where slavery and the plantation had existed. I placed Tuskegee, and particularly its approach to agriculture, at the center of that story to demonstrate how an institution rooted in the US South is not backward. It's not pre-modern. That's firmly rural, but that rurality... they're taking the knowledge that's cultivated there and disseminating it to other Black people in other parts of the world to aid in their struggles toward freedom and citizenship. I think this is an important point to make. And I know we've had conversations about this as you were developing the book. And I'll just say again, out of my rural Southern agricultural background, I often found a sense that people thought, oh, well you must be backward. Oh, you must come from this... and that's not a good thing. I can only imagine that people of this time must have thought, well, shouldn't people want to move away from agriculture? Why would you want to be invested in this thing that was a part of former enslavement? How do you think about this in light of this notion of agrarian futures? You would think people would want to move away from that. What is your understanding of sort of this move towards agriculture and seeing this as something for the future and even modern. That's such a great question. And I, you know, I have to say that I came to agriculture relatively late in the project. I was initially most interested in what Tuskegee was doing with Black aesthetics: with photography and with music and with literature. I'm a literary scholar after all. But as I sat with Tuskegee's aesthetic output, I realized the significance of agriculture within that. And as I began to explore the ways that Tuskegee was being disseminated to other parts of the Black world, to places like Haiti, to places like Puerto Rico. And as they were admitting students from those particular colonies at that time. Now some of them are countries; Puerto Rico is still a territory. But I realized that what other Black people, both in the US South and abroad, were interested in was its agrarian vision. Was the work, the research that someone like George Washington Carver was doing at Tuskegee and as a mode of self-help. And so I really had to wrestle with that because it was outside of how I had conceived of agriculture. And in many ways, writing this book transformed my own understanding of what the modern was. And, you know, forced me to, or perhaps invited me, to think about agriculture to understand it as intellectual. To understand it certainly as a skill, in all of these ways that I had not really given much thought to it previously. But as I sat with George Washington Carver's bulletins. As I sat with Tuskegee's extension initiatives. As I sat with the knowledge that they were producing, the various print cultural artifacts, the newspapers. And again, the agricultural bulletins and so forth and so on. I realized, wait a minute. This is a site of knowledge production, and its modern up-to-date knowledge production that actually still has a lot of sound basis that can be used in contemporary agriculture to this very day. And so, it radically transformed my understanding of Tuskegee, of a figure like Booker T. Washington. who as we know, is a much-maligned figure in Black studies and American studies because of his conservative politics. But agriculture gave me another way into that institution and to think about, again, the significance of the cultural and intellectual contributions of the US South at this particular period. Thank you for that. I want to talk about a particular section of the text that has to do with both the agricultural philosophy, but also this idea of sharing information, and you've made some reference to it. So, I grew up, as I mentioned, going and being a part of the 4-H program, which was a part of the Cooperative Extension System. And Tuskegee, in many ways, helped form and helped inform what extension would look like. Which ultimately became a thing, federally, in 1914. But I want to read this one passage from your text, and you say: "In 1897, the state of Alabama passed legislation allocating $1,500 to establish an agricultural experiment station on campus. The station also known as the Experiment Plot." And plot is something you come back to. And I would love to hear your thoughts about this garden plot and the Experiment Plot and just the metaphor of plot throughout your text. "But the station also known as the Experiment Plot, was managed by George Washington Carver. Washington insisted that the experiment station ' should not be used for scientific experiments of interest only to experts. Should deal with the fundamental problems with which the Negro Farmers of Alabama were daily confronted.' The results of Carver's experiments were thus published in bulletins that were then distributed among farmers throughout Alabama and the broader US South." And then you go on and talking about the different courses that were made available. But I wanna get this one quote from the Tuskegee student. And you said the Tuskegee student observed: 'Tuskegee Institute is primarily a school for the masses of our people. Both old and young and in all degrees of development.' I mean, Tuskegee was doing something that other land grant institutions would eventually take on, is this idea of sharing knowledge and using this. As a means of uplift and I would say even citizen building. What are your thoughts about that sort of perspective? Yeah. Yeah. I'm going to try to wrap all of those questions up into one response. We'll see how successful I am. I know I gave you a lot. Well, one of the things that I wanted to say, that I did not get a chance to say in my response to your previous question is that, you know, the majority of African Americans lived in the South in this particular period. And many of them viewed agriculture as a viable future. And that was one of the aspects of, you know, doing research on this book that was transformative for me. Was understanding that they did not hold this same necessarily, sort of, denigrating attitudes toward agriculture. In part because the United States was largely agricultural writ large, right? [00:11:00] And so it was across the country, across the color line, was regarded as a viable pathway. But it is the case that Booker T. Washington was attempting to rebrand agriculture, to re-signify it. Because there were a number of African Americans who did not want to have anything to do with it because it reminded them of the degradation of slavery. And so, what Washington said was he said, hey, you know, that there's a distinction between working and being worked, right? Being worked means degradation. Working for oneself, right? Being independent is a mode of civilization, is what he argued. And so what I argue in the book is that Washington is attempting to resignify labor, to make it something that is regarded as self-proprietorial, right? And that is a necessary tool in not just labor but agricultural labor in particular. But we can add, I would say, industrial labor also as something that is self-proprietorial and that is a part of that citizenship making project. So, I wanted to be sure to home in on that aspect of your previous question. And then I think the way into this next question is to talk a little bit about the plot. The slave garden plot. So, this idea in the book, right? The subtitle is Plotting Agrarian Futures. And there are multiple residences of the plot throughout the book. But the easiest way to, sort of, describe it is that it is an elaboration on the slave garden plot. The patches of land that enslaved people could cultivate throughout the Americas to grow foods to nourish themselves, because the rations that were provided from the plantation owners, those rations were too meager, right? A number of scholars and theorists across disciplines have theorized that the slave garden plot was a site of resistance to the plantation system. In part because it is enabling them to survive, to live, to nourish their bodies, right? But also because of what they did on the plot, right? Not only growing food, but also perhaps growing flowers. There's one scholar who regards it as the botanical gardens of the dispossessed, right? And so this idea that on these garden plots where they could cultivate food for themselves, their time was their own. They weren't growing food for sale on the global market, necessarily, or other cash crops for sale in the global market. They were growing foods that perhaps have been a part of their diets in Africa. And in addition to that, they were engaging in communal practices, singing, dancing, and sometimes perhaps even plotting revolutions, right? Another valence of the plot. And so, a scholar like Sylvia Winter establishes a kind of dichotomy between the plot and the plantation under enslavement. And when I realized that Tuskegeeans were also trying to encourage Black folks to grow food, and in doing so helping them to circumvent the predatory practices of sharecropping, of tenant farming, that would have those sharecroppers and tenant farmers to buy their foods from the local commissary and to remain in cycles of debt. And that of course, that they had an experiment station that they called an Experiment Plot. I thought, okay, this is the post emancipation iteration of the slave garden plot. It stands as a counterpoint to the plantation system, and it is imbued with these logics and ethics of care. And one of those logics and ethics of care is the dissemination of knowledge, right? Ensuring that rural Black farmers who were perhaps too old to attend Tuskegee, or could not afford to do so, that they could come to campus and learn the most up-to-date agricultural knowledge, right? And for those who couldn't come to campus, to attend the Tuskegee Farmers Conference, they would take the Jessup Agricultural Wagon into the countryside and teach them about crop rotation. Teach them about how to grow certain food crops, right? Teach them about how to grow certain plants to beautify their homes and so forth and so on. And so I think about that dissemination of knowledge, right? Whether it's those farmers coming to campus or Tuskegee taking those ideas into the countryside, as an ethic of care that is connected to the way that the plot exists as a counter to the plantation. Yeah. Wow, this is really wonderful. I love how you're able to weave in this agricultural philosophy that had deep resonance with people of the rural American South. But you also saw this as something that moved beyond the borders of the American South, and thus in your subtitle, the Global Black South. How did Tuskegee get involved in this transnational sharing of knowledge, and working in the Caribbean, and particularly, Puerto Rico, Haiti? Tell us a little bit more about that experience. Absolutely. Absolutely. Tuskegee really began to recruit students from the broader diaspora in the latter part of the 19th Century. So, around 1897. Certainly, the Caribbean, certainly Cuba and Puerto Rico, following the Spanish American War. And Booker T. Washington sent a Tuskegee student who was actually fluent in Spanish into Florida, and then later on to Havana, to recruit students to Tuskegee. He understood, he believed, that because they were experiencing conditions that were very similar to African Americans, they too were responding to the afterlife of slavery in the plantation. Given that emancipation in Cuba and Puerto Rico, in particular had just occurred in the late 1880s, he believed that their conditions were very similar to those of African Americans and that they could benefit from agricultural and industrial education as well. And there was a reformer by the name of Grace Mins. She was based in Boston. And she ensured that Booker T. Washington's autobiography, Up From Slavery, was translated into Cuban Spanish. And then that autobiography was then disseminated. A thousand copies were disseminated throughout the island of Cuba. And so as a result of that, he inspired, or the model of self-help that Washington depicted in Up From Slavery, inspired a host of Afro-Cuban readers. Students and parents and government officials and educational officials then begin to write to Tuskegee, write to Washington, wanting entry into the school. It's also translated into French, right? And so, you have French readers, particularly in a place like Haiti coming to Tuskegee. Someone by the name of the Jean Price Mars, who was the foremost Haitian intellectual of the 20th Century, actually met Washington in France when Washington was traveling there on vacation and became inspired by that model. A year later, he comes to the United States to attend the 1904 World's Fair and then spends two weeks at Tuskegee, learning those ideas and wanting to take them back to Haiti. So, through translation, right? Into different languages, those ideas then circulate throughout the Black world, but also through efforts to actively recruit students from those other places that Washington understood as experiencing a similar condition as African Americans. People whom he understood could benefit, he believed, could benefit from agricultural and industrial education. Great. And one of the things I loved in the way you talked about this in the text is you talked about not only translation but transplantation. And I thought that was an interesting turn of phrase because of what you were trying to communicate through that term. I want to, sort of, bring us up to some things that are currently happening. We just had a conference and you were a participant on a panel on humanistic issues around addressing food waste. And I've got to say, this was one of the panels that people really leaned into, that were really caught up by it. And you made some really insightful interventions based on some of the work that you've done in your book. So, you spoke about the anti-waste ethos at Tuskegee and I really found that interesting. Could you speak to that for a moment? Absolutely. Well, first I want to say thank you again for the opportunity to participate in that symposium. I really enjoyed it, and it really gave me an opportunity to think about various dimensions of a kind of anti-waste ethos at Tuskegee. And I think that there are a couple of different ways in which it manifested at the institution. So first there's a kind of metaphorical dimension to waste at Tuskegee. When Booker T. Washington writes to George Washington Carver to hire him, to recruit him to the institution. He said, I can't pay you a lot of money, but we have been tasked with helping to transform formerly enslaved people from conditions of waste to full manhood. Right? And so there is that sort of metaphorical, or what I would argue in the book is a kind of ontological understanding of waste, given the degraded status of the enslaved. And then there's a kind of philosophical dimension to waste as well. One, so Washington, Tuskegee, they are informed by the progressive era, right? It's a progressive era institution that's guided by a commitment to thrift and economy. And so, they're very much interested in a kind of practical attitude toward not being wasteful, right? To being thrifty with money, but also with resources. And what we see is, you know, complaints about food waste in the dining hall at Tuskegee, right? A very practical issue for a poor rural institution wherein the students are growing the food, right? Wherein the students are making the bricks, right? Are helping to transform this plantation into a school. We can't afford to waste food, right? But they're also teaching students and Black folks in the countryside how to preserve fruits and vegetables. There are these photographs of them teaching folks how to can and preserve fruits and veggies, right? To ensure that they have food throughout the winter months, so that they are not stricken by hunger and poverty and starvation. So that they aren't forced to borrow additional money from the plantation owners if they are indeed in sharecropping and tenant farming arrangements. And so, the last aspect I suppose of waste at Tuskegee that I want to highlight here is a kind of ecological one. Where in George Washington Carver is calling on farmers to take advantage of the quote unquote waste that is on their farms, right? The cow manure, right? To regenerate the soil. The swamp muck, right? The dead leaves, the night soil; to use that waste to regenerate the soil, to replenish it, right? In addition to practices of crop rotation and so forth and so on. And so that ecological dimension of waste is really important for understanding Tuskegee's ecological vision. I think this is so important because conversations around regenerative agriculture, and going back to, sort of, broader notions of traditional farming practices, minimizing the use of chemicals, people were talking about this. Folks like Carver were trying to find ways of using very little resources to help support the growers that he worked with. And we're hearing these echoes again and again. I'm so grateful that you illuminated that throughout your text. Thank you. I am not the only one who seems to have appreciated that because you won the 2026 Association for the study of African American Life and History Book Prize and the 2025 On the Brink book Award from the University of New Mexico School of Architecture and Planning. Why do you think this narrative of agricultural liberation is resonating with people so strongly? You know, first of all, Norbert, I just have to say how honored I am that the book has received these recognitions. And that it's finding its audiences. Audiences that I couldn't have imagined. Imagine my seeing my face when I opened the email to see that it had been acknowledged by both of these institutions. But especially the architecture and planning. I thought, oh my goodness. I, could not have, I could not have imagined this. So, I just want to say that I'm grateful first and foremost. You know, as I've been talking to people, you know, and as I've been moving around and talking to readers at my book tour, or people have been writing to me via email, what I've found is that the historians really appreciate the archival richness, and robustness of the text, right? So, the historians, the literary scholars, they really appreciate that aspect of the book. Many people, I think, also really appreciate the fact that it is giving us a new way to think about Tuskegee and Booker T. Washington. A place and a person who we thought we knew, right? And not in a flat way; a way that holds the complexity of that institution in place. And throughout the text, I really try to wrestle with the critiques, the valid and legitimate critiques that are coming from people like Ida B. Wells Barnett, and WEB Du Bois, about the limits of Booker T. Washington's political philosophy. But at the same time, I say, but if we don't acknowledge what they were doing through agriculture and by extension through aesthetics, then we're missing a really important part of this story, right? And I think that the book is giving us a model for thinking about how to engage in criticism that is both generative and productive, I suppose, right? Like how do we hold them to a particular standard where we say, you know, here are the limits of your political vision, but at the same time, this is what you enabled, right? And that's what the text is trying to do. And I think, you know, others have shared that they appreciate that it honors the intelligence and sophistication and dignity of Black rural people, of Black Southerners, who in my opinion, are often written out of Black studies in a way that is substantive. In a way that honors their contributions, especially in this period. The South is a space that people are simply fleeing from because of Jim Crow. And I'm saying, wait, what about the people who remain rooted in the land, on the land, either in the US South or in other sort of rural places throughout the diaspora. And then finally, I think that the book seems to be connecting to people who really care about our world. Who really care about the state of environmental degradation that we have found ourselves in as a result of institutions like the plantation, of monocrop agriculture, of industrialization in the way that it abuses, and misuses the earth. And so, because the book is invested in thinking about regeneration and repair, and about more sustainable methods from the past that can be useful for our present. I think that it seems to be connecting with readers who are interested in issues like climate change and environmental catastrophe. So that's what I suspect, based on some of the feedback that I have received. But I just want to reiterate just how grateful I am that it is finding its audience. BIO Jarvis C. McInnis holds a BA in English from Tougaloo College in Jackson, Mississippi, and a Ph.D. in English & Comparative Literature from Columbia University in the City of New York.  Jarvis is an interdisciplinary scholar of African American & African Diaspora literature and culture, with teaching and research interests in the global south (primarily the US South and the Caribbean), sound studies, performance studies, and visual culture. Jarvis's research has been supported by numerous grants and fellowships, including the Mellon Mays Undergraduate Fellowship, the Ford Foundation Pre-doctoral and Dissertation Fellowships, and Princeton University's Department of African American Studies postdoctoral fellowship. His work appears or is forthcoming in journals and venues such as Callaloo, MELUS, Mississippi Quarterly, Public Books, and The Global South.
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  E293: From Truffles to Trash - Lessons on Food Waste Prevention 19.03.2026 23min

  Over the last several years, I have been thinking about food waste and food loss a lot. It's been a topic that we've seen in many spaces in the US and around the world. And it's interesting to compare how the US handles food waste with other countries. To that end, we will learn more about how Belgium addresses food waste in a conversation with an anthropologist and journalist, Dr. Kelly Alexander from the University of North Carolina at Chapel Hill. Her book, Truffles and Trash: Recirculating Food in a Social Welfare State, explores community driven solutions and policy around food waste. And Belgium's capital city of Brussells. Interview Transcript Let's start with your research in Brussels at a high end truffle restaurant... but you ended up in food banks and social restaurants and community kitchens. Tell us a little bit about the evolution. How did this project evolve to finding yourself in these new places? Yeah, it's a, a strange trajectory. I did not start out to be a food waste researcher. But how it started and how it's going, you know, that meme from 2018? This is like what I love to talk about when I talk to my food study students, because I started out, as a researcher, very interested in the development of haut cuisine. I had worked in a lot of restaurants. I had worked as a journalist for several food magazines. And the question that really animated me was how a truffle, this little spore on a fungus, has become one of the world's most expensive ingredients. And so I was doing ethnographic research in the kitchen of a Michelin starred truffle restaurant. And there is not that many of those, and one of them happens to be in Brussels, Belgium. And I'm in the kitchen there and I'm working on the line. And I usually have to specify to my students like it wasn't a stunt. Like you can't write to a Michelin star restaurant and say, 'Hey, can I come on in and work in your kitchen?' I had a lot of credentials as a journalist and as a chef first. What I did have going for me is that I was in a funded doctoral dissertation program, actually the anthropology program at Duke. So, I had funding to go and do that research in this kitchen. And there's probably no restaurant in the world, no matter how high end, that is not willing to accept some free labor. So, I'm working in that kitchen. I'm working with fantastic chefs. And what happens when you work at a super high-end restaurant is that is aesthetics are valued above all else. The food has to be really, really beautiful. And this restaurant charges extraordinarily. It's called La Truffe Noire. It's still in Brussels now. It's a truffle restaurant. The black truffle. Super high prices for very, very refined food. And in order to do that, a large part of my job was brushing priceless truffles, throwing away an unbelievable amount of very beautiful produce that would otherwise have been exceptionally valued in other contexts. And I come from a background - my grandmother was a Russian Jewish woman. She grew up in Brooklyn. She moved to Atlanta, Georgia after World War II. She taught me to cook, and she never threw anything away. And when I say that to people, I think they're like, oh yeah, I have a grandmother like that. But she really never threw anything away, like can of grease under the sink. The whole thing. Every little butt of a vegetable was saved for stock for later. And I was throwing away so much good food working in La Truffe Noire just making beautiful garnishes and vegetable carvings and things like that, that I started following the food waste around the city. I was wondering where all of this went. And I actually asked the chef in the restaurant, you know, we throw away so much food, would it be possible to give some of it to people who could really use it? And his response really interested me and changed the whole course of my research because he said, I am really willing to do that. However, I pay chefs to cook food and not to give it away. So, if somebody was willing to come here and pick it up, I'd happily give it to him. But I'm not going to pay people to go and do that. And I thought, well, I wonder what else is going on in this city in terms of this. Like where does all this food go? And I discovered I was doing this research at a fortuitous moment in the EU when the EU had just made this compulsory policy aimed at supermarkets. So, all large scale supermarkets across the EU were suddenly required to donate all edible but unsellable food. And the EU didn't give a lot of direction about how they could do that, and also didn't give the supermarkets any money. So, what happened as a result of that? Well, there were lots of local grassroots efforts communicating directly with supermarkets who were like, 'Hey, we're over here. We'll come pick up the food that you don't want to sell that's still good to eat. And we'll use it in our food banks and in our zero food waste popup restaurants.' And all the supermarkets had to do was get the food waste off their books. So, while I was there working in this truffle restaurant, all this other food waste activity was going on. And I discovered that's really what I wanted to be doing. I loved working as a chef, but I wanted to see what the possibilities were for recuperating food around the city. So, I changed. I changed everything I was doing pretty quickly. Oh, this is really fascinating. Thank you for sharing that. I know that the field of anthropology and other fields, you can start off on one project and discover that there's this whole new world that you didn't even realize until you started down the path. This is fascinating and I'm sure your advisor was thrilled to know that you wanted to change topic midstream. But it worked out. It worked out beautifully, it seems. It is true. I couldn't look away from the food waste to the point where I was taking pictures of the garbage can in the restaurant every day. And this big industrial garbage can filled with like priceless wild mushrooms. And a big part of my job is the restaurant made this dish. This is what changed my life. There's like a series of food journalists who talk about the dish that changed my life and what they're talking about is when you eat something super delicious and you have some kind of awakening, this is like the opposite of what happened to me. I am making this dish called Salad Stephanie. It's like a 40-euro salad that has a lobster tail in it and all these beautiful wild mushrooms, and it has eight spinach leaves. So, a big part of my job when I worked at La Truffe Noire was to hold up individual spinach leaves up to the light, and if they had any blemish or like a broken vein in them to throw it away. So, this is beautiful, this is like the best spinach that you could get. The best produce in all of Europe was coming to this restaurant and I was throwing it away. And I started taking photographs just to document all the food I was throwing away. And I couldn't look away. And actually my advisor, Dr. Anne Allison, in cultural anthropology at Duke, was really excited because I had been doing a project on aesthetics and now I was proposing a total change to do this much more political project about where food waste goes. So, she was like, yes, let us follow the food waste. This is so much more interesting. So that was kind of a nice nod that I was thinking in the right anthropological direction about food and value. Thank you. This is such an important uncovering that, you know, research isn't static. It's not linear. It takes deviations and it's in those deviations that you find the real truths. The real exciting things. Let's continue the conversation because I think there's so much more to uncover. In your book, Truffles and Trash, you describe a particular day of field work at a Brussels food pantry. It was a really powerful moment. And I will say, having worked at food pantries in different parts of the US, I recognize this story in a serious way. You mentioned that this moment turned into a tense moment around fish and pork. Can you describe this to our listeners and why did this experience stick with you? What did it teach you about the hidden social politics of food waste and redistribution? Yeah. I often frame, you know, I did this work back and forth to Brussels for about six years and certain moments just absolutely have stayed with me and haunted me in a lot of ways. And one of them was working at this food bank in a former hospital. So, there's a former hospital that had shut down. It was still like a hospital with rooms for sick people in a giant sick bay. And it had been turned into a kind of community residential center where people could rent rooms, they could use the kitchen to prepare their food. That had been the hospital's kitchen. And the bottom floor of it, which had been the whole emergency triage center, was turned into a thrice weekly food bank. So, I'm volunteering at this food bank and there's tons of food coming in from grocery stores. And this is Brussels in the summer. It's pretty hot outside. A lot of people go on vacation. There's a lot of expensive food coming in, including fish and pork, fresh fish and fresh pork. I am assigned to work on this station. The person who usually runs the station, who is my boss, is an older Vietnamese woman who's an immigrant herself to Brussels. And she is kind of giving me the ropes. And she has figured something out where she says, you know, we have to give equal things to equal people, right? And she's telling me this before anybody comes in the food bank. Yes, sure. We will give one to one to each person as the people are coming through the food bank. Brussels has a very high population of Moroccan immigrants, and this is due to historical factors. The Nation of Belgium invited Moroccan immigrants to help them build their subways in the '50s and '60s with the promise of citizenship, including they have an amazing educational system. It's a whole social welfare state, healthcare, everything. So, this is guaranteed to those Moroccan immigrants. What the Belgian government didn't do, and has been pretty clear on admitting, is create any social programming around those assimilation efforts. So, the generations of those people who came to build the subways are now a lot of them living on social assistance. That is who is coming through. A lot of Moroccan people who are Muslim, into this food bank. Muslim people typically have prohibitions against eating pork. So, we have fresh fish and fresh pork. There are women coming through, they're in hijabs, they're obviously presenting as Muslim and they are asking, could I have the fish please? And we were told to give the pork first and then the fish, because the fish is considered more valuable. And I am thinking, in my own head, oh, I'll just be an amazing social innovator here. Yes, of course. If you don't eat pork, please let me give you this fish. It is not occurring to me that other people coming through the line are considering this preferential treatment. So, I am giving fish to these Muslim women. One of them sees me in line and says, my friend is back there. Can you put aside a piece of fish for her? Yes, sure, no problem. I set it aside. A woman who is Flemish is coming through and she's speaking to me in Dutch and I'm handing her pork. Pork is super popular amongst Flemish diners. No problem. And she's pointing down and she had seen me put the fish away and said, can I have that fish? Well that fish is for someone else and she absolutely threw a fit. No, you can't do that. It's not fair. It's not just, you must give me a fish. Long story short, there's a whole tug of war between this package of fish. There's a security person at the food bank, which I had not considered why there would need to be a security person at the food bank who has to come in, break up this fight. It was, it was so humbling. I had not considered these factors. It's really on me. It's like you as a social scientist who's thinking it's not on me to innovate this food bank's pantry. I didn't follow directions. I thought I was doing a good thing. You know, the whole war over this fish. And when you see what it means to someone's culture to eat the foods that are appropriate to your culture, I would fight if someone was like, you can't have that matzo ball soup again. I'm going to take it away from you. There's no telling what I would do to get my hands on it. And I just felt in that moment, like I had done it all wrong. Like I had really misunderstood food waste distribution. But more than that, of course, I'm not the star of this story. If you are at the mercy of what is available and without choice... anthropologists spend a lot of time talking about the good life and what constitutes the good life and studying the good life. I would define the good life as being able to eat the food that you wish when you wish for it. If you don't have that and you are at the mercy of the state to decide what is appropriate for you, then you find yourself in these kinds of conflicts. And you see them, you said you could relate, you see them in food banks playing out all over the world. Yeah. First, Kelly, thank you for sharing that because I know that wasn't a fun story. I mean, I can only imagine the, the, the pain of you watching this scene unfold. I mean, that must have been difficult. Especially when the security guard is called in. Okay, that's tough. And realizing that there were differences in cultures that were clashing. All of that happening at the same time. And one of the things I pick up out of this story is that which is considered food that could be wasted, that could be redistributed, is not acceptable for all people. And like, how do we then make sense of that? Because you're in a culture where something is considered a good product...pork, but it's not considered a good product for other people. And so, you know, our food system, and I always say this about food banking in general, people complain about the foods that show up in food banks, in sort of a traditional sense. But it's just a reflection of the food system of that country, right? It just looks like what we have. And we may think that's not good, but it's, it's what you see in the grocery store often. And for all those reasons, I think there's such a richness to this story. So, thank you for sharing and also the humility it takes for telling that story too. I wanted to not be intrusive like any social scientist. I was there to share my time to do some participant observation research. Suddenly I had ignited this culture war amongst these two women, which is the least population I would want to affect. And you know, the security guard turned to me at the end of it, which is in the book and said, you get what you get. That is the policy. Yeah. If they want to trade when they get outside, you do not decide. You get what you get. That's how we do it. And I saw the wisdom of it in that moment. But at the same time, to your point, you see, sort of, like there have been much bigger tensions in Europe, especially around halal meat. You see it in France all the time, should McDonald's serve halal meat. And there's a certain very conservative contingent of Flemish people who are like, you can't tell us what we can eat. You can't tell us how we have to butcher our meat. And that's what I had seen firsthand happening in a food bank, which you think of as a place of lack where politics don't come, and politics are there. Yes, very much so. And the idea of equitable distribution; it can feel restrictive in some ways, but it serves a purpose. And like I said, I really appreciate you sharing that, and I think it's an important thing for all of us to understand the complexity of those environments. I want to move on and ask about sort of regulatory and legislative realities in Europe. So, Europe, as you mentioned, has this compulsory legislation requiring supermarkets to donate edible but unsellable food. While in the US food redistribution is often framed as charity. How does this policy difference shape what's possible? Yeah. This is the question. So, you know, one of the things I learned, even in that example. I always highlight like my worst, hardest, saddest day of participant observation in six years, which was that one. Which shows a kind of flaw in a food bank model. And sometimes I have students who say, oh, you hate food banks. I don't hate food banks. I think food banks have a lot of flaws. And what they do is continue to reproduce this structure of givers and receivers, right? Like there's, on one hand, one side of the equation are people who are giving food and on the other side who are people who were receiving food. And one thing this policy did this, like compulsory policy of forcing supermarkets... and you can't really force them, you can only levy huge fines with them. Which is... I am a big fan of policy with teeth, not just policy, but policy with teeth. You will have to pay a huge fine as a supermarket if you don't want to do this. And very few supermarkets have had to pay that fine as a result of this. There was massive compliance. But one thing I discovered was really better ways than food bank models, or that I think are better ways. In part because they're more equitable. And one of them is this concept of a social restaurant, which is very European, although you're seeing them spring up in the US more and more. So, a social restaurant, according to this model, is a government institution. It's funded by the government. And it has internship programs that people who are job seekers can apply to. They can learn skills on the job to work in restaurants, to work in the service industry. This is really important in a place like Belgium where there are two official languages, French and Dutch, but most immigrants come with only one, if any. And to be bilingual in a job market makes you far more competitive. So, you can learn this in these restaurants. You have language lessons. And then you also learn how to run a restaurant. The restaurant is entirely powered by this surplus distributed food from supermarkets, which gives you an idea of the scale. In my thinking, I was like, how can a couple of supermarkets possibly be giving an institution so much food that it could run a restaurant? The restaurant where I worked called Bel Mundo had four gigantic rooms of freezers, all of which had been donated, and they were turning away supermarkets. So that's how much food was coming in every day, just to say that. And so my greatest day of field work was called Steak Night. You wouldn't believe that you could find steak that was coming from a supermarket into a zero-food waste restaurant. And by the way, the restaurant sells meals at a lower cost. A lot of the meals were for pensioners. And also sliding scale. So, you know, one day I walked into the kitchen and there were 25 steaks, and they were fresh and they were going to expire in the next couple of days. And we needed to make them. The chefs were so excited. The chef trainees were so excited that diners were so excited about Steak Night. It was easily the happiest day of field work I'd ever had. People were dancing in the kitchen, we're playing music. It felt like we were doing something that was really luxurious and that's what that kind of policy can enable, right? There was a freezer full of unsold Christmas gooses from December that were then served for spring for Easter. That was like amazing. It's just another model. It's another way of doing things, right? That that policy made possible. Yes, and that's a great set of examples of how we can think about new ways of meeting these needs, using the surplus of our food system in creative and innovative spaces. And there's this possibility of training and development. I think there's something valuable there. You report that people in the US who talk with you about food waste, including your students, often ask, why don't we do this here? After everything you've seen, what's one realistic lesson or one small shift that communities in the US could adopt, right here, right now to rethink food waste? This the best question, and it is the number one question I get. Why don't we have this here? And we have seeds of some of it here already. I always point that out. One of the best programs I've ever seen is a program that is associated with the city's abattoir, which is a huge outdoor market that runs only on the weekends. And this grassroots group got together and said, you know, nobody's ever hanging out in this market during the week, we want to revitalize it. And one of the ways that they did it, just to get people to use the space more, was to take all the unsold produce. So instead of having vendors at the end of a market, and I think of my Carborro, NC farmer's market like this, at the end of the market, which is a pretty bougie farmer's market lots of chefs go there and get local produce. But at the end of the market instead of having farmers and produce vendors take home what they couldn't sell, they have an aftermarket. And the aftermarket turns that produce into edible meals. Everybody pays $5. There are people who come and cook the meal. If you cook the meal, you get to work for free, and it's a whole community workforce. It has had a tremendous effect. So, 60% of that market's food waste is now consumed. That's a big shift and it's happening at a local level. So, one thing, I think Michael Pollan's an amazing food journalist, but one of his great conclusions is that people need to grow their own food. And I'm critical of this. I don't think that's appropriate. I don't think that's a sustainable solution for a lot of people. But what I do think is sustainable in a market like that where there's food that doesn't sell, instead of throwing it away or taking it back or letting it rot, we could do something with it on the spot. And that's a little thing that makes a big difference. So, I am a fan of that. Food waste is one of the problems that is actually, in my view, best solved by local efforts because it's there, it's just sitting there. If you can move it around before it spoils you have won. If the ultimate goal is to just not throw away food. Now I do have students, I will say who are brilliant, who say stuff to me like isn't that neoliberalism? Look, yes. The answer's, the answer's yes. The answer's yes. If what your goal is, is to make sure that more edible food is not buried in landfills, which is bad for the environment and is not helping hungry people, it can be really effective. It can be really effective to say we don't actually have to overthrow the whole system while we're looking for better solutions. We can work within it. And that's probably my biggest takeaway is that even within a global industrial food system, there are lots of ways of moving food around from people who choose, who opt, who have the luxury of opting against it to people who would really like to have it. And it actually creates more equity instead of a culture of lack. I love your enthusiasm, and I love your vision of how we can work within the system to make it better for all people. Kelly, thank you so much for this engaging conversation. BIO Dr. Kelly Alexander is an assistant professor and George B. Tindall Fellow of American Studies in the University of North Carolina's College of Arts and Sciences, where she also co-directs the minor in Food Studies. She holds a bachelor's degree in journalism from Northwestern University's Medill School of Journalism and a doctorate in cultural anthropology from Duke University. She is a James Beard Award-winning writer and former editor at Saveur and Food & Wine magazines. Dr. Alexander's work has appeared in The New York Times, Newsweek, and O: The Oprah Magazine. She is also co-author of The New York Times best-selling barbecue cookbook Smokin' with Myron Mixon. Her research has been supported by the Mellon Foundation, the New York Botanical Gardens, Duke University, and the University of North Carolina at Chapel Hill. 
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  The downstream effects of disasters on food supply chains 06.03.2026 14min

  It seems like the frequency of weather-related disasters is increasing. Across the US we're seeing wildfires, tropical storms and hurricanes, extreme heat, extreme cold with snow or ice. And torrential rain leading to a loss of property, life, and livelihoods. What's more, similar extreme events are happening across the globe. These disasters all can have an impact on our food supply and the ability of people to access food. Today, we're speaking with environmental sustainability management expert, Betsy Albright, who is an associate professor of the practice at Duke University's Nicholas School of the Environment. Betsy's research centers on how policies and decisions are made in response to weather related disasters. Interview Summary Betsy, I've been wanting to have you on the podcast for a while, so I'm excited to get you now. So, let's begin with the first broad question. I'd be really interested to learn a little bit more about your research to make sure that our listeners are up to date on it. And I know you really study disasters, but could you explain or expand on what that really means for our listeners? I'm an environmental social scientist who studies the human and social side of disasters. And I ask questions about how climate related disasters or climate driven disasters, or weather disasters affect communities and households. And how individuals perceive risks from disasters, how they're affected by disasters, how they learn from make changes and adapt after disasters. My work started with my dissertation in central Europe. I had a Fulbright in Hungary. But from then I've expanded and moved most of my work to the US context. And our research team and I have done work on flooding and wildfires in Colorado, hurricanes in North Carolina. And I'm also working on a study of the flows of disaster assistance funds from FEMA to communities. And all of this is with or through a lens of equity or inequities and thinking about that across the disaster cycle. This is really important, and I remember being at a conference with you and learning about your work. And I was struck by what happens after the disaster. And in particular what happens to availability of food. And I work with the food bank here in North Carolina. And one of the things I know is when there is a disaster, like when Helene hit Asheville, there are real challenges in getting food out to people. Does your work touch on those topics as well? Yes. I would not say that our work centers on food, but food definitely intersects across all phases of the disaster cycle from preparing for disaster, experiencing disaster, the immediate response- that food bank getting food out- to long term recovery and thinking about risk mitigation. And we can think about that, you know, through a number of different lenses. Both on the food access side, but also on the food systems agriculture side as well. As I mentioned earlier, I take an equity lens on much of the work that we do. It's really important to recognize that disasters hit unevenly across society, across the landscape. Disproportionately they magnify social and environmental stressors that are already there. Communities with limited access to wealth, limited access to food, who are underserved, rural communities, racialized communities, often experience greater impacts from disasters. Disasters occur on top of histories of disenfranchisement. For example, centuries of marginalization of the minoritized Romani peoples of Central Europe they've seen great impacts from flooding. And in North Carolina, Black and African American communities whose ancestors were enslaved and suffered land loss through racist systems of who gets access to loans, access to land ownership. And because of these systems and processes, communities, families, individuals may live on marginal lands, may not own their lands. Their lands may be more prone to flood risk. May be underserved. Their housing may be more at risk. They may rent and not own. May have less agency and resources to repair their homes. And may have less trust in government and government systems. So really thinking about all of that, and then piling on disasters over these centuries of marginalization, disenfranchisement, underinvestment is really critical when trying to disentangle all these processes and develop policy solutions. This is really fascinating work and so thank you for laying out the sort of reality of the experience of disasters where people who have been marginalized may have difficulty accessing resources or there may be some concerns about trust. Broadly, we're interested also in the food system, and I'd be interested to understand how, when disasters strike, do you see effects upon the food system or the food system responding to these disasters? Recognizing that some individuals have higher food stress, even without a disaster, they may have higher pollutant burden because they live next to a concentrated animal feed lot operation. They may have weaker infrastructure systems: electricity, transportation, because of disinvestment. And so, when a disaster strikes, pollution loads may increase, access to food becomes even more of a challenge. Food stress increases. For example, in North Carolina, across the Southeast and further in the United States, Latino migrant farm workers face higher risks during hurricanes and floodings because of barriers, like limited access to emergency information and Spanish language barriers, fears about government intervention, fears tied to immigration status, housing conditions, lack of transportation. And these factors can delay access to food, evacuation, reduce preparedness, slow recovery. And yes, it's a challenge to really think then hard about what policy solutions make sense. That does make me also appreciate when we think about some of the folks involved in the food system, that the disruption that a disaster can bring will also mean a loss of employment or opportunities to continue earning income. And that seems to be a sort of a knock-on effect of these disasters. It's not just the immediate weather event. It's all of the other things that follow afterwards. Yes. And so when thinking about policy solutions, I really think it's critical to address these inequities even outside of the disaster cycle, or outside of the framing of disasters. And can we think about and develop ways, for example, to do reduce the risks of concentrated animal feedlot operations in North Carolina. Other ways for more resilient and sustainable and local ways of farming that minimize environmental risks, increase wealth, increase jobs, access to jobs. That then, when disaster strikes, are going to be more resilient because they're more resilient even before disasters. You know, I'd like to see greater investment in areas of food access, strengthening support for farm workers, encouraging development of local food hubs. Also thinking about making food access hubs more resilient to extreme weather events. Maybe elevating them, getting them all generators or solar microgrids. So that when disaster does happen, they're more resilient and then they can serve as community hubs with less reliance on supply chains at the national level. Really, coming back local, mutual aid, supporting each other, community supporting communities, non-governmental organizations, government, faith-based organizations strengthening local food systems. Also, everything that I just said for food I also think for health. You know, access to healthcare goes along with access to food in terms of critical infrastructure for community to flourish. And so, making sure there are local hospitals, not just in time of disaster, but in time of not disaster. So, expedite funding for small businesses, for neighborhood organizations, neighbors getting to know neighbors in disasters. Neighbors relying on neighbors. And that's critical. Anything we can do to build up networks. And that doesn't necessarily have to be government intervention. That could be faith-based organizations, churches, working with communities. It could be Little Leagues. There's lots of different ways to help build that social infrastructure that's so critical during disasters. Betsy, thank you for that. And as I hear you talk about these issues, what I am grateful for is we normally talk about food and the food system, but it's a parallel reality of what happens with the healthcare system when the disaster strikes. I can only imagine if someone is in need of a certain medicine when the disaster hits access to that medicine may be called into question as happens with food. But one of the big things I get out of what you're saying is we need to build resilient communities. Not when the disaster happens but do that work now. How do we create mutual aid? How do we create actual neighborhoods that know what's going on and to care for one another. Because it's that THAT helps us through these difficult times. Is that a fair assessment? Yes. That's more well said than I said it. So yes. Thank you. I am so grateful for this. Betsy, is there anything else we should think about when it comes to disasters and the food system or how we should prepare for disasters in the future? One thing that I didn't emphasize that my early work really looked at is how we grow food. And in Central Europe and Hungary in the area that I studied, this large-scale infrastructure on land that had previously, centuries ago, been wetlands. And then was drained for large scale agricultural systems, not unlike what we see in much of the Midwest of the United States. But as climate change worsens, we're seeing more extreme rain events. It's becoming harder and harder to basically fight against these floods in our agricultural system. And so really rethinking. What a resilient kind of agroecological system could look like on the food growing side. And that could be issues of what is grown, that could be issues of scale, thinking about maybe we need to put more land aside and not farm. But really thinking hard about how we incentivize, how do we set up insurance to help mitigate some of the risks. But I think that's going to be one of the major challenges moving forward. Bio Elizabeth (Betsy) Albright is the Dan and Bunny Gabel Associate Professor of the Practice of Environmental Ethics and Sustainable Environmental Management at Duke University's Nicholas School for the Environment. Her current research centers on how policies and decisions are made in response to extreme climatic events. She is interested in collaborative decision-making processes, particularly in the realm of water resource management. The Midwest Political Science Associated recently awarded Elizabeth the 'Best Paper by an Emerging Scholar' award at their national conference. Her geographic regions of interest include the southeast US and Central and Eastern Europe. Prior to completing her Ph.D. Elizabeth worked for the State of North Carolina in water resource management.
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  Pathway to Market is Complicated for Cell-Cultivated Protein 24.02.2026 19min

  As global demand for meat grows, this episode of Duke University's Leading Voices in Food podcast examines cell-cultivated protein—real meat grown from animal cells—and the evolving U.S. policy landscape shaping its future. Host Norbert Wilson (Duke World Food Policy Center) speaks with postdoctoral researchers Kate Consavage Stanley (Duke/Bezos Center for Sustainable Proteins) and Katariina Koivusaari (NC State/Bezos Center) about their article in Trends in Food Science and Technology on U.S. regulatory and legislative activity. The conversation explains the joint FDA–USDA regulatory approach for cell-cultivated meat (FDA oversight through cell cultivation; USDA oversight from harvest through processing, packaging, and labeling) and FDA oversight for cell-cultivated seafood (except catfish). They discuss timelines companies report for approval (often two to three years), the lack of federal public guidance on naming and labeling so far, and how USDA label approvals are currently handled case by case (e.g., "cell-cultivated chicken" and "cell-cultivated pork"). The episode also covers state-level labeling laws and the likelihood of federal preemption if state requirements conflict with federal statutes, as well as a growing wave of state restrictions and bans—Florida and Alabama in 2024, followed by Indiana, Mississippi, Montana, Nebraska, and Texas in 2025—plus funding restrictions in South Dakota and Iowa. The guests explore implications for consumers, interstate commerce, innovation, investment, and U.S. leadership, noting ongoing lawsuits in Florida and Texas and continued legislative activity such as a proposed ban in Georgia.   Interview Transcript Kate, let's begin with you. In the paper, you write about the regulatory frameworks that have been developed for cell-cultivated meat and seafood products in the US. To start, let's talk about what's unique about cell-cultivated products from a regulatory standpoint and how the US Department of Agriculture and US Food and Drug Administration have decided to handle cell-cultivated protein products. Kate - Yes, so as you mentioned in the introduction, Norbert, cell-cultivation is a new technology for use of the food supply. So, the US government had to adapt its existing legal frameworks for food safety regulation. As your listeners may already know seafood is regulated by the FDA, so it was within their scope to also regulate cell-cultivated seafood. The FDA therefore regulates all cell-cultivated seafood products with the exception of catfish. When it came to determining the regulatory approach for cell-cultivated products from livestock, poultry, and catfish, it was a bit more nuanced as the processes and components evolved fell under both USDA and FDA purview. In 2019, the FDA and USDA therefore agreed on a joint regulatory approach where the FDA regulates the early stages of the cell cultivation process, including when those cells are taken from the animal, grown in the bioreactor, and matured into specific cell types such as muscle or fat cells. At the point where those cells are ready to be harvested from the bioreactor to use in a food product, oversight transfers to USDA who oversees that harvesting process as well as food processing, packaging, and labeling. I know this joint regulatory approach may sound complicated, but it's important to note that USDA and FDA already coordinate oversight over other foods in the food supply. I'll give you an example that we all love pizza. A frozen cheese pizza is regulated by the FDA, whereas a frozen pizza with meat toppings like pepperoni is regulated by the USDA. It is therefore not unprecedented that FDA and USDA would agree to jointly regulate cell-cultivated products. And while the process is new, the products go through the same safety checks as other foods in the food supply. In the past few years, we've seen four cell-cultivated meat products go through the joint USDA-FDA regulatory process, meaning they can be sold in the US food supply. And one cell-cultivated seafood product has gone through the FDA regulatory process. Kate, thank you for sharing this. And I've used a pizza example in my class, and it is super complex this regulatory maze that we're talking about. It seems like there has been a lot of collaboration between these two agencies, and so that's important to hear. But it is also the case that it seems challenging for cell-cultivated protein companies to get through this process. Is this a fair assessment and would you elaborate? Kate - Yes, absolutely. We've heard from cell-cultivated companies that it can take two to three years to get through this process. And there certainly is a lot of back and forth between the companies and FDA and USDA. Great, thank you. Katariina, now let's turn to you. How do these regulations extend to labeling and what do we know about the federal government's approach to labeling the sale of cultivated products thus far? Katariina – So, labeling regulations are the most consumer facing part of regulations, really. And they are used to ensure that the product label has information that's truthful, that's not misleading. And that the package has sufficient information and consistent information also across products so that the consumer can make an educated decision on what product they want to purchase. And you'd think that how you label the product or just how you call the product on the label would be simple. But there are certain regulations in place that define how food items can or cannot be called. Now, when it comes to cell-cultivated products, as you and Kate mentioned, they are novel in the food supply. So, there is not a long-established term or nomenclature on how we should call these products. The federal regulators, FDA and USDA, to date have not released any public guidance either on how these products should be called on the label. The USDA did release an advanced notice of proposed rulemaking back in 2021, requesting comments from stakeholders on how these products should be labeled. And the FDA has also requested comments when it comes to labeling cell-cultivated fish and seafood. But to date, no guidance has been published yet. Kate gave an overview of the regulatory process between FDA and UFDA when it comes to labeling this product products. The USDA oversees labeling cell-cultivated meat, and the FDA oversees labeling cell-cultivated fish and seafood. The USDA has a pre-market approval process for labels, similarly to conventional meat industry. So, whenever a company wants to bring to market a new product, they first submit their label to the USDA. And the USDA reviews it and make sure that they agree with the language used in the label. The FDA does not have a similar pre-market approval process for labeling fish or seafood or cell-cultivated fish or seafood. So, currently cell-cultivated meat labels are approved on a case-by-case basis. And we can see from the products that have gone through the regulatory review so far that the USDA seem to approve the use of 'cell-cultivated' as a qualifying term, together with a meaty term such as chicken or pork. So, the products that we've seen approved to date or brought to market to date are called cell-cultivated chicken or cell-cultivated pork. This is really helpful to know what's happened at the federal level. We also know that there are several actions happening at the state level, so several states have proposed their own laws outlining how and what to label these products. Katariina, can you talk us through what this study regarding state labeling? Katariina - To date, about half of the US states have enacted or proposed their own labeling legislation on cell-cultivated products. Missouri became the first state in 2018, so well before any of these products was available on the market. And they specifically prohibited the use of word meat unless the food was from harvested production livestock or poultry. Restricting, therefore, the use of meat not only on cell-cultivated, but also on other alternative protein products such as plant-based meat analogs or fermentation derived proteins. And this is true for many state level labeling laws. That they are applicable not only to cell-cultivated meat, but also other alternative proteins aiming to mimic meat. In addition to Missouri, there are six other states that prohibit the use of meat or meat related terms, such as chicken or pork. Now, the other group of states that have restrictions on cell-cultivated meat labeling do not concentrate on prohibiting the use of word meat, but they require the use of qualifying terms or other additional language that clearly states that the product does not come from livestock or poultry. And this group of states, there are 18 states, have quite a bit of variation in what kind of qualifying terms they require to be used. And I thought I'd give a couple of examples here. For example, Indiana requires the package to include the phrase this is an imitation meat product. Iowa requires the product to be labeled with qualifying terms such as cell-cultivated, cell-cultured, fake, grown in a lab, imitation, lab grown, lab created, meat free, or meatless. What's interesting though is that the federal statutes that regulate the US food supply have actual language that prevents states from establishing laws or regulations that conflict with or are additional to the federal labeling regulations. So, this means that the state level labeling laws are actually likely to be preempted if they conflict with the federal regulations. So, we've only talked about labeling so far. Kate, I want to go back to you. More recently, we've seen a number of states propose greater restrictions on these products. Can you describe these attempts to restrict cell-cultivated meat and their immediate implications? And how have cell-cultivated companies and other stakeholders responded? Kate - In the past few years we've seen quite a few attempts by states to ban or restrict cell-cultivated meats. And these attempts fall into two buckets: bans that aim to restrict the manufacturer sale or distribution of cell-cultivated products and bans that aim to limit the use of state funding to support these products. In 2024, Florida was the first state to pass a ban on the manufacture, sale, and distribution of cell-cultivated meats. Alabama followed shortly thereafter. In 2025, five more states passed similar bans on cell-cultivated products, including Indiana, Mississippi, Montana, Nebraska, and Texas. And many other states proposed bans that ultimately didn't pass. The language on what is banned differs some between states. For instance, Texas only bans the sale of cell-cultivated products. Whereas Florida and others also ban cell-cultivated manufacturing and distribution. But the core message in all these bans is similar. Cell-cultivated meats are not welcome in those states. The time span for the bans differs too. So, Indiana and Texas have two-year bans while Florida and other states passed indefinite bans. And we've seen two states, South Dakota and Iowa pass legislation to restrict the use of state funding to support cell-cultivated products. What's frustrating about these bands and confusing for those in the alternative protein sector is that cell-cultivated technology is largely still in the early stages. Yes, as I mentioned earlier, five products have passed through the regulatory process. But these products have mainly been made available in small tasting events. And only one has actually made it to retail. Most Americans have never had a chance to actually try these products. So, it begs the question, why is there such resistance? State bans on these products mean that Americans will not have the chance to decide for themselves if they like these products, or if and how they want to incorporate them into what they eat. Another big concern is that these bans create a fragmented policy landscape that's challenging for cell-cultivated startups, especially, to navigate. And it raises a lot of concerns about cross state sales. Concerns like these are the basis for two lawsuits against cell-cultivated bans in Florida and Texas. Those lawsuits are still playing out in court, so we don't yet know how those may Kate, this is really fascinating. And as both you and Katariina described, there's a patchwork of policies and a complex landscape for these companies to navigate. It has the potential of keeping consumers from even trying the products, as you've already suggested, when they're made available. And what I'm hearing from both of you is that this is an ongoing project. So even though there's a paper that's published now, it seems like there will be opportunities to keep going back as new laws and new regulations and new lawsuits are decided. So, this is a policy space that we need to keep an eye on. That's something I want to pick up on this last question. In closing, what does this legislation mean for consumers and the future of cell-cultivated products in the US and even globally? Katariina, let's begin with you. Katariina - Yes. In addition to impeding interstate and international commerce of cell-cultivated products, these bans could negatively impact the US investment climate on these products and technologies. For example, China has included developing cell-cultivated meat in their five-year plan. Within Europe, there's some variation. Some countries are being rather supportive of these technologies and products, whereas others have tried to ban them similarly to some US states. But I think it's important to note that even with some states in the US banning these products, the US will still likely remain a significant market area for cell-cultivated products. And it still takes significant investment and infrastructure to produce the products on a large scale enough to even reach the whole country. Another really important thing to mention here is that the global demand for meat is growing. If we look at global population forecasts, global meat or protein consumption forecasts, we need these alternative proteins. Not only cell-cultivated meat, but also for example, plant-based meat alternatives to help meet the increasing demand for protein and complement conventional meat supply. Kate, what about you?   Kate – I agree with everything that Katariina said. To add on to her points, I note that the US has been a leader in the cell-cultivated research development and innovation spaces to date. We are one of only a few countries that have both developed a framework for regulating these products and had products successfully pass through that process. The bans tell a different story, and they may restrict US innovation in the cell-cultivated space because companies will be limited to only the states where they can produce and sell these products. What this means for US leadership in the space remains to be seen. However, one could ask will cell-cultivated companies choose to set up shop in the US versus another country that isn't facing such legal challenges? We don't yet know the answer to that. You also mentioned consumers. We don't yet know about how these bans and the media surrounding them may influence consumer perceptions of cell-cultivated foods. Products, as you said, they've never even really had the chance to try. But these bans will certainly restrict consumer access to these products in certain states, and the varying state approaches to labeling that Katariina described are likely to confuse consumers. Going back to something you mentioned earlier, Norbert, we're excited to have this paper out in the world. But this work is certainly continuing to evolve. Just recently, a senator in Georgia proposed a new ban on cell-cultivated meat in the state, and other countries have faced similar legislative challenges against these products. So, we'll be watching and learning as these challenges continue to play out. Bios Katariina Koivusaari, Ph.D. is a postdoctoral researcher at the Bezos Center for Sustainable Protein at North Carolina State University. Her work focuses on stakeholder engagement and the regulatory and policy landscape of alternative proteins, including cell-cultivated products, fermentation-derived proteins, and plant-based proteins. She received her Ph.D. in Public Health Nutrition and M.Sc. in Food Sciences from the University of Helsinki. Prior to her current role, she worked in the biotechnology industry as a Senior Regulatory Scientist, where she focused on scientific strategy and regulatory affairs related to cell-cultured human milk ingredients. Katherine (Kate) Consavage Stanley, Ph.D., serves as a postdoctoral associate within the World Food Policy Center at the Sanford School. In this role, Kate supports Duke's research for the Bezos Center for Sustainable Protein housed at NC State. Her research seeks to detail the complexities of the consumer, market, and policy landscapes for alternative protein products. Kate holds a Ph.D. from Virginia Polytechnic Institute and State University where her research focused on how diverse U.S. food and health systems actors can support sustainable diet transitions through promoting plant-rich dietary patterns and reducing red and processed meat intake. She has also published scholarly work on digital food and nutrition literacy, sugary beverage media campaigns, and incorporating sustainability considerations into dietary guidelines, among others. Prior to starting her doctoral studies, Kate worked for the U.S. Agency for International Development (USAID) where she developed technical, communications, and advocacy-focused materials on key nutrition and maternal and child health issues. Kate holds a Master of Science in global health from Georgetown University and a Bachelor of Science in biology from Emmanuel College.      
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  E290: Grading the Biggest US Grocery Stores on Healthy Offerings 15.01.2026 39min

  Do you ever wonder whether your grocery store cares about whether you have a healthy diet? Every time we shop or read advertisement flyers, food retailers influence our diets through product offerings, pricings, promotions, and of course store design. Think of the candy at the checkout counters. When I walk into my Costco, over on the right there's this wall of all these things they would like me to buy and I'm sure it's all done very intentionally. And so, if we're so influenced by these things, is it in our interest? Today we're going to discuss a report card of sorts for food retailers and the big ones - Walmart, Kroger, Ahold Delhaize USA, which is a very large holding company that has a variety of supermarket chains. And this is all about an index produced by the Access to Nutrition Initiative (ATNi), a global foundation challenging the food industry investors and policy makers to shape a healthier food system. The US Retail Assessment 2025 Report evaluates how these three businesses influence your access to nutritious and affordable foods through their policies, commitments, and actual performance. The Access to Nutrition Initiatives' director of Policy and Communications, Katherine Pittore is here with us to discuss the report's findings. We'll also speak with Eva Greenthal, who oversees the Center for Science in the Public Interest's Federal Food Labeling work.   Interview Transcript Access ATNi's 2025 Assessment Report for the US and other countries here: Retail https://accesstonutrition.org/index/retail-assessment-2025/ Let's start with an introduction to your organizations. This will help ground our listeners in the work that you've done, some of which we've spoken about on our podcast. Kat, let's begin with you and the Access to Nutrition Initiative. Can you tell us a bit about the organization and what work it does? Kat Pittore - Thank you. So, the Access to Nutrition Initiative is a global foundation actively challenging the food industry, investors, and policymakers to shape healthier food systems. We try to collect data and then use it to rank companies. For the most part, we've done companies, the largest food and beverage companies, think about PepsiCo, Coca-Cola, and looking are they committed to proving the healthiness of their product portfolios. Do the companies themselves have policies? For example, maternity leave. And these are the policies that are relevant for their entire workforce. So, from people working in their factories all the way up through their corporate areas. And looking at the largest companies, can these companies increase access to healthier, more nutritious foods. One of the critical questions that we get asked, and I think Kelly, you've had some really interesting guests also talking about can corporations actually do something. Are corporations really the problem? At ATNi, we try to take a nuanced stance on this saying that these corporations produce a huge amount of the food we eat, so they can also be part of the solution. Yes, they are currently part of the problem. And we also really believe that we need more policies. And that's what brings us too into contact with organizations such as Eva's, looking at how can we also improve policies to support these companies to produce healthier foods. The thought was coming to my mind as you were speaking, I was involved in one of the initial meetings as the Access to Nutrition Initiative was being planned. And at that point, I and other people involved in this were thinking, how in the world are these people going to pull this off? Because the idea of monitoring these global behemoth companies where in some cases you need information from the companies that may not reflect favorably on their practices. And not to mention that, but constructing these indices and things like that required a great deal of thought. That initial skepticism about whether this could be done gave way, at least in me, to this admiration for what's been accomplished. So boy, hats off to you and your colleagues for what you've been able to do. And it'll be fun to dive in a little bit deeper as we go further into this podcast. Eva, tell us about your work at CSPI, Center for Science in the Public Interest. Well known organization around the world, especially here in the US and I've long admired its work as well. Tell us about what you're up to. Eva Greenthal - Thank you so much, Kelly, and again, thank you for having me here on the pod. CSPI is a US nonprofit that advocates for evidence-based and community informed policies on nutrition, food safety and health. And we're well known for holding government agencies and corporations to account and empowering consumers with independent, unbiased information to live healthier lives. And our core strategies to achieve this mission include, of course, advocacy where we do things like legislative and regulatory lobbying, litigation and corporate accountability initiatives. We also do policy and research analysis. We have strategic communications such as engagement with the public and news media, and we publish a magazine called Nutrition Action. And we also work in deep partnership with other organizations and in coalitions with other national organizations as well as smaller grassroots organizations across the country. Across all of this, we have a deep commitment to health equity and environmental sustainability that informs all we do. And our ultimate goal is improved health and wellbeing for people in all communities regardless of race, income, education, or social factors. Thanks Eva. I have great admiration for CSPI too. Its work goes back many decades. It's the leading organization advocating on behalf of consumers for a better nutrition system and better health overall. And I greatly admire its work. So, it's really a pleasure to have you here. Kat, let's talk about the US retail assessment. What is it and how did you select Walmart, Kroger, and Ahold Dehaize for the evaluation, and why are retailers so important? Kat - Great, thanks. We have, like I said before, been evaluating the largest food and beverage manufacturers for many years. So, for 13 years we have our global index, that's our bread and butter. And about two years ago we started thinking actually retailers also play a critical role. And that's where everyone interfaces with the food environment. As a consumer, when you go out to actually purchase your food, you end up most of the time in a supermarket, also online presence, et cetera. In the US 70% or more of people buy their food through some type of formal food retail environment. So, we thought we need to look at the retailers. And in this assessment we look at the owned label products, so the store brand, so anything that's branded from the store as its own. We think that's also becoming a much more important role in people's diets. In Europe it's a really critical role. A huge majority of products are owned brand and I think in the US that's increasing. Obviously, they tend to be more affordable, so people are drawn to them. So, we were interested how healthy are these products? And the US retail assessment is part of a larger retail assessment where we look at six different countries trying to look across different income levels. In high income countries, we looked at the US and France, then we looked at South Africa and Indonesia for higher middle income. And then finally we looked at Kenya and the Philippines. So, we tried to get a perspective across the world. And in the US, we picked the three companies aiming to get the largest market share. Walmart itself is 25 to 27% of the market share. I've read an amazing statistic that something like 90% of the US population lives within 25 kilometers of a Walmart. Really, I did not realize it was that large. I grew up in the US but never shopped at Walmart. So, it really does influence the diet of a huge number of Americans. And I think with the Ahold Delhaize, that's also a global conglomerate. They have a lot of supermarkets in the Netherlands where we're based, I think also in Belgium and across many countries. Although one interesting thing we did find with this retail assessment is that a big international chain, they have very different operations and basically are different companies. Because we had thought let's start with the Carrefours like those huge international companies that you find everywhere. But Carrefour France and Carrefour Kenya are basically very different. It was very hard to look at it at that level. And so that's sort of what brought us to retailers. And we're hoping through this assessment that we can reach a very large number of consumers. We estimate between 340 to 370 million consumers who shop at these different modern retail outlets. It's so ambitious what you've accomplished here. What questions did you try to answer and what were the key findings? Kat - We were interested to know how healthy are the products that are being sold at these different retailers. That was one of our critical questions. We look at the number of different products, so the owned brand products, and looked at the healthiness. And actually, this is one of the challenges we faced in the US. One is that there isn't one unified use of one type of nutrient profile model. In other countries in the Netherlands, although it's not mandatory, we have the Nutri Score and most retailers use Nutri Score. And then at least there's one thing that we can use. The US does not have one unified agreement on what type of nutrient profile model to use. So, then we're looking at different ones. Each company has their own proprietary model. That was one challenge we faced. And the other one is that in other countries you have the mandatory that you report everything per hundred grams. So, product X, Y, and Z can all be compared by some comparable thing. Okay? A hundred grams of product X and a hundred grams of product Y. In the US you have serving sizes, which are different for different products and different companies. And then you also have different units, which all of my European colleagues who are trying to do this, they're like, what is this ounces? What are these pounds? In addition to having non-comparable units, it's also non-standardized. These were two key challenges we face in the US. Before you proceed, just let me ask a little bit more about the nutrient profiling. For people that aren't familiar with that term, basically it's a way to score different foods for how good they are for you. As you said, there are different profiling systems used around the world. Some of the food companies have their own. Some of the supermarket companies have their own. And they can be sort of unbiased, evidence-based, derived by scientists who study this kind of thing a lot like the index developed by researchers at Oxford University. Or they can be self-serving, but basically, they're an index that might take away points from a food if it's high in saturated fat, let's say but give it extra points if it has fiber. And that would be an example. And when you add up all the different things that a food might contain, you might come away with a single score. And that might then provide the basis for whether it's given a green light, red light, et cetera, with some sort of a labeling system. But would you like to add anything to that? Kat - I think that's quite accurate in terms of the nutrient profile model. And maybe one other thing to say here. In our retail index, it's the first time we did this, we assess companies in terms of share of their products meeting the Health Star rating and we've used that across all of our indexes. This is the one that's used most commonly in Australia and New Zealand. A Health Star rating goes zero to five stars, and 3.5 or above is considered a healthier product. And we found the average healthiness, the mean Health Star rating, of Walmart products was 2.6. So quite low. Kroger was 2.7 and Food Lion Ahold Delhaize was 2.8. So the average is not meeting the Health Star rating of 3.5 or above. We're hoping that by 2030 we could see 50% of products still, half would be less than that. But we're not there yet. And another thing that we looked at with the retail index that was quite interesting was using markers of UPFs. And this has been a hotly debated discussion within our organization as well. Sort of, how do you define UPF? Can we use NOVA classification? NOVA Classification has obviously people who are very pro NOVA classification, people who also don't like the classification. So, we use one a sort of ranking Popkins et al. developed. A sort of system and where we looked at high salt, fat sugar and then certain non-nutritive sweeteners and additives that have no benefit. So, these aren't things like adding micronutrients to make a product fortified, but these are things like red number seven and colors that have no benefit. And looked at what share of the products that are produced by owned label products are considered ultra processed using this definition. And there we found that 88% of products at Walmart are considered ultra processed. Wow. That's quite shocking. Eighty eight percent. Yeah, 88% of all of their own brand products. Oh, my goodness. Twelve percent are not. And we did find a very high alignment, because that was also a question that we had, of sort of the high salt, fat, sugar and ultra processed. And it's not a direct alignment, because that's always a question too. Can you have a very healthy, ultra processed food? Or are or ultra processed foods by definition unhealthy beyond the high fat, salt, sugar content. And I know you've explored that with others. Don't the retailers just say that they're responding to demand, and so putting pressure on us to change what we sell isn't the real problem here, the real issue. It's to change the demand by the consumers. What do you think of that? Kat - But I mean, people buy what there is. If you went into a grocery store and you couldn't buy these products, you wouldn't buy them. I spent many years working in public health nutrition, and I find this individual narrative very challenging. It's about anything where you start to see the entire population curve shifting towards overweight or obesity, for example. Or same when I used to work more in development context where you had a whole population being stunted. And you would get the same argument - oh no, but these children are just short. They're genetically short. Oh, okay. Yes, some children are genetically short. But when you see 40 or 50% of the population shifting away from the norm, that represents that they're not growing well. So I think it is the retailer's responsibility to make their products healthier and then people will buy them. The other two questions we tried to look at were around promotions. Are our retailers actively promoting unhealthy products in their weekly circulars and flyers? Yes, very much so. We found most of the products that were being promoted are unhealthy. The highest amount that we found promoting healthy was in Food Lion. Walmart only promoted 5% healthy products. The other 95% of the products that they're actively promoting in their own circulars and advertising products are unhealthy products. So, then I would say, well, retailers definitely have a role there. They're choosing to promote these products. And then the other one is cost. And we looked across all six countries and we found that in every country, healthier food baskets are more expensive than less healthier food baskets. So you take these altogether, they're being promoted more, they're cheaper, and they're a huge percentage of what's available. Yes. Then people are going to eat less healthy diets. Right, and promoted not only by the store selling these products, but promoted by the companies that make them. A vast amount of food marketing is going on out there. The vast majority of that is for foods that wouldn't score high on any index. And then you combine that with the fact that the foods are engineered to be so palatable and to drive over consumption. Boy, there are a whole lot of factors that are conspiring in the wrong direction, aren't there. Yeah, it is challenging. And when you look at all the factors, what is your entry point? Yes. Eva, let's talk about CSPI and the work that you and your colleagues are doing in the space. When you come up with an interesting topic in the food area and somebody says, oh, that's pretty important. It's a good likelihood that CSPI has been on it for about 15 years, and that's true here as well. You and your colleagues have been working on these issues and so many others for so many years. But you're very active in advocating for healthier retail environments. Can you highlight what you think are a few key opportunities for making progress? Eva - Absolutely. To start off, I could not agree more with Kat in saying that it really is food companies that have a responsibility for the availability and affordability of healthy options. It's absolutely essential. And the excessive promotion of unhealthy options is what's really undermining people's ability to make healthy choices. Some of the policies that CSPI supports for improving the US retail environment include mandatory front of package nutrition labeling. These are labels that would make it quick and easy for busy shoppers to know which foods are high in added sugar, sodium, or saturated fat, and should therefore be limited in their diets. We also advocate for federal sodium and added sugar reduction targets. These would facilitate overall lower amounts of salt and sugar in the food supply, really putting the onus on companies to offer healthier foods instead of solely relying on shoppers to navigate the toxic food environments and make individual behavior changes. Another one is taxes on sweetened beverages. These would simultaneously nudge people to drink water or buy healthier beverages like flavored seltzers and unsweetened teas, while also raising revenue that can be directed towards important public health initiatives. Another one is healthy checkout policies. These would require retailers to offer only healthier foods and beverages in areas where shoppers stand in line to purchase their groceries. And therefore, reduce exposure to unhealthy food marketing and prevent unhealthy impulse purchases. And then another one is we advocate for online labeling requirements that would ensure consumers have easy access to nutrition, facts, ingredients, and allergen information when they grocery shop online, which unbelievably is currently not always the case. And I can also speak to our advocacy around the creating a uniform definition of healthy, because I know Kat spoke to the challenges in the US context of having different retailers using different systems for identifying healthier products. So the current food labeling landscape in the US is very confusing for the consumer. We have unregulated claims like all natural, competing with carefully regulated claims like organic. We have a very high standard of evidence for making a claim like prevents cold and flu. And then almost no standard of evidence for making a very similar claim like supports immunity. So, when it comes to claims about healthiness, it's really important to have a uniform definition of healthy so that if a product is labeled healthy, consumers can actually trust that it's truly healthy based on evidence backed nutrition standards. And also, so they can understand what that label means. An evidence-based definition of healthy will prevent misleading marketing claims. So, for example, until very recently, there was no limit on the amount of added sugar or refined grain in a product labeled healthy. But recent updates to FDA's official definition of healthy mean that now consumers can trust that any food labeled healthy provides servings from an essential food group like fruit, vegetable, whole grain, dairy, or protein. And doesn't exceed maximum limits on added sugar, sodium, and saturated fat. This new healthy definition is going to be very useful for preventing misleading marketing claims. However, we do think its reach will be limited for helping consumers find and select healthy items mainly because it's a voluntary label. And we know that even among products that are eligible for the healthy claim, very few are using it on their labels. We also know that the diet related chronic disease epidemic in the US is fueled by excess consumption of junk foods, not by insufficient marketing of healthy foods. So, what we really need, as I mentioned before, are mandatory labels that call out high levels of unhealthy nutrients like sodium, added sugar, and saturated fat. Thanks for that overview. What an impressive portfolio of things you and your colleagues are working on. And we could do 10 podcasts on each of the 10 things you mentioned. But let's take one in particular: the front of the package labeling issue. At a time where it seems like there's very little in our country that the Democrats and Republicans can't agree on, the Food and Drug Administration, both previously under the Biden Harris Administration, now under the Trump Vance Administration have identified for a package of labeling as a priority. In fact, the FDA is currently working on a mandatory front of package nutrition label and is creating a final rule around that issue. Kat, from Access to Nutrition Initiative's perspective, why is mandatory front of package labeling important? What's the current situation kind of around the world and what are the retailers and manufacturers doing? Kat - So yes, we definitely stand by the need for mandatory front of package labeling. I think 16 countries globally have front of package labeling mandated, but the rest have voluntary systems. Including in the Netherlands where I live and where Access to Nutrition is based. We use the voluntary Nutri Score and what we've seen across our research is that markets where it's voluntary, it tends to not be applied in all markets. And it tends to be applied disproportionately on healthy products. So if you can choose to put it, you put it all on the ones that are the A or the Nutri Score with the green, and then you don't put it on the really unhealthy products. So, then it also skews consumers. Because like Eva was saying, people are not eating often. Well, they, they're displacing from their diet healthy products with unhealthy products. So that that is a critical challenge. Until you make it mandatory, companies aren't going to do that. And we've seen that with our different global indexes. Companies are not universally using these voluntary regulations across the board. I think that's one critical challenge that we need to address. If you scan the world, there are a variety of different systems being used to provide consumers information on the front of packages. If you could pick one system, tell us what we would actually see on the package. Kat - This is one we've been debating internally, and I saw what CSPI is pushing for, and I think there's growing evidence pushing for warning style labels. These are the ones that say the product is high in like really with a warning, high in fat, high in salt, high in sugar. And there is evidence from countries like Chile where they have introduced this to show that that does drive change. It drives product reformulation. Companies change their products, so they don't have to carry one of the labels. Consumers are aware of it. And they actively try to change their purchasing behaviors to avoid those. And there's less evidence I think interpretive is important. A Nutri Score one where you can see it and it's green. Okay, that's quick. It's easy. There are some challenges that people face with Nutri Score, for example. That Nutri Score compares products among the same category, which people don't realize outside of our niche. Actually, a colleague of mine was telling me - my boyfriend was in the grocery store last week. And he's like picked up some white flour tortillas and they had a Nutri Score D, and then the chips had a Nutri Score B. And he's like, well, surely the tortillas are healthier than the chips. But obviously the chips, the tortilla chips were compared against other salty snacks and the other one was being compared to bread. So, it's like a relatively unhealthy bread compared to a relatively healthy chip. You see this happening even among educated people. I think these labels while well intentioned, they need a good education behind them because they are challenging, and people don't realize that. I think people just see A or green and they think healthy; E is bad, and people don't realize that it's not comparing the same products from these categories. One could take the warning system approach, which tells people how many bad things there are in the foods and flip it over and say, why not just give people information on what's good in a food? Like if a food has vitamins and minerals or protein or fiber, whatever it happens. But you could label it that way and forget labeling the bad things. But of course, the industry would game that system in about two seconds and just throw in some good things to otherwise pretty crappy foods and make the scores look good. So, yeah, it shows why it's so important to be labeling the things that you'd like to see less of. I think that's already happening. You see a lot of foods with micronutrient additions, very sugary breakfast cereals. You see in Asia, a lot of biscuits and cookies that they add micronutrients to. I mean, there's still biscuits and cookies. So Eva, I'd like to get your thoughts on this. So tell us more about the proposed label in the US, what it might look like, and the history about how this got developed. And do you think there's anything else needed to make the label more useful or user-friendly for consumers? Eva - Absolutely. It is a very exciting time to work on food policy in the US, especially with this momentum around front of package labeling. CSPI actually first petitioned calling for front of pack labeling in 2006. And after more than a decade of inaction, industry lobbying, all these countries around the world adopting front of pack labeling systems, but not the US. In 2022 CSPI filed a new petition that specifically called for mandatory interpretive nutrient specific front of package labeling, similar to the nutrient warning labels already required in Mexico, Canada, and as Kat said, around 16 other countries. And in early 2025, FDA finally responded to our petition by issuing a proposal that if finalized would require a nutrition info box on packaged foods. And what the nutrition info box includes is the percent daily value per serving of sodium, added sugar and saturated fat, accompanied by the words high, medium, or low, assessing the amount of each nutrient. This proposal was a very important step forward, but the label could be improved in several ways. First off, instead of a label that is placed on all foods, regardless of their nutrient levels, we strongly recommend that FDA instead adopt labels that would only appear on products that are high in nutrients of concern. A key reason for this is it would better incentivize companies to reduce the amount of salt, sugar, or saturated fat in their product because companies will want to avoid wasting this precious marketing real estate on mandatory nutrition labels. So, for example, they could reduce the amount of sodium in a soup to avoid having a high sodium label on that soup. And also, as you were saying before around the lack of a need to require the positive nutrients on the label, fortunately the FDA proposal didn't, but just to chime in on that, these products are already plastered with claims around their high fiber content, high protein content, vitamin C, this and that. What we really need is a mandatory label that will require companies to tell you what they would otherwise prefer not to. Not the information that they already highlight for marketing purposes. So, in addition to these warning style labels, we also really want FDA to adopt front of package disclosures for foods containing low and no calorie sweeteners. Because this would discourage the industry from reducing sugar just by reformulating with additives that are not recommended for children. So that's a key recommendation that CSPI has made for when FDA finalizes the rule. FDA received thousands and thousands of comments on their labeling proposal and is now tasked with reviewing those comments and issuing a final rule. And although these deadlines are very often missed, so don't necessarily hold your breath, but the government's current agenda says it plans to issue a final rule in May 2026. At CSPI, we are working tirelessly to hold FDA to its commitment of issuing a final regulation. And to ensure that the US front of pack labeling system is number one mandatory and number two, also number one, really, mandatory, and evidence-based so that it really has the best possible chance of improving our diets and our food supply. Well, thank you for the tireless work because it's so important that we get this right. I mean, it's important that we get a system to begin with, even if it's rudimentary. But the better it can be, of course, the more helpful it'll be. And CSPI has been such an important voice in that. Kat, let's talk about some of the things that are happening in developing countries and other parts of the world. So you're part of a multi-country study looking at five additional countries, France, South Africa, Indonesia, the Philippines, and Kenya. And as I understand, the goal is to understand how retail food environments differ across countries at various income levels. Tell us about this, if you would, and what sort of things you're finding. Kat – Yes. So one of our questions was as companies reach market saturation in places like France and the US and the Netherlands, they can't get that many more customers. They already have everyone. So now they're expanding rapidly. And you're seeing a really rapid increase in modern retail purchasing in countries like Indonesia and Kenya. Not to say that in these countries traditional markets are still where most people buy most of their food. But if you look at the graphs at the rate of increase of these modern different retailers also out of home, it's rapidly increasing. And we're really interested to see, okay, given that, are these products also exposing people to less healthy products? Is it displacing traditional diets? And overall, we are seeing that a lot of similar to what you see in other context. In high income countries. Overall healthier products are again, more expensive, and actually the differential is greater in lower income countries. Often because I think also poor people are buying foods not in modern retail environments. This is targeting currently the upper, middle, and higher income consumer groups. But that will change. And we're seeing the same thing around really high percentages of high fat, salt, sugar products. So, looking at how is this really transforming retail environments? At the same time, we have seen some really interesting examples of countries really taking initiative. In Kenya, they've introduced the first Kenyan nutrient profile model. First in Africa. They just introduced that at the end of 2025, and they're trying to introduce also a mandatory front of package warning label similar to what Eva has proposed. This would be these warnings high in fat, salt, and sugar. And that's part of this package that they've suggested. This would also include things around regulations to marketing to children, and that's all being pushed ahead. So, Kenya's doing a lot of work around that. In South Africa, there's been a lot of work on banning marketing to children as well as front of package labeling. I think one of the challenges we've seen there, and this is something... this is a story that I've heard again and again working in the policy space in different countries, is that you have a lot of momentum and initiative by civil society organizations, by concerned consumer groups. And you get all the way to the point where it's about to be passed in legislation and then it just gets kicked into the long grass. Nothing ever happens. It just sits there. I was writing a blog, we looked at Indonesia, so we worked with this organization that is working on doing taxation of sugar sweetened beverages. And that's been on the card since 2016. It actually even reminded me a lot of your story. They've been working on trying to get the sugar sweetened beverage tax in Indonesia passed since 2016. And it gets almost there, but it never gets in the budget. It just never passes. Same with the banning marketing to children in South Africa. This has been being discussed for many years, but it never actually gets passed. And what I've heard from colleagues working in this space is that then industry comes in right before it's about to get passed and says, oh no, but we're going to lose jobs. If you introduce that, then all of the companies that employ people, people will lose their jobs. And modeling studies have shown this isn't true. That overall, the economy will recover, jobs will be found elsewhere. Also, if you factor in the cost to society of treating diabetes from high consumption or sugar sweetened beverages. But it's interesting to see that this repeats again and again of countries get almost over the line. They have this really nice draft initiative and then it just doesn't quite happen. So, I think that that will be really interesting. And I think a bit like what Eva was saying in many of these countries, like with Kenya, are we going to see, start seeing the warning labels. With South Africa, is this regulation banning marketing to children actually going to happen? Are we going to see sugar sweetened beverage taxes written into the 2026 budget in Indonesia? I think very interesting space globally in many of these questions. But I think also a key time to keep the momentum up. It's interesting to hear about the industry script, talking about loss of jobs. Other familiar parts of that script are that consumers will lose choices and their prices will go up. And those things don't seem to happen either in places where these policies take effect. But boy, they're effective at getting these things stomped out. It feels to me like some turning point might be reached where some tipping point where a lot of things will start to happen all at once. But let's hope we're moving in that direction. Kat - The UK as of five days ago, just implemented bans on marketing of unhealthy products to children, changes in retail environment banning promotions of unhealthy products. I do think we are seeing in countries and especially countries with national healthcare systems where the taxpayer has to take on the cost of ill health. We are starting to see these changes coming into effect. I think that's an interesting example and very current. Groundbreaking, absolutely groundbreaking that those things are happening. Let me end by asking you each sort of a big picture question. Kat, you talked about specific goals that you've established about what percentage of products in these retail environments will meet a healthy food standard by a given year. But we're pretty far from that now. So I'd like to ask each of you, are you hopeful we'll get anywhere near those kind of goals. And if you're hopeful, what leads you to feel that way? And Kat, let's start with you and then I'll ask Eva the same thing. Kat - I am hopeful because like you said, there's so much critical momentum happening in so many different countries. And I do find that really interesting. And these are the six countries that we looked at, but also, I know Ghana has recently introduced a or working to introduce a nutrient profile model. You're seeing discussions happening in Asia as well. And a lot of different discussions happening in a lot of different places. All with the same ambition. And I do think with this critical momentum, you will start to break through some of the challenges that we're facing now too. Where you see, for example, like I know this came up with Chile. Like, oh, if you mandate it in this context, then it disadvantages. So like the World Trade Organization came out against it saying it disadvantaged trade, you can't make it mandatory. But if all countries mandate it, then you remove some of those barriers. It's a key challenge in the EU as well. That the Netherlands, for example, can't decide to introduce Nutri Score as a mandatory front of package label because that would disadvantage trade within the European Union. But I think if we hit a critical point, then a lot of the kind of key challenges that we're facing will no longer be there. If the European Union decides to adopt it, then also then you have 27 countries overnight that have to adopt a mandatory front of package label. And as companies have to do this for more and more markets, I think it will become more standardized. You will start seeing it more. I'm hopeful in the amount of momentum that's happening in different places globally. Good. It's nice to hear your optimism on that. So, Eva, what do you think? Eva - So thinking about front of package labeling and the fact that this proposed regulation was put out under the previous presidential administration, the Biden Harris Administration and is now intended to be finalized under the Trump Vance Administration, I think that's a signal of what's really this growing public awareness and bipartisan support for food and nutrition policies in the US. Obviously, the US food industry is incredibly powerful, but with growing public awareness of how multinational food companies are manipulating our diets and making us sick for their own profit, I think there's plenty of opportunity to leverage the power of consumers to fight back against this corporate greed and really take back our health. I'm really happy that you mentioned the bipartisan nature of things that starting to exist now. And it wasn't that long ago where you wouldn't think of people of the political right standing up against the food companies. But now they are, and it's a huge help. And this fact that you have more people from a variety of places on the political spectrum supporting a similar aim to kinda rein in behavior of the food industry and create a healthier food environment. Especially to protect children, leads me to be more optimistic, just like the two of you. I'm glad we can end on that note. Bios Katherine Pittore is the director of Policy and Communications at the Action to Nutrition Initiative. She is responsible for developing a strategy to ensure ATNi's research is translated into better policies. Working collaboratively with alliances and other stakeholders, she aims to identify ways for ATNi's research to support improved policies, for companies, investors and governments, with the aim of creating a more effective playing field enabling markets to deliver more nutritious foods, especially for vulnerable groups in society. Katherine has been working in the field of global nutrition and food systems since 2010. Most recently at Wageningen Centre for Development Innovation (WCDI), where she worked as a nutrition and food security advisor on range projects, mostly in Africa. She also has also worked as a facilitator and trainer, and a specific interest in how to healthfully feed our increasingly urbanizing world. She has also worked for several NGOs including RESULTS UK, as a nutrition advocacy officer, setting up their nutrition advocacy portfolio focusing aimed at increasing aid spending on nutrition with the UK parliament, and Save the Children UK and Save the Children India, working with the humanitarian nutrition team. She has an MSc in Global Public Health from the London School of Hygiene and Tropical Medicine and a BA in Science and Society from Wesleyan University.  Eva Greenthal oversees Center for Science in the Public Interest's federal food labeling work, leveraging the food label as a powerful public health tool to influence consumer and industry behavior. Eva also conducts research and supports CSPI's science-centered approach to advocacy as a member of the Science Department. Prior to joining CSPI, Eva led a pilot evaluation of the nation's first hospital-based food pantry and worked on research initiatives related to alcohol literacy and healthy habits for young children. Before that, Eva served as a Program Coordinator for Let's Go! at Maine Medical Center and as an AmeriCorps VISTA Member at HealthReach Community Health Centers in Waterville, Maine. Eva holds a dual MS/MPH degree in Food Policy and Applied Nutrition from Tufts University and a BA in Environmental Studies from University of Michigan.  
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  E289: Posting calorie counts on menus should be just one strategy of many 16.12.2025 33min

  In this episode of the Leading Voices in Food podcast, Norbert Wilson of Duke University's Sanford School of Public Policy speaks with researchers Jean Adams from the University of Cambridge and Mike Essman from Duke's World Food Policy Center. They discuss the mandatory calorie labeling policy introduced in England in April 2022 for large food-away-from-home outlets. The conversation covers the study recently published in the British Medical Journal, exploring its results, strengths, limitations, and implications within the broader context of food labeling and public health policies. Key findings include a slight overall reduction in calorie content offered by food outlets, driven by the removal of higher-calorie items rather than reformulation. The discussion also touches on the potential impacts on different consumer groups, the challenges of policy enforcement, and how such policies could be improved to more effectively support public health goals. Interview Summary Now everyone knows eating out is just part of life. For many, it's a place to make connections, can be a guilty pleasure, and sometimes it's just an outright necessity for busy folks. But it is also linked to poor dietary quality, weight gain, and even obesity. For policymakers, the challenge is identifying what policy changes can help improve population health. Jean, let's begin with you. Can you tell our listeners about the UK's menu labeling intervention and what change did you hope to see? Jean - Yes, so this was a policy that was actually a really long time in coming and came in and out of favor with a number of different governments. So maybe over the last 10 years we've had various different suggestions to have voluntary and/or mandatory calorie labeling in the out-of-home sector. Eventually in April, 2022, we did have new mandatory regulations that came into a force that required large businesses just in England - so not across the whole of the UK, just in England - if they sold food and non-alcoholic drinks and they had to display the calories per portion of every item that they were selling. And then have alongside that somewhere on their menu, a statement that said that adults need around 2000 calories per day. The policy applied just to large businesses, and the definition of that was that those businesses have 250 or more employees, but the employees didn't all have to be involved in serving food and drinks. This might apply also to a large hotel chain who just have some bars or something in their hotels. And the food and drinks covered were things that were available for immediate consumption. Not prepackaged. And then there was also this proviso to allow high-end restaurants to be changing their menus regularly. So, it was only for things that were on the menu for at least 30 days. You mentioned that this policy or a menu labeling might have at least two potential modes of impacts. There's first this idea that providing calories or any sort of labeling on food can somehow provide information for consumers to make what we might hope would be better choices. Might help them choose lower calorie options or healthier options. And then the second potential impact is that businesses might also use the information to change what sort of foods they're serving. It might be that they didn't realize how many calories were in the foods and they're suddenly embarrassed about it. Or as soon as their customers realize, they start to put a little bit of pressure on, you know, we want something a little bit lower calorie. So, there's this potential mechanism that operates at the demand side of how consumers might make choices. And another one at the supply side of what might be available to consumers. And we knew from previous evaluations of these sorts of interventions that there was some evidence that both could occur. Generally, it seems to be that findings from other places and countries are maybe null to small. So, we were thinking that maybe we might see something similar in England. Thank you for sharing that background. I do have a question about the length of time it took to get this menu labeling law in place. Before we get into the results, do you have a sense of why did it take so long? Was it industry pushback? Was it just change of governments? Do you have a sense of that? Jean - Yes, so I think it's probably a bit of both. To begin with, it was first proposed as a voluntary measure actually by industry. So, we had this kind of big public-private partnership. What can industry do to support health? And that was one of the things they proposed. And then they didn't really do it very well. So, there was this idea that everybody would do it. And in fact, we found maybe only about 20% of outlets did it. And then definitely we have had government churn in the UK over the last five years or so. So, every new prime minister really came in and wanted to have their own obesity policy threw out the last one started over. And every policy needs consulted on with the public and then with industry. And that whole process just kind of got derailed over and over again. Thank you. That is really helpful to understand that development of the policy and why it took time. Industry regulated policy can be a tricky one to actually see the results that we would hope. You've already given us a sort of insight into what you thought the results may be from previous studies - null to relatively small. So, Mike, I want to turn to you. Can you tell us what came out of the data? Mike - Thank you, yes. So, we found a small overall drop in average calories offered per item. That amounts to a total of nine calories per item reduction in our post policy period relative to pre policy. And this is about a 2% reduction. It was statistically significant and we do in public health talk about how small effects can still have big impacts. So, I do want to sort of put that out there, but also recognize that it was a small overall drop in calories. And then what we did is we looked at how different food groups changed, and also how calories changed at different types of restaurants, whether it was fast food, restaurants, sit downs that we call pubs, bars, and inns. And then also other different types of takeaways like cafes and things like that where you might get a coffee or a cappuccino or something like that. What we found was driving the overall reduction in calories was a reduction in higher calorie items. So, as Jean mentioned at the outset, one of the things we were trying to identify in this analysis was whether we saw any evidence of reformulation. And we defined reformulation as whether specific products were reduced in their calories so that the same products were lower calories in the post period. We define that as reformulation. And that would be different from, say, a change in menu offering where you might identify a high calorie item and take it off the menu so that then the overall calories offered goes down on average. We found more evidence for the latter. Higher calorie items were removed. We separated into categories of removed items, items that were present in both periods, and new items added in the post period. There were higher calorie items in the removed group. The items that were present in both periods did not change. The new items were lower calorie items. What this says overall is this average reduction is driven by taking off high calorie items, adding some slightly lower calorie items. But we did not find evidence for reformulation, which is a crucial finding as well. We saw that the largest reductions occurred in burgers, beverages and a rather large mixed group called Mains. So, burgers reduced by 103 calories per item. That's pretty substantial. One of the reasons that's so large is that burgers, particularly if they're offered at a pub and might even come with fries or chips, as they say in the UK. And because they have such a high baseline calorie level, there's more opportunity to reduce. So, whether it's making it slightly smaller patty or reducing the cheese or something like that, that's where we saw larger reductions among the burgers. With beverages, typically, this involved the addition of lower calorie options, which is important if it gives an opportunity for lower calorie selections. And that was the main driver of reduction there. And then also we saw in Mains a reduction of 30 calories per item. A couple of the other things we wanted to identify is whether there was a change in the number of items that were considered over England's recommended calories per meal. The recommended calories per meal is 600 calories or less for lunch and dinner. And we saw no statistical change in that group. So overall, we do see a slight reduction in average calories. But this study did not examine changes in consumer behavior. I do want to just briefly touch on that because this was part of a larger evaluation. Another study that was published using customer surveys that was published in Nature Human Behavior found no change in the average calories purchased or consumed after the policy. This evaluation was looking at both the supply and the demand side changes as a result of this policy. Thanks, Mike and I've got lots of questions to follow up, but I'll try to control myself. The first one I'm interested to understand is you talk about the importance of the really calorie-heavy items being removed and the introduction of newer, lower calorie items. And you said that this is not a study of the demand, but I'm interested to know, do you have a sense that the higher calorie items may not have been high or top sellers. It could be easy for a restaurant to get rid of those. Do you have any sense of, you know, the types of items that were removed and of the consumer demand for those items? Mike - Yes. So, as I mentioned, given that the largest changes were occurring among burgers, we're sort of doing this triangulation attempt to examine all of the different potential impacts we can with the study tools we have. We did not see those changes reflected in consumer purchases. So, I think sticking with the evidence, the best thing we could say is that the most frequently purchased items were not the ones that were being pulled off of menus. I think that would be the closest to the evidence. Now, no study is perfect and we did in that customer survey examine the purchases and consumption of about 3000 individuals before and after the policy. It's relatively large, but certainly not fully comprehensive. But based on what we were able to find, it would seem that those reductions in large calorie items, it's probably fair to say, were sort of marginal choices. So, we see some reduction in calories at the margins. That's why the overall is down, but we don't see at the most commonly sold. I should also mention in response to that, a lot of times when we think about eating out of home, we often think about fast food. We did not see reductions in fast food chains at all, essentially. And so really the largest reductions we found were in what would be considered more sit-down dining establishment. For example, sit-down restaurants or even pubs, bars and ends was one of our other categories. We did see average reductions in those chains. The areas you kind of think about for people grabbing food quickly on the go, we did not see reductions there. And we think some of this is a function of the data itself, which is pubs, bars and inns, because they offer larger plates, there's a little bit more space for them to reduce. And so those are where we saw the reductions. But in what we might typically think is sort of the grab and go type of food, we did not see reductions in those items. And so when we did our customer surveys, we saw that those did not lead to reductions in calories consumed. Ahh, I see this and thank you for this. It sounds like the portfolio adjusted: getting rid of those heavy calorie items, adding more of the lower calorie items that may not have actually changed what consumers actually eat. Because the ones that they typically eat didn't change at all. And I would imagine from what you've said that large global brands may not have made many changes, but more local brands have more flexibility is my assumption of that. So that, that's really helpful to see. As you all looked at the literature, you had the knowledge that previous studies have found relatively small changes. Could you tell us about what this work looks like globally? There are other countries that have tried policy similar to this. What did you learn from those other countries about menu labeling? Jean - Well, I mean, I'm tempted to say that we maybe should have learned that this wasn't the sort of policy that we could expect to make a big change. To me one of the really attractive features of a labeling policy is it kind of reflects back those two mechanisms we've talked about - information and reformulation or changing menus. Because we can talk about it in those two different ways of changing the environment and also helping consumers make better choices, then it can be very attractive across the political landscape. And I suspect that that is one of the things that the UK or England learned. And that's reflected in the fact that it took a little while to get it over the line, but that lots of different governments came back to it. That it's attractive to people thinking about food and thinking about how we can support people to eat better in kind of a range of different ways. I think what we learned, like putting the literature all together, is this sort of policy might have some small effects. It's not going to be the thing that kind of changes the dial on diet related diseases. But that it might well be part of an integrated strategy of many different tools together. I think we can also learn from the literature on labeling in the grocery sector where there's been much more exploration of different types of labeling. Whether colors work, whether black stop signs are more effective. And that leads us to conclusions that these more interpretive labels can lead to bigger impacts and consumer choices than just a number, right? A number is quite difficult to make some sense of. And I think that there are some ways that we could think about optimizing the policy in England before kind of writing it off as not effective. Thank you. I think what you're saying is it worked, but it works maybe in the context of other policies, is that a fair assessment? Jean - Well, I mean, the summary of our findings, Mike's touched on quite a lot of it. We found that there was an increase in outlets adhering to the policy. That went from about 20% offered any labeling to about 80%. So, there were still some places that were not doing what they were expected to do. But there was big changes in actual labeling practice. People also told us that they noticed the labels more and they said that they used them much more than they were previously. Like there was some labeling before. We had some big increases in noticing and using. But it's... we found this no change in calories purchased or calories consumed. Which leads to kind of interesting questions. Okay, so what were they doing with it when they were using it? And maybe some people were using it to help them make lower calorie choices, but other people were trying to optimize calories for money spent? We saw these very small changes in the mean calorie of items available that Mike's described in lots of detail. And then we also did some work kind of exploring with restaurants, people who worked in the restaurant chains and also people responsible for enforcement, kind of exploring their experiences with the policy. And one of the big conclusions from that was that local government were tasked with enforcement, but they weren't provided with any additional resources to make that happen. And for various reasons, it essentially didn't happen. And we've seen that with a number of different policies in the food space in the UK. That there's this kind of presumption of compliance. Most people are doing it all right. We're not doing it a hundred percent and that's probably because it's not being checked and there's no sanction for not following the letter of the law. One of the reasons that local authorities are not doing enforcement, apart from that they don't have resources or additional resources for it, is that they have lots of other things to do in the food space, and they see those things as like higher risk. And so more important to do. One of those things is inspecting for hygiene, making sure that the going out is not poisonous or adulterated or anything like that. And you can absolutely understand that. These things that might cause acute sickness, or even death in the case of allergies, are much more important for them to be keeping an eye on than labeling. One of the other things that emerged through the process of implementation, and during our evaluation, was a big concern from communities with experience of eating disorders around kind of a greater focus on calorie counting. And lots of people recounting their experience that they just find that very difficult to be facing in a space where they're maybe not trying to think about their eating disorder or health. And then they're suddenly confronted with it. And when we've gone back and looked at the literature, there's just not very much literature on the impact of calorie labeling on people with eating disorders. And so we're a little bit uncertain still about whether that is a problem, but it's certainly perceived to be a problem. And lots of people find the policy difficult for that reason because they know someone in their family or one of their friends with an eating disorder. And they're very alert to that potential harm. I think this is a really important point to raise that the law, the menu labeling, could have differential effects on different consumers. I'm not versed in this literature on the triggering effects of seeing menu labeling for people with disordered eating. But then I'm also thinking about a different group of consumers. Consumers who are already struggling with obesity, and whether or not this policy is more effective for those individuals versus folks who are not. In the work that you all did, did you have any sense of are there heterogeneous effects of the labeling? Did different consumers respond differentially to seeing the menu label? Not just, for example, individuals maybe with disordered eating? Mike - In this work, we mostly focused on compliance, customer responses in terms of consumption and purchases, changes in menus, and customers reporting whether or not they increase noticing and using. When we looked at the heterogeneous effects, some of these questions are what led us to propose a new project where we interviewed people and tried to understand their responses to calorie labeling. And there we get a lot of heterogenous groups. In those studies, and this work has not actually been published, but should be in the new year, we found that there's a wide range of different types of responses to the policy. For example, there may be some people who recently started going to the gym and maybe they're trying to actually bulk up. And so, they'll actually choose higher calorie items. Conversely, there may be people who have a fitness routine or a dieting lifestyle that involves calorie tracking. And they might be using an app in order to enter the calories into that. And those people who are interested in calorie counting, they really loved the policy. They really wanted the policy. And it gave them a sense of control over their diet. And they felt comfortable and were really worried that if there was evidence that it wouldn't work, that would be taken away. Then you have a whole different group of people who are living with eating disorders who don't want to interact with those numbers when they are eating out of home. They would rather eat socially and not have to think about those challenges. There's really vast diversity in terms of the responses to the policy. And that does present a challenge. And I think what it also does is cause us just to question what is the intended mechanism of action of this policy? Because when the policy was implemented, there's an idea of a relatively narrow set of effects. If customers don't understand the number of calories that are in their items, you just provide them with the calories that are in those items, they will then make better choices as rational actors. But we know that eating out of home is far more complex. It's social. There are issues related to value for money. So maybe people want to make sure they're purchasing food that hasn't been so reduced in portions that now they don't get the value for money when they eat out. There are all sorts of body image related challenges when people may eat out. We didn't find a lot of evidence of this in our particular sample, but also in some of our consultation with the public in developing the interview, there's concern about judgment from peers when eating out. So, it's a very sensitive topic. Some of the implications of that are we do probably need more communication strategies that can come alongside these policies and sort of explain the intended mechanism impact to the public. We can't expect to simply add numbers to items and then expect that people are going to make the exact choices that are sort of in the best interest of public health. And that sort of brings us on to some potential alternative mechanisms of impact and other modes of labeling, and those sorts of things. Mike, this has been really helpful because you've also hinted at some of the ways that this policy as implemented, could have been improved. And I wonder, do you have any other thoughts to add to how to make a policy like this have a bigger impact. Mike - Absolutely. One of the things that was really helpful when Jean laid out her framing of the policy was there's multiple potential mechanisms of action. One of those is the potential reformulation in menu change. We talked about those results. Another intended mechanism of action is through consumer choice. So, if items have fewer calories on average, then that could reduce ultimately calories consumed. Or if people make choices of lower calorie items, that could also be a way to reduce the overall calories consumed. And I would say this calorie labeling policy, it is a step because the calories were not previously available. People did not know what they were eating. And if you provide that, that fulfills the duty of transparency by businesses. When we spoke to people who worked in enforcement, they did support the policy simply on the basis of transparency because it's important for people to understand what they're consuming. And so that's sort of a generally acceptable principle. However, if we want to actually have stronger population health impact, then we do need to have stronger mechanisms of action. One of the ways that can reduce calories consumed by the consumers, so the sort of demand side, would be some of the interpretive labels. Jean mentioned them earlier. There's now a growing body of evidence of across, particularly in Latin America. I would say some of the strongest evidence began in Chile, but also in Mexico and in other Latin American countries where they've put warning labels on items in order to reduce their consumption. These are typically related to packaged foods is where most of the work has been done. But in order to reduce consumer demand, what it does is rather than expecting people to be sort of doing math problems on the fly, as they go around and make their choices, you're actually just letting them know, well, by the way, this is an item that's very high in calories or saturated fat, or sodium or sugars. Or some combination of those. What that does is you've already helped make that decision for the consumers. You've at least let them know this item has a high level of nutrients of concern. And you can take that away. Conversely, if you have an item that's 487 calories, do you really know what you're going to do with that information? So that's one way to have stronger impact. The other way that that type of policy can have stronger impact is it sets clear thresholds for those warnings. And so, when you have clear thresholds for warnings, you can have a stronger mechanism for reformulation. And what companies may want to do is they may not want to display those warning labels, maybe because it's embarrassing. It makes their candy or whatever the unhealthy food look bad. Sort of an eyesore, which is the point. And what they'll do is they can reformulate those nutrients to lower levels so that they no longer qualify for that regulation. And so there are ways to essentially strengthen both of those mechanisms of action. Whereas when it's simply on the basis of transparency, then what that does is leave all of the decision making and work on the consumer. Mike, this is great because I've worked with colleagues like Gabby Fretes and Sean Cash and others on some menu labeling out of Chile. And we're currently doing some work within the center on food nutrition labels to see how different consumers are responding. There's a lot more work to be done in this space. And, of course, our colleagues at UNC (University of North Carolina-Chapel Hill) have also been doing this work. So, this work is really important because it tells us how it can help consumers make different choices, and how it can affect how companies behave. My final question to the two of you is simply, what would you like policymakers to learn from this study? Or maybe not just this study alone, but this body of work. What should they take away? Jean - Well, I think there's lots of information out there on how to do food labeling well, and we can certainly learn from that. And Mike talks about the work from South America particularly where they're helping people identify the least healthy products. And they're also providing messaging around what you should do with that - like choose a product with fewer of these black symbols. But I think even if labeling is optimized, it's not really going to solve our problem of dietary related diseases. And I think I always want policymakers to know, and I think many of them do understand this, that there is no one magic solution and we need to be thinking about labeling as part of a strategy that addresses marketing in its entirety, right? Companies are using all sorts of strategies to encourage us to buy products. We need to be thinking of all sorts of strategies to support people to buy different products and to eat better. And I think that focuses on things like rebalancing price, supporting people to afford healthier food, focusing advertising and price promotions on healthier products. And I also think we need to be looking even further upstream though, right? That we need to be thinking about the incentives that are driving companies to make and sell less healthy products. Because I don't think that they particularly want to be selling less healthy products or causing lots of illness. It's those products are helping them achieve their aims of creating profit and growth for their shareholders. And I think we need to find creative ways to support companies to experiment with healthier products that either help them simultaneously achieve those demands of profit or growth. Or somehow allow them to step away from those demands either for a short period or for a longer period. I think that that requires us to kind of relook at how we do business in economics in our countries. Mike? Yes, I think that was a really thorough answer by Jean. So, I'll just add a couple points. I think most fundamentally what we need to think about when we're doing policy making to improve diet is we need to always think about are we helping to make the healthier choice the easier choice? And what that means is we're not implementing policies that merely provide information that then require individuals to do the rest of the work. We need to have a food environment that includes healthier options that are easily accessible, but also affordable. That's one thing that's come through in quite a lot of the work we've done. There are a lot of concerns about the high cost of food. If people feel like the healthier choices are also affordable choices, that's one of many ways to support the easier choice. And I really just want to reiterate what Jean said in terms of the economics of unhealthy food. In many ways, these large multinational corporations are from their perspective, doing right by their shareholders by producing a profitable product. Now there are debates on whether or not that's a good thing, of course. There's quite a lot of evidence for the negative health impacts of ultra-processed (UPF) products, and those are getting a lot more attention these days and that's a good thing. What we do need to think about is why is it that UPFs are so widely consumed. In many ways they are optimized to be over consumed. They're optimized to be highly profitable. Because the ingredients that are involved in their production means that they can add a lot of salt, sugar, and fat. And what that does is lead to overconsumption. We need to think about that there's something fundamentally broken about this incentive structure. That is incentivizing businesses to sell unhealthy food products with these food additives that lead to over consumption, obesity, and the associated comorbidities. And if we can start to make a little progress and think creatively about how could we incentivize a different incentive structure. One where actually it would be in a food business's best interest to be much more innovative and bolder and produce healthier products for everyone. That's something that I think we will have to contend with because if we are thinking that we are only going to be able to restrict our way out of this, then that's very difficult. Because people still need to have healthy alternatives, and so we can't merely think about restricting. We also have to think about how do we promote access to healthier foods. This is great insight. I appreciate the phrasing of making the healthy choice the easy choice, and I also heard a version of this making the healthy choice the affordable choice. But it also seems like we need to find ways to make the healthy choice the profitable choice as well. Bios: Jean Adams is a Professor of Dietary Public Health and leads the Population Health Interventions Programme at the University of Cambridge MRC Epidemiology Unit. Adams trained in medicine before completing a PhD on socio-economic inequalities in health. This was followed by an MRC Health of the Population fellowship and an NIHR Career Development Fellowship both exploring influences on health behaviours and socio-economic inequalities in these. During these fellowships Jean was appointed Lecturer, then Senior Lecturer, in Public Health at Newcastle University. Jean moved to Cambridge University to join the MRC Epidemiology Unit and CEDAR in 2014 where she helped establish the Dietary Public Health group. She became Programme Leader in the newly formed Population Health Interventions programme in 2020, and was appointed Professor of Dietary Public Health in 2022. Mike Essman is a Research Scientist at Duke University's World Food Policy Center. His background is in evaluating nutrition and food policies aimed at improving diets and preventing cardiometabolic diseases. His work employs both quantitative and qualitative methods to explore drivers of dietary behavior, particularly ultra-processed food consumption, across diverse environments and countries. Mike earned his PhD in Nutrition Epidemiology from the University of North Carolina at Chapel Hill, where his research focused on evaluating the impacts of a sugary beverage tax in South Africa. He completed MSc degrees in Medical Anthropology and Global Health Science at the University of Oxford through a fellowship. Prior to joining Duke, he conducted research at the MRC Epidemiology Unit at the University of Cambridge, where he evaluated the impacts of calorie labeling policies in England and led a study examining public perceptions of ultra-processed foods.  
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  E288: Farmlink's responsive, logistical success preventing food waste 08.12.2025

  Today we're speaking with Aidan Reilly, co-founder and chief of External Affairs at the Farmlink Project, a national nonprofit connecting farmers with surplus produce to communities facing insecurity. What's especially interesting about Farmlink (https://www.farmlinkproject.org/) is that it was started by college students in 2020 as a response to the food supply challenges our nation experienced during the COVID-19 pandemic. The project is now a nationwide movement of college students who provide a key logistical link in a food system that currently sees up to a third of all food produced go to waste. The program delivers fresh produce to food banks as opposed to packaged or processed foods at zero cost, as opposed to charging delivery fees. Interview Summary So, you were a student when you decided to take on this issue of food waste. Was there sort of a moment where you realized that there was an opportunity in this area of food recovery? And how were you able to move from an idea to action so quickly, especially just being a college student? Yeah, I would say the moment where we realized the opportunity was actually well after we started. So maybe a couple weeks after we started. Initially, we figured that we might have been the first people to ever have this idea. We basically went to our local food bank. It was April of 2020 and classes had been canceled. We weren't doing anything, wanted to be helpful in our community. And the food bank told us we don't need any more volunteers. But we do need food and we especially need fresh food. That's what we're really short on right now. And we have a lot more people coming to our food bank compared to usual. And so, they were naming things like eggs, milk, produce. And then I happened to read a New York Times article that was talking about farmers who were dumping those very items due to supply chain breakdown. They were smashing eggs into the ground, dumping into farms because they couldn't store it anymore. And that's where the idea was initially born. And we just figured, why don't we call these farmers and reach out and ask if we can have this excess instead of them dumping it, so we can get it to our food bank. And those initial deliveries that we did, it was basically us driving the trucks ourselves. Driving it on the freeway, getting it to the food bank. But within three weeks, we'd moved a million pounds of food. And we realized, wow, there's potentially not a lever or an existing organization that is suited to solve this issue at scale. And this issue of food waste and fresh food going to waste while people need it, that's definitely not unique to the pandemic. One out of every three pounds of food we grow in this country is getting thrown out on a year-to-year basis. And there's tens of millions of people in the country who could use that. That's when the opportunity struck us that we could do something much, much larger than just a grassroots pandemic project. Pretty remarkable. So where were you in school at the time? Where did this take place? I was at Brown University, but I was sent home so I was in Los Angeles at the time. Okay. So, tell us what Farmlink does and how it works. It's a pretty basic concept. When I say farm, I'm basically referring to every point along the supply chain before it gets to the supermarket, let's say. So that means all the distribution centers, the packing houses, everything from field to packing house to distribution center, to that food being on a truck on its way to a grocery store. And then the grocery store might reject it due to it arriving late, for example. So when that happens, at the moment there really is no solution for that kind of large scale surplus, that kind of large scale waste. There are a few things you might be able to do. Like at the farm, they might be able to till it back in, use it for fertilizer. They may be able to send it to animal feed. In some cases, they can compost it. In some cases, you can send it to a bio digester to create methane - usable natural gas. That being said, there's so much of this. And oftentimes producers don't have the time. And when we're dealing with 24-to-48-hour window or less, if the food's already on that truck, it's much easier to just send it to a landfill. That's where we make ourselves available. All you have to do is give Farmlink a call. Doesn't matter where you are in the country. Often doesn't matter where you are in North America. We're going to be able to book the truck, find out a location that can receive it in the capacity and the packaging that it's in. And then we coordinate the delivery, and we cover the cost of that delivery so that it's ultimately at no cost to the food banker community. So how do you support the expenses? We're 501C3. We're a nonprofit. And we're about five and a half years in. And to this date, we've moved just under 500 million pounds of food. I don't even want to put a ballpark number out there, but it's a fraction of a very small fraction of the cost it usually costs us around, let's say four and a half cents per pound of food that we move and. We do that all through philanthropic dollars. So, grants, corporate partnerships, private family foundations. That's really nice. And you mentioned that this has grown beyond its original location and you mentioned around the country. So how widely available is this and how big is Farmlink? We've moved food in every single state in the US. We've also moved food in Mexico and in Canada and are capable of doing so. And, you know, we don't own any assets for two reasons. The first being that there is enough available infrastructure at the moment that we don't think is being taken full, complete advantage of that can take in more excess food than is currently being taken in. The second reason is that if we don't have infrastructure, then we're not beholden to one particular region of the US. In the future, it might make sense for us to maybe get something like a packing house. We think there's enough available infrastructure that just needs to be maximized through connection and that's what we provide. Tell me how it works. Does the process in a given location get initiated by a call from a farmer saying, I have extra eggs, or extra lettuce, or whatever it is? Or is it a call from a food bank saying, we need these things, and who owns the truck? Who drives the truck? How does all that work? There are a couple different instances. One very common one actually is from food bank to food bank. So, that process is not a hundred percent efficient. Sometimes it's a lot less than a hundred percent efficient. One food bank receives, let's say they get a relationship with a company that has decided to do some good and donate a huge amount of their product to that food bank. There's kind of a misconception that food banks can take and want to take everything in. So, they might have excess that they're not sure what to do with. Farmlink will actually be able to coordinate. We'll get a call from that food bank. We will just connect them with another partner in our network who might need whatever they have access of, and then we'll facilitate that delivery. We don't count that towards our pounds of food move. That's just one way that we're easily able to make sure food's not going to waste at the end. The more understandable thing that we do is can really just be a call direct from a farmer. We've received calls from farmers who might tell us that a contract has been cut. We worked with a group of farmers in West Virginia who had a contract cut. They were apple farmers, and they were left with tens of millions of apples that they were basically having to burn them because storing them was so expensive and there was nowhere else they could meaningfully send them. And what we do is we have to basically find the demand. Let's say all the local food banks, institutions are full of all the apples that they could ever possibly need or want. But several states over, organizations, especially rural ones, might have no access to anything like that. We're going to work then with the third-party logistics company. It's kind of like Uber, but for a big semi-truck. Figure out how those apples are going to get packaged. If we're sending it to a local organization that has only volunteers and they don't have a forklift, if you just send them 800-pound bins of apples, it's going to hurt them more than it's going to help them. We've got to figure out how to get it packaged into smaller cartons. We could figure out if they need to be washed, if they need to be processed at all. Most of the time we don't have to do that. But if it's coming direct from a field, you never know. And then we pay for the truck and basically see the delivery all the way through until it gets to that food bank. And then from there, it's important to mention that the food bank itself is not necessarily always the end recipient. It goes from there to churches, schools, it goes in in smaller receivable loads to tens of thousands of different nodes across the country. Pretty remarkable. As you were building this, what were some of the biggest logistic challenges that you faced, and how did you overcome them? You know, it's relatively basic supply chain matching. And I don't say that to underplay what my team does because they are working literally around the clock. I mean, you have to work on the farmer's schedule. That's one big thing is that if you wanted to set this up out of the good of your heart and because you believe food shouldn't go to waste, great. But you've got to be ready to work on the farmer schedule. You know, I really don't know a busier working person and it's a Wednesday night and they've got a truck stuck on a road somewhere. Or whoever they might be working with, wherever they're sending it, they've got a truck stuck on the road and you don't pick up their call and you're not ready and capable to figure out how it's going to get sent, then they're never going to call you again. And even though there's all that available food out there, you're not going to have access to it. [00:10:00] And that was a huge distinguishing factor. We're not going to operate on the schedule of the charitable food system, which due to constrained resources having to depend on volunteers, might only be a couple days a week for a lot of these food banks. We're going to basically be available 24-7 and make this possible. The other thing is just the scale. I'll go back to this West Virginia example with the apples, because as far as we can tell, that was the largest food recovery ever done in the United States. We moved 50 million apples across 27 states. It took us about five weeks to do so. And, you can't have even one of those truckloads go wrong. You can't have one of them show up at a place where nobody's ready to receive it. You can't have one of them not be temperature controlled and have something spoil or get stuck. It basically has to be perfect. And that's round the clock extreme attention to detail. Working on the farmer schedule, but working based on the food bank and the community preferences. To be a middleman is a sense of responsibility. We are middleman to make things easier. The second we make it harder, then the importance of something like Farmlink existing is not, you know? Does all the middlemen activity occur in a one central location or is it somehow distributed all around the country? Yes, so on any given day, we could be moving food in California, Arizona, Texas, Michigan, Florida, and Ontario. On a given week it could be more than that. We have over 400 different recipient locations that we're pretty regularly sending food to and that we have done. But is all this work done in one central hub? No, it's not. It's really decentralized. First of all, our team is decentralized. I'm in New York City. The head of our farmer advocacy is in the middle of Texas. The head of our agency relations is in Los Angeles. We're decentralized. But we're booking these trucks and coordinating. If we're not there in person at the farm, it's happening over the phone, and you can book it from anywhere in the country. What metrics do you use to make priorities about what to deliver to the food banks and how do you collect data on the impact you're having? And one of the reasons I asked that is that food banks often use pounds of food distributed as the metric for how successful they are. But of course, a pound of broccoli is different nutritionally than a pound of sugar beverage. But it sounds like in your case, that's not such a worry because it's fresh, healthy food. And you're not worried about the kind of packaged processed food. There's a lot of metrics that get thrown around. We've spent years going over verbiage and that has to do with pounds of. It's not verbiage, it's real impact. I mean, it's pounds of food that we deliver. There's a kind of an industry standard that 1.2 pounds of food you're, you can call a meal. And so, we will kind sometimes refer to it as meals, but we feel like that's a little misleading because 1.2 pounds of onions is not a meal for anyone. There are emissions that's avoided. We basically did years of work to figure out and get a model that is third party verified that shows exactly the methane avoidance for every type of food and where it's coming from, that we avoid going to the landfill. That being said, I don't think metrics necessarily are going to be what's going to grow this industry into its potential. I think behavior change really could. I think when you look at what, you know, let's call it the food crisis in the United States, and what we see, it's often not that there isn't enough food, it's that Americans aren't getting the right kinds of food. We see refrigerators full that are supposed to be for fresh food that are just full of energy drinks. And people honestly not wanting or not knowing what to cook if they're given a bunch of organic produce. And what we'd like to track is if you can take excess food, surplus produce, get that into a community and do it in a way that is trustworthy such that you can see people start to familiarize with it and you can see diets change and the level of nutrition change over the period of a year or two consistently in that community. How are education levels changing? How are like graduation rates changing? How is the ability to meet your mortgage changing? I mean, there's so many different things that are tied into once you meet your basic level of nutrition that it kind of demands a level deeper of metrics that we're excited to explore but have not been able to yet. My guess is that this work is especially important at the moment because of cuts to the SNAP program, uncertainty about its future, problems with economies and the cost of food and things. Is that right? Is this an especially difficult time? Grocery prices are at all-time highs. There's economic uncertainty that comes and goes, but really there's a massive, short term blow that has come with federal funding since the start of 2025. So many, so many food banks that relied on federal cuts or on federal funding had billions of dollars cut from their budget, which means fewer employees, less ability to purchase food to give more round out meal, which means they're going to cheaper, more processed meals. And then to cap that off has been the uncertainty with SNAP that we saw at the beginning of this month where it looked like there was going to be no SNAP benefits given at all. And what ultimately was agreed on is a significantly reduced SNAP benefits going towards Americans. And you can't forget that SNAP provides more meals to people in the country than the rest of the charitable food system. Every food bank combined by a pretty significant multiplier. All is to say this is becoming a lot more visible for people. The fragility and the line between what it means to be food secure and to not know how you're going to afford your next meal. And that's something that you don't feel like is an issue that you live with day to day in the United States if you have a roof over your head or even if you have a job. But there's over 40 million Americans who are living like that, right at or under the poverty line. It's very relevant. It's the most extreme I've seen it ever, and that include the pandemic. It's pretty remarkable statement. My guess is that the answer to this question is going to be all of the above. But when you talk to a farmer who donates food to this process, is the farmer doing it because it just helps offload things he or she would have to deal with otherwise? Does it feel good to the farmer to know that all the things that he or she puts so much work into producing is actually getting used? They're helping people? I mean, how does that sort out? Why is it in their interest to do this? From what we heard from farmers, yes, they work a lot. That's a massive understatement. They work extremely hard and invest an incredible amount into growing this food first and foremost. They definitely don't want to see it just go to waste. And, if they have any ability whatsoever to get it to a secondary market, to be able to turn a dollar on that we don't want to take it. There's no other option for the farmer. We did not approach and do not approach this from the perspective of asking farmers to do this out of the good of their hearts. As much as they might like to, they don't have the time and they do not have the budget to do things out of the good of their heart. One of the things we did right initially and then have always continued to do is approaches from how is this going to save a farmer a headache and maybe save the farmer some money. If you've got a massive pile of something that you can't sell in your backyard it, I don't know if you've ever tried to just donate 50 pounds of something to a food bank. It's not as easy as you might think. Let alone 500,000 pounds. How are they going to call 30 different food banks or compost centers or whatever. It's just that much easier to go to a landfill. And then once they're going to the landfill that, especially depending which state they're in, it costs them money to dump it. There are tipping fees. And if it's already in packaging those can be significant. It can be $3,000 up to we've seen $15,000 for them just to dump fresh food. So, the concept is we're going to make it just one phone call away, no matter how big your pile of food is, we can take it. If it's 50 million apples or if it's a couple thousand pounds. And then we're going to save you the cost of that tipping fee. And so if we're working with you consistently, because you might grow extra so that if the weather changes, you're not going to under meet your demand. If we're working with you consistently, that's $3,000 on every truckload we're taking from you. That adds up. And then we'll get you a tax write off for a bit of the value of that food. And we are pushing for something that we see here in New York, which is the Farm-to-Food-Tank tax credit, where it's an actual credit that means cash actually back in the farmer's pocket. We'd like to see that instituted on a federal level because ultimately a write off is not enough. And often not taken advantage of for pretty clear reasons. So, that's a long answer, but we're farmers first. We need to figure out what helps them, what's easy for them, and that can put some money back in their pocket. And that's how we're going to be able to get available food to people who need it. So, let's end with a crystal ball type question. What do you hope the future of Farmlink will be and what will it look like in generations to come? You know, we put up billboards a couple years back, which said help put Farmlink out of business. And the mindset around that is the future you want to see really one where something like Farmlink is moving billions of pounds of food? Because that means there's still billions of pounds going to waste. It means there's still millions of people who could use that. But my mindset has actually shifted on that. I think what our role is, and organizations that are similar to us, is to show what's possible to drive the political will to institute incentive to have this be an existing lever. I think we've seen other countries do this effectively. The United States is just such a large and extremely productive country that it's a big undertaking. But when you get a big group of students who are able to move half a billion pounds of food on a pretty minimal budget, and continuing to climb that number year after year, then we start seeing people turn their heads and pay attention. Oh, this might actually be possible. And there's a lot of creative things that you could do with this food. You see other companies pop up. Some for-profit some non-profit and basically you develop an industry around this. Food recovery, I think has been an edge case industry where it's been something that's either done locally or it's been done in an incredibly scrappy, grassroots way. The future needs to be that this is an industry and that has the same level of attention as any other industry in the United States. So that we have a built-in solution for billions of pounds of food going to waste. And we can deal with that abundance by re-routing it back to the people in the country who need it. I think that's the kind of country that the United States should be and the one that I think we're working towards. But I think we live in a society where it's got to be done to get people to follow. You can't just say it, you got to go do it. And that's what we're here for. Well, thank you for your inspired work. It's really pretty remarkable what you've accomplished in such a short period of time, and it shows how much difference one or two, or three people can make if they have vision and passion and creativity in trying to implement new solutions to existing problems. I hope your crystal ball works out and that what you're hoping to come true really will and it would be so good for the planet, for people who don't have enough food, for the farmer, just for everybody in the whole chain. So again, congratulations for such great work and thanks so much for joining us. BIO Aidan Reilly is Co-Founder and Chief of External Affairs at The Farmlink Project, a national nonprofit connecting farmers with surplus produce to communities facing food insecurity. Within its first five years, the organization has rescued and distributed nearly 500 million pounds of food that would have otherwise gone to waste. 
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  E287: Food policy insights from government agency insider Jerold Mande 25.11.2025 32min

  In this episode, Kelly Brownell speaks with Jerold Mande, CEO of Nourish Science, adjunct professor at the Harvard School of Public Health, and former Deputy Undersecretary for Food Safety at the USDA. They discuss the alarming state of children's health in America, the challenges of combating poor nutrition, and the influence of the food industry on public policy. The conversation explores the parallels between the tobacco and food industries and proposes new strategies for ensuring children reach adulthood in good health. Mande emphasizes the need for radical changes in food policy and the role of public health in making these changes. Transcript So, you co-founded this organization along with Jerome Adams, Bill Frist and Thomas Grumbly, as we said, to ensure every child breaches age 18 at a healthy weight and in good metabolic health. That's a pretty tall order given the state of the health of youth today in America. But let's start by you telling us what inspired this mission and what does it look like to achieve this in today's food environment? I was trained in public health and also in nutrition and in my career, which has been largely in service of the public and government, I've been trying to advance those issues. And unfortunately over the arc of my career from when I started to now, particularly in nutrition and public health, it's just gotten so much worse. Indeed today Americans have the shortest lifespans by far. We're not just last among the wealthy countries, but we're a standard deviation last. But probably most alarming of all is how sick our children are. Children should not have a chronic disease. Yet in America maybe a third do. I did some work on tobacco at one point, at FDA. That was an enormous success. It was the leading cause of death. Children smoked at a higher rate, much like child chronic disease today. About a third of kids smoked. And we took that issue on, and today it's less than 2%. And so that shows that government can solve these problems. And since we did our tobacco work in the early '90s, I've changed my focus to nutrition and public health and trying to fix that. But we've still made so little progress. Give us a sense of how far from that goal we are. So, if the goal is to make every child reaching 18 at a healthy weight and in good metabolic health, what percentage of children reaching age 18 today might look like that? It's probably around a half or more, but we're not quite sure. We don't have good statistics. One of the challenges we face in nutrition is, unfortunately, the food industry or other industries lobby against funding research and data collection. And so, we're handicapped in that way. But we do know from the studies that CDC and others have done that about 20% of our children have obesity about a similar number have Type 2 diabetes or the precursors, pre-diabetes. You and I started off calling it adult-onset diabetes and they had to change that name to a Type 2 because it's becoming so common in kids. And then another disease, fatty liver disease, really unthinkable in kids. Something that the typical pediatrician would just never see. And yet in the last decade, children are the fastest growing group. I think we don't know an exact number, but today, at least a third, maybe as many as half of our children have a chronic disease. Particularly a food cause chronic disease, or the precursors that show they're on the way. I remember probably going back about 20 years, people started saying that we were seeing the first generation of American children that would lead shorter lives than our parents did. And what a terrible legacy to leave our children. Absolutely. And that's why we set that overarching goal of ensuring every child reaches age 18 in good metabolic health. And the reason we set that is in my experience in government, there's a phrase we all use - what gets measured gets done. And when I worked at FDA, when I worked at USDA, what caught my attention is that there is a mission statement. There's a goal of what we're trying to achieve. And it's ensuring access to healthy options and information, like a food label. Now the problem with that, first of all, it's failed. But the problem with that is the bureaucrats that I oversaw would go into a supermarket, see a produce section, a protein section, the food labels, which I worked on, and say we've done our job. They would check those boxes and say, we've done it. And yet we haven't. And if we ensured that every child reaches age 18 at a healthy weight and good metabolic health, if the bureaucrats say how are we doing on that? They would have to conclude we're failing, and they'd have to try something else. And that's what we need to do. We need to try radically different, new strategies because what we've been doing for decades has failed. You mentioned the food industry a moment ago. Let's talk about that in a little more detail. You made the argument that food companies have substituted profits for health in how they design their products. Explain that a little bit more, if you will. And tell us how the shift has occurred and what do you think the public health cost has been? Yes, so the way I like to think of it, and your listeners should think of it, is there's a North star for food design. And from a consumer standpoint, I think there are four points on the star: taste, cost, convenience, and health. That's what they expect and want from their food. Now the challenge is the marketplace. Because that consumer, you and I, when we go to the grocery store and get home on taste, cost, and convenience, if we want within an hour, we can know whether the food we purchased met our standard there. Or what our expectations were. Not always for health. There's just no way to know in a day, a week, a month, even in a year or more. We don't know if the food we're eating is improving and maintaining our health, right? There should be a definition of food. Food should be what we eat to thrive. That really should be the goal. I borrowed that from NASA, the space agency. When I would meet with them, they said, ' Jerry, it's important. Right? It's not enough that people just survive on the food they eat in space. They really need to thrive.' And that's what WE need to do. And that's really what food does, right? And yet we have food, not only don't we thrive, but we get sick. And the reason for that is, as I was saying, the marketplace works on taste, cost and convenience. So, companies make sure their products meet consumer expectation for those three. But the problem is on the fourth point on the star: on health. Because we can't tell in even years whether it's meeting our expectation. That sort of cries out. You're at a policy school. Those are the places where government needs to step in and act and make sure that the marketplace is providing. That feedback through government. But the industry is politically strong and has prevented that. And so that has left the fourth point of the star open for their interpretation. And my belief is that they've put in place a prop. So, they're making decisions in the design of the product. They're taste, they gotta get taste right. They gotta get cost and convenience right. But rather than worrying what does it do to your health? They just, say let's do a profit. And that's resulted in this whole category of food called ultra-processed food (UPF). I actually believe in the future, whether it's a hundred years or a thousand years. If humanity's gonna thrive we need manmade food we can thrive on. But we don't have that. And we don't invest in the science. We need to. But today, ultra-processed food is manmade food designed on taste, cost, convenience, and then how do we make the most money possible. Now, let me give you one other analogy, if I could. If we were CEOs of an automobile company, the mission is to provide vehicles where people can get safely from A to point B. It's the same as food we can thrive on. That is the mission. The problem is that when the food companies design food today, they've presented to the CEO, and everyone gets excited. They're seeing the numbers, the charts, the data that shows that this food is going to meet, taste, cost, convenience. It's going to make us all this money. But the CEO should be asking this following question: if people eat this as we intend, will they thrive? At the very least they won't get sick, right? Because the law requires they can't get sick. And if the Midmanagers were honest, they'd say here's the good news boss. We have such political power we've been able to influence the Congress and the regulatory agencies. That they're not going to do anything about it. Taste, cost, convenience, and profits will work just fine. Couldn't you make the argument that for a CEO to embrace that kind of attitude you talked about would be corporate malpractice almost? That, if they want to maximize profits then they want people to like the food as much as possible. That means engineering it in ways that make people overeat it, hijacking the reward pathways in the brain, and all that kind of thing. Why in the world would a CEO care about whether people thrive? Because it's the law. The law requires we have these safety features in cars and the companies have to design it that way. And there's more immediate feedback with the car too, in terms of if you crashed right away. Because it didn't work, you'd see that. But here's the thing. Harvey Wiley.He's the founder of the food safety programs that I led at FDA and USDA. He was a chemist from academia. Came to USDA in the late 1800s. It was a time of great change in food in America. At that point, almost all of families grew their own food on a farm. And someone had to decide who's going to grow our food. It's a family conversation that needed to take place. Increasingly, Americans were moving into the cities at that time, and a brand-new industry had sprung up to feed people in cities. It was a processed food industry. And in order to provide shelf stable foods that can offer taste, cost, convenience, this new processed food industry turned to another new industry, a chemical industry. Now, it's hard to believe this, but there was a point in time that just wasn't an industry. So these two big new industries had sprung up- processed food and chemicals. And Harvey Wiley had a hypothesis that the chemicals they were using to make these processed foods were making us sick. Indeed, food poisoning back then was one of the 10 leading causes of death. And so, Harvey Wiley went to Teddy Roosevelt. He'd been trying for years within the bureaucracy and not making progress. But when Teddy Roosevelt came in, he finally had the person who listened to him. Back then, USDA was right across from the Washington Monument to the White House. He'd walk right over there into the White House and met with Teddy Roosevelt and said, ' this food industry is making us sick. We should do something about it.' And Teddy Roosevelt agreed. And they wrote the laws. And so I think what your listeners need to understand is that when you look at the job that FDA and USDA is doing, their food safety programs were created to make sure our food doesn't make us sick. Acutely sick. Not heart disease or cancer, 30, 40 years down the road, but acutely sick. No. I think that's absolutely the point. That's what Wiley was most concerned about at the time. But that's not the law they wrote. The law doesn't say acutely ill. And I'll give you this example. Your listeners may be familiar with something called GRAS - Generally Recognized as Safe. It's a big problem today. Industry co-opted the system and no longer gets approval for their food additives. And so, you have this Generally Recognized as Safe system, and you have these chemicals and people are worried about them. In the history of GRAS. Only one chemical has FDA decided we need to get that off the market because it's unsafe. That's partially hydrogenated oils or trans-fat. Does trans-fat cause acute illness? It doesn't. It causes a chronic disease. And the evidence is clear. The agency has known that it has the responsibility for both acute and chronic illness. But you're right, the industry has taken advantage of this sort of chronic illness space to say that that really isn't what you should be doing. But having worked at those agencies, I don't think they see it that way. They just feel like here's the bottom line on it. The industry uses its political power in Congress. And it shapes the agency's budget. So, let's take FDA. FDA has a billion dollars with a 'b' for food safety. For the acute food safety, you're talking about. It has less than 25 million for the chronic disease. There are about 1400 deaths a year in America due to the acute illnesses caused by our food that FDA and USDA are trying to prevent. The chronic illnesses that we know are caused by our food cause 1600 maybe a day. More than that of the acute every day. Now the agency should be spending at least half its time, if not more, worrying about those chronic illness. Why doesn't it? Because the industry used their political power in Congress to put the billion dollars for the acute illness. That's because if you get acutely ill, that's a liability concern for them. Jerry let's talk about the political influence in just a little more detail, because you're in a unique position to tell us about this because you've seen it from the inside. One mechanism through which industry might influence the political process is lobbyists. They hire lobbyists. Lobbyists get to the Congress. People make decisions based on contributions and things like that. Are there other ways the food industry affects the political process in addition to that. For example, what about the revolving door issue people talk about where industry people come into the administrative branch of government, not legislative branch, and then return to industry. And are there other ways that the political influence of the industry has made itself felt? I think first and foremost it is the lobbyists, those who work with Congress, in effect. Particularly the funding levels, and the authority that the agencies have to do that job. I think it's overwhelmingly that. I think second, is the influence the industry has. So let me back up to that a sec. As a result of that, we spend very little on nutrition research, for example. It's 4% of the NIH budget even though we have these large institutes, cancer, heart, diabetes, everyone knows about. They're trying to come up with the cures who spend the other almost 50 billion at NIH. And so, what happens? You and I have both been at universities where there are nutrition programs and what we see is it's very hard to not accept any industry money to do the research because there isn't the federal money. Now, the key thing, it's not an accident. It's part of the plan. And so, I think that the research that we rely on to do regulation is heavily influenced by industry. And it's broad. I've served, you have, others, on the national academies and the programs. When I've been on the inside of those committees, there are always industry retired scientists on those committees. And they have undue influence. I've seen it. Their political power is so vast. The revolving door, that is a little of both ways. I think the government learns from the revolving door as well. But you're right, some people leave government and try to undo that. Now, I've chosen to work in academia when I'm not in government. But I think that does play a role, but I don't think it plays the largest role. I think the thing that people should be worried about is how much influence it has in Congress and how that affects the agency's budgets. And that way I feel that agencies are corrupted it, but it's not because they're corrupted directly by the industry. I think it's indirectly through congress. I'd like to get your opinion on something that's always relevant but is time sensitive now. And it's dietary guidelines for America. And the reason I'm saying it's time sensitive is because the current administration will be releasing dietary guidelines for America pretty soon. And there's lots of discussion about what those might look like. How can they help guide food policy and industry practices to support healthier children and families? It's one of the bigger levers the government has. The biggest is a program SNAP or food stamps. But beyond that, the dietary guidelines set the rules for government spending and food. So, I think often the way the dietary guidelines are portrayed isn't quite accurate. People think of it in terms of the once (food) Pyramid now the My Plate that's there. That's the public facing icon for the dietary guidelines. But really a very small part. The dietary guidelines are meant to help shape federal policy, not so much public perception. It's there. It's used in education in our schools - the (My) Plate, previously the (Food) Pyramid. But the main thing is it should shape what's served in government feeding programs. So principally that should be SNAP. It's not. But it does affect the WIC program- Women, Infants and Children, the school meals program, all of the military spending on food. Indeed, all spending by the government on food are set, governed by, or directed by the dietary guidelines. Now some of them are self-executing. Once the dietary guidelines change the government changes its behavior. But the biggest ones are not. They require rulemaking and in particular, today, one of the most impactful is our kids' meals in schools. So, whatever it says in these dietary guidelines, and there's reason to be alarmed in some of the press reports, it doesn't automatically change what's in school meals. The Department of Agriculture would have to write a rule and say that the dietary guidelines have changed and now we want to update. That usually takes an administration later. It's very rare one administration could both change the dietary guidelines and get through the rulemaking process. So, people can feel a little reassured by that. So, how do you feel about the way things seem to be taking shape right now? This whole MAHA movement Make America Healthy Again. What is it? To me what it is we've reached this tipping point we talked about earlier. The how sick we are, and people are saying, 'enough. Our food shouldn't make us sick at middle age. I shouldn't have to be spending so much time with my doctor. But particularly, it shouldn't be hard to raise my kids to 18 without getting sick. We really need to fix that and try to deal with that.' But I think that the MAHA movement is mostly that. But RFK and some of the people around them have increasingly claimed that it means some very specific things that are anti-science. That's been led by the policies around vaccine that are clearly anti-science. Nutrition is more and more interesting. Initially they started out in the exact right place. I think you and I could agree the things they were saying they need to focus on: kids, the need to get ultra-processed food out of our diets, were all the right things. In fact, you look at the first report that RFK and his team put out back in May this year after the President put out an Executive Order. Mostly the right things on this. They again, focus on kids, ultra-processed food was mentioned 40 times in the report as the root cause for the very first time. And this can't be undone. You had the White House saying that the root cause of our food-caused chronic disease crisis is the food industry. That's in a report that won't change. But a lot has changed since then. They came out with a second report where the word ultra-processed food showed up only once. What do you think happened? I know what happened because I've worked in that setting. The industry quietly went to the White House, the top political staff in the White House, and they said, you need to change the report when you come out with the recommendations. And so, the first report, I think, was written by MAHA, RFK Jr. and his lieutenants. The second report was written by the White House staff with the lobbyists of the food industry. That's what happened. What you end up with is their version of it. So, what does the industry want? We have a good picture from the first Trump administration. They did the last dietary guidelines and the Secretary of Agriculture, then Sonny Perdue, his mantra to his staff, people reported to me, was the industries- you know, keep the status quo. That is what the industry wants is they really don't want the dietary guidelines to change because then they have to reformulate their products. And they're used to living with what we have and they're just comfortable with that. For a big company to reformulate a product is a multi-year effort and cost billions of dollars and it's just not what they want to have to do. Particularly if it's going to change from administration to administration. And that is not a world they want to live in. From the first and second MAHA report where they wanted to go back to the status quo away from all the radical ideas. It'll be interesting to see what happens with dietary guidelines because we've seen reports that RFK Jr. and his people want to make shifts in policies. Saying that they want to go back to the Pyramid somehow. There's a cartoon on TV, South Park, I thought it was produced to be funny. But they talked about what we need to do is we need to flip the Pyramid upside down and we need to go back to the old Pyramid and make saturated fat the sort of the core of the diet. I thought it meant to be a joke but apparently that's become a belief of some people in the MAHA movement. RFK. And so, they want to add saturated fat back to our diets. They want to get rid of plant oils from our diets. There is a lot of areas of nutrition where the science isn't settled. But that's one where it is, indeed. Again, you go back only 1950s, 1960s, you look today, heart disease, heart attacks, they're down 90%. Most of that had to do with the drugs and getting rid of smoking. But a substantial contribution was made by nutrition. Lowering saturated fat in our diets and replacing it with plant oils that they're now called seed oils. If they take that step and the dietary guidelines come out next month and say that saturated fat is now good for us it is going to be just enormously disruptive. I don't think companies are going to change that much. They'll wait it out because they'll ask themselves the question, what's it going to be in two years? Because that's how long it takes them to get a product to market. Jerry, let me ask you this. You painted this picture where every once in a while, there'll be a glimmer of hope. Along comes MAHA. They're critical of the food industry and say that the diet's making us sick and therefore we should focus on different things like ultra-processed foods. In report number one, it's mentioned 40 times. Report number two comes out and it's mentioned only once for the political reasons you said. Are there any signs that lead you to be hopeful that this sort of history doesn't just keep repeating itself? Where people have good ideas, there's science that suggests you go down one road, but the food industry says, no, we're going to go down another and government obeys. Are there any signs out there that lead you to be more hopeful for the future? There are signs to be hopeful for the future. And number one, we talked earlier, is the success we had regulating tobacco. And I know you've done an outstanding job over the years drawing the parallels between what happened in tobacco and food. And there are good reasons to do that. Not the least of which is that in the 1980s, the tobacco companies bought all the big food companies and imparted on them a lot of their lessons, expertise, and playbook about how to do these things. And so that there is a tight link there. And we did succeed. We took youth smoking, which was around a 30 percent, a third, when we began work on this in the early 1990s when I was at FDA. And today it's less than 2%. It's one area with the United States leads the world in terms of what we've achieved in public health. And there's a great benefit that's going to come to that over the next generation as all of those deaths are prevented that we're not quite seeing yet. But we will. And that's regardless of what happens with vaping, which is a whole different story about nicotine. But this idea success and tobacco. The food industry has a tobacco playbook about how to addict so many people and make so much money and use their political power. We have a playbook of how to win the public health fight. So, tell us about that. What you're saying is music to my ears and I'm a big believer in exactly what you're saying. So, what is it? What does that playbook look like and what did we learn from the tobacco experience that you think could apply into the food area? There are a couple of areas. One is going to be leadership and we'll have to come back to that. Because the reason we succeeded in tobacco was the good fortune of having a David Kessler at FDA and Al Gore as Vice President. Nothing was, became more important to them than winning this fight against a big tobacco. Al Gore because his sister died at a young age of smoking. And David Kessler became convinced that this was the most important thing for public health that he could do. And keep in mind, when he came to FDA, it was the furthest thing from his mind. So, one of it is getting these kinds of leaders. Did does RFK Jr. and Marty McCarey match up to Al Gore? And we'll see. But the early signs aren't that great. But we'll see. There's still plenty of time for them to do this and get it right. The other thing is having a good strategy and policy about how to do it. And here, with tobacco, it was a complete stretch, right? There was no where did the FDA get authority over tobacco? And indeed, we eventually needed the Congress to reaffirm that authority to have the success we did. As we talked earlier, there's no question FDA was created to make sure processed food and the additives and processed food don't make us sick. So, it is the core reason the agency exists is to make sure that if there's a thing called ultra-processed food, man-made food, that is fine, but we have to thrive when we eat it. We certainly can't be made sick when we eat it. Now, David Kessler, I mentioned, he's put forward a petition, a citizens' petition to FDA. Careful work by him, he put months of effort into this, and he wrote basically a detailed roadmap for RFK and his team to use if they want to regulate ultra-processed stuff food. And I think we've gotten some, initially good feedback from the MAHA RFK people that they're interested in this petition and may take action on it. So, the basic thrust of the Kessler petition from my understanding is that we need to reconsider what's considered Generally Recognized as Safe. And that these ultra-processed foods may not be considered safe any longer because they produce all this disease down the road. And if MAHA responds positively initially to the concept, that's great. And maybe that'll have legs, and something will actually happen. But is there any reason to believe the industry won't just come in and quash this like they have other things? This idea of starting with a petition in the agency, beginning an investigation and using its authority is the blueprint we used with tobacco. There was a petition we responded, we said, gee, you raised some good points. There are other things we put forward. And so, what we hope to see here with the Kessler petition is that the FDA would put out what's called an advanced notice of a proposed rulemaking with the petition. This moves it from just being a petition to something the agency is saying, we're taking this seriously. We're putting it on the record ourselves and we want industry and others now to start weighing in. Now here's the thing, you have this category of ultra-processed food that because of the North Star I talked about before, because the industry, the marketplace has failed and gives them no incentive to make sure that we thrive, that keeps us from getting sick. They've just forgotten about that and put in place profits instead. The question is how do you get at ultra-processed food? What's the way to do it? How do you start holding the industry accountable? Now what RFK and the MAHA people started with was synthetic color additives. That wasn't what I would pick but, it wasn't a terrible choice. Because if you talk to Carlos Monteiro who coined the phrase ultra-processed food, and you ask him, what is an ultra-processed food, many people say it's this industrial creation. You can't find the ingredients in your kitchen. He agrees with all that, but he thinks the thing that really sets ultra-processed food, the harmful food, is the cosmetics that make them edible when they otherwise won't I've seen inside the plants where they make the old fashioned minimally processed food versus today's ultra-processed. In the minimally processed plants, I recognize the ingredients as food. In today's plants, you don't recognize anything. There are powders, there's sludges, there's nothing that you would really recognize as food going into it. And to make that edible, they use the cosmetics and colors as a key piece of that. But here's the problem. It doesn't matter if the color is synthetic or natural. And a fruit loop made with natural colors is just as bad for you as one made with synthetics. And indeed, it's been alarming that the agency has fast tracked these natural colors and as replacements because, cyanide is natural. We don't want to use that. And the whole approach has been off and it like how is this going to get us there? How is this focus on color additives going to get us there. And it won't. Yeah, I agree. I agree with your interpretation of that. But the thing with Kessler you got part of it right but the main thing he did is say you don't have to really define ultra-processed food, which is another industry ploy to delay action. Let's focus on the thing that's making us sick today. And that's the refined carbohydrates. The refined grains in food. That's what's most closely linked to the obesity, the diabetes we're seeing today. Now in the 1980s, the FDA granted, let's set aside sugar and white flour, for example, but they approved a whole slew of additives that the companies came forward with to see what we can add to the white flour and sugar to make it shelf stable, to meet all the taste, cost, and convenience considerations we have. And profit-making considerations we have. Back then, heart disease was the driving health problem. And so, it was easy to overlook why you didn't think that the these additives were really harmful. That then you could conclude whether Generally Recognized as Safe, which is what the agency did back then. What Kessler is saying is that what he's laid out in his petition is self-executing. It's not something that the agency grants that this is GRAS or not GRAS. They were just saying things that have historical safe use that scientists generally recognize it as safe. It's not something the agency decides. It's the universe of all of us scientists generally accept. And it's true in the '80s when we didn't face the obesity and diabetes epidemic, people didn't really focus on the refined carbohydrates. But if you look at today's food environment. And I hope you agree with this, that what is the leading driver in the food environment about what is it about ultra-processed food that's making us so sick? It's these refined grains and the way they're used in our food. And so, if the agency takes up the Kessler petition and starts acting on it, they don't have to change the designation. Maybe at some point they have to say some of these additives are no longer GRAS. But what Kessler's saying is by default, they're no longer GRAS because if you ask the scientists today, can we have this level of refined grains? And they'd say, no, that's just not Generally Recognized as Safe. So, he's pointing out that status, they no longer hold that status. And if the agency would recognize that publicly and the burden shifts where Wiley really always meant it to be, on the industry to prove that there are foods or things that we would thrive on, but that wouldn't make us sick. And so that's the key point that you go back to when you said, and you're exactly right that if you let the industry use their political power to just ignore health altogether and substitute profits, then you're right. Their sort of fiduciary responsibility is just to maximize profits and they can ignore health. If you say you can maximize profits, of course you're a capitalist business, but one of the tests you have to clear is you have to prove to us that people can thrive when they eat that. Thrive as the standard, might require some congressional amplification because it's not in the statute. But what is in the statute is the food can't make you sick. If scientists would generally recognize, would say, if you eat this diet as they intend, if you eat this snack food, there's these ready to heat meals as they intend, you're going to get diabetes and obesity. If scientists generally believe that, then you can't sell that. That's just against the law and the agency needs them to enforce the law. Bio:   Jerold Mande is CEO of Nourish Science; Adjunct Professor of Nutrition, Harvard T.H. Chan School of Public Health; and a Non-Resident Senior Fellow, Tisch College of Civic Life, Tufts University. Professor Mande has a wealth of expertise and experience in national public health and food policy. He served in senior policymaking positions for three presidents at USDA, FDA, and OSHA helping lead landmark public health initiatives. In 2009, he was appointed by President Obama as USDA Deputy Under Secretary for Food Safety. In 2011, he moved to USDA's Food, Nutrition, and Consumer Services, where he spent six years working to improve the health outcomes of the nation's $100 billion investment in 15 nutrition programs. During President Clinton's administration, Mr. Mande was Senior Advisor to the FDA commissioner where he helped shape national policy on nutrition, food safety, and tobacco. He also served on the White House staff as a health policy advisor and was Deputy Assistant Secretary for Occupational Health at the Department of Labor. During the George H.W. Bush administration he led the graphic design of the iconic Nutrition Facts label at FDA, for which he received the Presidential Design Award. Mr. Mande began his career as a legislative assistant for Al Gore in the U.S. House and Senate, managing Gore's health and environment agenda, and helping Gore write the nation's organ donation and transplantation laws.  Mande earned a Master of Public Health from the University of North Carolina at Chapel Hill and a Bachelor of Science in nutritional science from the University of Connecticut. Prior to his current academic appointments, he served on the faculty at the Tufts, Friedman School of Nutrition Science and Policy, and Yale School of Medicine.
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  E286: How 'least cost diet' models fuel food security policy 04.11.2025 33min

  In this episode of the Leading Voices in Food podcast, host Norbert Wilson is joined by food and nutrition policy economists Will Masters and Parke Wilde from Tufts University's Friedman School of Nutrition, Science and Policy. The discussion centers around the concept of the least cost diet, a tool used to determine the minimum cost required to maintain a nutritionally adequate diet. The conversation delves into the global computational methods and policies related to least cost diets, the challenges of making these diets culturally relevant, and the implications for food policy in both the US and internationally. You will also hear about the lived experiences of people affected by these diets and the need for more comprehensive research to better reflect reality. Interview Summary I know you both have been working in this space around least cost diets for a while. So, let's really start off by just asking a question about what brought you into this work as researchers. Why study least cost diets? Will, let's start with you. I'm a very curious person and this was a puzzle. So, you know, people want health. They want healthy food. Of course, we spend a lot on healthcare and health services, but do seek health in our food. As a child growing up, you know, companies were marketing food as a source of health. And people who had more money would spend more for premium items that were seen as healthy. And in the 2010s for the first time, we had these quantified definitions of what a healthy diet was as we went from 'nutrients' to 'food groups,' from the original dietary guidelines pyramid to the MyPlate. And then internationally, the very first quantified definitions of healthful diets that would work anywhere in the world. And I was like, oh, wow. Is it actually expensive to eat a healthy diet? And how much does it cost? How does it differ by place location? How does it differ over time, seasons, and years? And I just thought it was a fascinating question. Great, thank you for that. Parke? There's a lot of policy importance on this, but part of the fun also of this particular topic is more than almost any that we work on, it's connected to things that we have to think about in our daily lives. So, as you're preparing and purchasing food for your family and you want it to be a healthy. And you want it to still be, you know, tasty enough to satisfy the kids. And it can't take too long because it has to fit into a busy life. So, this one does feel like it's got a personal connection. Thank you both for that. One of the things I heard is there was an availability of data. There was an opportunity that seems like it didn't exist before. Can you speak a little bit about that? Especially Will because you mentioned that point. Will: Yes. So, we have had food composition data identifying for typical items. A can of beans, or even a pizza. You know, what is the expected, on average quantity of each nutrient. But only recently have we had those on a very large scale for global items. Hundreds and hundreds of thousands of distinct items. And we had nutrient requirements, but only nutrient by nutrient, and the definition of a food group where you would want not only the nutrients, but also the phytochemicals, the attributes of food from its food matrix that make a vegetable different from just in a vitamin pill. And those came about in, as I mentioned, in the 2010s. And then there's the computational tools and the price observations that get captured. They've been written down on pads of paper, literally, and brought to a headquarters to compute inflation since the 1930s. But access to those in digitized form, only really in the 2000s and only really in the 2010s were we able to have program routines that would download millions and millions of price observations, match them to food composition data, match that food composition information to a healthy diet criterion, and then compute these least cost diets. Now we've computed millions and millions of these thanks to modern computing and all of that data. Great, Will. And you've already started on this, so let's continue on this point. You were talking about some of the computational methods and data that were available globally. Can you give us a good sense of what does a lease cost diet look like from this global perspective because we're going to talk to Parke about whether it is in the US. But let's talk about it in the broad sense globally. In my case the funding opportunity to pay for the graduate students and collaborators internationally came from the Gates Foundation and the UK International Development Agency, initially for a pilot study in Ghana and Tanzania. And then we were able to get more money to scale that up to Africa and South Asia, and then globally through a project called Food Prices for Nutrition. And what we found, first of all, is that to get agreement on what a healthy diet means, we needed to go to something like the least common denominator. The most basic, basic definition from the commonalities among national governments' dietary guidelines. So, in the US, that's MyPlate, or in the UK it's the Eat Well Guide. And each country's dietary guidelines look a little different, but they have these commonalities. So, we distilled that down to six food groups. There's fruits and vegetables, separately. And then there's animal source foods altogether. And in some countries they would separate out milk, like the United States does. And then all starchy staples together. And in some countries, you would separate out whole grains like the US does. And then all edible oils. And those six food groups, in the quantities needed to provide all the nutrients you would need, plus these attributes of food groups beyond just what's in a vitamin pill, turns out to cost about $4 a day. And if you adjust for inflation and differences in the cost of living, the price of housing and so forth around the world, it's very similar. And if you think about seasonal variation in a very remote area, it might rise by 50% in a really bad situation. And if you think about a very remote location where it's difficult to get food to, it might go up to $5.50, but it stays in that range between roughly speaking $2.50 and $5.00. Meanwhile, incomes are varying from around $1.00 a day, and people who cannot possibly afford those more expensive food groups, to $200 a day in which these least expensive items are trivially small in cost compared to the issues that Parke mentioned. We can also talk about what we actually find as the items, and those vary a lot from place to place for some food groups and are very similar to each other in other food groups. So, for example, the least expensive item in an animal source food category is very often dairy in a rich country. But in a really dry, poor country it's dried fish because refrigeration and transport are very expensive. And then to see where there's commonalities in the vegetable category, boy. Onions, tomatoes, carrots are so inexpensive around the world. We've just gotten those supply chains to make the basic ingredients for a vegetable stew really low cost. But then there's all these other different vegetables that are usually more expensive. So, it's very interesting to look at which are the items that would deliver the healthfulness you need and how much they cost. It's surprisingly little from a rich country perspective, and yet still out of reach for so many in low-income countries. Will, thank you for that. And I want to turn now to looking in the US case because I think there's some important commonalities. Parke, can you describe the least cost diet, how it's used here in the US, and its implications for policy? Absolutely. And full disclosure to your audience, this is work on which we've benefited from Norbert's input and wisdom in a way that's been very valuable as a co-author and as an advisor for the quantitative part of what we were doing. For an article in the journal Food Policy, we use the same type of mathematical model that USDA uses when it sets the Thrifty Food Plan, the TFP. A hypothetical diet that's used as the benchmark for the maximum benefit in the Supplemental Nutrition Assistance Program, which is the nation's most important anti-hunger program. And what USDA does with this model diet is it tries to find a hypothetical bundle of foods and beverages that's not too different from what people ordinarily consume. The idea is it should be a familiar diet, it should be one that's reasonably tasty, that people clearly already accept enough. But it can't be exactly that diet. It has to be different enough at least to meet a cost target and to meet a whole long list of nutrition criteria. Including getting enough of the particular nutrients, things like enough calcium or enough protein, and also, matching food group goals reasonably well. Things like having enough fruits, enough vegetables, enough dairy. When, USDA does that, it finds that it's fairly difficult. It's fairly difficult to meet all those goals at once, at a cost and a cost goal all at the same time. And so, it ends up choosing this hypothetical diet that's almost maybe more different than would feel most comfortable from people's typical average consumption. Thank you, Parke. I'm interested to understand the policy implications of this least cost diet. You suggested something about the Thrifty Food Plan and the maximum benefit levels. Can you tell us a little bit more about the policies that are relevant? Yes, so the Thrifty Food Plan update that USDA does every five years has a much bigger policy importance now than it did a few years ago. I used to tell my students that you shouldn't overstate how much policy importance this update has. It might matter a little bit less than you would think. And the reason was because every time they update the Thrifty Food Plan, they use the cost target that is the inflation adjusted or the real cost of the previous edition. It's a little bit as if nobody wanted to open up the whole can of worms about what should the SNAP benefit be in the first place. But everything changed with the update in 2021. In 2021, researchers at the US Department of Agriculture found that it was not possible at the old cost target to find a diet that met all of the nutrition criteria - at all. Even if you were willing to have a diet that was quite different from people's typical consumption. And so, they ended up increasing the cost of the Thrifty Food Plan in small increments until they found a solution to this mathematical model using data on real world prices and on the nutrition characteristics of these foods. And this led to a 21% increase in the permanent value of the maximum SNAP benefit. Many people didn't notice that increase all that much because the increase came into effect at just about the same time that a temporary boost during the COVID era to SNAP benefits was being taken away. So there had been a temporary boost to how much benefits people got as that was taken away at the end of the start of the COVID pandemic then this permanent increase came in and it kind of softened the blow from that change in benefits at that time. But it now ends up meaning that the SNAP benefit is substantially higher than it would've been without this 2021 increase. And there's a lot of policy attention on this in the current Congress and in the current administration. There's perhaps a skeptical eye on whether this increase was good policy. And so, there are proposals to essentially take away the ability to update the Thrifty Food Plan change the maximum SNAP benefit automatically, as it used to. As you know, Norbert, this is part of all sorts of things going on currently. Like we heard in the news, just last week, about plans to end collecting household food security measurement using a major national survey. And so there will be sort of possibly less information about how these programs are doing and whether a certain SNAP benefit is needed in order to protect people from food insecurity and hunger. Parke, this is really important and I'm grateful that we're able to talk about this today in that SNAP benefit levels are still determined by this mathematical program that's supposed to represent a nutritionally adequate diet that also reflects food preferences. And I don't know how many people really understand or appreciate that. I can say I didn't understand or appreciate it until working more in this project. I think it's critical for our listeners to understand just how important this particular mathematical model is, and what it says about what a nutritionally adequate diet looks like in this country. I know the US is one of the countries that uses a model diet like this to help set policy. Will, I'd like to turn to you to see what ways other nations are using this sort of model diet. How have you seen policy receive information from these model diets? It's been a remarkable thing where those initial computational papers that we were able to publish in first in 2018, '19, '20, and governments asking how could we use this in practice. Parke has laid out how it's used in the US with regard to the benefit level of SNAP. The US Thrifty Food Plan has many constraints in addition to the basic ones for the Healthy Diet Basket that I described. Because clearly that Healthy Diet Basket minimum is not something anyone in America would think is acceptable. Just to have milk and frozen vegetables and low-cost bread, that jar peanut butter and that's it. Like that would be clearly not okay. So, internationally what's happened is that first starting in 2020, and then using the current formula in 2022, the United Nations agencies together with the World Bank have done global monitoring of food and nutrition security using this method. So, the least cost items to meet the Healthy Diet Basket in each country provide this global estimate that about a third of the global population have income available for food after taking account of their non-food needs. That is insufficient to buy this healthy diet. What they're actually eating is just starchy staples, oil, some calories from low-cost sugar and that's it. And very small quantities of the fruits and vegetables. And animal source foods are the expensive ones. So, countries have the opportunity to begin calculating this themselves alongside their normal monitoring of inflation with a consumer price index. The first country to do that was Nigeria. And Nigeria began publishing this in January 2024. And it so happened that the country's national minimum wage for civil servants was up for debate at that time. And this was a newly published statistic that turned out to be enormously important for the civil society advocates and the labor unions who were trying to explain why a higher civil service minimum wage was needed. This is for the people who are serving tea or the drivers and the low wage people in these government service agencies. And able to measure how many household members could you feed a healthy diet with a day's worth of the monthly wage. So social protection in the sense of minimum wage and then used in other countries regarding something like our US SNAP program or something like our US WIC program. And trying to define how big should those benefit levels be. That's been the first use. A second use that's emerging is targeting the supply chains for the low-cost vegetables and animal source foods and asking what from experience elsewhere could be an inexpensive animal source food. What could be the most inexpensive fruits. What could be the most inexpensive vegetables? And that is the type of work that we're doing now with governments with continued funding from the Gates Foundation and the UK International Development Agency. Will, it's fascinating to hear this example from Nigeria where all of the work that you all have been doing sort of shows up in this kind of debate. And it really speaks to the power of the research that we all are trying to do as we try to inform policy. Now, as we discussed the least cost diet, there was something that I heard from both of you. Are these diets that people really want? I'm interested to understand a little bit more about that because this is a really critical space.Will, what do we know about the lived experiences of those affected by least cost diet policy implementation. How are real people affected? It's such an important and interesting question, just out of curiosity, but also for just our human understanding of what life is like for people. And then of course the policy actions that could improve. So, to be clear, we've only had these millions of least cost diets, these benchmark 'access to' at a market near you. These are open markets that might be happening twice a week or sometimes all seven days of the week in a small town, in an African country or a urban bodega type market or a supermarket across Asia, Africa. We've only begun to have these benchmarks against which to compare actual food choice, as I mentioned, since 2022. And then really only since 2024 have been able to investigate this question. We're only beginning to match up these benchmark diets to what people actually choose. But the pattern we're seeing is that in low and lower middle-income countries, people definitely spend their money to go towards that healthy diet basket goal. They don't spend all of their additional money on that. But if you improve affordability throughout the range of country incomes - from the lowest income countries in Africa, Mali, Senegal, Burkina Faso, to middle income countries in Africa, like Ghana, Indonesia, an upper middle-income country - people do spend their money to get more animal source foods, more fruits and vegetables, and to reduce the amount of the low cost starchy staples. They do increase the amount of discretionary, sugary meals. And a lot of what they're eating exits the healthy diet basket because there's too much added sodium, too much added sugar. And so, things that would've been healthy become unhealthy because of processing or in a restaurant setting. So, people do spend their money on that. But they are moving towards a healthy diet. That breaks down somewhere in the upper income and high-income countries where additional spending becomes very little correlated with the Healthy Diet Basket. What happens is people way overshoot the Healthy Diet Basket targets for animal source foods and for edible oils because I don't know if you've ever tried it, but one really delicious thing is fried meat. People love it. And even low middle income people overshoot on that. And that displaces the other elements of a healthy diet. And then there's a lot of upgrading, if you will, within the food group. So, people are spending additional money on nicer vegetables. Nicer fruits. Nicer animal source foods without increasing the total amount of them in addition to having overshot the healthy diet levels of many of those food groups. Which of course takes away from the food you would need from the fruits, the vegetables, and the pulses, nuts and seeds, that almost no one gets as much as is considered healthy, of that pulses, nuts and seeds category. Thank you. And I want to shift this to the US example. So, Parke, can you tell us a bit more about the lived experience of those affected by least cost diet policy? How are real people affected? One of the things I've enjoyed about this project that you and I got to work on, Norbert, in cooperation with other colleagues, is that it had both a quantitative and a qualitative part to it. Now, our colleague Sarah Folta led some of the qualitative interviews, sort of real interviews with people in food pantries in four states around the country. And this was published recently in the Journal of Health Education and Behavior. And we asked people about their goals and about what are the different difficulties or constraints that keep them from achieving those goals. And what came out of that was that people often talk about whether their budget constraints and whether their financial difficulties take away their autonomy to sort of be in charge of their own food choices. And this was something that Sarah emphasized as she sort of helped lead us through a process of digesting what was the key findings from these interviews with people. One of the things I liked about doing this study is that because the quantitative and the qualitative part, each had this characteristic of being about what do people want to achieve. This showed up mathematically in the constrained optimization model, but it also showed up in the conversations with people in the food pantry. And what are the constraints that keep people from achieving it. You know, the mathematical model, these are things like all the nutrition constraints and the cost constraints. And then in the real conversations, it's something that people raise in very plain language about what are all the difficulties they have. Either in satisfying their own nutrition aspirations or satisfying some of the requirements for one person or another in the family. Like if people have special diets that are needed or if they have to be gluten free or any number of things. Having the diets be culturally appropriate. And so, I feel like this is one of those classic things where different disciplines have wisdom to bring to bear on what's really very much a shared topic. What I hear from both of you is that these diets, while they are computationally interesting and they reveal some critical realities of how people eat, they can't cover everything. People want to eat certain types of foods. Certain types of foods are more culturally relevant. And that's really clear talking to you, Will, about just sort of the range of foods that end up showing up in these least cost diets and how you were having to make some adjustments there. Parke, as you talked about the work with Sarah Folta thinking through autonomy and sort of a sense of self. This kind of leads us to a question that I want to open up to both of you. What's missing when we talk about these least cost diet modeling exercises and what are the policy implications of that? What are the gaps in our understanding of these model diets and what needs to happen to make them reflect reality better? Parke? Well, you know, there's many things that people in our research community are working on. And it goes quite, quite far afield. But I'm just thinking of two related to our quantitative research using the Thrifty Food Plan type models. We've been working with Yiwen Zhao and Linlin Fan at Penn State University on how these models would work if you relaxed some of the constraints. If people's back in a financial sense weren't back up against the wall, but instead they had just a little more space. We were considering what if they had incentives that gave them a discount on fruits and vegetables, for example, through the SNAP program? Or what if they had a healthy bundle of foods provided through the emergency food system, through food banks or food pantries. What is the effect directly in terms of those foods? But also, what is the effect in terms of just relaxing their budget constraints. They get to have a little more of the foods that they find more preferred or that they had been going without. But then also, in terms of sort of your question about the more personal. You know, what is people's personal relationships with food? How does this play out on the ground? We're working with the graduate student Angelica Valdez Valderrama here at the Friedman School, thinking about what some of the cultural assumptions and of the food group constraints in some of these models are. If you sort of came from a different immigrant tradition or if you came from another community, what things would be different in, for example, decisions about what's called the Mediterranean diet or what's called the healthy US style dietary pattern. How much difference do this sort of breadth, cultural breadth of dietary patterns you could consider, how much difference does that make in terms of what's the outcome of this type of hypothetical diet? Will: And I think, you know, from the global perspective, one really interesting thing is when we do combine data sets and look across these very different cultural settings, dry land, Sahelian Africa versus countries that are coastal versus sort of forest inland countries versus all across Asia, south Asia to East Asia, all across Latin America. We do see the role of these cultural factors. And we see them playing out in very systematic ways that people come to their cultural norms for very good reasons. And then pivot and switch away to new cultural norms. You know, American fast food, for example, switching from beef primarily to chicken primarily. That sort of thing becomes very visible in a matter of years. So, in terms of things that are frontiers for us, remember this is early days. Getting many more nutritionists, people in other fields, looking at first of all, it's just what is really needed for health. Getting those health requirements improved and understood better is a key priority. Our Healthy Diet Basket comes from the work of a nutritionist named Anna Herforth, who has gone around the world studying these dietary guidelines internationally. We're about to get the Eat Lancet dietary recommendations announced, and it'll be very interesting to see how those evolve. Second thing is much better data on prices and computing these diets for more different settings at different times, different locations. Settings that are inner city United States versus very rural. And then this question of comparing to actual diets. And just trying to understand what people are seeking when they choose foods that are clearly not these benchmark least cost items. The purpose is to ask how far away and why and how are they far away? And particularly to understand to what degree are these attributes of the foods themselves: the convenience of the packaging, the preparation of the item, the taste, the flavor, the cultural significance of it. To what degree are we looking at the result of aspirations that are really shaped by marketing. Are really shaped by the fire hose of persuasion that companies are investing in every day. And very strategically and constantly iterating to the best possible spokesperson, the best possible ad campaign. Combining billboards and radio and television such that you're surrounded by this. And when you drive down the street and when you walk into the supermarket, there is no greater effort on the planet than the effort to sell us a particular brand of food. Food companies are basically marketing companies attached to a manufacturing facility, and they are spending much more than the entire combined budget of the NIH and CDC, et cetera, to persuade us to eat what we ultimately choose. And we really don't know to what degree it's the actual factors in the food itself versus the marketing campaigns and the way they've evolved. You know, if you had a choice between taking the food system and regulating it the way we regulate, say housing or vehicles. If we were to say your supermarket should be like an auto dealership, right? So, anything in the auto dealership is very heavily regulated. Everything from the paint to where the gear shift is to how the windows work. Everything is heavily regulated because the auto industry has worked with National Transportation Safety Board and every single crash investigation, et cetera, has led to the standards that we have now. We didn't get taxes on cars without airbags to make us choose cars with airbags. They're just required. And same is true for housing, right? You can't just build, you know, an extension deck behind your house any way you want. A city inspector will force you to tear it out if you haven't built it to code. So, you know, we could regulate the grocery store like we do that. It's not going to happen politically but compare that option to treating groceries the way we used to treat the legal services or pharmaceuticals. Which is you couldn't advertise them. You could sell them, and people would choose based on the actual merit of the lawyer or the pharmaceutical, right? Which would have the bigger impact. Right? If there was zero food advertising, you just walked into the grocery store and chose what you liked. Or you regulate the grocery store the same way we regulate automotive or building trades. Obviously, they both matter. There's, you know, this problem that you can't see, taste or smell the healthiness of food. You're always acting on belief and not a fact when you choose something that you're seeking health. We don't know to what extent choice is distorted away from a low-cost healthy diet by things people genuinely want and need. Such as taste, convenience, culture, and so forth. Versus things that they've been persuaded to want. And there's obviously some of both. All of these things matter. But I'm hopeful that through these least cost diets, we can identify that low-cost options are there. And you could feed your family a very healthy diet at the Thrifty Food Plan level in the United States, or even lower. It would take time, it would take attention, it would be hard. You can take some shortcuts to make that within your time budget, right? And the planning budget. And we can identify what those look like thanks to these model diets. It's a very exciting area of work, but we still have a lot to do to define carefully what are the constraints. What are the real objectives here. And how to go about helping people, acquire these foods that we now know are there within a short commuting distance. You may need to take the bus, you may need carpool. But that's what people actually do to go grocery shopping. And when they get there, we can help people to choose items that would genuinely meet their needs at lower cost. Bios Will Masters is a Professor in the Friedman School of Nutrition, with a secondary appointment in Tufts University's Department of Economics. He is coauthor of the new textbook on Food Economics: Agriculture, Nutrition and Health (Palgrave Macmillan, 2024). Before coming to Tufts in 2010 he was a faculty member in Agricultural Economics at Purdue University (1991-2010), and also at the University of Zimbabwe (1989-90), Harvard's Kennedy School of Government (2000) and Columbia University (2003-04). He is former editor-in-chief of the journal Agricultural Economics (2006-2011), and an elected Fellow of the American Society for Nutrition (FASN) as well as a Fellow of the Agricultural and Applied Economics Association (AAEA). At Tufts his courses on economics of agriculture, food and nutrition were recognized with student-nominated, University-wide teaching awards in 2019 and 2022, and he leads over a million dollars annually in externally funded research including work on the Agriculture, Nutrition and Health Academy (https://www.anh-academy.org), as well as projects supporting government efforts to calculate the cost and affordability of healthy diets worldwide and work with private enterprises on data analytics for food markets in Africa. Parke Wilde (PhD, Cornell) is a food economist and professor at the Friedman School of Nutrition Science and Policy at Tufts University. Previously, he worked for USDA's Economic Research Service. At Tufts, Parke teaches graduate-level courses in statistics, U.S. food policy, and climate change. His research addresses the economics of U.S. food and nutrition policy, including federal nutrition assistance programs. He was Director of Design for the SNAP Healthy Incentives Pilot (HIP) evaluation. He has been a member of the National Academy of Medicine's Food Forum and is on the scientific and technical advisory committee for Menus of Change, an initiative to advance the health and sustainability of the restaurant industry. He directs the USDA-funded Research Innovation and Development Grants in Economics (RIDGE) Partnership. He received the AAEA Distinguished Quality of Communication Award for his textbook, Food Policy in the United States: An Introduction (Routledge/Earthscan), whose third edition was released in April 2025. 
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  E285: Gut instincts, food, and decision making 23.10.2025 19min

  The gut is in the news. It's really in the news. Catapulted there from exciting developments coming from laboratories all around the world. Links of gut health with overall health are now quite clear and surprising connections are being discovered between gut health and things like dementia and Alzheimer's. But how does the gut communicate with other parts of the body in ways that make it this important, and where does the brain figure into all this? Well, there's some interesting science going on in this topic, and a leading person in this area is Dr. Diego Bohorquez. Dr. Bohorquez is the associate professor of medicine, of molecular genetics and microbiology and of cell biology at the Duke University School of Medicine. Interview Transcript Diego, your bio shows that you blend work in nutritional biochemistry, gastrointestinal physiology, and sensory neurobiology. It took me a little time to figure out just what these things are, but what this represents, to be a little more serious, is a unique ability to understand that the different parts of the body, the gut and the brain in particular, interact a lot. And you're in a very good position to understand how that happens. Let's dive in with the kind of a basic question. What got you interested in this interaction of the gut with the brain and why care about it? Yes. Kelly, I think that that's all technicalese for saying that we are at the interface of food, the gut, and the brain. Apart from the fact that we are what we eat and if we truly believe that then food will be shaping us. Not only our body, but also like our belief systems, our societal systems, and so on and so forth. I don't think that that is anything new. However, what is new is the ability of the gut to guide our decision making. And it was interesting to hear in your introduction that now the gut is all in the news. In 2005 when I came to the United States, and I was at North Carolina State University, and I joined a graduate school. I remember taking a graduate course in physiology in 2007. And when the professor opened the session on gastrointestinal physiology, he said the gut is one of the most misunderstood and mysterious organs. It has almost as many neurons as the spinal cord, or more. But honestly, we don't give a lot of respect to the gut. We only think that it does some digestion and absorption, and we judge it more for the value of its products of digestion than what it does for the entire body. And fast forward almost 20 years later now, partly my laboratory and other laboratories that have entered this field since some of our discoveries started to emerge, it's very clearly showing that the gut not only has its own sensory system that is behind what we call gut feelings. The gut feelings are actually real. But it actually can influence our decision making. Like specifically, we have shown that our ability to choose sugars and consume sugars and feel sugars and choose them over sweeteners, it can be pinpointed to a specific set of cells in the intestine called neuropod cells and specific receptors in those cells. And the intestine is right after the stomach. And this is where these cells are exposed to the surface of the gut and detect the chemical composition of food to guide our decision making. Let's talk about that a little bit more. So, you've got this axis, or this means of communication between the gut and the brain going on. And let's talk about how it affects what we eat. You just alluded to the fact that it's pretty important. What does it tell us? What to eat, how much to eat? What we like to eat? When we're hungry, when we've had enough? How does this affect our eating? We are beginning to understand how much it affects this eating. And obviously we are departing from understanding, right? And an understanding is cognitive. In the 1500s is when the idea of 'we think therefore we are,' came online. And we needed to think things before we actually will understand them. But well before thinking them, we actually feel them. And you probably have noticed that. If anybody offers you maybe a cup of water at 5:00 AM, 6:00 AM, it will be very welcome. Especially with it's a little bit warm. If they offer you a steak at 5:00 AM you will run away from that. But in fact, you'll create distress I think unless you are like severely jet lagged. And a lot of those feelings not only come from the experience, but even if you blind are blindfolded, your gut will be able to evaluate what you just ingested. And it is because the intestine, it is the point where those molecules in the meal or in the drink, will be either absorbed to become part of who we are, or will be excreting and expelled. And that absorption of who we are is dependent on the context. Like for instance, the part of the month, morning versus afternoon, health status, age, will influence specifically like at the molecular level, what it is that we need to continue to thrive. It sounds like there's lots of potential for the gut and its interaction with the brain working in concert with the rest of the body. Things are in balance and working like they should be. But there are lots of things going on out there that disrupt that. Tell us more about that and how it affects eating. For example, the levels of obesity have risen so much in the past decades. How does the gut figure into that, for example. Could there be environmental things like the microplastics or exposure to toxins like pesticides and things that might be affecting the gut that throws the system off? I think that that is a very timely question for the days. Over the last 10 years, we have documented that the gut has its own sensory system. And in fact, it's one of the most ancient sensory systems. At the very beginning, 600 million years ago, when cells started to coalesce into animals, multicellular organisms, they needed to eat. And they needed to not only find the food but create a sensory representation of the food. What do I mean by that? Eating algae is very different than eating bacteria, for instance. And the gut needed to have these sensors to be able to rapidly create first a representation, this is bacteria. And then put out the molecules to digest that bacterium or those bacteria. And then ultimately absorb them, turn them into metabolites and continue to thrive, right? Perhaps reproduce, coalesce and so on and so forth. This is a very important concept because our reality, the reality that you and I are having right now, it is guided by our senses. And we have multiple senses. Like for instance, we are able to communicate partly because of the sound that is going through our ears. And then there are inner hair cells that are picking up those waves. Passing that information to the brain, decoding it, and then the brain coalesces with everything else and saying like, 'okay, Diego, you're in a podcast. Make sure that you say something hopefully reasonable, right?' What the gut is doing, as a true sensory system, is also detecting the food that we have ingested, creating a rapid representation. It's not the reality itself. It is a representation of the reality. Because when we eat an apple, ultimately the gut, what it's doing is creating a representation that was an apple and not an orange. And then telling the brain, look, you're going to get some glucose, some fiber, a little bit of a skin. And you may need to adjust it with water, right? And then that will trigger the desire to, 'oh, maybe I should have also a cup of water.' Why does that have to do with, the societal issues that we are facing? Since the 1970s, we learned to disentangle the sensory experience of food, not only as humans or scientists, but also that was extrapolated to the society. So, if you go and look, and it is not a secret, it has been very well documented. For instance, the ability to put artificial sweeteners out there. It has really changed the health landscape. And it was just a normal progression of how it is that we humans think. We thought well, people consume sugars because they're sweet. If we take out the calorie and we just leave the sweetness, it will be totally fine because it's benign. You're not consuming anything else. However, the gut, you have promised the gut something sweet. That it has always, or almost always, invariably, been associated with a nutritional value. Then the gut is fed this information that is skewed. Then it has to go and adjust. And we actually have demonstrated that in the laboratory that when the neuro pods detect a non-caloric sweetener, they actually release a different neurotransmitter that communicates to the brain that artificial sweeteners have arrived at the gut, as opposed to glucose, which triggers the release of glutamate. And that glutamate is essential for the organism to know that we have consumed sugar. Is it safe to say then that the body has evolved to be able to have effective signaling and feedback systems with things that are found out there in nature, like sugar or an apple or an orange. But when you start introducing things that don't exist in nature, like the artificial sweeteners, then bad things can happen. Yes. Because imagine right now your brain will swap the reality and you will transport yourself or the beach. You may not even have the clothing ready to confront the breeze of the beach, right? Or the salt. You would have not been prepared, right? We evolved around nature because nature was there before us. Therefore, we had gradually adjusted to what nature had to offer. Eventually we introduced fire, and we were able to transform simple or complex carbohydrates into something digestible. And then the body had the ability to adjust to it. And not only the body, but also the microbiota in the gut. Now we are talking about like the transformation of foods. And especially I think in the last 30 years we have been able to transform those foods. Beverages have sweeteners now. We have energy drinks that have a composition of vitamins and other things. And while those things individually perhaps are not innocuous, we haven't explored what is the conglomerate effect on long-term health. When we talk about these things being added to foods, I mean, there are whole classes of things like colorings and dyes and artificial sweeteners and things. And then there are processing things that go on, like extrusion and different things that take something like wheat or corn and turn it into something that the body is not accustomed to dealing with. Is the body incapable of perceiving what these things are? Does it get send out wrong signals? Why should we be worried about these things? I don't think that we should be worried necessarily because that's alarming, right? But we should be aware, certainly, that the body keeps tabs on it. Something very simple. If you rub water on your skin versus if you rub oil on your skin, your brain already starts to perceive that substance as different. Now, imagine the gut is going to know exactly the same thing. It knows what water is. It knows what oil is. It knows what carbs are. It knows what protein is. And depending on what it has been fed for, thousands of years, it will be able to create that representation as I alluded to. And therefore, if there is a foreign composition, it's going to have to adjust to the situation. And that is how you can end up altering the composition of a regular body. Because like, for instance, in nature if you go and look at native populations that live very close to nature, you know, the body composition is in a certain form. But in cities where you're exposed to foods that have been transformed, the body composition is very different. And I'm not talking only about body weight, but also height, shape, you know. That certainly makes sense. You know, something that's been in the news a lot lately are the GLP1 drugs like Ozempic and Zepbound and they have very powerful effects on appetite, satiety, and weight regulation. How is the gut brain axis involved in this? I would like to make a couple of points in there.The first one is that glucagon-like peptide is obviously is very similar to glucagon. Glucagon is produced in the pancreas. Glucagon-like peptide is actually produced in the gut. And it is produced by these neuro pod cells that also produce some neurotransmitters. And it is produced in response to specific nutrients like glucose. And it is a signal glucagon like peptide 1. It is a signal for not only adjusting insulin release, but it is also a signal for coordinating what has arrived in the gut. It does affect motility. Eventually it is thought that goes into the bloodstream and affects the nervous system. However, and I said it is thought because the brain also produces glucagon-like peptide. There are cells in the skin. There are cells in the urethra. There are cells in the bladder. There are cell cells in the spinal cord in the choroid plexus that is exposed to the cerebral spinal fluid that also produces some of these peptides as signaling molecules. And I have to make that clarification because traditionally it has been thought to be a signal from the gut, per se. But these are just signaling molecules. The second part is that the arrival of Ozempic, I thought that it was obviously a very important step not only scientifically, but also societally. Why? Because up until 1980s and I have thought with many colleagues especially in medicine. And they will say like, when an obese patient will arrive in the office, first of all, there was not a lot of options. One of the recommendations is - are you doing enough dieting or exercise? And if the patient was like, you know, I'm not eating even a lot, but I'm gaining weight. Or it was perhaps psychosomatic because we didn't have the molecular language to be able to explain what was going on. I think that Ozempic clearly has shown that when we are affecting a set of receptors in the body, perhaps in the gut, it's changing many different things. Not only like food intake, but also alcohol intake and how people feel. I think that is definitely a breakthrough. Where are we going from here? I think that this is the beginning of a long conversation in which we are going to be looking for options not only to reduce the amount of food, but actually to steer food choices from the gut. Because the gut is still as an external surface. And that's what I've mentioned that the discovery that these neuro pot cells can guide our food choices, I think that is very attractive for future options on how we are going to steer decision making. So, let me ask a final question. You partly just answered it, but where do you see this field going? What are you excited about and what do you think the next frontiers will be? I think that I'm a little bit more close to nature. I think that on moving forward, there's all obviously a lot of technologies and molecules that are going to be developed to perhaps treat some disorders. Not only related to the body, but also to the mind. Chronic depression and so on and so forth. But I think a lot of these elements have already been explored in nature. And if we look back anthropologically, people were solving the issue of medicine with their environment. In fact, what we call metropolitan medicine evolved largely from natural medicine. And in fact, today, 80% of the world, they still rely directly on plants and other compounds that are directly from plants for healthcare. I think that there is a lot to learn in there and a lot to merge, especially with the new technologies on diagnostics. And I think that that's a very exciting area to keep nature in mind. And when I said nature is like our relationship with environment, right? Bio Diego V. Bohorquez is an associate professor of medicine, associate professor in molecular genetics and microbiology, associate professor of cell biology, associate research professor in neurobiology, and an associate professor in pathology at Duke University's Department of Medicine. Bohorquez is a gut-brain neuroscientist and holds a Ph.D. from North Carolina State University. His research focus is to unveil how the brain perceives what the gut feels, how food in the intestine is sensed by our body, and how a sensory signal from a nutrient is transformed into an electrical signal that alters behavior.